View of Performance in Music Therapy: Experiences in Five Dimensions

Performance in Music Therapy: Experiences in Five Dimensions

By Peter F. Jampel

Introduction

Building community through music therapy performance has been at the heart of the work that I have done with a band of musicians who have serious mental health issues over the past twenty years at the Baltic Street Clinic in Brooklyn, New York. The complexity of their personalities as expressed through performing music intrigued me and challenged me to try to understand how to best work with them. This examination led me to ponder not only what worked and what did not in terms of treatment strategies, but also how it worked and why, questions that are critical in addressing what is therapeutic about performing music when working with people who experience persistent mental illnesses. Eventually an approach of identifying and treating these issues developed. In this process, I have considered the thorny question of how to promote the health of the individual performer, work with the manifestations of their illnesses while also attempting to build community.

This paper will address performance from a music psychotherapy perspective something that in the current context of community music therapy literature, is controversial. Additionally, it discusses the process of performing music in terms of dimensions of experience. This approach allows the clinician to describe, assess, analyze and evaluate the components of what is happening both over time and in the moment. It is my intention to develop a language not only between therapists but with clients. It is an attempt to promote a consistent means of description. The five dimensions of performance in music therapy are not meant to exclude other possible dimensions that might exist but were found to be a concise, descriptive shorthand that covers the essential aspects of the performance experience (Jampel, 2007).

Theoretical Perspectives on Performance in Community Music Therapy

Communities unlike the one at Baltic Street that are formed through shared neighborhood, religion, hobbies or employment have the advantage of the cohesive effects of having things in common, of membership that reflects a willing intention to be part of community (Stige, Ansdell, Elefant & Pavlicevic, 2010). Bonds built on the basis of having joined a community because a mental or physical illness has seriously impaired one’s lifestyle or level of functioning, do not necessarily reflect shared beliefs and interests. These membership conditions of necessity can contribute to a sense of alienation, of having been thrown together with other people because of the unfortunate circumstance of an illness that itself, can be hard to accept. In order to promote community connection and belonging that is heartfelt, people in this instance need to find some greater sense of meaning and purpose. How can music performance foster a sense of volitional identification, strengthen the bond of connection, and promote a feeling of purposeful action?

The community discussed in this article initially reflects the kind of thrown together quality that Gary Ansdell (Stige et al, 2010, p. 44) discussed as circumstantial. As the music therapy program expanded from its origins in individual and group music psychotherapy, an environment was created which provided increasingly frequent opportunities for clients to perform music at a monthly cabaret called The After Hours Club. This seemed to strengthen the bonds not only between individuals who played music but also collectively among those who came to listen. Ansdell explains this process as communities forged through communication and practice. They increasingly share music as a way of communicating. It serves “to actively construct, sustain and develop particular modes of community, and its accompanying experience of belonging” (p. 47). Music performance groups in my experience are more motivated to learn how to communicate in music because such skills improve the quality of performances. In this view, communities are created through the developing competencies and shared interests of its members. Practice and rehearsals consist of doing and learning something together repetitively, through the experience of sharing passions, interests and knowledge, of planning together while learning to negotiate differing musical needs and tastes. Through this process, individuals can experience meaning, identity, engagement and ultimately belonging. An essential characteristic of this type of community is the acceptance of the difference, strangeness or otherness of each member of the group. Stige (2002) call this “unity beyond uniformity” (p. 173). Music making provides equipoise between the individual’s state of existence and those groups to which they belong.

The achievement of a balance between individual needs and the good of the group is no small feat. In my experience, considerable skills are needed to prepare the individual musician to be able to contain personal agendas and to come to see the larger rewards of sensitive listening and playing. Central to this process is preparation to perform. For some music therapists like Stuart Wood (2006), preparation for performance involves individual sessions and music therapy workshops in order to create a psychological foundation for building meaning and readiness. His work with people who have experienced neurological trauma addresses the differing demands made on clients in stepping from private music making to the public nature of performance. His matrix model of community music therapy customizes the design of music therapy services around the particular needs of the individual. Though we work with different populations, I have also found that services that are designed around the special needs of the individual tend to promote a better balance between those personal needs and the context of working within a community.

It is of utmost importance in my experience to design music therapy services that take into account individual complexity along with the psychological ramifications of performance in order to avoid possible undesirable outcomes. Inadequate preparation can result in feelings of stress, anxiety or even worse, a sense of failure. This perspective on performance preparation or the lack thereof is offered by Jon Hawkes, a well-known Australian cultural analyst, in an interview conducted by the music therapist Katrina McFerran (O’Grady, 2008). Music performed publically, he warns, risks one’s health by the effects of the adrenaline surge that often accompanies it. This he believes accounts for the prevalence of performance anxiety. He encourages music to be made rather than witnessed and goes on to discuss the culture-bound aspects of performance as music making versus music witnessing. In Hawkes’ view, performers who perform with and for one another learn to direct their energy (and satisfaction) in connecting to each other and not to their audiences. He believes that only when performance emerges as a genuine client interest should it be then pursued as a possible direction by the music therapist.

Another perspective on the balance between the experience of the group and that of the individual is offered by Ansdell (2005, 2010) as he addresses performance as both a self and collaborative effort. In his view, reparative work is done both within the individual and to their connection with others in both spheres simultaneously. Careful attention to musical listening and organization of material in rehearsals is needed as clients are assisted to work through pathological attitudes in their self-identity, social relationships and work lives. He maintains that the collaborative nature of performance and the public completion of this process act powerfully to contribute to the meaning derived. Ansdell does recognize the pressures that can exist on performers when the experience is ladened by attitudes of competition and judgment. This position resonates with my own observations about the mutuality of growth and development that can occur for individuals within the context of a maturing performance group.

Although Ansdell and Wood seem to appreciate the potential pitfalls of performance, what is absent in their discussion is some systematic way of assessing who their clients are as performers, what clinical issues they present for treatment and how performance can address them. Without such procedures, I have experienced the discussion around individual cases to lack clarity and specificity. In his work with his client Maria Logis, Alan Turry (2005) addresses these challenges. Finding meaning in performance, carefully working through the implications of this process for the client, and understanding its impact on the therapeutic relationship are all hallmarks of Turry’s work. Through the process of song improvisation, she went on to become a songwriter, performer and inspirational speaker sharing with her audiences the power that music and performance had on her struggles to survive cancer. Carefully sifting through her transference and his own counter-transference, Turry explores the implications of bringing these improvised songs into the public domain. He develops a procedure to assess and ascertain information about her capacity to form trusting, intimate connections through performance while also listening for the possibility of substituting external recognition for authentic relationships.

These theoretical perspectives illuminate the essential challenges that I have experienced. The ensuing discussion will develop the historical context in which they came to life.

Background

The people I worked with are adults diagnosed with mental illnesses such as schizophrenia, bi-polar disorder, severe anxiety disorders and recurrent depression. They are people from a diverse, heterogeneous ethnic, cultural and racial background typical of clinical populations in New York City. This cultural context is critical when considering the attitudes I encountered about performance. This was reflected by the many styles of music that were made, the attitude toward solo versus ensemble performance, and the expectations that these musicians have with and from their audiences. These embedded cultural aspects of music performance are very particular and vary significantly from that of other cultures (Nzewi, 2006; Oosthuizen, Fouché, & Torrance, K., 2007; & Inoue, 2007). The individuals discussed here are those drawn deeply to making music. This is a subset of the general adult psychiatric music therapy population. Their love of music is far more critical than the extent to which they are gifted. Almost invariably they share a sense that making music is a core aspect of their selves.

It is not my intention to imply a hierarchy here where performing music is somehow viewed as the pinnacle of therapeutic music making. It is just one possible direction but one that seems more likely to occur when music therapy is conducted in a long-term community setting such as the one described in this paper. In this context, wanting to perform can be seen as a natural extension of the evolving interest that can take place in community music therapy settings (Aigen, 2004; Jampel, 2007).

Though there was interest in performing music from the inception of the music therapy program that began in 1975, there were also challenges to address. The performers who emerged in the community sing that ended each week’s program had problems ranging from insecurity and musical inhibition to narcissistic exhibitionism. Singers, bass players, drummers and the occasional keyboard player or solo instrumentalist would emerge and gain recognition for their emergent talents. Even though these musicians solidified into a back up band, it was difficult to find a consistent time and place to work on the problems they experienced in performing music.

By 1991 with the addition of a monthly cabaret called the After Hours Club, they had coalesced into the in-house performance group that has become The Baltic Street Band, a group that continues to this day (Aigen, 2004). The members of the band wanted more time to play with each other. They were motivated to accept more discipline as their interests in music performance grew. This process became more gratifying as their labors produced music that gained increasing recognition from their peers. New members joined the band as their exposure grew. Jobs developed by playing for other communities and some of these were paid performances. Today the band continues to both perform and record its own music. Yet as it became bigger and more skilled, personality issues became increasing obstacles. Lack of preparation, lateness, missed practices and ongoing conflicts between certain band members became disruptive and divisive.

My perception was that persistent personality problems interfered with the working environment of band rehearsals. Patterns emerged in the clashes between performers that appeared to be repetitive and pathological. Patterns of disturbance became evident regarding certain performers’ relationship to their own music making process. Sometimes these issues seemed to be complicated by the presence of an audience. Interventions designed to address these issues were made during rehearsals but often the resulting process took time away from preparation for performances. This led to resentment from some musicians that valuable rehearsal time was being consumed by extra musical difficulties. Not to address these recurrent problems seemed out of character with my intention of promoting healthier group dynamics and facilitating individual growth. I perceived that the flaw in this strategy was not in my therapeutic intention but in trying to do both a therapy group and a band rehearsal at the same time. Neither was being done as consistently nor as effectively as was needed.

The Music Therapy Performance Group (MTPG) was first designed in 2004 to both research and treat this dilemma. Meeting as it did on the morning of rehearsals, it was intended to siphon off the need to make therapeutic interventions during band rehearsals. The group focused on the needs of the individual performer. It did not take time away from performance preparation but was in addition to it. Attendance was encouraged but not required for band members. Later after the research study was completed, another treatment group was formed in 2006. This group was opened up to other musicians who did not as yet feel ready to perform. Rehearsals were now free to get down to the business of making music in the time frames needed in order to get ready for upcoming gigs. Persistent and distracting pathological behaviors such as chronic lateness, unexplained absences, lack of work preparedness, or seemingly intractable personality conflicts were addressed in the MTPG. It was here that we could consistently work on performing music and the personality of the performer.

Assessment, Treatment and Evaluation Considerations

Interviews were conducted with each participant prior to the group. The interviews were designed to ascertain past personal history in music including the level of musical training each participant had. As a staff member, I had access to medical records that contained other aspects of their past personal, medical and psychiatric histories but music history was not part of the medical record. Additionally, information elicited in staff meetings from other members of the interdisciplinary team augmented my working knowledge of each member of the group.

Past personal history in music provides an assessment perspective that crosses an array of contributing factors: it provides a different glimpse into parent-child relationships and sibling rivalries; it allows the clinician to assess self-directedness, perseverance, and task completion; it offers a view on assessing the relative health of the creative personality from a viewpoint where spontaneous expressiveness is on one end of the spectrum and pathological anxiety, rigidity and narcissism are on the other; it also provides a window into cultural/family attitudes towards music and the effect this has on an individual’s attitude toward making music. The assessment process takes into account the dynamics of musical activities in families where this is an important aspect of family life. Often times the expectations, musical accomplishments or disappointments of the parents are visited upon the child. These attitudes can be extended, altered or exacerbated by subsequent musical history with teachers, producers, promoters, musical juries or with other musicians.

The therapist should be looking to assess various areas of functional capacity. Does the individual engage differently in group music making environments than they do in one to one situations? Does the individual possess flexibility in their musical interactions with others or are they limited or inhibited by this? Does music highlight alternative areas for expression and learning that taps previously unknown or under-utilized pockets of intactness? This is particularly important for individuals who due to the onset of mental illness often suffer cognitive losses. Identifying past trauma in music making with parents, teachers, or in front of critics sensitizes the music therapist to the possible occurrence of traumatic re-enactment.

With sufficient knowledge of the person’s musical background, the earned trust of the therapist, and the evolving safety of the group, conditions can now be established where promoting a re-working of the performance experience can allow for a greater sense of meaning and satisfaction to occur. The resulting treatment implications of this process point to the making of music in front of others as a necessary reconstructive strategy. Verbal interventions help create the corrective performance conditions and are also used to evaluate how effectively progress is being made. The relationship between assessment, treatment and evaluation are all bound together in a procedure that examines and analyzes performance from the five experiential components that will comprise the main focus of this discussion.

The Music Performance Personality Profile

This profile incorporates elements of the person’s self-image as a musician and how this is embedded into the individual’s overall personality development. This required assessing parental/family attitudes about music. In all but one case in the group, music was seen as a significant dimension in family dynamics. Often parents, siblings, grandparents, uncles and aunts were either musicians, musical or cared deeply about music. In some cases, the attitudes cited represented consistent and supportive parental involvement. For others, it was only a small island of support in an otherwise strained or neglectful relationship. Then for others still, past history of music demonstrated patterns of harsh and abusive behavior. With parents who were either musical or musicians themselves, aspects of the parent’s past musical experiences often promoted a vicarious experience as the parent relived their own musical experiences through their children’s accomplishments or lack thereof. Three group members had parents who were both musicians and abusive parents. For these participants, performance was an opportunity to try to understand and work through their still unresolved feelings about these troubled parents (Borczon, Jampel & Langdon 2010). Sometimes the histories indicated pathologically competitive environments in which siblings were compared to or pitted against one another in terms of the degree of perceived talent that led to preferential behavior. This often set into motion patterns of interaction within the group that seemed to recapitulate past family dynamics (Yalom, 1970).

When the assessment was completed, an initial plan evolved that targeted goals to build upon existing healthy ego structures and to identify pathological features in need of reconstruction. Patterns of behavior as they emerged within the group, were then brought to the awareness of the individual. The intention was to promote more accurate observing ego and the capacity for self-reflection.

Setting and Participants

The Music Therapy Performance Group occurred in a setting in which a multiplicity of music therapy services were provided including other group and individual approaches. One of the participants was 78 years old at the time and had been an active recipient of services at this facility since 1972. Many of the group participants had long-standing connections to the music therapy program. The long-term nature of their connection to treatment at this facility is vital in understanding the impact that the MTPG had.

The work described herein occurred over a period of two and a half years from 2006 to 2008. The new clinical group provided services to a total of 15 adults ranging in age from 24 to 78 years old. Five participants completed their participation prior to the end of the group. This was due to various reasons: changes in schedule due to work or school, moving away or ending treatment at the clinic or in one case, the completion of short term goals. The ethnic and cultural backgrounds of the participants varied. There were three people of African background (two from Caribbean origins and one African-American), five Hispanics, and seven white participants of various ethnic backgrounds.

Group size in any given week varied from as few as three to as many as nine members. They met once a week for forty-five minutes. Most of the group members were also members of the Baltic Street Band consisting of about twenty mentally ill musicians. The group met in the auditorium space where weekly rehearsals and monthly performances took place. The meeting space was in front of a small spot lighted stage located nearby to an acoustic piano. We sat in a circle in front of the stage. My antique tenor banjo sat waiting in its brown alligator and green velvet-lined case. One client loved to play it and his instinctive musicality allowed this to happen almost immediately. Guitars both acoustic and amplified, a bass guitar, hand drums, floor drums and a full drum kit were all made available to participants in order to facilitate the use of instruments for accompanying singers or for instrumental work. The stage, the stage lights and the instruments were all used to create an environment that replicated being in a performance.

Group Structure and Process

“So what would you like to work on in today’s Music Therapy Performance Group?” threw the initial direction of the session onto the participants. Their self-image as musicians came up, how they worked with and reacted to other performers, and how they felt about particular audiences. This sometimes led to past performance memories and how their current experiences often had their origins in the past.

Once a theme was centered upon, we might process a recent performance experience including how they felt about it, what it meant to them, and what their reactions were about. For example, one group member who felt anxious and distracted by audience inattentiveness in the After Hours Club the day before, discussed her fear that nobody was listening to her because they did not like her singing. She recounted how in the past, she would become petrified to sing before her parents who she felt were dismissive of her singing when she was a child. After much encouragement from other group members, she sang the Cole Porter (1932) song “Night and Day” accompanied on tenor banjo by the group leader. This time with a new arrangement, she was able to sing in a more intimate way and connect more deeply to the song. The group response was warm and appreciative. This promoted her sense that she could re-construct the performance experience thereby making her less vulnerable to worrying about how she sounded to others. She developed a clearer picture about how the distraction she feared in her audience was really her own projection. By redoing this particular song, connecting more fully to the message in the lyrics, trying a different tempo, accompaniment and arrangement, she was able to alter her relationship to the music, her accompanist, the audience and herself.

We often processed how they experienced the music, how connected they felt to the song, how connected they felt to the other musician(s), how they experienced being listened to. This often brought up aspects of their pasts when similar feelings occurred and what this might signify. Repeating a song invited the musician to try to connect more deeply, concentrate more fully or to realize how the images that sprang to mind while performing might offer them additional fuel to work with. Explorations included: memorable past performances both good and bad; what life was like in their past performing lives; life on the road, special audiences, amazing performers they had seen or with whom they had played. They talked about drugs, money, jealousy, competitiveness, anxieties, self-image, sexuality, hopes, dreams and nightmares. The culture among performing musicians was a favorite topic. They talked of the camaraderie that developed between performing musicians. Their common fears, inattentive audiences, anxieties and insecurities but also the closeness forged by pushing through these difficulties and learning how to cope with them. While they acknowledged their appreciation for each other’s skills, they also were able to acknowledge their envy and jealousy of each other as well. They learned by watching and imitating each other. Fine points such as intonation, breathing, microphone technique, body language and movement, story telling through song, stage presence, dressing and costumes, shaping your appearance, the use of make-up, and the capacity to read audiences all were frequent content areas in the group.

Performances were taken apart by the group and analyzed. Rivalries, fears and insecurities were processed but so too were triumphs. Feelings about the leader emerged, sometimes spontaneously, sometimes elicited. Often group members had powerful needs for attention or approval. If these dynamics seemed to be repetitive, the leader offered them back for individual reflection and feedback and as opportunities for the identification of triggering mechanisms. As pathological patterns among members of the group diminished, trust and cohesion developed which then allowed for more risks to be taken both in the music and verbally.

The five dimensional evaluation model was explained and used in the group to foster a systematic representation of performance as a dynamic psychotherapy process. The dimensions formed a shorthand language that objectified each individual experience into something that could be shared and comprehended. By exploring the family music history and the performance background of each group member, people came to a better understanding of themselves and of each other. It provided a focused context for personal disclosure that promoted a sense of safety and trust.

Attendance, Individual Communications and Transference

People who missed a session were expected to call. Unexplained absences or excessive lateness were addressed in the group. If it became a pattern, I met with the individual in my office. One member left the group due to his inconsistent and erratic attendance. He did continue to participate in the band. Several members experienced medical and psychiatric problems that kept them from coming in but as long as they kept in touch, they were encouraged to return as soon as possible. Three people were hospitalized during the course of the group, two for psychiatric reasons and one for medical reasons. Only one did not return to the group after his psychiatric discharge.

Attendance in the group was offered to but not required for members of the band. Eight of the active members in the band attended. Six members of the performance group eventually joined the band. The only one who did not was a nightclub singer who came to group after experiencing severe performance anxiety following a vocal lesson from a teacher who she felt was severely critical of her. This criticism brought up pre-existing areas of sensitivity that made her feel vulnerable and self-conscious. These conflicts illuminated historical patterns of criticism in her family. She was encouraged to try to perform in the group when she felt ready. After she finally did so, she reported that the support she received had helped her to resume her nightclub career as well as prompting her to find a new vocal coach. With this, she left the group reporting that she had accomplished what she had set out to do.

A number of people sought me out to talk to me about a range of issues outside of the group. I would see them but not to discuss group issues. If however I felt that a member was being disruptive to the group either by repeated unexplained absences or chronic lateness, I would request a meeting. I did this in an effort to provide additional support or clarification of problems that were occurring for them. This happened most frequently with two particular people who both had fragile and abuse filled histories. One person eventually left the group and the other Trisha, will be the subject of the case study discussed later in this article.

The issues brought up in group were considered confidential and group participants were asked not to discuss them outside of group. When necessary, I discussed significant developments both with the director of the band and with other clinicians on the treatment team.

I also attended the last hour of band rehearsal each week. I was thus able to observe how each individual operated. This gave me first hand information that I found useful in my work in the next weeks’s group. I was an occasional instrumentalist and back-up vocalist in the band as well as the Master of Ceremonies for the monthly cabaret. In both of these roles I was able to witness their performances.

I played other roles outside of the group: administrator, clinician, and internship supervisor. I was also the individual therapist to three members of the group. These multiple roles had evolved over the many years that I worked there and tended to complicate my relationships in the MTPG. They became topics for discussion in the group and added complexity to the transference process.

One of my individual clients saw me as too busy and at times less than available to him. He dropped out of group after he exhibited inconsistent attendance but continued in individual verbal psychotherapy. He focused on his relationship with his deceased, abusive musician father who when not constantly working on the road, got into drunken rages at home where he threatened and abused his wife and children. He reported feeling that in the group, I did not having enough time to see him and that he stopped coming because of this. Over time, he became more able to discuss his feelings about my perceived lack of availability to him and established a better capacity to process his feelings. As he worked through his anger, his attendance in band rehearsals and in performances improved. The relationship that he had with his father affected his ability to connect with other musicians. The dimensions of how this process works will now be explained.

The Five Dimensions of Performance

The experience of performing music involves a complex interplay of connections: between the musician and the music that is being played; between performing musicians in terms of how they feel together playing on stage; between the performer and the audience in terms of the connection that develops between them in both directions; and between the performer and the thoughts within his/her own mind while performing. The experiential totality of these four co-existing states or dimensions, represent the presence of a fifth dimension - the feeling state of the performer. If all four previous dimensions are in a relational state of maximum connection toward themselves and each other, a complementary process ensues. The performer and the music are one, players riff off of each other and move more deeply into sync together, the audience gets drawn in by the action on stage which is felt by the musicians who then play off of the audience’s energy, and the performers inner thoughts and feelings act to provide emotional connection which heightens the act of music making by adding depth and meaning. When all of this is synergistic, the effect can be riveting, transforming the moment into a peak experience (Maslow, 1971) or as Ansdell (2005) describes it performance as epiphany. Such reports described by the performers in the 2004 research group (Jampel, 2007) used the word "spiritual" most often to try to capture this electrifying sensation. But when one or more of these dimensions becomes disturbed, the result is a lessened sense of satisfaction. This can take the look of a musician who does not feel connected to the music, or performers who feel out of sync with each other, or an audience that by being noisy and distracted either affects or were affected by the performers on stage, or the inner thoughts and feelings of the performer (inner audience) becoming a source of negativity and loss of focus. All of this affects the fifth dimension. When looked at from this perspective, the goal of the music therapist is to identify areas of conflict within the four previous dimensions that may be inhibiting the performer’s optimal sense of satisfaction and meaning.

These phenomenal states may be all operating simultaneously or in different combinations with each other. A performer can be so absorbed in the music that they might not be fully aware that they are performing before an audience. On the other hand, internal thoughts of doubt, insecurity or negativity may overwhelm the performer and promote a sense of isolation or alienation between the player and fellow performers or from the audience. Because it is a shifting and interactive process, evaluating the performance experience in this multi-dimensional model adds descriptive and causal flexibility. These five states can be best understood as a fluid experience with each dimension containing shifting phenomenological aspects. Repetitive patterns of disconnection in any one or more of the dimensions can be seen as performance psychopathology. Bad performances happen and the dimensional disturbances may be merely transient or reactive to recent stressors. But persistent patterns whose roots extend deep into personality formation tend to be more durable and difficult to work through. On top of this, one must account for the abnormal psychopathology states of psychosis, mania, or severe anxiety and depression that exist within this population. This often complicated the treatment process.

The evaluation process revolves around perceiving changes in any one or more of the dimensions and then adding to or modifying long term or short-term goals accordingly. This process entailed highlighting dimensional strengths and identifying and working through dimensional pathology. Self-reports and first hand observational data were the means by which this clinician was able to understand the impact that this approach had on each of the five dimensions. In the ensuing discussion, clinical vignettes will illustrate each dimension to be followed by a case study that will integrate all five.

The First Dimension: Connecting Within to the Music

Since the end of the MTPG in 2008, I continue to observe performers having difficulty connecting to their music. Whether it is a student, a client or a professional, one can at times detect through body language, facial expression or a perceived lack of conviction in the music that something is missing. Yet only so much can be known through observation.

Choosing the right material is a critical and necessary step. Some performers are clear about what they want to do, what feels right to them. They know themselves musically and when the time is right they may rediscover some old chestnut or to try something new or different. These individuals seem adept at interpreting their material and finding some deeper meaning that promotes connection to the lyrics or to the music. For others however, connecting on the first dimension brings up difficulties in making appropriate musical choices that seem to reflect on the larger problems they have in making appropriate life choices. They are unsure of themselves and of what may be expressive of their present mood. They lack conviction or passion about decisions, or are over determined to try something, or constantly change their mind or just give up too easily. Addressing this situation is tantamount to addressing issues such as why they cannot seem to find themselves, or not know what feels right for them, or how they continue to have persistent feelings of uncertainty about the direction they find themselves going in. Deeply connecting to one’s own music can be seen as a statement about how well a person has learned to regulate life, of understanding what works best, of learning how to choose among the myriad options that life and music can offer and learning how to make the best decisions. Inside of this process, there is considerable room for making adjustments, finding new meanings and interpretations, looking and listening with fresh ideas and perspectives. If one cannot consistently regulate how to choose music satisfactorily, broader problems with life regulation often persist.

“What made you choose that song?” is a question that begins exploring the experience of internal connection to song choice. “How did that feel?” allows for the identification of associated affect after the song is performed. The crucial intervention is “Did that song seem right for you?” This question promotes an understanding about whether both song and affect were mood congruent. In other words, if the song evokes an unwanted mood or association even if the song had felt right at other moments, the song will start off as ill-suited for that person in this moment. Sometimes it may just be a matter of changing tempo, key, instrumental accompaniment or arrangement. These adjustments may allow the musician to feel the song differently and permit them to find an alternative path to get into it. But some pieces of music are just not right and if this is the case, the music therapist must facilitate that awareness in the client.

If left unresolved, the first dimension (D1) can spill over into dimension two (D2) and to three (D3). If the music does not feel right, playing it with others gets off track. At times, musical interaction may experienced as a beacon promoting one to come back. But if the music within is not sufficiently connected, the second dimension of connecting to other performers is often negatively impacted. This is I believe discernable to the audience. When disconnected to their own music and consequently to other performers, connecting to an audience is ever so much more difficult. The little voice in one’s head experienced in dimension four (D4), can intrude into the performer’s thoughts and wreck havoc with concentration and effort. Wrong notes, forgotten parts, overplaying can all result. This will all register in the performer’s fifth dimension (D5) report of satisfaction and meaning. It is therefore most critical to find music that promotes the experience of inner connection. This process might be different with professional musicians who are required to play certain kinds of music whether they want to or not but in a music psychotherapy group such as this, this first element is vital. Knowing that you don’t feel it but having to play the music anyway is one thing. Not knowing how to get that feeling is quite another.

A discerning performer may change or modify their play list depending on how they feel that day, or how they read the mood of the audience, or how illness or injury can affect song choice. An experienced musician uses these factors in calculating when to make certain adjustments. However, when these choices grow out of fear or anxiety about the music chosen, the result can reflect internal disturbances that can project unresolved D1 states onto the music. The question then becomes one of how to promote more accurate self-perception through greater connection to song choice.

Sometimes evaluating these factors is easier to do in a post performance process. After the dust has settled, an individual can often better assess how well they adjusted to the performance environment. Such discussions were frequent in the Music Therapy Performance Group. As trust developed, group feedback was more seen as supportive, non-judgmental and not as intended to be critical. Group members shared their observations with each other much like a Monday morning quarterbacking session where the team might look at the videotape (which sometimes happened) and discuss the performance from a detailed technical analysis viewpoint. Risk taking was promoted as performers encouraged each other to try out new ideas. However when this experience was perceived as criticism, the therapist had to carefully monitor this process and point out if old transferences were being kicked up. When things got to this point, often it was an indication that some pathological D2 aspects were emerging that required further exploration and understanding.

A MTPG member who had not performed for years reported he no longer did so because he did not like to play the drums. They brought up memories for him of playing in bands past where he felt too responsible to keep the beat. Though he no longer enjoyed playing music as a drummer, he was an enthusiastic singer and was also the one who loved to strum the tenor banjo. When given permission to sing, he was able to concentrate completely on his voice and enjoy himself again. This led to his performance in the After Hours Club several months later singing a duet of the song “Strangers in the Night” (Singleton & Snyder, 1966). He reported in the group the next day that he had felt relaxed and comfortable. To this observer, he looked and sounded fully connected to the music.

Dimension Two: Performers Connecting with Each Other

The conversation between musicians on stage is at its best a healthy, balanced and reciprocal relationship. There is a sensitivity in listening, selflessness, being together yet maintaining individuality, lifting and holding each other, a lightness, passion, a sharing of beauty and discovery. But when the musical conversation is a struggle, maturity is needed in order to resolve the inevitable conflicts that are normal even necessary in the creative relationship between adult musicians. Managing this phenomenon successfully promotes authenticity and healthy collaboration. But when patterns of conflict repeatedly emerge between particular performers, there is a likelihood of deeper disturbances dwelling within or between them.

According to the musicologist Christopher Small (1998) the meaning to be found in musicking is in the creation of relationships formed through the act of playing together not in the sound they produce. These relationships promote and nurture communication and listening skills and represent an ideal of how people work with one another. “Performance does not exist to present musical works, but rather, musical works exist to give performers something to perform” (p. 8).

Such was not the case initially for two members of the who fought incessantly with each other and who often but less frequently, battled with other group members. Performances for them were often highly mercurial events filled with behind the scenes drama that at times, spilled over into tantrums and sudden withdrawals. During performances these individuals often tugged in different directions from the other musicians on stage in terms of tempi, dynamics, pitch accuracy, feel and interpretation. Conflict always seemed to swirl around them. They collaborated with other musicians but could not work together. They did not seem to listen well and isolated themselves. They were easy to anger and to suffer emotional injury. Performance day reflected a high drama of uncertainty about whether they would appear at all or if they did, what they would perform and with whom. Trisha (our case study subject) would inevitably show up but late, unprepared and disorganized. She would often appear visibly upset during performances, grimacing and shaking her head while hurtling ahead of the instrumentalists ignoring cues and cadences. Another group member who was her primary antagonist in the band, would just not show up on performance day leaving fellow performers to scramble without his keyboard, drum accompaniments and vocals. These precipitous actions left the band shaken and mistrustful of both of them. Each had been in the original research group and both were encouraged to enter the new Music Therapy Performance Group.

Not surprisingly, these two individuals, one a 53 year old, white male, who I worked with in individual psychotherapy, and the other Trisha, a 62 year old white female, each had histories of being in abusive relationships. Both were diagnosed with Post Traumatic Stress Disorder. Both were the victims of abusive parents, both had abusive sibling relationships, and both had been involved in adult partnerships where patterns of abuse emerged. They also perceived each other as abusive.

The work for them in D2 involved uncovering the reasons for their tendency to be distrustful of others. Through a gradual process of disclosure of their family histories in music in the group, a context was developed between them in which they became better able to understand how they triggered feelings of being abused in each other. In fact a bond started to develop between them as they came to realize that they had much in common. They began to experience an empathic connection. They felt encouraged to try and sing together in group and when they did, both expressed satisfaction about how it felt. Finding a way to join their voices instead of using them to fight with each other helped to form a bond. They later decided to perform as a duet in the After Hours Club.

What unfolded for Trisha was a tendency to feel a sense of rivalry with others. She reported that positive attention in her family for her artistic achievements was hard to come by but for her pretty younger sister, it seemed to simply rain down for just being attractive. Criticism on the other hand seemed to pour down on her. She experienced this as ridiculing her efforts to sing or play an instrument. Her mother’s critical voice often sounded within her head that she was just worthless, untalented and unattractive. For him, praise was just not available from his alcoholic and violent father. No matter how hard he tried, he and his efforts were belittled. Along with several of his eight siblings, music was a central aspect of family life. He performed with three brothers in a Rock ‘n Roll band. This disintegrated into constant disputes, violent confrontations and episodes of alcohol and drug abuse although he reported that he never drank, smoked or abused drugs. Feuds persisted for years in this family. Music was the only means by which members of the family could come together though this was only a faint connection amid a sea of emotional family turmoil.

They fell into a relationship with each other where she thought that he was getting all the attention and he felt that her outbursts and tantrums were emotionally abusive to him. The group leader sought to bring their historical patterns of social interaction to their attention and by so doing, promote self-reflection and observing ego in terms of the causes and triggers for their behavior. Though his erratic attendance eventually resulted in his leaving the MTPG, he did become more consistent in attending After Hours Club performances.

She integrated the feedback in the group, learned to recognize similarities in the present to past patterns of abuse and victimization, and eventually opened up to partnering musically with him. They still had their moments together but each developed a greater capacity for connecting musically and emotionally. Both seemed less prone to missing cues, singing too loudly, making errors or experiencing other musicians as insensitive to them. They were able to perceive how their personal tensions affected the way they made music together. This resulted in their acquisition of greater nuanced musical expressiveness.

The relationship that evolved between these performers displayed aspects of the kind of rapport that Small (1998) referred to. The interpersonal themes were extracted through the filter of their family histories in music. For the music therapist, making this process conscious opened up new possibilities for connection in D2 in terms of musical collaboration. From a group therapy viewpoint as Yalom (1971) observed, the group allowed them to experience a corrective recapitulation of their primary family group. It seemed to create a new kind of musical family, one in which each could be safely heard and listened to.

Dimension Three: Connecting to the Audience

The first two dimensions are present in most music therapy experiences. Connecting deeply to music is a desired outcome for therapists who work with music as an expressive modality. Optimizing the musical connection between members of a group playing music together is a highly desirable social and communication outcome. Though groups may also serve as audiences for each other on occasions, the presence of an audience whose role is distinct from that of the performing musicians, is a phenomenon unique to the performance environment and one that can alter the experience of being in the first two dimensions. Evaluating how an audience alters the experience in dimensions one and two offers additional information to the clinician. It can enhance or disrupt connections to the music within or between performing musicians. Self-consciousness, anxiety or exhibitionistic tendencies may psychically protrude resulting in feelings ranging from constant inhibition and distraction to feeling the need to show off. The mere presence of an audience alters the experience. From a clinical assessment standpoint, the phenomenon of playing music in front of others allows the therapist to understand the degree of health or psychopathology that may exist. What patterns of behavior does the performer exhibit and what do they mean?

The audience effect may vary for the same person from each audience to each performance. Such variability may be an accurate reflection of certain variables like the room acoustics, the quality of the other musicians, ambient noise, difficulty of the music and the degree of preparation, or the health of the performer that day. However, certain people display patterns of behavior in front of an audience that seem less dependent on the variability of the performance environment and more the result of the internal state of the performer. This has been discussed in the music therapy literature in terms of developing working strategies to deal with performance anxiety in musicians (Berger, 1999; Montello, 1989; Montello, Coons, & Kantor, 1990). What has not been discussed in the literature is the significance of this phenomenon for people who may have been too frightened to perform and who were not working musicians. The work described herein is designed to address performance psychopathology for all people. Some may have been interested in performing but for many reasons, may not have had a chance to do so. For others, the experience was brief and buried in their past. For others still, mental illness may have terminated their careers prematurely. In each instance, discerning what performing before an audience means to the individual is the critical link. For the music therapist the salient concern is to understand how that individual operates in front of an audience.

For example one performer in the 2004 research group did not want to see the audience because it made her feel self-conscious "She performed best when she felt enveloped by the music and darkened by house lights. ‘I don’t want the audience to be known to me. They’re not hidden. I want them hidden, no lights and not there’" (Jampel, 2007, pp. 125-6). The significance of this experience may lie in her relationship to her mother who at that time suffered from Alzheimer’s disease. Both of them were professional singers but her abusive mother constantly derided her and her voice saying that both were worthless. She reported that she tried to freeze these thoughts out of her mind when performing before an audience. She also said that the songs that she sang were songs that her mother loved and in this way, she was trying to reconcile with her ailing mother by performing her songs (Borczon, Jampel & Langdon, 2010).

Creating reconstructive experiences for the performer in the presence of an audience was a major group strategy. People not only learned about the importance of thorough preparation but perhaps more importantly, discussed the reasons why they had a hard time being on time and consistent in their work habits. These behaviors were examined from a psychodynamic viewpoint in which avoidance and withdrawal were possible signs of internal distress.

Practical skills were shared such as cuing each other on stage during the music and learning to look at and feed off each other’s energy during concerts. In this way the group members were able to incorporate ideas for warding off distractions, improving focusing and concentration and building confidence through repetition. The power of the third dimension was huge. The group learned how to become each other’s best audience. The feeling of reciprocal interplay going from performer to audience and back again was palpable. When that feedback loop did not happen during live performances, the performers attempted to compensate for that by sitting together in the audience and shouting vocal support. They would hush the crowd by standing up and rotating 180 degrees while putting a finger to their lips in an attempt to hush the crowd when the ambient noise became too much. Often they would hunch forward in their seats, applaud instrumental solos, and stand up and cheer wildly for each other. Handshakes, high fives and hugs would greet the performer as they returned from the stage.

Applause was the single most telling evidence of success for each performer. As one performer commented, she felt devastated when she received only “pity claps” after one particular performance (Jampel, 2007, p. 132). The quality of the applause seemed to trigger memories of her need for approval from her family. “I never had approval. If I wasn’t good nobody said I was good… What I learned from that is I can’t judge by my feelings. I never had approval” (p. 140). The issue of being applauded and what it meant to each person was a frequent topic of conversation in the group. The idea of how popular culture focused on audience approval came up when one member discussed her fascination with how contestants were judged and treated on the TV show American Idol. She commented in particular about the “spectacle” made by the daughter of another member of the band whose appearance on the show seemed to play up her obvious symptoms of mental illness. By appearing confused and rambling in response to not being chosen to advance to the next round, the group saw this segment as a shameless effort to humiliate a mentally ill performer. Several members of the group felt this episode was scary and depressing. What was even worse was the seemingly insatiable appetite of the audience to revel in the degradation of the performers who did not make it. It was thought by some that this reflected negatively on the larger cultural attitude of ridiculing vulnerable or less talented performers.

Some performers were more susceptible to patterns of self-doubt and lack of focus. For them a pre-disposition to anxiety states seemed rooted in historic patterns of harsh parental criticism and abuse. The treatment process involved working with them to gain insight into understanding the reasons for these patterns, developing the capacity to self-reflect when they began to emerge, and in promoting a stronger sense of self-worth in order to be able to withstand the emergence of these feelings in the group and on stage. The goal was to establish more stable emotional conditions within the performer so as to promote more musical consistency in each performance. This involved the working through of ingrained patterns of self-doubt, diminished self-worth and self-inflicted failures.

The audience in the After Hours Club was comprised of community members and friends and family of consumers. This gathering was mostly a familiar and friendly crowd. It was the kind of atmosphere that encouraged people and often inspired members of the audience to want to perform themselves. Many times over the years, someone would spontaneously get up and want come on stage to sing or play. An open microphone segment in the After Hours Club promoted this phenomenon that frequently led to the recruitment of new members for the band. However, when the performers went on the road, the audience experience was quite different. The room, the sound and the audience presented new challenges. The more experienced performers offered tips to the less experienced ones on how to read the audience, feel out the house and alter your play list accordingly. After having played a particularly tough house in the Bronx in 2004, one member of the performance group remarked, “You know what that proves? When you want to do something, you can do it. I don’t think any of us in this group can say, no I can’t.” (Jampel, 2007, p. 151).

Dimension Four: The Audience Within

Performers carry their own audiences around inside of them. These are our music teachers and mentors, as well as our critics, juries and doubting parents. This audience is unseen to others but present in the mind of the performer. They may be heard intoning words of admonishment, advice, warning or support. These internal presences can serve a deepening, connective function. A face from the past associated to a particular song can evoke an authentic emotional memory. When produced intentionally it can provide an emotional basis for the music much in the same way an actor does in preparing for a role. It may also happen without design as when in the musical moment an internal association occurs that transports the artist to a particular image, feeling or place.

Performance however can also manufacture the presence of ghosts who hover in the shadows of artistic insecurity. When feeling the need to be perfect in order to gain special recognition or by getting caught up in feelings of competition with other performers, inner voices may be stirring underneath. These stirrings may be exhibited as anxiety, feeling distracted or as the fretful anticipation of a certain musical passage. Without understanding the source or origin of these issues, the performer may experience others as potential critics or rivals. Performance failures can be seen as self-fulfilling: the fear of the noxious element ends up interrupting the moment of musical flow that then leads to the undesirable outcome that was feared all along.

The capacity to harness the inner audience effectively is an evaluative landmark of creative health. Musical personalities that successfully internalize the presence of one’s formative influences tend to display the capacity to bring them forth and integrate them into new and original experiences. Even when disturbances emerge, these performers can rapidly identify the triggers, know the origins of what is happening to them and through accurate self-observation, move through this process. However, when the internal presences are pathological, one sees an increase in the frequency and severity of these disturbances. The internal presences feel like an inner audience sitting in continual judgment of the performer. At its most extreme point, the performer is either frozen in a state of dreaded terror, unable to function, or overcome by a feeling that the inner audience has crept out of its internal sanctum and now sits in place of the real one. In such instances, this process may not be a part of the performers conscious awareness. This often results in the occurrence of distortions and projections.

The reality is that many performers’ lives are stressful. Harsh critics not only exist but they abound. The music education system of much of Western music promotes performance pathology through rigid and highly inflexible standards of perfection and stressful competition. For the mentally ill musician whose inner life has been torn by unusually high levels of psychological trauma and cognitive difficulties, the toll is even worse. For people who are psychotic, the inner audience is real and alive. Helping them to focus on performing for the outer audience is the goal. Seven out of the fifteen members experienced visual or auditory hallucinations at some point during the duration of the group. Remarkably, making and performing music seemed almost invariably to provide them with relief from their psychosis. They each had the capacity to draw upon when healthy, a range of past memories and feelings that provided meaning to the act of performing.

Messages must be deciphered from the members of the inner audience to the performer. Who are they and what are they saying? This requires restoring some balance to the person’s self-image when these inner states become unduly punishing. The leverage of the group is especially important here. It is more persuasive when eight people tell you that your singing is lovely than it is when there is only one. The structuring of feedback loops can break the cycle of self-deprecation. Conversely, when narcissistic features emerge that overvalue or hoard the spot light, a balanced group perspective may be more powerful than an individual therapeutic framework. Overall however, the likelihood of success for the narcissistic personality in music performance psychotherapy is more problematic due to the pathological social defensive structure of this personality type.

Through the experience of leading the Music Therapy Performance Group for two and a half years, the concept of the fourth dimension went through a process of expansion and clarification. I have come to appreciate the significance of the inner audience for assessment, treatment and evaluation. It seemed clear even six years ago that the inner audiences were present. The process and significance of how they were internalized and then projected onto the music performance experience was not then fully articulated or understood. The dualistic nature of performance with its inner and outer audiences has also evolved. I now believe that pathology in the other dimensions is most often the result of D4 pathology. One can liken it to the process of forming healthy/pathological attachments through the connection that develops in the musical relationship. Disturbances can impair the performer’s ability to connect within themselves to music (D1), between others (D2), with the audience (D3), and resulting in a diminished sense of satisfaction (D5).

Dimension Five: The Totality of Experience

The fifth dimension (D5) has also undergone revisions with the passage of time. In 2004 several participants reported their performance experiences in terms of peak, altered or spiritual states (Jampel, 2007, pp.151-3). This author speculated that the experience of exultation occurred when all four dimensions optimally came together. This produced a heightened state of consciousness. Yet the reports also indicated that each performance experience differed, sometimes radically so. Disappointment or frustration occurring in one or more of the dimensions resulted in a range of feeling outcomes. For example, one person felt that her two most recent performances (in 2004) were “like a flip-flop. The best audience and the best time, the best everything that I had was up in the Bronx and then I can flip it around and say it was the worst” (p.130). She described her second performance like an “elevator that never got off of the first floor” (p. 130).

It is only reasonable to expect that there will be a variety of reactions to a given performance. Although peak states in performance were reported with greater frequency than in other situations, the evaluation of this phenomenon should take into account all nuances of experience. What seemed like a great concert to one person might seem very different to another. Though the variations in reports of felt experience were clearly present in the original research study, the discussion of the fifth dimension did not sufficiently factor into it the richness and diversity of how the performer felt about the performance and how useful this is as an evaluative device.

As I now understand it, the experience of the fifth dimension represents the totality of the performer’s reactions. This includes the feelings of inner connection to the music, how that individual felt about the way the musicians played together, how they experienced the audience, and the felt presence of the inner audience. Together this might or might not rise to the level of a spiritual or peak moment but more importantly, it describes the precise contours of the feelings, concerns and thoughts of the performer. Here is how one group member described her recent performance experience, “It’s a high when everything hits with the audience and you’re clicking with the musicians and you’re true to yourself. I can’t think of any better expression. It’s the totality of who you are” (Personal Communication, May 2008).

This dimension is based on the report of the individual and it is entirely subjective. If it seems exaggerated, distorted or extreme in its account of what happened as compared to the reports of other participants, the clinician’s evaluation should consider the possibility of dimensional pathology. For instance, other group members who were present experienced the devastation that was felt by the performer who received “pity claps” after one particular performance, very differently. She felt that she sang miserably while others who were there (including this clinician) did not perceive this. One might postulate that the inner audience had been shouting negative comments. Some skewing of felt experience in performance is to be expected. However when the D5 experience of one person tends to reflect more consistent negativity than that reported by others, the likelihood is that pathological features exist in the person’s performance personality profile. The evaluation process should follow the trail to the affected dimension(s) and explore the underlying causes. In the group, the music therapist should facilitate awareness of these issues, encourage feedback from others, and try to promote a greater sense of accuracy in the person’s capacity for healthy self-regulation. The MTPG provided a supportive environment where feedback from other musicians who also frequently experienced musical insecurities, helped to balance out and even to outweigh those negative self-images. The reports of the D5 experience over time, reflected more consistently satisfying performance experiences.

Case Study

In May 2008, I conducted interviews with fifteen people who had received music therapy services in performance. I hoped to find out why they performed, what it meant to them, and what drawbacks they experienced in doing it. The following case study was partially drawn from one of these interviews.

Trisha was 63 years old at the time of the interview, an Italian-American female, divorced without children who had come into treatment in 1995 complaining of having experienced episodes of panic that prohibited her from working as a mid-level executive in a large corporation. She had recently divorced an Egyptian man who she reported was violent and abusive toward her throughout their marriage of eight years. Her early history revealed multiple episodes of abuse starting with her mother and brother who were reported to have been physically and emotional abusive toward her throughout her childhood and adolescence. Trisha was a trained dancer who also had participated as a member of several choirs throughout her life. Her younger sister was musical and according to Trisha, received all the praise and attention not because of her talents but because of her beauty. Neither parent was trained musically but her father was an opera lover and was the more loving and understanding parent. Trisha experienced her mother’s attitude toward her interest in music as negative and discouraging. Her psychiatric diagnoses were Panic Disorder and Post Traumatic Stress Disorder.

Trisha has been involved with the band as a singer since 1997. Her ongoing difficulty in working cooperatively with the other members of the band, led to the idea that she could benefit from individual music therapy where she could focus on her own music. It was there that she began to compose her own songs and since then, has composed more than twenty songs that she has both performed and recorded. Songwriting offered a structure, which as DeNora (2000) observed, helped her to find a container for traumatic memories. Her music became an outlet for putting the past behind her and finding a way of moving ahead with her life. Her voice was another focus in individual music therapy. It was the target for reducing stress, improving her focusing and concentration, and providing greater emotional expressivity through changes in her vocal breathing technique.

Despite progress in these areas, she continued to labor in the band with difficulties in working with other musicians. She often erupted into arguments that spilled over into personal disputes that left her feeling victimized and abused. In the music, she had a tendency to race in front of the melody, sing out of turn, and find difficulty in maintaining accurate pitch. These disturbances in the music were closely connected to the interpersonal problems that she experienced. What became apparent was that her pitch and rhythm issues grew out of her problems with other people. Interventions strategies developed in band rehearsals to address her pitch and timing issues focused on promoting movement while singing so that she could both feel the music as a singer and as a dancer. This helped to a degree but recurrent personality issues continued to interfere. Despite efforts to address the destructive dynamics between her and other band members in rehearsals and in individual meetings, it became evident that too much time was being taken away from the music and from other band members without sufficient resolution of her interactional dysfunction.

After her entrance into the Music Therapy Performance Research Group, her psychotherapy needs could be attended to without time being taken away from rehearsals. No longer were individuals pitted against each other in proportioning time based on the need to get ready for the next performance. Now rehearsal schedules could be more closely adhered to. Once this inherent conflict was resolved, the level of tension between Trisha and the rest of the band eased considerably.

Dimensional Evaluation of Trisha

Trisha’s performance experience was characterized by her harsh self-criticism that she reported in the following manner “I’ll believe the negative before I believe the positive. I’m very self-critical. I have my mother’s voice in my head all the time” (Personal Communication, May, 2008). From a dimensional viewpoint, one can look at this as D4 pathology. The intrusive, self-critical nature of her introjected maternal voice developed into a punishing musical super-ego. She was her own worst critic who often revoked permission to herself to complete a performance when she felt that she did not meet up to her own punishing standards of perfection “My self-consciousness takes over… which is extremely painful and embarrassing.” This anxiety spilled over when she sang in front of an audience. “I am self-conscious in front of an audience. I always have been. That’s why I always sang in groups.” The anxiety of performing before an audience can be likened to singing in front of a room full of critics. She projected her D4 self-expectations onto others. The D3 audience effect can be seen as a pathological projection of her self-criticism. When activated in this way, Trisha’s projections extended to her experience of working with other musicians in D2. Her relationship to the 53 year-old group member was sibling-like as he was perceived as an abusive brother. Her relationship with other females was characterized by anger and jealousy as was the case with the 78 year-old member whose deep and husky female contralto voice received much praise from others. Trisha often felt that she was given preferential treatment in rehearsals and said this in reference to her “I have had a very hard time in the band. We had women who had powerful lower voices than I did. I was very high and lyrical. You know I was criticized for whatever.” Ironically, the 78 year-old was an abuse survivor herself and had always been belittled by her musician father for her voice that he regarded as unfeminine. Praise was hardy something she assumed was forthcoming.

It took Trisha time to place me in her constellation of family characters. At first, she experienced me as favoring other people. She also said that I never had a complimentary word for her music. It was only later on that she experienced me as being more caring and appreciative of her. I would say that her transference could be described as similar to her relationship with her mother. I seemed unappreciative of her talents and often I was perceived as highly preferential to others. Eventually I defied easy description, as a more healthy D2 connection became her dominant perception of other performers, myself included. But first we had to work on her overtly critical D4 issues in order to restore her capacity for self-worth. Over time she was able to balance out how she saw herself and consequently, how she saw herself in relationship to others.

All of this pathology on D4, D3, and D2 took a tremendous toll on her D1 inner connection to the music. “I have been judged and have been criticized but no one is worse at criticizing me than myself. I have had to let go of that.” As she did so, she began to experience music differently. It was like she could hear it better, reproduce pitch more accurately, feel the rhythm and tempo better, remember the words and connect more deeply. She stopped fighting in rehearsals, moved more fluidly and became more expressive. The reaction of audiences was telling. She experienced recognition even admiration for her performances and as compliments came her way, “finally one day I decided to believe it.”

Her D1 pathology looked like never being sure which song was right for her. Often she felt the register was too low or too high for her voice, the key was wrong, it needed to be faster or slower and finally, she just wanted to move to another song. With the breakthrough in her D4 and D1 pathology, new channels were opened to her. She re-examined her experience of playing with other musicians in the MTPG and began using the group as an opportunity to become more comfortable with her D1 connection to the music. Her vocal duets solidified her D2 connection. The group became a new kind of supportive audience that encouraged a healthier D3 connection. One day she received a standing ovation in the After Hours Club “that put me over. I crossed over from timidity, if that is a word, over to the other side.” When asked about the importance of playing in front of an audience she responded:

Yes, I got a lot of confidence by trusting in myself and the feedback that I have gotten. I’m really appreciative. I have never taken it for granted. Each time I perform it’s a new day, a new performance that I don’t take for granted. I will achieve what I want to achieve.

No longer did she transfer sibling issues onto other performers but now she could take in what they had to offer without seeming to flinch or duck as she had before. “They have come to accept me. We don’t have that friction anymore.” The improved regulation of projections from D4 onto D2 and D3 allowed her to concentrate better and focus on D1, D2 and D3 without as many intrusions. The synergistic effect of all levels flowing together produced a sense of lift and well being in her. She was able to balance out her perceptions of herself with what others thought of her. “I just balanced myself because if I’m satisfied with a performance, it doesn’t matter what someone else thinks.”

As her self-critic eased up, Trisha’s sense of accomplishment came through more often. “Sometimes I’ll be very good and sometimes I won’t (laughs) but that doesn’t take away from my expressing myself.” The experience of performing music on D5 portrayed a person who had a greater degree of personality integration and realistic observing ego. This was evident when she said, “I feel like a whole person. I feel very cleared to all negativity. I may not always think that I performed my best but that’s just a performance. It’s not taking my voice away and forgetting who I am.”

The quality of being more fully in each moment reflected a person who had managed to free herself of her inner tormenter. “However I could express myself at that moment is the best that I could do at that moment and there always is another moment.” This fluid state of being characterizes a healthier personality that has opened more her optimal creative flow (Csikszentnihalyi, 1990).

It was not surprising that her D5 experience summed up how performance offered her transcendence.

The spontaneity of being in the moment and feeding from the audience and seeing their faces light up. I still could look up or down, close my eyes. I could look at the audience and feed from the audience and the other musicians. If they are playing well and if they are in sync with me and I am in sync with them and you’re feeding off each other, it’s a tremendous experience.

In this statement, Trisha summed up the essence of how it feels when all the dimensions are aligned for optimal flow. The "feeding" from the audience, the "in sync" feeling when you are locked in with other musicians, and of being ‘true to yourself’ in the sense of connecting with your inner music and to your inner audience.

For Trisha, performance brought out her playful side. It allowed her to dress up in costumes, put on make-up, and use her talents as a dancer and actor. She found new ways to interpret the emotions of the characters in her songs. She composed music that employed her talents for poetry and writing. And perhaps most significantly, she found a new family that recognized and appreciated her talents.

Conclusion: Brothers and Sisters in Performance

The connections established in the MTPG produced a strong bond. A feeling of shared experience occurred that promoted a culture of belonging to some bigger entity than oneself. The traditions of performers, their customs, common language, their encounters and experiences, the sense of being part of a larger community of artists, was all felt. The relationships that evolved in the group explored, affirmed, and celebrated the empowerment of the performer. The members came to embrace performance as the domain of the committed not just the gifted.

Ansdell (2004) describes the experience of communitas (first used by the anthropologist Victor Turner and discussed by Even Ruud) in referring to the feeling of membership promoted by performance. Aigen (2005) uses this term to denote the camaraderie that develops between members of a band through the ritual of playing music together. He discusses the "liminal" or timeless qualities of performing as “losing oneself in the experience, leaving behind symbols and practices of previous positions, ambiguities, perceived danger, the absence of roles and a transcending of previously defined borders” (pp. 91-92).

Despite the strong presence of camaraderie that developed, inevitably individuals continued to struggle. The liminal aspect of the performance process can be deceptive. It can overshadow the personal experience of one performer who may not feel the same glow that is shared by the rest of the group. A therapist should not assume that all moments even the peak ones, are being felt in the same way by each person. What often develops is a special understanding between performers. The experience comes to feel more like a band of performing brothers and sisters in the way that people come to feel about having gone through a lot together even if it was not always easy. One difference between this group and their own families of origin however was in the support and encouragement that they found that was often missing there.

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