The Music in Music Therapy

Psychodynamic Music Therapy in Europe: Clinical, Theoretical and Research Approaches

Jos De De Backer, Julie Sutton

• Publisher: Jessica Kingsley Publishers
• Year: 2014
• Print ISBN: 9781849053532
• eBook ISBN: 9780857007124
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Bringing together a wide range of European thought on music therapy practice, this book provides a deeper insight into the aspects of the therapeutic process which are enabled by music.

With a theoretical, psychodynamic approach and high quality clinical case material from across Europe, the editors stress the role of music within music therapy and show how essential the musician is within the identity of a music therapist.

The first of its kind, this comprehensive text is an invaluable resource for experienced music therapists worldwide, alongside students and trainees.

1

Introduction

The Music in Music Therapy: Writing without a Pen

Jos De Backer and Julie Sutton

When the grammar of music coincides with the grammar of a particular person’s body, cognitive resonance can be felt and apprehended partly because of learned social experience. But when the grammar of music coincides with the ‘musical’ bio-grammar of the human body, in the most general sense, cognitive resonance can be felt and apprehended regardless of specific social experiences.

John Blacking1

Introduction

This book aims to place music, as well as musical processes and ways of thinking that make use of musical material as it is experienced, in a central position in music psychotherapeutic practice. As Blacking noted above, thinking about music is a complex business, because it involves our fullest sense of ourselves in and through time. Throughout the book we have approached authors who have different thoughts and attitudes to psychodynamic music therapy, via a stance that we define generally as musically focused music therapy that attends to both body and mind phenomena.

We have planned this book to be both a resource and a stimulus for European music therapy. We will show how a detailed and in-depth musical thinking is integral to music therapy. We aim to consider not only the musical focus of music therapeutic work, but also the complex musical phenomena and processes that we experience in clinical work. We demonstrate how these musical phenomena extend beyond the notes played, or the musical score; we show that musical phenomena include the psycho-emotional aspects incorporated in bodily sensations, affect and mind – body states. Therefore, all the authors represented in the book have a music-based, music-focused stance to their practice that is integrated within a psychodynamic or psychoanalytic understanding and experience.

In aiming to represent these musical – psychotherapeutic frames of work we looked for practitioners across Europe who have significant experience in a range of clinical settings, including those who have not necessarily published in a primarily English text. In deciding to include work from a number of European countries, we have limited a number of chapters to single authors and thus there will be colleagues whose work we have missed, either due to the richness of practice in their country, or because of the publication timeline for this book.

Within this book the reader will find authors engaged in psychodynamic music therapy and whose work is reflective of practice across Europe. As the editors we have also taken space to present the work from our own countries in order to be able to explore the links and differences in practice as music therapy has developed nationally. This will be seen particularly in the chapters on supervision and continuing professional development. We encourage the reader to make use of this dialogue in reflecting on their own work.

We emphasise that this is not a book exclusively for therapists in Europe. We want to present a clarity of understanding of a European music therapist identity that can inform a music therapist’s practice anywhere in the world. We have also paid attention to the professional future of music therapy in aiming to introduce the theoretical and technical aspects of practice over different clinical settings in a way that will be of direct interest to music therapy students. Perhaps the heart of the book is to look towards our professional future: to speak directly to our music therapy trainees.

The student reader will find a range of clinical settings of relevance to their first steps into the music therapy world alongside a clarity of the individual theoretical stance. Of special interest will be the integration of thinking about musical phenomena and how this relates to the therapeutic stance such as the therapist’s inner space, the anticipating inner silence and the role of transference.

The experienced therapist will discover a range of authors whose names will be familiar, writing on topics that they have expertise in. We have ensured both that familiar material will be re-worked, alongside new material and thinking. Furthermore, new ideas and questions will be incorporated into the text, thus making the book a rich resource for future investigation of our individual practice.

For the reader new to the area, the text will demonstrate a breadth and scope of practice. The book will reveal how music therapy has developed and is continuing to develop across Europe, with concepts and themes central to music therapeutic work. It will also introduce the reader to an evidence base for the profession and describe the range of literature music therapists draw upon.

We now return to the title of this chapter, which is the title of the book itself: the music in music therapy. At the centre of this publication is the music in music therapeutic work. In relation to this, the next section of this chapter describes thinking in relation to music and musical thinking about music psychotherapy, beginning with the concept of psychodynamic music therapy.

Psychodynamic music therapy

Psychodynamic music therapy can be defined as a form of psychotherapy with a focus on a musical, form-giving exchange between therapist and patient, undertaken during musical improvisations or via listening to music. The therapeutic frame of thinking for this exchange is psychodynamic. It is based on psychological theory describing mental structures and processes such as found in the work of Bion (1962), Freud (1925), Klein (1948) and Winnicott (1971). This describes a therapeutic frame that makes use of specific psychoanalytic phenomena and interventions, such as transference, counter-transference, holding, containment, projective identification, free-floating attention and reverie. These are important psychoanalytic concepts that sit beside specific music therapeutic phenomena such as therapeutic provocation, anticipating inner silence, musical reverie and post-resonation (De Backer 2008). All these phenomena are ways of describing how one person may interact with another, and also where interaction changes and becomes relationship.

The therapeutic relationship between patient(s) and therapist(s) is at the centre of this thinking. In music psychotherapy it involves a process that relies on musical improvisation played by the patient and the music therapist. If the patient is not in a position to participate actively in the improvisation, we maintain that the musical improvisation is still present because treatment begins from the affective resonance of the patient. We believe that music takes place at the same level as the trauma experienced by the patient and thus is an ideal modality for treatment in this way. Case studies and clinical experience of such patients provides evidence for the unique usefulness of music therapy for those pathologies in which the patient does not have the ability or motivation that is required for more classical forms of psychotherapy because of strong defences, aphasias, dementia, motor restrictions and so on.

Thus, psychic problems can be addressed in musical improvisation through a form-giving process that moves towards a musical form. By this we mean that psychic problems can be given shape in musical form. This is at a musically symbolic level, where the process of musical improvisation or listening to music occurs in tandem with verbal reflection within a therapeutic relationship. By alternating verbal reflection with musical improvisation and listening, there is the possibility of conscious or unconscious layers of the human psyche tapping the often untapped (i.e. that which is at the frontiers of the psyche).

Musical processing and verbal processing are both alike and different. They both involve layers of awareness that move between what is conscious and preconscious, and from which what is unconscious might become more apparent. However, in not involving words, musical processes are closer in essence to what is not yet able to be spoken about. While this is available during verbal work, it is perhaps closer to what dreams and dreaming bring into the clinic room. In psychoanalytic terms, we think of the term sounded dreams to encapsulate this idea about music. Patients may free associate musically as they improvise, a process by which they and we may hear in sound their inner world – their mind.

To summarise so far, in making use of structural mental models from psychotherapeutic and psychoanalytic literature, we are able to think about the aspect of music that comes closest to traumatic psychic material. Music is the medium close or closest to where the traumatic resides, in the body. This makes music therapy a particularly suitable modality for a number of patients for whom verbal psychotherapy is difficult to access. It is relevant to consider this musical and psychotherapeutic aspect of music therapy in more detail.

The music in music therapy: musical bio-grammar

We know from musical analysis that structures originate in music to which we escape. At the moment one is caught in the music, one is being subjected (in the sense that one begins to sense oneself in relation to a phenomenon outside oneself, yet which is also internally felt). This can be explained as if it is a call that goes out from the music through which the subject can already exist a little in regard to this music. In this way through improvisation the subject comes under the influence of the music and is caught up in it.

We believe this can be noticed first in rhythmic pulsing. Psychotic patients or autistic people present as having no internal pulsing: they play without any metre. While there may be a perception that they play along with or to a beat, their playing does not make sense musically. One may detect minute fluctuations to their ‘beat’ that make it impossible to join in with. The usual musical expectations cannot be fulfilled in this music, because however rhythmic it may be, this music has no form to it, no internal continuity or no reference point to move to or from. In this sense, however tightly organised the music is, one feels it is mechanical and can thus be said to have a quality of timelessness. Time is not alive, because time does not move forward in a way that creates something new. This is music that sounds circular.

However, within the transference the therapist can offer the patient the possibility of coming into a kind of inner pulsing. The concept of inner pulse is difficult to define because pulse entails movement. This is not the rigid movement of a metronome that rocks back and forth, like the musical rocking of an autistic person. Pulsing in the music therapy context is related to a kind of ‘movement in the movement’ (De Backer and Foubert 2011). It is a flexible, varying organic movement, rather like the rhythm of the heart, that is never rigid and always subtly fluctuates. It may change in response to the person’s emotional state, for example becoming faster with increased anxiety states. In the concrete, physical sense, ultimately when pulse loses its variation and degenerates to a rigid beating there is a danger of death. There is evidence of the significance of this in gynaecologists and midwives monitoring the danger of a change from a flexible to a rigid heart rhythm in premature infants.

Pulse in this way occurs on an affective level. It can be thought of as an affective matrix that is embedded in the body itself. It does not indicate anything other than what it is. Rather than being an image or a symbol for something else, it is a type of structure that carries a relational imprint. Therefore the moment at which pulsing occurs in a music therapy session becomes one that is the edge of and basis for symbolising. This is where the music already anticipates something, but it anticipates something that is not yet there. We call this a kind of structure because it has the potential for the patient to join it. It may be termed a proto-structure because of how its presence makes something possible. It may also be thought of as the place at which thinking might emerge from.

These phenomena are not easy to describe in words, because they are non-verbal experiences. They are mirroring experiences, for example as described by Lacan (1955) when he talks of a developmental experience. Mirroring in Lacan’s terms is found in the fact that one does not correspond only to oneself, that there is not one unity, but rather something which is torn apart, and is the basis of each symbolisation. This is the developmental process of movement from a sense of oneness to an identification with something from outside oneself that is both a reflection of oneself and also something separate, sensed at the body level. It is in this way that the ego becomes established as dependent upon others; through a maturational process that involves the acquisition of language, it serves as a template for the growth of the individual’s unique personality via interactions with others.2 A more general notion of mirroring has been taken up by others such as Winnicott, who saw mirroring occurring in the loving gaze of the mother. The gaze of the good-enough moth...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgements
• 1 Introduction: The Music in Music Therapy: Writing without a Pen
• Part 1 The Context For Music Therapy In Europe
• Part 2 Clinical And Research Perspectives
• Part 3 Continuing Professional Development
• Afterword
• Contributors
• Subject Index
• Author Index
• Also available