[Position Paper]
Psychodynamic Music Therapy
By Jinah Kim
Abstract
This paper introduces and explores the basic principles of psychodynamic approaches in music therapy. Music is used as a means to explore both conscious and unconscious issues as well as the internal world of the individuals involved in music therapy. However, the focus of therapy is on therapeutic relationship, especially the dynamics of transference and counter-transference between the client and the music therapist. Musical experiences, such as music listening, songs, and improvisation, can be used to facilitate the therapeutic processes, and to achieve individualized therapeutic goals. When clinically appropriate, verbal processing might play as crucial a role as the musical processing. Practitioners of psychodynamic approaches often strive to gain meaning and in-depth understandings from therapeutic experiences, and the approach is therefore suitable for individuals who are ready to work through their personal issues within a therapeutic relationship. Various approaches and techniques have been developed in psychotherapy as well as in music therapy. Perhaps the only commonality in these approaches is that psychodynamic thinking informs the direction of the therapy and therapeutic processes. Clinical vignettes will be introduced within the article to highlight a triadic dynamic—the client, the music therapist, and the music—in order to illustrate the core aspects of psychodynamic music therapy.
Keywords: psychodynamic music therapy, transference, countertransference, free improvisation
Editorial note: In 2016, Voices hosted a special edition to accompany the launch of a Massive Open Online Course (MOOC) on the topic of "How Music Can Change Your Life". Thirteen authors agreed to develop position papers for the MOOC, with two articles being developed to accompany each of the six topics within it. Each author has highlighted the theorists and researchers who have influenced their thinking, and included references to their own research or music practices where appropriate. These papers have been written with a particular audience in mind—that is, the learners who participate in the MOOC, who may not have had previous readings in any of the fields being canvassed. We hope that you find these articles interesting, whether reading as a MOOC learner, a regular VOICES reader, or someone who is discovering VOICES for the first time.
Introduction
Juliet Alvin, who was one of the early pioneers in music therapy in the United Kingdom (UK), stated that we could discover ourselves in the music we create (1975). She believed when conditions are created that promote freedom to choose and play without any pre-imposed rules (free improvisation), the player’s character, pathology, and personal issues will be reflected in music. Nor is it unusual in my practice to see clients exhibiting a similar pattern of behaviors during music making processes with the music therapist to those they display outside of therapy situation. This means that the therapist can use music as means to work through therapeutic issues the client brings in to the music therapy.
In order to give a clear picture of how psychodynamic music therapy works, I will present a case vignette of a client in a psychiatric hospital. For confidentiality, pseudonyms will be used to describe each client in this article.
Tom was a man in his mid-40s with chronic schizophrenia who attended a day hospital for adult psychiatry at a university hospital. The staff at the day hospital considered him a very well-adjusted patient in that he appeared to be polite and well-behaved. He also regularly attended the short-term open music therapy group that I ran at that time (once a week for 12 consecutive sessions) with the occupational therapist as co-therapist. As it was an open music therapy group, any patient at the day hospital could join; therefore, the size and members in the group varied each session. The group had a basic structure of choosing the instruments and themes for group improvisation, playing group improvisations, and then talking about what we played and how we felt in the group. Regardless of the theme for group improvisation, Tom always chose a single large instrument such as the bass xylophone (the largest melodic instrument in the group except the piano), the Orff timpani (the largest drum in the group), or the piano. He played with a steady beat on the instrument he chose (constant quarter notes with mezzo forte [neither too loud, nor soft] without any alteration of tempo or dynamics). For example, when he played the piano, he only used the index finger of his right hand, going up and down every white note consecutively. His style of playing remained the same no matter what other members of the group played or how they played. At times, I tried to introduce new ideas and alternative ways of playing by either joining him in his piano/xylophone playing or accompanying him with another instrument, but it was in vain.
Working with him in the open group reminded me of his usual behavior at the day hospital. Every time we passed each other in the lobby, he had slightly awkward smile on his face, and whenever I greeted him by saying “Tom, how are you today?” he always answered “Fine, thank you.” Tom’s response was the same, even when his partner committed suicide.
During the case conference at the day hospital, I presented a couple of excerpts of recorded group playing in which Tom’s rigid playing stood out. The staff and I talked about the way he was playing on the instruments. The staff began to realize that what was previously perceived, as well-adjusted behavior, might be his pathological way of dealing with the world around him. Tom’s way of being was expressed through making music in the group and improvisation became a forum for projection of his self.
Active music listening can play a similar role when clients appear to hear themselves in a self-chosen song, even while they are unable to speak for themselves. Jin was a 12-year old boy with borderline intelligence at a local primary school. He had lived with his grandparents since his birth. He was the child of a rape victim living in residential care for those with severe and profound intellectual disabilities. As his mother was unable to care for him when he was born, he was placed under his grandparents’ care. During his individual music therapy sessions, he had chosen to listen to a theme song from a Korean drama series, ‘Slave Hunters’, repeatedly for 12 sessions. This song contains desperate lyrics as follows:
I am suffering from the irrevocable trauma that my heart feels like burning, and deeply wounded. I wonder whether I am still alive, or the world has abandoned me. A day feels like a year. I long for the moment when the morning comes...(https://www.youtube.com/watch?v=xgmoUZo5U0Y).
Jin had been severely abused (physically and verbally) by his alcoholic grandfather for years. He was not a verbally articulate boy who could talk about his thoughts and feelings. He was not able to say why he had chosen to listen to this song continuously, or what his feelings and thoughts were for this song. However, his choice of the song gave the strong impression to his therapist that the lyrics seemed to represent what he might have been feeling. In this case, the song became a powerful medium to explore his feelings and thoughts that might not otherwise have been easily accessible to him, or communicable to others.
Diverse theories and concepts stemming from psychoanalysis have informed the various developments in psychodynamic music therapy (Austin, 1996; Bruscia, 1998; Kim, 1997, 2006; 2009; 2014; Hadley, 2003; Wigram, Pedersen, & Bonde, 2002). Psychodynamic music therapy is not just one model in music therapy, but rather a collection of models rooted in and diverted from psychoanalysis. Hadley (2003) noted that psychodynamic music therapy is “a continually growing field” (p. 4 ). For this reason, I will use the term psychodynamic approaches in music therapy interchangeably with psychodynamic music therapy. Hadley suggested that specific clinical training, the type of clients, the work environment, the kind of supervision, and the culture of the therapist play decisive roles in how each therapist works in psychodynamic music therapy.
While there are myriad theories and concepts developed from psychoanalysis, the core aspects that apply to most psychodynamic approaches are that therapy focuses on the internal world of individuals in order to gain deeper understandings into their relationships and experiences, and into how they come to relate to and view the world around them. This is achieved by examining past experiences and unconscious forces. Music is used as a medium for therapy, but the core aspects exist within therapeutic relationship. That is to say that music experiences such as music listening, songs, and improvisation can be utilized to facilitate the therapeutic processes between the music therapist and the client to work through whatever therapeutic issues the client brings to the therapy. Within such therapeutic processes, the focus of the therapy is on the dynamics of transference and counter-transference between the client and the music therapist (Hadley, 1998).
Bruscia (1998, p. xxii) explained that there is “no universal definition of transference and countertransference” that explains and satisfies every clinical situation and therapist. He defined transference as “the dynamic of the client’s conscious and unconscious psyche relating to the therapist, and counter-transference is the dynamic of the therapist’s conscious and unconscious psyche relating to the client (p. xxii).” Literally the word transference means transferring one’s own feelings and thoughts about a person outside of therapy onto the therapist (vice-versa for countertransference). The theory is that closer examination of such dynamics within the interpersonal relationship can help a client to gain insights into relationship patterns and to better deal with therapeutic issues. The dynamics of transference and counter-transference can be elicited through non-verbal and verbal communication between the therapist and the client, and can also be sounded in the music during music therapy.
Basic Assumptions and Core Principles of Psychodynamic Therapy
Psychodynamic traditions in therapy are rooted in Sigmund Freud’s psychoanalysis, but include various practices and theories derived from it such as analytical psychology, object relations, ego psychology, self-psychology, and more.
Research findings of developmental psychology and neurobiology and other closely related fields are continually assimilated and up-dated into the theories and practices of psychodynamic therapy (Brockman, 1998; Damasio, 1999; LeDoux, 1996; Siegel, 2007; 2010). Since so many diverse theoretical models exist in psychodynamic therapy, I am going to focus on the common aspects in all psychodynamic therapies in order to provide an overview.
Freud, the founder of psychoanalysis, introduced the talking cure method, from which many concepts, theories, and branches of psychotherapy have been introduced and developed. Freud believed that our feelings, attitudes, behaviors and personalities are largely determined by the past experiences and governed by unconscious motives (Freud, 1921). According to Freud, psychological problems are caused by unresolved inner conflicts due to childhood trauma, or past experiences that are somewhat hidden from the conscious. Inner conflicts can create anxiety and give rise to defense mechanisms such as projection, denial, repression and rationalization. Defense mechanisms with the primary function of protecting the self from painful and/or unbearable emotions such as anxiety, guilt and fear are largely unconscious reactions. As defense mechanisms can trigger abnormal behavior and psychological problems, the goal of classic psychoanalysis is to bring unconscious issues, inner conflicts, forgotten childhood traumas, and defense mechanisms into consciousness through talking about them using techniques of free association[1], dream analysis[2], as well as analysis of transference, and resistance (Brown & Pedder, 1991; Freud, 1915; 1921).
The theories of psychoanalysis were continually amended and shaped over the years by Freud himself, and these left a lasting impact on the development of psychotherapy, psychology, and psychiatry. Freud’s theories were largely based on in-depth individual psychoanalysis (often 3–5 days a week) with middle to upper-middle class Viennese women suffering from neurosis and emotional disorders; therefore, generalization to wider contexts and populations is bound to be limited. The following are some examples of further development of psychodynamic approaches in psychotherapy.
Anna Freud, the daughter of Sigmund Freud, applied theories of the ego for analysis with children, and became the founder of Ego Psychology.
Carl Jung, the founder of Analytical Psychology, was mentored by Freud in the early 20th century. Jung developed distinctive theories of the ego, comprising the personal unconscious and the collective unconscious. Jung also recognized spiritual aspects as relevant to therapy and emphasized the role of images in the human psyche to facilitate the ego in the direction of psychic wholeness, which influenced the birth of the Transpersonal Psychology (Brown & Pedder, 1991).
Alfred Adler, the founder of Individual Psychology, was also a follower of Freud in early 20th Century Vienna. He broke away from psychoanalysis and emphasized the need to understand the individual as indivisible whole within his/her social context by addressing issues such as parent education, the effects of birth order, and life style (Oberst & Stewart, 2003). Individual psychology subsequently influenced Humanistic Psychology and counseling.
Another important development of psychodynamic theory is object relations. Object relations theory attributes the patterns of adult relationship to the origin of the early infant-mother (later expanded to include the primary-caretaker of any gender) relationship. Klein (1935; 1946) stressed how crucial aspects of internalized objects (e.g., internalized mother) exerting a considerable influence over one’s lifetime, and that these might be different from external objects (e.g., the real mother). Klein’s concept of projective identification is currently understood as analogous to transference, and therefore holds a potential key to therapeutic understanding (Hinshelwood, 1991). Bion (1967) illustrated projective identification through mother-infant interaction. If the baby cries with the intense anxiety and fear of dying, such intense feelings are stirred up similarly in the mother. A psychologically healthy and stable mother contains and acknowledges such feelings from the baby, and then mentally digests such feelings and returns them to the baby in a more bearable form. The baby can then introject the contained and digested feelings from the mother. This experience helps the baby to be able to digest such feelings by him/herself in time. Dynamics of projection and introjection largely occur spontaneously and unconsciously. “The concepts of mental digesting (Klein), holding (Winnicott) and containment (Bion)” have been widely acknowledged as highly relevant to clinical practice in psychodynamic music therapy (Kim, 2014, p.269).
The last person I would like to mention is Daniel Stern (1985). Through direct observation of mother-infant interaction, Stern identified the musical-improvisational nature of early pre-verbal human interaction between the infant and the mother, as well as the effects of such interaction on the interpersonal development of the infant. Correspondingly, he stressed how the implicit and the non-interpretative aspects of psychotherapy are analogous to early preverbal human interaction. Some music therapists recognized that improvisations between the client and the therapist are nonverbal experiences that can facilitate the implicit aspect of therapeutic relationship (Holck, 2004; Kim, 2009, 2014; Kim, Wigram & Gold, 2008, 2009; Wigram & Elefant, 2009 ; Wigram, Pedersen & Bonde, 2002). This explains how psychodynamic music therapy has unique therapeutic potential for working through dysfunctional relationship issues originating from early childhood where verbal communication is not relevant.
Pioneers in Psychodynamic Music Therapy
There are three women who are usually acknowledged as pioneers of psychodynamic music therapy: Juliet Alvin, Mary Priestley, and Florence Tyson. Juliet Alvin, a pioneer of music therapy in the UK, was the founder of Free Improvisation Therapy (Alvin, 1975; 1976). Alvin developed her model based largely on the psychoanalytic concepts of Freud. She directly associated musical process in music therapy with key concepts of psychoanalysis: music as means of projection (1974); the musical object as an intermediary object (1977); and regressional techniques in music therapy (1981). Alvin stressed the importance of developing the client’s musical relationship as the key to successful therapeutic process and outcomes. She also considered the therapist’s main instrument as “the primary means of communication and interaction” (Wigram, Pedersen, & Bonde, 2002, p. 132), and used a method of empathic improvisation in relation to the client’s way of "being" in music therapy (Alvin, 1974; 1977; 1981). Her method was integrally musical in that she used “every conceivable kind of musical activity”, both music listening and active music making, and including free improvisation (Wigram, Pedersen, & Bonde, 2002. P. 131). When using improvisation, she imposed no musical rules or directions, and gave complete freedom to the client to make music. Alvin thought that music provided potential space for free expression (1975; 1977) and free improvisation is often likened to free association in psychoanalysis. The concept of free improvisation was regarded as original and almost revolutionary for music therapy in the 1960s, since the music therapists following other approaches, such as behavioral modification and Nordoff-Robbins Music Therapy, employed either precomposed music or structured improvisation and composition respectively (Wigram, Pederson, & Bonde, 2002). Alvin had a lasting impact on many music therapists and educators worldwide, and her methods were further developed and applied in other training courses by Tony Wigram (Denmark), and Helen Odell-Miller and Leslie Bunt in the UK (Wigram, Pedersen, & Bonde, 2002).
Mary Priestley was one of the first generation of music therapists trained by Alvin in the UK. She further developed Alvin’s theories and established Analytical Music Therapy. While Alvin used both music listening and active music making methods, Priestley focused mainly on using improvisation to explore unconscious issues that had detrimental effects on the client’s present life (Priestley, 1975; 1994). She stressed the importance of verbal processing before and after improvisation in order to bring unconscious materials into conscious. She believed that joint improvisation between the client and the therapist contained transference and counter-transference responses (Eschen, 2002).
Florence Tyson was an American music therapist who wrote a book on psychodynamic orientation to music therapy. She viewed music as “the only bridge from inner world to outer reality” (2010, p. 94) and felt that the music therapist should use music as means to explore and deal with the inner reality of the client (Tyson, 1981, 2010). Like Alvin, her approach was eclectic, employing a vast range of theories in her clinical practice, including behavioral, cognitive, humanistic, and psychoanalytic concepts, even though she was more inclined to psychodynamic approaches. She viewed the role of the music therapist in relation to the client in terms of object relations, and saw regression as an essential process in music therapy for patients with mental health problems.
All of these pioneers worked in psychiatry and the mental health sector. Alvin and Priestley emphasised improvisation as the primary medium for music therapy while Tyson employed both music listening and music playing activities in her practice. Each of them recognized the importance of triadic relationship—the music, the therapist, the client—as the key components for successful music therapy.
Psychodynamic Music Therapy in Everyday Practice
Winnicott (1971) is another key scholar whose work has been utilized by many psychodynamic music therapists. He wrote about the connection between playing and creativity as the key component to mental health across the life span. Winnicott claimed that whatever age one is, only through playing can one be creative, and that when one is being creative, one discovers the true self. Having used improvisation with children who have a wide range of developmental disorders in music therapy for the last 20 years, I have always considered music therapy to be playing with music for children who are not readily able to play as typically developing children do, due to their pathology. Therefore I understand psychodynamic music therapy as a creative process involving exploration of various instruments and their sounds in relation to the client-therapist relationship. Improvisational psychodynamic music therapy is a largely non-directive, unstructured approach allowing the therapeutic process between the client and the therapist to spontaneously unfold as the session goes on. Clients are encouraged to choose what instrument to play, or to vocalize, according to his or her preference and mood, and to spontaneously express her or himself through improvisation.
The therapist, through training, should be able to identify therapeutic issues and relationship patterns that are played out in the client’s improvisation, and also be able to respond and intervene, musically or verbally, when clinically appropriate. Musically, the therapist may utilize empathic techniques such as matching[3], mirroring[4], accompanying[5], or frameworking[6] in response to the presenting needs of the client, informed by the therapeutic judgment and intuition of the therapist (Wigram, 2004).
In my experience, joint improvisation can function as a medium to build the therapeutic alliance between the therapist and the client at the beginning of therapy. Mutual music making that is shared between the client and the therapist often encourages a musical projective identification process where projection and introjection can occur simultaneously (Kim, 1997; 2006; 2014). Joint improvisation between the therapist and the client is frequently likened to early mother-infant interaction due to the finely tuned, reciprocal, and improvisational nature of the interaction. Such a therapeutic encounter often brings about a human drama of the people involved in it; how one gets to know another, to trust, and to love. Therapeutic process also involves working through obstacles and difficulties in therapy (Kim, 2009).
For example, children with autism spectrum disorder (ASD) often have limited capacity for the basic psychodynamics of human engagement, such as projection and introjection (Alvarez, 1992; Kim, 2006; 2015; Meltzer et al., 1975). Projection and introjection through music making appears to be easier to process for children with ASD than through any other means (Kim, 1997; 2009; 2014). The child’s behavioral and musical expression can be met by the empathic improvisation of the therapist in the mutual music making process, and the child often seems to perceive the therapist’s music as part of his own expression originating from himself (musical projective identification, Kim, 1997; 2009; 2014).
When working with young children with ASD, uncovering past experiences and unconscious issues are usually not the focus of therapy as there is not much unconscious material to access at this developmental stage. However, in improvisational music therapy, musical attunement by the therapist to the child’s behavioral and musical expression in the here-and-now can play a significant role in the development of the therapeutic relationship. This can be particularly powerful experience for children who have not had much experience of a finely tuned dyadic attunement with their mother, or other primary caregiver (Kim, Wigram, & Gold, 2008; 2009; Kim, 2014).
I have previously (Kim, 2014) described the development of early improvisational interactions with Sam, an 8-year-old boy with ASD and a severe intellectual disability. I imitated the tapping sound Sam was making in a turn-taking way. There was qualitative similarity between Sam and my improvisations similar to the kinds of initiation and imitation that prevail between an infant and parent. Sam was eager to participate in this predictable interaction where he controlled how to play, what to play, and what to expect from me whereas in previous sessions he prevented me from playing or introducing any musical activities. Simple initiation and imitation of rhythmic sound generated an interest in further musical engagement for Sam that allowed us to share the affect and meaning of what we were doing in the here-and-now. Sam soon developed a strong enthusiasm towards music therapy, and an intense attachment to me as his therapist. Other young children with ASD have also developed an intense attachment to their therapist when engaging in improvisational music therapy. Some non-verbal children begin to develop language through the improvisational-musical interaction, and start to call the music therapist ‘mummy’ even before they began to call their own mother ‘mummy’. Some verbal children with ASD even speak out in music therapy. In one case, a child said, “I want to have music therapy every day from 9 in the morning till 9 in the evening!” (Kim, 2014, p. 267). Other high functioning older children with ASD have shared their fondness in writing cards (Kim, 2014). At times, these children appear to be more attached to the therapist than to their own mother.
In such cases, it seems the children idealize the therapist. Klein (1935/1991) explained idealization of the therapist as follows: aspects of the self or an internal object are split off and attributed to an external object as either good or bad. For example, a fear of dying may be projected by the client to the therapist, as well as the good/ideal parts of an internalized object. Alvarez quoted Klein and her followers explaining idealization as “a defence against persecutory anxiety” (1992, p. 118), generating a phantasy of perfection (Klein, 1935/1991; Hinshelwood, 1991). Alvarez (1992) emphasised the “ hopeful developmental aspects of idealization for children who are autistic, borderline, deprived or abused” (Kim, 2014, p. 268). Alvarez thought the idealization of the therapist could be a therapeutic turning point, enabling the child with ASD to overcome serious developmental pathology.
I interviewed the mothers of two children with ASD who developed a strong attachment towards the music therapist when participating in the Korean site of a multi-site, early intervention project for children with ASD in improvisational music therapy which involved nine countries (the TIME-A project). The mothers informed me that they had never seen their children forming such strong attachments to any other human being. The mothers were very touched by the fact their children missed and talked about the therapist at home, and were looking forward to coming to music therapy again. The children never showed such an attitude towards any other intervention they had attended since their early diagnoses of ASD. This illustrates how the therapeutic relationship often resembles the early bonding between the mother-infant, and the quality of such a relationship may function as a foundation for further interpersonal and social development for children with ASD.
Application of Psychodynamic Music Therapy Principles to Peer-Supervision
A group of four 3rd-year undergraduate music therapy students had just started their first clinical placement, and had formed a peer-supervision group. For convenience and confidentiality, I will address the students as A, B, C, and D. The group had three male (A, B, C) and one female student (D). B and D were transfer students from different departments, and it was their 2nd year in music therapy, while A and C were in their 3rd year in the music therapy major. Although they had clinical supervisors who guided them through clinical placements, they felt the need for further exploration and peer-support to process their first clinical placement. They met once a week for peer-supervision, and the peer-supervision group itself was supervised by me, also once weekly. This is the description of their first peer-supervision.
The structure of their peer-supervision group consisted of talking about their issues concerning the clinical placement, choosing instruments for a group improvisation to explore those issues further, and then talking about their experiences of group improvisation. Three of the students (A, B, D) were already assigned and had their first sessions with their clients. C was to start his first session the following week, but had not been given any information about his client. All four students talked about how anxious and how unprepared they felt for their first clinical placement in music therapy. A and B were assigned together to a residential hospital for older adult patients. They ran the first group music therapy session as a team while they had individual music therapy assigned to them respectively. A and B then talked about how embarrassed and awkward they felt when the on-site supervisor at the hospital asked them to sing for the group out of the blue. They were unprepared for such a request and were not sure what song would be appropriate for the patients. They were hesitant, but eventually chose to sing a well-known Korean folk song, “Arirang”. C talked about how frustrated he felt due to his difficult relationship with the fellow music therapy student who was assigned to the same clinical placement, and that he felt his clinical placement was somehow compromised because of it. D talked about how her first session did not go as she planned, and how difficult it was for her to focus on what was happening in the session with her client because she was so concerned about how to implement her planned music activities. She was not sure whether she was helping the patients or not.
When they decided to play free group improvisation without any rules or preimposed structures, A chose the piano, B the guitar, C the kokiriko (Japanese wooden percussion), D the alto xylophone.
During my supervision for the peer-supervision group, I asked what and how they played, and how they interacted in group improvisation. A responded indicating what he played, but that he was so absorbed in his own piano playing that he did not hear others’ playing at all. Moreover, A wanted to fully explore his own issues through the piano improvisation. When A talked about his own musical absorption, the rest of the group also described how they were also focused on their own music making process, and it was difficult to hear what others played. It turned out that each student kept physical distance from the others in order to focus on what they themselves played. While I was listening to their description of what and how they played, I had an image of four separate islands existing respectively.
I asked what they made of such experience in group improvisation. They were uncertain about what they felt and how to understand the experience, or if there was meaning at all. C described the music as becoming chaotic and loud in time, and that there were hardly any coherent musical elements that held the group together. Other students joined in by saying they also could not make any meaning out of the improvisation.
I mentioned how anxious and uncertain they were for their first clinical placement and first music therapy sessions. In group improvisation, they were eager to explore their own individual experiences, but somehow the chaotic music that they produced did not seem to be meaningful to them. I then asked how they reacted to A’s piano playing since the piano was the most dominant instrument in the group in terms of size, dynamics, and the harmonization capabilities. As soon as I mentioned the characteristics of the piano, C blurted out how annoyed and frustrated he was about A’s piano playing that was so loud and dominating. Instead of playing what he wanted to express, C was constantly finding himself following the rhythm and dynamics of the piano playing. B and C also noticed the loudness of A’s playing, and found themselves playing within the A’s dominant rhythm, even while mostly absorbed in their own playing. When I asked A whether he knew the impact of his playing on the group, he said apologetically that he was so determined to explore his own personal issues in his improvisation that he did not notice others’ playing in the group.
I mentioned the similar interpersonal issues of C, who felt compromised by the fellow student at the clinical placement, as well as in the group improvisation. C wanted to go his own way but found he was following the dominating individual. Each student began to reflect on how they were in real life and how they improvised in the group. They began to notice their own patterns of behavior reflected in the way they improvised. A talked about a trust issue and that he did not wish to disclose any personal issues to others, even in this peer-supervision group. It was his conscious decision not to talk about his personal issues and how he felt in the group, just as he did not hear others’ playing at all in the group improvisation. B said that A’s playing did not bother him much and that he could still play his guitar although it was hard to hear his own playing. B was a competent guitar player, but a very quiet person who tended to speak only when being asked to. In fact, no one else remembered hearing his guitar playing. D began to voice her lingering doubts about whether music therapy was the right profession for her and whether she was going in the right direction in her life, a feeling which others also shared.
Through group improvisation, these music therapy students explored their own issues verbally and musically, and were working through their own difficulties. They began to notice their own behavioral and relational patterns reflected in their improvisation. The group improvisation functioned as a vessel for non-verbal musical projection of each student’s personality and how they were with one another, and the music reflected the dynamics and processes of how they were in relationships, and that of their current concerns.
Conclusion
Freud often likened psychoanalysis to astronomy or archeology (1933/ 2004). He meant that the parts that we, the therapists, get to know about the clients are very limited. Therefore, therapists have to accept the limitation as it is, and to do our best to overcome the limitation of knowing. Strictly speaking, the psychodynamic theories and concepts that therapists apply to the phenomena encountered in their clinical work are largely based on psychological inferences, and are hard to prove scientifically. Therefore, psychodynamic theories and concepts bear inherent uncertainty. The capacity to bear and accept uncertainty is required of any therapist working from psychodynamic perspectives. There are even several books focused on uncertainties in psychodynamic therapies (McCleary 1992; Snell, 2012; Waska, 2011).
When it comes to applying psychodynamic principles to music therapy, different therapists use music, theories, and concepts differently based on the needs of their clients, as well as their clinical and theoretical knowledge and experiences. It is worth noting that in general, current psychodynamic approaches in therapy are less concerned with the therapist’s interpretation and gaining insights from it, and more focused on exploring and working through whatever therapeutic issues the client presents in therapy. Improvisation appears to play an additional, special role in psychodynamic music therapy.
“Therapy deals with human encounters” (Kim, 2014, p. 276), and there unfolds a human drama involving the music therapist and the client(s) with their music experiences in music therapy. Psychodynamic music therapy offers a certain explanation and some insights into what goes on in that experience, however limited that is. Priestley (1994, p.119) stated that music therapy is a “special way of loving.” Just as any human relationship involving love entails a spectrum of emotional and interpersonal experiences in real life, the therapeutic relationship between the therapist and the client may bear both highs and lows, gains and losses, and perhaps pride, joy, frustration, disappointment and regrets too. A large spectrum of love can be reflected and contained in music in psychodynamic music therapy as music takes almost infinite forms and styles. Within that therapy drama, learning from the experience happens for both the therapist and the clients.
Notes
[1] In therapy, the client is encouraged to say whatever comes to his/her mind in association of series of words that are presented by the therapist.
[2] Freud thought that dreams are the royal road to the unconscious due to the fact that conscious censorship is lowered when we sleep.
[3] “Improvising music that is compatible, matches or fits in with the client’s style of playing while maintaining the same tempo, dynamic, texture, quality and complexity of other musical elements” (Wigram, 2004. P.84).
[4] “Doing exactly what the client is doing musically, expressively and through body language at the same time as the client is doing” (Wigram, 2004, p.82).
[5] “Providing a rhythmic, harmonic or melodic accompaniment to the client’s music that lies dynamically underneath the client’s music, giving them a role as a soloist” (Wigram 2004, p.106).
[6] “Providing a clear musical framework for the improvised material of a client, or group of clients, in order to create a specific type of musical structure” (Wigram, 2004, p.118).
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