First Love—An Idealized Object in Music Therapy
Therapy often involves the development of an intimate therapeutic relationship between the client and the therapist. By introducing the story of Hyun in music therapy, I invite readers to discover what happens during a mutual music making process and what this process means to the child and the therapist. I also situate this story within a triadic relationship—the child, the therapist and the family (especially the mother) so that one can see a comprehensive picture of how the happenings of music therapy relate to immediate outside world of music therapy, and vice versa. More importantly, I try to show the inner workings of the therapist and her wonderings in response to the client in order to clarify the core aspects of therapeutic process. This study will be viewed from psychodynamic, especially the British object relations theories, and developmental perspectives.
This is a case study that deals with transference love at pre-oedipal and oedipal levels between the child and the therapist, and the role of mutual music making processes, as well as that of the therapist in improvisational music therapy.
In improvisational music therapy with a child with special needs, the mutual music making processes between the child and the therapist often facilitate the simultaneous process of projection and introjection (i.e., projective identification). The child's being and doing in the here-and-now can be met by the therapist's improvised music. The child then senses that the therapist's music has something to do with him, or herself. Such responsive music often encourages early interaction between the child and the therapist. This process seems to highlight musical projective identification phenomena in music therapy (Kim, 1997, 2006 b). This is particularly relevant when working with children with developmental disorders. Many children with developmental disorders do not readily project, or introject for some reasons. Therefore, the process and the development of social learning may often go astray.
Musical encounters like this between the child and the therapist in music therapy can evoke very specific, profound and often powerful feelings in the child and the therapist, which is often described as analogous to early mother-infant interaction. At the heart of these relationships, the child and the therapist, and the mother and infant, lies we find the development of love.
Like any other human encounters that involve love, a therapeutic encounter with a child with special needs in improvisational music therapy can bring forth a drama that deals with how we come to get to know, love and trust. It also deals with how we get through the obstacles such as frustration, disappointments, disillusionment, hurts, and pain.
In order to distinguish clinical phenomena from the inner workings of the therapist, I have used indentation to specify the musings of the therapist in relation to the specific issues and concerns the client brings into the therapy.
Hyun was a four and a half year old little boy of slight build with mild form of Cerebral Palsy (CP). He was the only child of his family at the time of referral. His parents were highly educated people. Hyun's parents were very supportive of him. Hyun's father changed his job in order to spend more time with Hyun and his mother left her work to take care of him full-time since the diagnosis of CP in his infancy. The family moved their house to be near the Rehabilitation Center (where I worked) for Hyun's on-going therapy services. Hyun's cognitive ability was intact. He displayed idiosyncratic behaviors such as stiff hand movement right before his eyes, and making a sudden freezing posture while walking, etc. His mother referred Hyun to music therapy for his difficulties in communication and social interactions. Hyun's mother was a well-meaning person. However she found it difficult to relate to Hyun. The typical interaction between Hyun and his parents had been mostly one directional; i.e., Hyun demanded something and his parents responded, or vice versa. Their interaction was often short-lived and quite functional. Hyun's parents did not seem to know how to play with Hyun. According to his parents, Hyun hardly showed any interest towards his peers. Only two years later (age six and a half), he was diagnosed with Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) in addition to CP.
First love - An Idealized Object in Music Therapy
I saw Hyun twice a week for half an hour in individual music therapy for eight months. My first impression of Hyun was that he had an intense, somewhat obstinate look in his eyes and he was a very cute little boy.
From the early sessions in eight months of treatment with individual music therapy, it was apparent that a mutual music making process in which I was sensitively and musically matching Hyun's musical and non-musical expression in order to provide a shared context for both of us to meet and play, brought a jubilation in him. I paid undivided full attention to him through joint improvisational processes, and I noticed that he was vigilant at what I did both musically and non-musically noticing minute details of my actions. Soon he began to show enthusiasm towards music therapy and the therapist. His favorite instruments were the piano and the xylophone. Every time he played these instruments with me, he used to say in excitement. "Hyun wants to have music therapy from nine o'clock in the morning till ten o'clock in the evening. Hyun wants music therapy from Monday till Sunday." While it is standard to use personal pronoun explicitly in English, Korean language does not require the speaker to use personal pronouns explicitly when the context is easily understood. Even considering that, Hyun did not use the first-person pronoun "I" as frequently as typically developing children of his age in Korea. Instead of using the first-person pronoun I, he often addressed himself Hyun as if he were talking about a third person. Soon he began to question, "why not have music therapy every day?" I acknowledged how much he liked to come to the music therapy that he enjoyed so much, and how hard it was for him to wait till next session.
As therapy is such an intimate process, the therapist is bound to feel whatever the client is feeling at the moment—both highs and lows. But for a long time, there were only highs in Hyun in relation to me. As an experienced music therapist with children with special needs, I encountered children showing enthusiasm both towards music therapy and the therapist early on in therapy. In fact such enthusiasms can be a positive sign to evaluate whether therapy was working for that particular child. However the intensity and suddenness of his enthusiasm appeared to be quite forceful even to me.
According to his mother, Hyun hardly ever liked other educational and therapy services such as physical therapy, occupational therapy, and kindergarten he attended. His mother expressed how happy she was to see that Hyun liked both music therapy and the therapist so much. At home, he often asked his mother when he could go to music therapy. In time, his family showed much trust in the music therapist doing something good for Hyun that I got to meet many of his family members visiting music therapy at some point—his father, grand parents and aunts.
The mutual music making process continued to provide such fulfilling emotional satisfaction to Hyun that he seemed to feel being at one with me through music. After satisfying joint improvisation together, he literally threw himself on me, and then either passionately rubbed his face against mine or kissed me. This sudden gesture was often felt more like an attack than endearment that startled me. He said, "Hyun likes Sunsangnim very very much" repeatedly. Instead of feeling glad, I was beginning to feel slightly intruded upon and bemused.
While Freud (1915) thought of transference love as a form of resistance for the therapist to overcome, David Mann (1997) considers it as the core element of the therapeutic process between the therapist and the client enabling growth, change and transformation.
I also thought about the very nature of music since we often talked about music bringing people together. The momentary sense of being at one with others while music lasts is true to many of us especially when we are part of an enjoyable and meaningful music making process. Erich Fromm (1956) describes human desire for interpersonal fusion as the most powerful striving in us because modern man is alienated even from oneself and one's fellow man. Consequently we try to escape from aloneness and alienation by trying to achieve a unity with another human being. That is in conceptual sense, love. What Hyun displayed seemed so primitive and powerful that my feelings and thoughts are mobilized to wonder about the very nature of love.
He also began to express repetitively how much he liked to come to music therapy with his father. His mother informed me that Hyun liked his father more than he liked his mother since his father was very permissive towards Hyun whereas his mother was a more disciplinary figure in his family. Hyun's father was a successful scientist who was willing to help Hyun, but a somewhat socially awkward man. His mother suspected her husband of having some form of autism. She suspected of Hyun the same. Hyun's wish to come to music therapy with his father seemed as if he wanted to create a perfect family in music therapy. While I acknowledged his wish to come to music therapy with his father, I told him that music therapy was for him, not for his father.
I also wondered about the degree to which he seemed to idealize me. Klein (1935) explained idealization and ideal object as linked to the mechanisms of splitting—the concept of good and bad object. Hinselwood explains (pp.318-319, 1991); "When an object is conceived as primordially good then it is said to be 'idealized'; good aspects of the object have been separated off by splitting, followed by the annihilation (denial) of the bad aspects, and this gives the illusion of perfection". Perfection in itself is an impossible state in a human being, therefore is likely to create persecutory reaction leading to further primitive defence mechanisms. While Klein thought of idealization as defence against persecutory anxiety (against a frustrating bad object), Alvarez (1992) considered that it was not only essential, but also an important developmental achievement especially for children who were autistic, borderline, deprived, or abused.
Soon he began to get obsessed about me and my personal belongings such as wrist watch, socks, nylon stockings, and even the chair I sat on. These objects had adherent qualities to my body. At some point during the session he had to wear my wristwatch, touch my socks or nylon stockings (depending on what I was wearing that day), and sit on my chair, otherwise he got very agitated. These were his precious rituals. Certain features of his behavior felt almost like fetishes that I could not help but feel uncomfortable. However, it was profoundly more than fetishes. He seemed to derive both soft and hard skin sensations that felt infantile, primitive and somewhat sensual.
There was another ritualization developing. After each joint improvisation, he began to stick himself to me by leaning his body against mine or sitting very close to me with no gap left between us. He resisted and even panicked when I tried to keep some physical space between us.
He also began to insist that we play same instrument together, and then he mimicked exactly the way I played. In that way, he left no space between us even musically. I began to feel deeply intruded upon and somewhat smothered by the lack of space imposed upon me. Gently and gradually I tried to introduce him other ways of playing—what might have been a new interesting instrument, or playing different instruments, or the same instruments in turns, etc. However, the more I tried to separate (create a space) between myself and Hyun, the harder he tried to adhere himself to me. He became extremely vigilant at any sign of my trying to separate myself either musically or physically, and would prevent me from doing so in advance. When almost every attempt to create even a slight space between us failed, I felt stuck to him, and there was such a deadening quality in it.
Not knowing what was going on in music therapy at that time, Hyun's mother confided in me: "Don't you think he's autistic? He's my boy, but frankly he is very weird. I know I've got to love him, but he doesn't look lovely to me at all. You see, I am a loving person and I love babies and small children. Before I got married, I always enjoyed playing with nephews and nieces in my family. But with Hyun, I've tried hard — I've found myself unable to love him." His mother seemed to have carried enormous guilt of not loving him the way she was supposed to, or would have wanted to. By telling me how she really felt and by watching her child forming what seemed to be the strong attachment to another woman similar to her age (the music therapist), part of her might have felt ambivalent, but also seemed to be relieved. When I was listening to his mother, I felt somewhat guilty and realized Hyun did not look lovely to me anymore.
From infant observation studies, Bick (1968) describes skin contact between the mother and the infant as a crucial aspect in the earliest ego development and relationship. According to Bick, the experience of skin contact enables the infant to internalize the first object (skin), and the sense of the skin acts as containment. Bick explains that in order to internalize the first object, the infant should have a well established sense of internal spaces. If the infant lacked the sense of internal space for some reasons, the process of projection and introjection (i.e., projective identification) cannot be mobilized due to "an absent sense of internal space" (Hinshelwood, 1991). Meltzer and his colleagues (1975) recognize the lack of projection and introjection in children with autism. Deriving from Bick's concept of skin, Meltzer and his colleagues introduce the term adhesive identification, and consider as important feature in children with autism. What they recognize was a pattern of second skin formations through the act of mimicry. They claim that the act of mimicry represented the experience and phantasy of sticking oneself to an object (adhesive identification). What I encountered with Hyun can be described as adhesive identification. I wonder whether I created a kind of musical skin for him that could provide some profound sense of containment, and then he tried to create a physical sense of skin by adhering himself to me.
I began to almost fall asleep during the session. Session after session, however I resisted the sleepiness, I became irresistibly sleepy with him. At first, I did not know what was happening, and I began to feel ashamed of myself for not being able to pay full attention to him. I prepared myself to get as much rest as possible before his session. Even then I became unbearably sleepy. I wondered what was happening to me.
Alvarez (1992, p.5) describes the mechanism of projective identification as "the child's desperate need to do us what he feels was done to him." I felt smothered and squeezed out of my own internal space. I wondered whether he felt the sense of absent space in him that he had to project this sense to me. Therefore this might be his need to communicate something that was so profound at the pre-verbal level where there was no word to describe what was happening. What was projected onto me, I could not bear so I closed my eyes and almost fell asleep on him. I remembered how his mother felt unable to love him and what it felt like to be helpless. Bion (1967) talks about containability of the baby's mother, and that of the therapist, and how the therapist (the mother) enables a thought to become thinkable. Meltzer et al (1974) and Tustin(1990) considers the importance of auxilliary ego or 2nd ego function of the therapist that the therapist needs to act and to think for the child until the child can do it for himself.
Then how can I create the internal space that was absent in the first place? Klein (1935) thought that the introjection of the good objects (good experience) formed the core part of the ego. There was some confusion between self and object (the therapist) in Hyun's case. I considered the early period of music therapy when Hyun showed genuine bursts of happiness in our mutual music making process. Alvarez (1992) also points out that such burst of happiness can be a crucial turning point for the very deprived children. I began to consider Winnicott's concept of maternal pre-occupation and good enough mother allowing her baby a moment of omnipotence (Winnicott, 1990). Winnicott claims that the mother's role is to offer the infant the needed satisfaction at the right moment and place until the baby is ready to leave his omnipotence. I considered the possibility of a different sense of time and timing between myself and Hyun. Was he not ready to be reminded that we were separate beings from each other? Was I too anxious and too eager to separate myself from him without the consideration of his readiness? I wondered whether he truly needed to go through the process of being merged into oneness (or being stuck) with me musically as well as other means, and only in this way could he grow out of, and eventually be able to separate from me, but in his own time.
As I began to work on my counter-transference, I was more able to allow him what he wanted to do in our session, and reacted to what appeared to be pathological behavior of Hyun with less anxiety. I was glad that I was no longer sleepy in my sessions with him. Even though Hyun still maintained his tendency to stick to me musically and physically, the degree, to which he adhered to me began to lessen in time. As I allowed myself to think, feel, wonder and muse more about what it feels like to be playing and being with him—the deadly boredom of ritualization, the helplessness, frustration and intrusiveness - the space between us slowly, but gradually grew. In time I was not only able to be in tune with his state, allowing him his moments of jubilation through musical interaction, but also began to genuinely enjoy the moments of meeting him in our mutual music making process again. Bion (1967) claims that containment at its best can bring the transformation.
When we approached the 8th month in therapy, his mother informed me that she was pregnant with her 2nd baby. She was recommended to get hospitalized due to the complication of her medical condition. There was no one who could bring him to music therapy regularly. His mother genuinely expressed her wish to continue music therapy some time after the birth of the baby. I asked her whether she could arrange for someone in her family to bring him for the following 2 weeks for the ending of the therapy. I was concerned about the possible difficulties about separation. I asked his mother to prepare him by explaining the situation as honestly as possible to him, and to emphasize the possibility of coming back to music therapy some time after the birth of the baby. His mother agreed to this. I had four sessions to address the ending of the therapy and he seemed to have understood.
In our last session, we played the chroma harp together, and then he chose the drum, the cymbals, and the windchime to play with my piano accompaniment. Our last play was at the piano in a joint improvisation. While playing with him, I felt a sense of profound connection to him. Our music was rich in texture and was deeply satisfying. It was hard to describe, but there was something very potent and magical about it.
When the last joint improvisation ended, Hyun did not say a word, but looked quite serious. He began to rub and press my abdomen with his hands. I commented that he was rubbing and pressing my tummy and asked why. He said, "Hyun heard that women have babies—.so trying to find a baby in Sunsangnim's tummy." I asked whether he found one. He did not answer readily but took his time, and then he said; "you are a woman ("yeja" in Korean, which can be translated either a woman, or a female), aren't you?" I told him that I was indeed a woman, and then conversed with him: "I see. Is that the reason why Hyun is looking for a baby in Sunsangnim's tummy? Because Sunsangnim is a woman?" He paused little while, and then told me that he was a man (""namja" in Korean, which can be translated as a man, or a male in English). When I heard him saying that, I understood what he meant. Therefore I told him: "ah, Hyun and Sunsangnim made music together. That's why Hyun was looking for a baby in Sunsangnim's tummy. A music baby."
He listened intently without looking at me. As I talked to him, I saw a hint of smile appearing in his face, and then heard him saying "yes." Hyun's parents probably explained him that they were expecting a baby. And the baby was conceived because they loved each other. Hyun must have felt that he was loved by me, and he loved me in our mutual music making processes. In this case, joint improvisation can be described as an act of love. Therefore he wanted to know (or to confirm) whether I was pregnant. What really mattered in his mind was that he communicated how he felt to me in our music making process that I understood him. When I acknowledged this, he was content and had no further questions.
David Mann points out the two significant metaphors for therapy in British Object Relations School: "(1) the analytic couple is seen in terms of the mother and infant dyad; (2) psychological development between this pair is the analytic child... The analytic couple, therapist and patient, have an analytic baby, the psychological growth of the analysand (and often of the therapist, too). The metaphor is pregnant with meaning... . The use of metaphor is not accidental, but unconsciously determined (Mann, 1997, p.7)."
I was reminded of the famous Greek mythology of Oedipus, and Oedipus complex in Freud's theory on psychosexual development. Mann points out the similarities between the mother's and the therapist's role—both nurturing and erotic functions in the dyadic relationship.
As a Korean female therapist, I used to have great difficulties in dealing with infantile sexuality, and any erotic implication of the small children's play since I was brought up in a society where sexuality was more or less repressed, not to mention female and infantile sexuality. Undergoing my own personal therapy and clinical supervisions with a music therapist, and a psychotherapist helped me in dealing with such aspects of clinical work. I have learned over the years that whatever issues the client brings to the therapy, however difficult that might be to the therapist, therapy is the place where those issues can be recognized, acknowledged and dealt with so that the client can do the same for her/ him.
While preparing this paper, I remembered an episode with my 4 year old nephew during a recent family trip to Xian, China. My 4 year old nephew asked my sister-in-law. "Mum, is Daddy coming to join us tonight?" When my sister-in-law answered that his daddy was too busy at work to come and join us, this little boy blurted out: "Cool, I can have Mum all by myself tonight (without annoying Daddy)!" The whole family laughed and understood that he was at the oedipal stage in his development.
I would like to quote Mann again: "because the erotic is at the heart of unconscious fantasy life it is, therefore, necessarily at the heart of the therapeutic process" (Mann, 1997, p.11).
It was in part, a continuation of his omnipotent fantasy, which was related to the issue of separation and his family circumstances. Frankly I was both delighted and surprised by his fantasy. I was partly glad that the nature of his fantasy was relational—very much in touch with what's going on in his family and also in therapy. This fantasy was evidence that he grew out of adhesive identification where self and object were not separated. Previously he was desperate to vanquish all signs of separateness between us by sticking himself to me both musically and physically. Having such a fantasy meant that at that stage of his development, he developed a sufficient sense of internal space. Therefore what we dealt with on our last day of music therapy was a milestone from where we had been.
Impregnated, I was in his fantasy. I wondered whether this was his way of maintaining the extension of oneness with me by leaving a music baby inside of me. In this way he could leave without a sense of impingement because there was hope to continue. This baby might represent a part of himself wanting to grow inside of me as well. A defence against separation anxiety that was manifested through a fantasy of his—I pondered.
I wondered what kind of baby we were having. Were we having a healthy, promising baby? I thought so.
Hyun came back a year later with his baby sister and his mother. After much consideration, his mother and I decided that it would be best for him to begin a small group therapy rather than continuing with individual therapy. He was expected to enter the mainstream primary school soon and his mother wanted me to help him be prepared for the school. Therefore Hyun had 2 years of group music therapy with two other children (1st year), and then with seven other children (2nd year). When he started the group music therapy, he was very unhappy: he often stood in front of me (blocking everyone else) and asked me why Hyun and Sunsangnim were not meeting alone as before, and why there should be other children in music therapy. Seeing the therapist interacting with another child one-to-one was obviously the most tantalizing and tormenting experience for him. He acted like the jealous lover trying to win back the love he lost. Here I am not implying an adult-like romantic relationship, but rather a full-blown oedipal episode. In some ways, other children in the group represented sibling figures as the therapist often represented the mother figure. Therefore it could be interpreted as sibling rivalry as well. He frequently interfered with me musically, verbally, and physically. During that time, he could not play instruments as well as before. When things were getting desperate, his ultimate solution was to take the therapist for himself by sitting on her lap and fixing her face towards him. In that way he could momentarily possess the therapist all by himself, and perhaps show the world that the therapist was his. His mother informed me that he did not show any sibling rivalry towards his baby sister at home. He watched the baby, but was not very interested in her yet.
Dealing with jealousy, whether the person who is jealous is a child, or an adult, is never easy, but quite a handful. Nevertheless considering the nature of jealousy that is a part of social emotions (Damasio, 1999), I half-heartedly welcomed it as inevitable and more positive than a negative process of the development. He was experiencing more developmentally advanced (mature) emotions. For the child with PDDNOS, this meant something. Of course it was a difficult period. However we, the therapists, have to recognize the fact that he was not indifferent towards his peers, but jealous of them. That meant that he was socially more aware of others and had strong social reactions towards them.
Very gradually he accepted other children's presence after much frustration, disappointment and disillusionment on his part. He seemed to face the fact that the therapist was not exclusively there for him, but for other children as well. He accepted that he had to share the therapist with other children, but he wanted to be the therapist's favorite child. Through playing instruments in group, he began to notice not only what I played, but also what other children played with their own choice of instruments. He began to laugh more while he was playing instruments in group improvisation. In time, he smiled and laughed during other children's playing, and during his musical interaction with them too. His interests towards his peers grew gradually so that when treatment was about to end after two years of group music therapy, he told me who he liked most in his class (a girl's name). He obviously had a crush on her. He was a 2nd grader at a mainstream primary school when we ended music therapy. It was hard for him to fit into schooling. He did not mix well with other children, but he had a very considerate schoolteacher who helped him, and there were a few considerate girls who were willing to help him in his class too. The girl he liked was one of them.
His mother and I formed a trusting working alliance. We communicated very closely about Hyun. Even to date, I am grateful for her enduring trust, respect and also love. When his baby sister was about a year old, he began to get interested in the mother-infant interaction between his mother and his sister. After the birth of this second child who was a typically developing baby, his mother seemed to have gained some confidence in mothering and in her ability to love her own children through caring for her 2nd child. His mother also informed me that Hyun, as a baby, never interacted with her like the way his baby sister did. She realized that he missed out on the very early developmental stages (dyadic and triadic interaction period, approximately 3 months up to 18 months of age). What happened was that Hyun watched intently how his mother and baby sister interacted, and began to act "baby" (sic) at home. His mother took this as a positive sign. His mother told me that Hyun looked lovely to her eyes now: "he is still odd, but I love him." That was the most wonderful news I heard from her.
For my part, I had to face my child/my lover (metaphorically speaking!) in music therapy getting over me and moving on. He found a sweetheart at school that he told me enthusiastically even though it was one-sided. I felt quite proud of him. Probably he will always be different, a bit unusual, and will have his fair share of struggles in this world. But don't we all? I was hopeful that he was learning everyday with his supportive family.
Music has such power to bring people together, and to get to know each other deeply especially when it is improvised in relation to one another (Kim, 1997, 2006a).
In music therapy, we, the therapists, work with the music to reach, establish and develop some kind of human communication and relationship with our clients. Through musical interaction, both the therapist and the client listen, react, and often immerse themselves in music making processes.
This is basically a love story between a child and a therapist within the improvisational music therapy framework. As any love story does, the music we create with our client also has its own drama to unfold in time. Within that drama, both the therapist and the client learn from the experience and grow together.
The literal meaning of sunsangnim is "the one who did it before us." This is a respectable way of addressing a teacher, or professor. In Korean culture, the therapist is also addressed in the same way.
According to Antonio Damasio (1999), there are six primary or universal emotions: happiness, sadness, fear, anger, surprise, or disgust. There are numerous other emotions labeled as secondary, or social emotions: embarrassment, jealousy, guilt, or pride; there are background emotions; well-being, malaise, calm, or tension.
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