Case Examples of Guided Imagery and Music [1 ed.] 9781937440350

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Case Examples of Guided Imagery and Music Compiled by Kenneth E. Bruscia

Case Examples of Guided Imagery and Music Copyright © 2012 by Barcelona Publishers All rights reserved. No part of this e-book may be reproduced and/or distributed in any form whatsoever.

E-ISBN: 978-1-937440-35-0 Distributed throughout the world by: Barcelona Publishers 4 White Brook Road Gilsum NH 03448 Tel: 603-357-0236 Fax: 603-357-2073 Website: www.barcelonapublishers.com SAN 298-6299 Cover illustration and design: © 2012 Frank McShane

Dedication

In loving memory of my “Aunt Mit” Dominica Barcelona Scoma

Table of Contents PREFACE Kenneth E. Bruscia INTRODUCTION The Boundaries of Guided Imagery and Music Kenneth E. Bruscia CASE ONE Guided Imagery and Music (GIM) and the Mandala: A Case Study Illustrating an Integration of Music and Art Therapies Helen Lindquist Bonny Joan Kellogg CASE TWO Case Study: Cheryl Helen Lindquist Bonny CASE THREE Embracing Life with AIDS: Psychotherapy through Guided Imagery and Music (GIM) Kenneth E. Bruscia CASE FOUR Emerging Through Music: A Journey toward Wholeness with Guided Imagery and Music Rebecca Buell CASE FIVE Bringing Light into Darkness: Guided Imagery and Music, Bereavement, Loss and Working through Trauma Leslie Bunt CASE SIX Emergence of the Adult Self in Guided Imagery and Music (GIM) Therapy Marilyn Clark CASE SEVEN Healing an Inflamed Body: The Bonny Method of GIM in Treating Rheumatoid Arthritis Denise Grocke CASE EIGHT Experiencing the Music in Guided Imagery and Music

Connie Isenberg-Grzeda CASE NINE Dealing With Physical Illness: Guided Imagery and Music and the Search for Self Ann Newel CASE TEN Chaos, Crisis, Development, Cosmos Mark Nielsen and Torben Moe CASE ELEVEN The Integration of Metaphorical and Logical Thinking Through Guided Imagery and Music: A Case Study Gabriella Giordanella Perilli CASE TWELVE Guided Imagery and Music (GIM) With a Dually Diagnosed Woman Having Multiple Addictions Eugenia Pickett CASE THIRTEEN Guided Imagery and Music (GIM): Healing the Wounded Healer Rhonda Lineburg Rinker CASE FOURTEEN Out of the Ashes: Transforming Despair into Hope with Music and Imagery Cecilia Herzfeld Schulberg CASE FIFTEEN Music Therapy and Depression: Uncovering Resources in Music and Imagery Lisa Summer CASE SIXTEEN Case Examples of Levels of Guided Imagery and Music (GIM) Therapy: The Evolution of a Continuum Lisa Summer CASE SEVENTEEN Tools of Rediscovery: A Year of Guided Imagery and Music “T” and Jenny Martin Caughman CASE EIGHTEEN The Voice from the Cocoon: Song and Imagery in Treating Trauma in Children Susan Bray Wesley

CASE NINETEEN Review of Guided Imagery and Music Sessions: William’s Story William Alison Short

Preface Kenneth E. Bruscia Case examples provide very unique and valuable insights into how different forms of therapy are practiced, as well as how clients respond to those therapies. This ebook describes various ways that a particular method of music therapy—Guided Imagery and Music or GIM—has been used to help various clientele. Its main purpose is to present music therapy students and professionals with a wide array of case examples that when carefully analyzed and compared can provide in-depth insights into how GIM is most effectively used for therapeutic purposes. The Preface and the Introduction provide material that can help the reader compare and analyze the cases from different perspectives and along different dimensions. More specifically, this preface offers suggestions on the various perspectives that can be taken in reading a case study. The premise is that there are various ways to read and interpret a case study, and that when different perspectives are considered, richer insights can be gained. Perhaps the best way to derive the most benefits from a case is to read it from a particular perspective, and to interrogate the case or group of cases from that perspective. Essentially, the reader adopts a particular lens or viewpoint to study the case(s), and then asks questions that arise as a result. Three of the most helpful reading perspectives are: scientific, personal, and clinical perspectives, each of which poses very different questions for the reader to ponder. Reading from a Scientific Perspective Scientists usually look for answers to two basic questions when reading a case. First, is the case credible? That is, how accurate were the perceptions and interpretations of the writer, and how trustworthy are the findings and conclusions presented? Of course, this is not a question that only scientists pose. One’s natural propensity as a reader is to question the truth value of what is read. And certainly if the reader has any experience working with the same problem or condition as the client in the case study, or if the reader practices the same method of therapy, the truth value of the case is of vital interest. That leads to the second scientific question. Can the information learned in this case be applied to other cases? Or even more rigorously, can the findings of this case be generalized to similar or matched cases? Here too, readers who have experience with the same clientele and method are just as interested in this question as scientists. Their interest is in whether they can utilize the techniques or principles exemplified in the case with their own clients and in their own practice. Does the case give the clinician any credible ideas about how to enhance their own work with clients? Scientists can also glean other very important information from case studies. Because they provide rich descriptions of the therapy process, cases usually provide

myriad ideas for what needs to be studied scientifically. By describing what seemed to work and or not work for a particular client, a clinical case reveals to the researcher which clinical protocols and therapeutic outcomes warrant further research, while also suggesting specific hypotheses that might be tested. Moreover, because events unfold naturally in a clinical case as they do in real-life, and because variables cannot be controlled as in laboratory research, the clinical case gives very important information on what specific variables must be considered when doing research, not only the most likely independent and dependent variables that are likely to be related, but also what extraneous variables need to be controlled. Reading from a Personal Perspective By its very nature, case examples invite the reader to identify with one or more characters involved in the case, and then move from identifying with one character to identifying with another. The characters may include the client, the therapist, other clients, loved ones, and so forth. Identifying with people involved in the case not only helps the reader to understand first-hand what each character is experiencing, but also gives the reader an opportunity to compare how the character reacted with how the reader would react. Here are some examples: 1) Identifying with the GIM client: What must the client be thinking or feeling about the therapist, music, and images? If I were the client, would I think or feel the same? What does this client need and want from the guide, and from the music? What moves or surprises me about the client’s images? What do I believe those images might mean for the client? 2) Identifying with the GIM therapist: What must the GIM therapist be thinking or feeling about the client, the client’s images, and the client’s response to the music and the therapist’s guiding? Would I think or feel the same? Would I be able to empathize with this client? What music might I use? The fascinating thing about taking an empathic position is that once one successfully steps into a character’s shoes, and becomes sensitive to who he or she is, an endless number of additional empathic positions arise, and one’s entire personal reaction to the case becomes enlivened. Reading from a Clinical Perspective A clinical perspective is concerned primarily with methodological questions that are most often posed by other practitioners of the method. Clinicians want to know what does and does not work when working with a client. Practically speaking then, they are most interested in the following kinds of questions:

1) Based on this case, what should I be looking for in my GIM clients? What client needs and resources do I need to address more in my own work? How can I assess these facets of the client in GIM? 2) Does this case affect how I think about the indications and contraindications for GIM? Would I modify the method when working with this client? 3) Based on this case, what kind of therapist-client relationship is best for this kind of client, and what is the best way of forming such a relationship? 4) Which orientation is most appropriate when working with this kind of client in GIM, psychodynamic, humanistic, transpersonal, other? 5) What is the role of music in working with this clientele? What are the client’s musical preferences and listening styles? What types of music would be most therapeutically relevant and effective? What kinds or styles of music seem to elicit the most feelings, or evoke the most significant images? 6) How did this client respond to the various GIM programs? What can I learn about using those programs from this case? 7) Based on this case, what are the best ways of responding to the client when he or she is abreacting, resisting, or not progressing? 8) Based on this case, what clinical criteria should be used in evaluating the client’s therapeutic progress? Final Comments All of the case examples in this e-book were taken from books already published by Barcelona Publishers, except for Case 16 by Summer, which was taken from her dissertation and another book in Korean. When taken together, the cases give voice to both GIM therapists and clients, while also showing how GIM is practiced in a variety of settings with various clientele. GIM has been practiced in regular and special education classroom, correctional settings, medical clinics and hospitals, psychiatric hospitals, mental health clinics, addiction centers, religious communities, hospices, and private practice. Clients who have responded favorably to GIM or modifications of GIM include individuals with problems in living or relationship problems, individuals seeking personal growth, individuals diagnosed with personality disorders, addictions, depression, anxiety, and psychosis, individuals with a history of abuse or trauma, individuals with chronic or severe medical conditions, and individuals who are at the end of life.

Case Examples of Guided Imagery and Music

Taken from: Bruscia, K., & Grocke, D. (Eds.) (2002). Guided Imagery and Music (GIM): The Bonny Method and Beyond. Gilsum NH: Barcelona Publishers.

INTRODUCTION The Boundaries of Guided Imagery And Music (GIM) And The Bonny Method Kenneth E. Bruscia Over the last few decades, considerable confusion has arisen over the names and definitions for the various practices inspired by Helen Bonny involving spontaneous imaging to music while in an expanded state of consciousness. At first, every practice that met this description was called “Guided Imagery and Music” or “GIM;” then distinctions began to emerge between the individual form (which had evolved into a more in-depth therapy), and the group form (which was originally developed for nontherapeutic purposes) (Bonny & Savary, 1973). As a result, the individual form was dubbed “GIM,” and all non-therapeutic uses of the group form were dubbed “Music and Imagery.” Meanwhile, therapeutic applications of the group form were being developed in institutional and clinical settings by various music therapists (Summer, 1988). Because these applications were therapeutic, the group form was also dubbed “GIM." At that point, then, “GIM” was being used to refer to both individual and group forms that were therapeutic in intent, irrespective of whether the practice was developed by Bonny herself; while the term “Music and Imagery” remained a catch-all for a myriad of group practices that were not therapeutic. Meanwhile, confusion was also brewing in psychotherapy-related fields. With the explosion of imagery techniques in the late 1970s and 1980s, the term “Guided Imagery” was used pervasively in the literature for any variety of therapeutic practices involving the imagination, some including music and others not-none developed by Bonny, and many not even remotely related to GIM. During these same years and into the 1990s, the applications of “GIM” and “Music and Imagery” continued to grow, and more and more modifications were being made to accommodate the needs of different clientele, and the working styles of diverse practitioners. Then in the mid-1990s, in an apparent attempt to clarify the situation, Bonny added her name to the method, and GIM became the “Bonny Method of GIM” or “BMGIM.” While this created a clearer boundary for differentiating forms of musicimaging that she inspired from unrelated imaging practices in other fields, the name change did not provide a means of differentiating all the adaptations that had been made to her method by this time. The most obvious question that emerged was whether “BMGIM” includes both the individual and group forms that Bonny herself developed. And this question quite naturally led to many more: Should all modifications

and adaptations to Bonny's method be called the “Bonny Method?” If so, then exactly where are the boundaries of the Bonny Method? Exactly what did Bonny develop, and exactly what have others done to advance or expand upon her work? Should Bonny be identified with all the work done in her name, even if it is antithetical to what she intended? Unfortunately, no consensus has been reached on these questions within the GIM community. At present, some practitioners use the Bonny Method as an umbrella term for all practices inspired by Bonny, including both individual and group forms that she herself developed, as well as modifications and adaptations to them. Others use “GIM” as the umbrella term for all practices inspired by Bonny, but then distinguish between those forms developed by Bonny herself (which are most accurately called the “Bonny Method”), and modifications and adaptations developed by her followers. The stance taken in this chapter is the latter one. Specifically, the following terms are used as defined below. · “Guided Imagery and Music” or “GIM” refers to all forms of music-imaging in an expanded state of consciousness, including not only the specific individual and group forms that Bonny developed, but also all variations and modifications in those forms created by her followers. GIM is therefore the umbrella title that subsumes all practices involving imaging to music in an altered state of consciousness, including work done in individual or group settings, for purposes of therapy, healing, self-development, or spiritual growth, whether the images are guided or unguided, whether classical or non-classical music is used, and notwithstanding variations in the form of the session itself. As will be discussed later however, GIM does have boundaries; it does not include a host of related techniques that belong to music therapy. · The “Bonny Method” refers to all of Bonny's original work. Logically, this includes both the individual and group forms that she developed; however, because of the important differences between these forms (e.g., therapy versus growth goals, and dialogue versus no dialogue with guide), some writers (including the present author) reserve the acronym “BMGIM” for only individual work, and then refer to her group form as either “Group GIM” or “Music and Imagery.” Because there is no uniformity in the GIM literature, and because there is no consensus within the GIM community, readers must take note of how each author uses and defines these terms. Perhaps, in a future publication, after there is more consensus on these matters, confusion might be avoided if “I” and “G: were inserted in the acronym to specify the individual or group form respectively. Thus we would use BMIGIM for the individual Bonny form, and BMGGIM for the group Bonny form. · The Bonny Method does not include any adaptations or modifications in the individual or group form as originally developed by her. These variations may be referred to as “Modified BMGIM" or more generically as “GIM.” In short: “GIM” is all forms of music imaging within an expanded state of consciousness; the “Bonny Method” refers to all of Bonny's work; “BMGIM” is Bonny's individual form; and “Group GIM” or “Music and Imagery” refer to Bonny's group form.

As will become evident, a wide array of techniques and practices can be subsumed under the generic category called GIM—some clearly falling within the boundaries of the Bonny Method, and others going outside them. In addition, there are a host of music therapy techniques that involve music, relaxation, and/or imagery that developed quite independently from the work of Bonny and her followers, and clearly fall outside the boundaries of GIM and the Bonny Method. All of these techniques and practices vary considerably in goal, technique, orientation, and process; yet, they are often confused with one another, causing lack of conceptual clarity in the work itself, as well as misunderstandings about the competence requirements for practitioners. This in turn raises serious issues about the ethics of safe practice in GIM. Who is competent to do what kinds of work, and what kinds of training are necessary to practice the various techniques combining music, expanded states of consciousness, and imagery? The purpose of this chapter, then, is to establish boundaries for what is GIM and what is not, and within that generic category, what is Bonny's Method and what is not. In doing this, distinctions will also be made between the various adaptations to GIM and the Bonny Method when compared to related music therapy techniques. Hopefully, these boundaries and distinctions will ensure the integrity of Bonny's Method, preventing unworthy identifications with it, while also freeing her proponents to develop their own concepts and styles of working. Such clarification may also help to define competency requirements for ethical practice of all forms of GIM. To identify these boundaries, several questions must be answered: 1) Does Bonny's work have the theoretical, empirical, and procedural integrity needed to qualify as a method in its own right? 2) What is Bonny's work a method of? Is it a form of music therapy, psychotherapy, pastoral counseling, spiritual direction, or education? 3) What features define the Bonny Method as originally conceived? 4) What variables have been manipulated to vary, adapt, or expand upon the Bonny Method? 5) How do the various forms of GIM compare to music therapy techniques? Did Bonny Create A Method? In surveying any field, a fundamental question that eventually arises is: what constitutes a distinct method of practice? For without an answer to that question, the various methods within a field cannot be accurately identified, defined, and differentiated, which in turn renders them useless in guiding practice. If all the methods are essentially the same, then one way of practicing is essentially no better or more appropriate than another, and variations in method are serendipitous rather than purposeful. So it is important to ask: Does Bonny's work constitute a method in its own right? Does it have the distinct-ness and clarity needed to guide practice in a consistent way? A method can be defined as a complete system of practice, consisting of: theoretical principles, goals, indications and contraindications, methodological procedures and techniques, guidelines for relationships within the practice, expectations for the process of development, and competency or training requirements (Bruscia, 1987). Developing such a complete system requires that: 1) the originator has

worked with the method in an in-depth and focused way for a sufficient length of time, and that 2) based upon this prolonged experimentation, the originator has identified a set of principles, methods, and techniques that fit together coherently (Bruscia, 1987). When considered in terms of these criteria, Bonny's work certainly qualifies as a method. For over three decades, Bonny devoted her attention to the development of two forms, one for work in an individual setting, and the other for group work. In the process, she discovered indications and contraindications, created all the musical materials required (i.e., discographies, recorded music programs), and developed very specific techniques for implementing each method. Bonny also applied principles from humanistic and transpersonal theories to define the goals and processes of her individual and group forms, and the nature of the client-therapist relationship. Thus, without reservation, GIM as originally developed by Bonny is truly a method of practice. Going one step further, because methods are defined by their uniqueness and originality, it is important to look at what is unique and original about Bonny's method. While Bonny was certainly not the first to use music for changing consciousness or for evoking imagery, she was the first to devise a procedure that put both of these processes together. That is, based on her work with music in LSD therapy (Bonny & Pahnke, 1972), Bonny discovered that helping a person enter into an expanded state of consciousness before listening to the music greatly enhanced the person's responsiveness to the music, and in doing so, also gave the person greater access to his/her imaginal world. What she also discovered was that as a person listens to the music for an extended period, his/her consciousness continues to deepen, shift, and expand as a result (Bonny, 1999). Thus, one can certainly say that Bonny's strategy for working simultaneously with consciousness, music, and imagery is uniquely and originally her own, and thus defines her method. Another important innovation by Bonny was her use of specifically designed classical music programs to guide the person's imagery experience. No other form of imagery work, within music therapy or related fields, has relied upon a library of music programs, pre-designed with general purposes and applications in mind. (While the programs are used primarily in Bonny's individual form, they also form the basis for selecting and sequencing music for her group form, where there is less need for an entire program because of the shorter music listening period). Finally, Bonny's discovery of how to verbally interact with a person while in an expanded state of consciousness is also unique and original. What Bonny found out after years of experience working in LSD therapy and her own method is that when guiding an individual, there are some verbal interventions that facilitate the experience, and there are some that are intrusive and disturbing. The most effective interventions are: 1) nondirective (the guide allows the imager to direct and control his/her own experience), 2) non-analytical (the guide refrains from asking questions that would lead the imager into intellectualizing about the ongoing experience), and 3) music-based (the guide contextualizes all interventions according to what is happening in the music) (Bonny, 1978). Interestingly, these guiding approaches are very consistent with her humanistic orientation to therapy, and her basic premises about the process, thus bringing considerable coherence to the method (Bonny, 1999).

What Kind Of Method Is It? Because Bonny was employed as a music therapist when she originated her method, and because most of her early publications appeared in the music therapy literature, one might likely assume that the Bonny Method quite naturally belongs within the discipline of music therapy; yet, a cursory look at the Journal of the Association for Music and Imagery quickly reveals that GIM (generically defined) is practiced within a variety of other treatment modalities, including psychotherapy, counseling, psychiatry, medicine, healing traditions, nursing, spiritual direction, and education, to achieve quite varied goals. Moreover, practitioners have quite varied educational backgrounds and areas of expertise. As a result of this diversity, GIM is conceived in a variety of ways. Some see GIM as rooted in the field of music therapy, some see it as a method of verbal psychotherapy or counseling that uses music and imagery; some see the music as the healing and transformative agent; some see music as supportive of the healing and transformation that takes place within other aspects of the work (e.g., imagery, relationship, etc.). To understand where GIM fits, it is first necessary to see how it relates and overlaps with music therapy. Music therapy is the use of music experiences (e.g., improvising, listening, composing, performing), within the context of an interpersonal relationship, for purposes of therapy, healing, and self-actualization (Bruscia, 1998a). Thus, to the extent that GIM uses music listening, within an interpersonal context for the same purposes, it can be seen as a form of music therapy. Another fundamental similarity between GIM and music therapy is that their boundaries are both defined by the method that they use (i.e., music) rather than by the outcomes they induce (e.g., insight, healing, behavior change). Music therapy does not become another discipline merely because it leads to outcomes that are psychotherapeutic, or spiritual, or medical rather than musical. Music therapy is defined by the use of music as its core method-not by its goal, not by the context or setting in which the method is applied, and not by the expertise of the practitioner. In this regard, music therapy and GIM are similar to art, dance, drama, and poetry therapies. All of these modalities are defined solely by the fact that they use an art form as the method for producing any variety of outcomes. As such, GIM and the arts therapies are defined quite differently from psychotherapy, medicine, education, spiritual direction-all of which are defined by the nature of the outcome, rather than the specific method used. For example, psychotherapy is defined by the psychological nature of its outcomes, rather than by the methods used to achieve that outcome. Similarly, medicine, education, and spiritual direction are defined by the specificity of their outcomes rather than the diversity of methods that may be used to achieve the outcomes. The implications for GIM are clear: GIM does not become a form of medicine when the goal is medical, nor does it become a method of nursing when it brings comfort to a hospitalized patient; moreover, GIM does not become a form of counseling simply because it has been used by someone trained in counseling, nor does it become psychotherapy or counseling simply because verbal discussion is used in tandem with

the music listening. GIM, like the other arts therapies, is defined by the fact that music is used as the chief method. But then, how does one explain why, in the literature, GIM is conceived as method of psychotherapy, healing, spiritual direction and so forth, rather than as a form of music therapy. What determines whether GIM is being practiced as a form of music therapy or as part of another modality? The shortest and most direct answer to this question is: it all depends upon how the music is used. Presently, there are myriad ways that music is conceived and used in GIM, some relying more on the actual music experience than others. How music is used may vary from one session to another, one client or population to another, and one practitioner to another. Sometimes the work focuses and relies entirely on the music experience, and sometimes it focuses and relies more on other elements of the work. More specifically, sometimes the session, client, or practitioner focus and rely upon the music listening as the core experience in GIM, and sometimes the session, client, or practitioner focus and rely upon the imagery, the expanded state of consciousness, the verbal discourse, body work, or work done in other art modalities. Similarly, sometimes the actual change or transformation is causally linked to the music, and sometimes it is not. All of these variations in how music is used have significant implications for whether GIM belongs to the discipline of music therapy or another treatment modality. When considering music as a central variable in practice, GIM can be seen along a continuum, ranging from music therapy on one end, to other modalities on the other. On the music therapy end of the continuum, music is used as therapy or as the transformational agent; on the other end of the continuum, music is used in therapy, or as one of many agents of transformation. (Bruscia, 1987). With specific reference to GIM, when the work consistently relies primarily on the music listening experience as the main agent of therapy or transformation-regardless of the nature of the desired change-it clearly falls within the boundaries of music therapy; however, when the GIM work relies variously on the imagery, the verbal discussion, relationship, the expanded state, the music, or other arts, it falls within the boundaries of other treatment modalities, depending on whether the desired change is emotional, spiritual, medical, and so forth. Let us know look at how these two ends of the continuum are manifested in the actual work itself. Music as Transformation: GIM is Music Therapy When music is consistently used in GIM as the transformative agent, the client's change process is evoked, worked through, and completed through the music listening experience, with very little reliance on other modalities (verbal discourse, art work, movement, etc.) to shape the change process. This complete and focused experiencing of the music is commonly observed in GIM sessions when the imager opens up to the music and enters into the transformational processes unfolding in the music itself (Bunt, 2000) When this happens, the imager steps into the structures and processes unfolding in the music from moment to moment, and begins to live within them, generating

images and inner experiences that arise directly out of the music. And by living in these musical structures and processes as they continually transform themselves, the experiencer and the experience are similarly transformed. The entire phenomenon is intrinsically musical in nature, and similarly ineffable; and this seems to hold true, even when the imager tries to describe the experience verbally, using nonmusical referents (e.g, images of an animal, person, situation, etc.). In fact, often the nonmusical images and the verbal reports of them seem like mere artifacts of an essentially musical experience. Bush (1995) shared one of her own personal experiences as a traveler that provides a perfect example of music as transformation. During the experience, her guide suggested that she let the music take her. This is how Bush described what happened: I shifted positions and refocused my attention on the implicit feeling in the music. As I did the sounds began to take on substance, totally absorbing me in their melodic flow. I began breathing in sync with the rhythms, entering what felt like hyperspace in the intervals between the sounds. My body forgotten, I became living harmony. All parts of my consciousness were in attunement with the music. I was being played. I had become a musical force field. Time and space were nonexistent. The music and I were one (pp. 8-9). It is important to realize that these transformational music experiences may arise spontaneously, initiated by the client, or they may be evoked purposely by the guide; they may also be an entire approach to GIM work, or an occasional happening. Much depends on how the guide conceptualizes GIM, and how it works. Nevertheless, when GIM is consistently practiced, conceptualized, or experienced in this way, it clearly falls within the boundary of pure music therapy. Music In Transformation: GIM Is Adjunct To Another Modality On the opposite pole of the continuum is when music is used to facilitate transformations taking place in other media. This occurs in GIM when the client's change process is evoked, worked through, and completed in the imagery experience, the body work, the art work, or the verbal discourse, all with the help of music as the background stimulus. Here the focus is not on experiencing the music as an intrinsically transformational experience in itself, instead, the focus is on generating nonmusical images and experiences with the help of the music. Practitioners here regard GIM as the use of music-evoked imagery, rather than the use of music per se, and consequently tend to guide, explore, and discuss the meaning of the imagery rather than the transformations experienced in the music. Here verbal segments of the GIM session take on more importance than the music-listening segment, and the insights gained are more verbal than ineffable (musical). This approach to GIM moves away from music therapy and into another treatment modality, as defined by the goals or desired outcomes established for or with the imager.

In summarizing the above continuum, practitioners who typically “guide to the music” and who rely upon the music as the primary transformation agent are using GIM as a form of music therapy. In contrast, those who guide, explore, and discuss the imagery and experiences that arise out of the music are using GIM as a form of psychotherapy, counseling, medicine, body-work, and so forth, depending upon the purpose or outcome. In short, when GIM is method-centered, that is, when music is relied upon as the chief agent of transformation, it belongs to the discipline of music therapy; when it is outcome centered, that is when music is used to facilitate transformations in other modalities, it belongs to another discipline, depending on the nature of the outcome. What Defines The Bonny Method? Bonny developed two forms of GIM, which for purpose of this book have been given two names. The individual form is called the “Bonny Method of Guided Imagery and Music” (BMGIM), and the group form is called “Group GIM.” Individual Form Based on a synthesis of Bonny's writings (2002), BMGIM may be defined as: 1) an individual form 2) of exploring consciousness (e.g., in healing, psychotherapy, selfdevelopment, spiritual work), 3) which involves spontaneous imaging 4) in an expanded state of consciousness 5) to pre-designed (taped) programs of classical music, 6) while interacting with a guide, 7) who uses nondirective, non-analytical, music-based interventions, 8) within a client-centered orientation, 9) all within a session that has the following components: preliminary conversation relaxation/induction, guided musicimaging experience, return, and postlude discussion. These nine characteristics define the method, and all must be present to be considered the pure form of BMGIM, as originally developed by Bonny. Thus, if any of these characteristics are missing or significantly different from what has been described above, the method should not be regarded or labeled as BMGIM; rather it should be considered: an adaptation of Bonny's method which, depending upon how many of the above defining features have been modified, may fall under the generic category of “GIM” or qualify as a different method altogether. Group Form Based on a synthesis of Bonny's writings (2002), the Group GIM may be defined as: 1) a form of working with individuals in a group setting, 2) for purposes of exploring consciousness (e.g., in education, training, self-development or spiritual work), in which 3) each member images spontaneously, 4) while in an expanded state of consciousness 5) to one or more pieces of music (any style), 6) without ongoing direction or dialogue with the leader, 7) working in a client-centered orientation, 8) within a session form that includes: a preliminary conversation, relaxation/induction, music-imaging experience,

and postlude discussion. Here again, if any of these defining features are modified in any way, the practice must be considered an adaptation of the Bonny Method, that falls either within the boundary of GIM or outside of it. What Variables of the Bonny Method Have Been Modified? The variables used to define the Bonny forms of GIM can be modified in myriad ways to accommodate the client, the situation, the goal, or the practitioner. The discussion that follows explores these modifications and attempts to place them in relation to the boundaries for GIM and the Bonny Method. Goals In comparing the individual and group forms, there seem to be no difference in goal. Both are aimed at exploring and expanding consciousness. Yet, Bonny's writings, and the history of her work, suggest that she did very different kinds of consciousness work in individual versus group settings. Originally, she presented individual GIM as a form of music psychotherapy (Bonny 1976), and throughout her later writings (Bonny, 1999) and case studies (Bonny, 2002), she continually referred to her own individual work with clients as psychotherapeutic in nature. In contrast, the group form, which received much less attention in her professional writings, was originally presented as a way of working with Music and Imagery" to pursue non-therapeutic goals, such as education, training, personal growth, spirituality, and so forth (Bonny & Savary, 1973). Bonny (1994) explains: With the discovery of the dyad as the primary and most effective mode of exploration into the deeper unconscious, the descriptions given of the technique in Music and Your Mind looked peripheral by comparison. They were part of the exploratory process and, as such, had value in certain situations (p. 72). Notable examples of extending Bonny's group form into therapeutic arenas include the work of Summer (1988) who described clinical applications of Group GIM in various institutional settings, and who also developed Group Music and Imagery Therapy (see chapter in this book). Short (1992) also differentiated between ongoing therapeutic groups using music and imagery with a clinical population and Bonny's approach to groups. Bonny's long-standing commitment to humanistic psychology is undoubtedly a factor that confounds whether her goals for the individual and group form were therapeutic. In the humanistic orientation, health is emphasized over pathology, and the primary goal of all work, whether called therapy or not, is self-actualization (Bonny, 1999). Consequently, even when Bonny worked with individuals within a clear psychotherapeutic framework, the goals were characteristically holistic, growthoriented, and transpersonal rather than pathology-driven and purely psychological (Bonny, 1999). Thus, while she followed this orientation in both individual and group forms of GIM, her goals certainly varied, and the nature of her relationship with clients varied as well.

When the previous criteria for a method are applied—that the originator must have worked with the practice in an in-depth and focused way for a sufficient length of time, and as a result identified a set of principles, methods, and techniques that fit together coherently—a clear boundary can be identified. Bonny did not work extensively with nor did she develop methodological principles for using the individual form for non-therapeutic purposes; likewise, she did not work extensively with nor did she develop sufficient methodological principles for using the group form for therapeutic purposes. Thus, technically speaking, though Bonny advocated the use of both forms for both therapeutic and non-therapeutic purposes, her own work included only therapeutic uses of the individual form, and non-therapeutic uses of the group form. All other uses or adaptations of GIM, though inspired by her, were not fully developed by her, and thus fall outside the boundary of the Bonny Method. State of Consciousness An expanded state of consciousness is an integral part of all forms of GIM work (Bonny, 2002). Entering into such states helps the traveler to open up more fully to the music listening experience, which in turn leads to further exploration of expanded states. Thus, GIM uses expanded states of consciousness as a means to an end, and also fosters the exploration of these states as an end in itself. One might even say that the entire GIM session serves as an induction into expanded consciousness work. Two boundaries must be drawn in reference to states of consciousness. The first is that only those music listening experiences that occur within an expanded state of consciousness fall within the boundaries of GIM. All other kinds of listening experiences do not. Thus, whenever the guide makes efforts to prevent, contain, or limit an expansion of consciousness before or during the music listening, the practice falls outside the GIM boundary. Two examples are projective listening and relaxation listening. Projective Listening. In this music therapy technique, the therapist presents music to clients who are in an upright position or ordinary state of consciousness, and then asks the client to react to it imaginatively. This includes free association to music, projective story-telling or dramatizing to music, projective drawing or moving to music, and so forth (Bruscia, 1998a). Thus, GIM is different from projective listening in that, in GIM, the therapist encourages the client to enter an expanded state of consciousness, whereas in projective listening, the therapist works to maintain ordinary levels of consciousness or limit the amount of expansion. Relaxation Listening. The second boundary is that the purpose of GIM is to explore consciousness, it is not to reach and maintain a state of relaxation. In GIM, the guide helps the client to enter a relaxed state so that it is easier to explore deeper states of consciousness with the help of the music. The aim of GIM is certainly not to hold the client in a relaxed state without any further exploration of that level of consciousness. Music therapists often use music listening to help clients enter and maintain a relaxed state. These relaxation listening experiences are quite different in goal and outcome than GIM, though they typically involve the same elements of music, imagery,

and relaxation. In relaxation listening, the music therapist narrates a relaxation induction (often employing images), using supportive music in the background. For example, the therapist may present a “ball of light” induction, wherein the client imagines the ball moving systematically through each part of the body, bringing warmth and relaxation, all while a very quiet music selection is heard in the background. In these experiences, the client is encouraged to follow the image presented by the therapist, rather than to allow additional personal images to arise. Most often, the background music is New Age" in style because it has the repetition needed to support the repeated verbal suggestions in the induction, and because it is less likely to evoke additional imagery than classical music (Bonny, 1994). Note that in relaxation listening, the image and music are used to induce and maintain an extended period of relaxation. In contrast, in GIM, the traveler undergoes a relaxation induction such as the “ball of light” before the music begins, in order to facilitate free imaging to the music. At this point, the image and music help the client to move beyond the “relaxed” feeling to a fuller exploration of more expanded states of consciousness, as they shift in depth and breadth from moment to moment. Thus, relaxation listening is a music therapy technique that is significantly different from GIM in goal and procedure, and therefore falls outside of its boundaries. To summarize distinctions made with regard to states of consciousness: neither GIM, the generic method, nor the Bonny Method in particular, includes projective listening and relaxation listening techniques employed in music therapy. While projective listening engages the client's imaginative responses to music, it does not involve an expanded state of consciousness. Thus, though similar to GIM, projective listening is not a part of GIM or the Bonny method. While relaxation listening directs the client's imagination to use specific images to enter and maintain a relaxed state, it does not involve free exploration of the client's consciousness through spontaneous personal imagery and music listening. Thus, though similar to GIM in its components, relaxation listening is not part of GIM nor the Bonny method. Spontaneous Imaging Both the individual and group forms of the Bonny Method involve free, spontaneous imaging. The traveler allows his or her imagination to unfold freely and extemporaneously, exploring whatever experiences emerge each moment in response to the music. The only direction the guide may give to the traveler is to suggest a starting image as the music begins, but even then, the traveler is free to follow or abandon this image at any time. Of course, there are also instances when a traveler may not be ready for such spontaneity in the imagination, when the goal of the imaging is somewhat different. The following types of imaging are examples. Contained Spontaneous Imaging. In this approach to imaging, the guide presents an image (e.g., a house), invites the traveler to explore one part of the image (the front door) for a few moments, then moves the traveler progressively along in the same image (into living room, dining room, etc.), so that the traveler images freely

within a contained matrix, as presented throughout the imagery experience by the guide. This contained spontaneous approach may be used in individual or group sessions. It is particularly helpful with healthy travelers who need preparation or practice before imaging completely spontaneously, or with psychiatric patients whose fragility necessitates a more structured approach to listening to music in a relaxed state (Moe, Roesen, & Raben, 2000). It is also highly recommended for travelers who have been traumatized and who need to contain the amount of unconscious material released at one time and thereby limit any accompanying cathartic reactions (Blake, 1994: Blake & Bishop, 1994). While this type of contained imaging is not indigenous to the Bonny Method, in either the individual or group forms, it is an approach to imaging that requires the specific guiding skills of a GIM practitioner. Thus, though it is not an approach specifically developed by Bonny as part of her method, this modification, by merit of the nature of the guiding skills required, does belong within the boundaries of generic GIM practice. Directed Music Imaging. In contrast to spontaneous and contained spontaneous imaging, music therapists use a highly directed form of imaging, which falls outside the boundaries of GIM and the Bonny Method. The purpose of directed music imaging is to take the traveler step-by-step through an imagery experience that activates, reproduces, or rehearses a desired process or outcome, such as pain management (Rider, 1987; Steinke, 1991), enhancement of immune responses (Tsao, Gordon, Maranto, Lerman & Murasko, 1991), stress or anxiety reduction (Hammer, 1996), and healing of disease processes (Rider, 1987). Here, the image reenacts a sequence of physical or psychological events that are deemed to be therapeutic for the traveler. Given the close relationship between the image and therapeutic outcome, it is important for the traveler to experience the image as directed, without any further expansion or development of the image. Thus, the guide directs the traveler in a very detailed way, specifying all aspects of the imagery experience from beginning to end, while managing the attention and consciousness of the traveler carefully to intensify his or her concentration on the image and its desired outcome. Notice that the aim of directed imaging is outcome-specific; it is not free exploration of outcomes that may arise in the traveler's imagination or consciousness. Reimaging. Yet another approach is called reimaging (Bruscia, 1998b). In reimaging, one person has a short BMGIM session focused on exploring a previous imagery experience of another person. The technique is used in individual, couple, and group settings, for clinical or supervisory purposes. The sessions are guided in individual and couple settings, but unguided in group settings. ·

Group Re-Imaging (Unguided). After an induction, all members of the group enter into a previous image of one person, and participate in or observe what happens from his or her own perspective. The group images to a short excerpt of the same music heard by the person when creating the image originally. Usually the music is no more than five minutes in length. Each member images

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independently and silently, without dialoguing with other members or the guide. The guide assists the group in entering and leaving the person's imagery or dream, but does not dialogue with the group during the actual reimaging experience. The aim is to help one member benefit from the imaginal resources of the entire group. By all experiencing the same image from their own perspective, the group can gain new insights, or find new solutions or options to a particular problem that a member is confronting within his or her imagery. Couple Reimaging (Guided): After an induction, one partner in a relationship enters into a previous image of the other, and participates in or observes what happens from his or her own perspective. The person images to a short excerpt of the same music originally heard by the other partner. The guide maintains a dialogue with the traveler throughout the entire experience, using standard guiding techniques in BMGIM. Both partners may be present, or each partner may work alone with the guide. The aim is to help partners empathize more fully with one another, while also sharing one another's insights and problem-solving resources. Supervisory Reimaging (Guided). After an induction, a trainee or practitioner enters into a previous image of a client who is being brought to supervision. The supervisee participates in or observes what happened in the client's image from his or her own perspective, while listening to a short excerpt of the same music heard by the client. The supervisor guides the supervisee throughout the entire reimaging experience, using standard BMGIM guiding techniques. The aims may be to: help the supervisee empathize more fully with the client; gain insights into the client's problems and possible solutions; bring into consciousness the supervisee's unconscious reactions to the client; and to explore options for working with the client more effectively. Two examples can be found in Bruscia (1998b).

Reimaging is a somewhat “contained” form of imaging, in that the experience of the other person provides a container for exploring his or her imaginal world. As such, like contained imaging, all forms of reimaging fall within the generic category of GIM, but go beyond the Bonny Method. To summarize the three forms of imaging: Free spontaneous imaging is a defining feature of GIM as originally developed by Bonny; contained spontaneous imaging and reimaging are modified forms of GIM but are not within the boundaries of the Bonny Method; and directed music imaging is beyond the boundaries of both GIM and the Bonny Method, belonging to the discipline of music therapy. Thus, as the traveler moves from free exploration of consciousness to directed consciousness, the practice moves further away from Bonny's GIM. Dialoguing with Guide in Individual Work The individual form of Bonny's Method always involves a dialogue between traveler and guide during the entire music-imaging experience. In the dialogue, the

traveler reports his or her ongoing experiences, and the guide responds non-directively and supportively. Thus, a defining feature of Bonny's individual form is an ongoing, nondirective dialogue between guide and therapist during the music listening. This creates a clear boundary for the individual form: Whenever there is no dialogue or whenever the dialogue is consistently directive, the practice should be considered a modified form of GIM or beyond its boundaries altogether, and in both cases, beyond the Bonny method. While this may seem unnecessary to point out, such clarification calls into question many practices assumed to be part of GIM or the Bonny Method that are actually beyond one or the other. Three practices provide good examples. First, Marr (1998-99) and Clark (1999) both describe the use of short individual GIM sessions that are unguided. These types of sessions are clearly forms of GIM, but are nevertheless, modifications of the Bonny Method. A second example is directed music imaging (when the guide directs the traveler through a specific imagery sequence), which as established earlier, is beyond the boundaries of both GIM and the Bonny Method. The third example arises when directive interventions are used by the guide in response to spontaneous images being created by the traveler. Most often, such interventions are borrowed from another treatment method or orientation (e.g., Gestalt, cognitive, somatic, or energetic therapies). Invariably, the intervention is aimed at achieving a particular therapeutic outcome that is not occurring spontaneously in the traveler's imagery. For example, the guide may try to get the traveler to bring an empty chair into the scene for dialogue purposes (Gestalt), or the guide may ask the traveler to “reframe” a particular image (cognitive), or the guide may apply specific pressure points in the traveler's body in order to elicit a certain reaction. In all these examples, the practice falls within the boundaries of GIM, but certainly not the Bonny Method. Throughout her writings, Bonny (2002) has consistently advocated that a nondirective stance be taken by the guide or therapist when dialoguing with the traveler during the music listening portion of the session, and that the entire session be approached within the humanistic or transpersonal traditions. Thus, whenever techniques are borrowed from other methods and orientations and introduced into a GIM session, two boundaries become necessary. • When the guide approaches the work to be done in the prelude or postlude outside of the humanistic or transpersonal orientations, but maintains a nondirective approach when guiding the music experience, the work falls under the generic category of GIM, but remains outside the boundary of the Bonny Method. Thus, for example, when discussions before or after the music imaging are psychodynamic or cognitive in focus, or when Gestalt exercises are used (e.g., empty chair), the session should be considered a form of GIM that is beyond the Bonny Method. Though GIM certainly lends itself to such adaptations, and though these are certainly fruitful approaches to GIM therapy, they were not developed by Bonny. • When the guide intervenes in a consistently directive way in the traveler's imagery, or when the guide dialogues with the traveler within a particular

orientation (e.g., psychodynamic, cognitive, behavioral), the work falls within the boundaries of GIM but outside the boundaries of the Bonny Method. The Bonny Method is defined by a nondirective, humanistic approach to guiding. Dialoguing in Couple and Group Work In contrast to individual work, Bonny's Group GIM does not involve a dialogue between each traveler and the guide. Instead, each traveler images without verbally reporting the images as they occur, and without verbal interventions by the guide. An exception is the dialogue among group members that was reported in Music and Your Mind (Bonny & Savary, 1973, p. 109), but never further developed in any of Bonny's writings. In the “Group Fantasy,” one group member begins to create an image, and when ready signals the next person to carry forward the image, who then signals the next person to continue, and so on until everyone in the group has contributed. Unfortunately, for some unknown reason, Bonny did not further develop or write about this form of group imaging, and therefore did not make it an integral part of her group form. Many advancements have been made in the kinds of dialogues conducted in music-imaging sessions involving more than one person. In the early 1990's, the present writer began to study and experiment with how to guide several travelers as they spontaneously co-image to music together. As a result, the writer identified and worked with several, specific types of co-imaging, and began presenting these techniques in his training manual (Bruscia, 1992). The various types were defined according to whether the imaging is done by couples or groups, how the imaginal interactions are sequenced, and the extent to which the guide is involved. Progressive Group Imaging: Each member takes a turn contributing to an evolving image or story. When one member finishes, he or she signals the next member to continue; members do not respond to one another image's out of turn. Other than preparing the group to begin, and perhaps providing a starting image, the guide's involvement is minimal. Thus, progressive group imaging is mostly unguided. As mentioned above, this type was used by Bonny, and termed a “group fantasy.” Group Go-Rounds On Individual: Each member of the group takes turns imaging something about one person in the group; the person in focus may or may not react or respond to each group member's images. Group members usually follow a predetermined sequence, and do not participate out of turn. The guide always assists the group in entering and leaving the imagery experience, but during the actual imaging, may or may not enter into the dialogues between each dyad. Thus group go-rounds may be guided or unguided. Eventually, each member becomes the imagery focus of the group. An example is provided by Shorr (1986) who instructed a particular group as follows: “Imagine standing on Steve's shoulders. How would it feel and what do you imagine will happen?” (p. 173). Individual Go-Rounds On Group: This is the reverse of group go-rounds. Here one person is the main imager, who goes around imaging something about each member of the group. Each group member may or may not respond to the person

imaging, but never out of turn. The guide always assists the group in entering and leaving the imagery experience, but during the actual imaging may or may not enter into the dialogue between each dyad. Thus, individual go-rounds may be guided or unguided. Shorr (1986) gives an example of asking a person to imagine being an animal, and then going around to each member of the group, one by one, and entering into a dialogue with each. Group Reimaging (Guided). After describing in detail a particularly significant image or dream with the group, a person selects members of the group to enter into the image or dream as participants or observers. The guide assists the person and coimagers in entering and leaving the reimaging, and then plays an active but nondirective role in guiding the actual experience, using all the techniques belonging to individual BMGIM. The imagers dialogue with one another during the experience, and with the help of the guide, explore their own perspectives as well as unrealized options that the person may have within the image or dream. As the image or dream is continually reworked, new perspectives and action sequences are developed in the group interaction. Thus, ultimately, the image or dream is transformed. Couple Co-Imaging (Guided). Two partners in any kind of relationship have a joint GIM session, entering an expanded state, and then cocreating imagery to music while dialoguing with a guide. Merritt and Schulberg (1995) reported on such an approach in working through collective grief over the Holocaust. The partners were an American Jewish woman whose mother had been imprisoned in Auschwitz, and a German woman whose father had driven equipment into the camp as a soldier. The guide gave an induction and presented a starting image of looking into the stones the two women had picked up from the ground when they had visited Dachau together. The partners then explored the stone image from their own cultural and personal perspectives, dialoguing with one another and the guide. Group Co-Imaging (Guided). All members of the group spontaneously co-create the imagery experience while dialoguing with one another and the guide. The guide assists the group in entering and leaving the experience, and then plays an active but nondirective role in the dialogue, using all the techniques belonging to individual BMGIM. Two subtly different approaches have been taken, but very little has been written about either. In the present author's approach (Bruscia, 1992), the guide provides a starting image for the entire group, places each member in the imagery scene, and then invites them to begin interacting within the image. The guide holds the group within the imaginal space that continually evolves, using all of the nondirective guiding techniques of BMGIM. The second approach, as reported by Merritt and Schulberg (1995), was developed by Carol Bush and Sara Jane Stokes. In it, the guide provides a starting image, and invites members of the group to each go on their own separate journey, “relating aloud their experiences with the music as they feel moved to speak. The GIM facilitator guides the experience when direction or reinforcement seems appropriate. What begins as a separate journey ends in a joining together of each separate journey into one common experience” (Merritt & Schulberg, 1995, p. 106). Use of Classical Music Programs

One of the hallmarks of the Bonny individual form is the exclusive use of classical music (Bonny, 1978); whereas in the group form, various styles and genres of music may be used. She explains: Through trial and error, we have learned that for dyadic applications, classical selections are able to provide depth of experience, variety of color and form, harmonic and melodic complexity which are qualities needed for self-exploration. . . . Popular music, on the other hand, is more peripheral, simpler in form and less intrusive. Therefore popular music of the appropriate kind (usually instrumental) may serve as well in group GIM sessions (Bonny, 1999, p. 73). Another hallmark of Bonny's individual form is the use of pre-designed programs, consisting of carefully selected and sequenced pieces of classical music. In fact, Bonny (1978) created an entire library of taped programs, with the clear intent that these programs be used in individual work. Bonny designed these programs with a particular intensity profile in mind. That is, each program was given its own affective contour, sensitively timed to lead the traveler into a particular state of consciousness and/or emotional space, hold the traveler there, and then provide a pathway out or back. Thus, these music programs, as designed by Bonny, are intended to shape the traveler's experience. As such, they are a core component of the individual session, and a defining feature of the method itself. It is important to realize that, because the programs were presented on audiotape, there was little opportunity for guides to alter the program itself during the music imaging. The only options were to change midway within a program to another program, to add or omit a piece at the beginning or end of a program, or to present two or more complete programs in sequence (i.e., Death-Rebirth, Peak Experience) (Bonny, 1978). With the advent of CD technology, however, guides have gained much greater flexibility in selecting and sequencing the music for an individual session. Guides can now skip from one piece to the next within a program, or easily switch to any place within another program, thus opening up the possibility of completely spontaneous music programming. When Bonny's original conception of classical music programs is considered in light of more recent developments, two important boundaries need to be drawn. First, only classical music is used in Bonny's individual form; thus, all uses of non-classical music in individual GIM sessions go beyond the boundaries of the Bonny Method. Second, only pre-designed programs are used in Bonny's individual form; thus, all spontaneous music programming in individual GIM sessions goes beyond the boundaries of the Bonny Method. In contrast, the boundaries for Bonny's group form are much larger; they include the use of non-classical music, and there is no assumption that pre-designed programs be used.

Length of Session and Music As originally designed by Bonny, individual sessions usually last 1 to 2 hours, and on rare occasions may even extend up to 3 hours, depending on the length of the music used, and a variety of other factors. These sessions can seem quite long when compared to the 50-minute hour that characterizes traditional psychotherapy practice. For this reason, Ritchey Vaux (1993) adapted the BMGIM session by using shorter music programs, and taking less time for prelude and postlude processing. She has found that even these shorter sessions, when adequately prepared, can work at a level beyond the limits where brief psychotherapy is usually effective" (p. 29). Nevertheless, shortening the traditional individual GIM session goes beyond the Bonny Method. Two reasons can be given. First, full music programs of the usual length are rarely possible, and as established earlier, BMGIM is defined by the use of pre-designed programs, most of which exceed 30 minutes. Second, the depth of the work in a short session can rarely match the depth in a longer session, not only because the music continually deepens the traveler's experience as a full-length program unfolds, but also because, in a shorter session, the therapist must continuously monitor the depth of consciousness so the traveler can successfully negotiate the experience. Group GIM sessions, on the other hand, can vary considerably in length, without going beyond the boundaries of the Bonny Method (see the length of music suggestions in Bonny and Savary [1973]). Much depends on the amount of music presented, and the needs and goals of the group in entering and leaving the imagery experience. For example, Moe, Roesen, and Raben (2000) describe the need to shorten the musicimaging portion of group sessions to accommodate psychiatric patients. They presented only 10 minutes of music in a 1Y hour session. Short (1992) found that when working with a physically disabled elderly group, the music imaging could last from 3 to 12 minutes, and that it is better to use two pieces instead of one for longer listening periods. In other group circumstances, the length of an unguided music-imaging experience may take anywhere from 5 to 20 minutes, with the prelude and postlude activities varying in length accordingly. Summary The purpose of this chapter has been to identify boundaries for the generic practice called GIM, as well as the individual and group forms originated by Bonny. First, it was established that GIM is truly a method in its own right, and that Bonny worked sufficiently with the method to develop a coherent set of principles and techniques that are uniquely and originally her own. Then, it was argued that GIM is a form of music therapy whenever it is method-centered, and that it becomes something else when it is outcome centered. Specifically, GIM is music therapy whenever the guide and traveler use the music as the primary agent or context for therapeutic change, regardless of whether the change is physical, emotional, mental, or spiritual. GIM becomes a form of psychotherapy, healing, education, medicine, self-development, and so forth, whenever

the guide and traveler focus on a particular outcome in these areas, and then use music as only one of the means of achieving it. The individual and group forms of GIM as originated by Bonny were defined in terms of their essential features; then the myriad variations in each feature were examined and compared. Several practices were placed in relation to GIM and the Bonny Method. Three main categories emerged: Bonny Method: ·

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Individual form: a modality of therapy involving spontaneous imaging, expanded states of consciousness, pre-designed classical music programs, ongoing dialogues during the music-imaging, and nondirective guiding techniques. This is most often referred to as “BMGIM.” Group form: a modality for self-development involving spontaneous imaging, expanded states, various styles of music selected by the guide, and no dialogues or guiding during the music-imaging. This is most often referred to as “Group GIM” or “Music and Imagery.”

GIM Practices (Outside Bonny Method) · · · · · · · · ·

Contained spontaneous imaging (as defined previously) Reimaging (unguided and guided work with couple, group, and supervisees) All GIM work done in orientations other than humanistic or transpersonal All directive approaches to guiding spontaneous imagery Group and individual go-rounds Co-imaging (guided work with couples and groups) All uses of non-classical music in individual GIM sessions All spontaneous programming of music for individual GIM sessions All shortened individual GIM sessions

Music Therapy Practices (Not GIM Bonny Method) · · ·

Projective listening Relaxation listening Directed music imaging

References Blake, R. (1994). Vietnam veterans with Post-Traumatic Stress Disorder (PTSD): Findings from a music and imagery project. Journal of the Association for Music and Imagery, 3, 5-17.

Blake, R., & Bishop, S. (1994). The Bonny Method of Guided Imagery and Music in the treatment of Post-Traumatic Stress Disorder (PTSD) with adults in a psychiatric setting. Music Therapy Perspectives, 12(2), 125–129. Bonny, H. (1976). Music and Psychotherapy. Doctoral dissertation, Union Graduate School. Bonny, H. (1978). GIM Monograph #2: Facilitating GIM Sessions. Salina, KS: The Bonny Foundation. Bonny, H. (1980). GIM Monograph #3: GIM Therapy: Past, Present and Future Implications. Salina, KS: The Bonny Foundation. Bonny, H. (1994). Twenty-one years later: A GIM update. Music Therapy Perspectives, 12(2), 70-74. Bonny, H. (1999). GIM Monograph #1: Facilitating GIM Sessions.(Revised Edition). Salina, KS: The Bonny Foundation. Bonny, H. (2002). Music and Consciousness: The Evolution of Guided Imagery and Music. Gilsum, NH: Barcelona Publishers. Bonny, H., & Pahnke, W. (1972). The use of music in psychedelic (LSD) psychotherapy. Journal of Music Therapy, 9(2), 64-87. Bonny, H., & Savary, L. (1973). Music and Your Mind: Listening with a New Consciousness. New York: Harper & Row Publishers. Bruscia, K. (1987). Improvisational Models of Music Therapy. Springfield, IL: Charles C. Thomas. Bruscia, K. (1992). Level Three: GIM Training Manual. Unpublished manuscript. Philadelphia, PA. Bruscia, K. (1998a). Defining Music Therapy (Second Edition). Gilsum, NH: Barcelona Publishers. Bruscia, K. (ed.) (1998b). The Dynamics of Music Psychotherapy. Gilsum, NH: Barcelona Publishers. Bunt, L. (2000). Transformational processes in Guided Imagery and Music. Journal of the Association for Music and Imagery, 7, 44-58. Bush, C. (1995). Healing Imagery and Music: Pathways to the Inner Self. Portland, OR: Rudra Press. Clark, M. (1998-99). The Bonny Method of Guided Imagery and Music and spiritual development. Journal of the Association for Music and Imagery, 6, 55-62. Clarkson, G. (1999). The spiritual insights of a Guided Imagery and Music client with autism. Journal of the Association for Music and Imagery, 6, 87-103. Hammer, S. (1996). The effects of guided imagery through music on state and trait anxiety. Journal of Music Therapy, 33 (1), 47-70. Marr, J. (1998-99). GIM at the end of life: Case studies in palliative care. Journal of the Association for Music and Imagery, 6, 37-54. Merritt, S., & Schulberg, C. (1995). GIM and collective grief. Journal of the Association for Music and Imagery, 4, 103-121. Moe, T., Roesen, A., & Raben, H. (2000). Restitutional factors in group music therapy with psychiatric patients based on a modification of Guided Imagery and Music (GIM). Nordic Journal of Music Therapy, 9 (2), 36

50. Rider, M. (1987). Treating chronic disease and pain with music-mediated imagery. The Arts in Psychotherapy, 14 (2), 113-120. Ritchey Vaux, D. (1993). GIM applied to the 50-minute hour. Journal of the Association for Music and Imagery,2, 29-34. Shorr, J. (1986). Techniques in psycho-imagination therapy. In A. Sheikh (ed.), Anthology of Imagery Techniques. Milwaukee, WI: American Imagery Institute. Short, A. (1992). Music and imagery with physically disabled elderly residents. Music Therapy: Journal of the American Association for Music Therapy, 11 (1), 65-98. Steinke, W. (1991). The use of music, relaxation, and imagery in the management of postsurgical pain for scoliosis. In C. Maranto (ed.), Applications of Music in Medicine, 141-162. Silver Springs, MD: National Association for Music Therapy. Summer, L. (1988). Guided Imagery and Music in the Institutional Setting. St. Louis, MO: MMB Music. Tsao, C., Gordon, T., Maranto, C., Lerman, C, & Murasko, D. (1991). The effects of music and directed biological imagery on immune responses (S-IgA). In C. Maranto (ed.), Applications of Music in Medicine, 85-121. Silver Springs, MD: National Association for Music Therapy.

Taken from: Bonny, H. (2002). Music and Consciousness: The Evolution of Guided Imagery and Music. Edited by Lisa Summer. Gilsum NH: Barcelona Publishers.

CASE ONE Guided Imagery and Music (GIM) and the Mandala: A Case Study Illustrating an Integration of Music and Art Therapies Helen Lindquist Bonny Joan Kellogg “My mandalas were cryptograms concerning the state of the self which were presented to me anew each day. In them I saw the self—that is, my whole being—actively at work. To be sure at first I could only dimly understand them; but they seemed to me highly significant, and I guarded them like precious pearls” (Jung, 1961, p. 195). Introduction The positive integration of music therapy, using the Guided Imagery and Music (GIM) technique for psychotherapy sessions developed by Helen Bonny, RMT, and then ending of the session by the drawing of a mandala, that was monitored according to the approach of art therapist, Joan Kellogg, ATR, has proved to be an innovative combination of these two expressive therapies. At the Maryland Psychiatric Research Center the authors collaborated in using music sessions followed by the drawing of the mandala in the context of short term, intensive psychotherapy. The music technique, called Guided Imagery and Music (GIM) is composed of relaxation exercises followed by continued therapist support during the playing of musical selections. GIM has been defined elsewhere, by Helen Bonny, RMT (1975), as listening to selected music, a programmed tape or live music, in a relaxed state to make use of the imagery, symbols, and/or feelings that arise from the deeper self for the purpose of encouraging creativity, therapeutic intervention, selfunderstanding, aesthetic imprinting, religious, and/or transpersonal experience (p. 121135). The GIM sessions were given on a weekly basis, each lasting from one and a half to two hours, and followed by the drawing of a mandala. The music therapist does not provide client information or test scores to the art therapist. After each session the mandala was mailed to the art therapist who wrote out and returned a diagnostic interpretation. In this psychiatric research, the mandala, a circular art form, is used as a projective device for the purpose of visually monitoring the ongoing therapy process of patients by Joan Kellogg, ATR. The procedure consists of having subjects use colored oil pastels to fill a pencil-outlined circular area of about ten inches in diameter in the center of a sheet of drawing paper 12×18 inches. The subject is asked to focus on the center of

the circle first, make a shape there, color it, and to keep working it in the round. Whether he goes beyond the circle outline is up to him, it is not a fence but a guide. On completion, the top of the mandala is identified, and date/initials/sex is added. Paper or plastic dinner plates are used for outlining the circle in pencil, lightly. Pastels with a minimum of 36 shades are used. Case Study We are going to present a case study in which this approach was used in an attempt to enhance the therapeutic movement toward health and wholeness. From the point of view of the music therapist, the drawing of the mandala seemed (1) to allow the client an opportunity to make a concrete representation of certain non-verbal elements of his music experience, (2) and to allow him to experience an easy and pleasant reentry into the normal conscious state. Often the music session, as we shall see, takes a client into a deeply altered state, and it is advisable that a gentle and nonabrupt return to the normal state occurs. The mandala interpretation which was received by the music therapist from the art therapist was diagnostic for it seemed to point toward current positive or negative tendencies which were valuable in helping the music therapist make decisions about her work with the client. In our case study the music therapist will discuss the content and affect of each music session after which the interpretation of the mandala will be presented by the art therapist. This case represents a total time schedule of 30 hours of therapy over a fivemonth period. As a part of his acceptance into our program a number of testing procedures were required, with the results available to the authors. The tests administered were: The 16 PF Test Profile, The MMPI (Minnesota Multiphasic Personality Inventory), The POI (Personal Orientation Inventory), and The Hypnosis Susceptibility Scale. John (a pseudonym) was a 22 year old, single college student who was referred for assistance in resolving moderate depressive episodes that he periodically experienced. He stated that such episodes typically lasted from two to four days. During these times, he had fantasies about suicide, but he had never made an overt gesture. He was referred to us by a professor with whom he had shared his problems. Personal History John was the older of two children in his family, with a sister three years younger. His father, a Navy career man, was of Philippine heritage; his mother was of German background. For long periods of time during his early maturation, his father was away on Navy tour duty. Otherwise, he described his childhood as normal. Most of his school years were spent in a large American city. He attended one year of college, and then, like his father, joined the Navy. A month after boot camp, he began feeling depressed which he attributed to the treatment of fellow recruits whom he felt were being humiliated (a projection of his own feelings onto others). On the basis

of humanistic objections to war, he was able, through his own counsel to secure an honorable discharge from the service. After this experience he felt lost and depressed. He decided to return to school, enrolled, and then transferred successively to three different colleges. At referral he was contemplating dropping out of college entirely. He had no drug abuse history of any kind and, essentially, had shown minimal sexual interest in others. He stated that he did not have much time for dating, nor was there much interest in such activities. His religious background was strict Lutheran, and he described his upbringing as moralistic. He had rebelled, however, against his background and spoke with much distaste of Christian hypocrisy and of lack of pacifism in the Church. He typified his religion as being essentially ethical in nature. He was overwhelmed by what he termed “the existential problems of the world” and felt responsible in some personal way to bring about their solution. He expressed a deep sense of hopelessness about life and held a pessimistic view of human nature. John strongly emphasized the importance of his intellect in problem solving; and correspondingly, he downgraded the intuitive facets of his personality. He kept himself very busy with outside activities to counteract his depression, and did not know what a sense of “inner peace” was like. He was presently living at home, and not happy. His stated goals for therapy were, “Personal balance and inner directionality.” He said that he was “afraid of involvement because it had no value.” My personal goals for him as his therapist were: greater self-esteem, a lessening of anxiety, emotional control (he cried very easily), uncovering and resolution of areas of frustration, anger, disappointment, and help in accepting the non-cognitive aspects of his personality—the Jungian anima. Mandala One (Pre-therapy) John drew the following as his first mandala prior to therapy. All of the darker lines comprising this drawing are black and blue; the lighter lines are yellow. There is one central circle in the middle that is drawn with red. The “X” inside the small circle is yellow.

John was given a mandala interpretation before he began therapy. About the mandala he wrote: “Possibly electron cloud mappings...the center X was the last marking.” Report on Pre-Therapy Mandala This person seems to be a rationalizer; it is hard for me to tune in to his way of being as the mandala suggests that he may be out of touch with his feelings; really impoverished. He used brown consistently which may have to do with anal characteristics. He is probably inclined to be orderly, careful with money, and preoccupied with intellectual pursuits. Rather puritan in background, not much laughter in his home, probably a model of decorum. He feels stuck as far as being able to grow because his male yellow X in the center is surrounded by a garden wall of the dismal restricting colors. (The yellow in the mandala represents a number of functions, replicating creative aspects of the sun; the cross, or X figure, points to problems in expression of these aspects, hence a crossroads, stuckness or crux.) Music Session One In John’s first session, in which relaxation exercises were followed by the playing of a music tape of some six selections, he was able to get more deeply into his imagery than anticipated considering the low score he had on the Hypnosis Susceptibility Scale. He relaxed, went with the music, at first as observer of imagery that was closely connected to the music, but later in the session he was able to briefly identify with the figures in the fantasy.

Most helpful was a cathedral scene (during the playing of Tschesnekoff’s Salvation is Created) when he gave over his mind to feeling impulses leaving him “calm, solemn, sad, but not depressed.” After the session he was asked to specify the difference between sadness and depression. He defined the latter as “frustrated anger.” He expressed optimism about his own involvement in the process. During a music session the client is encouraged to verbalize the ongoing imagery and feeling states that are being experienced. During the week after each session clients are encouraged to write intervening thoughts and reactions to the sessions. Music Session Two In the second music session, during the playing of Copland’s Appalachian Spring, he said, “There is a feeling of tragedy—crucifixion, a foreknowledge of its coming, knowing that it is there. It’s not fear—just knowing,” and later, “looking at a flower, its origins, meaning, existence. The bass notes in the music corresponded to deeper questions relating to existence; de-emphasis of the base issues, and acceptance without a real knowledge.” At the end of the session we talked about getting into his feelings. About this he agreed, but he expressed a fear of getting into sexual subjects. When I gave him the mandala, he resisted by saying, “I feel vacant.” I suggested that he draw as best he could that feeling. Mandala Two. John’s second mandala had yellow lines that spiral into the center of the circle. The figures are drawn in different colors; the hexagon is orange; the straight line and grated figure are red; the “X” and the oblong figures are blue; the wavy line extending from the center is black.

Interpretation. Whirlpool of yellow with various linear shapes that I think is another way to demonstrate his linear frame of reference. The only curved shape is on the left and is blue. I believe he has repressed his intuitive functions as well as most feminine receptive qualities. Perhaps a better way to say this is his analytical mind has developed at the expense of his feelings and intuition. (The blue is an expression of receptive qualities, symbolically equated with feminine aspects of water. The dark blue indicates intuitive functions placed on the left side in the preconscious.) Post Session Two After the session, during the next week he wrote more expressly of his feelings, “I slipped into a state of depression today, and by mid-afternoon as I sat in the library, I felt terribly distant from everyone there. All the problems of the world seemed to weigh in on me. Something must be done, I don’t know what, I don’t know where the problems come from...It may be anger, origin unknown, which eats away at me, but in its deepness it surfaces as anxiety.” Music Session Three Fear, anger, and boredom were all emphasized during the playing of the music. He asked that the music selection be changed, again and again. Rapport with the therapist was still a question. We had not really become involved with basic problem issues. His defenses were strong; and he would, in all probability, not be able to relinquish them for a while. His comment, in the last session, that he was unprepared to talk about sex may be a major defense. Another strong defense was his “head” talk. His anger at the world definitely appears to be a projection of his anger at parents and possibly himself. Mandala Three. The lines that spiral into the center of the circle are yellow. The four smaller spirals are drawn alternately in green and red. The two arrows drawn between the spirals are both blue; and the two curled lines drawn between the spirals are both dark green.

Interpretation. This is made of whirlpools, pointing to involution (going back). It may indicate that he went with the music session well. Post Session Three From John’s personal reaction to the session he writes (in a more hopeful vein), “If some spontaneous, personal feeling could be achieved, then the question of worth might never arise. I am beginning to feel the present distance between my thinking and feeling self.” Music Session Four Preliminary to the music session, John talked about his growing restlessness with living at home. He was thinking of finding an apartment and being on his own. This would free him from what he described as the “overbearing influence of parental values and structure.” A tension-relaxation exercise was used before the music tape was started, and a more structured imagery procedure after the Guided Affective Imagery of Hanscarl Leuner (1969). The music session went well, and I felt that we were getting closer to a discussion of personal needs. Mandala Four. In this mandala, the brick-like lines drawn outside the main circle are yellow. The central circle consists of two rings and a center. The outer ring is blue; the inner ring red; the center is drawn in yellow.

Interpretation. This is frankly obsessive compulsive. When he begins to make progress, he begins to defend himself in this way. This is the target mandala, and is rather classic as a demonstration of a defense mechanism at work. When you get too deep into introspection this is what happens. Presto, a formula appears, or something triggers the nest-building circular process that keeps one so busy, one cannot reflect. The yellow web affair is a reflection of the dependency needs, the need for structure in this kind of person; but unfortunately, at the same time, this prevents the happy accidents that make for growth. Music Session Five For many clients, the fifth session usually coincides with a breakthrough of catharsis and/or insight into themselves. John was one of these. Rapport had been established. In the preliminary interview, he stated for the first time that his pessimistic feelings about the world may have been projections of his own inner state of turmoil. He felt a need to be more receptive to others; that perhaps a lack of communication was more his fault than that of others. John said that he was feeling less depressed, but that he was afraid to trust the feelings. During the music, he reported quiet feelings; and then feelings of anger came to the surface. I encouraged these feelings through the use of an Affect-Release music tape, and through bio-energetic exercises which provided muscular resistance. I encouraged him to press against the palms of my hands, as I pressed down on his palms suggesting that he push me off; he did. We repeated the exercise several times to the evocative

music of “Mars” from Holst, The Planets. He reported feelings of emptiness, disgust, anger, coldness, and aggression, in that order. I repeated the music tape again applying the same pressure for some 20-minutes of playing time. No mandala #5 was drawn at his request after this session. Music Session Six Getting John in touch with his body through the above approach was a breakthrough into his feeling state, but it was threatening to him. He asked to not have music this session, but to talk because, “I feel confused.” He talked in circles then was finally willing to listen to the music without eye shades or earphones. We talked at length about his extreme sensitivity, and of the possibility of its being a form of “tendermindedness.” As he got into the feeling areas, John experienced confusion and uncertainty in his thinking. Mandala Six. This mandala is drawn in blue, yellow, and red. The circle is outlined in blue. The lines that swirl into the center are drawn in yellow and red. They are yellow from 12 to three o’clock and from six to nine o’clock; they are red from three to six o’clock and from nine to 12 o’clock.

Interpretation. This appears to be a reaching back counterclockwise into the unconscious area, and very good in terms of the “journey into the self.” Surrounded by a ring of negative mother blue; the red and yellow are both active aspects of himself and shows he is engaged actively in the search. Music Session Seven

John had a good week and was feeling better. He spoke of his need for structure. If things are not described and discussed in detail, he feels unhappy. The music session brought up pleasant feelings of unity with nature, satisfying interpersonal relationships with people, and a realization of his need of them. Mandala Seven. In this drawing, the small circle is outlined in white. The large star formation in the middle is drawn in blue, and flesh-color (the largest points of the star are yellow, the smaller points are blue and flesh-color).

Interpretation. Well, this one is a surprise; a new and promising center is born like a star in the sky--iridescent and luminous, pregnant with many colors or aspects of self. Lighter colors are used, a flesh color that is healthy and ruddy, so certainly his flesh was involved on a feeling level, a positive mother blue, and a beautiful yellow of mind. Surrounding it is just a white ring that in no way blocks him off from others. This is great. Music Session Eight John had two short depressive periods in the preceding week. He spoke again about his extreme sensitivity and of his strong feelings. He recalled that he cried frequently at school as a child until he reached the seventh or eighth grade. He also remembered that he had asthma that started when his father first left home for Navy duty. During the music he reported a “gut” feeling in his stomach. It was suggested that he go with the feelings and this led to remembering a Valentine’s Day at school in

the sixth grade. He had a romantic crush on a girl in his class, and he proudly presented a large candy valentine to her. He was the only one to do this and was laughed at and teased by teacher and children and embarrassed in the presence of his peers. We worked with the embarrassed feeling and with the anger that came up. When I pressed down on John’s shoulders to encourage a catharsis, he stated that it was not anger he was feeling, but the need to reach out to others. He asked to reach out to me. He asked for my hand, which he held, accepting and giving warmth. I put my arm around his shoulder; he accepted this gesture of warmth and nurturing. The basic acceptance of warmth and recognition of his need for it was the strong element in this session. Mandala Eight

Interpretation. This appears to be a conjunction of the opposites within him, a mixture of curved and straight, blue and red, female and male, from the conjunction of the four directions. But, no fifth element has appeared in the center to herald a new ego nucleus. This seeming conjunction is an illustration of the “dragon fight,” complete with swords, but it is here a stalemate and leads nowhere. (Red and blue used in this fashion can be significant as a confrontation of the libido as red, primary energy, separating from blue, the depressing, negative attributes of the negative mother image. I keep waiting for a good, firm center and some expression of yellow to indicate real progress.) Music Session Nine During the past week, John had an argument with his parents. They said that he was aloof and arrogant and that he “cut them down.” During the music session, John

described love as “an abstract principle—which has no real feeling in me. My parents say that they love me, but I can’t feel it.” After the session, we spoke of lack of feelings, especially for his mother. I suggested that we work on “clogged” love feelings toward his mother and others at our next session; he agreed. Mandala Nine. This mandala is drawn in two colors: purple and brown. The three lines at the top and the three lines at the bottom are purple. The four lines on the left and the right are brown.

Interpretation. Again, the tension of the opposites; but no nucleus, just a point in space. The fight is on. Tension is mounting. We will hope it leads somewhere. (The red is lost in the blue or incorporated, yielding purple. Purple frequently points to energy locked up in ambivalent feeling in the maternal bond.) Music Session 10 This session was a breakthrough session for John. Although the scenes from school days were observed for most of the music session, there was no imagery. The feelings were very present and led to a good understanding of his problem of lack of expression of feelings, except the channeling of them into social problem-solving. As far as his own emotional needs are concerned, he seems acutely aware that he has been denying them, suppressing them, and even feeling guilty about their presence. We discussed his need to balance his life, to accept and reach out for emotional warmth for himself—in short, to stop starving himself in these areas. I encouraged such activities as music, dancing, poetry, painting, or anything which would help him to express his need for strong emotions in a way that is acceptable and good for him. After the music, there

was a noticeable afterglow. He looked more relaxed and “himself” than I had ever seen him. Mandala 10A. There are four formations in this mandala. Each formation is a different color. The short wavy lines within each formation are the same color. From right to left, the formations are colored red, yellow, blue, and green.

Interpretation. This one seems to indicate a flowing expression, certainly less compulsive, and more open to possible change. It is balanced, but not compulsively. The outside rim is open as well, so a great deal of trust is apparent. Mandala 10B The outlines of the large crystal-like form are drawn in green. Each figure within the sections is a different color. Beginning with the largest circular form and moving clockwise, the forms appear as a red, wavy circle, an orange zigzag, blue crossing lines, a black triangle encased within the outline of a yellow triangle, a yellow rectangle, and a blue star.

Interpretation. This one is definitely different, rather like a crystal, just kind of growing spontaneously without worrying about preplanned order, again reflecting a kind of trust in going with things, rather than insisting on a road map. Some intense feelings via the orange; certainly getting some emotional response now. Looks good. Music Session 11 The music session was used to work through a dream which John had had that morning. The dream was as follows: he was to be placed upon a cross in a living room-not his own--by his father. His mother was nearby in the shadows. Two unknown girls were watching. The cross itself was as tall as he in its vertical beam, but very short horizontally. There was no show of emotion by any member of those present, nor did he feel any emotion. (You will remember that a scene of the crucifixion had occurred in his second session.) John said “no” to the idea of being put on the cross. The “no” was more in the anticipation of pain than to the humiliation of the event. He ran upstairs and escaped through a window. The dream ended at that point. I suggested to John that we could relive the dream in fantasy in the music session, which we did. Its ending was as follows: he escaped through the window to a railroad track, but he was concerned about where the track would lead him. More present was the sense of freedom and release. In the discussion that followed, John said, “I think of the dream symbolically, as seeing through the past the conservative emphasis, and then breaking away from it, from its restrictions.” John identified the dream with feelings of wanting to leave the

insensitive past in which he had put himself up “on a cross”—as regards his interest in social action projects which were “too big” with which to comfortably identify; what he considers his over concern with ethics and religion. He feels free now from the paralyzing effect of his overcompensation for feelings of helplessness. He is more interested now in local politics, and plans to get involved in them. We discussed the termination of therapy. He felt that a breakthrough for him had come at the previous session (10th). He did, however want to continue for a while to see how the new freedoms worked out. I reassured him that he could continue until he felt ready to terminate therapy. Mandala 11. The central circle has four lightly drawn rings of various colors. From the central ring to the outside, the colors are: green, red, yellow, and light purple. In addition, the outer ring of the circle is clearly drawn with a thin, light purple line. The square drawn at one o’clock is blue; its inside is shaded in light blue. The diamond shape within it is drawn and shaded with green. The square drawn at seven o’clock is green; its inside is shaded in light green. The triangle shape within it is drawn and shaded with blue.

Interpretation. Here we go on the nest building trip, what ticks this off is the threat of change, I believe. He began to just let it happen and, because of defenses carefully built over the years, this is called into play when change or growth is called for. I expect this will tend to happen until he practices change and is less threatened by it. The inside of it is fairly loose until he gets wrapped in the purple. Don’t get discouraged, he’ll get there; it will just take longer perhaps. (This one illustrated a new nucleus in green, significant because green is the coming together of yellow and blue, father and

mother internalized, an acceptance of parenting oneself. However, the purple outline restricts growth.) Music Session 12 John is definitely over the hump in his therapy. He will be coming every other week or so now. When he arrived, he gave me three concerns which I observed as growth occurrences: (1) discontent with school, but willing to stick it out to graduation, (2) decision to move out of his parents’ home to have greater freedom, (3) a need for a close love relationship. (On the latter, I will try to be of some help in bringing out feelings of warmth in the last few session periods.) During the tapes, John was quiet, “just listening to the music.” Mandala 12. The leaves in the mandala are lightly drawn in green; the thin branches are lightly drawn in black; behind the leaves is a background shaded lightly in blue.

Interpretation. This must have been a banner week. I never expected to see anything done by him that is so loose and free. The growing branch with the curved leaves of green, are fine, pointing to the conscious side; it is growing toward the sun, with the roots in the unconscious. The other colors surrounding it are light blue and light red, and the way they are worked makes me think he might have touched, however tentatively, another dimension. So, the winter of himself, the black branches have sprouted spring foliage. (I am so very glad for him).

Music Session 13 John reported some conflict about whether to stay in school or not. He felt less compulsive, more open to pursing an understanding of himself and his inner needs. He was no longer depressed, but he reported some inner confusion, a sense of shakiness. When he drew the mandala, he entitled it “a budding tree I saw in West Virginia.” Mandala 13. This mandala is drawn lightly with green, red, and blue; the colors are blended together.

Interpretation. Very beautiful, growing out of the subconscious into the conscious, with buds at the tips. Other than feeling very good about this, there is little to say. Mandala 14 When John returned for termination, after a three-month interim, the following mandala was drawn. The flower shape in the center of this mandala has very light yellow petals and is outlined in soft blue. The center of the flower is black.

Interpretation. It appears that he is definitely a mental kind of person, but it is a soft, full kind of mentality rather than a linear kind now, more emotional life. The color of the center flower is a light yellow, so I would feel he would be an idealist in a positive sense. The green surrounding it, if it represents parenting, control, or perhaps his marriage or emotional environment, is loose and flowing and certainly not restricting but growth enhancing. There is a small amount of red, throughout, so I feel his primary needs are fulfilled. So the basic four colors are reflected; though the blue is obscured in the green, it is represented along with yellow and red. If you need visual proof for a successful resolution, this is it. (Contrary to general practice, I had been informed via telephone conversation of his marriage. The green is significant here as internalized parenting of self, perhaps). Therapeutic Outcome John’s post-testing scores showed the growth he had achieved in therapy. The MMPI was within normal limits. The 16 PF indicated increases in emotional stability, group dependence, casualness, and relaxation. The post treatment POI profile indicated some progress in self-actualization. The music tapes which were used were: Beginners Group Imagery, Imagery, Peak, Comforting, Death-Rebirth, Affect-Release, and CosmicAstral. Post-Therapy Interviews Gleaned from the interviewers. The impact of John’s therapy indeed appeared to be dramatic. Whereas he had little time for women and no interpersonal sexual

history at the time of his screening interview, he has since been married. He started dating the woman who became his wife several months after termination of his therapy, lived together with her for a few weeks, and then was married by a justice of the peace with the parents in attendance. He feels that his experience in psychotherapy enabled him to become more sensitive to his own needs to love and to be loved and credits this as a significant factor in his subsequent involvement with the woman who is now his wife. He strongly emphasized that he felt that therapy allowed him to be much more realistic in setting goals and making demands on himself...and he is much more compassionate in regard to his own human limitations and also those of other persons. He denies any feelings of depression during the past few months, a definite change from his condition at the time he requested therapy. He describes this lessening of depression within himself to be due to a better understanding of himself and of other people. He still finds himself to be angry at times but it is not the debilitating anger that he has experienced before, and is more realistically expressed. John commented that he feels more responsible now, primarily because he does not commit himself to attend more activities than it is possible for him to manage. He finds it much easier to set limits on his involvement in various good causes. I also noted a healthy sense of humor that was not previously apparent. As a whole, he seemed much less of a brilliant, rational robot, and much more of a warm, sensitive human being. He commented incidentally, that the sexual facet of his relationship with his wife was without conflict and very meaningful. When asked about the feeling of pessimism that he strongly expressed about the world and the future of man, he said that objectively, he still feels a sense of pessimism but “it does not upset me personally as much.” John feels that his appreciation of classical music has been enhanced by his participation in this program. He listens to music more closely now and finds that it helps him to (reach) feeling levels within himself. As far as his sensitivity is concerned he finds that it can be a gift of insight; he can be hurt, as well, because of that sensitivity. About the hurts, he has discovered that it is easier to be objective and to understand the reasons for his feelings. In conclusion, “I feel strong and confident and I feel that the things that I have gained through therapy will serve me well in my life.” Conclusion The combined approaches of Guided Imagery and Music as psychotherapy by a music therapist and the subsequent drawing of a mandala at the end of each session for monitoring by the art therapist, is one demonstration of the value of combining the creative expressive therapies. This presentation reflects the limitations imposed by the research protocol for this project that was to test the efficacy of music therapy as a treatment modality and a pilot test of art therapy as a valid monitor in a “blind study.” This meant limitations for the art therapist, the absence of patient information and lack of personal interaction with the patient and the music therapist. A research study

designed to allow for interaction between patient and art therapist in regular sessions is another approach. In this latter case, the patient would benefit more equitably from both expressive therapies. The monitoring effect could be more accurate with shared information throughout treatment. A still broader conceptualization that could encompass both therapy and monitoring, even possibly some diagnostic aspects, could be eventual goals for art therapists to explore research and document. References Bonny, H.L. (1975). Music and consciousness. Journal of Music Therapy, 12(3), 121–135. Jung, C.G. (1961). Memories, Dreams, Reflections. Aniela Jaffee, Ed., and Recorder. New York, NY: Vintage Books. Leuner, H. (1969). Guided Affective Imagery (GAI). American Journal of Psychotherapy, 23(1), 4–22.

Taken from: Bonny, H. (2002). Music and Consciousness: The Evolution of Guided Imagery and Music. Edited by Lisa Summer. Gilsum NH: Barcelona Publishers. Reprinted from: Bonny, H. (1976). Music and Psychotherapy. Doctoral dissertation at Union Graduate School, Union for Experimenting Colleges and Universities. Mandala interpretations by Joan Kellogg were taken from Bonny’s personal notes.

CASE TWO Case Study: Cheryl Helen Lindquist Bonny Introduction Cheryl arrived as a client in the GIM research program through the efforts of her husband, Bill (a pseudonym), who had been an enthusiastic participant in more than one of the 1973 summer workshops conducted by the Institute for Consciousness and Music. Exhibiting a type of missionary zeal, he felt that the self-revealing experiences that he had had might have an ameliorating effect on the problems of his wife: her personal conflicts and their marital difficulties. Bill was a musician, a singer. His responses to Guided Imagery and Music were strongly related to the aesthetic effects of the music itself, the power and religious implications of which often took him into areas described as peak or transcendental--this was seen as a positive response to the “getting high naturally” emphasis of the GIM process. His volatile nature was supported by a fairly strong ego. Inner exploration touched the rich areas of his being which had been well planted and nourished in his early life. This was not true of Cheryl, who carried within herself early insecurities and selfdoubt. She attended the last workshop of the summer series. During the second music session Cheryl experienced a spontaneous primal-type abreaction that regressed her to birth and early childhood. Two therapists shielded her with their bodies to form a pseudo-womb, a protective and warm retreat from her terror. The workshop experience had a “loosening effect,” and other psychodynamic material began to surface. It was at this point that she sought inclusion in our program and was accepted as an experimental subject. In the screening interview, it was revealed that both she and her husband were involved in the theatre arts. There was a slight suggestion that she may have been under some pressure at the workshop to “perform” as well as her husband. At the interview Cheryl appeared as an attractive 25-year-old married woman, feminine-appearing, but rather sloppily dressed in blue jeans and an unironed blouse denoting a lack of caring about her appearance. There was a certain “Women’s Lib” jauntiness about her which she emphasized by mentioning that she did not shave her legs or use her husband’s name and that she wanted freedom to explore her sexuality. In answering questions she was very verbose, and compulsively filled the spaces between words with gestures and

repetitious pronouncements. She was observed to be tense, tearful, and restless in the interview. She did not claim to be depressed; but acknowledged problems with anxiety, guilt feelings, and phobias such as fear of insects, being alone, and being in crowds. She was troubled by tics: twitching of the eye, itching and clearing of the throat. These were described as coming on when she was “trying to please” her husband, friends, employer, or important others. Feelings of inadequacy, indecision, and lack of self-confidence seemed to inundate her. She was at times reclusive, desiring to stay indoors, fearing to go to the store, to take a bus to work, or to be with a group of people. Her moods were inconsistent: tears at one moment, laughter the next, suggesting emotional instability. There was ambivalence between a strong desire to be independent versus an equally strong need to be dependent. This was especially apparent in her relationship with her husband--independence in not wanting to take his name, an insistence on her own freedom to come and go without question, freedom for sexual experimentation; and yet, a recognized unwillingness to allow him to have the same freedoms. She was prone to nightmares in which she would awaken screaming and would be comforted by her husband. Personal History Cheryl was the oldest of four children. She described the family as not being close. The father was the more stable parent. Her mother was often sick, retreating to bed for three days to several weeks at a time without tending to the family’s needs. As the oldest, Cheryl took over the responsibility for the care and feeding of the family. On three occasions her mother’s allegedly psychosomatic difficulties led to hospitalization in private or state hospitals. Other children were not welcomed into the house by the parents and Cheryl felt keenly her inability to entertain her peers in the normal way. She deeply resented her mother’s recurring illnesses and felt guilty about her lack of love for either parent. She felt responsible for her mother’s unhappiness. Her father was uncommunicative, and dedicated to earning a living for the family. Cheryl did not get along well with her next younger sister. In school Cheryl was a good student, recognized for her ability in art and drama. (She described herself currently as an artist, specializing in theatre.) She had a baccalaureate degree and had been enrolled in a graduate program in theatre at a university until she left because she could no longer live with the feelings that “I had to please the director and audience.” She met her husband while both were traveling in a theater group. They dated for a year before marriage. She was not too eager to marry because her friends said, “Why marry when you can live together?” At the time of the screening interview she still expressed resistance to the marriage, although they had been married for two years. The sexual relationship was described as difficult and she viewed herself as frigid. In the first 12 sessions, she often expressed a fascination with trying sex with other males or females.

Her medical history was unremarkable, except for an operation within the past year on a benign tumor on her thyroid gland. At the beginning of therapy, she was working for a consumer organization, earning a small salary. Her husband was, at the time, out of work. She resented the fact that she had to work for them both. Her husband was studying voice, unemployed because he could not find a satisfying job. Cheryl’s religious background was Roman Catholic. She had faithfully attended church up until a few years previously. She presently called herself agnostic. A positive relationship was initiated with me at the music workshop. But before therapy began, Cheryl challenged me as being “too straight.” She said, “I need to talk about my sexual needs, about my need to have other partners besides my husband.” It was felt that these statements were less a lack of confidence than a plea for acceptance--a need to be reassured. Goals for therapy were identified as follows: · · · · ·

Reducing of anxiety level Uncovering of guilt feelings Dealing with phobias Working to alleviate sexual fears and to promote a positive feminine identification Enhancing self-esteem GIM Therapy: Cheryl’s Course of Treatment

Cheryl received 19 sessions over a period of five and one-half months (a total of 38 hours of therapy). I have summarized each of her sessions, and included a posttherapy follow-up report. Music was utilized in 15 of Cheryl’s 19 sessions (it was absent from sessions 6, 8, 17, and 18). The music tapes utilized, in the order of frequency were: Peak Experience tape, used eight times; Comforting-Anaclytic, Affect-Release, and Imagery tapes, used four times each; Cosmic-Astral tape, three times; Positive Affect tape, used twice; Death-Rebirth tape, used once; other tapes were used in three sessions. Mandalas were drawn by Cheryl in 16 of her 19 sessions (absent from Sessions 1, 11, and 17; two mandalas were drawn in Session 3). I used mandala drawings for two reasons. First, to help Cheryl return to a normal state of consciousness but remain in right brain mode with the ability to capture in a drawing the most relevant images from her session. Secondly, through the mandala, I could more easily encourage verbal description of the session. The work with the mandala was kept client-centered all the way without any interpretation on my part. Because Cheryl was part of a research project, each of her mandalas was interpreted by an art therapist colleague, Joan Kellogg. I was careful not to divulge to Joan any information about Cheryl or about the content of her GIM sessions. Joan’s interpretation included her diagnosis and prognosis of Cheryl’s course of therapy. Since she was unaware of Cheryl’s history and of the content of her sessions, Joan’s interpretation rested solely upon her “reading” of each mandala. Joan’s interpretations can be read while viewing the plates of Cheryl’s mandalas, and juxtaposed with my

summary comments and Cheryl’s reflections upon her sessions. The post-session comments are verbatim excerpts from Cheryl’s personal journal. Some of these comments refer to her mandalas; some are extensive written reflections that she shared with me after particular sessions. Session 1: October 29, 1973 Summary. Music for the session included Peak Experience, Comforting-Anaclytic, and Affect-Release tapes. The Peak Experience tape was used because in our preliminary sessions, emphasis was placed on the tender emotions and a sense of the religious. She was emotionally affected by each piece of music, crying with the Beethoven and Bach, feeling somewhat threatened by louder sections and by the crescendos, while at the same time seeming to be excited by them. At one point she said, “The low notes make me feel suspicious like I have to be careful.” With the Sibelius she stated, “Oh, I see ovens like at Dachau. Ugh!” During the Fauré number she was both attracted to and repelled by the women’s voices. She experienced a feeling of fullness at the top of her head, and stated, “I’m glad that piece wasn’t the end.” During the Brahms she felt “anger against the process and against you,” and “trapped by my feelings.” At the end she stated that she was tired of what she called “sweety” music. The music was changed to the Affect-Release tape playing the “Mars” movement from Hoist’s The Planets and the Bach Toccata and Fugue in D minor. She especially enjoyed the latter number and said that it made her feel good. Session 2: November 7, 1973 Summary. Music for the session included the Imagery and Affect-Release tape. This proved to be a very intense session. Cheryl was in a jovial mood when she came to the session. She had had success in speaking to her superiors at work and was feeling confident about herself. When the music session started she stated that the violins sounded sad. It was suggested that she let as much of the violin music as she felt comfortable with enter her body. She visibly relaxed at this suggestion. She then reported imagery of a railroad tie hanging in the air above her head. With the beginning of the Copland number there were tremors, deep breathing, and a reaction characterized by terror and fear. At this point the music was changed to the AffectRelease tape which facilitated an experience of intense anger. The feelings she described were centered in her head, mouth and chest. It was suggested that she let it build up and come out of her mouth and arms. Her arms remained very flaccid. She did, however, call out forcibly several times. I suggested that she make her hands into fists, and I encouraged her to push and struggle against my own hands. With the strength of her anger directed outward she was able to pound the pillows rhythmically. After the energy of the anger was expended, she laid down and expressed amazement at the sensation of lightness in her limbs. Her voice became very childish and soft. Her face took on a worried look and her body expressed immature kinds of anxiety movements. There was such a drastic change in her behavior (which became almost totally primary

process) that concern was felt about reaching her in that much regressed state. When she was questioned about whether she wanted to sit up, the questioning eventually brought her out of the deeper state. It took her some time, however, to come completely back, and when the eye shades were removed, she experienced aesthetic three-dimensionality, deeper colors, and depth perceptions that were very similar to those experienced in some hallucinogenic drug states. Cheryl’s Post-Session Comments. I was rocking back and forth, partly because I was caught in anxiety not knowing which way to go: to stay with Helen and describe my feelings or totally go into being a little baby, which is how I felt. I was embarrassed to say I experienced feelings that I felt long ago--embarrassment is what I feel and felt sometimes during the session. At the same time I was feeling strongly that I was a baby...Thursday at my theatre class I noticed that I didn’t feel as vulnerable, selfconscious, competitive, and hoping that people liked me...I notice that I really respond to--identify with--violins in a minor key, violins that sound mournful...I’ve been very conscious of looking racky and boyish in the last several weeks, especially today when there were men whom I wanted to like me. Mandala. This mandala is drawn with only two colors: shades of turquoise and white. The outer rim of the circle is ringed with a dark turquoise blue; the center circle is a light turquoise. Both circles are drawn in heavily. The space in between is shaded in lightly with lighter shades of turquoise and white.

Mandala Interpretation. This mandala is an exercise in exploring the facets of mother or woman, it is ringed in the negative blue and centered by the positive blue and she bounces from one to the other trying to blend them or integrate them. Cheryl’s Comments on Her Mandala. She wrote “Me and Helen.”

Session 3: November 19, 1973 Summary. The Imagery tape was used. Cheryl was afraid that another intense experience might occur, but at the suggestion that the depth of her regression could be controlled, she was willing to go into the music. Later, in the music, she requested silence so that she could follow the beckoning of the music. She had three important imagery experiences. The most outstanding event in her session was seeing her mother, young, pretty, and liking what she saw. But she did not like the plaid dress that her mother wore. It was felt that this session increased trust and rapport, and contributed to a good basis for future work on her feelings regarding her mother. She also experienced having a baby and watching the baby grow up. She interpreted this experience on several levels saying that it meant that she literally wanted to have a baby; and in addition that, “I suddenly realized that the baby in the dream was myself, and that I was discovering that I liked myself, a new person--that I am loveable, and that made me happy.” The third experience was of mouths, women’s mouths with red lipstick. She said, “I have seen these before, open mouths, sneering, laughing, not friendly.” Cheryl’s Post-Session Comments. One vivid experience was of a long silver cylindrical pipe upon which I sat, riding it like a horse. I thought I’d climb along the pipe to see where it went, but I soon determined to stay on it hoping I would not fall off. The moment I thought of falling off, I did, sliding around, never being able to keep still or to control my movements. Something else seemed to be more powerful than myself. Finally I decided to give up and find out what would happen if I fell. I fell away of my own will and it was wonderful to tumble in space. I saw as if I was at the bottom of a canyon. I decided to go back up out of the pipe and slide around again. This time it wasn’t slippery. My body and hands could not keep my balance so I fell off again on purpose. But this time I did not fall free. I bumped into things. I didn’t know why and the pleasure of the fall and the potential speed was interrupted and I couldn’t experience what I wanted. I was bored and angry. I think something stopped my fall or flight the minute I feared something might stop it...When one piece of music ends, in the stillness before the next piece, I drop away. I leave my body and go deep. It feels great and exciting. Mandala. In the first mandala drawn in this session, the outside of the circle is colored with a thick, bright yellow strip. Inside the yellow rim and covering the left side of the circle is a brown C shaped figure. Covering the right side of the circle is a black figure; embedded in the black (lower right-hand), the word “WHAT?” is printed in green and orange letters. Above it is a brown grate, shaded in with a lighter brown. A small red sperm-like object is in the circle, and the word, “eek” is written outside the circle. Mandala Interpretation. The mandala (below) has a sperm of red in the center. This is rather good in terms of impregnating with chance of change or using the red rage space to throw light on another area. This area is shitty brown on the left and black despair on the right surrounded by inflation yellow. I rather think this is good from a therapeutic standpoint. Seems to be a confrontation with these areas.

Cheryl’s Comments on Her Mandala. Cheryl wrote on the back of this mandala: “This is pondered and constipated and gives me little satisfaction.”

Mandala. The second mandala Cheryl drew in this session is seen below. It is all red, and very heavily drawn. There are very faint lines etched out in the red, all crossing the center like pie slices. Mandala Interpretation. This one would be the angry space or the blood space or the space that she can better describe.

Session 4: November 26, 1973 Summary. The Peak Experience tape was used. Insights about phobias and reactive behavior were coming through in the session as well as in preliminary and post verbal sharing. The blocks or bars which she described as stopping her from acting, she was now able to see as fears--fears especially of the lack of love and attention from approving adults, particularly her mother. At one point she felt angry at me for being comforting while at the same time she desired it. When asked what was most important: being important so as to be noticed, or simply being herself, she could not make a decision. This session showed more willingness to work through a problem. Cheryl was becoming more patient than she had been in former sessions. Mandala. This drawing below is a circle heavily colored with turquoise blue; the circle contains an olive green figure.

Mandala Interpretation. In the mandala above, there is a light behind the intruding floating shadow. This seems to be another experience of the mother or woman part of herself, but more of a blending of the two sides of it, the green is rather ominous in terms of the dark forest where the witch lives. “Between the impulse and the response falls the shadow” (T.S. Elliot). Session 5: December 12, 1973

Summary. Music for this session included the Peak Experience, Affect-Release, and Positive Affect tapes. This session seemed to be a tremendous breakthrough on several levels for Cheryl, especially in the area of affect release which led to a new acceptance of herself on both the mystical and practical levels. The steel girder appeared again, but this time it turned into glass, and then a metal horseshoe. Complaining about her eye and head hurting, she said, “I give myself a headache.” She felt frustration with the steel girder, saying, “Maybe it is always hanging out there.” She shook the girder and it turned into a mirror. When she tried to grab it, it spun away. The musical tape, Affect-Release, was played and she was encouraged to struggle with the girder. I grabbed her hands and suggested she push with all her strength and cry out whatever came to mind. She finally was able to yell, “Get out, I don’t need you,” again and again. Pounding the pillow, she yelled, “Don’t come back!” The Toccata and Fugue by Bach, was played to help facilitate a renewal of energy, strength and self-esteem. After the release and inflow she appeared to be relaxed and happy. To the playing of the Positive Affect tape she said, “This is important. I’m in charge now. I don’t want to fight all the time. I want fun! It feels like stars shining through a dark night--God shining down on me,” she said. “I experience my body.” With this she lovingly touched various parts of her body as if she were getting acquainted with them for the first time. At the end she said, “Each new piece of music is like a gift! Resolution and joy!” Cheryl’s Post-Session Comments. When I first began the session, my body was really resisting a lot. I kept coming back out of deep inner states in which I felt very relaxed and deep. I suddenly wanted to fly so I just flew up, surrounded by darkness to a kind of universe...of just black, up in the sky, but not close to the sky. I just suddenly took a leap like a frog swims. You put your hands in front of you and push the air aside. I suddenly shot forward into this big thing. A big girder, a steel girder, black. I told Helen and she said, “What’s it doing now?” And I said, “Its spinning.” It was very cool, a very cool girder--it definitely was alive, and it definitely was a force. It just wasn’t a piece of steel, that’s for sure. Very cool, very remote, very strong, I thought at the time. It turned around to show me a side of itself, to preen itself like a peacock, or something. It was turning around and then it just started spinning around faster and then just spun off, and the girder was on my left, actually in the same position as my headache. Helen said, “Just let it spin,” and so I didn’t try to hold onto it. I just let it spin away and it felt good for Helen to say it. The next thing I think that happened was that I started to get angry. I just felt angry because the girder spun away. I don’t know, but I felt angry. Then Helen said to let the anger build, and so then we started pushing on the pillows and against Helen. I couldn’t push hard enough. I really wanted to. I just really wanted to throw my body around and yell, but I didn’t want to do that with another person there. I felt like a wildcat, and I felt that enough of it had been released even though I felt that I wanted to express it more physically. I could have jumped around, but that would have broken the flow of being with the music. I really felt very primitive and animal, but I was embarrassed to make those sounds without some kind of prompting, and I was glad that Helen prompted me. She said, “Who are you angry at?” And I thought automatically of

my mother and my two sisters. “Get away and just leave me alone,” I kept saying. “Get out of here, get out of here, and let me do what I want to do.” I have this awful pressure to act out whatever people expect me to do. And I have always been aware of other people’s expectations. I decided that was damaging and decided to let all of myself loose. I felt pouty and I felt childish, and I was talking like a child. I was in a rage, it felt like letting off steam and that felt really good. Then I started to fly and bumped into this girder, and I fought and told it to get out of here. It went away slowly, but I knew it would come back. I felt equal to it. It felt automatically easier to deal with. I felt strong because I had the experience of telling something to get out of my life. I then concentrated on flying and not falling. I wanted something to help me fly so I remembered something I learned in acting class the week before which is called “leading center.” You focus on the center of your chest as being the center of yourself, and then place that center about a foot or two in front of you. You then have that center draw you along. It moves first everywhere you go and you follow it. Not something other than you, it’s you, but you’re not focusing on your body. I felt fine. I was following my leading center, but I was also setting my leading center into motion--it wasn’t an independent thing. All of a sudden, in a flash, the leading center turned into this machine. I saw this machine clearer than anything I have ever seen in my dreams or elsewhere. I was really glad for this machine, and was delighted to see that it was in working order and oiled. I was excited to see that there is an amount of me that if I keep in working order, will function for me. There are certain parts of me that have just to be gotten in order like a machine. It’s all got to be together. I’ve got to give it fuel and it will work for me, and then I can just enjoy life. Then I looked up into the sky and into the black and the darkness and I saw the white light, perhaps it’s not cosmic. It was cloudy and nice. I looked at the sky and it occurred to me that the blackness of the sky is just covering all that white. The brightness is behind the black sky and stars are part of the white shining through at the world. In other words, the sky is not it, but is in front of it. All of a sudden, I was aware of one of the stars shining on me right at the top of my head, like a beam, and I was standing there really liking it and thought “Maybe that’s God--God patting me on the head.” And then I decided to do this for myself. I decided to touch my own body. I patted myself on the head, but it felt nicest when I imagined it to be another person...God. This idea is kind of difficult to express. I want to express it profoundly and as clearly as it was expressed to me then. I had to make myself somebody else in order to love myself. My hands became God’s hands--it felt really good when it was another person. When I got into my hands, when I was my hands feeling my head and giving affection it was good, but I couldn’t be the receiver of the affection. I could be the lover and the loved. Whenever I needed affection I didn’t need to look to someone else for it. I could just give it to myself. I had time to love myself as much as I wanted or as much as I found at the time that I needed. I touched many parts of my body very lovingly, parts I didn’t love very much like my chapped lips, or knees, or parts of my eyelids always twitching. I just felt it with great love. Oh, that’s you, Cheryl. It’s beautiful. It’s you. Then

Helen said, “Just absorb the music and get strength from the music,” and that was really nice and I would let the music flow in and go to different parts of my body--the strength of the music in my arms or in my chest or in my pelvis or my sexual organs. It was just to experience great strength from the music. And I realized that some people’s bodies feel strong like that all the time. My body doesn’t have to feel nervous or the way it does now. It can feel any way... Mandala. The next drawing she did is ringed outside its main circle with purple curved stripes and the main circle is outlined in a bright blue. At the bottom of the circle are layers of raindrop shaped objects: the central raindrop is white, encased by blue, encased again by light purple, and finally encased in dark purple. The sprouting vine-like figures are also dark purple. To the left of the raindrop is a pink area. Throughout the circle are differently shaded areas and swirls in light greens, blues, and purples. A bright yellow circle sits prominently at the top center of the circle; a bright red bone-shaped form sits prominently at the left; the inside of the circle is covered in light green swirls. Mandala Interpretation. This mandala is very beautiful and is expressive of an encounter with the divine mother in violet or unity experience or wholeness or whatever you choose to call this experience. The sun at 12 o’clock is a very good sign, as well, and is a good omen; the green is lighter and tendrils of the tree or vine of life extend into all creation. Very good; the only negative thing in it is the bone in blood color hanging from the vine on the left. This appears to me to be an old trauma, sexual in nature because of the blood connotation, which would imply either removal of an organ such as abortion or the penetration of her organism by an outside organism such as a rape.

Session 6: December 12, 1973

Summary. Cheryl requested to talk this session rather than have music. She felt that in the last session she had been able to go deeply within and that, as a result, much material had been brought to the surface. She stated that she now felt she had a new ability to be objective, both interpersonally and personally. She felt that it was within her power to resist the commands and demands of others, and to control the compulsions within herself that lead to inner conflict and a lessening of energy and accomplishment. It was agreed that this assertiveness reflected a natural working through of dependency, of wanting to please others and do things in a required way. She seemed to be launching herself into new ways of being--a scary and difficult process. She spoke of her sexual relationship with her husband, saying that she is often frigid when the act of sex is in progress. She spoke frankly of her attraction to certain women, and her fear that this entailed sexual overtones. Although she has had no sexual intimacy with women she stated that she has dreamed about the possibility. She seems to confuse sexuality with a need for warm human relationships and nurturing which she missed having when she was a child. She spoke of a new interest in and practice of meditation and chanting which is more satisfying to her than her Roman Catholic background. Through these experiences she has come to a more satisfying realization of God within. The latter part of her experience of last week, which dealt with the stars as patterns showing through the darkness of the great light beyond, and the star which shed light on her making her feel warm, complete and wanted; these she saw as a part of her new religious experience. She is exhibiting a new image of herself as being good and desirable. She claims that how she looks, the clothes she wears, is more important to her now than has been the case in recent years. Mandala. The drawing from this session is ringed outside its main circle with soft stripes in light blue, pink and purple stripes and the main circle is outlined in orange and turquoise. There are lightly shaded areas throughout the inner circle and sprouting from the bottom of the circle is a flesh-colored rose with its leaves colored variously in pastel colors. Prominently featured are a red blotch at 9 o’clock, and black snake-like line that threads around the rim and into the rose, and protruding from the circle at 2 o’clock is a green stem with a greed bud that reaches out past through all of the circle’s outer rings.

Mandala Interpretation. Another beautiful one with a rose in it. However, the rose has a black stem; and because the rose is flesh color, I think this may be a way to come to grips with the trauma just mentioned. On the left is a splotch of red, again the same bloody scene. Progress: On the right is a splotch of dark green. Things are definitely at work in her, notice the snake like affair going both forward and backward, weaving and winding bringing bits and pieces to the surface. Session 7: December 21 1973 Summary. The Comforting-Anaclytic tape was used. The theme of the session was deep feelings about her mother and her family. She cried when I came into the room and on several occasions during the session itself. There were indications that the crying was for her mother as well as for herself. She thinks of her parents as dead persons. For her, it is easier to think this way than to try to deal with them. She stated that she feels alone in the world, except for her husband, and jealous of others who have families with whom they can interact. She responded very deeply to the music of the session and, during the first piece of the Comforting-Anaclytic tape, she said, “Love this music. The music feels just like me now--I feel even and balanced, I feel that I want to keep this music, and am afraid it will end.” She asked permission to have it played again. At the end of the session during the playing of Brezairola by Canteloube she said, “What a beautiful experience to have a voice like that inside my head--so lovely!” Mandala: Outside of the circle, extending to the edges of the paper is a cacophony of white, pink, blue, green, orange, yellow, red, and purple squiggles. The main circle is outlined in orange. In the center of the circle is a smaller circle, outlined in blue and divided into three sections: the middle is colored blue; the bottom, red; and the top, orange. The space in between the main circle and the center is shaded in a light blue, and features seven loops in green.

Mandala Interpretation. This one is very beautiful and seems to reflect a positive meshing of various aspects of her womanhood, as it is sort of a playing with blue. She filled in the ground as well so that it comes off as a recognition of her being part of it all in a cosmic sense and yet keeps her identity as self without diffusion. Pleased to see this one, as it reflects a positive experience. Cheryl’s Comment on Her Mandala. “It’s beautiful, I loved doing it!”

Session 8: December 28, 1973 Summary. No music was used in this session. Cheryl was depressed and lying on the couch when I came into the room. She said that she couldn’t think of anything to talk about, and then proceeded to talk for two hours. She had heard women talking in the hall and was afraid that they would be coming into the room. She said, “And I thought I didn’t want to see them.” I asked her if she felt the same way about her entrance, and she said, “No.” She talked at length about a party she had given and her expectations of the perfect affair--which didn’t come off. She spoke especially of her feeling of responsibility that everyone had a good time. As she talked she was able to relate these unrealistic expectations to her relationship with her mother when she felt obliged to keep things on an even keel so that “mother wouldn’t get sick,” and to her gut reactions when mother did get sick. At this point she burst into sobs, and cried off and on for most of the session. Her mother evidently used illness, going to bed for several days at a time, to control everyone in the family. Cheryl was aware of the inappropriateness of her continuing guilt and feelings of responsibility in present situations, but was fearful, and unable situationally to reverse her behavior. At one point I expressed my own deep feelings of sympathy about her difficult childhood. She withdrew with the comment that it was difficult for her to receive any show of sympathy and caring, and that she was not worthy of that kind of attention. Ambivalence was expressed: wanting the sympathy, but feeling unable to accept it;

aware that little by little she was able to be more open and receiving, less guilt-ridden and demanding of herself. This was the first session in which Cheryl had talked at length about her childhood. Cheryl’s Post-Session Comments: Every time I have a wish to do something, a fear stops me. Helen’s feeling for me and my withdrawal helped open up a lot of unhappy pictures of childhood...I was glad to have let myself cry when I “fill up,” instead of holding back. My husband is sympathetic and accepts that. After the last session I was angry at Helen, at my Mother, just angry. This was [at the end of the session] when I sat down to draw my mandala. I felt Helen had abandoned me. I thought the colors were ugly, but was glad I could use them. I was truly satisfied with this mandala and did it in about five minutes. I felt a degree of finality as I drew it. It felt good, both direct and vague, and uncomplicated. I knew it was unlike any other I had drawn and that felt good, too. I was hopeful I would learn a lot, suffer a lot, release a lot, grow a lot, because of the profound effect the session obviously had on me, and the change in my mandala drawing was a good sign of this to me. In a vague way I felt I was punishing Helen with my ugly mandala since I knew she liked pretty ones, though realistically I know she is, of course, interested in any expression of me. I felt I was surprising and in a way disappointing both her and my old “trying to be vibrant” self with this mandala and that felt good. I felt honest. All the way home I was angry, with no real direction. I walked in the apartment and burst out crying when he saw my face, my husband asked me what the matter was? I cried a long time and he held me. The most profound change in me due to this therapy is that I look upon myself, the way I feel, act…respond…as all right…understandable and good...It’s hard for me to leave the house, but it is becoming easier as the therapy progresses. The house is like me, I guess. The more I go exploring, leaving what I know, I’m sure of, into the unknowing, the less fear I have and the stronger I feel. Doing things by myself and/or for myself is a very new experience for me and hasn’t ceased to feel like an adventure every time I do them. I felt badly after the last session that I didn’t directly let Helen know how much I value her as a person, how much I value her deep-felt response to my feelings and environment as a child...I also value her as simply existing in the world. I feel very badly that, though she says she understands why I withdrew from her when she came and sat by me and expressed sympathy for me, I may have suppressed a genuine and spontaneous response, made her feel rejected, in a way, punished her for her response. I felt she was vulnerable, made herself, or let herself be vulnerable, and I punished her for it. This happened once before and I told her of my analysis of the situation then, but I didn’t feel as badly then as now about Helen as a person, about what I did to her in that moment, having sympathized with me; and me, as a result, having withdrawn from her. Mandala. There are four black lines that intersect in the middle of the page and extend to the edges of the paper. There is one turquoise blue line sitting on top of the left-hand portion of the horizontal line that extends from 3 o’clock to 9 o’clock. The main circle is filled with orange, green, and black squiggly lines as well as variously

colored figures, and dotted with several turquoise and black spots. The drawing is ringed outside its main circle with several dark green circular lines.

Mandala Interpretation. This one beautifully expresses her concern with soma via the flesh and death via the black, and one’s vulnerability to mortality or immortality. This is a piece that speaks of dependency needs, as well in the way it latches onto the outer ground via the black web affair. The blue, since it penetrates the mandala to the center and is sprinkled here and there, I feel is the mother presence of the therapist. There is a readiness to place trust therein. She is saying here, I feel, “I am letting you into the center of myself, see how afraid I am, lead me out of this trap.” I must also point out that she uses a lot of gray in this one, which is an expression many times of guilt, a dirty self, ashes and penitence. Session 9: January 8, 1974 Summary. Music for this session included the following tapes: Peak Experience, Positive Affect, and Comforting-Anaclytic. Cheryl reported that she had resigned from a job with the consumer organization. Her husband had secured a job as a mailman, and she was now able to stay at home. This was the first time in a session that she had asked for relaxation exercises. She was able to ask me to lay my hand on her head and forehead to ease her tension. She had a good time “flying” during the session and reported that there were fewer obstructions and girders than formerly. In the music session an episode in which she felt an ant crawling on her face occurred. She was able to follow the suggestion that she allow the ant to crawl around. She stated that it reminded her of a time when she felt that a bee had attacked her. She immediately went into the experience of being attacked by the bee. Utilizing a Gestalt technique, a dialogue with the bee was initiated. In the confrontation she was able to tell the bee to go away, to get away from her. This led to talking about her space, and ways in which she might be able to protect it. She felt that she no longer needed to be the hapless victim of ants or bees, or other external situations. She was then asked to go down into

the center of herself where she had feelings of worry and anxiety. The one thing she felt good about was her hands, because, as she said, “I have done good things with my hands.” Picking up on this suggestion I asked that she put her hands on the “worried places.” She did that, and said, “It feels good.” She then went through the ritual of putting her hands on various parts of her body. Bringing “peace” through her hands to her face “was the hardest.” Mandala (see next page): The drawing is ringed outside its main circle with bright white and yellow stripes. The circle is divided into two parts by a yellow stripe extending from 12 o’clock to 8 o’clock: the smaller section (at the left) is bright green and contains yellow spots; the larger section has background shading in flesh-color/light blue, with figures clearly outlined in red/purple with white centers. There also appears a formation of red detached lines in this section. Mandala Interpretation. I cannot effectively read this one, except to point out the area that is walled over by the strip of yellow, which usually tells of an area of consciousness that is unavailable because of resistance of some sort. I can only conjecture that the color may relate to home and authority. The many shapes of light yellow portend fragmentation or multiplicity, if penetrated too soon.

Session 10: January 15, 1974 Summary. Music for this session included the Cosmic-Astral tape, and the Meditation tape by Halpern. Cheryl was now feeling more at ease and was able to express her feelings with more freedom. She has discovered a lump in her breast; however, her doctor felt that it was benign. A tumor removed a year before from the throat area was benign. Perhaps as a result of her anxiety about her physical condition, the subject of death came up within the session: “calling me, death is calling me. It’s

nice to be involved in something important, something exciting is happening.” When asked what her answer was, she said, “I do not have a choice.” When, in answer to her request, I put my hand on her forehead, she said, “Good, it takes away the thoughts!” She then experienced guilt feelings which revolved around sex and death. During the playing of Scriabin, Poem of Ecstasy she experienced the following sequence of images: “I smell burning fuel.” In response to my suggestion, “Go with that,” she replied, “pain in the stomach...getting anxious.” “What’s happening to the pain?” I asked. “The pain came after I was thinking about pre-marital sex with my husband...feel nauseous as I tell you about it...the sex and death thing...a D. H. Lawrence film in which lovers drown while making love...I burst out crying when I saw it...I switch from a scene of life to a scene of death...I wish that the note in the music could go on forever...let myself go...lose myself. A fan fell on Thomas Merton when he died...like being stabbed...needle in the breast incident made me afraid...” (Breast cancer fears and operation fears are apparent here.) I covered Cheryl with a blanket while the Meditation tape played. The music brought about a change to a more positive mood. “I feel so lucky to be here,” she said. “I feel like I have always wanted this all my life. I remember when I didn’t have it; in the past I loved it but couldn’t let myself enjoy it. I can enjoy it now.” (Speaking of the warmth and caring of the session period) At the very end she reiterated: “I can do whatever I want to do.” Cheryl was experiencing very positive, pleasant feelings at the end of this session. Mandala. This drawing features a small central circle. It is outlined in bright red and has a bright white center.

Mandala Interpretation. This is an interesting one, just a white circle surrounded by red, period. I think this one is a psychological expression of an attempt to grasp the idea of non-existence, a sort of existential attempt to explore non-being and to feel comfortable by being able to conceptualize it by enclosing the red matter. I think this

has some relationship to her somatic concern and the whole thing she is dealing with on a micro-basis in her own body. Now if there is nothing seriously physically wrong with her (and I don’t think there is anything seriously wrong with her physically), then she really has to come to grips with her fears regarding mortality and this means formulating some kind of philosophical framework regarding death, and this means further developing some sort of framework for life. This is what she has been avoiding, and her body has been her co-conspirator in coming up with physical emergencies to prevent her from making changes that would permit her to live in the way she is meant to live, and this may be different from her present way. Session 11: January 22, 1974 Summary. One day after the previous session, Cheryl called to say that she had seen the surgeon about the lump on her breast. He wanted to remove it immediately. She wanted to wait, to explore other alternatives. She was counseled to postpone the decision for surgery until her ambivalence could be further explored. Cheryl came into the session anxious about the cyst on her breast and uncertain as to whether she should have it removed. A visit with a medical doctor on our staff was arranged for a “medical opinion.” The interview was helpful from a medical and from a psychiatric point of view. She gained an insight from this visit: the cyst felt like punishment for doing well in therapy and for wanting a baby. After the interview she felt much relieved and better able to make a decision about the removal of the cyst. The Peak Experience tape was used for this session. Her previous work with the music had given her encouragement that: “I can do what I want to do and nothing can harm me.” Session 12: January 29, 1974 Summary. Music included the Cosmic-Astral tape building to Peak Experience. When Cheryl arrived for the session she expressed anxiety in the form of criticism of the manner in which I was handling her sessions. She was petulant, demanding that I be sure to start the session on time, to inform her when to begin the music part of the session; in general, she was acting out in a childish and belligerent manner. After getting into the music, it was apparent that her resistance was fear of rejection mixed with selfpunishment. During the session, Cheryl became cold and frightened. I covered her with a blanket and held her close. She accepted the warmth and closeness that she claimed was a beautiful release for her. At one point there was a pleasant memory of an early life experience when she felt at peace and at home with herself and with her environment. This breakthrough during the music allowed Cheryl to receive the warmth and closeness which was offered, enabled her to experience a trust that she had not dared to explore before. Resolution and an afterglow were apparent. The lump on the breast would be removed on Thursday. Mandala. Outside the main circle, extending to the edges of the paper is a background of black spotted by shapes (mostly circles and lines) that are clearly outlined

in turquoise. The main circle is ringed by a line drawn with various pastel colors. Within the main circle are more shapes (circles, lines, and lines within circles) that are similarly outlined with various pastel colors. The two horizontal lines at the bottom of the circle are bright red.

Mandala Interpretation. This one reminds me of a slide for the microscope. It might reflect her concern with body and the vulnerability to outside bacteria, all of which are female--by that I mean purple or blue, which would be saying, “My womanhood makes me vulnerable to all sorts of danger.” The big thing seems to be to awaken her to the deadly nature of passivity. In living out this passivity and feeling herself a pawn, lies her danger. There may have been some altering of consciousness during this session because of the willy-nilly color surrounding the circle and white luminous shading. Cheryl’s Comments on Her Mandala. “The white trying to get through the dark purple feels good, as well as the white around me. The white spaces around me are pockets of good things possible for me. I got fun out of making the circle around the mandala different colors.” Session 13: February 4, 1974 Summary. The cyst on Cheryl’s breast had diminished in size and she decided against its removal. Success in a class (a presentation) had reinforced her recent feelings; “I can do what I want to do and it won’t hurt me.” She expressed feelings that she was boring me, and that perhaps the sessions should be terminated. Music for the session included the Imagery and Peak Experience tapes. In the music she continued to report the problem of “bumping into things” when she “flies.” The remainder of the session dealt with images symbolic of sub-personalities (Assagioli, 1965). One self she identified as her old self, which was black in color. Her new self was

white. Cheryl cried for her “black” self. Although fearful of the “other” (white) self’s needs and resistances, she was finally accepting of both selves. She decided that neither the black nor the white parts of herself could overpower her. “I’m like two people,” she said. “One of me is here looking down on my other self and crying for her, pulling her to me. She’s black. I don’t want to lose her. She’s dying. I kiss the black hand, and get black on my lips. I draw back but feel that it is part of me. Death comes to all.” “The white lady is in control--the giver. She will decide things; she is magnanimous. She is kind of unreal, goody-sweet. I don’t like her that much. Neither of them can overpower me! Glad of that. The white one is not in control either, like a man, on top of the black one, as to make love. I’m glad to be getting some male in me. The black one is like a child; white one is like an adult. I don’t like the relationship. The black one is more real. The black one is on top of the white one, like a man. It’s got to be equal, to work it out.” Later in the session, there was imagery of a pretty garden. She felt independent, like she was going her own way, content to be alone. The soil was seen as black and fertile, and plants could sprout. Holding the “sick” part of her body, she imagined the cyst being absorbed into her body. She saw the cyst as white. “It is okay to have it absorbed.” At the end of the session, we discussed her feelings of disapproval of the sexual parts of her body. Mandala. Outside the main circle is a dark purple line with a colored-in dark purple circle at 1 o’clock. Small pastel figures (bone-shapes and circles) dot the outside of the circle. The main circle is outlined with many colors--heavily on its right half with black; heavily with mustard-color on its left half. The main circle is filled with a grate drawn in blue, purple, and green as well as clearly drawn shapes (circles, and half-circles) in purple, green and black. There is one black square with black rays extending from it located near the bottom of the circle at 7 o’clock.

Mandala Interpretation. This one is very disturbed and must reflect her confusion. The important thing to notice is the negative feeling about her breasts, which would make them perfect target areas for disorders. The large green one is the dark forest green which is the place where the witch lives, so would be full of poison, so her own breast memories would be bad, downright poisonous. The upper one is black which would be a destructive attitude to breasts, and the opposite of nurturing. This is interesting in view of the need for operations seen in some women--the preoccupation with female organs. Perhaps she has incorporated this image into herself, in such a way that would make her hate her own breasts or her womanhood. The ambivalent feelings as regarding males is apparent in the blacking out the right side; and the black square at the bottom radiating destruction would be her reaction to accepting a female role that, to her, is a door to death. Her mother, whether living or dead, is still operating via the satellite spinning around the outside, and is incorporated inside as well; a lot of feeling is tied up in this person. Now the one positive sign is the red lines in the center, and they give the clue that she is actively engaged in working this out; but, it has to be an active role. Her life is completely in her own hands and she does have the ability to sort it all out, but she has to initiate the changes and not get back into the box. The greatest disservice that could be done to her would be to have her adjust to circumstances. Everyone in her circle--parents, husband, doctor want her to adjust, but her own soul knows the way out; and it is in exercising the male part of herself, or the active part of herself, that salvation lies. Session 14: February 19, 1974 (2½ hours long) Summary. The Comforting-Anaclytic and Peak Experience tapes were used. Cheryl was coming to terms with her new sense of self. Although there was still a war between her old ways of struggling to try to be and the new way of being herself, in this session she made good progress. She lay in the music for a long time content to just be; she felt “closer to the music” than before; the new “creative me” was painful but she was accepting it. “I’m fond of what I am and I don’t need to change it.” She worked with an image that helped her understand “that I don’t need to know how other people feel about me.” The black box (in two former mandalas) bothered her, but she did not feel as yet ready to open it. “The black boxes are what is hidden--they have locks on them,” she said. “I try to pry them open and what is inside gets all damaged.” She was reassured that the boxes would open when it is time. At the end of the session she stated: “I feel I can be practical; I can accept this for what it is and not want it to last forever.” Mandala (see next page): The mandala contains a figure comprised of a pink/orange line; there are three light blue lines that extend upward; each line is connected to a bright red circle.

Mandala Interpretation. Here we have the three, the drive to activity, the creative function. When she expresses this, no black appears. Apropos to this is the number three, indicated in this one and also, in the red division above. This is a male number and is an active principle, and thus would indicate the way out of the dilemma. Session 15: March 12, 1974 Summary. The Imagery tape was used. During the pre-interview Cheryl listed five areas in which she was noticing a change in feeling and behavior: 1. Attendance at daily Mass, a return to former religious beliefs. 2. Exploration of the possibility of having a child, dealing with the responsibilities involved and asking herself whether she is ready to accept these. 3. Ability to become involved in reflective thinking versus the obsessivecompulsive thinking of her former self. 4. Ability to rest, reflect, relax and listen without feeling guilty about her “inactivity” during a time of illness. 5. Better ability to express ideas and share insights in her drama class. Questions regarding her sexual identity and sexuality are coming to the foreground. In this session she reviewed how she feels about women: her need for them, the comfort she felt when she slept with a younger sister, a homosexual scene in a recent dream; conflicting feelings she has about me--anger and warmth. Mandala. The main circle is ringed with a green vine with small green and red leaves. The inside of the circle is colored with a black background. There is a small, central circle outlined in red and colored in deep blue. The bird is drawn with bright

orange, purple, red, blue, and green. The main circle is extended at 9 o’clock by the bird’s plumage and a light blue background.

Mandala Interpretation. This is beautiful and very prophetic, the dark night of the soul so aptly shown by the black (void), rising in the center of the waters of life in the center pool. The waters of life, representative of her feminine self, and the bird whose plumage is rainbow, or very like the Mayan bird God, the male side or Fire. So the conjunction of fire and water, male and female is interesting. The phallic tongue-just ready to inseminate the egg. The peak experience is waiting in the wings (left, unconscious side). The whole surrounded by a wreath not unlike the Greeks’ wreath of green, the initiate crown. This is simply smashing. She is on her way. Session 16: March 19, 1974 Summary. Before the music session, Cheryl talked about the two recent incidents that have been on her mind. The first was a performance she had given. Although she felt confident that the reading of a fairy tale was well done, she stayed after her presentation hoping to get what she called a “true” evaluation of her performance from others. After waiting for a while, she decided that perhaps she didn’t need that kind of reassurance, that she could feel good about herself without needing feedback from others. The second incident was a dream that she had had recently which involved an old friend. After having the very vivid dream she was able to sit down and write for five hours to this friend with whom she had not communicated for many years. She felt good about this, too, because it seemed to bring her past into the present through the symbolic act of joining the past experience with her friend to her present feeling state.

She then spoke about her interest in exploring her feelings about sex in the music session. During the early part of her marriage to her husband, she found that the least close times were those when they practiced sex. More recently, her husband had been less interested in sex because of his involvement in religious forms of experience that emphasize detachment. On the other hand, recently she has had the beginnings of good feelings about sex. She described these feelings as totally spontaneous within herself and not “generated by the accepted norms of people around her.” Her interest was in finding out how she feels about sex. During the playing of the music tape Cosmic-Astral, Cheryl almost immediately began striking out and yelling that she felt angry. The behavior was encouraged. It wasn’t long until she mentioned the fact that she was glad to have had the freedom to do so. The next feeling was that of fire in her chest, and then finally, warmth. But with the warmth in her chest and in her hands she also had feelings of nausea. She had a special warm feeling in her chest that she liked very much, and asked that I exert pressure in that area. Pressure on the chest tended to release the warm feeling into other areas of her body. She then saw herself as a child and was acutely aware of the smells of her body, both the good smells and the bad smells. She stated that both good and bad smells made her feel lonely. During the playing of Scriabin’s Poem of Ecstasy, she saw a pool of water into which she wanted to throw herself. But as she got closer, she found that the pool had no water in it. This made her feel very frantic, particularly when she found a fence around the pool and a black mass within the pool itself. When asked to explore this she did, with much fear. She found it to be very slimy and was afraid that it was poisonous. She mentioned that it was full of decayed stuff, rancid and stagnant. At this point she stated that she was more frantic and she started holding herself very tightly and became more frightened. She was encouraged to go into the feelings as much as she felt that she could. When she felt a sense of blocking, I put my hands on Cheryl’s and encouraged her to not hold the feelings within, but to press them out. After pressing against my hands and pushing back two or three times she started to yell. Encouragement was given again and again to express her feelings outwardly. This was repeated two or three times and toward the end she saw an image of a huge hulk of a ship. She was able, through the physical act of pressing, to push this tremendous hulk of a ship away from her. As the ship sailed away, she reported a sense of exultation and completeness within herself. The second side of the Building to Peak tape which starts with “Salvation is Created” was played. During this piece she rested in the music and commented that she felt at one with her body. She started touching different parts of her body, feeling a sense of peace and wholeness that seemed very much like a high “peak” restful state. Mandala. The main circle is colored in bright turquoise blue. The “T” shaped object in the upper part of the circle is green; the three star-like forms within the “T” are yellow.

Mandala Interpretation. This one is blue and with a mushroom shape of dark green in the center which I feel is the environment and by the dark color rather unhappy. However, it has three window-like affairs in it of bright yellow, which I assume are ways out of her situation. She seems to be aware of these options of promise. At this point she is open to not one way, but to many ways of hope and growth. Being within a universe of blue, I would assume that it would be in expressing her life within the framework of her womanhood. Cheryl’s Comments on Her Mandala. “Feels solid and pleasurable. Want to move the green object down into the center. It bothers me up so high in the blue--like a mushroom, an atomic bomb or the frame of thoughts or words in cartoons.” Session 17: March 26, 1974 Summary. No music was used. This session was spent reviewing and discussing a dream Cheryl had had the preceding week. In her own words, Cheryl wrote: My husband, my parents and I were in a stocky woman’s house on the ocean. We suddenly realized we should go, as there was a fear of her keeping us; she was sitting, writing something (she was like a Gertrude Stein woman) and suddenly the others escaped and I was locked in. I jumped through the glass window but was all bloodied up. I thought, “No, I can’t do this--I’ll die,” so I went back inside the house (as if I hadn’t made that choice--like a “retake” of that scene, like backing up and redoing it). I read the note she had on a chair or table. It was typewritten, stating that she must keep me because she needed me. I couldn’t believe it, but there was no convincing her otherwise. She loved me and

wanted me--needed me. I felt that I might be there a long time but I was patient, not wanting to be there but accepting it. I would win her trust by not trying to run away at first, and then, sneak away. Next scene: I’d been there a while, months I think, maybe a year, when suddenly I remembered my old self and life with my husband. It was as if I’d forgotten about that life, and so, hadn’t missed it. We had wanted to have a baby. The pain of the memory, now a lost possibility, was total, and overwhelming; I cried so hard...hoping she would let me go with sympathy. But, I knew, and she knew, that she needed me and wanted me...could not let me go. It was as if I was so involved in...pretending...to build her trust in me (so that I could escape) that the time had flown by. I’d forgotten my old desires...about escaping, and about my husband... Next scene: Two years elapsed. I suddenly thought that my husband might forget me. I wanted to be with him. The game was up (somehow I had enjoyed the game of winning her over and her wanting me so much). There was a sexual feeling involved. I then noticed I was next to my bed which was right next to hers. It could have looked like a double bed. I thought: I hope nobody thinks we are lesbian. Then I thought, as if watching my dream, hmmmm...are we? Is this a relationship? Do we sleep together? The stocky woman in Cheryl’s dream became a nun. In the next scene she was having a party for her nun friends, one of whom Cheryl knew from her high school days in a parochial school. The “big” nun was proud of Cheryl, introducing her around. This allowed Cheryl to whisper to several of the nuns she knew, “I’m kidnapped. I don’t want to be here. Help me, tell the police.” She had a hard time convincing the nun that she did not want to stay and that she wasn’t there of her own accord. I was frantic because that had been true in a way. (She had forgotten to escape.) I’d just discovered that I wanted to leave, discovered it urgently, and was embarrassed that I’d stayed so long and forgotten to escape--the escape was always an idea off in the future, while I enjoyed pretending I liked it there. The nun friend agreed to tell the police. “Thank God,” I thought, “I’m free.” The “big” nun knew, too, that I was free, but there was nothing she could do. Comment in my diary the next day after writing up the dream sequence: “Oh God, what does this all mean? This is an allegory of my separate battling selves. I pray I know the key, the answer, the translation, so that I can be freed. I want to be freed!” Note the next day: When I suddenly thought of the woman today, she was round in a baby-faced way--the way very fat people look like babies, but also I thought--“What a big baby that she needed me so much that she was content with my false love.” As Cheryl shared her dream there were tears and a reaching out for support; fears of her new, bolder behavior and how it is affecting her husband and those around her. She is more expressively aggressive. All of this is indicative of a working-out period for Cheryl, an outward expression of inward change.

Session 18: April 2, 1974 Summary. No music was used. This session was an integration of recent insights. Cheryl was in a happy, bright mood. She spoke of new experiences of being herself in situations: expressing anger she felt at being subjected to a boring concert, religious conflicts resolved through meditation and mantra. She stated often: “I am who I am,” expression of the feeling that by being herself she does more good in the long run than by subjecting herself to the will of others. This bears out the learning from her dream of the last session. Although she is nearing the end of therapy, she is hesitant to discuss it, to see the end of it. There are still some feelings about dark areas in her, which now are “attached and available to me when I want to ‘work on them.’” Mandala. The main circle is outlined with a thin green line; the lines extending outward from the circle are black; the figures attached to these lines (an eye and several splotches) are also drawn in black. The main circle is “squared” inside by a bright blue square. Most of the forms are drawn in blue; including the water-like form at the bottom (the water contains a bright red line at its bottom left-hand side). The circle in the upper left-hand corner of the square is green. The word “OH!” and the lines extending outward from it are red.

Mandala Interpretation. This is difficult to figure out, but appears to be an expression of squaring the circle. I rather think the black serpents of doubt were added last. By squaring the circle, I mean intuiting real changes possible (square), within infinite possibilities (circle). Now this takes great courage to do; the alternative is to just dream changes and to live in a dream world. Consequently when she tries to adjust things on the physical plane, she immediately has these serpents of doubt to assail her-notice the very paranoid eye of the one on the left. These are no more than vestigial eyes of the avenging mother, implanted in her own unconscious, programmed guilt about doing anything about things. Evidently she was constructing a more compatible

way to be in this world and her stricken “OH” is in response to the unintentional arousal of the serpents. Do notice that the water of life is in her projection of how things could be. Session 19: April 9, 1974 Summary. The Death-Rebirth and Peak Experience tapes were used. This session included integration of some of the many experiences Cheryl has encountered and dealt with in recent months. She is involved in bringing the two areas of her life, past and present together. Therefore, the insight that the music made her feel realistic, “between joy and sadness, between nothing and everything” was significant. She claimed to feel very good and was hungry at the end of the session. She went into the music to discover religious insights and, at the end, she felt that she had. The need to open her eyes at times she interpreted as symbolic of her need to “see ahead on her own,” free of dependence on her therapist and others in her life. Mandala (below): The main circle has five elements. The large area on the bottom is colored light green and contains a large arrow that is turquoise. A yelloworange line divides the circle. The top area of the circle is shaded light pink. The dark area on top of the circle at 12 o’clock is bright red.

Mandala Interpretation. This is a reflection of a new nucleus, or birth of new self or new nexus to grow around. It is a vibrant shade of rose red, which would imply a great deal of primary energy. It is interesting to note how she is frightened by the arousal of this from the bottom, which would imply a rising out of her. It is viewed positively when looked at as coming from above, relieving one of the responsibility for it,

so to speak. One could say, “It hit me like a bolt of lightning!” A certain readiness on the part of her seems to be ignored. The blue arrow seems to be interesting in terms of backbone, the color being feminine. The green is nice in terms of joining of male and female, apropos of the bird mandala, fertilization taking place. The orchid is very transpersonal. The most positive thing is the absence of any negative mother. Post-Therapy Report Within a week of her last session, Cheryl was called home because of a family emergency. Her mother, who had periodically been hospitalized for depression was again ill. Cheryl went home, and without resentment, was able to be supportive of the family, arranging for doctors and for a short hospitalization for her mother. She continued to stay on for several weeks after her mother’s return home. She called me on several occasions during that period. At no time was she depressed; instead, she experienced euphoria, pleasure at seeing herself able to function this well in the family situation; a new experience that contributed to her self-esteem. For two months, July and August, I was in the hospital. My illness posed an interesting problem for Cheryl who had by this time established a strong mother-child transference. Excerpts from her letters reveal her conflict and how she dealt with it: When I heard you were sick, it took me a long time to write you. I was afraid. How I felt about you didn’t match with how I must relate to you. I mean I felt that I must write to you as a child to its parent and how could I comfort you, or send any of my serious thoughts, which I respect, thinking them of any help to you, as I felt the child. But I had to have the courage to change the relationship, as I have changed. (I feel equal to you now Helen, in the sense that I respect myself.) I hesitated to share my thoughts about your present struggle because I just feared they would appear false (affected) and trivial to you, you who have been caring for me. This action of mine, responding to inner truth has strengthened me, and even now, so soon, I feel glad to be rid of the child who made me feel so uncomfortable, so cow-towing. Playing a role of needy but beautiful inferiority. This is what happened--abstractly, but this is how it strikes me--though these are only words: the child pushed forward into a higher level, a stronger, natural next step. I feel relief because this next level is more wholly me. But I understand sympathetically and with understanding affection, the child, and do not harbor any loathing, but only sorrow at the discomfort (but necessity) of that position; and joy for the push forward, the jump, the fly up to this next...can’t explain it, the words aren’t full enough for the feeling. When I first heard you were ill--the first moment--I prayed for you. I loved you deeply and was deeply upset at your state, though I only had a vague idea what it was. Then, I thought of you guiltily--I should write, but I don’t want to. I feel uncomfortable writing her, feel dishonest, feel “bad” inside me, a self-denigrating kind of feeling. I tried to pray for you, but felt like I didn’t care about you really. I prayed on principle, though the feeling of affection and care was blocked. I felt like I was

punishing you. Then after a few days I pushed through that and called...I feared I wouldn’t be “good enough” on the phone for you. It would be a burden to you to hear from me since you were in need and here was me whose relationship with you was to “take from you.” But I said, “Fuck that fear. It’s my own crazy insecurity, I’m challenging this feeling of inferiority with Helen and to my own heart I’ll be true and tell her what I feel--advice and affection or whatever, because it’s truly me.” So there have been two “push-throughs” with regard to you. Two important ones. Post-Therapy Research Interview: August 26, 1974 Cheryl had returned to school to complete her master’s degree. A paper she wrote as a prerequisite for the degree was highly rated by her instructor. She planned to direct and/or act in a play, a story of the “to be sainted” Mother Seton, an autobiography which is based upon the theme of personal and spiritual growth. Cheryl felt confident in her ability to project this character; reporting that she feels that she now has something to give, something to share with others. During her post-therapy interview with our staff, Cheryl declared that a major change had occurred in her life. In the therapy itself she felt really loved and accepted by her therapist and that no demands had been made upon her. The psychologist who rated Cheryl’s interview found her relaxed and spontaneous. She made no effort to please the interviewer (in contrast to the preinterview). She was comfortable in her feminine role, i.e., was dressed more attractively, was not averse to becoming a mother herself. Interview: December 1974 Cheryl called for an interview. She made the trip from New Jersey to consult about a “personal problem.” There was a noticeable change in her physical appearance: she was more poised and more feminine, attributes which added a new dimension to her beauty. She spoke of the very successful production of the play and of the growth she had experienced as a result of her portrayal of the lead character. The area mentioned was in religious depth and personal forthrightness (ability to act from the point of her needs). The latter, she said, was responsible for a freer sexual responsiveness. During the autumn months she had been able to reach sexual climax with her husband. Her new responsiveness had attracted her to the lead man with whom she was having a flirtation. She was worried about how this new relationship would affect her marriage. She was encouraged to bring her husband for a second interview. During the interim her husband had mentioned his own need for therapy. The opportunity to air their feelings seemed helpful to them both. They were encouraged to see a marriage counselor in New Jersey. Cheryl mentioned one area in which little or no progress had been made: a physical tic, sniffing, which was socially embarrassing and which came upon her when she was under stress.

Two Year Report: September, 1975 It has been two years since Cheryl’s first therapy session. She claims that the effectiveness of her work has continued to stay with her. It is apparent that most of the goals for therapy that were delineated at the beginning of therapy had been dealt with. These were: reduction of anxiety level, uncovering of guilt feelings, dealing with phobias, alleviation of sexual fears (homosexual) and promoting a more positive feminine identification, and the establishment of a more positive concept of self. Postlude GIM seems to provide the setting within which it is possible for the processes of regression and maturation to be mutually supportive as in no other easily accessible form of therapy. In other words, GIM may enable the client to easily retreat and advance without the usual conflict that accompanies the struggle to grow. This process may manifest itself in several ways. Growth in self-esteem may be slow and tortuous in some forms of intervention but in GIM it may emerge with a minimum of stress and a maximum of freedom as the responding self is set free from the usual modes of self-assessment. The priority of the self responding freely to the musical stimulus tends to assert itself with less of the inner struggle and conflict that other modes of inner change might create. The processes implicit in GIM tend to produce a unification of being, a holistic sense, that is moved toward its goals by the musical movement. Musical language may have the capacity for self-integration at the same time that the self is participating in the experience of creative listening. It is not unusual for participants to evaluate their experience as being put “all together.” It is an interesting aspect of GIM that the creativity implicit in the music itself seems to communicate a creative impulse in the guided listener that broadens horizons for viewing problems. This stimulates the element of creativity so that new insights to old problems are found. New skills emerge, new talents assert themselves, and forms of initiative in problem-solving manifest themselves. The process of growth is aided by the creative insight of the guide. These several responses to the musical process give an indication of the breadth and range of the psychological movement that can take place under GIM. The skilled therapist will find that the greater the perception and skill of the guide, the more manifest may be the client’s responses. The rapidity of movement stimulated by the music may provide economy of time along with a degree of safety that comes with the self-monitoring of the client. Movement is determined by inner sensors that go as fast as the person is ready to go. In addition to economy of time and safety of method is the fact that it can easily be adopted by or adjusted to most other forms of therapeutic intervention. Reference

Assagioli, R. (1965). Psychosynthesis: A Manual of Principles and Techniques. New York, NY: Hobbs, Dorman & Co.

Taken from: Bruscia, K. (Ed.) (1991) Case Studies in Music Therapy. Gilsum NH: Barcelona Publishers.

CASE THREE Embracing Life with AIDS: Psychotherapy through Guided Imagery and Music (GIM) Kenneth E. Bruscia Abstract This case describes individual psychotherapy with Matt, a 26-year old man recently infected with the AIDS virus. In the eleven sessions, Guided Imagery and Music (GIM) was used as the main technique within a psychodynamic orientation. Through an intense process of imagery transformation, Matt gained insight into how traumatic events from his past prevented him from coping with the emotional challenges of living with AIDS. Ultimately, this led him to confront one of the most important questions of his life: Shall I live dead, or shall I die living? Background Information At the time we met, Matt was 26-years-old, and had been diagnosed as HIV positive just a few months earlier. I remember our first meeting quite vividly. When he shook my hand, I could feel him trembling. He was tall and gaunt, and had dark circles around his eyes. He looked scared and worried, and smoked one cigarette after another. When he smiled, he had to visibly work the muscles in his face. Sometimes I caught him looking at me to see if I was looking at him. Matt complained of dizziness, tremors, nausea and fever, for which he was taking several different medications—in addition to AZT (an anti-viral drug for AIDS) and Xanax (a drug to control anxiety). He talked about his symptoms and medication needs in a very serious way, almost as if he needed me to know how much he was suffering, or how sick he was. Perhaps he was trying to tell me how much help he needed. I felt uneasy because, in fact, I was wondering if he really needed to take so many things, especially since many of his symptoms can be side-effects of Xanax (Schatzberg & Cole, 1986). I was also worried that he might be relying on drugs to fix (or numb) everything in his body and thereby relinquishing responsibility for his health to doctors and medicine. Matt had stopped working, and in the last few months, had also stopped going out altogether. He was “petrified” of passing out on the street from dizzy spells, or having a full-blown anxiety attack with other people around. Apparently, he spent most of his time at home watching television, trying to distract himself from his ruminations and fears.

Matt told me that he had contracted AIDS through his work as a hemodialysis technician in a nearby hospital. He said that on several occasions he had stuck himself with an infected needle. As he told me these things, the tone of his voice became quite emphatic, even clipped. It sounded like he did not want me to assume that he had been promiscuous or that he used drugs. It upset me that he might worry about such a thing, so I tried not to change my facial expression or body language. I wondered if he had already experienced blame from others. I thought of all the people I know who justify their detachment from AIDS or their negligence of those who have it by simply saying, “They deserve it!” On the other hand, he himself may have feelings of guilt and shame. Maybe he feels he deserves it. As Matt continued, I had to change my body position to let go of some of the tension building. Matt has been in a love relationship with the same man for six years. They live together, and Matt feels their relationship is quite strong. John is ten years older, and has a Ph.D. His results were negative on the HIV test. Right now they are having serious financial problems because John has just lost a high-paying job as a hospital administrator. To make matters worse, Matt’s current insurance company refuses to cover his medical expenses. Matt changed jobs (and insurance companies) before being diagnosed, and now neither company will take financial responsibility. Matt has also been refused Social Security benefits and welfare. Understandably, his face was filled with anger and frustration. Matt then shifted the conversation to his family. He has already told them all about his situation: that he is gay and that he is infected with the virus. I was relieved, for this is not always the case: many men like Matt face AIDS alone, without the support they need from loved ones. Matt is very close with his two sisters, and talked at great length about them and their children. Then becoming rather terse, Matt described his mother as a “dominating bitch,” and said he has an ongoing battle with her. He then described his father as passive and uninvolved, and said no more. I then asked him what he would like to accomplish in our work together. Matt replied: I get these terrible images... I can see myself dead... It feels like I am falling backward into a deep black hole... I live in constant anxiety, dreading the minute that they will come back... When they don’t go way, I go into complete panic... Sometimes I imagine John sitting beside me, and that helps to calm me... After the images go away, I get very depressed... I can’t live like this. I was moved by what he said, realizing more each moment how desperate his cry for help was. I also realized that his trembling was more than a body symptom: his whole being was shaking. I began to explain how Guided Imagery and Music (GIM) works: that after helping him to get relaxed and focused, I would put on a specially designed tape of music that would stimulate his imagination; that while listening, he might have body sensations, visions, feelings, memories, fantasies, or any variety of internal experiences;

that while he was imaging, we would have an ongoing dialogue which I would transcribe for later reference; and that I would be with him throughout, helping him to explore his inner world in whatever way he wished. We talked about the possibility of his fearful image coming up, and that eventually he may need to confront it. Matt felt willing to take those risks, if someone was at his side. Treatment Process Moving into Imagery After preparing the space and making both of us as comfortable as possible (Matt lying on a floor mat, and me sitting beside him), I asked Matt to close his eyes and to start breathing deeply. I then led him through a relaxation induction that I created based on our previous discussions. It involved having Matt imagine a ball of light moving through his body and making each part feel “strong” and “alive.” I took this approach for several reasons. First, I was worried that closing his eyes and experiencing the darkness would trigger his fearful image of falling back into a black hole. Thus, focusing him on a light would help him to illuminate or move away from the darkness. Second, Matt expressed such fear over “falling dead,” that I felt that he needed to perceive himself as strong (in control) and alive in order to relax more fully. Third, I purposely used a “see-feel” sequence in the induction (i.e., see the light, feel strong and alive), because in our previous discussions he had described his experiences in this way (i.e., seeing himself dead then immediately feeling himself falling backward). Following how someone sequences their sensory channels to process their experience helps to build rapport while also facilitating inductions to an altered state of consciousness (Grinder & Bandler, 1981). I selected a GIM tape program that is commonly used for a first session. It consists of six musical selections (which are cited in italics below), lasting a total of 42 minutes. As each piece is quite different in instrumentation, mood and style, the tape has the potential to evoke many different imagery processes (visions, memories, fantasies, feelings); and since each piece is relatively short, the tape also allows the imager to move in and out of each image or process as desired. By encouraging the imager to explore different areas and layers of the imagination, the tape is useful for clinical assessment. The Imagery Preview Often GIM sessions present different chapters in the person’s life, with the first session giving a preview of the entire story about to unfold. This was particularly true with Matt. Images from his first session set the stage, painted the scenery, and introduced the main characters of his life story. In the ten weekly sessions that followed, these same images returned, transformed, generated new stories, and clarified themselves continuously—as if they were speaking to Matt’s psyche with insight and loving persistence.

Matt’s began his story alone—stranded on an island. The opening sections of Ravel’s ballet, “Daphnis and Chloe” set the scene. {Note to the reader: The italicized sections below are taken from session transcripts. Brackets have been used to enclose my interventions or observations, and titles of the music being heard. Ellipses have been used to indicate silence, passage of time, or irrelevant segments of the transcript.} I am walking along a deserted beach...alone and stranded... I can see a huge rock ahead, blocking the shoreline...[Allegretto from Brahms’ First Symphony begins]... I want to walk around it and get to the other side... but I don’t know how... [Take a good look around]... [The “Gianicolo” from Respighi’s “Pines of Rome” begins]... Gulls are hovering over the edge of the rock, way out in the water... I can’t get around it in the water... I have to walk inland...I’m climbing around the rock... I see a cave that looks like a big black hole in the ground... [How do you feel?]...lam scared... But I’m OK—there are iron gates blocking the entrance... I am walking past the cave entrance... I see an old dead tree that has fallen to the ground... Its roots are all sticking up... Its trunk has been burned and there is a hole in it... [The “Sirenes “from Debussy’s “Nocturnes” is playing]... It’s getting dark and starting to rain... I don’t think I can get around this rock... It seems senseless to go on in the dark... I better go back to the beach... I’m walking back... [How are you feeling?]... Really frustrated... and anxious. I want to get off this island, but for some reason, I can’t... [Tschesnekoffs “Salvation is Created” begins almost inaudibly] I’m back on the beach... [How does it look now?] Over the water, where the gulls were, I can see people dressed in black, floating and hovering in the air... [Notice anything else?]...I’m looking all around... Oh, my God... Two men are coming to rescue me in a boat... I can’t see their faces, but one is dressed in red and the other in blue... They’re taking me to their boat... They don’t have faces... [Pachelbel ‘s “Canon in D” begins]...I’m getting in... we’re leaving... I’m looking back at the beach... I see a small child that we’ve left behind... and a huge black bird is perched on the hill behind him, looking down... We are reaching the mainland... The blackbird has followed us here, and is hovering over us... I’m going home now, where I can be safe. As the tape ended, I helped Matt to return to waking consciousness. In our discussion of the imaging experience afterwards, I encouraged him to react to whatever affected him most, while also focusing him on aspects of the experience that I felt were significant to his therapeutic process. This session gave an incredibly accurate preview of Matt’s process. In the next seven sessions, he weaved in and out of the main images in this session, and each time, the images transformed or moved his life story along. What follows is a description of how Matt worked through these central images (i.e., the black bird, the rain and the

house, the island cave, and the abandoned child), and as a result was resurrected to a life with AIDS. The Black Bird The black bird was a key image in the first session—one that had already begun some kind of active transformation process—from a gull, to hovering people dressed in black, to a huge blackbird with a foreboding and ominous presence. Matt felt threatened by the bird, yet he did not voice his fears, neither during nor after the imaging—as if it was too much for him at the time. Matt was also unable to identify what kind of bird it was. I allowed my own feelings to enter my awareness: I did not trust it with the child. I did not like it hovering and following—like a vulture insidiously waiting to devour a carcass. I was afraid of it. Before the second session, I went through the transcript I had taken of Matt’s imagery, and discovered that the bird appeared when Matt was confronted with an obstacle, when he felt powerless to escape, and when he left the child behind. My inquiry made me feel like I had begun to hover over the bird hovering over Matt, and I wondered why I felt it was important to do this. Does Matt need to be protected, or do I need to reassure myself that (like any good therapist) I could protect or rescue him? Will my rational understanding of the image somehow make it go away? Did I need protection from it? The bird did not re-appear in Matt’s imagery for several sessions, however it did arise quite prominently in his mandala drawings. In the first, he drew the bird quite representationally, flying beneath the sun. In subsequent portrayals, it changed positions and shapes. In the next drawing, it was so big that it created an eclipse of the sun; in another it was a large ground mass (like a black hole); and in the next, it turned into shadowy human figures on the edges of the mandala, with their backs towards the viewer. Then, in the fourth session, the bird presented itself again in Matt’s imagery. Bach’s “Passacaglia and Fugue in C Minor” set the stage. Matt was walking along a path with the blueman and redman, when the bird appears and starts to follow them. As the melody in the bass repeats over and over, the bird circles and hovers around them, getting closer and closer with each increment in volume. The fugue begins, and relentlessly piles layers of fear and frustration on top of one another as the three men watch the bird hovering over them, arguing among themselves. A terrifying climax is inevitable, and as the chords crescendo to a crashing close, the blueman overcome by anger, shoots the bird to the ground. A long silence ensues before Bach’s “Come Sweet Death” begins—the music is now slow and desolate, and Matt sighs deeply, showing great consternation in his face, despite the relief evident in the rest of his body. When asked, he explains that he feels confused about why the blueman, who is his model of goodness, has killed the bird— rather than the redman (who Matt believes has an evil side). In the next piece (Bach’s “Sarabande” from the “Partita in B Minor”), Matt questions the blueman, who refuses to explain himself other than to say: “One day you will understand.” Matt’s frustration

with this evasiveness builds during Bach’s “Little Fugue in G Minor” until all three men decide to leave. As they do, Matt has to pass by the dying bird. As he does, the bird tries to communicate to him, but is barely audible. Matt refuses to listen, and supported by the strong bass notes in the fugue, steps over it quickly, in contempt and disgust. In the final fortissimo chord of the fugue, a black snake sneaks away in the grass. The slow movement of Brahms’ “Violin Concerto” begins, and as the violin plays long, tender melodies over a soft orchestral accompaniment, Matt shares how he feels about the redman and blueman. Despite their differences, he loves and accepts them both. Then a wonderful transformation takes place during Bach’s “Double Violin Concerto.” Matt takes the blueman and redman by the hands and pulls them into himself, as if to unite them and to reincorporate them into his own being. As he does this, the three merge to form a large green swirl. This integration takes place as the two violins (blueman and redman) play with orchestra (Matt) in perfect, harmonic counterpoint, each part barely distinguishable in timbre but clearly different in contribution. Afterwards, Matt and I talked about what a relief it was to be rid of the bird. Matt felt like he had been successful in overcoming a menace that had tortured him for a long time. We talked about what menaces in Matt’s life this bird might have represented, and how good it felt to triumph over them. We talked about the need to be strong to conquer the menaces of life, including AIDS. We also discussed how uniting the redman and blueman felt like he was literally “pulling himself together.” I was silently skeptical because of the black snake that appeared—I suspected that it was yet another transformation of the bird. The next week, Matt drew a mandala that had a huge black phallus penetrating the lower left part of the circle. In my thinking, the bird had transformed yet again, but I said nothing to Matt. He believed that the bird had really gone away, and in fact, it did not appear in his images for several sessions. Then, another mandala appeared with many black spots evenly scattered throughout the space. I could not help relate it to the previous drawing. It looked like the black phallus had exploded, and germinated enough spots to completely occupy the territory. The spots looked like sperm—the black sperm of the bird (or snake). Since AIDS can be transmitted through sperm, I further imagined that, in Matt’s psyche, the bird was the carrier of AIDS, the 20th century black plague, and the black messenger of death. In the fourth session, the bird re-appeared. Matt was sitting under a tree, as the Adagio from Marcello’s Oboe Concerto edged him into feelings. The tree was alive, and its roots were in the ground, but it was very sad and lonely. Its branches were drooping downward, and there was a large hole in the trunk. It sounded like the tree he saw in the first session—before it had been uprooted from the ground. I wondered if Matt had gone back to an earlier time in childhood. He had. I am wearing blue pants and a red shirt... an outfit I had when I was 8-years-old... The blackbird is back... It’s perched on top of the tree... [The Adagio of Rodrigo’s Concerto de Aranjuez begins]. The tree is trying to shake it off...but it can’t. It’s starting to rain... My throat is tickling... [Matt’s body begins to writhe, and his voice gets constricted]. I am stuck on the ground... I feel caught... paralyzed... My arms and legs are so heavy I can’t move... I am trying desperately to move... but I can’t....[long silence

during orchestra version of Bach’s Prelude in E-flat Minor]... [What’s happening now?]...I am down at the stream... washing myself... The bird has gone away. Matt’s images came to a close peacefully, with the Romanze from Dvorak’s Czech Suite—as if nothing had happened. I was shocked. What had transpired in those few moments of silence? Since it was not possible to pursue the matter within the imagery, I waited until Matt had regained consciousness, and then asked how he freed himself from the ground. Staring straight into my eyes with a stone face, Matt answered: “Sheer rage!” I noticed that he was trembling again. No more was said. Strangely enough, the bird never reappeared in Matt’s imagery. I took this as a sign that the full story, without symbolic or fictional characters, was ready to unfold. Often, images and symbols provide us with safe ways of dealing with very disturbing material, things that we repress and do not allow into consciousness. The bird had been very important to Matt because, as we shall see, it allowed him to work through very painful material in a gradual and ambiguous way, just as dreams do. The elusive nature of the image and its lack of reality as a “figment of his imagination” allowed Matt to deny or distort its true meaning at the earlier stages; however, every time it recurred, the bird further redefined itself, and in so doing began to gradually debunk each denial and distortion, until Matt was willing and able to admit and integrate into his consciousness what really transpired in that image and what the bird really signified. This did not happen until a few sessions later. Several other recurring images had to develop sufficiently until Matt would be ready to recount the life events that he was trying so desperately to forget and confront at the same time. The Rain and the House Images of rain storms appeared in several of the early sessions. Rain is so ambiguous! It cleanses, muddies, and fertilizes. It can bring relief from a drought, or it can flood the landscape. It can pour down from black clouds or fall gently from grey skies, and when the sun follows, it can bring rainbows and pots of gold. It comes from above, as if the good and bad of it are sent to us from the heavens by God (Cirlot, 1971). When Matt encountered rain, it was “stormy weather,” and he frequently sought refuge in a house. On the first occasion, Matt was walking along a country road, and passed by a white house that belonged to an elderly couple. Sometime later Matt saw black swirls in the sky, and fearing that a storm was coming, ran back to the house for protection. Upon his return, he found that the windows and doors had been boarded up. Unable to go inside, Matt stood on the porch and waited until the dark clouds and rain had passed. I remember this image so vividly. In my mind’s eye, the house looked like the faces of his parents: with their eyes, ears and mouths completely covered. It was as if Matt were seeking the safety of his home, wanting to take refuge in the laps of his parents (the porch), but they had gone off somewhere and left him behind, at least in spirit. Their eyes had blinders on and they were unable to see the storm; their ears had been plugged, and they could not hear Matt’s call for help; and most disturbing, their doors were closed, as if they were no longer willing or able to give him refuge from the

storm. The image of Matt standing on the porch reminded me of the child who had been left behind on the island, unprotected from the bird. Each time Matt saw a house in subsequent sessions, there was danger lurking. In the third session, he escaped another storm by running onto the same porch with his lover; in the fifth session, he passed a house before entering the island cave which had frightened him earlier. Again it was raining. The Island Cave Matt went to the same island in three of the initial five sessions. Islands are often isolated places where people go to withdraw (very much like Matt’s apartment). They are also places of refuge from the ocean—or the deep, threatening waters of the unconscious (Jung, 1954). I felt that this was particularly relevant to Matt. He seemed to be struggling with whether he should allow certain material to emerge or to suppress it. Every time he went to the island he encountered some kind of threat, but then would leave before confronting it. His images on the island were full of fantasy and symbolism, with very few real-life people or events, suggesting that he could only deal with these images if their true meaning was disguised in some way. His repeated returns gave me the sense that he had some unfinished business to clear up there before he could leave it once and for all. After the bird had been slain, Matt gained greater confidence in confronting images that frightened him. In the seventh session, he returned to the island and proceeded directly to the cave. This time Matt was accompanied by a man dressed in green (the swirl that merged the redman and blueman into Matt). It’s too dark to go in... I’m lighting a torch... We’re inside... We‘re walking on a bridge over a huge cavern. At the bottom are deep craters... filled with bubbling black tar. I’m real uncomfortable in here... (What do you want to do?) I’m going to solve this once and for all... We’re going back outside, to climb the hill over the roof of the cave. [With determination and a bit of anger in his voice, Matt says to the greenman]: “Let’s dig a hole in the ground, and let sunlight into this f—king cave once and for all.” We are digging... We’ve reached through the roof of the cave. I can see down into the cave. I want to go back inside now, and see what’s inside. We’re back where the hole in the roof is... I can see rays of sunlight coming down... There are tons of green powder everywhere... We are putting it in buckets and throwing it over the bridge... It’s cooling down the tar... kind of deactivating it... We’ve won a battle. Afterwards, Matt was quite proud of himself. I told him how much I admired his courage and determination. He saw this session as a triumph over the big black hole that frightened him so, and therein his fear of death. I cautioned him that this image could still return, but that the important thing was that he had created his own “antidote” for it. We also explored what the greenman and the green powder might represent in terms of resources within himself. Matt concluded: “I have to care enough to do something about my problems.” For me, this was one of those split-level discussions therapists sometimes have. Outwardly, I was focused on helping Matt relate his experience and images to his life.

Inwardly, I was focused on what implications these images had within the therapeutic process. I was struck with Matt’s boldness in letting the sunlight flood the cave, and illuminate its contents. Was Matt readying himself to let the painful material into the light of day? What would emerge from the cave? I agreed with Matt that the greenman was a part of himself—that part that wanted to help him—not only to pull himself together, but also to help bring something from his unconscious into the light. But I also realized that the greenman was an image of me as therapist. In Matt’s positive transference towards me, he was beginning to see that I cared, and that through me, perhaps he could care and do something about himself. If there was a negative transference, Matt’s concluding statement could have been a warning to me: “You have to care enough before I can do something about my problems.” Paradoxically, it is always scary for a therapist to gain this kind of trust or hope, even though it is a primary goal. I could not help think of all the greenmen in my life. I hoped that, for Matt’s sake, I could be like the best of them—not the many that had let me down. I realized that this was a countertransference reaction that needed to be examined closely at another time; meanwhile, I had to refocus myself on Matt’s needs in the here-and-now. I often find that significant sessions such as this mark off stages within the therapeutic process, and that a review of what has been accomplished to date is very helpful in consolidating and integrating material that has been brought into consciousness. After we had finished discussing the specific details of the imagery in this session, I asked Matt if we could spend some time going over earlier sessions. To guide our discussion, we put all of his session transcripts and mandala drawings in chronological order, and then proceeded week by week. I asked him to summarize what each session and drawing meant in a few words, as I took notes. Upon finishing, we turned the individual statements into a brief narrative: All of my troubles appear when I am alone—marooned on an island. I let the bird do his thing, as evil as it is, and I will face obstacle after obstacle until the nicest part of me reaches the breaking point. Before I do, I am consumed by fear, and I feel paralyzed to do anything about things, but then I become enraged and this gives me the power I need. There are different parts of me that take over at different times. The most frightening thing is when I stop caring and give up. If I really care—if I really want to live—then I can find the courage to work out my problems. Maybe the courage comes from rage over what life has brought me. As a result of this review, Matt and I both felt good about his progress. After the session, I realized that there was still one recurring image that Matt had not explored— the house. The Abandoned Child

In the eighth session, the tar bubbled up and the full story of Matt’s life was brought to light. It was a horrible tale of childhood—one that had made it necessary for him to create his images of the bird, the rain, the house, the island, and the cave. Matt and I had decided to begin the session with a house as a focus or starting image. To prepare him, I asked him to concentrate on taking in-breaths that brought him inner strength, and releasing out-breaths that brought calmness. I then asked him to return to his favorite house from childhood. Matt began: I am playing in the back yard... where I lived when I was six... I have on red pants and a blue shirt... Mom is calling me to go inside... Everyone has been packing... We’re moving... Mom and Dad are leaving to take the last truckload... They have left me behind with Bruce, a friend of theirs... He’s picking me up... I’m getting real nervous... He’s holding me too tight.. [Matt’s body tightens up so much that his trembling stops; his face reddens as if he cannot breathe] I wish he’d stop... Stop I...He’s getting on top of me... crushing me... I can’t move... I can’t breathe... I can’t even scream. He had been raped. I remember crying—realizing that he could not do so—not then, and for some reason, not now either. I also remember holding back the tears. Matt needed more than tears, he also needed someone strong who could support his rage, and help him survive this ordeal. As soon as the rape scene ended, Matt’s images were flooded with memories of violence and blood, all episodes that actually took place later in his life. He recalled: breaking the neighbor boy’s arm with his bare hands (age 8); cleaning up the blood after his grandfather had a lung hemorrhage (age 12); being beaten by his pimp (age 15); killing a squirrel who had been hit by a car (age 18); and being struck by a car himself (age 21). Afterwards, we talked very little. I said I was sorry for what Bruce had done to him. He said he still felt ashamed, because Bruce continued to rape him for several years. Apparently, his parents were completely oblivious. He admitted that most of the time, he controlled his anger over what had happened to him, but that occasionally it surfaced. When the session ended, I remember hating to say good-bye. I did not want our parting to feel like another abandonment. All I could think of was how he had been left alone that day in the empty house, and that later, he would be alone again in his apartment. He assured me he would be “fine.” As I drove home that night, Matt’s images flooded my consciousness, coming together in streams: The hovering bird had descended upon an unsuspecting child who had been left behind, a child who was wearing red and blue. Then, while being held down and unable to move, the phallus was inserted. The rains came in storms of dirty sperm, and the house stood empty with no one to protect him. The family tree had been uprooted, and if it was to turn green again, someone would have to care. Matt was the island, alone then and now, for his secret would always set him apart. Yet he was surrounded by oceans of feelings that could flood him at any time. As with the cave,

a part of him had fallen into a black hole and died, and the remains had been locked there with iron gates. In the aftermath came blood—blood that would be shed as sacrifice, blood that caused shame, and ultimately, blood that would become infected as a final punishment. Resurrected: To Live or Die? After this, Matt’s images were quite different. None of the previous images recurred. The bird, the rain, the house, the island, and the cave had all given full voice to the horrors of his past life. The grief and rage of the child he had left behind were now in his awareness. Matt’s life story had been told; it was up to date. The irony of releasing the past is that, despite the relief that comes, the person is plummeted into the realities of the present—which for Matt, were as ugly as those in the past. The fact that he had AIDS came to the forefront of his consciousness, bringing increased anxiety. His symptoms seemed to worsen, and he became even more of a recluse. He took no consolation in the news from the doctor that his blood count was better than ever, and he ruminated over the progression of the disease. He seemed more frightened than ever, and his trembling was more pronounced. Even his imaging, which had been so easy and productive, was beginning to falter. Though this seemed like Matt’s bleakest hour, his imagery said otherwise. In the next (and final) three sessions, he had tremendously healing images—all related to the death and resurrection of Christ: Matt forgave his father for abandoning him and healed their relationship through a cross; his side was pierced with a harpoon, and he tried to wash it clean with water; and as he walked through the cemetery, Easter lilies bloomed over each grave. Then came the turning point: I am standing over my own grave...It’s open, and I’m looking down at my body... 1 feel a man’s presence behind me. I can only see his face. He’s beautiful. His hands are on my shoulders now, and he is telling me to be strong...in a very fatherly and loving way... I feel love towards him, but I am afraid... He is telling me to go back into my body...to get into my body and live...But I ‘m afraid... how strange... I wonder if I am afraid of living or dying... He is repeating it again: “Go back into your body, and live!”... I feel unsteady... like I’m falling back... I can’t stand it anymore... I have to come out! Suddenly (midway into the tape), Matt’s eyes opened and he rose up, like he had just awakened from a terrible dream. Then, with seemingly no rhyme or reason, he blurted: It’s all so clear to me now: Dizziness is not being held up... Nausea is what I get instead of crying...

The knot in my stomach is when I lose myself... Trembling is not having anything to hold onto... This was the first time I saw Matt lose control of his emotions. And unlike anything that he had ever done before, he asked if I would hold him. I sat next to him, and as I put my arm around him, he rested his head on my chest and cried—very much like a child who needed to cry in the safety of his parent’s embrace. I rocked him until his crying and trembling subsided, and then he said something I will never forget: “Living is more like falling into a black hole than dying is.” I was reminded of what Laing (1967) said about the human dread of nothingness: “We are afraid to approach the fathomless and bottomless groundlessness of everything. “There’s nothing to be afraid of [is both] the ultimate reassurance and the ultimate terror” (p. 20). The relevance of an existentialist such as Laing made me realize that Matt had moved from an early life (or psychosexual) crisis to a full-blown existential (cognitive) one. The Truth Sets Him Free A few days later, Matt called me at home, and said that he needed to talk. After hemming around for several minutes, he told me that he had not been completely honest with me. For a long time, he had been abusing alcohol and his medications, and could not bring himself to tell me. I could hear in his voice how difficult this admission was for him, and despite my own feelings of shock, I tried to reassure him that his telling me was a significant turning point. I then asked him: “Why are you telling me now? What makes this secret so difficult for you to keep any longer?” In his reply, Matt’s progress and the value of our work together was revealed: “Before it didn’t make any difference. In the last session, I realized that I have been more dead than alive for a long time. If I’m going to try to live, I better do something about this now, before it’s too late.” Matt checked into an in-patient unit of a local hospital for detoxification and treatment, where he stayed for nearly two months. After being discharged, he began regular follow-up treatment with his psychiatrist, and joined a weekly support group for alcoholics who are HIV infected. Several months later, I called Matt. From what he said, it sounded as though he was back on the road of the living, taking full responsibility for himself. Before we ended our conversation, Matt thanked me and said: “You really helped me to take a look at myself, and to begin embracing the life I still have to live.” Discussion and Conclusions Psychotherapy with Matt involved five dynamic elements: the imagery, the music, the mandalas, my personal perspectives, and our relationship as client and therapist. The roles of each are described below. Role of Imagery

As implied throughout the case, imagery probably played the most significant role in Matt’s treatment. Because they carry symbolic meanings and are by nature ambiguous, images provided Matt with the distance he needed to eventually integrate very threatening material into his awareness. As containers of feelings and the energy attached to them, images also helped Matt to acknowledge his despair, powerlessness and rage which had been buried deep inside since his childhood trauma. Early in his work, Matt himself realized that his imagery provided symbolic vehicles for working through inner struggles. As we made progress, he also realized that transformations in his imagery provided symbolic representations of real interior changes taking place in his psyche. Matt once commented that when new images appeared, it gave him an opportunity to discuss things about himself that he had never shared with anyone. Somehow his imaginary world brought forth reality, and presented it in terms that he could talk about with as much distance as he needed. Images also bring time and timelessness into perspective. Because they are not limited to one time zone, they often reveal the links between different time periods. Thus, the stories that unfolded with each image allowed Matt to see the continuity of his own past, present, and future. Time made sense; sequels from the past became cycles of the present. The evil that the bird perpetrated on him in the past had planted the seeds of shame and guilt, which formed the basis of his present reaction to his AIDS diagnosis, which in turn spread the bird’s blackness into an eclipse of his future. Matt realized he had given up on life a long time ago, and that rage was one of the few things left—even if it was suppressed. Finally, images also instruct and inform the psyche by bringing forth the wisdom that already lies within the person. Matt’s images helped him to find meaning in himself and to create meaning for his life. Perhaps, this newly discovered possibility—to find and make meaning out of the meaningless—had more significance for Matt than anything. His past was filled with pain and sorrow—which he suffered for no good reason; his present was filled with anxiety and fear, because of a disease that struck him—for no good reason; and now his life would prematurely come to an end—again for no good reason. What does it all mean? What is life really all about? Is it worth it? These are questions that haunted Matt. In terms of process, imagery first served as an uncovering technique—one wellsuited for exploring secrets of the unconscious and past. But as Matt progressed in therapy, the past was uncovered, the experiences of the wounded child were revisited, and his unconscious scars were revealed. This allowed the images to move forward in time, and to focus Matt on current issues, and how these issues were residues from the past. At this point, Matt was ready to face the existential conflict that he was experiencing as a person living with AIDS: to live dead or die living. Throughout this case, and in my discussion of the role of imagery, I have given a great deal of attention to the symbolic meaning and significance of Matt’s imagery. I have done this, not because I believe that images always need to be interpreted, nor because this is common practice in GIM, for neither generalization is true. I have

emphasized interpretation for several reasons peculiar to Matt’s case. First, imagery was the main arena for action and change within Matt’s therapeutic process. His progress was inextricably linked to and expressed within his images and transformations therein; it did not depend upon verbal interactions or our relationship, though these elements played important supporting roles. Second, Matt’s images were primarily of the symbolic or metaphoric type: he did not often have purely sensory or affective types of images, or images that contained real-life people and places. Third, according to Wilber (1986), different pathologies characterize different developmental stages in the life span, and consequently call for different psychotherapeutic techniques and orientations. I believe that Matt was in the stage of personal development which is characterized by problems originating from the repression of unconscious conflicts from childhood. Unconscious material does not present itself to the psyche in a logical or direct way: rather it relies upon symbolism and ambiguity to make its entry into consciousness more acceptable. Thus, much of our work was geared toward gradually translating the symbolic language of Matt’s unconscious into acceptable and decipherable terms, thereby moving him from pathologies steeped in the past to realities of the present. Role of Music The significance of music in Matt’s case is quite basic: without it, his imagery (which was so central to his process) would not have been as rich, productive, or transformative. Matt was very susceptible to the various elements of music and to changes therein, and his images always related directly to what was happening in the music. In fact, Matt’s images were so closely related to the music that I sometimes wondered whether they were dependent upon it. I find that when a person’s imagery is “music-dependent,” there are two potential problems in guiding, both of which I considered at various times in working with Matt. First, it gave me too much control over his images. I did not want to manipulate his process by selecting and changing the music in ways that would push his imaging in a particular direction. Second, it gave him an opportunity to resist the process. Sometimes, as he would approach an important experience within the imagery and the music changed, Matt would move away from the image to accommodate the music, thus avoiding something difficult or unpleasant that he may have been ready to confront. Other imagers are more “music-independent” and forge ahead with the imagery process they are undergoing, regardless of shifts or even drastic changes in the music. Ironically, Matt did not respond to music very emotionally. When Matt had intense feelings, they arose from the images, which in turn were supported or amplified by the music—not vice-versa. I might even say that Matt resisted the emotional force of the music, and did not allow it to trigger any cathartic releases. In contrast, the music helped me to stay emotionally involved and attuned to Matt’s images. As suggested earlier, I often felt that I had to model the feeling responses that Matt denied himself.

Last but not least, the music helped to take Matt into deeper levels of consciousness, while also providing him with the supportive matrix he needed to do so. The Mandalas Matt thoroughly enjoyed drawing mandalas. From a therapeutic point of view, I found that they helped Matt in several ways. First, they helped him to contain threatening feelings aroused by the music and the imagery. Putting the images, shapes or colors into the confines of the circle provided boundaries for all the material that was escaping from his psyche; it also gave him the means by which he could exercise some control over the emotions attached to the material. Being a recognizable, archetypal form, the circle also afforded him some intellectual control over its contents, for after he was finished, he could take a good look at how everything fit together, and in doing so, he could see the “whole” of it. From my point of view, the mandalas provided a framework or context for understanding Matt’s imagery. And related to this, they helped me to recognize symbolic equivalents in his unconscious material. For example, he used black for several things in the mandalas which related directly to the black bird and its equivalents in the imagery (e.g., eclipse, dark clouds, phallus, seeds, black hole, snake, cave, grave, Bruce, etc.). These equivalences in the mandalas and images bring together seemingly unrelated unconscious material, and reveal symbolic themes or underlying processes operating in the psyche. For example, all of the black images or symbols used by Matt were either evil forces that penetrate (phallus, seeds, snake, Bruce) or empty spaces that are penetrated (black hole, cave, grave). Going one step further, the theme of penetration can be further understood by examining equivalences in the qualities and activities associated to it in the mandalas and imagery. Matt associated penetration to sexual exploitation, fertilization, infection, and burial. Personal Perspectives Throughout this case, I have kept the reader informed of my own personal thoughts and reactions to Matt and his imagery processes. I have even shared my projections, interpretations, and countertransference issues. I have done so because these personal perspectives are central to the way I work. For me, psychotherapy, regardless of mode and technique, is a process of travelling between three experiential spaces: the client’s world, my own personal world, and my world as therapist. I see the process as “lending” myself to the client—but not only myself as therapist, but also my personal self. Without going into every one of these spaces, psychotherapy is impossible: I cannot be fully present or empathic to the client without entering his/her world—however to do so, I must leave my own world as person or therapist to do so; I cannot react to the client authentically if I do not leave his/her world and return to my own personal world; and I cannot intervene therapeutically if I do not monitor my travels to both other worlds by seeking the expertise and skill found in my world as therapist. Of course, central to the ability to move between these worlds

is the ability to have both fluid and firm boundaries, depending on what is required. A therapist must be able to leave him/herself, but also return at will. These world travels are required regardless of method, technique or theoretical orientation: for who I am as person and therapist, and how I feel as person and therapist ultimately determine how I will use music, imagery, mandalas, verbal discussions, etc. Without me being fully human as both person and therapist, these are mere artefacts of therapy. From an existential point of view, I can experience these worlds on three levels: (1) directly (i.e., through spontaneous and unmediated apprehension through the senses); (2) perceptively (i.e., through perceptual or affective classification of the experience, such as hot/cold, sad/happy, etc.); and (3) reflectively (i.e., through thoughtful analysis of relationships between experiences and worlds). Thus, depending on which world and level of experience is relevant to the moment, I may experience any of the following: THE CLIENT’S WORLD: Directly, perceptively or reflectively; MY WORLD AS PERSON: Directly, perceptively or reflectively; MYWORLD AS THERAPIST: Directly, perceptively or reflectively. Of course, it is important to also acknowledge that the client has similar options as to which world and level of experience s/he will enter at any point in time. Client-Therapist Relationship Matt and I had what I considered a very positive relationship. At the most basic level, I liked him and he liked me. We enjoyed being with one another, and we were rarely at a loss of words. We also laughed a lot. From a psychodynamic point of view, Matt had an essentially positive transference towards me through most of our work together. This was extremely important, and not always easy, given Matt’s past experiences with men in my same age bracket. He resented his father for being weak, blind, and not protecting him from Bruce; and he hated Bruce for the unforgiveable crime of raping him. With this in mind, I had to be strong, reliable, present, kind, and nonsexual. I also took note of what he resented in his mother: she tried to dominate Matt in every way; yet because of her own oblivion, had no control over what Bruce was doing to him. I was careful therefore not to be directive, oblivious, or useless! I felt that it was important to avoid inviting or working through these negative transference issues with Matt because time was limited, and I felt that he desperately needed a positive male or father image. I was also certain that he could not meet the emotional challenges he had to face in our work together without unequivocal trust in me and the support that I would provide. As for negative aspects of the transference, certainly Matt’s concealments could be seen in this light. He had concealed his childhood “shames” from his own father until he was an adult, and similarly, he had hidden his adult “shames” from me until he was ready to terminate therapy. Ultimately, I suspect that the abruptness of our termination

also had its origins in negative issues that were out of my awareness and therefore left unresolved. I have often wondered whether he “abandoned” me to punish his own father for abandoning him. Unfinished Business Matt’s termination was timely yet premature. I missed the opportunity for us to achieve some kind of closure in our work. Given his decision to enter a residential treatment program, it was impossible for us to continue working together until after his discharge; and by that time, we were both in very different circumstances. Had we continued, I feel that our work would have focused on two areas: dependency and the expression of feelings. My approach to his dependency issues would have been existential, emphasizing the importance of personal freedom, will, choice, and responsibility—this in contrast to a psychoanalytic approach focusing on dependency relationships and deficiencies in holding environments of the past. If a negative transference was present, I would stress the need to be “authentic” in our own here-and-now relationship rather than stuck in someone else’s from the past. Improvisational therapy would have been the method of choice, as it can explore these kinds of issues so directly, and especially within the context of authentic interpersonal relationships (Bruscia, 1987). Matt did not express his feelings very freely. Even in the most intense GIM sessions, it was difficult for him to cry, lose his composure, or even raise his voice; yet it was quite obvious that he had very intense feelings that were suppressed. Here again, my approach would have been improvisational. I believe that Matt first needs to “sound” his feelings out with full use of his body, before he would be ready to release them fully in non-musical ways. Once Matt became freer with musical self-expression, we could have resumed receptive methods of cathartic release, such as GIM. Postscript Matt’s case has truly been a source of wonderment to me: How indomitable must the human spirit be—that Matt has survived the ravages of so many rainstorms! How powerful must images be—that they healed Matt’s deepest wounds and resurrected his life! What a gift of life music is—that it goes in and out of our deepest and most intimate spaces with such ease—resonating, soothing, and understanding the very fiber of our being. And how human a therapist has to be—to realize that it is not in our knowing or doing that we can help someone like Matt to move along his life path— but in our accepting and loving wherever he is. Glossary HIV Positive: Presence of the Human Immunodeficiency Virus (or retrovirus) in the blood, causing an excessive increase in immune suppressor cells and a corresponding decrease in immune helper cells.

AIDS: Acquired Immune Deficiency Syndrome. Guided Imagery and Music (GIM): Originated by Helen Bonny (1978), GIM is a method of psychotherapy, healing and self-actualization which involves spontaneous imaging to music in a relaxed state, while dialoguing with a guide. The practice of GIM requires special training. Mandala: A drawing enclosed in large part within a circle. Transference: Reactions client have towards therapists wherein the client relates the therapist as if the therapist were a significant person in the client’s life, usually his/her parents. In a positive transference, the client projects positive feelings about the associated significant person onto the therapist/associated significant person; in a negative transference, the client projects negative feelings. Countertransference: Traditionally, the therapist’s reaction to the client’s transference. The author’s definition is: any conscious or unconscious reactions of therapists to clients which have their origins in the therapist’s own personality or life experience. A positive countertransference takes place when the therapist uses these personal reactions to the therapeutic advantage of the client; a negative one takes place when the therapist is unaware of personal reactions towards the client, and because of this, puts the client at risk and endangers the therapeutic process. References Bonny, H. (1978). Facilitating GIM Sessions. Salina, KS: Bonny Foundation. Bruscia, K. (1987). Improvisational Models of Music Therapy. Springfield, IL: Charles C Thomas Publishers. Cirlot, J. (1971). Dictionary of Symbols. (Second Edition). Translated from Spanish by Jack Sage. New York: Philosophical Library. Grinder, J., and Bandler, R. (1981). Trance-formations. Moab, Utah: Real People Press. Jung, G. (1954). The Practice of Psychotherapy. (Collected Works: Volume 16). New York: Pantheon Books. Laing, R. (1967). The Politics of Experience. New York: Pantheon Books. Schatzberg, A., & Cole, J. (1986). Manual of Clinical Psychepharmacology. Washington, DC: American Psychiatric Press. Wilber, K. (1986). The Spectrum of Psychopathology. Treatment Modalities. In K. Wilber, J. Engler, and D. Brown (Eds.), Transformations of Consciousness. Boston: New Science Library - Shambhala.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE FOUR Emerging Through Music: A Journey toward Wholeness with Guided Imagery and Music Rebecca Buell Introduction I decided to try Guided Imagery and Music (GIM) therapy when I was in my early forties. I had been trained as a psychotherapist, but I was working in an administrative/clerical position. I was experiencing an underlying sense of dissatisfaction with my professional life. I was tired most of the time and had frequent colds and other minor illnesses. I was paying the bills, something that had been a challenge for me most of my adult life, but there was no sense of satisfaction in my daily work. I wanted to start a practice in psychotherapy, the work I had been trained for, but I was terrified of leaving the financial security of my job. I felt terribly stuck, trapped by my own fear and tortured by the knowledge that I was not living authentically. I was drawn to GIM because I had experienced the power of imagery through my studies of Jungian dreamwork. I sensed that it could be very helpful to have a therapist to help me into a relaxed state and to be present as my imagery actually unfolded, rather than relating the imagery at a later time, as I had done with dreams. I am also a musician, and the idea of using classical music to evoke imagery was very appealing to me. I am a music therapist, but in this narrative, I speak as a client. The descriptions of the imagery from my GIM sessions are taken from a journal I kept during the time I was involved in this therapy. I have chosen not to use my real name and, by mutual agreement with my therapist, I have not identified my therapist. The imagery descriptions are written in the present tense (a technique that I found helpful in working with dream images) and indented. Between session seven and eight, I have described a dream that seemed to relate to the process I was experiencing in my GIM sessions. For each session, I have also given my impressions of what the imagery represented to me, including insights I gained from discussions with my therapist. The Sessions Session 1 I am in a beautiful old house. I go upstairs to the bathroom and begin painting it an ugly shade of sick green. I don’t want to be making it ugly and I realize this is

someone else’s idea. However, I feel like I must continue the project. Eventually an old woman comes to the door and tells me to stop painting and come with her. I am relieved to be able to abandon the project. It was clear to me that painting the bathroom represented my job. I was carrying out someone else’s plan. I did not even like what I was creating, but I felt obligated to continue. This is very familiar to me. The old woman seemed to be a Wise One. Perhaps she is the part of me that knows I must stop this work. Maybe I can learn to listen to her and trust her more. Session 2 A black woman in a white dress with a red sash shares a drink with me. After [I drink] it, my body is filled with streaming energy. I see brilliant colors radiating from the energy centers in my body, especially my heart center. I have an experience of a sensation throughout my body of joy and power. I have never felt this fully alive! This session was certainly a peak experience. The black woman seemed to be another Wise One. She showed me a part of myself that I had not experienced before. This part of me is very alive and very powerful. The strong emotions and body sensations that I felt were unlike anything I had previously experienced. It has been difficult for me to believe that I am worthy. This session seemed to be a confirmation that I am a strong and worthy person. Session 3 I am walking in deep sand on a barren, endless beach. Walking in the sand is very difficult. I am tired. This session felt like the opposite of my previous session. This is how I feel during much of my day-to-day life, going on and on with no purpose and becoming very tired. Session 4 I am in an underground room. I have a sense that it is both a womb and a tomb. An old woman (perhaps the one from my first session) puts me in a fire that doesn’t burn me. A dragon comes out of my solar plexus and eats its own fire. The underground room could have represented my unconscious or my inner self. The fire that does not burn could have been a form of purification or transformation. The dragon that ate its own fire was an unsettling image. Does it mean that I put my energy out into the world, but then I quickly swallow it back up, afraid of what it might do? Session 5 I become a white wolf and howl, giving voice to my frustration, sorrow, and anger.

This seemed to be a continuation of the previous session. This time, however, I did not swallow my fire. This time I gave it voice. Session 6 A huge vine is wrapping around me and constricting me. I do not want to kill it by uprooting it. I finally free myself by spinning out of it. The vine felt like my job, confining and constricting. I want to leave my job, but I do not want to destroy things when I do. This imagery seemed to be showing me there is another way out. Session 7 I am in an underground temple. People in white tunics are nurturing me. They put me in a small boat, which carries me downstream to the sea. I find a trunk on the beach. I open it and find a small photograph of my grandmother. I was underground again. This time, people were helping me. It is often difficult for me to accept help or to notice that help is being offered. The boat that carried me to the sea was also moving with the flow of the water. No effort was required. This is a contrast to my daily life, in which everything seems to take tremendous effort. My grandmother meant a lot to me. She was a creative, free spirit. Seeing her picture in my imagery was a surprise. This picture exists in ordinary reality. It is her high school graduation picture. I had not seen it since moving from Boston in 1982. After this session, I went through my things and was unable to find it. I did not mention this imagery or this picture to my mother; however, she sent it to me several weeks after this session with a note saying she found it among her things and thought I might like to have it! Is this synchronicity? Dream Later that week, I had the following dream: I go to a trash can and lift off the lid. Inside the trash can are the bodies of two kittens. They are my kittens. I wake up with a jolt, feeling intense emotion. This was an intense, shocking dream. I love animals. I was devastated to find my kittens dead and to find that their bodies had been disposed of like trash. No respect had been shown to them. How had I let this happen? The kittens seem to represent my own creativity; it is still in its infancy, and I am allowing it to be killed. I am not even showing respect for it. This feels like a wake-up call. Session 8 I become a snake. I have a very palpable sensation of what it is like to be a snake, to crawl on the ground, feel my strong rippling muscles, and “taste” the scent of other

animals with my tongue. This is a very different, almost alien form of life energy I am experiencing. A snake had appeared to me in a dream I had about a month earlier. In the dream, I was too fearful to engage with it, so my ability to become the snake in this session felt very significant. It seemed to represent a willingness to accept a way of being that is unfamiliar, to experience life from a different perspective. This is what I must do if I want to move beyond my habitual way of being. Maybe I am breaking through my fear. Session 9 I lie in a stream and let the water flow around me, nurturing me and restoring my energy. This session was simply restful and nurturing. I feel like I need more of this in my life right now. Session 10 A young prince appears as my guide. He leads me behind a waterfall to an underground passage and tells me I must go on by myself. When I emerge from the passage, I see myself as a dismembered skeleton surrounded by glowing green light. I feel free, fresh, and renewed. This seemed to be a death-rebirth image. Seeing my dismembered body actually gave me a huge feeling of relief! I have a sense that I do not have to try to hold it together any longer. Even if it looks like everything is falling apart, it will be okay. Things may have to fall apart before something new can emerge. Session 11 Several days prior to this session, I gave notice that I would be leaving my job. I climb down a ladder in a dark chute that leads to an underground sewer. There is a strong feeling of sadness here, but it is not my sadness, and I know it is not my responsibility to stay here and fix it. I find a way out by crawling through the water until I come to an opening. This seemed to be about guilt for giving my notice. Sewers represent guilt to me. Even though I feel sure I made the right decision, I feel guilty about the situation I am creating by leaving. This imagery shows me that it may not be easy; I may have to crawl through sewer water, but I will find a way out. Session 12 I am in an underground cavern. There is a bright fire burning here. I take a burning stick from the fire and go out of the cavern. I start a new fire from the burning stick. A crow emerges from the smoke.

I was underground again in my inner world, my unconscious self, and there was a fire there. Perhaps this fire represents my energy and my creativity. It seems as though it is time for me to take the fire into the outer world and let other people see it. The crow is an omen of change. It feels like a good omen. Session 13 I am walking down a road with an old man on one side of me and an old woman on the other. They tell me, “Look ahead. Don’t look back.” I am suddenly surrounded by a blinding, bright light. I feel powerful emotions of simultaneous sorrow and joy coursing through my heart center, my body becomes very hot, and my back arches involuntarily. I join hands with the man and woman and move up a column of energy and constantly changing color. I emerge in a place of wondrous emptiness and stillness. I have no sense of boundaries and am unable to determine where my body ends. This was another peak experience. It was very different from the previous experience in which I contacted my own power. This was about something much bigger than myself. It is very difficult to describe this state in words. This was a profoundly moving experience, and as a result I will never have quite the same perspective on my life that I had in the past. It is as if I have suddenly seen my life in the context of a much greater whole and I can trust what unfolds for me. Session 14 I am a young girl. It is night, and there is a celebration going on. I am dancing. People follow me and I show them a bright star. I am relaxed, playful, and unselfconscious. This was my final session. It was much less intense than my previous session, but it felt like a confirmation of the choice I have made and a readiness for new beginnings. A few weeks after this session, I received a phone call from a friend I had not seen in several years, asking me if I would like to become a partner in a psychotherapy practice with her. Conclusion As I reflect on my experience with GIM, what impresses me the most is how changes in my outer life were foreshadowed by changes in my imagery. As my imagery changed, the outer world responded. Many of these responses were not initiated by me. Part of me knew what needed to happen, but I was unable to access this knowledge through normal, logical thinking. Imagery was a channel through which my inner knowledge became accessible. The music invited my imagery to flow more easily and helped sustain and support some of the strong emotions I experienced during the sessions. I am also grateful for the insights I received that came from what I consider to be a spiritual perspective. This was not something I had expected. I came to therapy

looking for the courage to let go of a limiting job. I left with experiences that changed my fundamental relationship with life. Through this work, I was able to uncover the strength and trust that allowed me to become a more fully realized human being.

Taken from: Meadows, A. (Ed.) (2011). Developments in Music Therapy Practice: Case Study Perspectives. Gilsum NH: Barcelona Publishers.

CASE FIVE Bringing Light into Darkness: Guided Imagery and Music, Bereavement, Loss and Working through Trauma Leslie Bunt Introduction This is the story of a courageous woman who used a series of 17 Guided Imagery and Music (GIM) sessions to bring light and healing into very dark and troubled places. Fiona was originally referred for bereavement support following the loss of her partner, but as the case narrative unfolds it will become apparent that working through this specific loss triggered exploration of earlier losses and traumas resulting from periods of childhood abuse. GIM can provide a safe setting for containing the expression of some of the complex feelings associated with the grieving process, including sadness, isolation, guilt and anger, and can also assist a client to strengthen the inner resources required to allow other deeply buried losses to be recalled and moved into the light of consciousness. Given sufficient ego strength (as was the case with Fiona) it is then possible for further mourning of these earlier losses to be reconstructed and worked through in the present moment. Reflecting on Fiona’s entire journey benefited from insights gained during discussions with my supervisor, a Jungian analyst. The chapter continues with some background to GIM and concepts central to the approach adopted, before introducing Fiona and the main stages and themes of the unfolding therapeutic process. Words taken from session transcripts are in italics. Foundational Concepts The GIM method adopted in this context is the one pioneered by Helen Bonny (2002) and defined by the Association of Music and Imagery (AMI) as “A music-centered exploration of consciousness that uses specifically sequenced classical music programs to stimulate and sustain a dynamic unfolding of inner experiences” (AMI, n.d.). The individual hour and a half to two hour session is divided into four interlinked phases: 1) Prelude: generally verbal in nature, although drawing and other non-verbal media may be used. 2) Relaxation induction: assisting the client to enter an altered state of consciousness (ASC) and moving to the point when the therapist provides an opening focus for the client’s imagery ‘journey.’

3) Music listening: in which the client shares with the therapist the various feelings, body sensations, insights, memories, connections with the music, images, colors etc. that arise while the therapist supports with a range of verbal and non-verbal interventions aimed at holding, containing and deepening the client’s inner experiences and process. 4) Postlude: the therapist assists the client to return to the ‘here and now’ and to make further verbal connections between imagery and issues. Other nonverbal media may also be used. (For more detailed elaborations of each phase see Abrams & Kasayaka, 2005; Bonny, 2002; Clark, 1991; Goldberg, 1995) GIM provides a supportive and safe containing therapeutic space for the facilitating and gradual uncovering of the bereavement process (see, for example, Creagh, 2005). Listening to music in a very relaxed state with the witnessing support of the therapist provides opportunities for clients to find, at their own pace, the internal resources and strength needed to work through the shifting emotions associated with grieving. As shall be seen in Fiona’s story, time is also needed for sufficient trust to occur with both the music and the therapist before there are sufficient inner resources to enable the specific loss to be addressed (for further exploration of the complex relationships transferred between music, images and therapist see Bruscia, 2002). Sometimes the music listening evokes the additional presence of inner helpers to support this unfolding process. We shall see in Fiona’s story the importance of such figures as guardian angels. Support from these kinds of helpers has been reported by other therapists using GIM in grief work (Smith, 1997). The choice of music is also crucial in this early unfolding stage. Music of a highly supportive, predictable, and nurturing quality was used in the early sessions as Fiona began to connect with the feelings associated with the presenting loss. But, as uncovered in these early sessions, the loss of her partner was the trigger for the gradual unraveling of a more obscured loss, that of her own childhood innocence due to a sustained history of abuse by family members. Once she had gained sufficient strength to work through some aspects of her bereavement process, she was able to bring memories of this darker material into the light of the present moment in order to reexperience these earlier losses and traumas. In this phase of the work stronger, more challenging music was used to hold and contain these complex and difficult memories and emotions. In reviewing the case material retrospectively with my supervisor, it became clear that the gradual unfolding and expression of this traumatic material echoed the three-stage ‘recovery’ process elaborated by Herman (1992). Having established ‘safety’ and trust in the ‘first stage’ of the work, opportunities for the ‘second stage’ of ‘remembrance and mourning’ of the earlier losses arose before leading to a ‘third stage’ of ‘re-connection to ordinary life’ and the making of future plans (Herman, 1992 p.155). Ventre (1994/1995) used Herman’s stages to frame a ‘two-year GIM process’ that aided a 32-year-old woman to heal the ‘wounds’ from childhood periods of traumatic abuse. Later Moffitt co-published, including drawings, a journal ‘reflections and poetry choices’

from her client, a study that incorporated aspects of Herman’s stages into the recovery process from the long-lasting effects of sexual abuse from family members (Moffitt & Hall, 2004). These studies contribute to a developing literature of using GIM to address the complex issues of loss and trauma. How GIM can begin to help the abused client to acknowledge deeply buried feelings of anger, fear, sadness and resentment was discussed by Borling (1992). Also see Pickett, 1995, for a further case study example of the use of GIM to aid recovery from trauma. The gradual accumulation of fear and anger associated with periods of abuse can lead to physical tensions kept locked within the body and the manifestation of a primitive ‘freezing’ response (Rothschild, 2000). This can be viewed as a means of defense, as can any resulting state of desperate ‘helplessness’ (Levine, 1997). There are examples of such freezing in the early parts of Fiona’s narrative. There are also later moments when these deeply rooted and locked-in memories were given physical expression and release. A review of Fiona’s GIM journey provides examples of rich symbolic content existing in the liminal spaces between conscious and unconscious realms, between lightness and darkness. Romanyshyn (2007, p. 27) echoes this when, referring to Jung, he notes that one of the functions of a symbol is to exist in this space between what remains hidden deep within the psyche and what is brought into the ‘light’ of conscious awareness. Symbols such as swans accompany Fiona at various stages throughout her journey. Other archetypal figures also occur, for example the appearance of a wise old woman, as does the exploration of younger parts of Fiona’s self. A Jungian framework was used by Tasney (1993) in a GIM case study that investigated archetypes including the hero and shadow. Bringing light to illuminate the darker and more shadowy aspects of Fiona’s psyche also relates to the Jungian emphasis on the union of opposites, active use of the imagination, and living through the experiencing of the images (Meadows, 2002; Ward, 2002). The Client Fiona was in her early fifties at the time of the referral. She had lost her partner Robert recently from cancer. She was referred to GIM to support the bereavement process but, as mentioned above and can be read in this following narrative, the loss of Robert connected to earlier experiences of death and other traumas. Fiona’s father was dead but her mother was still alive, although during the course of the sessions she was becoming increasingly unwell. Fiona worked as a volunteer career. She was interested in art, meditation, and loved nature. Although she talked of spending time with her friends, she was rather a shy and anxious person who lacked confidence. The Opening Assessment Phase (‘Taster’ and Sessions 1-3) The opening sessions of a course of therapy regularly introduce themes that permeate the entire therapeutic process. Working through the loss of her partner occupied some of this process for Fiona. But exploring this particular loss became part

of a gradual unfolding of traumatic memories of child abuse with Fiona reporting that she had moments of not speaking during her childhood. Since the environment provided by her own parents was not safe she would often look for alternative mothering from her mother’s sister. This pattern of seeking out different secure attachment figures has been observed in people suffering from early trauma (Körlin & Wrangsjö, 2004). Although Fiona presented with some of the features of ‘Complex Post-Traumatic Stress Disorder’ (Herman, 1992, pp. 119-122), such as feeling guilty, she had a strong sense of self with extant coping mechanisms and defenses. This strong enough ego enabled Fiona to withstand explorations of these early memories (see Rothschild, 2000 for further psychobiological discussion of trauma and Korlin, 2002 for neuropsychological perspectives related to GIM). Bringing light to illuminate a pathway was there from the start as the focus to the short introductory ‘taster’ session. Fiona felt supported during the opening two pieces of Bruscia’s Pastorale1 program: Debussy’s Prelude à l’après- midi d’un faune and Liadov’s The Enchanted Lake (see the Appendix A for an outline of each session). She was walking by a river with her well-trusted dog and saw two swans – so white, pure and untouched. She wished (not without some sadness) to be as strong, free, fearless, proud, and confident as these beautiful creatures. The complex symbol of a swan points to ‘the complete satisfaction of a desire’ with a ‘swan-song’ also holding connections with death (Cirlot, 1971 p. 322). There was much beauty in this introductory session, beauty that she could smell and touch as she moved with the swans and her dog into a sunlit garden. Suddenly scared by someone jumping out, she felt protected by her dog and the swans who told her no one will come out and hurt you. She felt stronger, finding it hard to leave the garden. During the next three sessions she began to trust more and to bring the light to move further away from safe pathways into denser and darker woods, a symbolic gradual unfolding of hidden subconscious material. The smell of Lily of the Valley reminded her of a favorite perfume on her bedroom table when a young child. She had been sent to bed for something she had not done. Too frightened to go downstairs to the bathroom she eventually was calmed to sleep at a synchronous moment with the music, being cradled and rocked during the Shepherds’ Cradle Song from Bach’s Christmas Oratorio (from the program Caring). Younger and older parts of Fiona began to emerge. At the start of the second full session she recalled being frozen with fear on encountering some steers on a recent walk and the instant connections with suffocating childhood fears. Adult Fiona asked to find ways of taking care of her younger self and began to take young Fiona by the hand into the GIM journeys. During session three an older woman, who could connect to the Jungian archetype of the wise woman, showed Fiona a beautiful, warm, and sunlit house and garden. Older Fiona revealed this house (too grand for me) to younger Fiona. This is what it should have been like and was taken from her. She was entitled to this. The older Fiona became angry (another reaction to the freezing response; Levine, 1997) before this turned to pain and sadness….She’s been in the dark for so long, she has the light now, she’s so lovely, such a good person, her body’s getting old.

At this integration of younger and older parts of self, Fiona seemed strong enough for the appearance of the first significant image of her dead partner. It was as if up to this point she had been gathering her personal resources, preparing the safe ground herself. Robert appeared during another musically synchronous moment, during the opening bars of Duruflé’s In Paradisum from his Requiem, a piece not known to Fiona. Robert floated past wearing a long gown, appearing like a merman or fish and smiled as if to say ‘Hello.’ Fiona felt he had moved on and she was happy about this. The Therapeutic Process The Loss of Robert (Session 4) The first anniversary of Robert’s death occurred near the time of the fourth session. Fiona was terrified to think of Robert’s bones rotting in his dark grave. She asked for the focus for the session to be at his graveside and that the music (the program Grieving) could help her to look into the grave, again using light to look into a dark place. The image of a broken skull connected with one of a broken doll in the cellar at her childhood home. She wanted to put the bones in the right order and the image kept shifting between Robert’s body and her doll. She went into the nearby church to light a candle. She felt calmer. Everything was o.k; the bones were all clean, white, pure and untouched (as were the earlier swans). Fiona saw a white shadowy figure, full of light. She was not alone and felt better. She too had been waiting for someone to bring her out of the dark. The light drew her between graveside and the church, the same light for Robert and for her. Robert’s spirit is in the church, in the light. The bones aren’t important. They can look after themselves. The session culminated with the appearance of four big strong angels whose wings are like swans (again). They were gentle, kind and understanding and Fiona felt that she had known them for a long time--they’re not strangers and like a nice family--mother, father, auntie, uncle (my supervisor noted a possible connection with the four archangels). Fiona felt vibrations in her body at the reply when she asked the angels to look after Robert. The angels invited her to move on, to go beyond the pain. They told her: You must trust, if you trust we will never let you down. Fiona ended the journey by placing flowers on the grave in glorious sunlight. The Childhood Traumas (Sessions 5 – 8) Fiona was beginning to feel safer and more trusting of the GIM process. The mourning and some healing of Robert’s memory provided a kind of catalyst to allow some of these early memories to take more shape. Glimpses had occurred from the outset with the untouched swans, the taking care of younger Fiona and the co-existence of the broken doll/bones in Session four. In allowing these earlier memories to surface it was as if she was beginning a grieving process for her own losses. Stronger music used during these pivotally central sessions enabled her to explore the symbolic potential of such fearful images as:

• • • • • •

Hiding in a smelly upstairs cupboard during one of her mother’s terrifying rages; The boarded-up fireplace and door in her bedroom; The room where her grandmother died; Both her grandfather and her father returning home drunk in the middle of the afternoon; The cellar where she was often thrown; A dark and gloomy bricked-up well (glimpsed as early as Session two) that frightened and angered her parents.

So many of these images were concerned with hiding, being in the dark or with something blocked up. Fiona needed to find ways of protecting and defending herself, of distancing herself from suffering and pain. During the orchestral arrangement of Bach’s Passacaglia and Fugue in C minor (Session six), her guardian angel gave her the strength to look down into the well, finding life in the trapped water. Fiona began to realize her father was the weak one, controlled by her mother and who did anything to keep the peace. She became no longer scared of her father but began rather to pity him. Fiona began to feel freer and have more control. The well scared them more than me. I took their fear on. But, tragically, this house held more horrors for her. She needed a lot of light and support from her ever-important guardian angel to re-visit (Session seven--DeathRebirth) the recurring traumatic memory of discovering in the cellar the coffin of a family member who had died at a young age in childbirth. Fiona also felt as if part of her was in the coffin with the mother and child. During this journey she screamed for both the child and herself to be let out. Subsequent to this session, the following questions were explored in supervision. Was she mourning her own lost childhood? Was some of this material a creative and metaphoric fantasy all needing to be released? How did she feel at the threshold of her own adult life? Fiona remembered how frightened she felt at the funeral, worried that perhaps the baby was not dead. Fiona created a beautiful new grave and funeral for the child and mother. Her last words of the session were: Now there is light. She hasn’t been forgotten, she’s always with me, goodbye my love. They were evoked by the final bars of Mahler’s Der Abschied from Das Lied von der Erde, a farewell described by Fiona as perfect for the funeral. Was she symbolically saying farewell to her own childhood? These central sessions were akin to the musical form of variations on a theme with an ever-deepening cycle of grieving, letting go and some beginning of restoration. By Session eight she had sufficient internal resources to confront the memories of the most dreadful damage done to her by family members. One constantly crippling fear was of dark buildings, church steeples, and towers, holding within them symbolically very painful associations. She asked if she could use the music to face her terror of one church steeple in particular. For the focus she opted to leave her friends at the end of an enjoyable evening and moved towards the bus stop close to the dreaded steeple. After gathering strength during excerpts from Elgar’s Enigma Variations (Positive Affect), she moved towards the steeple, terribly scared but aware that her guardian angel was with

her. During the singing in Mozart’s Laudate Dominum the angel seemed not to understand. At the start of Barber’s Adagio for Strings the angel looked sad. As the music moved towards its intense climax there was a clear transformational matrix of working relationships: Fiona’s connections to the music, the unfolding images, and to my guiding. The images unfolded thus: The angel can feel Fiona’s pain, is hunched up, holding her stomach. The angel weeps. The angel understands and holds Fiona’s hand, giving her strength. The angel stands up and let’s go of her stomach. She puts her arm around Fiona. They look up at the steeple together (during the general pause after the loudest moment). Fiona realizes that the steeple represents the family abuser. The angel asks what is to be done with him. Fiona replies: Let him go, let him flow away, take him out of the church steeple. The steeple is now just an empty, narrow passage, just stone. The steeple is a pointed ridiculous object. Following the Barber the know-it-all tenor and self-interested chorus in the Sanctus from Gounod’s St. Cecilia Mass annoyed her. They did not understand; only her angel did. She felt stronger when the voices disappeared during the excerpt from Strauss’ Death and Transfiguration. Here Fiona and her angel were drenched in cleansing and very healing rain. The overwhelming dark object had lost all of its symbolic potency. As a child this fear had petrified her. She was speechless and unable to tell anyone. Now she could see the steeple for what it was – it had been cut down to size. After the session she went to look up at this steeple and at the start of the next session reported that it no longer had the same horror for her. Releasing and Reconciliation (Sessions 9-14) Fiona often brought objects or paintings relating to her GIM journeys to subsequent sessions, including bird feathers (relating to the swans), a drawing of one of the angels at Robert’s grave, and, after the powerful work with the steeple, a painting of a black steeple now covered with glitter and white feathers. She began to talk about becoming freer, released from some of the memories and able to move on. She was aware that nobody was pulling her back, no Robert or abusive family figures. Sessions began to oscillate (at her request) between those focused on quiet, reflective healing and restoration and those where working programs with stronger music were employed to connect again to more fearful feelings. But now there was more integration with Fiona feeling less abandoned and frightened than before. Some of the journeys were magical in flavor, as in her very happy travel in a snowy landscape (Session nine – Quiet Music). A silver-clad lady took her (during Holst’s Venus) on a ride on a carriage pulled, on this occasion, by a clean, white swan. Fiona was

certainly using the music in its full liminal and transcendent capacity to enter through new portals into different spaces. Her angels began to take her to even more wonderful places, full of light and color, on one occasion showing me a door in the cloud, a beautiful place that must be heaven…I feel like I’ve been here before, been a long time away but now I’m back. I know this place, this is my home, my proper real home…..I can go anywhere I want to. I feel so special…..all the pain I’ve suffered has dissolved…She began to talk about wanting to help others. I want to help other people with similar circumstances, children who’ve been beaten, raped, locked in the dark….I want to be their angel, to show them the light and beauty. I’m telling a little girl not to give up, she looks so sad, so alone…I’ve put some light in her heart…when she’s strong one day she’ll put some light in someone’s heart. The continued releasing and reconciliatory work was exemplified by such moments as: • • • • • • •

•

•

•

Throwing all her past abusers to the bottom of the well where clear water and light dissolved them (Session eleven – Expanded Awareness) Gaining insight that the abusers were the scared ones Feeling that it was not her fault, and being sad when people continued to be angry with her Appreciating that she had worked hard for her good power Being thanked by Robert and letting him go, aware that he will be o.k. Realizing that she is still needed on this earth, things I need to do Restoring her childhood house to a place full of light and sunshine (Session twelve – Peak Experience) a house to be proud of, beautiful, my house…with the clear painted white and flowers around the well Tearing black clothes off her mother to reveal a sad and powerless old lady who says sorry; leading to a tender moment of forgiveness (at the end of Session twelve) Re-visiting the hospital room where Robert died and ritualistically saying her farewells and tidying up his personal items (Session thirteen, close to the second anniversary of his death, using the same music as in Session four, the first anniversary) One final visit to the dark cellar (Session fourteen – Inner Odyssey) and during the drum roll in Nielsen’s 5th symphony tearing up some black plastic trash bags she had brought to the session to symbolize the remaining dark images of black objects from that horrible cellar. Instead of it breaking me up, I’m breaking it up….no-one else will ever suffer in that place

Years of horrible memories, frustrations, and hurt were being torn up as trash and Fiona felt a new, good energy and tingling sensation in her fingers at the end of tumultuous Session fourteen. It felt as if some locked memories in the nervous system were being given an opportunity to be released on a physical level, having worked through the images, feelings and memories (Levine, 1997; Hall, 2009).

The Final Phase (Sessions 15-17) Colleagues were noticing how Fiona was looking different and speaking out with more confidence. She was sleeping better, having fewer migraines and bad dreams. She felt better about herself and about being ready for a new relationship. The recurrent image of a swan--a pure white swan, like an angel--occurred in Session fifteen during Mythic Journey, a program compiled by Clark (1995). Fiona threw a list of negative thoughts into the river but was troubled that the nearby swan would become dirty with all that negativity so close. The swan gave her the strength to let go and not feel guilty. The list of negative things was also burnt and all the black ash (memories of the ash in her grandfather’s fireplace) trampled underfoot. As Ravel’s orchestration of Mussorgsky’s The Great Gate of Kiev began, Fiona saw a funeral procession of ghostly black figures from the past coming towards her. She gathered strength so that the ghosts all turned back. At the climax of the music she realized that they could not touch or hurt her anymore. They were no longer a part of her. Standing on the top of a mountain she felt strong and guiltless. At the start of her final GIM session (Session seventeen) Fiona talked of starting the work like a bird with two broken wings. One wing was the grief over Robert, which she now felt was healed; the other was the traumatic memories of her childhood abuse which were healing, but she knew would never totally disappear. However, she knew that she now had the inner resources to cope, to be independent and to fly from this case/nest. She talked excitedly of the free bird meeting new friends. This final session was a kind of summary of all of the GIM journeys and a reflection of her desire to bring light into darkness. She asked if the music (the program Mostly Bach) could help her move from a dark memory from a summer holiday when a young child, to being taken by her angels to a place of light and transformation. The scene was familiar: being hit and sent upstairs to her room to wait in terror for her father’s return. She fell on the floor as if she had passed out. Sleep was an escape. I just want to die. Why are people so horrible? She saw the light bulb of her room sparkling through her tears, a comforting image. If I wasn’t crying I wouldn’t see the beauty in the light bulb. The sparkling image was like a magic fairy, strong and good. Fiona used these comforting images as a kind of refuge both at home and when she was being bullied at school. It was her means of survival, living as she said in my own beautiful world, inside of a fishbowl, small, safe, light, so high in the sky where nobody can touch me…..it’s my home. She still needed, at times, to go that fishbowl, although everything was bigger now. Her dog was allowed in with her and maybe one day I’ll trust someone and let them peep in. Fiona was hoping that more people could be allowed to look into that fishbowl and begin to share more of her life with her. She did not need to keep secrets and could do so without feeling guilty. She dreamt of helping oncology patients to draw and paint. At the last review session she talked about being able to speak up more, being less overwhelmed by anxieties and past horrors. She had learnt to defend herself: she had found her voice. Conclusion

During the review session we listened together to the Debussy Prelude as we had in the initial ‘taster’ session. As a focus to our joint listening, we used the image of the poppy field on the card she had left with me. The sun shone, she was with her dog, as in the ‘taster’, and she imagined herself as a beautiful lady wearing lovely clothes and carrying a sun umbrella. The session and our work together ended with her favorite tune – Greensleeves – in the arrangement by Vaughan Williams that ends the program Quiet Music. References Abrams, B. & Kasayka, R. (2005). Music imaging for persons at the end of life. In C. Dileo & J. Loewy (Eds.), Music Therapy at the End of Life (pp. 159-170). Cherry Hill, NJ: Jeffrey Books. AMI (n.d.) Association of Music and Imagery (Website). Retrieved from www.amibonnymethod.org. Bonny, H. L (2002). Music Consciousness: The Evolution of Guided Imagery and Music (L. Summer, Ed.). Gilsum, NH: Barcelona Publishers. Borling, J. E. (1992). Perspectives on growth with a victim of abuse: A Guided Imagery and Music [GIM] case study. Journal of the Association for Music and Imagery, 1, 85-97. Bruscia, K. E. (2002). A Psychodynamic orientation to the Bonny method. In K. E. Bruscia and D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 225-243). Gilsum, NH: Barcelona Publishers. Cirlot, J.E. (1971). A Dictionary of Symbols (Second edition). London: Rout-ledge & Kegan Paul. Clark, M. (1991). Emergence of adult self in Guided Imagery and Music (GIM) therapy. In K.E. Bruscia (Ed.), Case Studies in Music Therapy. Phoenixville, PA: Barcelona Publishers. Clark, M. (1995). The hero’s myth in GIM Therapy. Journal of the Association for Music and Imagery, 4, 49-65. Creagh, B. A. (2005). Transformative mourning: The Bonny Method of Guided Imagery and Music for widowed persons. Dissertation Abstracts International: Section B. The Sciences and Engineering, 66 (2-B). Goldberg, F. (1995). The Bonny Method of Guided Imagery and Music. In T. Wigram, B. Saperston and R. West (Eds.), The Art & Science of Music Therapy: A Handbook (pp. 112-128). London, Toronto: Harwood Academic Publications. Grocke, D. E. (2002). The Bonny Music Programs. In K. E. Bruscia and D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 99-133). Gilsum, NH: Barcelona Publishers. Hall, A. (2009). Personal Communication. Herman, J. L. (1992). Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror. New York: Basic Books.

Körlin, D. & Wrangsjö B. (2004) GIM European conference, Bulgaria. Personal communication. Korlin, D. (2002). A neuropsychological theory of traumatic imagery in the Bonny Method of Guided Imagery and Music (BMGIM). In K.E. Bruscia & D.E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 379-415). Gilsum, NH: Barcelona Publishers. Levine, P.A. (1997). Waking the Tiger: Healing Trauma. Berkeley, California: North Atlantic Books. Meadows, A. (2002). Distinctions between the Bonny Method of Guided Imagery and Music (BMGIM) and other imagery techniques. In K. E. Bruscia and D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 63-83). Gilsum, NH: Barcelona Publishers. Moffitt, L. & Hall, A. (2004). “New grown with pleasant pain” (Keats): Recovering from sexual abuse with the use of the Bonny Method of Guided Imagery and Music and the use of poetry. Journal of the Association for Music and Imagery, 9, 59-77. Pickett, E. (1995). Guided Imagery and Music: A technique for healing trauma. Journal of the Association for Music and Imagery, 4, 93-101. Romanyshyn, R. D. (2007). The Wounded Researcher: Research with Soul in Mind. New Orleans, Louisiana: Spring Journal Books. Rothschild, B. (2000). The Body Remembers: The Psychobiology of Trauma and Trauma Treatment. New York: W.W. Norton and Co. Smith, B. (1997). Uncovering and healing hidden wounds: Using GIM to resolve complicated and disenfranchised grief. Journal of the Association for Music and Imagery, 5, 13-23. Tasney, K. (1993). Beginning the healing of incest through Guided Imagery and Music: A Jungian perspective. Journal of the Association for Music and Imagery, 2, 35-47. Ventre, M. (1994). Healing the wounds of childhood abuse: A Guided Imagery and Music case study. Music Therapy Perspectives, 12 (2), 98-103. Ventre, M. (1995). Healing the wounds of childhood abuse: A Guided Imagery and Music case study: Errata. Music Therapy Perspectives, 13(1). Ward, K. (2002). A Jungian orientation to the Bonny Method. In K. E. Bruscia and D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 207-224). Gilsum, NH: Barcelona Publishers.

APPENDIX A Session Summaries Session Taster

Introduction – Focus Light --- path

GIM Programme Pastorale (part)

1 2 3 4

light --- path extra blanket --- wood crystal --- dark wood breeze --- grave

Caring Nurturing Nurturing Grieving

5

breeze --- old trunk

Creativity I

6

tense/relax…well

Mostly Bach

7

light/angel…house

Death / Rebirth

8 9

extra blanket…bus stop light…snow

Positive Affect Quiet Music

10

ball of light…into music

Sublime I

11

extra duvet…hill

12

light…garden

Expanded Awareness Peak Experience

13

light…hospital

Grieving

14

angel…energy

Inner Odyssey

15

new breath…dockside

Mythic Journey

16 17

ball of color…picture warm wave…holidays

Inner Odyssey Mostly Back

Some Images walk with dog, white swans perfume, bedroom big and little Fiona big and little Fiona bones, church, light, four angles old clothes well, Robert angel, life in well, father, garden cellar, coffin, new grave church steeple silver lady, white swan, flying in light angel flight, Christmas angel, own wings, dissolving pain lamb, new house, sad mother re-visit hospital, sort Robert’s things cellar, black trash bags swan flight, burning list, letting go poppy, mother mother, punishment, tears, light, fishbowl

Acknowledgements: To ‘Fiona’ for giving consent to use material from her GIM sessions and to my supervisor Shelagh Layet.

Taken from: Bruscia, K. (Ed.) (1991). Case Studies in Music Therapy. Gilsum NH: Barcelona Publishers

CASE SIX Emergence Of The Adult Self In Guided Imagery And Music (GIM) Therapy Marilyn F. Clark Abstract This case describes one year of GIM therapy with a young woman, who after undergoing an abortion, found a need to be healed emotionally on many levels. As a child, she had developed anorexic behaviors in response to a dysfunctional family system affected by alcoholism. Through GIM, the image of herself as a young female waif forced out on her own evolved into a mature woman seasoned in the trials of the world, able to care for herself and to create healthy relationships. Background Information At the time of therapy, Diane was a 35-year-old, white female who co-owned a small bookstore and had a private counseling practice. She was married, though not living with her husband, and she had no children. In appearance, she was quite petite, and had a childlike look about her. She came from a large, upper middle-class family of six children: three boys and three girls. Her father, whom she idolized, was a successful businessman and an alcoholic; her mother, a housewife, was loving but regarded by Diane as weak. Her home life as a child was chaotic: with mother trying to keep things peaceful, and father appearing on the scene aggressive, bullying and mean when drunk. Diane was a quiet, sensitive person buffeted about by circumstances. She felt neither in control nor protected, as her mother did not set boundaries for the family, nor did she chastise the father for his bullying behavior. Diane reacted by asserting control over her body with anorexic behavior when she was ten years old. Her mother noticed her weight loss over one summer and forced her to eat. The eating disorder returned when Diane went to college. The summer before she started college she felt as though she were going insane. There was something inside of her, a negative force, telling her she was crazy and no good. She spoke of college as the worst time in her life, a nightmare. The eating disorder was never treated nor even recognized as a problem at the time. As a child, she had sought the refuge of a dependent relationship with her mother. In college she met John, her future husband, and transferred her dependency to him. John, studying to become a lawyer, was a heroic figure to Diane. He was a man with a cause. He wanted to liberate the downtrodden, and he espoused radical politics. Diane saw him as someone who could save her too.

In their marriage, she gave him whatever he wanted. She was passive and had very low self-esteem. She felt as though he was the one who mattered, and that his decisions were important; whereas she was insignificant and a littly crazy. Their sexual relationship was not pleasurable for her. She felt it was something she had to do and often felt invaded. While he earned very good money as a lawyer, she was uncomfortable using his money and tried to live on the small income she made. This was another means of depriving herself in order to be in control of her life. During college, Diane began to study psychology as an attempt to understand what was going on inside of her. She went into the counseling profession as a natural outgrowth of her studies; however, her primary interest was still in trying to heal her own pain. After a few years of marriage and work as a counselor, she opened a women’s bookstore with a friend. In books she had found much support and affirmation of herself. The bookstore was probably the first major step she made towards her own expression in the world. When Diane learned she was pregnant in her mid-thirties, she became very panicky. This was her second pregnancy. The first ended in an abortion. She became pregnant the second time when she and her husband were on vacation, although they had stopped living together at the time. She chose to terminate this pregnancy also, and John went along with her decision. Diane was not ready to have a baby. She feared the loss of control over her body, and feared becoming like her mother: lacking clear boundaries, having no control, and surrendering to another’s will. She knew that her fourteen years of marriage had ended with the abortion. These losses precipitated the crisis which brought her into therapy soon afterwards. Diane was present at a GIM demonstration which I did for a small group of therapists. She was very attracted to the method and felt an affinity for my style of working. She telephoned me soon after seeing the demonstration and asked to begin working with me. She presented as a very articulate and aware person, who was highly motivated to work in therapy. In her first session, she demonstrated that she was particularly well-suited to GIM therapy: she worked extremely well with imagery processes, and was very responsive to the music. Method The method used throughout Diane’s therapy was Guided Imagery and Music (GIM), as originated by Helen Bonny (1978). GIM is a method of self-exploration in which carefully selected musical pieces are used to elicit an internal response. Essentially, it involves imaging to music in a nonordinary (relaxed, altered) state of consciousness, assisted by a guide or therapist. Several basic steps are involved. After building a solid rapport, the therapist guides the client through a physical relaxation and then focuses the client’s imagination in preparation for listening to a specially designed tape of classical music selections. The client then shares with the therapist the various impressions, feelings, and images which arise spontaneously while listening to the music. Throughout the process, the therapist supports, amplifies, and resonates with the client’s feelings and experiences through verbal and non-verbal techniques. When the music ends, the therapist assists the client to return to waking consciousness. A time of integration of new awarenesses follows, through discussions or the use of other expressive modalities.

Often the music imaging process stimulates experiences which were previously not available to conscious awareness. These experiences may be discussed or examined afterwards, or they may be allowed to remain in an imaginal state, so that they can inform the client’s consciousness through a gradual process of integration. My therapeutic orientation is client-centered, that is, I believe that individuals are capable of self-directed growth within the context of a therapeutic relationship. I regard GIM as an uncovering form of therapy, one which accesses unconscious material, and which requires indepth work on the part of the client, and advanced, specialized training on the part of the therapist. I view the psyche from a Jungian framework, and regard it as a rich source for healing. I also find that the archetypes identified by Jung are often helpful in understanding therapeutic movement in the GIM process. Treatment Process Diane received GIM therapy for about a year. The sessions were 90 to 120 minutes long, and were scheduled according to the urgency of the process. Altogether she received 20 sessions. The primary theme of Diane’s therapy, the emergence of the adult self, can be understood through looking at her inner world of imagery. Summaries of each therapy session are presented below with emphasis on the imagery process as it evidences therapeutic growth. Setting the Stage SESSION 1: THE BASEMENT WITCH. Diane begins her imagery as a girlchild exploring a house. She finds a room with desks, and she says “I want to learn,” showing her readiness to begin therapy. She then goes to the dark basement where a witch lives. The witch knows the story of the house. Diane confronts the witch, telling her: “Don’t scare me! You’re bad and you have no right to frighten a child. Stop it. You’re taking advantage of me and I won’t have it. When I ask you to come out, you come out. But I won’t have you terrorize me. I’m not as big as you, but I have the power to say stop it!” Diane begins to explore parts of the self which have lain in the shadow as depicted by the witch in the basement. She leaves the session feeling she has faced fears. SESSION 2: THE MAGIC FOREST. Diane continues her exploration as a child in a magical forest, where she can understand the animals and were she is taken care of. She becomes a mature woman and dances. The forest is no longer enchanted. She is experiencing briefly the outcome of the therapy work. As gentle humming voices from Puccini’s opera, “Madame Butterfly,” accompany her, she becomes an adolescent and sneaks into a castle. She is exploring different times in her development through these shifts of the imaging ego. There is relief in being the adult self, but she cannot maintain that identification for long at this point. SESSION 3: THE CASTLE VISIT. Diane encounters the King and Queen of the castle and demands to be accepted on her own terms. The archetypal relationship to mother/father, female/male is further seen in images of the sun and the moon. She says to the sun, “Why won’t you speak back to me? All I can do is breathe you in.” The sun responds “I’m trying to reach you, too.” With the moon she feels safe and able to speak the same language. The

parental relationship is played out in this session in ways which feel safe and where she has control and respect. SESSION 4: THE BEACH COTTAGE. Diane is an orphaned child who finds a homey beach cottage. A protective mother invites her in to share the family’s meal. She is accepted by the father who takes a walk with her on the beach. The Pachelbel “Canon in D” gives grounded support as she integrates into the family making friends with the children. Diane is continuing to establish a safe space in which to work by populating her image world with a supportive family. SESSION 5: DEATH/REBIRTH. Diane begins to surrender to the process of change in this session as she experiences images of being in a coffin. The Bach “Passacaglia and Fugue in C minor” with its strong descending patterns helps her to surrender to the inevitable ending of life and the reintegration into the earth. Images of spring and new life follow. She has a meeting with herself as a child. She promises to listen now to the little girl. The last images are of the funeral procession of the Queen. This theme of the death of the mother and birth of the child is key to her growth. These images set the stage for a more intense encounter later in her process. SESSION 6: LEARNING TO TRUST. Diane is an adult feeling isolated, homeless, not knowing where she fits in. She does not yet feel confident in her adult self. A vaporous form takes human shape and communicates to her about trusting and patience. She is introduced through the music to many people. She sings with them while Vivaldi’s “Et in Terra Pax” from the “Gloria” is heard on the tape. She makes a homey place for herself and gives herself permission to just be. SESSION 7: THREE GENERATION DANCE. Carrying forward the positive feelings from the previous session, Diane begins this session at a dance feeling free and graceful. She heals a sick child by gently dancing with her. She meets an older woman whose dance shows the lessons of age. Once again Pachelbel’s “Canon in D” helps to bring these three parts of herself together in a dance in which each one, the child, the adult, and the old woman are valued by the others. SESSION 8: RAISING BABY BROTHER. Diane returns to the magical forest where she finds her baby brother. She is fiercely protective of him, and takes him to the city where she finds a gentle old man to help raise him. As with other elements of her personality, the young animus, or male part of her, must find a safe place in which to develop. Integration SESSION 9: THE FEMALE GUIDE. Diane meets a woman who counsels her to relax and trust. She tells Diane “I needed to take you on this lonely route so you could learn to love yourself.H The imagery suggests a transference to the therapist. Diane admits that, though she still feels resistances, she feels her life is different than it has been for a long time. They dance together in celebration. Confronting Family Patterns SESSION 10: THE FAMILY SCENE. The first movement of Brahms’ “Second Piano Concerto” helps to evoke the first look at Diane’s chaotic childhood home. A quiet moment with her mother is interrupted by the family returning from a day at the beach. Father comes home and begins to put demands on Mother. Diane goes into a rage and threatens to attack anyone who does not show respect to her mother. She says, “See, Mother. This is what you needed...I’m

your protector...I’m the best daughter you could want.” In the imagery, she creates safe boundaries which were not present when she was a child, and she expresses anger at both parents. Father SESSION 11: FATHER GOD. Diane takes the struggle with Father to an archetypal level in this session. She becomes very angry when her devotion to a deep and powerful voice is not recognized. It’s as if she has been pushed out of heaven. She finds a stream where she refreshes herself. The water shows her how to flow through life without caring. She feels as if she has aged. At the end of the session she reflects that this is the story of her life. She idolized her father, but he did not cherish her devotion. SESSION 12: SLEEPING WITH THE STARS. Diane’s psyche gives her a rest from the intensity of the previous sessions. She has images of sleeping. She floats among the stars in her sleep. This sleeping imagery is like a stop-action, giving her a break and a time to be nurtured by musical excerpts from Faure’s “Requiem” and Wagner’s “Lohengrin.” SESSION 13: FREEING THE KING’S HEART. Diane begins to integrate the work with Father in this metaphorical fantasy. She enters into a field in which a beating heart lies protected by barbed wire fences and daggers—poised to penetrate the heart if anyone invades the space. As she carefully makes her way to the heart, she wonders if this is a fetus, a reminder of the abortion. She learns this is the King’s heart which he has put here and will protect at any cost. She teaches him about how to place the heart in his body where it naturally belongs. She says, “I thought he was a fierce, cruel, mean king. But he was just a lonely, empty man. This wouldn’t have been possible if I hadn’t taken the journey into the center of the heart.” SESSION 14: SHADOW MAN. Diane continues to work with her animus, this time in its authoritative and competency aspects. She begins with memories of a horseback ride with her father, where she proved her stamina. Then to earlier memories and a fantasy of a mysterious military man who helps her discipline herself to not eat. She wanted to be different from her mother whom she saw as a fat, weak person with no will of her own. Diane felt she had a special purpose and was different from the women in her family. The shadowy male figure is an aspect of her animus in its most negative, controlling aspects. Integration SESSION 15: COMING HOME. Diane returns to the fantasy style of imaging experienced in the first part of her therapy. She enters into a land that is completely welcoming to her; all of nature is glad to have her there. She finds a loving woman there who wants to hear about all of her adventures. Diane struggles to fully trust her until the woman reveals that she is a Goddess. The Goddess tells her “You have to walk through the darkness and know it’s a passing dream...Let your feelings play out...You’re strong enough to pass through these times.” Her inner self is strengthening as she begins to find positive female images within her own psyche. SESSION 16: CELEBRATION. Diane continues with the positive feelings experienced in the last session and has a peak experience which further reflects her inner strength. In a spirit state, she meets the God and Goddess and dances for them. She celebrates her expansive feelings

while flying around the world with the accompaniment of Barber’s “Adagio for Strings.” In the end, the Goddess appears to her in a rainbow, like the goddess Iris from Greek mythology. .

Mother SESSION 17: DEATH-REBIRTH II. Strengthened by the last two sessions, Diane moves into deep material once again. Intense colors herald feelings needing to be explored which may be of a pre-verbal nature. Colors give way to a fantasy scene observed by the two-year old Diane of a fawn massacred by a bear, and a witch running madly into the woods. Diane, now older and surrounded by an aura of health and light, walks around her childhood home. She feels evil coming from her mother’s bedroom, perhaps indicating the confused messages she had received as a child about intimacy. She realizes her mother is dying and that she has killed her. From her mother’s body comes a young girl. Diane brings the girl into her light to grow strong. She tells the girl that she can grow up and be who she wants to be. It is interesting to note that the music played through this session was gentle and nurturing. The music provided a safe space in which this intense work could proceed. Finding Herself SESSION 18: INTEGRATION. Diane’s imaging ego watches her double frantically riding horseback to no destination. The Goddess emerges from the woods and encircles both images of Diane, giving them a blessing. The two Dianes go to a land they can call home and where they can rest. SESSION 19: EMERGING FROM THE OCEAN. With a dolphin as guide, Diane leaves the ocean and swims to a river. Once again she is back home. A woman comes out of the woods and is a channel for Diane’s healing. The woman is connected to the moon, the archetypal feminine. Closure SESSION 20: THE DEATH OF THE QUEEN. Returning to an earlier theme, Diane returns to the castle where the queen is dying. This time, Diane appears as both a man and a woman: the man is a knight and the Queen’s son who has returned home, the woman is the Queen’s daughter and knight’s sister. As the queen dies in peace, Diane (the son) vows to take care of his sister (Diane, the daughter). They move to the woods where he takes care of her by day, and she takes care of him by night. The Goddess helps Diane (the daughter) through the night and promises to be with her whenever she has need. This was the promise she wanted from her mother, but was never able to get. As her therapy reaches closure, she integrates the male and female, and is able to find a caring balance between the two. Discussion Diane stated candidly in our first session that she had a clear feeling she could trust me. This enabled me to challenge her with some of the more intense musical selections in my tape

collection. She was never frightened by the music and easily accepted it into her inner world. I was also able to encourage engagement and confrontation with the images as necessary. When working with scary and intense imagery episodes, she was always courageous. Her trust of me, the music, and the imagery were key to the success of GIM therapy for her. Diane often preferred not to translate the imaging experiences into intellectual explanations. Yet, she was aware that on a deeper level, she was working through many feelings, and in the process, inner transformations were taking place. Throughout the course of therapy, she reported that she felt better, although she could not always explain why. The first part of the series, Setting the Stage, was primarily metaphorical fantasy. Dramas were played out where Diane tested the safety of her inner world. She found places where she was accepted, where she could assert herself and where she could do as she pleased. She found friendly and loving companions. She protected the more vulnerable parts of herself. All of these experiences laid the foundation for the deep personal work which took place during the second part of her therapy. In the second part of the series, Family Patterns (Father and Mother), Diane moved into the challenging and painful experiences from childhood with images of memories and fantasy bringing hidden parts of her personality into focus. Strong feelings of rage, frustration and anger flowed as she reenacted memories. She compensated for her powerlessness as a child through these images by bringing the help of her adult self. She also relied on the magical thinking of a child to make sense out of a chaotic environment. When particularly difficult work had been done, she took time to rest and to integrate what had happened. Her inner world presented nurturing and sometimes spiritually uplifting imagery at these rest times. The imagery during this period suggested early traumas of which Diane had no conscious recall. The intensity of some of her imaging experiences led me to consider the possibility of childhood abuse. Upon reflection and conversation with her, it appears that what was being uncovered was emotional incest with her mother, brought about by the alcoholic behavior of her father. Her mother substituted emotional intimacy with Diane for sexual intimacy with her husband (Diane’s father). This enmeshed relationship hampered Diane’s ability to grow into the maturity of adulthood and to take on the responsibilities of developing authentic relationships with her husband and with herself. The outcome of the work was a deep integration of the child, mother, and father into the adult self. From a homeless waif to the recipient of the Goddess’ blessing was a journey marked by honest confrontation with fears and old patterns. The GIM process worked well for her as she was able to give clear voice to her inner world. She believed in it and acknowledged early in the course of therapy that she was feeling better and better. When the series was over, she took the advice of her guide, the Goddess, and gave herself time to rest. Her divorce was finalized, her share of the bookstore was sold. She took the opportunity to return to her family home for a visit and to get to know her parents from her adult perspective. Glossary Animus: A Jungian archetype which represents the male or masculine experience within a female. It may be particularly apparent in authority and competence matters (YoungEisendrath and Wiedemann, 1987).

Archetype: A universal pattern or motif which comes from the collective unconscious, and is the basic content of myths and fairytales. It may appear in visions and dreams (Hall, 1986). Imaging ego: The ego as it is located in the imagery. In an image, it is that element which makes “I” statements (Clark, 1990). Iris: In Greek myth, the goddess of the rainbow (Herzberg, 1954). Metaphorical fantasy: One type of fantasy imagery which has a metaphorical meaning relevant to the imager’s life (Clark, 1990). Peak experience: Religious or spiritual experience of unity with nature or with one’s understanding of the divine (Maslow, 1968). Shadow: An unconscious part of the personality characterized by traits and attitudes which the conscious ego chooses to ignore. It may be positive or negative (Hall, 1986). Transference: Projection onto the therapist of conscious or unconscious emotional connections to others (Hall, 1986) Waking consciousness: Awareness in an alert, awake state; normal consciousness (Clark, 1990). References Bonny, H. (1978). Facilitating Guided Imagery and Music Sessions. Salina, KS: Bonny Foundation. Clark, M. (1990). Guided Imagery and Music. Unpublished lecture notes. Temple University, Philadelphia, PA. Hall, J. (1986). The Jungian Experience. Toronto: Inner City Books. Herzberg, M. (1954). Myths and their Meaning. New York: Allyn and Bacon. Maslow, A. (1968). Toward a Psychology of Being. Princeton: D. Van Nostrand Co. Young-Eisendrath, P., & Wiedermann, F. (1987). Female Authority. New York: The Guilford Press.

Taken from: Hadley, S. (Ed.) (2003). Psychodynamic Music Therapy: Case Studies. Gilsum NH: Barcelona Publishers.

CASE SEVEN Healing an Inflamed Body: The Bonny Method of GIM in Treating Rheumatoid Arthritis Denise Grocke Abstract This chapter will describe the psychodynamic features of the Bonny Method of Guided Imagery and Music (GIM) therapy with a forty-three-year-old woman who, at the start of GIM therapy, had a fifteen-year history of rheumatoid arthritis (RA). The psychodynamic aspect of the study is based on the concept of physical illness as a manifestation of unresolved issues in the client’s life, and that the symptoms of the illness depict the client’s psycho-emotional needs. The case study will illustrate how GIM sessions over five years allowed the client to relive events from childhood, and to express emotions relative to those events. The client’s imagery was symbolic of the manifestation of the illness and she frequently had imagery relating to her blood stream, joints, and cells, and learned quickly that she could enter the imagery of the body as a means of engaging the precipitating cause of the irritation. The issue of counter transference will be discussed with respect to two significant sessions in which the client was in extraordinary pain. The countertransference issue was whether the choice of music (which exacerbated the pain) made her condition worse, or whether the pain she was suffering was a necessary process of working through the disease. Introduction The Bonny Method of GIM is a specialized area of therapy in which clients listen to prerecorded classical music in a deeply relaxed state and in which visual imagery, changes in mood, and physiological effects in the body are experienced. GIM was developed by Dr. Helen Bonny, a music therapist at the Baltimore Psychiatric Institute, USA, in the 1970s. The method is based on the principles of psychodynamic therapy, where unresolved psychological issues in the client are brought to the surface and may be resolved. In GIM, the clients’ issues are represented in symbolic form in the visual images, feeling states, and body responses. The music programs used in GIM were designed by Bonny, and each incorporates selections from the classical music repertoire. The music contour of the program is designed to have a beginning piece which stimulates imagery, a middle selection to deepen the experience emotionally, and a final selection which returns the client to a nonaltered state of consciousness. A section of a large music work (e.g., a symphony or concerto) may be programmed alongside a work of another composer or another stylistic period. The choice of

music for each program is made according to the potential for inducing imagery and deepening emotion. A GIM session lasts approximately two hours. There is a period of discussion (of approximately fifteen minutes) in which the client and therapist decide together on a focus issue for the session. The client moves to a relaxation mat and reclines with eyes closed. The therapist provides a relaxation induction which is individually tailored to the client’s energy level and to the focus issue for the session. A focus image is given to stimulate the commencement of the imagery process, and the music program is chosen (by the therapist). As the music plays, sequences of images unfold, and these are verbalized by the client. The therapist makes interventions which are designed to bring the client closer to the image, and to notice any feelings or emotions which are associated with the images. The therapist also takes a transcript of the imagery sequence. At the end of the music, the therapist helps the client bring the imagery to a close, and a reorientation to the non-altered state of consciousness is given. The client processes the meaningfulness of the imagery in relation to their daily life issues. This processing is done through verbal discussion or through free drawing or mandala drawings. Only one study has been done on the efficacy of GIM in treating patients with RA (Jacobi, 1994; Jacobi & Eisenberg, 1996). Twenty-seven patients with RA received ten individual sessions of GIM, and data were collected on medical measures (including walking speed, joint count, and perception of pain intensity), and general psychological status (including mood, symptoms of distress/anxiety, and “ways of coping”). Statistically significant results were found for lower levels of psychological distress and subjective experience of pain. Statistically significant differences were also found for walking speed and joint count. There were no statistically significant results, however, in disease status, and it was argued that a longer period of treatment with GIM may be indicated for changes to occur in disease indicators. In working with clients who have physical illness, Short (1990, 1991) noted that images emerging during GIM sessions may be physical markers of the illness. She found further that the marker could be useful in diagnosis. The image may be directly similar to the diseased body part, or may be an image of the fight against disease. Background Information Sandra referred herself to GIM at the age of forty-three. She came from a large family of eight children and was the third daughter. She had married in her early twenties and given birth to three children. Her husband was frequently relocated by the company he worked for, so that Sandra lived in various houses throughout the marriage. After one such relocation, she was diagnosed with rheumatoid arthritis (RA). The psychodynamic features of this disease are fascinating. One of the group of autoimmune diseases, RA affects women more than men in a ratio of 3:1, with the age of onset being between twenty to fifty years. The etiology of RA is unknown, but there is evidence of genetic predisposition to the disease (Akil & Amos, 1999, p. 40). The onset of the disease is thought to take place when an antigenic stimulus activates the components of the immune system. The antigen is picked up by a cell of the body, activating the secretion of antibodies. The antibody then binds to the antigen. Once the immune system has detected foreign antigens, this is communicated to other systems within the body, thus complicating a vicious cycle — the body detects the antigen, produces antibodies, and these

may be deposited in tissues, joints or blood vessels causing inflammation (Morrow, Nelson, Watts, & Isenberg, 1998). In essence, the body “turns upon itself.” In the acute stage, symptoms include painful joints, accompanied by a low level fever, fatigue, weight loss, and anemia. In the advanced stage there may be severe muscle wasting and deformity of joints and loss of movement resulting from contractures. In the acute phase, rest and analgesics are required for the pain and immobilization of the joints. A wide range of medications is used, particularly anti-inflammatory drugs and gold salts (Collins Concise Medical Dictionary, 1986, p. 326), and these are potentially toxic. A condition associated with RA is Sjögren’s syndrome, a key symptom of which is dry, gritty eyes, which may appear to be inflamed (redness), although vision is normal. The progression of RA is one of “flare-ups” and periods of remission. It is interesting to note that symptoms of RA disappear during pregnancy, but flare up after childbirth, indicating that hormones may play a major role. Since there is no cure for the disease, patients frequently turn to complementary medicine for relief of pain through diet, gentle exercise, and other forms of treatment. Naparstek (1995) uses Guided Imagery (without music) in treating patients with a range of conditions. In relation to RA she comments: “Generally speaking rheumatoid arthritis erodes the bone at the joint and swells the soft tissue surrounding it.... Corrective envisaging includes ‘filling in’ the bone at the eaten-away points...” (p. 60). The key symptoms of RA lend themselves to symbolic interpretation. Inflammation suggests heat, fire, and anger, and the term “flare-up” suggests a spontaneous rapid increase in these symptoms. The “dry, gritty eyes” of Sjögren’s syndrome suggest the need for fluid to flush out the residual grit, and this fluid can be found in tears. Interestingly, at the start of GIM therapy Sandra was wearing plugs in her tear ducts in order to keep her eyes moistened. From a psychodynamic point of view, the eyes could be better lubricated by naturally formed tears. In the process of GIM therapy it is common for therapists to look for symbolic associations between the symptoms of disease and the psychoemotional needs of the client. For Sandra, it appeared that her therapeutic needs might include an exploration of feeling inflamed (angry) and expression of tears (possibly of grief or hurt) that would moisten her eyes. In addition, the concept of flare-ups suggested that her symptoms and her progression in therapy might wax and wane, particularly her experience of pain, stiffness, and fatigue. And it was probable that, as GIM therapy progressed and unresolved issues came to consciousness, those symptoms might be exacerbated before they were ameliorated. Sandra responded extremely well to the Bonny Method of GIM. Initially she had monthly sessions, but these increased in frequency during times when she was dealing with an issue from childhood, or an issue evident in her current life situation. She had always enjoyed music, had been involved in musicals as a child, and loved to sing. She also played the guitar. She recalled childhood experiences where she had felt overlooked in the large family — her mother was constantly busy with many children and the needs of an aging grandmother and a busy farming business. From early childhood, Sandra had learned to be the peacemaker in the house, repressing her real feelings in favor of keeping the peace. Several of her siblings, however, were very vocal in making their needs known, so that Sandra developed a fear of speaking up in the presence of strong, authoritarian men and women. She was a qualified nurse,

and often had found it difficult to assert herself in the presence of authoritarian charge nurses and medical doctors. This nexus of issues was evident in the symptoms of her illness. Her difficulty in expressing anger, and in asserting herself, had led to the development of an illness in which the joints and tissues were periodically inflamed and painful. As a peacemaker, her tears of grief and disappointments from childhood had been blocked, and this was manifested in the plugs in her tear ducts which were necessary to keep the moisture inside her eyes. In GIM sessions, Sandra would often have imagery associated with water. In her early sessions she had the opportunity to swim in water, sometimes naked, and other times supported by key people in her life. She had imagery of significant animals, particularly a black snake. One of her most reliable sources of strength, however, was the image of a school friend, an Aboriginal girl whose name was Miriam. Miriam frequently appeared as a welcome face with a “huge smile.” Treatment In order to explain the elements of psychodynamic therapy with Sandra, three GIM sessions using the same music program will be discussed. In Sessions 38, 45, and 57, the program entitled Body Program (Bonny, 1987) was used. The Body Program comprises music mostly written during the twentieth century, including: Shostakovich: Allegretto, from the String Quartette #3 Shostakovich: Allegretto, from the String Quartette #8 Nielsen: Andante un poco tranquillo (excerpt), Symphony #5 Vierne: The Chimes of Westminster (a solo work for organ) Beethoven: Largo, from the Piano Concerto #3 Prokofiev: Larghetto, from the Classical Symphony The prominent features of the Shostakovitch selections are dissonant harmonies, short, angular melodies, and dancelike tempi. The music programs often chosen for Sandra in previous sessions had featured consonant harmonies and music with lyrical melodies, and so the decision to use more dissonant, angular music was a significant one. In Session 38, Sandra had presented for the session describing a flare-up of her arthritis. A measure of the activity of the illness is the erythrocyte sedimentation rate (ESR). The normal range is 4-19mm; Sandra’s level was 80. She described two issues that she felt contributed to this: her work environment, where she was required to take on more demands, and ongoing health problems with one of her children. She complained of pain in her head, shoulders, and neck, and that the sensation of the pain was “nagging.” As I mentally considered the range of music programs available, the Body Program seemed to best fit the sensation of “nagging,” and so I chose this music for the session. I asked Sandra to designate a color for the “nagging pain,” and she chose “dull dark blue.” I suggested she breathe this color through her body as a means of strengthening her awareness of her body. I then started the music. As soon as the music began, Sandra’s face changed. Her brow became furrowed, and her face was distorted with pain. She began to report what was happening in the imagery:

“someone has a paintbrush, painting my joints with blue” When I asked how that felt for her, she said, “Slapdash, a bit rough, grating.” I asked if she could see who was doing the painting. She said, “It’s a big hand, a man’s hand.” I asked if she had something to say to him. She replied, “You don’t understand how painful it is, I need something smoother, the bristle is too rough, it’s making the pain worse instead of better, it’s really irritating.” In the Bonny Method of GIM the therapist may change the music if it seems inappropriate to the client’s experience. In this session I was ambivalent about what to do. Sandra’s imagery suggested she wanted something smoother. Her words “you don’t understand how painful it is” I took to be directed to me, and my countertransference was activated. On the one hand, I felt I had made her pain worse. By choosing the “wrong” music I was inflicting greater pain on Sandra, rather than lessening it. On the other hand, the pain she described was a “nagging” pain, and the Shostakovich was a good match to the quality of the pain. In addition, I felt somatic changes within my own body — my heart rate had increased, and I felt stiff throughout my chest as I wrestled with what to do. My inner voices also clouded the decision: “This was a terrible choice of music,” and “I’m causing her pain.” Finally, I changed the music to a different program in which the music of Vaughan-Williams was gentle, calming, and consonant. The imagery then changed to images of her as a child with her hair in two long plaits. She ascended a castle staircase and was taken into a room where the young girl was gently massaged. Something was burning up inside her, like a fever, and the girl in the imagery began to cry. Sandra then recalled that her mother had said that when she (the mother) died, Sandra would be the one to ensure that the family stayed together. Sandra felt this was too big a responsibility, and that it was not fair for her to carry that responsibility. At the end of the music, and once Sandra had returned to a nonaltered state of conscious, she began to talk about the session. I commented that I noticed that the music at the beginning had made the pain worse, and apologized to her for exacerbating the pain. But Sandra commented that the music had forced her to feel the extent of the pain, and that it had opened up the insight into taking on the responsibility of keeping the peace. On reflection, I was uncertain whether Sandra’s reassurance was to placate my concern or whether it had been as helpful as she described. In my notes of reflection after the session I had written, “Had I taken on the role of peacekeeper, and placator in the session by changing the music?” Bruscia (1998, p. 76) has written about the aspect of choosing music in GIM as a point at which the therapist’s countertransference can be activated. When Sandra described the “nagging pain,” my choice for the music was influenced by my own experience of “nagging pain.” Thus, when she stated “you don’t know how painful it is” I felt responsible for causing the exacerbation of the pain and therefore decided to change the music to something more gentle. Some weeks passed, and in Session 45 Sandra presented with low energy. She had resigned from her demanding job and was preparing to start a new business from home. She was physically tired; however, she stated that her tiredness was also due to the domineering women at her workplace, who had in part influenced Sandra’s decision to resign from the job. As Sandra settled on to the mat, she spoke of an image of two domineering women pushing her in the back, and this was irritating her. As I considered all of the music programs available for the session, I again felt the Body Program best matched the irritation of being pushed in the back. As the first of the Shostakovich selections began, Sandra had an image of witch’s hands — they were long, thin, and pointy. Sandra was irritated by the witch and wanted

to be rid of her. This could only happen if she confronted the witch. During the Shostakovich piece, Sandra started to develop a body shape the same as the witch — her breasts became matronly, her bottom developed a wiggle, and she developed an authoritarian “strut.” “When I am sweet and docile, she walks all over me. I want to be her equal, meet her where she is at. I want her out of my body” Sandra reported. “She is like the music — powerful, with an authoritarian look. I don’t have to feel her power over me, I have to get rid of her, she’s not going to attack my back any more. The energy is coming out of my hands — I’m challenging her to a fight.” At this point I offered Sandra a high-density foam pillow to pound. This type of physical intervention can be helpful for clients in GIM in order to release pent-up emotion. After Sandra had pounded as much as she needed, I asked how her hands felt. I was concerned that the physical pounding may have hurt her arthritic hands. She commented that her hands were “relieved,” they had been “niggling and frustrated” and the pounding had done them good. In this session, I did not experience any of the ambivalence felt in Session 38. Sandra seemed to be empowered by the music and I did not take on any imagery experiences at a countertransference level. In Session 57, Sandra had presented with problems with her eyes. She had new plugs inserted in the tear ducts. Her eyes felt irritated and sore, and she had a visual image of a black zigzag across her eyes. The back of her head felt heavy, with a dull ache. Since Sandra had worked well with the Body Program in Session 45, I chose it again. Initially, she stated that the music corresponded with her head, and she was irritated “everywhere.” Her eyes were gritty and sandy, like sandpaper. It was like being in a dark room “not knowing where things are.” Small darting animals appeared, and then birds like magpies started pecking at her. While she was experiencing this imagery, she was “ducking” her head on the cushion, as if to protect herself from the attacking birds. At this point in the session I felt the same feelings of doubt that had emerged for me in Session 38. This music exacerbated her pain, but I thought it could also give her clarity about being “pecked” if she could explore the imagery further. Was the music I chose helping or causing more pain? If she was in greater pain, should I intervene by changing the music? Yes or no? Before I could act on this dilemma, Sandra’s imagery quickened — the magpies took on the faces of three domineering women in her life: They were “so quick, say things so quick, they go through you, so irritating right through my body, everywhere, my arms, head, shoulders, and eyes. I try to open my eyes slowly, to mesmerize the magpies, but the eyes are too irritated to open.” My counter-transference was enacted again — perhaps I was one of the domineering women, in choosing this music for her. Perhaps not opening her eyes was a form of resistance? I had written “resistance” (with a query sign [?]) in the margin of the paper used to transcribe the session. The music changed to the Nielsen selection of the Body Program and Miriam, her Aboriginal childhood friend, appeared in the imagery. “She’ll bathe my eyes with healing waters — the waters are cool on my eyes that feel SO hot. Miriam’s eyes are so beautiful, and she puts her fingers over my eyes, saying I should also put my own hands there. I can feel my own strength coming into my eyes.” During the Beethoven selection (the slow movement of the Piano Concerto #3), Sandra commented, “All the meanness I felt toward them, but not saying, was in my body. It’s all out

now, I don’t want to feel mean, I don’t want to feel irritated by them, I don’t want to fight fire with fire. I want to see them clearly, hear them clearly, then say back to them what I want to say. I’ve been scared of people all my life.” And later in the Beethoven: “There are electric charges going through my body, I am becoming more alive.” Miriam appeared once more in the imagery, saying, “You have your own strength.” By not changing the music in this session I allowed Sandra to bring about her own resolution to the irritating magpies. Her resolution was to invoke the image of Miriam, the Aboriginal girl, who healed the burning of Sandra’s eyes. Miriam could be seen as an archetypal figure, or as a projection of Sandra’s feminine identity. The important point, however, was that I did not act as peacemaker (as I had in Session 38) by changing the music to something more gentle. Instead she enacted her own inner strength to resolve the unpleasant imagery. Discussion Part of the process of the Bonny Method of GIM involves the client bringing to the surface images and associated feelings that have been repressed or unresolved in the unconscious. The music plays an integral part in bringing these memories to the surface so that they can be resolved in the imagery. The choice of music is therefore pivotal. Some aspects of the GIM session involve input from the client — in deciding on the focus issue for the session, in the imagery that comes forth, and in processing the meaning of the imagery at the end of the session. The one major decision in which they have little or no influence is the choice of music. Clients may infrequently request gentle music, or strong music, but they do not choose the program. This decision therefore depends on the therapist’s knowledge of the music, and an informed calculation of how well the music of the entire program (of 30-45 minutes) will relate to the issue brought by the client to the session. Should the music be inappropriate it is possible to change to another selection of music, or another program altogether, but such changes themselves involve a therapeutic decision made by the therapist. Countertransference may be operating as the therapist makes these choices. Priestley (1994) discusses different types of countertransference, including e-countertransference, in which the therapist “becomes aware of the sympathetic resonance of some of the patient’s feelings through his own emotional and/or somatic awareness” (p. 87). This was certainly my experience in all three sessions mentioned above. However, Summer (1998) has stated that “in all music therapy techniques there is a triadic, not dyadic relationship” (p. 433). That is, there is potential for the client to have transference to both the therapist and the music. Within the Bonny Method of GIM, Summer argues that transference may be a “pure music transference,” when “the music serves the essential therapeutic function” (p. 434). The client’s transference may also be split between the primary music stimulus, and the verbal interventions of the therapist. In Session 38, for example, Sandra’s experience of “someone has a paintbrush, painting my joints with blue” was influenced by my subsequent intervention — “How does that feel for you?” Although we argue that GIM therapists do not direct the imagery per se, the direction inherent in this intervention is to focus Sandra’s attention on her feelings about being painted, rather than, for example, the size of the paintbrush, or who might be holding it. Each intervention of the therapist, therefore, has a propensity for countertransference. Likewise, when Sandra reported the feeling was

“slapdash, a bit rough, grating,” my intervention was to ask if she could see who was doing the painting. “It’s a big hand, a man’s hand” prompted me to ask if she had something to say to him. And this intervention evoked the response “you don’t understand how painful it is, I need something smoother, the bristle is too rough, it’s making the pain worse instead of better, it’s really irritating.” From a psychodynamic perspective, both transference and counter-transference are operating interactively. Sandra’s transference is operating toward the music, but influenced by my interventions. My countertransference was operating toward Sandra’s exacerbated pain, and also to the music. Therapeutic Gains Each of the three sessions described above were pivotal sessions for Sandra. In each case, the sessions following unearthed memories of a significant event that needed to be reexperienced from her adult perspective in order to gain insight into the meaning of the event. After Session 38, when her ESR count was 80, Sandra telephoned for an extra session. The precipitating cause was the ongoing illness of one of her daughters. In this session, I used the program entitled Mostly Bach, a program comprising works of Bach orchestrated by Stokowski. Typically, this music program is used for sessions requiring strong music, to match an issue of similar content. Sandra’s imagery covered a range of hurtful events from her life — she recalled memories of the daughter (currently sick) as a baby; that soon after the birth her husband had been transferred by the company he worked for to a new location, and Sandra packed up the old house and moved once again into a new home. She recalled being overwhelmed by the physical work involved. In addition, her husband was working late into the night to acquaint himself with the new job. It was at this point that she received the diagnosis of arthritis. She was placed on medication, but one of the side effects was lockjaw. She recalled the terrifying feelings of not being able to move her mouth, or speak, and feeling a lack of control over the situation. The session following Session 45 also unearthed significant and traumatic memories. She recalled being a very small child, and being unnoticed by everyone around her. She had a profound feeling of not being wanted, or not belonging. She recalled slinking out of the family house and not being noticed, and she experienced grief over her father’s illness and subsequent death, recalling vivid images of him dying in hospital, an ashen gray color. Imagery Related to the Body After Session 45, Sandra began to use imagery to explore within her physical body. In Session 54 she arrived for her session describing her body as very tense and sore. During the relaxation induction she chose the color “electric blue” to illustrate the feeling within her body, and she imaged a gentle blue color to take into her body to relieve the pain and soreness. To the music of Vaughan-Williams (Fantasia on a Theme of Thomas Tallis), she found herself underwater. Initially she was weighed down with heavy armor, and instead of removing the armor (her defense), she decided to leave it on and journey inside her body to find the answers. At first, she explored her heart, which was a brown-red color, then she found tentacles growing

in her body — in her bones, muscles, joints, and the cells. As she looked closely at the tentacles they transformed into vines of ivy, twisting through her body, like poison ivy. I asked her to look to the roots of the ivy vine. She found herself inside a house, as a small child, aged seven. Her energy had been “zapped.” The girl was crying “burning tears” and the tears began to burn down the ivy. Later the armor fell off her body. In subsequent sessions, Sandra recalled hurtful events from her childhood, growing up in a household with seven other children and the challenge to be seen and heard. She recalled crying herself to sleep at night. She also recalled hurtful events at school where she was singled out for ridicule. In Session 56, a masculine figure appeared in her imagery with the same color hair and eyes as Sandra. She named him David. In Jungian theory this image represents the internalized masculine. But one week later she suffered a flare-up of the arthritis in her spine, sufficient to put her to bed for a period of four weeks. In the next GIM session she experienced quite grotesque imagery — a black spider with red stripes appeared, but the legs of the spider transformed into tentacles of burning hot coal. A red lump started to get bigger and bigger, ready to explode. An image of her domineering sister appeared. She was holding a thorn and was pressing the thorn into the lump. As Sandra screamed at the woman — “Don’t do this anymore” — the pain subsided. The spider reappeared with the message “speak the truth.” At this point in Sandra’s therapy there were visible signs of change. She had her hair cut short, and she felt she was becoming more assertive with her domineering sister. In Session 71, she re-experienced the onset of lockjaw, in which the jaw was rigid, unable to move. She was terrified by the sensation of having no control over her mouth. In Session 72, Sandra’s imagery returned to an exploration within her body. She was experiencing pain in her sternum, and as she imaged the pain, she found the ribs on either side of the sternum involved in a fight. The sternum was “caught in the middle.” This image was the catalyst for exploring further childhood memories where she was caught in the middle, and she would shut herself away from the family when others were arguing. In the ensuing months Sandra was faced with two significant losses — the death of her mother (which was expected) and the death of her youngest daughter (as a result of an accident, and unexpected). At a time when she expected her RA to reappear, it did not. Over several sessions, Sandra was able to mourn, and in one session found a place within her heart to rest. She imaged a seat where she could sit within her own heart and grieve for her loved ones. Her heart featured again in Session 84. The music program “Peak Experience” was used during the session, and during Wagner’s Prelude to Act 1 of Lohengrin, Sandra’s heart began to expand. Her heart became so enlarged that her body could fit inside it. A red and gold glow, like the sanctuary light in a church, filled the heart, and she felt enormous energy radiating from it. Sandra called this image of the heart the “core” of herself, and from this session on she frequently entered her heart to sit on the seat and rest there. In one session (98), she maintained a dialogue between her mind, body, and spirit, recognizing the “wise woman” within her and the “anxious woman” who disturbed the harmony of the mind-body-spirit connection. She felt she was beginning to recognize the different aspects of herself, and this was helpful when faced with stresses and demands. After a break over the Christmas holiday period, Sandra commented that she had not experienced a flare-up for more than a year, and that she was no longer taking medication. We

were fascinated that there had been no flare-up given the traumatic year she had experienced with the death of her mother and her daughter. It was as if the profound grief had brought the mind, body, and spirit together, and in that deep connection the RA had gone into remission. Most recently, Sandra has changed her focus of work, choosing to conduct grief counseling through her local church. She continues to be free of symptoms of RA, and has been off medication for three years. She believes that the Bonny Method of GIM completely changed her life. Summary In this case study, the Bonny Method of GIM was effective in many ways. It helped Sandra to confront the acute pain of arthritis, and via the imagery to find the root cause of the inflammation. This process of exploration, however, initially exacerbated the pain, and once this had occurred several times, I became more aware of her capacity for engaging the imagery and invoking images to help herself. Because the pain was heightened, Sandra was able to see clearly some of the childhood issues that had caused her to develop a pattern of repressing emotion, hiding from conflicts, and hiding disappointments and grief. Later GIM sessions allowed her not only to explore the very core of her body, but to find a sanctuary deep within her own heart where she could sit and rest. This sanctuary became an essential inner place during the profound grief she suffered over the loss of her mother and her beloved youngest daughter. That she is currently free of symptoms and medication is testimony to the capacity of the Bonny Method of GIM in bringing about life-changing transformation. References Akil, M., & Amos, R. S. (1999). “Rheumatoid Arthritis: Clinical Features and Diagnosis” (Chapter 10). In M. L. Snaith (ed.), ABC of Rheumatology. Second edition. London: BMJ. Bruscia, K. (1998). “Signs of countertransference.” In K. E. Bruscia (ed.), The Dynamics of Music Psychotherapy. Gilsum, NH: Barcelona Publishers. Collins Concise Medical Dictionary. (1986). London: Collins. Jacobi, E. (1994). The Efficacy of the Bonny Method of Guided Imagery and Music as Experiential Therapy in the Primary Care of Persons with Rheumatoid Arthritis. Unpublished doctoral dissertation. Union Institute. Cincinnati, OH. Jacobi, E., & Eisenberg, G. (1996). GIM in Medicine: Enhancing the Quality of Life in Rheumatoid Arthritis. Presentation to the AMI Conference, Vancouver, BC, Canada. Morrow, J., Nelson, L., Watts, R., & Isenberg, D. (1998). Autoimmune Rheumatic Disease. Second edition. Oxford: Oxford University Press. Naparstek, B. (1995). Staying Well with Guided Imagery. London: Thorsons. Priestley, M. (1994). Analytical Music Therapy. Phoenixville, PA: Barcelona Publishers. Short, A. (1990). “Physical Illness in the Process of Guided Imagery and Music,” Australian Journal of Music Therapy, 1, 9-14. Short, A. (1991). “The Role of Guided imagery and Music in Diagnosing Physical Illness or Trauma,” Music Therapy, 10 (1), 22-45.

Summer, L. (1998). “The Pure Music Transference in Guided Imagery and Music.” In K. E. Bruscia (ed.), The Dynamics of Music Psychotherapy. Gilsum, NH: Barcelona Publishers.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE EIGHT Experiencing the Music in Guided Imagery and Music Connie Isenberg-Grzeda (Speaking as Therapist) I had intended to provide a forum for a client to share his or her experience of the music in the Guided Imagery and Music (GIM) process. This felt safe. The client would disclose, thereby sharing the internal emotional experience, and I, the therapist, would move into my intellect to reflect, comment, question, analyze, synthesize. I could thereby share my thoughts, in writing, about someone else’s internal process. I could remain the therapist! I have decided, however, to contribute differently. I will share with you my own experience, from the perspective of client, of the music in the GIM process. I will briefly describe the GIM process. While in a deeply relaxed state, I listen to classical music selected by the therapist and I verbally share with the therapist the imagery that is evoked in me. The therapist, in turn, takes notes and verbally supports and encourages the deepening of my experience when necessary. The aspect of this process that I will focus on is neither the imagery nor the therapist, but rather the ways in which the music acts on me during these sessions. The examples that I present do not constitute an exhaustive list but represent some of the ways music has acted on me. I do not intend to complete this list because I believe that the complexity of GIM and of the relationship between music and the human psyche precludes arriving at a complete, neatly compiled list. Nor is it my intention to attempt to explain why the music acts on me in particular ways, or which music is most apt to act on me in specific ways, or how the music and the therapist interrelate in this therapeutic process. To struggle with these questions is to put myself back into the position of therapist. What I want to share is the experience of a therapist in the position of client. I notice that I use the word position rather than the more commonly used word role. I think that this is because the word role implies to me a part-self, whereas the word position implies a fuller use of self. A change in “role” leads me to temporarily close off certain aspects of myself, but a change in “position” involves movement into and out of different internal and external spaces while maintaining access to other spaces. I try to maintain open communication between my own internal therapist and client as I speak now from the position of client. Speaking as Client As I think about the music in the GIM process, I think of the way in which it acts on me, at times holding me, touching me, filling me. As I think about the therapist in the GIM process, I think about my longing for her to act on me. “Hold me, touch me, help me feel better,” I plead

silently. I plead, all the while knowing that what I long for is not necessarily what I need at this time and perhaps not even what I really want. The physical touch of the therapist or the physical holding may be too painful, too little, and too much. It cannot feel right. And yet I long for it. I am disappointed when it is not there. I would probably be enraged if it was there. I do not need to act on the music to get it to act on me. It simply acts on me. The therapist, however, is a different matter. I must act on the therapist to get the therapist to feel, to understand, to respond. Or so it has seemed. How does the music act on me as I listen to it in a state of relaxed preparedness? Sometimes it envelops me, holding me, caressing me. I sink into the music as a baby would sink into its mother’s arms and I allow it to rock me, to cradle me, and to help me feel safe. The more I let go, the closer I get to a state of blissful fusion with the music, a sleeplike state of total repose. The music is now all that exists for me; the therapist recedes into the background. Memory fragments sometimes emerge for me in this state: memories of early but verbal life, memories of preverbal life, muscle memories, visceral memories. Whereas I can verbally share the memories from the later developmental periods with the therapist, I find myself able to experience the earlier memories in the presence of the therapist but unable to share them verbally. At other times, the music acts in a far less nurturing manner. It sweeps over me in turgid waves, engulfing me, scaring me, and threatening to drown me. Barely able to breathe, I seek to fight it, to escape, or, alternatively, I succumb to the power of the onslaught. I do not consciously choose which of these paths I will follow -- it feels, rather, as if the chosen response just happens. If the choice is to fight, I might find myself physically attempting to push the music away as if it had a material or corporeal presence. The inevitable lack of success might impel me to attempt to escape. How do I escape? One way is to create images that save me from the threat: for example, seeing myself as a lifeguard, reducing the body of water to a tiny puddle, imagining that someone saves me. Another form of escape is to block out the music. Although I continue to hear the physical music, I somehow manage to deaden its emotional impact on me, to quiet its resonance with my internal state. How I do this, I do not know. What it is that is closing off inside of me, I do not know. How it is that I am only sometimes able to do this, I do not know. I do know what happens when I cannot escape -- I succumb or once again I fight. When I succumb, the waves sweep over me, submerging me, crushing me. Since they meet with no resistance, these waves may “flatten” me, numbing all affect. At other times they may manage to lift me up and carry me with them; my emotions merge with the intensity of the waves and pull me at once further into myself and further out, almost obliterating any sense of boundary between the inner and the outer reality. I thus feel as if I have become one with the music, one with the turbulent, intense, dynamic movement. And where is the therapist for me at these times? As I struggle to escape from the intensity of the music, I wish for the therapist to save me by reducing the volume, by changing tapes, or by turning the music off entirely. If I feel myself being carried away by the music, the therapist may once again recede into a seeming oblivion, ceasing to exist for me, momentarily. There are instances, though, when the therapist accompanies me on this journey, carried within my images. Yet there are other times when the therapist’s voice serves to ground me as I yield to the pull of the music; this grounding renders the experience less frightening.

What are some other ways that the music acts on me? Sometimes it penetrates my being, infusing me with its energy, moving me both emotionally and physically. When I am moved emotionally by the music, I feel myself being filled with the beauty contained in the music and I feel this beauty resonate with my internal state, with a preexisting internal beauty and with deep emotion. At times there is a concurrent physical process, albeit different in nature. It consists of a physical response to the music. The physical movement of my body parts, largely restricted to my upper extremities, is not volitional. Arms wave in the air; arms that have a seeming life of their own--as if part of me and yet autonomous--my arms. Who is moving my arms? Is it I or is it the music? Who is moving my arms? I do not know. Can I stop the movement when I desire to stop it? Not always. Can I control the intensity of the movement, the amplitude of the arc traced? Not always. What force is this that seems to overtake my will, rendering me helpless in the face of my own bodily movement? I do not know. I feel helpless but fascinated as if in the presence of something new, something to discover…something that, surely, is linked to other aspects of my life, my being, my past, my memories, and my fantasies. Perhaps this movement is a reenactment. Did my arms ever move like this before? Was there ever another force as strong--as compelling but perhaps more sinister or more playful--making my arms move? I do not know. Why only my arms? Why is this the only physical part of me to dance to the music? Is it a result of the recumbent position or is it linked to something else? I do not know. What is the role of the therapist as my arms, barely in my awareness and seemingly out of control, dance their own synchronous dance with the music? The therapist helps me to be aware of this movement, to be aware of how it appears in the external reflective glass; the therapist helps me to claim it as my own. Together, once the music has left us, the therapist and I weave our connection through our joint effort to arrive at intellectual understanding, to link the emotional and the physical; together we revel in the enchantment and wondrous grace of the “arm dance.” There are moments when the very structure of the music acts on me. It is as if the music lends me an internal structure, an organization, a psychic-affective map. Just as a mother can help to bring order to her child’s chaos, so can the music bring order at times. If it is the music that brings the order, what is the role of the therapist at these times? I think that for me the work of the therapist at this time is to recognize my internal disorder and the need for a structuring container and to select from among the music programs one that could provide the containment and organization. This heightened empathic response I have found more often to be a wished-for ideal than a reality. What is magical is the way that I have sometimes managed to use the empathic failures equally effectively. In fact, I have often found that the same music acts differently on me at different times. Music that can soothe me during one session can stir up rageful feelings during another session. Music that can feel not sufficiently “holding” in one session can provide a tight container in another. I feel that this lack of predictability speaks to the complexity and the richness of the relationship between music and the human psyche.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE NINE Dealing With Physical Illness: Guided Imagery and Music and the Search for Self Ann Newel Introduction As a music therapist, I had experienced Guided Imagery and Music (GIM) only as an academic exercise in a classroom setting, never as a means for my own in-depth therapy. GIM involves imaging in a relaxed state to prepared classical music. I had six GIM sessions, each about 2 hours long. My therapist helped me relax, chose the music, kept contact with me during my imagery, and helped me process the experience after the music. In telling the story of my GIM therapy, which began when I was diagnosed with cancer, I have chosen not to use my real name. I have used as sources my journals and transcribed notes of my ongoing imagery that I spoke out loud to my therapist during the music; the notes were given to me by my therapist. By mutual agreement with my therapist, I do not name the therapist. Background I never realized how important my relationship with music would be in my life until it seemed my world was falling apart. I’d grown up with music as my best friend all through childhood. The youngest child with much older siblings living on a farm with no playmates for miles, I spent many hours alone at the piano, playing and singing. My love of music continued through college, leading me to a profession in music therapy. As a music therapist, I made music with others and for others but forgot to take the time for my own expression; this pattern continued when I had a family to raise. Where did my music go? When metastatic melanoma to my lung was diagnosed when I was 39, I felt as if my life came to a halt. I can still remember the empty, sinking feeling in the pit of my stomach as my doctor gave me the cancer diagnosis. I was paralyzed emotionally and physically and felt as if the floor had fallen out from under me. Depression seemed to be my primary emotion through this time period. When I was alone, I would sob incessantly. I wanted to be with my family (husband and two young children), but I couldn’t cry in front of them. I was frantic, not knowing what to do. A friend suggested, “Do what you always dreamed of doing,” to which I responded, “Play the piano.” She suggested I write songs, but I was blocked by my critical self. During surgery to remove the tumor from my lung, I asked to have taped music played, as I knew it would be a calming force (after all, it had aided me in two wonderful natural

childbirth experiences). During recovery, I again experienced the power of music in pain management. After surgery, I knew I needed some way of dealing with all my confused thoughts and feelings: what treatment to choose (since no traditional treatments were known to be effective) and how to deal with my work, my family, myself, and my feelings. I wanted a therapy that would help me get to my unconscious feelings, as I was having poignant dreams. I felt traditional verbal therapy would get me only so far and that I needed something that would help me uncover and express my unconscious feelings through symbols. I kept coming back to my experiences with music and the expressive therapies, knowing that there had always been so much contained in the symbols in my work with clients. I really wanted to deal with the hidden issues which I felt were putting me in this state of dis-ease. GIM seemed to be the answer, as I knew there were unconscious feelings and issues I was not addressing in dealing with my illness and that GIM could bring these to the surface. Other secondary (but important) goals I had were to find a meaningful direction for my life: What was I meant to do? What can I leave for others? I needed help in balancing family, work, and spiritual self, and in obtaining support, since I knew that statistically, those who express feelings have a better chance of survival. Session 1: Fear I began GIM treatment 4 months after surgery, at a point that coincided with the beginning of my experimental vaccine treatment. I felt pulled in many directions. I wrestled with the question of how much longer would I have to live and how could I balance working and family and still take care of myself. My imagery began in a field of flowers in the city where I went for treatment, a trip that meant being away from my family and spending time by myself to rejuvenate and be introspective. The music takes me over a bridge to a green forest where the ground is covered with pine needles. I want to brush them away and see what’s there. It’s the earth. I feel resistance to look any further. I feel fear in my head. I begin looking up, curled up in a ball in the top of the tree. I am lonely but where I want to be. I want to hold on to the tree. I know I can’t break it. I can squeeze as hard as I can. I am able to let go of the tree while still in it. I feel its textures. It’s rough and difficult to get too close to unless I’m hugging it. It scratches. The only smooth part is on the needles. The tree is very tall and majestic. Floating above it, at first I feel propelled up. Looking around, I see the bridge. I’m trying to decide whether to stay in the city or go home. I feel pulled in each direction, by the idea of protecting myself or being with my family. My arms are being pulled in either direction. It’s painful and lonely. I want to go back and find out what’s under the pine needles. It’s my grandmother (who had passed away 4 years ago) with my ring on her hand. It’s the ring she had as a young girl and the one I had worn since I was in college. The ring stands out. Is it on my hand or my grandmother’s? It changes back and forth between being on my hand and her hand. It finally appears to be on her hand, and this leads me to make closure with her and relive all the goodbyes we said in the past. It also makes me realize my own life is not yet over. I experience several periods of my life that had brought me joy and grieve their passing. I end in the present

experiencing an intimate time with my family and realizing I don’t have to die; I should focus on living. The pine tree became a recurring theme, a symbol of connection between life and death and heaven and earth — life and feeling grounded on one end and heaven and the spiritual aspect of death as I went further toward the top. Fear was expressed in the need to “curl up” in the tree and “protect myself’ from all the “rough textures” of life along with the desire to hold on to life with all of my strength. The only parts of the tree that were smooth were the needles, which represented to me needles used in the vaccine treatment, the one thing I was involved in that gave me hope. The ring also was an integral symbol representing a connection to others, but in this case a connection to someone who was deceased. The fear of my diagnosis and imminent death came to a resolution when I saw that it was my grandmother and not me in the grave under the pine needles. I was then able to make closure with my grandmother and find the energy to spend time with my family. My final statement at the end of the session brought reassurance, hope, and direction. Session 2: Depression By the next session, I was very aware of the stress my illness was causing my family. I began to ask such questions as: Am I worthy of healing? Am I putting too much burden on my parents, husband, and children? Would they be better off without me? My children say they hate God; how can I offer them the comfort I get from my faith? Although I had received positive test results, I began to doubt my body’s ability to heal. At the same time, my life began to follow more of a routine: diet, exercise, yoga, reading, support groups, and spending time with my family — yet I was continually being distracted by my healing process. I see a reddish purplish light. I follow it into a cave. It’s cool, damp, dark. The rocks I’m stepping on are slippery. I want to stay inside. It’s calm and inviting, a hideout. There are faint carvings on the wall. It’s a stick person carrying a ball, a large ball, heavy. He’s trying to find someone to hand it to. The ball is lighter now and other people are joining him, festive, joyful, pleasant, nurturing. (Are you there?)* I’m not sure if I’m part of it; I might even be the man. The ball becomes a prop that everyone shares in the dance. But the man still is holding on to it. The music is pushing me toward the light. I discover a spongy shield of green vines. They become a trampoline. I’m doing flips. I feel like I could do anything. The rhythm of it feels good, like the rhythm of my breathing. I’m aware of a tall tree each time I bounce back. A pine tree with a point on the top. I almost bounce that high up in the sky; light, silly, I feel it in my soul and heart. I feel strength emanating from my body except my head and wish I felt stronger there. My head needs security, surety, a knowledge of what is right. (What message is your body giving your head?) Connect. We’ll share the strength if you’ll connect with us. (Another message?) Follow your body; disconnect your head. I picture my head up on top of the tree. My body is sitting at the edge of the trampoline. One can’t move without the other. My head feels like it needs some kind of inspiration or spiritual strength and it wants to be up there to feel that strength. My body needs groundedness and playfulness. I’m jumping with a headless body. I’m trying to make it to the top to get my head. I can do it only with my head on; I’m more whole. My head is jumping with

my body, trying to have the sensation of being up high and also [have] security and a spiritual sense. I want to climb the tree but am uncertain of whether to or not. (Either is okay.) I’m climbing the tree. My kids and husband are at the bottom and I want to help them. I’m going back to help. They’re not sure they want to go all the way up. We’re huddling together halfway. Part of me wants to go the whole way. It’s better for me to be with them awhile anyway. The top is closer to the stars and birds, an easier place to sit. They’re willing to go to the top, but I’m really tired now. It’s hard to pull them up. Maybe another day. (What can you do to share the top with them?) Take a picture of what it looks like at the top to show them. (What does it look like?) Tops of trees and vast blue sky. I have a sense of being connected to the tree itself. It’s strong and very tall, pointed at the top, with limbs you can sit on. The theme of this session highlighted my sense of depression and aloneness. I felt a sense of calm in the dark cave and wanted to hide from the world. The music brought others into the picture and I discovered that I gained strength to deal with the weight of my illness by accepting support from others. I began to understand the need to pay more attention to my body and intuition as opposed to my head and cognition. The green vines and trampoline represented to me the joy of being alive (where my body wanted to be) and again the tree reappeared as the place to contemplate and withdraw from everyday life (where my head was). There was ambivalence between my head and body, between being involved in life and being more self- and spiritually centered. My body sat on the edge of life as my head longed for spiritual strength. The importance of movement and playfulness in my life was obvious to me once again. I told myself to be more impulsive, creative; don’t hold back, let go, play, live! Finally, the need to connect spirituality with my body as well as my family was apparent. I was very concerned that my family, especially my children, would not be able to handle the stress of my illness, leaving lifelong scars. I battled with how to balance this part of my life as well as share my faith with my family. The imagery allowed me to find a solution: “Take a picture and share it with them.” I understood that all I could do was share with them the strength and hope I received from my faith and the rest would have to be with them. Sessions 3, 4, and 5: Anger The next three sessions unveiled pent-up anger that I had not yet dealt with or been aware of. I became more in touch with the dichotomy between the messages my head and my body told me, becoming more aware of my body and less worried about my head. I began to have dreams and images of shedding my skin, represented as layers of old clothes and the pruning away of dead branches. I had also produced two nondominant-hand drawings in a support group that seemed pertinent. In the first drawing, I had drawn my chest cavity with emptiness on the inside and arrows attacking from the outside with a boundary of “protection” separating the two. I started the imagery for this session with the second drawing I had done to describe the healthy part of me, a bright red ball (my soul) with yellow surrounding it. The red circle on the inside is soft and nurturing, like a heart with warmth. It’s flexible. If you put a fist in it, it leaves a dent. If I push my fist in far enough, it wraps itself around it. It can engulf anything. There are many arms protruding from the ball: red, reaching out with hands on

the ends, exploring the boundary. The hands are trying to pull at the boundary and pull it apart. It seems like it will break, but I’m not sure I want it to. It’s breaking and I’m putting it back together; it’s not quite as strong as it was. Now it breaks at times and some of the arrows get through, forcefully. The red ball in the center is getting very big, until the end, when hands direct arrows in and burst the ball. The hands and arrows are left. I feel like I was burst and attacked. It’s painful, like there’s nothing left. Betrayed, I feel cut in two. I feel it in my chest and gut. I feel angry, angry that I let people in and they hurt. (How can you get it out?) By talking. [To the image:] You promised me everything would be okay. You never listen to me. I hurt. I hate you. The music urges me on to let it out. The therapist tells me to push some pillows she is holding and I begin pushing. I feel helpless sometimes and sad and angry at the illness. I feel like I’m displacing it on my family. I just want to change everything inside of me. I’m scraping everything away that looks unhealthy, mostly on my lungs, and wondering if I can scrape enough away and still survive. I’ve got my old red ball. I’m trying to squeeze some of the red into the tissue. I’m in touch with the sadness and anger about the whole thing. The anger is giving me energy, assertion. I haven’t realized that anger before and how it can give me energy to fight. The music changes and gives me support and reassurance. I feel it as peacefulness. It has the strength of the sun, but I have fear of the sun’s rays. My chest feels clear, no garbage there. I’m afraid to let anything in that might be garbage. It needs peace. (What color do you see?) Green. The music played a vital role in unveiling the expression of anger. For whatever reason — the belief that expressing anger is socially unacceptable or the fear of loss of control — I had not expressed or felt any anger up until this time. The therapist gave me permission to express my anger and the music moved me to do so. Green is the color of new growth. I need green and red together. Red is the healthy color of tissue; it was what I was trying to see while scraping. The healthy red part of me was being bombarded by the stress of the environment and the illness. I felt betrayed by my body and wanted to scrape away everything that was unhealthy and negative in my life. I also saw the need to change on the inside how I perceived myself and how I handled life’s stressors. Although I was unable to identify who or what in particular I was angry at, I became more aware of the emotion being there and that I needed to not ignore it. It became apparent that I felt the anger as part of my soul and if expressed in some nondestructive fashion, it could free up energy to work in a productive direction, such as giving me the strength to fight for life. The therapist suggested that an outlet for anger is vital and we brainstormed about acceptable ways to express it. I felt much more tolerant of my family that week after I was able to release my own anger in the session. Going into session number 4, I continued to wrestle with the idea of finding direction in my life and what alternative treatments to pursue. My heart tried to take the lead but my head often got in the way. I felt apprehensive about what might come out in the session after having such an intense experience the previous session. The imagery began with the image of the labyrinth that I had experienced during a workshop the previous week. I see the labyrinth path, calming, winding back and forth. I have a hard time focusing; I’m veering off the path. I’m dancing on the labyrinth, not following the path. It’s freeing. My mind keeps wandering, preoccupied with what might come later. The music’s calling me like

angels calling me. I don’t want to give in. It’s scary. I’m amidst many angels; I feel sad, a cross between sadness and anger. (Where do you feel it?) In my chest. The music changes and I become anxious when I recognize the piece and know it will reach an emotional climax in the middle. I also realize the music will help me release whatever I’m holding in. (What do you see in your chest?) Dark purplish, green color; the shape of my fist. The object wants to tighten up. It takes a lot of energy. It doesn’t feel healthy and needs to come out. I’m reaching in and grabbing it. It feels squishy, like a piece of liver, hot or warm. There’s resistance to me getting it out. Wet and slimy, it’s connected by tissue and won’t come out. I have to get it out. I feel stuck; I know what I need to do is to pull out the diseased part of me, but it won’t come. I feel the need to be physical; I need to push but I feel ashamed that the only way I can rid myself of the anger is to regress. Music is telling me it’s okay, but I feel it’s not. I’m in limbo, feel hopeless. It’s just there. The music softens it. (Can you have a dialogue with it?) [Beginning the dialogue:] What do you want from me? [The disease’s voice:] To pay attention to me. [Me:] I am, but I don’t know what to do to get rid of you. You’re a force to be reckoned with. I’m afraid of you and angry, really pissed off that you changed my life. [The disease’s voice:] Maybe it wasn’t that great anyway. Maybe it needed a change. What was so good about your life anyway? [Me:] Maybe I wasn’t that happy with it. (How do you find that happiness?) Stop being so serious and self-conscious, soften up. My chest feels tight. I can imagine the blood flowing in. I feel very small, trying to relax and rest. I’m going to that spiritual tree to climb up, wondering why I can’t get the lump out. (What’s the message?) Try to look beyond yourself. Angels are there playing music. The anger in this session was overwhelming as I acknowledged an inability to get rid of whatever it was that was making me ill, as if there was a magic key inside of me that had the answer and I couldn’t locate it. I felt as if I should know what to do but couldn’t grasp what that was. There was resistance to my pulling the anger/disease out and possibly ambivalence as to whether I wanted to recover or doubt about my ability to do so. Again I told myself to make a change, to let go, but what did that mean? This was my wake-up call to do whatever would fulfill me, but what was it? Again there was the message to focus more on my heart and less on my head: “Stop being so serious and self-conscious; soften up.” Use a physical outlet to release the anger; express myself and not second-guess myself. The music helped me both to get to the anger inside of me and to find some answers of how to deal with it. It also helped me find a spiritual place to rest, grow, renew, and energize myself. At the suggestion of the therapist, I drew after the session but could only scribble furiously, filling the paper. I was then asked to do some drumming, which felt more fulfilling, as the air never runs out of space for sound, and the sound made some sense to me going in and out of an organized rhythm. Before session number 5, I felt more aware of myself becoming angry and the need to release it in some acceptable fashion. As a result, I felt more freedom to be present in the here and now. I became more aware of letting myself be me, rather than being self-conscious and worrying about appearances. This felt positive and rewarding. I also began developing more musical outlets, playing by myself and with others, and using music with children both

recreationally and educationally. This was an important part of my need to move on, to support the healthy part of me, and to find what was important for me to offer others. Communication between me and family members was still difficult; I felt the need to communicate on a heartfelt level and I became frustrated when the response was on a more superficial level. I also would become stressed when I experienced my children’s emotions. I felt responsible on some level for their emotional state, yet at the same time felt I could not deal with them effectively, which I was sure was detrimental to both me and them. Balancing life and finding my center began the session. There are many different pathways leading out from the center, like veins going out. I don’t know where any of them go. I feel myself getting sad because I don’t know where to go. (Where do you feel it in your body?) I feel it in my shoulders. (Can you let the music in to help you?) When I let the music in I get out of my head more, relax more. I’m thinking about my kids, watching them from a distance. If I’m with my kids they are more emotional and I get stressed. I’m keeping my distance; with music it’s okay to be with them. Three of us are playing together. I’m spinning around, dizzy. I feel sadness. It’s hard to hang out carefree and light feeling. There’s no whining, no worries. I feel anger for not being able to stay carefree, feeling anger in my chest. I want so much to stay relaxed in life, have some tranquillity. It’s always turmoil. I guess I want my life to be ideal. (What happened to the anger?) It dissipated. I’m trying to get back there. Why do I want to get back to anger? I feel something hard, solid. It feels immovable. It’s gray, hard. (What does it need?) I can’t say what it needs. It’s a rock and can’t move. It’s a part of me. (What do you want to say to it?) I wish you weren’t there. You’re a part of me that I don’t like. You make me negative and angry; You’re ugly and I don’t know how to deal with you. It scares me that I don’t know how to live with you there. I pop it with a pin. Steam or something is coming out, black. My chest feels more expanded. Everything surrounding the grayness feels like it’s getting bigger and can grow over it. At first when I talk to it, it gets bigger and bigger until it pops. I keep having a feeling I need to get mad at it, let it get big and ugly. I need to do that in life. I’m yelling at it. I am given pillows to push and hit. It’s about the size of a pea. It’s still there, still gray and hard, but smaller. I hold it in my hand, smooth and cool small gray rock, perfectly round. (What do you want to do with it?) Part of me wants to throw it across the room. But it’s a part of me, that makes me who I am. It gives me energy. It feels like it’s a part of me that needs to be expressed. It’s so ugly and thinks negative thoughts. It turns more green, gray green. I wonder how I can use it to heal. I guess by putting it back in the center and drawing energy from it to fight. (Can you do that?) I put it back. It stays small. The area around it still is expanded. It feels very, very small, perfectly round. Before it was more cocoon-shaped. It’s okay as long as it stays small. How do I keep it small? But it has to stay there because it’s part of my soul. (What does it have to say to you?) It says, “You need to deal with me. You can’t ignore me. I make you human.” (What can you do to keep it small?) I’ll try to be more aware it’s there. [To the rock:] Be ready to be popped when you get too big! In this session, frustration was expressed and answers were found concerning choosing the right direction to take, how to deal with my children’s emotions, and how to deal with my

own anger, which was certainly a part of me that was not going to just go away. I found that the music was valuable in helping me to relax and find my way when balancing life became overwhelming; I let the music relax me and take me out of my head. Also it reinforced what I already knew: using music, I could interact with my children more joyfully, take the focus off the day-to-day realities we all became stressed about, and be more “carefree.” Initially I turned the anger in toward myself, seeing it as a negative part of myself that would get in the way of interacting effectively with my children and causing stress in all our lives. I discovered that the anger was hard, solid, and immovable, a part of me that was not going to just go away, and when it was popped or acknowledged, the healthy part of me could grow and expand around it. I acknowledged that it was okay to get mad. This allowed the anger to remain a workable size that could then be used as a source of energy. Letting go was a recurring theme I found over and over again. To find my direction, I needed to balance my heart with my head, choose a direction, and then let go and believe. I had to trust myself to listen to my inner soul. Session 6: Closure This session took place after my final year-end evaluation by my medical doctor. The experimental treatment was to last only a year, and after follow-up tests, I had made it a year without any sign of recurrence. I felt successful and ready to breathe a cautious sigh of relief, as every year away from the illness meant a greater chance that something was working. I was anxious now that the vaccine would no longer be administered and my body would have to take over on its own. I was concerned about being too reliant on others for emotional support, the continued need to regulate the stress in my life, and the ability of my body to stand up to the cancer. The therapist and I also spoke about whether there was unresolved anger left from the previous sessions. The imagery began with a harpsichord, which I chose as a symbol for my body, relationships, and own neediness. The music reminds me of plucking on strings. The bass is vibrating. There is a lot of tension on the strings being pulled, being bowed; it is centered in my heart, very rich, intense, and warm. I like being able to feel the intensity there that is often lacking in life. Music is leading me down through a cave. The walls are shining and smooth. The music directs me upward, shoots me up in the sky, turning me around and somersaulting. It’s great. I’m in the top of the tree. I’m able to sit on the very tip and balance with my arms outstretched, soaking in the sun, air, and fragrance. I lie back and begin to slide down the branches on my back. It is cool and smooth. I land, sitting on the ground. I’m sitting on a bed of pine needles. A small white goat comes up and puts its nose on my cheek. It’s loving and wants to be nurtured. The music is leading me to a foggy field. I begin to get cold and try to get warm by hugging the goat, but it’s wet, too. I get a blanket. A bear comes toward us. I think he’s going to attack. I’m waiting, afraid. The goat’s afraid, too. I remember you’re supposed to yell at bears and run toward them. The bear is walking away. It gave up. I’m relieved but feel sad for the bear. He’s a beautiful animal. The sun is coming out and I’m warmed up. I’m inside my chest, a small seed inside, moving with the music around my lungs. The seed turns into a little vacuum cleaner,

housecleaning. I’m wondering if there is any anger here. It’s finding a peaceful environment, a place to dance. This session again underlined the healing force of music in my life. I was feeling the vibrations, getting in touch with the resonance in my body, and recognizing the positive energy that could be brought forth through music. It enabled me to be more in touch with my body and less in my head. I found myself balancing on the top of the tree, now able to balance both life and spirituality without the paralyzing fear and depression in the earlier sessions. In the goat, I met the needy part of me and of my children and was able to nurture and accept it. I also came face-to-face with my anger and fear when facing the bear and was able to face both emotions by using knowledge and self-assertion. Finally, the seed-like vacuum cleaner gave me a wonderful positive healing image to carry with me and use in visualization in the future. Closing Notes The music was very powerful in supporting and magnifying my emotions, helping me acknowledge them, express them, and then find solutions for how to deal with them. I found I anticipated where the music would take me and could feel it drawing me into its core. Rarely did I feel hindered by it, but rather the music met me where I was and moved me to places where I needed to go; I might not have had the courage to continue if it hadn’t been for the flow of the music itself. I was amazed that the same piece of music could be used during many different sessions without my awareness. Not only would I not recognize it as being the same music as the week before, but it would bring up different images each week depending on where I was emotionally on that particular day. This was empowering and gave me the awareness that I have “the answers” within myself. The images brought forth in these sessions have stayed with me long after the sessions. GIM aided me in finding balance in my life, underlined what was important to me and what my priorities were, and offered me support in dealing with a catastrophic illness. It allowed me to see that all of the emotions and feelings that surfaced were normal and necessary in the process of grieving and healing. _______________ * Throughout Ann’s narrative, the words of Ann’s therapist during the music are in italics and within parentheses.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences, pp. 53–60. Gilsum NH: Barcelona Publishers.

CASE TEN Chaos, Crisis, Development, Cosmos Mark Nielsen Torben Moe Torben’s Introduction I first met Mark in March 1995. He had endured 15 years of drug abuse. He was shy and insecure and believed that he was impotent. Two months earlier, he had entered, in miserable condition, the psychiatric hospital where I worked. In 1995, Mark had 16 sessions of music therapy. We used Guided Imagery and Music (GIM), meeting weekly and later twice a month while Mark was an inpatient. Therapy came to a close a few months after he was discharged in September 1995. Since then, I have had follow-up contact with him every 6 months. Mark (not his real name) was able to use GIM almost from the beginning. In our therapy, I helped Mark into a deeply relaxed state and put on specially chosen classical music; Mark verbalized his imagery and I kept in contact with him. After the music, we processed the experience. Every person who experiences GIM has a characteristic imaging style. Mark’s style was characterized by a myriad of symbolic images, often multisensory. Mark will tell his story and give an example from one of his sessions. Mark’s Story My name is Mark. I was born in Denmark on January 12, 1959, as an afterthought in a family of four children. We were three boys and one girl. My father was an independent master artisan and my mother was a housewife during my childhood, but in fact she was educated as a hairdresser. I would describe my childhood as being very secure. I was brought up in a loving atmosphere in a typical middle-class Danish family of the sixties. Music was always an intrinsic part of my life because my father was rather good at the violin; he played it often. My two elder brothers went to a music high school, and my sister played the piano. I began my musical career at the age of 4 with a little violin through instruction and playing with my father. But the violin was not my instrument. My parents’ attitude toward music was that it should be learned in a playful and pleasurable way; therefore, I changed to the marching drum, which I loved. This relationship to percussion instruments lasted and became an important part of my childhood, youth, and adult life. I went to an ordinary basic school, but at 15, before my second year in high school, I left, in defiance of my teacher, and was admitted to an excellent music conservatory.

Music Study: Teenage Years I studied for 5 years, but I did not take a final exam. In the same year that I was admitted, I began my career as a professional musician; I became an assistant in one of the most famous orchestras in the country. Obviously, this was possible only because of the intense experience I had gained from playing in several amateur orchestras since the age of 12. In 1978, I was an exchange student in Moscow. During my stay, I took part in the recording of the ballet Spartacus. Later in the same year, I had my London debut through several recordings with the London Symphony Orchestra. These were great experiences for me. This period had negative consequences, however. During my adolescence, I was mostly surrounded by men and women who were older than I and who treated me as a contemporary, for better or worse. This, of course, made me mature extremely fast on certain levels, but in other areas of my personality, there were—and there may still be—shortages of some building blocks, although hardly any of the essential ones. Because of the facts mentioned above—the unorganized structure of my everyday life and my lack of self-discipline—I started to virtually play Russian roulette with my life. First, I started to drink large quantities of alcohol and ended up with a serious case of pancreatitis and great pain. Next, I developed insulin-dependent diabetes and I started to receive controlled medicine containing great amounts of opiates (morphine) and various benzodiazepines. I was never high on the medicine, but because of my biological makeup and many other things, I quickly developed resistance to the various medicines. For a couple of years, I took gigantic doses of medicine—with and without recommendation from a doctor—to ease the pain and to damp down my whole emotional life. It is obvious that I could not maintain any sort of occupation in this condition and certainly not one demanding the precision of a percussionist in a symphony orchestra. My physical and social decline commenced. Seeking Help In October 1994, I realized that I could not continue to play; at that point, getting out of the hotel bed in itself was an effort. I was resistant to and fearful of going into professional treatment. In January 1995, I was removed to a psychiatric hospital and put on an open ward. Four months later, I had recovered enough that I was able to commence my first session with music therapist Torben Moe. Below I shall attempt to describe some of the highlights of the music therapy sessions and their importance to my new life. Before going into professional treatment, I was very close to having a physical and psychological collapse as a consequence of my medicine abuse. I sensed I had precluded all future possibilities of a professional career. I was so insecure that I thought I would never play music again. While listening to the wonderful music flowing out of the loudspeakers, I learned to relax my body and started to feel myself as “the real thing, all clean.” The imagery initiated a chain reaction of impressions, of visions, scents, flavors, and feelings, and on an emotional level, strange things happened.

At first, I withdrew a little from the ungovernably beautiful scenarios (the images) that came from my inner self, probably because I feared I could not contain them. I struggled to relax and give in to the unknown. After the first few sessions, I was able to relax so much that a lot of images came up. I remember conducting the music, being a sun, having an incredible sense of relaxation, and having a body experience of being very heavy and very light at the same time. I sensed vitality in my images and my fear of being impotent disappeared gradually. In the sixth session, I had a feeling of victory which I intuitively interpreted to mean that I somehow mentally had survived my drug addiction. Listening to the end of Mahler’s Fourth Symphony, I imagined myself standing on top of a hill with a view of a beautiful landscape that contained all the elements I had met during this session: a remarkable intensity of the sun and a landscape with white ancient columns decorated with gold ornamentation. Images During a Session The following are excerpts of my experiences in session 7 during Vaughan Williams’s Fantasia on a Theme by Thomas Tallis, followed by his Fifth Symphony: Romanza, and The Lark Ascending. There is a dark blue light around me, with thin light blue stripes in it. It is rather elegant. In front of me is a lot of light blue steam with golden spots in it. Now I see it becomes a very beautiful rainbow. I can look very far from up here in the air; it is as though everything stands in a faint haze. The landscape and buildings remind me of a concentration camp: barren, evil, and deserted. My legs are whirring. I feel pain. The colors change into blue and red and black, something blazes and flames — yes it flames— right next to me; it floats away, blows away, comes back, and disappears. I feel anger. My own body is red and violet blue in the lower part. At the same time as a powerful prickly feeling occurs, I feel weightless, free, and heavy at the same time. Something faint yellow appears; it is the white columns very slender and tall, one for each of my legs; I walk through them and on the other side an eagle awaits on my left. I start to fly and it draws me along. The colors vary between light gray and red — a brilliant combination— and I feel a wonderful fluctuation with the strokes of the eagle’s wings. It would be nice if it weren’t for that salty burned taste I have in my mouth. Never mind, I will defeat it because now I am in the middle of a lovely hardwood forest with the most beautiful golden colors. I am still very sore in my left side. I fly with the eagle; it is sunset now. There are strong beams of light coming into my solar plexus, and at the same time I feel I am stretching out in my body, as if somebody had a hook and pulled my head. Everything is dark red now. I feel the color coming into my legs and I am falling and falling until I land at the bottom. Yes, I think it is an old volcano and I am very deep down. I have a very salty taste in my mouth. Now it is as though heaven is coming down to me. I think I have been far away; my legs are gone and I am moving up again. I am goosefleshy all over. What stood out for me in this session was the view of the concentration camp, the eagle, and the volcano. The camp and the anger and pain I felt there were like all the pain I have gone

through as a drug addict and in the treatment of my pancreas inflammation. On another level, the pain reminded me of a very traumatic “falling in love” experience I had when I was very young and was playing in Russia. I had very strong feelings toward a ballet dancer. The relationship was impossible in many ways, mainly because of the East-West situation at the time. The anger I felt was somehow connected to my former teacher at the conservatory, whom I felt had let me down; I realized how ambivalent my relationship to him had been. It was very satisfying for me to get in contact with this feeling that I now also sense was a feeling of strength—like a readiness to fight for my life. The eagle image is a very powerful symbol for me, since it is an animal with strength and a breadth of view; it can connect me to the unknown and perhaps to repressed areas of myself. Finally, I think that moving down into the bottom of the volcano symbolized the expanding potentials of what I can be—by myself and in relationship to other people. At this point in therapy, I had regained more control of my body. I had lost about 10 kilos of weight [22 pounds], my diabetes was totally under control, and I had begun to play a bit of music again in an amateur orchestra. Reflections: Looking Back and Forward The reflections that I reported above are from notes I kept of each session. During music therapy, I had a lot of unexpected exceptional experiences; these we analyzed and worked with immediately after the music listening in each session. Sometimes the material had to lay and mature a bit in the afterthought universe; we took up these afterthoughts the following week. Another very important, almost archetypal figure that came up in my therapy was me as the jester-clown. This figure provided entertainment in a creative manner and had a light on each finger. The positive part of this image was the creative way he appeared and the negative part was that he never seemed to stop offering entertainment. Music therapy has given me new life. It has been part of my transformation (as the title of the chapter suggests): from chaos to crisis to development to cosmos. I will outline this idea. The chaos period was my drug addiction, and the crisis was when I lost my job and stopped playing music. The development stage was when I decided to seek help at the hospital and began my music therapy, and the cosmos is what I have gained from GIM therapy and, in a more spiritual way, how my view of life has changed. Here is an example. My taste in music became broader. I started to enjoy listening and playing a lot of different kinds of classical music that I was never able to take in before. Some of the softer romantic pieces from the Romantic era now came close to my heart. Most important for me was that I began to enjoy the silence! For as long as I can remember, I have had an almost manic obsession to have sounds around me day and night, but now I enjoyed quiet periods during the day and I stopped trying to escape from myself. When I left the hospital in the end of 1995, I returned to my apartment, which was in poor condition. A lot of crap was carried out from the place. With my renewed belief in life and renewed energy, I changed my drug addiction cave (my apartment) into a nice flat that reflected my new self: masculinity and musicality. Later, a famous Danish home magazine came to take pictures of the apartment.

During that period, I sometimes experienced all alone unexpected moments of happiness: tears of joy and goose pimples. My daily music practice went so well that the ambitious idea of a solo concert started to take shape. The big day came and the concert was a success. I have regained my old job as an assistant in the orchestra and I am usually the first person they call whenever they need a large crew. About 13 months ago, I met my current girlfriend and I believe we can create a future with lots of shared moments of happiness. Thus, I am back in the labor market as a musician and I also work part time as a teacher in a youth club. I keep up with daily instrument practice for various music competitions in which the winner obtains employment on a permanent basis in an orchestra. This practice helps me to keep up my solo repertoire. I have also started to take lessons in the marimba and this will ease my preparations for new and complicated music. Summary The scales fell from my eyes, and suddenly I could see and—more essential—I was aware of the beauty and grace of every atom of this world and the rest of the universe. You have to dare to see it and acknowledge it with open eyes and open mind; you have to be receptive and open to all the events of day-to-day life. Events can either become trivial repetitions or they can become new, wonderful happenings and experiences. It is your own choice. If you have physical and psychological energy, you can go very far in personal development with music therapy. Such development can be on many different levels and therefore useful throughout life. Music therapy can certainly open doors!

The introduction to this case study was excerpted from: Perilli Giordanella G., Cicinelli, R. (2012). From Tacit Knowledge to Narrative Re-Description Through Music Psychotherapy: A Perspective from Second-Generation Cognitive Science. In K. Bruscia (Ed.), Readings in Music Therapy Theory. Gilsum NH: Barcelona Publishers.

CASE ELEVEN The Integration of Metaphorical and Logical Thinking Through Guided Imagery and Music: A Case Study Gabriella Giordanella Perilli Introduction Cognitive scientists are now recognizing that human motivation and the activation of behavior are inextricably linked and that each informs and explains the other. This position, also called bio-behavioral or second-generation cognitive science, has found eloquent and forceful advocacy in the works of many psychologists, philosophers, linguists, and immunologists. Their general position is that language, behavior, and value depend upon and influence sensorimotor or bodily processes, and that both motivational and activational processes are based on neural patterns—all of which are susceptible to the effects of reinforcement (Donahoe & Palmer, 1994). Second-generation cognitive science includes various interdisciplinary contributions that describe how human beings develop and function. This complex system of knowledge forms the basis of the integrative process of Guided Imagery and Music (GIM) proposed here to respond effectively and flexibly to various levels of development and functionality. In this approach, music is used to facilitate imagery and the metaphorical representation of tacit knowledge in the form of analog. Once represented at a conscious level, the analogical tacit knowledge can be compared with what is already in consciousness, and possible discrepancies can be identified. Then logical-analytical thinking is employed to edit those forms of automated or nonfunctional thoughts that retain painful memories and suffering and/or hold back the patient from their potential growth. Guided Imagery and Music (GIM) is an approach to psychotherapy that fits well with second generation cognitive science. Its essential components take into account the belief that human beings are complex systems and that their development and functionality depends upon the integration of neurophysiological and psychological processes, tacit and explicit levels of consciousness, and nonverbal and verbal codes of meaning. The following paragraphs outline premises of this approach to GIM: The various stages of the session (Prelude, Induction, Music-Imaging Experience, and Postlude) are intentionally designed to help the client explore various levels of consciousness. In cognitive science terms, deeply relaxed states are used to explore “primary” consciousness, and alert states are used to reflect upon the material unearthed from primary consciousness

and thereby bring the material into “secondary consciousness.” Both states are explored in the GIM session through various verbal and nonverbal modalities. In GIM, music-imaging experiences are used to access tacit knowledge (primary consciousness) and thereby promote a metaphorical process. The metaphorical process in turn is used to bridge primary and secondary consciousness, and tacit and explicit knowledge. Taken together, music, imagery, and the metaphorical process are used to help the client develop alternative and preferred ways for experiencing, understanding, and coping with life issues. They are also used at the tacit level to create different narratives and descriptions of the self and outside world. In GIM, verbal processing (i.e., language) is used to integrate primary and secondary levels of consciousness and thereby reflect upon and gain insight into one’s tacit knowledge and automatic ways of being that maintain dysfunction and suffering. Language is also used to evaluate the coherence and viability of the various narratives developed at the tacit level and to decide which alternatives are preferable. Narratives reflect one’s values and therefore can be used to re-describe or reconstruct the self in a coherent, integrative way, thereby leading to appropriate changes in emotions, thoughts, and behavior. Within the frame of second-generation cognitive science, awareness is a primary therapeutic goal because it is the very foundation of psychological health or dysfunction. Because awareness evolves through the continuous oscillation between tacit and explicit knowledge systems, psychotherapy is aimed at achieving a dynamic balance between the two types of knowledge. The GIM session is so designed that it facilitates this oscillation between types of knowledge and the achievement of a dynamic balance. Through this process, individuals develop a greater capacity for complexity and a higher level of self-organization, both of which are useful for self-continuity and self-integration. A main challenge to this dynamic balance occurs when there is a discrepancy between tacit and explicit self-image. In alternating between tacit processes (sensorial, preverbal) and explicit processes (conscious verbal thought), discrepancies can occur between self-images that are developed at these different levels. In other words, the tacit self-image (and aspects thereof) may be very different from the explicit self-image. In some cases, this same alternation between tacit and explicit can lead to a new equilibrium that includes a more structured, integrated, and coherent self-image at a higher level of the person’s awareness. However, when the discrepancies between the tacit and explicit systems become too difficult to manage, the individual might not have the capacity to integrate the self on one’s own. This can lead to the emergence of disturbing and uncontrollable emotions because the individual would perceive contradictory aspects of the self without being able to reorganize an integrated selfimage at a conscious level. This situation could then lead to an imbalance and cognitive dysfunction, preventing the individual from maintaining a sense of personal uniqueness and historical continuity. In this case, as proposed by this approach, the disturbing sensory and emotional information could be represented and evoked via other modalities or ways, such as imagery, metaphorical music experiences, motor patterns, and viscero-muscular reactions. Language and secondary consciousness enable humans to integrate their emotions with their verbal thoughts and verbal evaluations of self and world. This means that in GIM therapy, it is often worthwhile to reflect verbally on the musical, metaphorical, and emotional experience, to grasp what is beyond, and to elicit its hidden source. Upon such reflection, the

client and therapist can identify “stereotyped thinking” (generalized rather than thinking based on the actual situation) and “rigid rules” (e.g., thinking that because something happened in the past, it will happen again; evaluating oneself as bad rather than one’s behavior or thought or emotion; maintaining an idealistic self-image as perfect; having unrealistic expectations or a low frustration tolerance). Thus, the experiential aspects of GIM (i.e., imaging to music in an altered state of consciousness while dialoguing with the therapist) are used in this approach to explore and evoke what is at a tacit level of awareness. This part of the therapeutic process may include risk-taking, attacking shame, lowering anxiety, diminishing phobias and panic attacks, and similar experiential tasks. It is important to keep in mind that the images evoked by the music in an altered state of consciousness are a product of the prototypical mental constructions that unwittingly determine the behaviors of the individual. The representations of these images, constructions, and behaviors are imaginative and metaphorical and therefore initially removed from the formal logical analysis of the verbal processes. Moreover, any interpretation of these representations while the client is actually engaged in the music-imaging experience are usually made through primary processing. Thus, such interpretations occur in a general and stereotypic manner and rely upon interpretive schemes of which we have less awareness and which are less reliable. Nevertheless, these analogical codes provide a cognitive bridge between tacit and explicit knowledge. The development of explicit knowledge begins in the “postlude” of GIM sessions, when the cognitive GIM therapist uses verbal methods to help the client to understand the images and metaphors and to identify, explain, and modify irrational or illogical ways of thinking that maintain the client’s suffering. This self-reflection begins with the therapist and client reviewing the transcript and the client assigning initial meanings to the images and metaphors. The therapist and client then further contextualize the images, metaphors, and meanings from this session by comparing them to previous sessions. After sufficient time has passed to give the client sufficient distance, materials gathered in several previous sessions are analyzed using cognitive techniques (e.g., using verbal constructs to depict oneself, debating irrational beliefs, employing metaphoric and narrative devices, etc.). All of the verbal processing of the material arising from the GIM experience serves several purposes: it enables the client to capture meanings and insights that were unavailable at the actual time of the session; it brings the metaphorical images closer to reality; it reveals the contradictions in one’s own self-image; it helps to develop strategies for resolving these discrepancies; it facilitates the construction of a more articulate and accurate narrative of oneself in the world; and it enables a reconstruction of the self that is more consistent with one’s own system of goals, values, beliefs, expectations, etc. Regarding the discrepancies between tacit and explicit knowledge, it is good to bear in mind that the distinction between comprehension and interpretation is greater when the imaginative experience presents irregularities and vagaries when comparing the real and imaginary worlds, the various meanings of a particular metaphor, and the contrasting or even incongruent emotions attached to them. The understanding that occurs immediately after the GIM experience is sometimes provisional and open to revision upon further reflection on the written transcript of the session. In reading the transcript, interpretive distancing permits the individual to take different perspectives on the tacit knowledge accessed through the music

imaging experience. In this way, the client is able to evaluate parts of the experience using logic-emotive abilities and therein focus on key issues. Only in this way is it possible to achieve an organized reworking of the episodes in a coherent narrative structure. Although initially represented in an indirect manner, the tacit content can now be personally verbally contextualized. This is consequently the therapeutic value of imaginative reenactment through music. Via this method, recovery is possible through imaginative metaphors, whose tacit knowledge constitutes the hierarchically superior level of informational processing of every human cognitive system (Guidano, 1987; 1991). We know that this kind of knowledge influences the very shape of the experience, but it is not directly accessible through language. The imaginative music experience may blend with aspects from the tacit level such as sensations, emotions, images, and motor patterns associated with internal operational models. As a result, the tacit contents are rendered amenable to analytical processing and, therefore, to a better understanding. This last step is the key to the subsequent change via a cognitive restructuring. Since in the actual perspective the therapist disposes him-/herself of a wide range of verbal and nonverbal methods to address tacit and explicit knowledge, he/she can be flexible in determining which could be the most appropriate methods or techniques for the client to be used at that time. It is important to note that each step of the therapeutic process is included in an expanded therapeutic plan; in other words, each session is part of a meaningful and unique puzzle illustrating each individual identity. To summarize the psychotherapeutic process: in the initial stage, the client acquires nonverbal awareness during a music-imaging experience, which is then enhanced by verbal analysis. Then, assisted by the therapist, the client begins to understand how nonadaptive or maladaptive ways of thinking maintain a painful state of being and prevent creative potentialities from developing. Through the metaphorical process, the client transfers the imagery and its meaning from tacit to explicit knowledge. Now the client is better able to evaluate and explain those behaviors, emotions, and thoughts that limit his/her opportunities and choices. Then, based on his/her own values, beliefs, and goals, the client has to work on modifying the behaviors, emotions, and thoughts that negatively affect his/her quality of life. In the final step, the client describes his/her own story in a new narrative that will illustrate the new, purposefully modified self-image. To illustrate these concepts, three particularly significant sessions from a case study are presented. Case Study Background Information Mary is a 45 year-old woman, married and working as a professional. She is very pleasant, and well-dressed. A few years ago she was diagnosed as having the HIV virus, and was in poor health due to the virus and to the strong drugs she had been prescribed. She came to me for GIM psychotherapy feeling both depressed and anxious, and together we formulated these goals for her work with me: · To explore inner resources that she could use to cope with her illness

· · · ·

To modify irrational beliefs that disrupted her emotional life: “My life must meet my expectations and desires;” “I must always be perfect;” and “Other people should accept me.” To develop the assertiveness needed to communicate her situation to her family To accept her life circumstances, without feeling overwhelmed and guilty To re-organize and give positive meaning to her life.

The Psychotherapeutic Process Mary had received many GIM sessions several years prior to our first meeting. We therefore decided that our first session would be verbal. This gave us an opportunity to not only review her life, but also talk about her previous experiences in GIM, and her present expectations. For the rest of our work together, we alternated between GIM sessions and verbal sessions. We did this because we found that our postlude discussion did not give us enough time to adequately deal with the material arising from the GIM experiences. I also asked Mary to write a narrative on each GIM session, so that we could review it at her next verbal session. The following is an excerpt from her second session, where she immediately began to address her health status through GIM. The program used was “Faith” by Bruscia (2002) (See Appendix A): I am in a field, where a furious battle took place. Corps lie everywhere, the ground is full of enormous fissures, there is smoke, everything was burnt. I see a little plant. I take away numerous corps nearby it. I clean and prepare the site around to protect it. I water it. I feel full of tenderness because this is still alive notwithstanding the disaster. It has to grow without being overwhelmed. It has to understand that it is alive. There is life not only death. It can grow in a wonderful way. I kneel down and pray together with the chorus to develop in myself an unbelievable power, a power to help me to afford my life. I feel such power coming out from my heart. It is a kind of energy I have never felt before. Clearly, this GIM session gave an overview not only of how she was experiencing her health condition, but also how she would overcome it. We therefore planned a few verbal session to identify some of her self-perceptions, inferences, and irrational beliefs, as revealed in the GIM session. As a result, Mary was able to formulate the following self-description: “Because I have the HIV virus, people will not accept me, but at the same time, I think they feel obliged to be compassionate towards me. I cannot accept the fact that I have this disease, and that I have had it for 15 years without knowing it. Having this disease, I cannot accept myself, I cannot love myself, and I do not trust myself. I am ashamed of myself.” Mary also experienced feelings of depression, guilt, anxiety, and anger. In next to the final GIM session, Mary had these images in respose to the “Integration” music program by Perilli (2011-2012) (See Appendix A):

It is a strong oak tree with a beautiful rough bark, with many deep fissures. It is the lord of this field, a wise guardian. It managed to grow up despite the bad weather. It was not easy. It has travelled a long journey through life, with patience and determination. Now it is fulfilled. I understand. I will do the same. I will take care of myself to make my own long journey. I thank the oak tree. Before I leave, I play with its young and flexible branches. My body feels very strong. I am leaving now. The music gives me the energy I need to re-think my situation carefully. I am smiling. I feel happy! This GIM experience helped Mary to modify her negative assumptions in the subsequent verbal session. She made this conclusion: “I begin to like myself more, I can accept myself. It is OK if people do not feel comfortable having a relationship with me.” To reinforce these basic issues she had one more GIM session, her last. The program was “Positive Affect - Modified” (Bruscia, 1996) (See Appendix A) and the induction was a ball of light giving positive energy. The focus was her Mandala titled “Unfinished Business” (See below), to which she associated feelings of coldness, detachment, anger.

I am going inside my mandala. It is turning into a brilliantly colored stained glass window in a cathedral. From the window, light is pouring out, and lighting up a scene in nature with an apple-tree. I am there, and I see a woman carrying a baby and a basket full of fruit. I feel the fresh air and hear the sound of a waterfall. I am amazed…surprised because I have not noticed this wonderful waterfall before now. I am diving into the water. It is fresh and clear, and somewhat joyful…I feel my body refreshed and toned up. While listening to Barber’s, Adagio for Strings, Mary no longer perceives the roar of the waterfall, so she decides to climb the rocks, grabbing at any solid branches coming out. She wants to see where the waterfall is coming from. The roar of the waterfall grows faint, as if there is a rest, or someone had closed a dam. She feels some nostalgia for the waterfall and all of her memories of it. She feels a little sad as if energy were going to dry up in her belly. She

imagines this sadness like a stone overgrown with moss. When she removes the moss, she discovers a smooth and nicely veined stone. She feels very pleased that she found such a beautiful stone. She wants to bring the stone home, but when she asks, the stone tells her that it prefers to remain in the river because this will allow it to recover more energy. Mary follows the stone’s advice and lays down in the water to also gain energy from both the stone and the water. She feels her body as light and strong. The moving water also sweeps away all dirty things, which makes her feel clean and refreshed. The running water also sweeps away every negative thought. The water never stops flowing, and nothing can block its energy. Mary holds the stone for support, letting the water caress, clean, and energize her body. She drinks the water. While sipping, Mary feels the water becoming a light beam cleaning her insides thoroughly. She feels purified and brighter. Now wearing a white, long tunic, she walks in the stream, to receive a foot massage. She goes towards the site where the stream has its source. Mary arrives nearby a huge, rocky mountain. She feels deeply moved realizing that the stream comes out from the belly of that magnificent mountain. She says a prayer of thanksgiving. In the postlude Mary described her journey as invigorating. For the first time she had a very strong physical experience, feeling refreshed, purified, and energized. She felt a wholeness with the environment. She closed her imagery contemplating the grandiosity and power of nature and life. Discussion and Conclusions During our work, Mary improved remarkably physically, and as a result was able to decrease her medication. Psychologically, her growth can be understood clearly through the metaphors she created in the GIM experience, and the meaning that she attached to them in our verbal sessions. Mary’s growth process can be illustrated through a sequence of three transformations: of HIV, of her power to live, and ultimately herself. The Transformation of HIV In Mary’s first GIM session with me, she immediately made a metaphor of the HIV virus. It was a field where a ferocious battle took place. The field was strewn with dead bodies, and enormous fissures in the ground—just like body wounds to the earth. The transformation began when these fissures or wounds turned into the beautiful rough bark of the oak tree, which also had deep fissures. But this oak tree was very sage, and possibly held the wisdom needed to heal her HIV. Then the fissures in the bark appear in a later metaphor as the veins in a stone. The healing process then begins when the stone immerses itself in water in order to receive its energy. The water also begins to refresh and cleanse the stone from all impurities. Mary holds the stone as if it were an anchor, like a tree, standing in one reality (the HIV), and yet having the energy needed to go on, and to accept both the negative and positive aspects during the flowing stream of life. The Transformation of Power to Live

Life represents a core value, a resource that could sustain Mary in coping with stressful life events. Metaphors of life in her imagery included the little plant, the oak tree, and the water, all of which gave her the confidence needed to overcome her problems. These metaphors were used in the verbal sessions to confront her negative inference, i.e. “since I am HIV positive, my life has no value.” Going further into these metaphors, the little plant grew into a strong, sage oak tree, and then into a fruit tree. The waterfall and water took away all negative thoughts, and refreshed and purified her self-perceptions of mind and body. All of these metaphoric images helped Mary to modify her irrational thoughts about her own self-worth, and to realize that she did have the resources and abilities to cope with her life! Another important metaphor was finding the source of the stream in the belly of the mountain (which she recognized as her own belly). This led her to the insight that her own power came from within herself, and that she had the power and energy to live her life. The Transformation of Self Transforming her images and metaphors about HIV and life inevitably led Mary to modify her self-evaluation. With the HIV as she originally perceived it, she felt deeply depressed and powerless. She saw herself as a “rotten person.” However, as her perceptions of HIV became more positive, she realized that she did not have to base her self-evaluation solely on the presence of this disease. She was more than the disease, and the disease was only a part of the whole. In addition, upon realizing that she had the power and energy within herself to go forward in life, she also began to develop more positive perceptions of herself. In her final GIM session, she becomes the master of her own journey. Donned now in a white tunic, she walks in the water to the source of the stream—to discover herself as the source of her power and energy, and to feel whole with nature and life. Closing Thoughts Emotions are considered the first evaluative, organized system to know self and environment. Neuroscience research underlines the consequence of the tacit level of consciousness, including sensory, motor, and affective esperiences. The affective responses evoked by music seem to be associated to the mirror neurons simulation mechanism. They involve functions and processes in sub-cortical and cortical brain areas. In clinical practice, it is fundamental to plan multidimensional interventions in order to work with the analogical-imaginative and analytical-verbal systems, in an ongoing dynamic interaction. In conclusion, GIM is ideally suited to work with the tacit knowledge because the music allows people to get in touch with their emotions which can be communicate through verbal words. As proposed in the Cognitive Integrated Approach, a further cognitive new elaboration is developed through verbal methods in order to reach an effective integration in various subsystems and functions and, thus, a lasting and meaningful modification in the self psychological organization.

Reference

Bruscia, K. E. (1996). Music for the Imagination. Gilsum NH: Barcelona Publishers. Bruscia, K. E. (2002). Appendix E. In K. E. Bruscia and D. Grocke (Eds), Guided Imagery and Music: The Bonny Method and Beyond. Gilsum NH: Barcelona Publishers. Donahoe, J.W. and D. C. Palmer (1994). Learning and Complex Behavior. Boston: Allyn and Bacon. Guidano, V. F. (1987). Complexity of the self: a developmental approach to psychopathology and therapy. New York: Guilford Press. Guidano V. F. (1991) The Self in Process. Toward a Post-Rationalist Cognitive Therapy. New York: The Guilford Press. Perilli, Giordanella. G. (2011-2012). Integration process in the Bonny Method of Guided Imagery and Music. Journal of the Association for Music and Imagery, 13, 23–44.

Appendix A GIM Programs Faith (Bruscia, 2002) Part: Cantus in Memory of Benjamin Britten Ives: Unanswered Question Alwyn: Symphony #5 (4th movement) Saint-Saens: Symphony #3 (2nd movement) Messiaen: O Sacrum Convivium (A Hymn for the World) Integration (Giordanella Perilli, 2011-2012) Wassenaer: Concerto # 3 in A. Largo Andante Cherubini: Requiem in A minor, Graduale Tartini: Concerto in A Minor for violin and orchestra, Grave Rota: Concerto for Strings, Prelude Morricone: Concerto # 1 for Orchestra (Excerpt) Paganini: Concerto for Violin # 1 in D, Op. 6, Adagio Rossini: William Tell, Overture (Excerpt) Corelli: Concerto Grosso in G minor, Adagio Positive Affect-M (Bonny & Bruscia, 2002) Elgar: Serenade for Strings, Larghetto Elgar: Enigma Variations (8 and 9) Mozart: Laudate Dominum Barber: Adagio for Strings Brahms: Requiem (Part VI) Strauss: Death and Transfiguration (Excerpt)

Taken from: Bruscia, K. (Ed.) (1991). Case Studies in Music Therapy, pp. 497–512. Gilsum NH: Barcelona Publishers.

CASE TWELVE Guided Imagery and Music (GIM) With a Dually Diagnosed Woman Having Multiple Addictions Eugenia Pickett Abstract This case describes how GIM helped a 35-year-old woman who had a dual diagnosis of major depression and addictions to food and alcohol. In the course of therapy, the woman identified and worked with various parts of her self, until she could coordinate and integrate their roles in her recovery process. Introduction Penny enters my office. Her eyes are downcast and she is mumbling, “I am drowning... invisible...empty.” Her pain is alarming, yet it lets me know that she will probably accomplish important therapeutic work today. I smile as we sit down. As she looks at me, I see fear in her clear blue eyes and tension furrowing her brows. This 39-year-old, 295-pound woman is exceptionally well-dressed, and is groomed to perfection. I hand her the art materials and say, “Show me how you are feeling right now.” As she reaches for the chalk box, I notice that her light perfume has carried a delicate sweet scent into the room. With shaking hands, Penny picks up the purple chalk and draws vertical parallel bars descending from the top to midway down the paper. She reaches for the black chalk, and slowly colors in three large black areas, pressing hard and moving the chalk methodically up and down at the bottom of the paper. With a fiery red chalk, she then fills in the spaces between and around the black areas, and then colors all the remainder of the paper with yellow. Her drawing is tight and compartmentalized. “My addictions,” she announces in a trembly belligerent voice; then tears fill her eyes as she says, “I am so trapped.” I direct her to the recliner, cover her with a light blanket and suggest she focus on her breathing...” Allow each inbreath to take you more deeply into your feelings and your self... and each outbreath to assist you in relaxing...I am with you now and will stay here with you while you explore whatever you need to explore today.” I put on Pierne’s Concertstucke for Harp and Penny embarks on the imagery portion of her session. As the music resonates with her emotional nature, tears begin streaming from her eyes, and she reaches out for my hand. This is our first intimate contact today. “I feel so far away from you,” she says. I take her extended hand in one of mine and cradle her neck with the other. Encouraging her to be with her strong feelings, I again reassure her that I will remain by her side. As the music continues, she says, “I am so alone... always alone...alone...I feel myself

lying here...heavy... ugly...fat...sad...behind a big wall...[she sighs]...the fat is my fault...if I didn’t eat so much, I wouldn’t feel like this.” This session is one of several which marked the beginning of Penny’s shift toward recovery. Previously we had been working in traditional, verbal psychodynamic psychotherapy. And although she progressed in self-understanding, she had bouts of extreme depression, and her addictive process was essentially untouched. Her weight increased to almost 300 lbs. Penny had psychiatric and substance abuse problems, and was in need of simultaneous treatment for both. She was suffering from a recurring major depression in addition to food and alcohol addictions. Dually diagnosed persons exhibit complex defenses of denial, and as a result are often very difficult to treat. The dual problems make them less amenable to conventional treatment approaches (Evans & Sullivan, 1990). Something more is needed. Beyond theory and method, they need to be engaged on an experiential level (Hornyak & Baker, 1989), and sometimes they need psychotropic medication. It was not until she began working creatively that Penny began her recovery process. About Guided Imagery and Music, Penny says, “My problems were so deeply buried and well protected, that I used to be unable to release control and allow them to surface... The music relaxes me into almost a dream state and feelings deep within me rise to the surface... This therapy seems like it works from the inside out... Talk therapy used to work from the outside in.” The Therapeutic Approach Imagery Guided imagery can be systematically used to bring about changes in emotional health. Information from the past, and the affect associated with it can be used to make sense of obstacles to emotional health in the present. For example, when unresolved grief issues are creating relationship problems, asking a client to imagine placing a flower on a parent’s grave usually elicits more emotion than talking about the death which may have occurred many years before. And once the affect is expressed, a person is able to get beyond the grief. Pribram (1981) described thinking as a process of searching through holographic memory in an imaginative and emotional mode. Based on this, he proposed that problemsolving is a sequence of repeated searches through holographic memory in imaginative and emotional modes. These repeated searches help to generate additions to previous holographs while also providing opportunities to rehearse new ones, thereby creating new possibilities for solving a problem, and ways of evaluating them. Systematic use of the imaginative process makes it possible to both assist in eliciting emotional response, and in generating resourceful behavior. Leuner (1984) encourages his patients to daydream on specific themes, and then guides them through their emotional responses to desirable changes in affect and attitude. He uses his technique in short-term psychoanalytic psychotherapy, and claims that it changes both perception and behavior. An individual can both explore emotions and then imaginatively create or generate more adaptive behavior. Cameron-Bandler and Lebeau (1985, 1986) provide specific formulas for this process.

Music Music animates the emotion below consciousness (Sessions, 1971). It reaches into the imaginative mind, beyond defense mechanisms, and accesses possibilities for self exploration, sometimes presenting emotions and moods that we have not felt before. One reason for the link between music and emotions is that they both unfold and reveal themselves through time. Zuckerkandl (1969) explained how there is “an interconnectedness between phrases, [wherein] each musical tone points beyond itself... We are auditively in the tone and... ahead to the next tone...” This means we are literally carried through our emotional experience by the movement of the music from moment to moment. Grof (1985) noted how this facilitates therapy: “Music creates a continuity and connection in the course of various states of consciousness,” and when used in a therapeutic context, it “creates a continuous carrying wave that helps the subject move through difficult sequences and impasses” (p. 386). Guided Imagery and Music Guided Imagery and Music (GIM) as originated by Dr. Helen Bonny (1978a, 1978b, 1980) is a method of self-exploration in which classical music is used to access the imagination. The technique is sometimes referred to as music assisted psychotherapy (McDonald, 1986), because music is the medium used to interact with and therapeutically influence the imaginative process. When chosen appropriately, music—being itself simultaneously multidimensional—will evoke emotional response, activate the senses, impact physiologically on the body, and stimulate symbolic representation or imagery (Bonny, 1986). Music-facilitated imagery such as this brings therapeutic issues into focus, thus making it possible to both work with them and to generate adaptive solutions (Bonny 1978a). Clark and Keiser (1989) further state that GIM helps a person to strive towards wholeness by self-actualization in the imaginal realm. For this reason, outward therapeutic changes resulting from an inward journey often yield benefits beyond stated therapeutic goals. Typical GIM sessions are 90 minutes in length. The beginning of each session includes a preliminary conversation, guided physical relaxation, focused concentration on an image relevant to the client’s goals, and the selection of a taped music program. Each taped music program is carefully constructed for both musical contour and the various elements which contribute to it (Bonny, 1978b). The contour is designed to carry the listener into a deep emotional experience, and then deliver him/her safely back to the present; it begins at a baseline, builds to a peak, stabilizes and then returns to the original baseline. The musical variables within this form are pitch, tonality, rhythm, tempo, vocal and instrumental considerations and mood. Tapes for music sessions are selected on a session by session basis so as to match the mood and needs of the client. Once the music begins, the therapist encourages, comforts, and actively inquires into the client’s imaginative process as it is occurring. Advanced, specialized training in GIM is necessary to use the method professionally. Besides having the necessary knowledge and skills to use GIM, Bonny describes the trained GIM therapist as a good listener, empathic, self-confident, imaginative, and intuitive (1980). Background Information

Penny is a 35-year-old, divorced woman who is obese. She has been in treatment with me for five years. She and her 11-year-old son live with her parents. At the time she began treatment, Penny was afraid to be alone at night, and was sleeping in the same bed with her son. He was plagued by multiple allergies and a school phobia. She moved back home with her parents when she left an emotionally and sexually abusive marriage which lasted for five years. She was out of touch with her feelings, overeating, abusing drugs, and dependent on alcohol. She seemed unsocialized, and she did not know how to carry on a conversation about herself. Her father is an alcoholic and a retired railroad worker, who according to Penny, was disappointed when she was born because he wanted a boy. He was hard on her. She said he cursed her, called her names, and tried constantly to make her rough and tough. In fact, she felt that she had not received even the slightest approval from her parents until she gave birth to the son they wanted her to be. Her mother, who worked outside of the home as a secretary, did not protect Penny from her father’s alcoholism, his roughness, or his abusive language. Penny remembers being jealous of her sister who she says was very smart, feminine and popular. She remembers her peers ridiculing her from an early age, and although she has lived in the same city all her life, she has no friends except for the ones she has made since she has been in therapy. She did poorly in school, and until two years ago believed she was “stupid.” Her eating disorder began in adolescence. She says that after school she would frequently eat an entire loaf of bread with lunch meat, and then buy more food to replace it before her parents came home. As an adult she learned to binge and vomit, and at the time she began therapy, she was bulimic. Penny missed a lot of school as a child and adolescent, due to multiple colds, allergies, and asthma. When she began therapy, she was sick a lot. She was taking oral medication for hypertension, weekly allergy shots for asthma, and she had kidney stones. Her blood pressure is now normal, she no longer takes allergy shots, she has developed no more kidney stones and is rarely sick. Penny was not sexually active until marriage. During the marriage, her ex-husband encouraged and enjoyed bondage and beating as part of their sexual experience. She says she enjoyed hurting him. She is attracted to women, but has never had a sexual relationship with one. She has been sexually inactive since the end of her marriage. Penny has had no hospitalizations except for childbirth and no previous psychotherapy. Treatment Process: The Beginning Developing trust was a major issue for Penny in our early work. We focused on two things. The first was for her to learn how to carry on a conversation about herself with me, and regardless of whether it really mattered to me if she did. The second was for her to discover what a therapy relationship is all about and whether it would work for her. Sessions were difficult for us both, and contained long periods of time when neither of us said anything. I was more comfortable with the silences than her confrontations of me; she was more comfortable with her confrontations! Eventually we developed a therapeutic alliance.

Our next focus was on her parenting skills. Her son needed protection and care. He needed to have his own room and bed, and he needed to be going to school. She learned to set limits, for both herself and him, while also becoming a caretaker who could properly express both positive and negative feelings. She got him in his own bed and to his own therapist, and his school phobia subsided quickly. Then Penny began her grief work—a process which continues today. She began dealing with the pain of losing her marriage, and she discovered how she used her addictive behavior to control this pain. She voiced her realization quite clearly: “Alcohol and fat keep me safe.” I expressed my concern about her weight and her drinking, and how they were affecting her health; it was clear she was on a slow suicide path with alcohol and food. At the time, I did not know that she was abusing her prescribed medications as well. She talked about her feelings of worthlessness and about there being “somebody in me who wants to be free.” She began attending Alcoholic Anonymous (AA), and started the recovery process. In the months that followed, her misuse of minor tranquilizers, blood pressure medications, and randomly chosen “over the counter” drugs was exposed. As she “got clean,” Penny became more frightened about exposure. Deeper feelings were closer to the surface. Being in recovery, she could not flee to her previous safety with alcohol and drugs. Being close to me began to feel dangerous. She was afraid most of the time. Her binge eating and purging skyrocketed. It was at this point that we began to work with music and imagery. Her food addiction, which had been present all along, was more accessible because of her recovery process with alcohol and drugs. So we began working directly with the addictive process. As this work progressed a major depression recurred, and the physician with whom I work prescribed Prozac. GIM Treatment Process The Wall In our initial work with GIM, Penny was confronted by a very high and very thick black cement wall. She said, “It looks like a dam, and it keeps everyone out and holds all my secrets in... I dwell on the private side and allow no one in... Some others know parts of the private side, but only as much as I want them to know... I can be on the other side of the wall if I want.” However, she spent all of her time isolated behind the wall, and was becoming lonelier and lonelier. Penny decided she wanted to remove the wall but was afraid of losing control if she did. One day she said, “It has gotten too painful to maintain such a solid and tall wall.” She had been drawing pictures and bringing them to therapy, and I noted a change in the wall’s height. In her session, Penny tried adding a door, but then voiced her fears: “There will be no way to control the door once it is opened... My secrets will spill out and people will come in...I will lose my protection and won’t be able to close the door.” She decided to make the wall lower instead. Eventually, Penny added doors with locks on her side. This was about the time she started making new friends. As subsequent GIM sessions dealt with making friends and being close to people, she added windows. Then the wall itself changed from black concrete to grey stones and mortar, with vines and flowers growing on it.

The Addict In working with addictive behavior, the person I first see in my office is the one who wants to be more disciplined—the one who wants to recover from the addiction. The undisciplined part that overindulges with food, alcohol, or drugs, rarely presents for psychotherapy. Successful therapeutic work involves getting the addicted part of that person involved in the recovery process. What follows is a transcript of one session with “The Addict” in Penny. I used a programmed tape entitled “Mostly Bach” which was created by Bonny (1978b). The music is very regular and structured. It is continuous, complex, and exalted in mood. The music helped to give Penny the energy and power needed to work productively with intense psychological material. I started her with an induction that invited the part of her that is out of control and taking control with food, to come forward and to join me in the treatment room. As Bach’s Passacaglia and Fugue in C Minor began playing, Penny looked peaceful. Her breathing was deep and regular. Her eyes began moving underneath closed lids and she said, “I am outside in a park...There are many trees... The grass is green, light green like in the spring. It feels good to be here...I feel good ... My body feels light.” I asked, “Is the part of you who is causing trouble with food around?” Penny’s face changed to a deep frown, and holding her breath said: “Yes, and she is surrounded in darkness... dark gray.” I reminded her to keep breathing evenly, and made a suggestion that the music could help her to meet and talk with this part who has been causing trouble. Then I suggested that Penny thank both herself and the “Other Part” for their willingness to communicate with one another. During Bach’s Come Sweet Death, Penny made friends with her Other part, as I helped her to ask: “What do you do for me? How are you helping me? What is your usefulness?” Penny continued a dialogue with that part of herself for some time. Trying to clarify its positive intentions, the Other Part told her, “I help you to relax, and to feel comfort and love.” I suggested that Penny and her Other Part together search for alternatives to eating which would fulfill the positive intentions of relaxation, comfort and love. During Bach’s orchestral Partita, Penny and her Other Part came up with several alternatives. Penny should resume work on her crafts, garden and car. She and Other Part also reached an agreement to generate more alternatives as necessary, rather than to revert to out of control eating behavior. During Bach’s Little Fugue in G Minor, Penny, with the help of her Other Part, began to explore and try out these alternatives. She saw herself creating ceramics and waxing her car, and she felt herself sorting packages of flower seeds for planting. I asked her, “Are you satisfied with what you have done so far? Do you have any concerns about doing this in the future?” She answered: “My Other Part is not satisfied because there is no plan to keep other people away. That’s what binging does—it keeps people away.” Penny continued: “When I was waxing the car a new friend dropped by, and my Other Part did not want to talk to her.” I told Penny that she and her Other Part can make anything happen here, and that the music might be of help.”

She replied: “My Other Part and I are blended together, and we are telling my new friend that I need space to be by myself right now.” The Adagio movement of Brahms’ Violin Concerto began playing and Penny said, “I have just finished waxing the car and I am going off by myself on a walk.” Towards the end of the movement, Penny returned home and decided to call her new friend on the telephone. She thanked the friend for understanding, and she told her that she was learning to say no, and that she would be asking for help too, because she had difficulty being close. Her new friend said that she had the same kinds of difficulties. During the Largo of Bach’s Double Violin Concerto, Penny repeated the process of choosing more appropriate alternative behavior. The Talking Loaf of Bread How many times in your life have you spent an hour and a half talking with a loaf of bread? Probably never! And you would probably balk at spending the price of a therapy session to do it. Clients often joke about spending money to listen to music, beat pillows, talk to chairs, fight with dragons, or confront whatever arises in their imaginations. And their jokes always end with their talking about how it was actually useful to do so. Hornyak and Baker (1989) stress engaging eating disordered clients on an experiential level, because the disorders have cognitive, somatic, and body image components. Persons suffering with them are cut off from their internal experience. Experiential techniques facilitate body responses, affect and cognition in a process which claims and integrates their inner world. A pivotal session for Penny’s eating disorder is one where she literally spent most of the session expressing her feelings to and making an agreement with a loaf of bread. The programmed tape I used for this session is entitled “Positive Affect” (Bonny, 1978b). It is characterized by music with very similar tempos and provides the listener with both orchestral and choral support. During Elgar’s Enigma Variation #8, Penny sets the stage for the session by setting an imagined table before her with white bread, salt, crackers, doughnuts, orange soda, alcohol and milk. She acknowledges that food is her friend, and after the full chords and expanding crescendos of the Variation #9, Penny chooses her most important friend—the white bread. During the tender and tranquil vespers from Mozart’s Laudate Dominum, Penny talks lovingly to the bread in soft tones: “You are so soft...always there when I need you... so nice to touch... You taste so good... and, no matter how much of you I eat, I can always eat more... You make me feel so good...and can even put me to sleep.” She picks up the bread lovingly, and as the soprano voice is heard, the bread speaks to Penny in very gentle tones: “I know why it is hard for you to give me up... I am here for you always... You have trouble breathing when you think about giving me up.” At this point, I say “That feeling is grief... loss... You might let yourself experience it here...now... The music will help...I am with you.” Barber’s Adagio for Strings begins, and Penny says to the bread: “You make up for not having friends.” As the sustained melodic line of the music builds evenly to its second peak, a full emotional response is evoked, and Penny calls out, “It never hurt as bad then [when little] as it does now... This is so hard... Without you [bread] to keep my hurt down.” I ask her: “Penny,

right now, how are you feeling?” While the music repeats its crescendoes and diminuendos, high and deep, with waves of tension and release, Penny, with tears streaming down her cheeks says, “I hurt... and I have to cut back even more... This is so hard.” I sympathize with and console her about her pain. Then I remind her that her food plan includes bread, and that she might think about what she can eat. She then says to the bread,” I must substitute you for whole wheat... and I don’t like it... It makes me mad...and it hurts... But I want friends, and stuffing myself with food prevents me from having friends... So I am going to have to feel the hurt when it happens instead of stuffing it.” As the music resolves, Penny says “good-bye” to the loaf of bread, and sighs deeply. The Offertory from Gounod’s St. Cecilia’s Mass has a stabilizing effect on Penny, and her focus shifts from food to friendship. “There are people in my life I can trust, and open my heart to,” she says. Then as the emotionally moving Sanctus begins, the orchestra, soloists and choirs identify themselves, and Penny begins to name her new friends: Paula, Joan, Betty—and me, her therapist. The programmed tape concludes with the powerfully majestic Death and Transfiguration by Strauss, and Penny returns to a stabilized and restful state of mind. The Dead Tree Penny took a very big step into recovery when she stopped drinking alcohol and abusing medications. When she began her food plan, the depression she had been masking with substances became evident. It came and went in cycles, and she struggled with it on her own, with the support of weekly GIM sessions, group psychotherapy, and 12-step recovery meetings. After four months, Penny went into two very deep depressions which she tried to “eat her way out of.” Despite working very hard in therapy, she could not control the depression. We discussed medication. She was afraid of abusing it. I brought up the possibility that appropriate antidepressants could allow her to engage in fuller recovery, and although medication would not do the work for her, it might help her to do it. She did not have to abuse the medication, but could learn to take it appropriately, just as she had learned to follow a food plan. She went for the evaluation for antidepressants and began taking Prozac. The following session occurred about three weeks later. I used the programmed tape called “Death - Rebirth,” created by Bonny (1978b). I chose it because Penny was in another cycle of grieving, and I was looking for musical selections to help her to complete the cycle, and perhaps start anew with the medication. The tape can be used to assist individuals in going through with the feelings aroused by grief. Supported by the low, mournful tones and slow measured rhythms heard in Siegfied’s Funeral March from Wagner’s “Gotterdammerung,” Penny revisited the house she had lived in with her ex-husband. It was a part of her life that she had not completely let go of, and as she approached the house she found herself walking to the back yard. Then, while experiencing seventeen churning minutes of sad and pulsing, never resolving 5/4 meter, and the rising and falling, struggling motif in Rachmaninoff’s Isle of the Dead, Penny grappled with a dying tree which she found in the back yard. Her head hurt, her chest hurt. She sat with the tree, a very heavy tree. She struggled to prune away the dead wood. At times, when she wanted to give up, I would remind her: “I am with you, and I will stay with

you in this process,” and “The music will help carry you through whatever you need to do today.” Shuddering as the piece was coming to a close, she said: “I have to take some of the tree with me, and leave some of it behind.” I assured her, “You can take what you need... leave what you don’t, and be able to sort the difference.” Then she told me she was in a light, which she said, “feels like being in a bubble... It looks so soft...It feels so soft” as the piece finally ended. The Crucifixus from Bach’s “B Minor Mass” follows in a somewhat slower, more subdued and restful mood. She sat in the light with the pruned tree on one side of her and a stack of dead wood on the other. She asked me if she could “Stay here in the light” and I replied, “Yes.” Then she said, “Wherever else on earth I go, I am going to sit under my tree.” Der Abschied from Mahler’s “Song of the Earth” followed, and Penny started to sort through the dead wood. As the mood of the music changed, Penny said, “I don’t have to be here alone... I will bring my friends... Paula, Joan and Betty... and you.” And with the uplifted tones of the music, she became more uplifted and said: “I am not ugly... I am real pretty,” and pointing to her chest, she said, “Special, joyful.” Judge, Nasty, Tender, Child, and Shame As Penny put it, “Through my imagery work with music, I have been able to see how big and powerful my addictions had become... The work enabled me to separate the parts that make up my addictive nature... Once I could identify each part and [its] purpose or need, [it] became less powerful... Once the parts were revealed, no one of them alone was strong enough to activate my addictive process... [Now] the parts are currently working together to help with my recovery... each part through GIM has been able to surface... and to be respected and loved.” Penny’s alienation from the world was a direct reflection of a deep internal alienation from herself. It took about three months of work to clarify this process, and in that time, Penny became aware of and learned to appreciate some of the fragmented parts of her ego which had been working at cross purposes. This process allowed her to relate in a caring manner both toward herself and toward the fragmented parts of her ego structure which were created by early neglect and trauma. The various parts known as “Judge,” “Nasty,” “Tender,” “Child” and “Shame” had been functioning in opposition to one another. The ego state work involved meeting them, finding out their trauma, consoling and respecting their presence, and then eliciting their aid in caring for Penny (Watkins & Watkins, 1990). She now understands them as the parts of her addictive process. When she begins to relapse into food, Penny rebounds quickly by using GIM to work with these parts of herself. “Judge” was the angry part of Penny who turned out to be essential to Penny’s intelligent functioning in the world. After she introduced herself and told her story, her judgementalness became less negative, allowing a positive critical intelligence to emerge. This critical intelligence has been exceedingly helpful to Penny when one of her parts was about to get her into trouble. “Nasty” was the three-year old Penny who had been held down and smothered to sleep by her mother because she would not stay in bed at night. Nasty’s healing was from asthma,

and she was rather easily healed with warmth and a tender listening ear. Penny no longer needs to takes asthma medicine. Sometimes Nasty’s job is to slow the therapy down to protect Penny from changing too fast. “Tender” is the one who eats. She was always present as the target of mother’s frustrations, and as a result developed multiple somatic problems and drug abuse. Tender used to be sick all the time. Now instead of taking drugs, she takes an antidepressant medication and bubble baths. When Penny is doing well, Tender often gets scared and begins to look for problems. The other parts have learned to console, cradle and nurture her. This is helping to transform her fear into the strength and courage to continue recovery. “Child” thinks she is ugly as a girl and should have been a boy. She hated to wear tops on her bathing suits because then everyone knew she was a girl. Her daddy wanted a boy. She disappointed him. She spent this past summer being proud to wear bathing suits, thanks to Judge, Tender and Nasty. And she is getting better since she has learned to talk about her feelings. “Shame” has been the last part to emerge, and is both boy and girl. It usually needs lots of encouragement to talk when something is on his/her mind. It remains confused about sexual preference right now, and needs some clarification. Its breathing is usually rapid and jerky. Shame has a lot of anxiety and suspects that a lot of pretending is going on about being healthy. I often assure Shame that relapses do occur, and the point is to rebound from them quickly. I also assure Shame that a large part of getting better is acting “as if” things are better. Shame says it was easier when things were “black and white,” and that all this “gray” is confusing. Discussion and Conclusions Persons who are dually diagnosed are among the most difficult to treat; their dual problems make them more defended and less amenable to conventional treatment approaches. With Penny, conventional psychotherapy only took us so far into her psychology and her recovery. We did not touch the deeper stronghold that the addictive process had on her until we began the GIM work. It was only then that she began working directly with her food addiction and the overwhelming alienation she was experiencing from the world and from herself. It was with GIM that she directly confronted her feelings about early childhood rejection, deprivation and abuse. It was with GIM that she worked through ridicule by her peers and her husband. And only now, by virtue of having done this work and having been in recovery, has she been able to make friends with people who value her as an individual and with them develop relationships which meet her needs. I think conventional psychotherapy probably would have viewed her as damaged, and the results might have been to expect less of her in therapy. Conventional therapies work rationally in an ordinary state of consciousness, and in a rational, ordinary state, she probably would have searched in panic and confusion for solutions to her overwhelming pain; in a creative state, the unconscious seems to bring solutions out of nowhere. Creative approaches call on fuller potentials than conscious process. With Penny, the conscious world of words is joined with the unconscious world of imagery, and in the interaction, I believe that she is able to simultaneously explore regions closed to one and open to the other. Music, as the medium,

carries her through the process. It takes unnecessary pressure off both Penny and me, and places responsibility on the creative process itself. Therapy within a single modality (like words alone) can be limiting. It would be far more difficult to generate alternative behaviors from an addict, to talk with a loaf of bread about selecting a more appropriate diet, to sort learnings of the past from what needs to be grieved by pruning a dying tree, or to separate and converse with fragmented parts of an addictive nature. Interplay between several modalities like words, imagery and music, which involve the creative process, opens psychotherapy to a broader experience of human potential and healing. Glossary Dual diagnosis: A substance abuse/dependency disorder, and a co-existing psychiatric disorder requiring simultaneous treatment. 12-step Program: Guidelines for recovering from alcoholism developed by the founders of Alcoholics Anonymous (AA). References Alcoholics Anonymous. (1981). Twelve Steps, Twelve Traditions. New York: World Services. Bonny, H. (1978a). Facilitating Guided Imagery and Music Sessions: Monograh #1. Salina, KS: Bonny Foundation. Bonny, H. (1978b). The Role of Taped Music Programs in the GIM Process: Monograh #2. Salina, KS: Bonny Foundation. Bonny, H. (1980). G.I.M. Therapy: Past. Present and Future Implications: Monograh #3. Salina, KS: Bonny Foundation. Bonny, H. (1986). Music and healing. Music Therapy: Journal of the American Association for Music Therapy. 6A (1), 3-12. Cameron-Bandler, L. (1985). Solutions. San Rafael, CA: Future Pace. Cameron-Bandler, L., & Lebeau, M. (1986). The Emotional Hostage. San Rafael, CA: Future Pace. Clark, M. F., & Keiser, L. H. (1989). Teaching Guided Imagery and Music: An Experiential-didactic Approach. Garrett Park, MD: Archedigm Publications. Evans, K., & Sullivan J. M. (1990). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser. New York: Guilford Press. Grof, S. (1985). Beyond the Brain: Birth, Death, and Transcendence in Psychotherapy. New York: State University of New York Press. Hornyak, L. M., & Baker, E. K. (1989). Experiential Therapies for Eating Disorders. New York: Guilford Press. Leuner, H. (1984). Guided Affective Imagery: Mental Imagery in Short-term Psychotherapy. New York: Thieme-Stratton. McDonald, R. (1986). Healing Parasitic Infection Through the Partnership of Guided Imagery and Music and Applied Kinesiology. Unpublished paper. Salina KS: Bonny Foundation.

Pribram, K. H. (1981). Languages of the Brain: Experimental Paradoxes and Principles in Neuropsychology. New York: Brandon House. Sessions, R. (1971). The Musical Experience of Composer. Performer and Listener. Princeton, NJ: Princeton University Press. Watkins, J., & Watkins, H. (1990) Ego state therapy. Workshop at the Second Annual Eastern Regional Conference on Multiple Personality and Dissociation. Mt. Vernon Hospital, June 21-25. Zuckerkandl, V. (1969). Sound and Symbol: Music and the External World. Princeton NJ: Princeton/Bollinger Paperbacks.

Taken from: Bruscia, K. (Ed.) (1991) Case Studies in Music Therapy. Gilsum NH: Barcelona Publishers.

CASE THIRTEEN Guided Imagery and Music (GIM): Healing the Wounded Healer Rhonda Lineburg Rinker Abstract A series of twelve GIM sessions was used to help a woman therapist heal emotional wounds of the past, and to bring resolution and closure to physical and emotional abuse that she had experienced. The safe, supported environment enabled her to work through and let go of the long standing pain from these experiences, and to emerge as a strong, self-assured individual capable of acknowledging herself as a worthwhile person. Introduction “There is an inner urge in our own minds to grow, to expand, to break down the barriers of previous limitations and to ever widen our experience” (Holmes, 1990, p. 20). It is this “inner urge” that draws a person to Guided Imagery and Music (GIM). I became involved with GIM in an effort to take care of the “me” who spent much of my time taking care of other people. Realizing the benefits of my own GIM experiences, I began offering workshops at the psychiatric facility in which I am employed, using guided imagery, relaxation, and imagery with music. The workshops were aimed at providing other mental health professional opportunities to take the time needed to take care of themselves. Several of these professionals wanted to continue work with GIM on an individual basis. Lauren, the subject of this case study, was one of them. Background Information Lauren is a woman in her mid-forties, with a master’s degree in a mental health field. She was involved in clinical work when she chose to pursue GIM as part of her personal process work. Many mental health professionals have had experiences in their own lives that put them in the category of “wounded healer”. Such was the case of Lauren. She had grown up in an emotionally distant family. She did not recall a childhood with much warmth. There was little affection displayed by her parents to each other or to her and her brother. She reported that her current relationships with parents and brother were not close, and that she was very comfortable with that. She is a divorced mother of four, with three children living at home. Her first marriage was at a reasonably young age and ended after four years. She separated from her husband prior to learning of her first pregnancy. Her son was approximately three years old when she

married her second husband. He chose to adopt her son and this marriage lasted for over 12 years. In this marriage, Lauren lived a reasonably affluent lifestyle with several opportunities for travel abroad. During her first pregnancy in this marriage, Lauren was physically and emotionally abused by her husband. She reported that her husband was not particularly interested in sexual intimacy except during her pregnancies. After a time, his interest then became somewhat abnormal and abusive. After the children were born, he began physically abusing her—pushing her around while she held the babies, shoving her and hitting her. During the last year of this marriage, Lauren was hospitalized for five weeks for severe depression. She participated in individual therapy with a psychiatrist, and was treated with antidepressants. While in therapy, she was able to see the destructive situation in which she lived. Her self-esteem and self-confidence were seriously damaged. As part of treatment, she was discharged back to the same home situation. She reported drinking, for a time, as a way to avoid confronting the horrors of her marriage. She worked with a social worker and participated in group therapy. Eight months later, she made the decision to take her children and to leave her abusive marriage to begin a new life. Life was not easy following her divorce. Her former husband provided minimal financial support. She put herself through graduate school while working part-time jobs and raising her children. She received no emotional or financial support from her parents. Her oldest son chose to live with her parents. Her remaining three children provided her the support and encouragement to complete graduate school. At the time she came to pursue GIM, she was actively engaged as a clinician. She presented as a healthy, happy, articulate woman. She is very well read in psychology, social theory, counseling methods, and all areas related to mental health. She is also very interested in “holistic” approaches and was drawn to GIM for that reason. Although Lauren’s previous therapy had begun the process of inner exploration, and her career as a mental health clinician had introduced her to the benefits of personal relaxation and meditation exercises, she was aware that she still had emotional issues that were unresolved. For this reason, she decided to pursue GIM. Treatment Process Lauren participated in 12 GIM sessions over a period of four months. Each session lasted from ninety minutes to two hours, and followed the same format. This included: a preliminary discussion, a relaxation induction, an imagery focus, imaging to music while dialoguing with the guide, a return to waking state, discussion and closure. As the guide, I had been trained in the Bonny Method of Guided Imagery and Music (1978), and I used the taped programs specially designed for GIM therapy. In the first session, Lauren began to reveal some of the experiences encountered in her abusive marriage. She described them in various ways: being cornered and scared, needing to get away and make a change, and not wanting to go back. She experienced sadness, anger, and fear very quietly, both in her body and in her words. Her imagery ended in a sandy, hot place where dust got in her throat and she was “not supposed to talk.” She had apparently reached a point where her psyche realized the amount of material coming up.

During the verbal processing of these images, she noted the vast changes that had taken place in her life over the years. She was acutely aware of how deeply GIM had “probed” into her inner process and how relevant the images were to her life. In this and the next few sessions, Lauren had an awareness of another person being there with her who did not reveal him/herself to her. She did not experience this person as frightening in any way, but rather as someone who was watching over her. In the third session Lauren revealed her sense of how others frequently did not understand her, her different way of looking at things, and “where she was coming from.” In fact, she was probably more enlightened and “in touch” with herself than most people she encountered. Apparently, her openness and honesty were very difficult for some people to accept. Lauren had experienced more pain than most people, and she had used it as an opportunity to grow, rather than as a weapon to hate and distrust others. The next few sessions showed an emerging awareness of her growing self-confidence, and especially in the GIM process. She stretched freely in the sun and encouraged others to do the same; she felt like she could do anything or go anywhere she wanted. She began to shed external barriers, and to dig deeper into inner places, trusting the music to support her. Her body began resonating with her experiences, as she touched stone walls and felt their textures and as she described warmth spreading through her body or tingling in her limbs. Colors frequently appeared in her imagery: in flowers, in the colors of flowing robes, in bubbles and in rainbows. Several colors appeared in many sessions, pink, purple, turquoise and a royal “gold.” These colors were important as they frequently brought her healing experiences. The fourth session brought deeper work. I used a face and head massage in the relaxation induction, while focusing Lauren on moving her breath throughout her body. This physical contact during the induction, from my experience, helps to connect the guide more closely with the subject and thereby facilitates deeper work to occur. I used a “Book of Life” as her beginning focus, and asked her to begin to look through the pages of her life as the music began. The music for this session was the taped program entitled, “Mostly Bach.” She immediately began describing her childhood home. It was “filled with all that I hate and love”. It was “split like I felt split.” Speaking of her parents, Lauren said: “they always made me do what I didn’t want to do, and never acknowledged me for what I could do.” As she recalled being a very small girl and being made to sing, “O Holy Night,” she broke into tears. She talked about her grandmother as being the only person who really loved her and cared for her. I asked if she would like for her grandmother to hold her now. She did. I held her as her grandmother had many years before. While being held, she began to let go of some of her childhood: how her mother hated her for being unable to tell her that she was a good mother; how her mother resented Lauren’s relationship with her grandmother, because it was the kind she should have had with her mother, but could not; how her mother disliked that she was a “pretty little girl with long blonde curls” and cut her hair off in an uneven, haphazard way. Lauren described her mother’s house today as being cold, and “all clean waiting to die.” She was glad not to live there anymore. As she continued to cry, she had an image of herself having “golden tears surrounded by a rainbow of blues and purples.” The tears were falling on her cheeks while the wind blew through her and took away all the “yuck.” I began the following dialogue: “Are the tears cleaning out the dark places?”

“Yes, the sun is trying to come out.” “Do you want it to come out?” “I’m not sure.” “You can stay in the dark or be in the sunlight. The choice is yours.” After a silence, a beautiful smile came over her face as she told me that she was lying in the sunlight thinking about all that she had done that was good. After the healing images, Lauren had an awareness that the person who had been with her in the previous sessions was no longer there and she did not know why. I asked if the person knew that she had to do this on her own. She replied: “Yes... I had to do it myself. And I did...without falling either.... and no one laughed. It’s a special gift I have.” I added: “So the gift was in you all along.” This was a very moving session for Lauren because it allowed her to deal with her childhood and the pain associated with it. In our discussion afterwards, Lauren speculated that her grandmother had been the person who had been with her in the earlier sessions. She also had a sense that her grandmother continued to watch over her. Most of the fifth session was spent healing herself in “medicine waters” and beautiful colors. However, near the end, she felt anger rising up “like a volcano inside me.” I was prepared to shift tapes to use music that would support the release of this anger, but Lauren chose to do it in a quiet, focused way: “It’s spitting mess everywhere all over my mother’s house.” She then took herself to a place of beauty where she could take care of herself. She used images from other session, such as healing water, bubbles of colors and so forth. Following this session, we discussed her anger and her unwillingness to express it through stronger affect or behavior. Lauren stated that her mother had yelled at her so much as a child that she has no tolerance for loud noises, and especially yelling. In fact, Lauren would cover her ears in a session whenever sounds in her images became too loud or unpleasant. She chose to work with her anger in quiet ways throughout her GIM work. According to Bonny (1978), “important breakthroughs seem to appear most frequently at the 5th, 8th and 10th sessions” (p.15). As will become evident, this held true for Lauren. Session 5 brought realization of all the pain that she had endured during a childhood in which she was never loved, acknowledged or appreciated for the person that she was. This theme continued in the next two sessions. She returned to her childhood home, and spoke of a doll that had been taken away by “somebody big.” She could not understand why her mother did not love her, and why she would say that Lauren “wasn’t the right kind of little girl,” and humiliate her in front of others. No wonder Lauren, the child, felt that she was a bad person. It was years later, and as an adult, that Lauren came to see her mother as the bad person. Her father had made no attempts to change any of this. Her parents did not have a loving relationship with each other, then or now. When the death of her parents came up, she expressed sadness but no grief, describing them as “alive but already dead.” She allowed herself to do some healing with colors and water. Throughout this process, Lauren reported feeling physical changes. She began to lose weight after being overweight for some time. Her children began to tell her there was something “different” about her. They were not able to determine what was causing this change, but they felt that it was good. Randall McClellan (1988) pointed out that: “Changes take

place within our physical bodies as a result of being exposed to both sound and music; these changes may take place whether we are consciously aware of them or not. Significantly, it may not be necessary that we maintain consciousness for these changes to occur or even that we give permission for those changes to take place” (p. 137). In guiding GIM sessions, one becomes very aware of the physical changes that are reported as part of the process: feelings of hot and cold, limbs trembling, body parts becoming numb, sweating, shaking, etc. The processing of the GIM experience does not stop at the end of the session but continues for some time after. These physical changes as part of this process may also continue for some time, consciously or unconsciously. The eighth session was difficult for Lauren. It dealt with the failure of her marriage. I used a light/energy source moving through her body for the relaxation induction, and then focused her on allowing the light from her unconscious mind to come into her conscious mind with the music. The music for this session was the tape entitled “Grieving.” Lauren began this journey at a church in France that she had visited with her former husband. She expressed a sense of sadness and loss: “I feel as though I have lost something, and don’t know how to find it....like a series of people... or some kind of relationship... or sad pattern.” I asked her where she felt the sadness, and she placed her hand over her chest/heart area. I followed with, “How does it feel to touch that sadness?” Lauren responded, “Warm... not as bad when you touch it... It feels really lonely... as if nobody else is alive... Wouldn’t that be scary?... That’s how I have felt all my life.” Her parents had been physically there, but they were never there in a nurturing, emotionally supportive fashion. She did not have a close relationship with her brother. She had experienced two marriages that had failed. With the exception of her children, Lauren really felt unloved. She felt separate from other people, and did not let herself get very close to too many people for fear of being hurt again. As the music progressed, Lauren contrasted two churches she had visited on that trip. The church in France recalled the sadness and stormy things that happened in her married life. Here she realized: “I’m there with the ‘goon’ who didn’t love me.” Her body felt heavy and angry, but not her head. I encouraged her to let go of the anger that she had been holding in her body for so long. Then an image came of herself as a little kid plucking out her mother’s eyes with her fingernails, ripping off her hair. She spoke of how shocked her parents looked, but then said: “They don’t even look real... They’re sort of like dummies that have learned how to talk.” In reality, their relationship with Lauren had been very artificial, and they had been more like mannequins than real parents. Memories of her honeymoon then came with the music, and she lamented that “it could have been so perfect... I could have overlooked a lot if with the right person.” Lauren described her marriage as “dreadful.” Her husband blamed her for everything, just as her parents had always done. She became acutely aware of the hate she felt for her parents and her former husband, and then saw the lesson to be learned: “You don’t have to punish yourself by trying to love people incapable of loving you!” She was loved by her children and no longer needed to punish or blame herself because others she had wanted to love had not been able to give that love to her. The next session was healing and fulfilling for her. She allowed herself to be playful, to enjoy, and to re-experience her healing colors. She explored being out of her body after it had been “weighted down with rocks,” and incapable of doing everything she wanted it to do,” and

she realized that she did not need it all of the time. She was more aware of the music and colors as they moved through her. Other people began floating with her but they were not discernible figures. The colors kept opening up over and over again, and she reported: “ Each time I get more beautiful... Everybody sees it... and smiles... as if they’re saying ‘Yes, we’re beautiful too’.” With each session, she had begun to open herself more, and in doing so, she was better able to see the beauty within herself. She had begun to acknowledge herself, and to permit others to do the same. Even when she had playful images, there was a real sense that Lauren was finally in touch with the essence of who she was and that she could enjoy that person and allow it to grow and emerge. The tenth session provided Lauren the opportunity to “look” more closely at herself. There appeared an elderly, wise man who was looking at his own eye. He admonished her: “You can look anyway you want... and you are wise when you learn to look both ways.” Lauren responded that she did know how. The man replied: “You have to be very brave... You must do what you think you have to do—even if others think it strange... You cannot skip over things you have to do.” Lauren had to look bravely at things that she had to do in her life. She had to grow up in a family that could not love her as she needed to be loved. She had to experience two marriages that were not right for her. She suffered terrible pain, physically and emotionally, in the second marriage prior to the realization that “she” was not doing anything wrong. And, she had to allow her parents to “die” in her imagery to permit the pain of her childhood to leave her. In the last part of this session, the image returned of a volcano of anger raging inside her, and she realized that: “I have to stop being angry with myself for things other people do... I have to let it all go... It’s floating away from my body... like really ugly black clouds.” With this, she allowed herself to let go of all the anger, the disappointment and the sadness with the people in her life who had hurt her. In the eleventh session, Lauren re-experienced images from earlier sessions, but this time as a strong, assertive person, capable of doing or accomplishing anything she wanted. She used the session to further strengthen and empower the person she had become. The image of herself as a little girl returned, and she allowed herself to nurture the little Lauren and teach her all the many things she knew. And at the end, she permitted herself to give something to that child part of herself that missed out on so many things while growing up. The twelfth session was our final session. This decision came several days after the session had taken place. In this session, I used an induction image of a rainbow, with a color from it coming into her to relax her. At the end of the rainbow was a pool of healing waters. Lauren was cued to go into the pool, to enjoy its waters and to allow the music to share this experience with her. The music for this session was the tape entitled “Quiet Music.” She immersed herself in the pool and allowed the waters to float through her body. It felt good and safe. She played with creatures that came from the nearby woods, and was surprised that they wanted to do what she wanted to do. The people in her life had never been able to do that. They had always told her what she had to do. She permitted snakes to go across the top of the water. They told her they were there to help her and not to scare her. There was a small stone

hut at the edge of the pool as she came out of the water. This was a safe place. The sun was touching her all over and the animals all went to sleep. In discussing this session, she talked about how she was not allowing herself to take things at surface value any more. Lauren appeared to reintegrate more slowly at the end of this session. Her body continued to feel a little strange, even after she had become fully alert and was moving around in the room. We spoke a few days later and she reported still feeling a little strange and decided to stop sessions for awhile. Her body responded very acutely to the GIM process. It was telling her that it had reached a place of closure, that it needed time to integrate all that had transpired over the four months. She had re-experienced all the pain she suffered as a child. She had reexperienced the emotional and physical abuse that was part of her childhood and her marriage. She experienced, again, the overwhelming sadness of never having felt truly loved throughout her life. All of this had transpired very quickly over a brief period of time. Many people are unable to work with that much material in years of therapy. Her body and psyche had worked with all that it could. She felt very positive about her work with GIM. She related it to her individual therapy in saying that therapy had helped her to intellectually resolve these issues for herself. GIM had allowed her to touch the pain associated with these issues and to let go of it. In allowing herself to let go of the pain, she could go forward with her life with confidence and a growing appreciation for herself. Discussion Lauren was an excellent subject for GIM. She was aware of issues in her life that traditional therapy had not adequately resolved. She was verbal, articulate and motivated to work. She had a healthy ego despite all of the emotional damage suffered during her life. She lacked some confidence in herself but made gains in that area as our work progressed. In conversations, long after her sessions had been completed, she felt very strongly that the GIM process had been the only method that allowed her to work with the pain of her life experiences. She felt safe and supported with the music and with me, and we developed a strong personal relationship during her work. I believe that Lauren benefitted a great deal from GIM. In working with her, I have come to realize the need for the guide to determine the spacing of sessions. This process is a very powerful one, evoking many painful and pleasant associations that actively involve both body and psyche. Lauren had done twelve sessions over four months, and a great deal of highly emotional material came up. Time was now needed to allow her to process this material and integrate it into consciousness. Lauren talks about coming back to do more sessions. I believe that she has completed her work, for now, with GIM. I see her as being a much stronger person now. She permitted herself to “trust the process,” and in doing so, she made significant gains in her perceptions of herself. She has a healthier, more positive outlook on her life. As a personal way of helping Lauren to integrate her GIM experiences and bring some closure to our time together, I wrote the following poem and gave it to her at our last session: For Lauren

Melodies, moving mysteriously and evocatively Touching places that have long been forgotten, That may have been hurt and damaged, Damaged to the point that I see myself as damaged worthless; Reliving all the pain and anger - crying those same tears over and over again. With the tears came the healing and the “letting go” of those fearful places within me. Beautiful colors appeared - golden images that told of the Hidden beauty, Beauty long since forgotten or felt overshadowed by the hurt and the “damaged” me. All the while alive and still growing in me. There is a re-birth process - a new person emerging with beauty, confidence and love for itself There is a new rhythm in me, stirred by the varied rhythms of the melodies. I am a new song waiting to be played and To be enjoyed by many. From Rhonda References Bonny, H. (1978) Facilitating Guided Imagery and Music Sessions, GIM Monograph #1. Salina, KS: Bonny Foundation. Holmes, E. (1990). The Eternal Path of Progress. Science of the Mind, 63 (10), 16-21. McClellan, R. (1988). The Healing Forces of Music. New York: Amity House.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE FOURTEEN Out of the Ashes: Transforming Despair into Hope with Music and Imagery Cecilia Herzfeld Schulberg Introduction I am a music psychotherapist, but here I write of my own experiences with music therapy as the child of Holocaust survivors. These experiences are transcribed from sessions that began during my training in the use of Guided Imagery and Music (GIM). During the sessions, I was in a deep state of consciousness listening to specially selected classical music that helped me face and work through the powerful images of the Holocaust. I am deeply indebted to the music therapists who helped me in this process. The Transforming The first time I was ever able to address this legacy was in a group GIM session. I was led into a relaxed state by the therapist who then put on a classical music program. The descending bass melody quickly pulled me into an experience I had feared my whole life. I smell the smoke and the stench of burning bodies. I hear the cries of the dying and the mournful sobbing of those who barely survived. I feel the heaviness and emptiness of death all around me. It is too real. And it seems like I am here for an eternity. A few remaining survivors are slowly, hypnotically making their way into a burned, desecrated synagogue. I find myself among them, also in a trance. The chanting, moaning of the familiar liturgy grows louder as the walking dead fill the remains of this holy place. I am surrounded by these rocking, half-dead bodies, their heads covered with prayer shawls, and I become one of them. My voice rises with theirs, crying, screaming, mourning. The sounds are filling a deep dark hole inside me. As the music ends, I felt my spirit rising from this place into my own shell of a body. I drew a mandala (a circular drawing) to capture this experience, and my body became filled with me — my heart, my life, my spirit — and I was born. I was no longer that 15-year-old who survived Auschwitz: she was my mother. It was in that music and imagery session that I was first able to look at how the Holocaust affected me directly as a child of Holocaust survivors. I experienced it with my whole being, from bodily sensations to psychic numbing. It was the ultimate death-rebirth experience: I was no longer my mother, a Holocaust survivor; I was reborn as me. The experience is as alive in me today as it was then, years ago. As a result of that session, I realized at a much deeper level how much I lived my life for and as my mother. I came in touch with loss, despair, and grief so overwhelming that I created powerful barriers of protection from the pain within

myself and in the world. That GIM session was the beginning of breaking through those barriers, the beginning of my life. My reconnection with music as a powerful source of life, healing, and spirituality enabled me for the first time to face, experience, and release some of the tremendous loss and grief I have felt since I was a child. This occurred in recurring death-rebirth GIM experiences. Although this first session highlighted the entanglement with my mother, following sessions intensified my lack of connection with her mother, after whom I am named; she was gassed at Auschwitz. The image of my grandmother during my GIM sessions embodied for me all the losses incurred during the war. These losses showed up in various images of death in my GIM sessions: being in a grave and not being able to get out; being dead for a whole session; being in a death march to the crematoriums and not being able to do anything to stop it; being surrounded by dead bodies, half-dead bodies, and mass graves without markers. I experienced death in my body as nothingness, heaviness, coldness, or emptiness in a shell. It was not the actual death that was so painful; it was the inhumanity. The image of my grandmother in my GIM sessions also provided me with the safety and protection I never felt in the world growing up, enabling me to work through and heal these traumas. In my GIM sessions, I experienced her comforting me as a child, rocking me in her lap. I felt safe in her arms while sirens were blaring and bombs were exploding outside her home. I have felt her presence with me throughout my life; but with the music, she helped to fill the endless void I had with the loss of her and everyone else. With the music and my GIM training community, I was developing resources for facing this “shadow.” Whether in individual or group sessions, I knew I was supported and I no longer felt alone. My first powerful encounter with my “Holocaust shadow” began in an individual session, with the music pulling me inward and upward this time. The image of a smokestack is emerging in my groin, and the music is drawing it up inside of me. I feel the music wrenching everything out of me — my essence, my soul— ripping me open. I feel a cord of light from the heavens latch onto me and lift me upward. I feel I am going to burst as the swells in the music are squeezing everything out of me from many lifetimes — it’s overwhelming! The violin plays on the strings of my heart from many lifetimes, everything of human experience — the joys, the sorrows, everything — it’s so wonderful it hurts, but it’s okay to feel that. The light now takes the shape of the smokestack and is so blindingly bright and powerful that I can no longer see the smokestack. The light is going through me and around me. When everything is squeezed out of me, all the heaviness, aches, and pains are gone. I become light and float up with the music. The violins are not gripping anymore. They are sweet. I am a transparent bubble, totally alone, but I do not feel alone. I am connected to the souls of the family I had lost, as we are all part of the light. However, I am starting to have feelings in my body again and float back down to earth; it is not my time to be there yet. [The music changes.] I come down to fire. It is strange. I do not feel it but I know it is hot. I can feel its heaviness and hear its deafening roar. The fire is in the belly of the smokestack, the furnace. There is no enclosure; the furnace is immense and open. It seems like I am in Hell. I have to work hard to keep myself out of the fire, to reach back up into the light. I reach beyond the flames up to the level of gas. But I can feel fingers of fire — misery, pain, sorrow — pulling me down. I have to fight hard not to let them keep me there. I become filled with despair,

feeling, “Why should I bother if I am going to lose anyway?” I am consumed by the flames and become crispy black embers. The fire wipes out everything without a trace. It pounds its chest in glory, boasting: “How dare you stand up against me? No matter how far you go (into the light), I’ll get you!” I respect its words, but I cannot let it get me. With the help of the music, I return to the light with a hole in my chest to remind me of what was lost. Death felt cold, but the light and the music fill (the hole in) my heart with warmth and life. The strings play in my body. I am back on earth with the light, without the consuming fire. The smokestack and light transformed into a powerful symbol of integration that I saw again later that year as the Jewish sanctuary in Dachau; I had never seen this structure before this GIM session. The actual integration of this shadow occurred during a group GIM experience a few weeks later. At this advanced training, we were learning how to facilitate the mind and body working together with the music. As the client, I focused on the chronic pain in my left shoulder, where stress tends to accumulate in my body. It is becoming a gray rock, which is there to store emotions. The rock spreads around my shoulders and over my head into a concrete prayer shawl to grieve, to say Kaddish (a Judaic prayer that is recited for the dead yet speaks of life). It continues to spread down over the rest of my body into a statue, as a memorial to those who were murdered in the Holocaust. And then, I become a smokestack. I can feel the flames coming up from my feet, roaring inside of me. I am horrified: I am killing all those people! It is the most painful experience. I am hysterical. All of a sudden, the smokestack and the fire are gone and there is nothing left but ashes. The pain in my shoulder is gone, too. The ashes are in a hole in my solar plexus, and I am Mother Earth. There is a new pain with this hole. It feels like a void in the universe, an emptiness; nothing is left. But then it becomes filled with dirt, which become people. I am Mother Earth and the people are my children, floating up into the light. I feel a seed planted in my pelvis, and a very powerful tree with one leaf grows out of it. The pain is gone. Out of the Ashes A flame ignited in the bowels of my groin, Fuelled with the energy and sounds of music, Spread out through my limbs, Sprouted into the wings of a white Phoenix That rose out of the ashes, ever upwards, As the music connected my many multicolored Threads around the world, Transformed into an angel, entering the heavens, Connecting with souls and the light, Tears flowing from the container of my soul. In subsequent GIM therapy, I continued to have death-rebirth experiences as I continued to mourn the losses and to let go of the damaging constructions I erected throughout my life to deal with the pain. The most significant construction, or barrier, was that of control. The myth was that (unlike those who were enslaved or murdered by the Nazis) I

could have control over my life. Unlike my parents, relatives, and family friends of that generation, I had the opportunity for education, freedom of choice, happiness, and life as I chose, so I was determined to make the most of these opportunities. I became a therapist, a social activist, and created a new family. But I also tried to control all the things I did not have control over (such as bad things happening) in an attempt to make my world safer than what my parents experienced. The music had all the elements that allowed me to break through this strongly erected barrier of control and pseudosafety. The music provided the dynamics that evoked the experiences, a structure that provided the safety to have the experiences, a container expansive enough to hold all the experiences, and the integration of all of these that supported healing and transformation. The music allowed me to experience the despair and still have hope about the outcome.

Taken from: Meadows, A. (Ed.) (2011). Developments in Music Therapy Practice: Case Study Perspectives. Gilsum NH: Barcelona Publishers.

CASE FIFTEEN Music Therapy and Depression: Uncovering Resources in Music and Imagery Lisa Summer Introduction This case study illustrates how I adapted the Bonny Method of Guided Imagery and Music (Bonny, 1978, 1980) to address my client Kyle’s depressive symptoms. Initially, GIM with its emphasis upon inner exploration and reconstruction exacerbated his symptoms. But through trial and error, I learned to rework the basic components of GIM. This reworking, over time, led to the discovery of the supportive and re-educative levels of practice in music and imagery. Each level of practice--supportive, re-educative and reconstructive--is concerned with transcending the emotional limitations that brought the client into therapy, yet each uses a different approach to this end. Supportive music and imagery uses positive inductions with simple, repetitive music with little harmonic tension. The re-educative approach uses symptomoriented inductions with repetitive music that matches the symptom with harmonic tension, but contains little structural development. In both levels of practice, the client is given a directed task during the music to hold him in a singular image. After the music, verbal processing techniques encourage the client’s in-depth relation to the image. Kyle’s sessions illustrate how the supportive approach circumvented his symptoms in order to connect him with positive resources lying dormant in his internal world. Subsequently, re-educative music and imagery brought Kyle new perspectives that enabled him to transcend his heavily ingrained and emotionally limiting symptoms. Foundational Concepts In the early 1970’s at the Maryland Psychiatric Research Center and the Institute for Consciousness and Music, Helen Bonny created specific procedures for an in-depth, humanistic music listening session and called it Guided Imagery and Music (GIM, also called the Bonny Method of GIM) (Bonny & Pahnke, 1972/2002; Bonny, 1995/2002). Bonny’s goal was a broadbased, free exploration of the unconscious. To achieve this, GIM utilized an altered state of consciousness and an exploratory, open-ended induction, paired with a 30-minute program of evocative classical music (Bonny, 1980/2002). Bonny created a series of 18 music programs, each with a different therapeutic contour (Bonny, 1978/2002). The musical selections used in the Bonny programs can be classified into three different categories (Summer, 2009). Supportive classical pieces, such as the Warlock Pieds en l’air from his Capriol Suite, have a simplistic use of all musical elements, a simple structure and little

tension. Within a GIM session these serve a restful, or re-fueling, function for the client. Reeducative classical pieces contain significant tension yet have a simple, straightforward and repetitive structure (often an ABA structure). These are evocative, “working” pieces, such as the Barber Adagio for Strings, whose function in the session is to match and hold a client’s tension. Reconstructive classical pieces are those “working” pieces that are characterized by significant development sections in which the musical material is extended significantly beyond its original exposition, and beyond a simply stated ABA format. These stimulative pieces function to “work through” and transform the client’s symptom. Each GIM program links these three types of music together into a unique intensity contour that consists of supportive, re-educative and reconstructive pieces. The GIM client experiences the music program in a completely individual and subjective way, but usually follows the contour of the program, refueling with positive resources during the supportive selections, exploring conflictual areas during the re-educative selections, and ultimately traveling to unknown territory with the reconstructive selections. Since GIM was primarily designed for use with well adults, the case study of Kyle illustrates how I made changes in my practice of GIM when I first encountered clients in a realworld practice. In essence, when working with a depressed client, I found the need to slow down and separate the GIM process into its three constituent parts: refueling, working, and transforming. Many sessions, especially at the beginning of a therapeutic process, consisted of only one of these aspects. My approach and terminology came to be basically aligned with Wheeler’s levels of music therapy practice (1983): supportive, re-educative, and reconstructive (taken from Wolberg, 1977), which actually represent a flexible continuum of clinical practice in music and imagery. All levels of this continuum have the same ultimate goal as derived from Bonny’s (2002) foundational goals for GIM: transcendence--transcendence of the external reality in which we are all immersed, with its practical limitations, in favor of the internal world which has no limitations but that of the individual’s imagination. The central assumption of the use of music and imagery is that the freedom we possess in our imagination transcends the limitations imposed upon us by external forces (parents, society, the expectations of peers and the like). The supportive level addresses the development of positive internal resources, the re-educative level directly addresses the client’s specific symptoms and the reconstructive level goes to the root of the resources and symptoms within the unconscious (Summer, 2002). The Setting The setting for this case study was within a private practice in the U.S. Virgin Islands. The practice consisted of a family physician, two verbal psychotherapists and me. Most of our clients were diagnosed with drug addiction, anxiety or mood disorders; about a third of the clients were on medication (they saw a psychiatrist to monitor their medication), and the majority were in recovery from alcohol or drug addiction. The verbal therapists took a psychodynamic approach and referred clients to me when they were “stuck” — having gained cognitive insights or symptom relief, yet without enough life change. When clients were referred to me for music and imagery, I consulted frequently with their verbal therapist, sometimes having co-therapy to integrate the music and verbal therapy. Kyle, one of my first

clients, illustrates the development of the music and imagery continuum of practice as it unfolded in my music psychotherapy practice. The Client Kyle, a physician, came to our first session in an expensive and stylish suit and tie, a starched white and monogrammed shirt. Referred to me by his primary therapist as depressed and obsessive-compulsive, he seemed so articulate, healthy, aware of himself and in control, so that even when he talked about being depressed and obsessive, I wondered whether he was simply confabulating. Despite that, he was working obsessively--at least ten hours a day, six days per week--and he could not rid himself of the feeling that his work was inadequate. Married, with two children, the 50-year-old professional was on medication for obsessivecompulsive disorder and major depression. He had been in verbal therapy for about two years. Verbal therapy and medication had improved many of his depressive symptoms, but his primary therapist had reached an impasse in her work with him to lessen his hours at work, to slow down his pace while he was at work and to deal with his feelings of inadequacy. Kyle spoke with celerity and perspicacity, changing topics faster than the island’s chameleons changed color. In an early session, I played for Kyle a Bonny program containing chatoyant impressionistic music with a great deal of musical tension, my goal being to match his demeanor. In a GIM session, when you can match a client’s in-the-moment state with music, they feel “understood” and “heard” on an emotional level. Having matched his state, the music stimulated an experience, as Kyle told me once the music concluded, exactly analogous to how he viewed his life. As Kyle listened, he reported fleeting and disturbing images: I see swirls, they are coming at me very quickly...now there are sketches, like black and white drawings of birds...it is very dark...Everything is coming and going so fast, I can hardly recognize anything; I am trying to slow things down, but they won’t listen to me...I am in a tomb--a grave, it is so dark and empty, I think I am in the tomb; I am trying to get out but I can’t. I tried several different pieces of music to see if the change in music would elicit a change in the nature or pace of his experience. No change in the music resulted in significant changes in his imagery. These unvarying images, Kyle told me, were akin to “symptoms” that afflicted him in his everyday life, a life he described as unconnected and distant. Nothing, he insisted, had real meaning to him, and he felt powerless to make any changes, as if he were simply an ineffectual observer of a life consisting of a series of mostly unpleasant events. Work, relationships, and events were all remote from him emotionally; and the prosperity, success and intellectual achievements that he had obtained were without meaning. Kyle worked obsessively to feel accomplished, bringing him fleeting positive thoughts, but kept himself emotionally distant from the fruits of his labor. Intellectually, he justified his disengagement as a necessity, paradoxically denying himself the joy of the rewards he worked so hard to accomplish. The momentary positive feelings generated by his accomplishments were destroyed by what was underneath, in the unconscious: an internalized (introjected) version of his mother (a depressed, needy perfectionist who was emotionally abusive to Kyle

and whose behavior was highly inconsistent in his childhood) and his father (who was highly critical, emotionally abusive, and paid little attention to Kyle). The internalized figures of his parents continued the abuse and criticism of his childhood and thus denied him any lasting feelings of self-worth. Instead, as revealed in his imagery, his inner world consisted of shells of defensiveness, nested in further shells of defensiveness. Feelings of sadness, helplessness, powerlessness, anger, despair, vulnerability--all the responses he had had as a child to his parent’s emotional abuse--were, by this time, chronically patterned in his unconscious. His imagery also uncovered the dark roots beneath his depressive defenses: a deep existential fear of death. When younger, he had periods of intense nightmares and night terrors that his parents had not addressed in any way. Using GIM had yielded, for Kyle, imagery that was fragmentary, fleeting and out of control, but I believed that this session would be helpful to him; that it would help him face his difficulties and bring him a new understanding of himself. Experiencing how out of control his life was, I thought, should bring him motivation to change--to work less, slow down, to become more engaged and thereby live life more fully. But when Kyle returned for his next session, it was clear that his condition had seriously worsened due to the GIM session. He reported to me that in the previous session he had realized how out of control his life was and that during the previous week, he had felt an increased sense of hopelessness about himself. Instead of relief and reinvigoration, he was despondent. He had become acutely aware of his wife and children’s complaints about his emotional distance from them, and yet he could not respond. He was pale, could not look me in the eye, seemed totally miserable, and his manner of speaking was more fragmented than in his previous session. Though most people have had some injurious parenting in their childhood, there are nearly always aspects of positive nurturance as well. When imagery is conflictual, one can expect some evidence of ego strength (positive resources, positive adaptations to tension and abuse), and even when such is not evident in a client’s imagery, there is likely to be evidence in the client’s positive response to the images. Kyle had no positive feelings whatsoever. If there was any ego strength, it was completely obscured by his unremitting depression. Though I did not expect to be able to remedy every client’s symptoms, it seemed here that I had actually made the situation worse. I wanted to rescue Kyle from himself, to give him some relief from his horrible and fragmented world, but I was at a loss as to how to proceed. The Therapeutic Process Supportive Music and Imagery It was clear to me that GIM would not help Kyle address and improve his symptoms. I had not yet worked with a client whose positive internal resources were so unavailable to him-even with the help of psychiatric medication. There had to be a positive experience upon which to rebuild his ego: a positive, innocent Kyle that existed prior to his abuse. But I did not know how far back in the past this true positive self remained, nor how deeply buried it was within his unconscious. As a beginning therapist, I was determined to help him find this positive kernel, but I did not have the technique or skills to locate it. I needed an approach to music and imagery that

was lighter, more structured and more directive than GIM. For several sessions I explored different approaches: relaxation techniques, music without imagery, imagery without music, though I was anxious myself about whether I was doing any good. At least, I thought, let me do no more harm. A breakthrough came in the eighth session. I asked Kyle to tell me if he had had even one positive, quiet moment by himself within the last few years. He had not, but he had had a vacation with his wife, and they had risen at dawn to see a sunrise, a thought which Kyle found pleasant. Nervous as I was to introduce drawing to a man dressed in an Armani suit, I suggested (in an induction prior to the first movement of the Dvorak String Serenade, Opus 22) that Kyle recall the memory of watching the sunrise, and that he draw the experience on the page in front of him. As the music started, I could see he was self-conscious about the idea of drawing a picture. After about a minute of hectic illustrating, Kyle relaxed. With the pace of his drawing slowed down, his arms began moving every once in a while with the rhythm of the music. Listening deeply, he allowed the beauty of the music to shape what he was drawing. I played the piece over and over again. Rolling up his starched, monogrammed white shirt Kyle proceeded to get it filthy with all the colors of the chalk he used — without any concern to his previously immaculate garb. He used pastel colors, putting them on the page and then using his hands to blend them together. When he had covered the entire page, and it seemed that he was finished, I stopped the music. After all the layering of pastels, his drawing appeared to be softly green, blue and purple inside the circle: with soft yellows and reds, respectively on the left and right side of the page outside the circle.

He was transformed, totally at ease and comfortable, the music and the drawing having created some kind of idyllic, positive experience. I did not really know how to verbally process what had just occurred, but, speaking slowly, I asked him to describe his experience. Kyle expressed that he had felt “focused,” “involved” and “creative” while he was drawing. He had tried, he confessed, to draw the sunrise in a literal way, but let go of that goal in favor of just expressing the feelings of the sunrise. He expressed gratitude that there were “no

interruptions,” unlike the interruptions that flooded his daily life (by which he meant his obsessive, depressive, fleeting thoughts). He was truly able to relax and enjoy the music. For the first time, Kyle had made contact with positive feelings in a session. He did so by initially recalling the memory of a sunrise as a visual image. Then, the music helped to focus him on the memory, and the simplicity and aesthetic beauty of the Dvorak Serenade held him in the image and called forth, into the present, the true and positive feelings contained within that image. The repetition of the movement (which I played four times) allowed the positive feelings that had emerged to gain strength. Kyle’s state of consciousness had totally transformed from the beginning of the session, when he entered feeling “pressured, left over from work,” to “content.” This change held throughout our discussion and continued until the end of the session. He titled his drawing “Contentment.”Kyle was pleased with the results of this session and came back to the next session with a positive attitude about the therapy. I continued to use the same format in all of Kyle’s supportive sessions: a positive induction tied to the task of drawing, with classical music. These sessions resulted in the following drawings: “Trying to blend chaos and pleasantness,” “Father and son dolphins, frolicking,” and “In touch.” Within two months of our work together, Kyle found that he was capable of establishing contact with positive resources (positive feelings) within himself. He described himself changing in his everyday life, finding focus, presence, openness, acceptance, hope, availability, relaxation, and contentment. In addition, he reported that he experienced--for the first time in his life that he ever remembered--really feeling what he knew were normal feelings of compassion for another person. This occurred at work when a client told him about her impending divorce, and for the first time, rather than offering the professional, artificial compassion that he employed only as a tool in his trade, he felt able to emotionally empathize with a patient. The supportive music and imagery sessions in which Kyle was in touch with positive feelings had crossed over into the real world and had already begun to take hold. He was developing a constant positive internal object, the beginnings of a healthy ego, previously absent due to his parents’ abusive and inconsistent nurturance. The repetition of internal visits to his positive core with classical music had taught his psyche about positive feelings, and was beginning to take root outside the session, even with people outside his immediate family. For the first time, he reported, he had been able to make a truly human connection with a patient, an amazing confession--coming as it did--from a physician. Over a period of approximately two months, the supportive music and imagery sessions allowed Kyle to discover a state of consciousness that was unattached to his usual psychological patterns. During the music, he was able to free himself from the omnipresent levels of defenses that otherwise plagued his every waking hour: the negative parental introjects, his depressive feelings and his existential fear of death. Kyle’s weekly “immersion” in a positive, healthy state with music began to free his psyche from psychologically debilitating defenses. Though these symptoms would always return, little by little Kyle generalized parts of this healthy state of consciousness into his daily life. The Process Deepens: Re-educative Music and Imagery

Although supportive music and imagery was changing the quality of Kyle’s daily life, it had not adequately or directly addressed his general anxiety or work-related problems. That required a deepening of his inner experiences that I have called re-educative music and imagery. In order to directly address Kyle’s symptoms, I kept the basic structure of using drawing with a piece of classical music. Yet I began to directly introduce his symptoms as an entrance point, an induction into the music, and I utilized evocative music that could match the tension of his identified symptom. Kyle’s therapy sessions were scheduled after work, and he arrived at sessions with a long list of complaints from the day. In one re-educative music and imagery session, Kyle initiated the session with his usual complaints about his day’s work. Although it was evident that he wanted to unburden himself with each successive complaint he stated, I asked him to close his eyes and rather than think about the frustration or talk about it, to allow himself to feel it. He described: “It’s a trapped feeling, a pressure, a tension in my chest. It wants to get out but I feel it’s trapped there.” As he described these internal sensations, I could better choose a piece of music to match his experience. I felt that the Passacaglia and Fugue in C by Bach, orchestrated by Stokowski, would match Kyle’s tension. With the suggestion that he let the music help him express his internal experience in drawing, Kyle began to draw a road on his page. With the music, he depicted a winding road, colored in black and dark blue with patches of mustard yellow. It wound around the page with several large curves in it. After the road was complete, he added, at different points outside the path, seven round figures. Each figure had a strong center and several small, bright fluorescent pink arms extended, touching the outside of the path. After the music had ended, we began to discuss the drawing, which he titled “No Exit.” Kyle described the feeling he had as one akin to being trapped on the road. “It meanders, it goes no place; it has nothing to offer.” As he described the drawing, the feelings became stronger. We went back and forth, referring to his feeling, referring to the image. He identified the feeling as frustration. Furthermore, he explained that the seven figures were people in his office who were ready to help him. However, he felt these figures--not as potential helpers, but rather--as a burden. They only served to cement his frustration with feelings of inadequacy. I continued to work with the image and his feelings until I saw that he had more fully accepted the two feelings: frustration and inadequacy. After this, Kyle’s perspective about the seven figures shifted. His expressions of inadequacy were replaced with a new feeling of desire to ask a secretary in his office for help. This is the hallmark of re-educative music and imagery. The therapist brings matching pieces of music to bear on a problem. But rather than becoming stuck in the problem as a client is wont to do, the client is “re-educated,” by which I mean that he/she gains a new perspective. In reeducative music and imagery, the image does not change; the client changes his relation to the image. Kyle’s perspective on the “no exit” drawing changed from frustration to inadequacy to acceptance and, finally, he arrived at a desire to ask for help.

In Kyle’s session, the strong, constant repetition in the music--Bach’s Passacaglia and Fugue--paired with the focus (induction) had held him in the internal feeling of frustration. The drawing had allowed him a full, yet contained, expression of feeling trapped, frustrated and inadequate, in an aesthetic image. The verbal processing of the “no exit” image further held Kyle in a here-and-now experience of the symptoms he had been experiencing on a daily basis at work. Each of these components contributed to Kyle’s “re-education.” The first step of Kyle’s re-education occurred when he was able to separate and identify the specific symptoms, frustration and inadequacy, that were keeping him trapped in his depression and unable to ask for help. The second re-educative step occurred when he was willing to accept, on a new level, the reality of his feelings. On the surface, it may appear odd to suggest that it was a positive result for Kyle to deepen the feeling and acceptance of being trapped since the goal of our therapy was to alleviate his symptoms. But this is a prerequisite to the amelioration of symptoms and a prerequisite to new insights and perspectives. Re-educative music and imagery sessions usually end with the verbal processing of the client’s new perspective, and I could have ended Kyle’s session after the first or second reeducative step had been achieved. But I sensed Kyle’s readiness to solidify his new perspective with another music experience. Therefore, I asked Kyle not to think about what just happened, but to embrace this new perspective in a second drawing as he listened deeply to another piece of music. I chose the second movement from Beethoven’s Piano Concerto #5, a supportive piece. He drew three concentric circles growing progressively larger from the center. Beginning in the center, the circles were bright yellow, light blue and fluorescent pink. Three green curving lines flowed through the center, and one green line circled around the center. Kyle reflected: I just need to do it. I have an opportunity to do it. It’s safe to do it here. I need to make the effort [at work] — it may not work out, but I think I have it within me now. I can take some time out and then ask someone to help me. He called the drawing “Opportunity,” and our discussion centered upon his feeling that there was a way out for him.

This additional supportive music and imagery experience helped him to more firmly access the feeling of opportunity, and with it, the possibility of asking for the additional help he needed at work. In effective re-educative music and imagery, the therapist’s aim is to stimulate within the client a new perspective that can be made usable in daily life. In fact, after his music and imagery sessions, Kyle often utilized his imagery to help him confront issues in his life.

Conclusion Kyle’s internal and external world was filled with symptoms that were unmanageable and rigidly fixed. His distance from everyone had caused his relationships to be devoid of feeling, his character to be devoid of depth, and his life to be devoid of meaning. Since his inner life was so fragmented any time he had closed his eyes in therapy, he was inundated with negative images of death and hopelessness. Immersing Kyle in his symptoms, while playing music, had availed him nothing. In fact, it had exacerbated his distress. Neither had positive inductions with light repetitive music offered respite from the horror because he did not have the ego strength to utilize the positive imagery he generated, until I had added the external task of drawing to enable him to successfully hold the positive experience and assimilate it. Using positive inductions paired with simple, repetitive music, Kyle was able to develop compassionate responses within the therapy sessions that were then made useable in his real life-- both with his patients and family. Re-educative music and imagery using simple inductions focused upon his symptoms, paired with music that contained harmonic tension and little development, helped Kyle accept and gain new perspectives in his daily life. The re-educative sessions significantly improved Kyle’s life by reducing his symptoms and giving him an increased healthy repertoire of responses to life events. Kyle’s therapy progressed in a flexible way, moving between supportive and reeducative approaches for three years. Through supportive and re-educative music and imagery, instead of simply ameliorating his depressive symptoms through medication, Kyle transcended

the ingrained negative patterns that had limited his everyday life and supplanted these with his previously buried positive internal responses to life. References Bonny, H.L. (2002). Music and Consciousness: The Evolution of Guided Imagery and Music (L. Summer, Ed.). Gilsum, NH: Barcelona Publishers. Bonny, H.L. (1978/2002). The role of taped music programs in the guided imagery and music process. In L. Summer (Ed.), Music and Consciousness: The Evolution of Guided Imagery and Music (pp. 299–324). Gilsum, NH: Barcelona Publishers. Bonny, H.L. (1980/2002). The early development of guided imagery and music (GIM). In L. Summer (Ed.), Music and Consciousness: The Evolution of Guided Imagery and Music (pp. 54–68). Gilsum, NH: Barcelona Publishers. Bonny, H.L. (1995/2002). Guided imagery and music: The discovery of the method. In L. Summer (Ed.), Music and Consciousness: The Evolution of Guided Imagery and Music (pp. 43–52). Gilsum, NH: Barcelona Publishers. Bonny, H.L. & Pahnke, W. (1972/2002). The use of music in psychedelic (LSD) psychotherapy. In L. Summer (Ed.), Music and Consciousness: The Evolution of Guided Imagery and Music (pp. 20–41). Gilsum, NH: Barcelona Publishers. Summer, L. (1988). Guided Imagery and Music in the Institutional Setting. St. Louis, MO: MMB Music, Inc. Summer, L. (2002). Group music and imagery therapy: An emergent music therapy. In K. Bruscia & D. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and Beyond (pp. 297– 306). Gilsum, NH: Barcelona Publishers. Summer, L. (2009). Client perspectives on the music in guided imagery and music (GIM). (Doctoral dissertation). Aalborg University, Denmark. Summer, L. & Chong, H. J. (2006). Music and imagery techniques with an emphasis on the Bonny method of guided imagery and music. In H.J. Chong (Ed.), Music Therapy: Techniques, Methods, and Models. (Korean language). Seoul, Korea: Hakjisa Publishing Company. Wheeler, B. (1983). A psychotherapeutic classification of music therapy practices: A continuum of procedures. Music Therapy Perspectives, 1(2), 8–12. Wolberg, L. R. (1977). The Technique of Psychotherapy (Third Edition, Part 1). New York: Grune & Stratton. Part of this case study was published in the Korean language in Summer, L. & Chong, H. (2006). Music and imagery techniques with an emphasis on the Bonny method of guided imagery and music. In H. Chong (Ed.), Music Therapy: Techniques, Methods and Models. Seoul, Korea: Hakjisa Publishing. With permission.

CASE SIXTEEN Case Examples of Levels of Guided Imagery and Music (GIM) Therapy; The Evolution of a Continuum Lisa Summer Preamble This chapter is an updated reprint of “Music and Imagery Techniques with an Emphasis on the Bonny Method of Guided Imagery and Music” (Summer & Chong, 2006) in which a continuum of GIM practice is described in three case studies (Kyle, Stan, and Bebe) organized— not chronologically—but rather by levels of psychotherapy: supportive, re-educative, and reconstructive. Preceding the three individual case studies is a group example from 1981, in which the component parts of the Bonny Method are separated and flexibly adapted in response to the needs of psychiatric clients. A positive induction, and the then unprecedented step of allowing the client to visually represent his imagery while listening to a single, repeated piece of supportive music are the two principal adaptations illustrated in the 1994 case study: Kyle. The extemporaneous selection of a music program, described in the 2004 case study: Stan, demonstrates a less radical adaptation of the Bonny Method. A case study from 1991: Bebe, evinces the transformative power of the original Bonny Method. Since “Music and Imagery Techniques with an Emphasis on the Bonny Method of Guided Imagery and Music” (Summer & Chong, 2006) was published, my understanding of the terminology in regard GIM practice underwent a sea change, addressed in “Music Therapy and Depression: Uncovering Resources in Music and Imagery” (Summer, 2011). This 2011 chapter is reprinted here (see previous chapter), and contains a clarification of supportive and reeducative music and imagery through the vehicle of additional material from the 1994 case study: Kyle. To reflect my 2011 corrections to the mislabeling of Stan and Bebe’s sessions in the 2006 publication, I have amended the terminology throughout this chapter as follows: · Bebe’s session is now labeled as a Bonny Method session (instead of the more generic term, GIM) because it utilizes all of the components in the original form that Helen Bonny designed. Everywhere Bebe’s session is mentioned, it is now called Bonny Method, not GIM. · Stan’s session is now labeled a GIM session (instead of re-educative music and imagery) because it utilizes all of the components in the Bonny Method except that instead of using a predesigned music program, the music program is extemporaneously chosen during the session. This single adaptation is not significant enough to be called reeducative music and imagery. Everywhere Stan’s session is mentioned, it is now called GIM, not re-educative music and imagery. · Finally, this chapter’s updating includes the relabeling of the expression “music and imagery practice” to “GIM practice” which is a cosmetic change, rather than a substantive one. The terminology “GIM practice” is universally accepted within music therapy.

Introduction The genre of music therapy broadly defined as “GIM practice” is predicated on transcendence—transcendence of the external reality in which we are all immersed with its practical limitations; in favor of the internal world which has no limitations but that of the individual’s imagination. In my monograph Guided Imagery in the Institutional Setting (Summer, 1988), I began, “We are what we imagine.” As naïve as that premise is, it is nonetheless potentially true for all humans, internally. The freedom that I experience in my imagination transcends the limitations imposed upon me by external forces (my parents, society, the expectations of peers, and the like) which informed my childhood. The kind of music therapy I attempt to deliver as a GIM practitioner uses techniques which focus upon the internal world in order to provide my client with permission to transcend emotional limitations imposed in childhood. Just as I used music as a young woman to transcend the limits of my upbringing, so do I attempt to provide the GIM client with the freedom to overcome the anxiety and depression which is the result of insufficient parental nurturance, inconsistent societal restrictions, or externally imposed traumas; and to achieve the potential of higher goals than simple comfort: the transcendence of reality and the attainment of self-actualization. My Personal Relationship with Music “The childhood shows the man, As morning shows the day.” (From Paradise Regained by John Milton [1608—1674]) As a music therapist I have reflected on my first impressions of the power of music to transform. Lessons of my youth, taught by the universe at large, without direction; with the advantage of age and experience gained since childhood, have informed my understanding of this transformative power. In my own case, music was the vehicle for my departure from childhood. My parents, who were supportive of me so long as I was their baby, became confused and incapable of open and honest communication with me during my adolescence. My parents withdrew into a gentle silence; unwilling to cope with my emergent intensity, my anger, and my contradictory need for parental nurturance. Neither my mother nor father offered me safe harbor during my passage through the typical tempestuous teenage years into adulthood. I took my anger, my frustration, my scorn to a new parent: music. I practiced piano and French horn, and listened to the rebellious popular music of my generation, as exemplified by the rock’n’roll music of the Rolling Stones. Listening to and playing music satisfied my desire for an emotional outlet, which my parents could not provide. It seemed to me that music “understood” me as my parents could not. It reflected the sublime and the overwrought emotions I was experiencing. During this period of my life I rarely listened to calm or stylized music. Though I did practice and perform Mozart, for example, I would not choose Mozart to put on the stereo. Upon reflection, I think now that the calm passivity of my parents precluded me from choosing Mozart. Rather, I needed the relative chaos of Mahler and his ilk to support

my strong feelings; and the Rolling Stones and Mahler understood and supported me then more than any relationship in my life. I felt more human, more real and truly “myself” only in music then. Music allowed me to individuate. It was impermissible—so I understood—to be or to act angry with my parents, but I discovered that I could be angry, non-verbally, as I played or listened to music. My parents could not support the intense parts of my emerging personality, but they supported and encouraged my development as a musician. They bought me a piano, a horn, provided me every opportunity to study, perform, and practice; and encouraged me to major in music in college, when finally it was time for me to leave home. So, it was music that helped me develop a full repertoire of emotions through my adolescence, rather than the limited palette that was modeled for me by my emotionally restricted family. As I traveled the path of music therapy education I was, naturally, drawn to the philosophy of emotional permissiveness that defines GIM. The support my family gave to me in my study, performance and listening to emotionally liberating music is reflected in the structure of the GIM session, (crafted by Helen Bonny) in which the GIM therapist serves the function of support, from which is created a musical space for the client to individuate. The function of the music is to support the client emotionally in a more liberating and limitless way than a human relationship can do—support that carries with it no pejorative judgments, support that transcends words. I went to college as a music education major, at Temple University in Philadelphia; but at Temple I began to worship music, and education could not contain this devotion. I switched my major to performance and became an acolyte of music in the form of a performer. While engaged in this—to me—holy obeisance to music my uncle Harry died. I despaired, suffering a deep existential crisis with attendant physical symptoms. I was unable to eat or sleep regularly. Receiving little comfort from my family, and uncomfortable with the idea of looking for empathy with my peers, I found solace in the repetitious practicing of a simple piece by Gliere, the Intermezzo, opus 35, number 11. After each obsessive iteration of the two and a half minute piece, I would lower my head and cry. Finally, following about ten reiterations, I felt relief. The veil of my heretofore inescapable despair had lifted and did not return. Whereas the wild music of my adolescent revolt carried me beyond my “here-and-now” feelings; the simple repetitive phrases of the Gliere held me in my inconsolable sadness, in essence forcing me to accept the loss of my uncle and to absorb the incontestable triumph of death. Rather than transcending the reality, the intermezzo held me down to Earth, an acceptance of reality. Later, I would appreciate the lesson of the lyrical passage, that music could facilitate the acceptance of external reality, of feelings that seemed imposed, rather than elicited. Without the Gliere I was burdened with feelings that seemed overwhelming, incapable of resolution, and unmanageable. I learned that people who come to therapy desiring to ignore large parts of their internal world, as I wished to do in regard the loss of Uncle Harry, need to come to terms with them rather than reject them. With the inchoate understanding that the application of this musical remedy had relieved my symptoms of despair and forever altered my perspective on the meaning of life I changed my undergraduate major one last time, from music performance, to music therapy. The undergraduate field of music therapy was primarily behavioral, not concerned with the examination of complex internal issues. Self-examination, awareness, and deep emotional

expression were not subjects of the field at an undergraduate level. It was not until I graduated that I could recommence my exploration into the more esoteric and elevated goals of music and imagery. Concurrent with graduate work at Hahnemann Medical College, (now called Drexel University) I was fortunate to begin the study of GIM with its founder, Helen Bonny, during GIM’s incipient stage in the field of music therapy (Bonny, 2002). Her first students, amongst whom I could be counted, were guinea pigs, and its restrictions were not immediately evident. In the beginning it was conjectured that GIM could be universally applied, a concept that was eventually superseded by a healthy reconsideration as GIM was experimentally expanded and tested with individuals by the handful of initial practitioners. The principles of humanistic and transpersonal therapy were taught by Helen Bonny herself in a three tiered training program that continued to redefine its boundaries even as I soon became a GIM trainer myself, assisting Bonny. Eventually I became the coordinator of GIM training at the Bonny Foundation. Choosing music for sessions, the methods for stimulating imagery, and the role of the guide were developed in collaboration with Bonny and her first students; however, clinical applications were not yet explored. Twelve Angry Men: First Attempts at Group Music and Imagery Therapy Gieng heut’ Morgens über’s Feld, Thau noch auf den Gräsern hieng sprach zu mir der lust’ge Fink; “Ei, du! Gelt? Guten Morgen!” “Wird’s nicht eine schöne Welt?” I went out this morning over the countryside, dew still hung from the grass; the merry finch spoke to me: Oh, it’s you, is it? Good morning! Is it not a lovely world?” (From Songs of a Wayfarer, [text and music] by Gustav Mahler) Some of the uses of the Bonny Method as a tool for group music psychotherapy were first tested at Northwestern Psychiatric Institute, an in-patient psychiatric hospital with a 28day program for addicts post-detoxification (Summer, 1988). My training with Helen Bonny had taught me how to practice the Bonny Method, but primarily with other therapists. We trained mostly with each other as clients. I had no real idea how to deal with adult clients who were not equally interested in the technique, or who were resistant to treatment. In my very first group session I encountered a monumental resistance when I tried to treat a group of twelve angry alcoholics and drug addicts with Debussy. It appeared that these dozen hospitalized clients did not find it plausible that I could offer them any valuable assistance to their travails. The group members voiced opposition to my selecting music for a therapy session, and they scoffed even at the idea of music therapy. If there was to

be music, they wanted music that they liked, not some French impressionist orchestral composition. In the session prelude, group members openly mocked me and were hostile to my suggestion that they “close their eyes and imagine relaxing in a meadow.” Nevertheless, I persevered, and played the Dances Sacred and Profane, by Claude Debussy. Following the music, I asked each group member to share their experience. The responses were at first unanimously resistant. They reported their boredom, that they slept, that they disliked the music, that they simply wished they were somewhere other than in the session room. One client, however, diverged from the group, reporting that he had imagined—vividly—“a beautiful meadow,” a truly peaceful place where he had never been, and that as the music played, he felt like he knew well the music, though, he explained, in fact, he had never before listened to classical music. Because he “knew” the music, (though by “knew,” he did not mean that he had ever heard it before,) he felt comfortable going into the meadow, as if he belonged there. He felt, he said to me and his fellow group members, like he “just knew the music,” and so, he could dance to it; which, he asserted, he had done. In his imagined meadow he danced to Debussy. His relation of the impact of this positive internal experience was evident not merely to me, but to his peers as well. Here, amongst these emotionally injured, angry men; he appeared calm and centered; uninhibited in his recital of his imagery and feelings, unconcerned about the group’s possible hostility to him and his experience. In the next, and subsequent sessions, the group’s resistance was significantly lower; due not to my inept therapy, but rather, I think, to the good fortune of the presence of this one client, amongst the twelve, who fortuitously wanted to find amelioration. This session taught me that I needed to radically change my approach to the use of music and imagery with psychiatric groups. The components (prelude, induction, music, and postlude) so effective with normal individuals who wanted the Bonny Method, was disastrously ineffective in group situations. The use of a broadly symbolic image with evocative classical music which is the hallmark of the Bonny Method had stimulated a meaningful experience for one of the twelve group members, but had narrowly avoided catastrophe with the other eleven. Additionally, my failure to directly address the issues which had placed these twelve men in a psychiatric hospital in the session prelude was negligent. I wasn’t doing therapy, I was performing, in this case performing GIM, just as I would perform a horn concerto, treating the group as an audience, not an assembly of clients. It was no wonder that the group had been resistant and hostile. During the year I worked at Northwestern Psychiatric Hospital with clients diagnosed with depression and anxiety disorders, as well as with addictions, I began to adapt Bonny’s GIM method to more effectively serve the client population. Utilizing very simple classical pieces with minimal development sections and a narrowed use of musical elements in order to stimulate singular, simple images that can be easily, and efficiently, shared in a group setting within a one or one and a half hour group session helped group members relate and empathize with each other. The inductions needed to be goal oriented. Dancing to Debussy in a meadow was not an especially useful way to help an addict cope with the decision to drink or not to drink. Granted, one of the twelve group members began to open up to therapy, but that was a very low percentage of moderate success to rationalize continued like manner treatment. Positive inductions were more powerful in activating group dynamics so that even when every group member did not have a positive experience, the group as a whole benefited from the sharing of those that did. Frequently, a domino effect would evince itself, as the positive

imagery and progress from several group members encouraged the less affected individuals to lessen their resistance to therapy. Many of these clients pejoratively equated imagery with fantasy, and fantasy to many of these men seemed either effeminate or absurd. If the inductions shared a common denominator to which all the members could relate, even the disaffected did not feel left out of the therapeutic process. Seeing their fellow group members enjoying some improvement through music and imagery was in itself ameliorative, if to a lesser degree. Additionally, the value of the common denominator allowed group members to empathize with each other because they understood the imagery. It was useful to either give the group an imagery induction that included directions for a concrete task, such as drawing, writing, or movement; or for me to narrate an imagery induction during the playing of the music. Either technique helped the clients access positive experiences during the music by stepping over their internal resistance to the abstract and esoteric idea of imagination Kyle: Supportive Music and Imagery “Nel mezzo del cammin di nostra vita mi ritrovai per una selva oscura che la diritta via era smarrita. Ahi quanto a dir qual era è cosa dura … “ Midway on life’s journey, I found myself In dark woods, the right road lost. To te About those woods is hard … (From the beginning of Dante’s Inferno, translated by Robert Pinsky) In 1993 I began a private practice with adults, working collaboratively with several verbal therapists who referred clients to me for music psychotherapy. The clients were not hospitalized, rather, they were working members of a large island community, many of whom held positions of responsibility and authority. Kyle, a physician, came to our first session in an expensive and stylish suit and tie; and a starched white, monogrammed shirt. This was not a broken-down addict in ripped jeans at a psychiatric hospital. He was, evidently, smarter and more prosperous than me and I wondered what possible help I could offer an upstanding citizen who helped run our island community? Referred to me by his primary therapist as depressed and obsessive-compulsive, he seemed so articulate, healthy, aware of himself and in control, that even when he himself talked about being depressed and obsessive, I wondered whether he was simply confabulating. When he told me that he worked obsessively, at least ten hours a day, six days per week; it seemed to me gallant and caring in regard his professional field. He could not rid himself of the feeling that his work was inadequate. Married, with two children, the fifty year old professional was on medication for obsessive-compulsive disorder and major depression. He had been in verbal therapy for about two years. Verbal therapy and medication had improved many of his depressive symptoms but his primary therapist had reached an impasse in her work with him to

lessen his hours at work, to slow down his pace while he was at work, and to deal with his feelings of inadequacy. Kyle spoke with celerity and perspicacity; changing topics faster than the island’s chameleons changed color. In an early session I played for Kyle a Bonny program containing chatoyant impressionistic music with a great deal of musical tension; my goal being to match his demeanor. In the Bonny Method, when you can match a client’s in-the-moment state with music, they feel “understood,” “heard” on an emotional level and can go into the music to experience its healthful processes. Having matched his state, the music stimulated an experience, as Kyle told me once the music concluded, exactly analogous to how he viewed his life. As Kyle listened he reported fleeting and disturbing images. “I see swirls, they are coming at me very quickly . . . now there are sketches, like black and white drawings of birds . . . it is very dark. . . Everything is coming and going so fast, I can hardly recognize anything; I am trying to slow things down, but they won’t listen to me . . . I am in a tomb—a grave, it is so dark and empty, I think I am in the tomb; I am trying to get out but I can’t . . .” I tried several different pieces of music to see if the change in music would elicit a change in the nature or pace of his experience. No change in the music resulted in significant changes in his imagery. These unvarying images, Kyle told me, were akin to “symptoms” that afflicted him in his everyday life, a life he described as unconnected, distant. Nothing, he insisted, had real meaning to him, and he felt powerless to make any changes, as if he were simply an ineffectual observer of a life consisting of a series of mostly unpleasant events. Work, relationships, events, were all remote from him emotionally; and the prosperity, success, and intellectual achievements that he had obtained were without meaning. Kyle worked obsessively to feel accomplished, bringing him fleeting positive thoughts, but kept himself emotionally distant from the fruits of his labor. Intellectually he justified his disengagement as a necessity, paradoxically denying himself the joy of the rewards he worked so hard to accomplish. The momentary positive feelings generated by his accomplishments were destroyed by what was underneath, in the unconscious: an internalized (introjected) version of his mother (a depressed, needy perfectionist who was emotionally abusive to Kyle and whose behavior was highly inconsistent in his childhood) and his father (who was highly critical, emotionally abusive and paid little attention to Kyle). The internalized figures of his parents continued the abuse and criticism of his childhood and thus denied him any lasting feelings of self-worth. Instead, as revealed in his imagery, his inner world consisted of shells of defensiveness, nested in further shells of defensiveness. Feelings of sadness, helplessness, powerlessness, anger, despair, vulnerability—all the responses he had had as a child to his parent’s emotional abuse—were by this time, chronically patterned in his unconscious. His imagery also uncovered the dark roots beneath his depressive defenses: a deep existential fear of death. When younger he had periods of intense nightmares and night terrors that his parents had not addressed in any way. Using the Bonny Method had yielded, for Kyle, imagery that was fragmentary, fleeting, and out of control; but I believed that this experience would be helpful to him; that it would help him face his difficulties and bring him a new understanding of himself. Experiencing how out of control his life was, I thought, should bring him motivation to change—to work less, slow down, to become more engaged and thereby live life more fully. But when Kyle returned for his next session it was clear that his condition had seriously worsened, due to the Bonny Method

session. He reported to me that in the previous session he had realized how out of control his life was; and that during the previous week he had felt an increased sense of hopelessness about himself. Instead of relief and reinvigoration he was despondent. He had become acutely aware of his wife and children’s complaints about his emotional distance from them, and yet, he could not respond. He also felt inadequate in regard our prior session. He did not understand what the images meant and so he felt stupid. He was convinced that I understood exactly what all those images meant psychologically and that I was judging and analyzing him as really sick. He was pale, could not look me in the eye, seemed totally miserable, and his fragmented manner of speaking had worsened. Though most people have had some injurious parenting in their childhood, there are nearly always aspects of positive nurturance as well. When imagery is conflictual, one can expect some evidence of ego strength (positive resources, positive adaptations to tension and abuse,) and even when such is not evident in a client’s imagery, there is likely to be evidence in the client’s positive response to the images. Kyle had no positive feelings whatsoever. If there was any ego strength, it was completely obscured by his unremitting depression. Though I did not expect to be able to remedy every client’s symptoms, it seemed here that I had actually made the situation worse. I wanted to rescue Kyle from himself, to give him some relief from his horrible and fragmented world, but I was at a loss as to how to proceed. It was clear to me that the Bonny Method would not help Kyle address and improve his symptoms. I had experience with clients whose internal world was replete with negativity, but I had not yet dealt with a client in my private practice who was so incapable of doing anything about it, one whose positive internal resources were so unavailable to him—even with the help of psychiatric medication. I questioned whether a positive experience was even possible for Kyle; or whether I was simply not capable of the effort and intellect required to “reparent” him, to give him the positive, nonjudgmental nurturing his parents had refused him. There had to be a positive experience upon which to rebuild his ego, a positive innocent Kyle that existed prior to his abuse, but I did not know how far back in the past this true positive self remained, nor how deeply buried within his unconscious it was. As a beginning therapist I was determined to help him find this positive kernel, but I did not have the technique or skills to locate it. I needed an approach to music and imagery that was lighter, more structured and more directive than the Bonny Method. For several sessions I explored different approaches: relaxation techniques, music without imagery, imagery without music; though I was anxious myself about whether I was doing any good. At least, I thought, let me do no more harm. In the eighth session came a breakthrough. I asked Kyle to tell me if he had had even one positive, quiet moment by himself within the last few years. He had not, but he had had a vacation with his wife, and they had gotten up at dawn to see a sunrise, a thought which Kyle found pleasant. Nervous as I was to introduce drawing to a man dressed in an Armani suit, I suggested (in an induction prior to the first movement of the Dvorak String Serenade, Opus 22,) that Kyle recall the memory of him and his wife watching the sunrise; and that he draw the experience on the page in front of him. As the music started, I could see he was self-conscious about the idea of drawing a picture. After about a minute of hectic illustrating, Kyle relaxed. With the pace of his drawing slowed down, his arms began moving every once in a while with the rhythm of the music. Listening deeply, he allowed the beauty of the music to shape what he was drawing. I played the piece over and over again. Rolling up his starched, monogrammed,

white shirt Kyle proceeded to get it filthy with all the colors of the chalk he used—without any concern to his previously immaculate garb. He used pastel colors, putting them on the page and then using his hands to blend them together. When he had covered the entire page and it seemed that he was finished I stopped the music. He was transformed, totally at ease and comfortable; the music and the drawing having created some kind of positive womb-like experience. I did not really know how to verbally process what had just occurred, but, speaking slowly, I asked him to describe his experience. He expressed that he had felt “focused,” “involved,” and “creative” while he was drawing. He had tried, he confessed, to draw the sunrise in a literal way, but let go of that goal in favor of just expressing the feelings of the sunrise. He expressed gratitude that there were “no interruptions,” unlike the interruptions that flooded his daily life (by which he meant his obsessive, depressive, fleeting thoughts).He was able to truly relax and enjoy the music. For the first time, Kyle had made contact with positive feelings in a session. He did so by initially recalling the memory of a sunrise as a visual image. Then, the music helped him to focus him on the memory; and the simplicity and aesthetic beauty of the Dvorak Serenade held him in the image and called forth, into the present, the true and positive feelings contained within that image. The repetition of the movement (which I played for him four times) allowed the positive feelings that had emerged to gain strength. Kyle’s state of consciousness had totally transformed from the beginning of the session when he entered feeling “pressured, left over from work” to “content.” This change held throughout our discussion and continued until the end of the session. He titled his drawing: “Contentment.” Kyle was pleased with the results of this session, and came back to the next session with a positive attitude about the therapy. I continued to use this supportive music and imagery format each week: an induction (usually positive) tied to the task of drawing, with classical music. These included the following drawings: “Trying to blend chaos and pleasantness,” “Father and son dolphins, frolicking,” “Let it go (anger),” “In touch.” Within two months of our work together, Kyle found that he was capable of establishing contact with positive resources (positive feelings) within himself. He described himself changing in his everyday life; finding focus, presence, openness, acceptance, hope, availability, relaxation, and contentment. The combination of music and drawing allowed Kyle to discover a state of consciousness that was unattached to his usual psychological patterns. During the music he was able to free himself from the omnipresent levels of defenses that otherwise plagued his every waking hour: the negative parental introjects, his depressive feelings, and his existential fear of death. Kyle’s weekly “immersion” in a positive, healthy state with music began to free his psyche from psychologically debilitating defenses. Though these symptoms would always return, little by little Kyle generalized parts of this healthy state of consciousness into his daily life. He reported to me that he felt the quality of his daily life changing; but the therapy had not adequately addressed his general anxiety or work related problems. Building momentum on the positive gains of these initial supportive music and imagery sessions, we entered into a new phase of therapy in which re-educative music and imagery sessions (see previous chapter) would sharpen his focus so that he could address his lingering malaise. Subsequent sessions that directly addressed Kyle’s depressive symptoms produced a plethora of drawings, drawings which he titled, for example: “Locked in depression,” “Sadness, trapped inside the anger,” “Distance from dad.”

In session twenty, he reported that he was able to emotionally empathize with a patient who told him about her divorce. He experienced—for the first time in his life that he ever remembered—really feeling what he knew were normal feelings of compassion for another person, not the professional artificial compassion which he employed only as a tool in his trade. The supportive music and imagery sessions in which Kyle was in touch with positive feelings, repeatedly, though in his internal imagining had crossed over into the real world and had really begun to take hold. He was developing a constant positive internal object, the beginnings of a healthy ego, previously absent due to his parents’ abusive, and inconsistent, nurturance. The repetition of internal visits to his positive core with classical music had taught his psyche about positive feelings, and was beginning to take root outside the session, even with people outside his immediate family. For the first time, he reported, he had had been able to make a truly human connection with a patient, an amazing confession—coming as it did—from a physician. Kyle’s therapy was lengthy, nearly once a week for three years, but he had changed himself successfully. Initially, his inner life was fragmented. Any time he had closed his eyes he was inundated with negative images, images of death and hopelessness. Immersing Kyle in his symptoms while playing music had availed him nothing, in fact, had exacerbated his distress. Neither had positive inductions with light repetitive music offered surcease from the horror because he did not have the ego strength to utilize the positive imagery he generated, until I had added the external task (in Kyle’s case, drawing) to enable him to successfully hold the positive experience and assimilate it. Traveling into the inner world is like taking a trip to a foreign country. We experience the equivalent of a different culture with an often perplexing and inscrutable set of rules. The language of this alien mindscape is the language of imagery. Kyle’s internal landscape was filled with intractably dangerous places. The familiar places, which are familiar to all cultures, the safe haven of the home and the nurturing family were hidden, inaccessible. Kyle’s internal world was in the midst of a civil war, when even home is unsafe. This chapter illustrates three different routes through this alien inner world: 1) supportive music and imagery, 2) re-educative GIM, and 3) reconstructive Bonny Method. [These levels conform with Wheeler’s (1983) established schema of levels of therapeutic practice.] A Bonny Method session is akin to touring a foreign country with no predetermined plan or destination; but rather in a free, meandering way. The visit unfolds spontaneously. The direction of the visitors’ tour is determined solely by the experiences at hand—one experience points to the next, like free association. In Kyle’s case, employing the Bonny Method, as I did initially, was unwise. Tourists do not fare well, generally, meandering unawares in foreign lands in the midst of internecine strife. Even the altruistic medical workers of “Doctors Without Borders” need safe places to retreat to when the fighting becomes intense, and Kyle had no knowledge of where to find refuge when we first began the Bonny Method. There are several prerequisites to using the Bonny Method. The client must be able to produce imagery (visual imagery, feelings, body sensations, etc.) when listening to music, able to describe verbally the imagery as well as understand symbolic images. The client must be able to apply the images to positively affect his external (daily) life (Summer, 1988). If the prerequisites are present the therapist should be able to see positive changes in the client’s life, assimilation of what he learned during the Bonny Method sessions. Likewise, success in the Bonny Method implies that the client returns from his internal voyage changed, and changed

for the better. Because the Bonny Method is so free and unstructured it is necessary to be prepared to utilize lighter, more structured approaches with music and imagery, as I realized I needed to employ with Kyle. Kyle, unable to maneuver in his internal world on his own to reach positive experiences, would drown in conflict when first I threw him into the deep waters of the Bonny Method. After I recognized my error of too quickly tossing him into the Bonny Method, Kyle went, through the medium of supportive music and imagery to visit positive experiences and then was able to establish within himself that lost feeling of safety, the beginning of a positive healthy ego. Stan: Re-educative Guided Imagery and Music (GIM) “Those living beings who Know not the root of suffering, Cling to the condition of suffering, Unable to leave it even for a moment.” (From a Mahayana parable contained in The Lotus of the Wonderful Law) Stan, a forty five year old lawyer had a dynamic but aloof personality. In our initial sessions, he was very withholding, withdrawn, and tentative. Hesitant even to say that anything was wrong with his life, I found it difficult to empathize with him. I think if I had not pushed him, he would have come in every week and told me that everything was just fine. Like Kyle, Stan was depressed, though less so than Kyle. Whereas Kyle had obsessions, Stan had an anxiety disorder. Stan’s therapist had treated his depression with medication and approximately six months of verbal therapy. Once the therapist had reached an impasse, rather than prescribing additional medication, Stan was referred to me. A recovering alcoholic, Stan had not had a drink for ten years. Raised by a highly critical father who had rejected him his whole life, called him a “misfit,” and who ridiculed him for any feelings he expressed and any decisions he made, I could understand how Stan had hidden his whole character so as not to “burden” his father with it. Contrarily, his mother had brought him up with much warmth and nurturing. His father was very “absent” in his upbringing, but his mother spent much time with him, playing spontaneously, and allowing him space to express himself. She suggested that he write stories, play fantasy games, and the like; but Stan repressed this expressive component of his childhood due to a series of tragic deaths in his life. At eight years of age, his grandmother, who had lived in Stan’s house, bedridden and sick for a year, passed away. Ten years later, while Stan, a teenager, still benefited from her loving care, his mother succumbed to cancer. Shortly thereafter, Stan married. Three years later, following his twenty-first birthday, his father died from complications brought on by asthma and, probably, alcoholism. At the same time that his father was buried, Stan’s young wife was diagnosed with cancer. She died shortly thereafter. Stan was barely twenty-two years old. Stan had prolonged periods of high anxiety following these brutal losses, and though there was currently no real-world parallel for these early traumas, Stan had severe anxiety even now.

“I can’t even imagine being anxiety free; it is like a security blanket to me,” Stan told me. “I’m still afraid of everything: of failure at work, or at anything I do. I am afraid that my dog will get lost, that there will be a hurricane. I make up worst-case scenarios in my mind every day, all day, about imaginary things. . . I think anxiety is my attempt to control external events, even though I know rationally that they can’t be controlled.” In our first sessions I determined that Stan’s ability to travel in his internal world was very good. The initial phase of therapy contained a mix of sessions—some were music and imagery, some were GIM. Music and imagery sessions helped him to reconnect with the positive core of his childhood and the period of his life immediately prior to the series of deaths—when he was in college. His college years were the time of his life when he felt most a sense of direction and meaning in his life, and when he experienced joy in the relationships he had. Several supportive sessions helped Stan begin to connect with his positive core, and these sessions led to an intense GIM session. This session, Stan’s seventh began with his telling of a dream that disturbed him and elicited enormous feelings of anxiety. I used part of his dream as an induction, and suggested that he explore the dream’s anxiety. The music program allowed him to transform the anxiety elicited by the dream into an inner impulse that reminded him of his creative writing which had been nurtured by his mother in his childhood. After this session his positive sense of self increased significantly. He took out a novel he had begun writing in college (and had put away), bought a computer, and began to write again, every day after work. Another GIM session took him to explore one of the roots of his anxiety: he revisited his father’s deathbed. His daily anxiety reduced somewhat after this session. He began to listen to music in his daily life, a pastime he had neglected since his youth when he listened to music every day. He purchased classical music recordings, and reacquainted himself with music that he had not listened to since his college years. His first comments in most sessions were about the classical music utilized in the previous session - how beautiful it was and how strongly he had been affected by it. By session fourteen Stan had developed a positive, working relationship with his inner world; and had begun to generalize into his life aspects of his positive core. His exploration of the unconscious roots of his anxiety had somewhat lessened its hold on his daily life. Session fourteen, a GIM session was key in helping Stan to deal with his anxiety on a day-to-day basis. In the prelude, I asked him to close his eyes and rather than think about his anxiety, to allow himself to feel it. Agreeing, he closed his eyes and began to describe his imagery, prior to my beginning the music program. “I see a picture of a pile of solid objects, all turned differently. It’s a mix of objects, different sizes. Actually, it is like a bowl of jewels and I feel very drawn to them. . . I wish they weren’t so attractive because I have to focus on them. . . I really feel an attraction to them. It looks like a picture—something that a child has drawn—it’s not real, it’s like a photograph, I can look at it from different sides, but I can’t get at it. . . It’s two dimensional.” I helped Stan to establish a solid visual image of his anxiety and then selected an initial piece of music to match the qualities of the image he had described. The first piece, the Faure Pavanne, with its simple, arpeggiated accompaniment, matched his image which helped to keep Stan’s attention on it, so he did not succumb to his tendency to avoid it and hence, drift away from the imagery of the jewels. The Pavanne’s accompaniment is all pizzicato, which seemed to match the static and separate nature of the bowl of jewels. A flowing, simple flute

melody brought some forward motion to the process, and the contrast between the repeated A and B sections provided stimulation to view the image from a different perspective. His immediate response to the opening measures of the music was to say: “Now the jewels aren’t so static and drawn, there is movement between them.” As the slow procession of the Faure played out, Stan reported, “It’s like someone is sifting them (the jewels). They are moving up and down, there is some friction between them, but it is a natural process. They are a part of nature; different things happen to them—rain, floods, snow—there is some kind of nobility about it. They are impervious to those forces; they don’t change, they just stay the same. Things act on them; I feel some sadness.” The image was clearly moving from its initial stasis, taking on a duality—moving; yet impervious. For the next musical selection in this session, I chose Warlock’s Pieds en l’Air, a very short piece, in a lilting triple meter; very repetitive, but with much more fluid movement than the Faure. I was matching the new quality that had appeared—movement—because I wanted to reinforce it; but I did not want to introduce too much tension. With the Warlock, Stan reported, “This is a lighter piece, it brings out the colors in the jewels. I’m looking at them in a new light. These aren’t just problems, they are elements. A jewel is actually a rock; this shows the rocks. They look different in different light. If the light is taken away, you would only see limited pieces. It’s kind of like looking at stars, everything else is dark. . . Oh, these are my issues, I feel them as anxieties.” Next I chose the “Air” movement from Grieg’s Holberg Suite. Stan had been focused on one image for two pieces, and the jewels had progressed from an unfeeling, two-dimensional visual apparition, to an emotionally connected experience. At first he would not own the image of his anxiety—noting that it appeared to have been drawn by someone else; and therefore, he believed, he could not get to it. With the impetus from the “Air” Stan was able to more thoroughly possess the image—attributing psychological meaning to it. His perspective about “jewels” shifted somewhat also when he acknowledged that jewels were simply and naturally: “rocks.” He opened up to a more visceral feeling of the image, as well. (I could also perceive the appearance of feelings in his voice, his face and his physical responses to the music.) This movement from Grieg has a musical home base that is filled with much more tension than the two previous pieces—this was to be the “working” piece of this session—and was to match the tension that was building. Similar to the other two pieces, the Grieg has a solid, repetitive accompaniment throughout almost the whole piece which is very useful for my goal of deepening Stan’s experience of the rocks. However, the piece is much tenser harmonically, and has a more complex development. Stan commented, “These are pieces of me, and I can look at them with a different light. The light hits the edge of one stone, and makes a glare. It is so bright that I can’t see the others. This brings tension because it puts an emphasis on one of the stones. I’m trying to perceive the others with my other senses. Some are more visual; some, I imagine feeling, the others, hearing. I need to use my other senses, I have to make the effort. It’s a good thing—they all should be noticed.” The therapeutic process for Stan expanded from a visual symbolic image to one that encompassed other senses, and most importantly: his feelings. The expansion evoked a new relationship for Stan with his anxiety. Armed with this increased apprehension, he was able to confront his anxiety instead of seeing it as separate and unconnected to him. “I’m trying. . . I have to make the effort… it’s a good thing.”

The second movement of the Albinioni Oboe Concerto in D major has a very different musical language, from the romantic tone of the Faure, Warlock, and Grieg. Most notably, it is baroque, and the prominent use of harpsichord differentiates it in timbre as well, from the previous three. (It is superficially similar to the Faure Pavane in its use of a staccato accompaniment with a fluid woodwind melody over it, but it is much more grounded and richer than the Faure.) My intention in choosing this piece next in the session was not to deepen the feeling; but rather, to provide structure and groundedness. Stan had done so much therapeutic work by accepting his anxiety on a feeling level and I thought, this was enough deepening for one session. At first, the more rigorously structured music of the Albinioni compelled Stan to respond with a defensive impulse to “organize” his feeling of anxiety, rather than simply to accept it. “Now, I’m trying to organize them,” he said of the jewels as the baroque selection began. Nevertheless, he immediately returned to his former perspective, remarking, “but no, they can’t be laid in rows. They must be in a mass.” He continued, “More than one stone catches the light. There is a harmony that there wasn’t before. All the facets face a certain direction. The light moves across them, and shows some similarity among the stones. The light makes them more beautiful. It is still sad, they are bits of sadness and anxiety. . . The light moving on them shows me the similarities . . They are visually disorganized, but I can see the harmony between them. It’s an expression of nature; elemental, fundamental. It’s still complicated, but more elemental; not unnatural. I feel I should embrace and welcome them. They are so fundamental. . .” I decided to play the Albinoni movement again, as I did not want to immediately curtail Stan’s passionate and sincere narration of his imagery. “They are pieces of nature; they are fundamental. It is a mystery, that’s part of the tension. As the light moves, I can see different colors. I can’t predict what color will be next, and I can’t see them all, but it’s natural. It comes from the nature of the object. There is light in the stones; there is inherent tension and mystery; it’s okay for it to be there. That’s a good thing.” In our postlude, Stan expressed to me that he understood that it was alright to be anxious, that anxiety is to be expected, that it is natural. “In my image, the stones are meant to be attractive and mysterious,” Stan explained to me. “It’s an inherent property of the substance. Judging them is like judging water for being wet.” Thus Stan showed he was prepared now to reconcile himself with his anxieties, accept them as having value; rather than run from them with fear and anger as he was wont to do previously. Stan’s initial imagery of haphazardly organized jewels in a bowl was imbued with feelings of natural beauty, “nobility,” (as he termed it,) and appreciation through the application of the music program. The tension in the music became identified with the tension inherent in the image of the jewels and once this isomorphism was established, Stan transferred properties of the music (beauty, clarity, aesthetic quality) to his internal struggle. This isomorphic relationship allowed Stan to accept his inner tension as beautiful, acceptable and natural; just as the tension in the music is beautiful, acceptable, and natural. The music did not alter Stan’s imagery as much as it altered Stan’s relationship to the image. Stan’s initial acknowledgment of his anxiety, prior to treatment, was not a truly felt acceptance of it; as evidenced by his initial image (it was lifeless, “not real”—a drawing) and his distance from the image, emotionally (it was two-dimensional and was someone else’s drawing). Acceptance came when Stan changed his view about the bowl of jewels, as made evident in his finding

“harmony” in the arrangement of jewels. “It’s an expression of nature; elemental, fundamental. It’s complicated, but not unnatural.” The music had helped Stan metamorphose his abstract angst into an aesthetically attractive image with which he was comfortable. On the surface, it may appear odd to suggest that it was a positive result for Stan to accept his anxiety. After all the goal of our therapy was to alleviate anxiety, not simply accept it, but this acceptance, and its healthy baggage of new insights and perspective, is prerequisite to amelioration. This GIM session allowed Stan to move from denial to acceptance. In effective GIM sessions, the therapist brings matching pieces of music to bear on a problem and guides the client to experience it deeply with a new responsivity gleaned from the music. This new response is then applied to daily life. For example, Stan reported that he returned to the jewel imagery when he experienced anxiety over a major financial decision. To this day, he continues to use imagery developed in our sessions to confront his anxiety. Bebe: Reconstructive Bonny Method “Long have I borne much, mad thy faults me make; Dishonest Love, my wearied breast forsake! Now have I freed myself and fled the chain, And what I have borne, shame to bear again.” (From the Elegies of Ovid, as translated by Christopher Marlowe) Sleepless in the tropics, Bebe, a woman just beginning her third decade, had first asked her physician for help with her insomnia. Her doctor, realizing that her sleeplessness was but one symptom of an emotional disturbance, referred her to a therapist. During seven months of verbal therapy it became evident that Bebe suffered from depression and that her boyfriend, Eric, with whom she had been living for seven years, was emotionally abusing her. She felt hopeless and helpless to cope with her feelings and with Eric. This became a central focus of her discussions with her therapist. In four months of therapy, Bebe had learned that her symptoms of depression matched those she had had at the age of sixteen when her brother, Kenny, had died. Aware of the necessity of addressing her depression and articulating clearly her recognition that she must extract herself from her relationship with Eric; she, nevertheless could not begin the exigent task of separating from her continuously abusive lover. She was fearful about the loneliness she felt would envelop her if she did. Weeks became months, and still, she could not leave. The excuses she enunciated for this failure to act encompassed her dread of loneliness, financial insecurity, and her misperception that there were “no other men out there.” Obsessive and irrelevant thoughts about Eric also thwarted her. She expressed anxiety and indignation over the thought that if she were to leave Eric, he would continue with his life “like nothing happened.” She rankled with jealous rage over her thoughts of him with another woman. Her primary therapist was of the opinion that Bebe’s resistance to leaving Eric was rooted in her unresolved feelings of loss from her brother’s death. Kenny had been the closest person to her in the world, her best friend. Bebe was extremely devoted to Kenny, and despite the fact that Kenny’s death did not come suddenly—he had died following a long illness—she still felt unprepared, and had difficulty allowing herself to mourn for him. Her

family had become fragmented during Kenny’s drawn out death, and had been unable to come back together even to mourn the immense mutual loss. She felt unsupported by them. They were not sympathetic with her feelings of helplessness, hopelessness, and loneliness; all normal reactions to the death of a loved one. Though she was only sixteen at the time of her younger brother’s death, she left home. Bebe’s therapist conjectured that this “geographical cure” for her feelings had left unresolved the feelings of depression she had at this time and that this was at the heart of her inability to leave Eric. Her fear of being alone, preferring abuse over the unknown future, stemmed from her feelings of abandonment when she was sixteen. Stuck as she was in this quagmire, her therapist did not believe medication was an answer for her client’s predicament; and so after seven months of verbal therapy, Bebe was referred to me for music psychotherapy. Bebe, stunningly elegant, well dressed, well spoken, strong, competent, quick thinking, and engaging when I met her, shocked me with her revelations about her emotionally abusive boyfriend. He persistently humiliated her, privately and in public; for example: making sexual advances to other women in front of her. After reviewing the facts of her case, we embarked on a series of sessions that helped her to mourn the loss of her brother. This accomplished, I felt that she was ready to address, head on, her current state of depression. In the prelude of our fifth session following three successful GIM sessions and one joint verbal session with her primary therapist, I asked her to close her eyes and allow herself to delve into the feelings of depression she was having—to not resist them—and describe them to me. She said, “I just feel down . . .The feeling is sinking, desolate, hopeless, there’s nothing to do, but I feel safe. I notice that I feel some fear. . . It’s like a knot in my stomach.” I challenged her to stay with the feelings of depression—to not reject or try to deny them; or fix them up in any way—and to allow the music to bring her an image of her depression; so that she could travel more fully into the feelings. I played a shortened Mostly Bach program (Bonny, 1977): Stokowski’s orchestral arrangement of the Bach Passacaglia and Fugue in Cm, BWV582; followed by Bach’s, Come Sweet Death, BWV487, and the “Sarabande” movement from the Bach Violin Partita in Bm, BWV1002. Bebe described her imagery: “There is a basement in New York. . .It’s dingy, depressing, there are lots of cockroaches, and it’s cold outside. . . How could anyone live there? It’s a basement, there are no windows, it smells, it’s very depressing. There is a painted door on the apartment and the music is opening the door. There is an old lady there, she’s an invalid, she looks terrible, she has a sad face, she’s wearing an old cardigan. She’s sad and abandoned.” At this point in her imagery, Bebe cried for several minutes. I encouraged her to “let the tears come,” and the crying built to a peak before finally receding. This was her first extended emotional catharsis in our therapy. She continued narrating her imagery as the Bach program played on. Further contemplating the image of the “old lady, she said, “I’m so sad for her, my tears are warm, though. This is like watching a sad movie. . .She sits, the clock ticks, no one loves her or thinks of her. I ask her how she is, but she doesn’t even respond to me,” she said. I asked her what the music suggested to her. “I am going to hold her hand—yes, that is comforting, it gives her comfort. Her hand is dried up and rough; she’s a little old lady, and this feels nice, it’s good. Oh, her name is Sheila and she wants to go for a walk. She’d like it if I take her outside. It’s sunshiny but cold. We chat, she likes this—its uplifting—someone cares about her. We’re having a cup of tea. . . I buy her flowers, we are watching the people in the park. It’s comfortable. She is happy,

glad to be outside; she doesn’t want to go back to her apartment. It’s dismal and lonely. In the apartment she just eats, watches TV, and wonders how come no one knocks on the door. The TV and food comfort her, but she is still very lonely. I feel sad for her.” Responding to this imagined empathy for the symbolic figure of the elderly woman, I asked Bebe to say what Sheila needed. “She needs me to visit her, take her to the hairdresser, to the movies, to visit others her own age in the park. . .on a regular basis. She just needs a helping hand and she’ll be okay.” As the music ended, Bebe said , “Now (Sheila is) not so desolate, she has some hope, energy, she’ll take care of herself, clean up, and think of herself. She won’t always feel good, but she is more relaxed, softer.” Bebe’s imagery immediately affected her life after the session. She was feeling stronger, and hopeful. “I’m still anxious, but I am ready to fly and I feel open to the future,” she told me. She was able to imagine, she reported, having left Eric and saying no if and when he asked her to return to him. She said, “I feel drained, but relaxed, and I know what I have to do.” Indeed, she conceived of a plan that would help her leave Eric; she decided to enroll in a six month educational program in the continental United States that she had been thinking of attending for some time. Reflecting on this powerful and transformative Bonny Method session later, I surmised that the invented “Sheila” was a symbol of Bebe’s depression, which had been unwanted, rejected, and hidden away from her own self since her brother’s death. Sheila was, in a sense, waiting for the return of Kenny. Sheila needed to take action, to move from the stasis in which she wallowed, and now Bebe was able to take her by the hand, and, figuratively fix Sheila’ life. In this session, when the tension of the opening musical material, the Bach Passacaglia and Fugue, matched the diffuse tension of Bebe’s depressive feelings, and stimulated a specific image of her depression (Sheila); the music brought an aesthetic beauty to the Sheila image (which represented Bebe’s depression) and made Bebe’s feelings of sadness approachable and bearable. Bebe was able to examine and appreciate her sadness rather than reject it. As she cried with the music, she was, finally, accepting of the sadness. In GIM, clients push beyond acceptance and begin true transformation. The music evoked the image of the dingy apartment (“there are no windows, it smells, it’s very depressing”) and the dingy old woman (“she’s an invalid, she looks terrible, she has a sad face,”) but once it did so, the music actually metamorphosed the image, (“I am going to hold her hand . . .She’d like it if I take her outside . . . She’s a little old lady, and this feels nice, it’s good,”) and in doing so, also metamorphosed her depression. “Now (Sheila is) not so desolate, she has some hope, energy, she’ll take care of herself, clean up, and think of herself.” As the music developed and changed, it brought fluidity, movement, and healthful processes to bear against the sadness, the image of Sheila. Even the locale changed as Bebe decided to take Sheila out to the hairdresser (improved self-image), the movies (ability to enjoy the excitement of life’s dramas), and the park (ability to enjoy the world, and life in general). The music activated Bebe’s positive internal strength (the part of her that could take care of Sheila) in order to take positive action in her own real life. The solution that the music brought was to hold Sheila’s hand and thus to connect with her sadness, accepting it unconditionally— not to judge Sheila as ugly, meaningless or in any way undeserving of hand holding nurturance and care—and to take action (a walk) to get her into the “light.” Bebe’s image of herself symbolized her own, positive, internal strength. The transformation of Sheila was the key to

changing Bebe’s inner life from one of depression and passivity to one of enjoyment and hope. With such an emotionally and symbolically powerful session accomplished, the application of the Sheila imagery transformation to her daily life would come very easily. We spent the next session exploring the levels of meaning in the imagery, as well as discussing her plan to separate from Eric. I was very attached to my own interpretation of this session and I was surprised that Bebe’s interpretation of the symbols of Sheila and herself were different from mine. But, her interpretation is what we discussed, not mine, which remained unspoken. In GIM the therapist does not interpret the imagery to the client; the client must glean her own meaning of the imagery. Bebe saw Sheila as a symbol of herself. She (Sheila) had been scared, needy, and sad. The image Bebe had named “Bebe” in the previous session, she determined represented Eric, the person she had been reaching out to as her sole comfort. She felt that “Sheila” was trying to avoid her internal feelings of sadness by relying on the diversion of socializing with another person, “Bebe” in her imagery. Contrary to my interpretation, she felt that the imagery was directing her to get out and be with her peers. She recalled from her previous session the advice she felt Sheila should heed, videlicet: “She needs. . . to visit others her own age,” which she interpreted as meaning to stop depending upon Eric, or anyone else to save herself, and to therefore leave her current life in order to make a new one. After seven more sessions (two of which were in tandem with her verbal therapist) Bebe left for school and told Eric that their relationship was over. The specific GIM procedures that I used with Bebe were designed by Helen Bonny. In the early 1970's at the Maryland Psychiatric Research Center and the Institute for Consciousness and Music, she created these specific procedures for an in-depth music listening session and called it Guided Imagery and Music (now called the Bonny Method, or Bonny Method of GIM). Rather than holding the client at a singular destination, it works through broad-based, free exploration of the unconscious. To achieve this, the Bonny Method utilizes an altered state of consciousness, with an exploratory induction paired with evocative classical music. Sessions unfold as the music suggests; but the suggestion is subjective and individual clients hear the suggestion in a myriad of ways. The musical selections alternate between tension and restfulness, complexity and simplicity. The “traveler” reflects the duality, exploring conflictual areas during the evocative, complex pieces; and returning “home” to positive resources during the simpler pieces. Bonny also created a series of eighteen music programs which are utilized in the Bonny Method of GIM. (To employ the technique correctly and safely, it is necessary to have taken a three year graduate or post-graduate training in the Bonny Method.) The Bonny Method centers upon the client's experience of listening deeply to a program of music. The therapist encourages the client to describe his internal experience (thoughts, feelings, images) in order to make it more real or vivid. Once the music brings images and feelings of tension, the therapist guides the client to listen deeply to the music, since it contains patterns of tension and release that the client translates into psychological solutions for his problems. The music program in Bebe's session spontaneously transformed Sheila from her state of depressed isolation into an active, functioning woman. A Continuum of GIM Practice

Each of these three case studies is concerned with addressing the emotional limitations that brought the client into therapy; each uses a different approach to these limitations. Kyle's internal and external world was filled with symptoms that were unmanageable and rigidly fixed; his distance from everyone had caused his relationships to be devoid of feeling, his character to be devoid of depth, and his life to be devoid of meaning. Supportive music and imagery served to circumvent his symptom in order to connect him with positive resources lying dormant in his internal world. Using positive inductions paired with simple, repetitive music with little tension, Kyle was able to develop compassionate responses within the therapy sessions that were then made useable in his real life—both with his patients and family. Supportive music and imagery therapy significantly improved Kyle’s life by giving him an increased healthy repertoire of positive internal responses to life events, instead of the ingrained negative ones. Stan came to therapy wanting to reduce his anxiety disorder, but psychologically unready to do so. His GIM session served to help him face, accept, and gain new perspectives on his anxiety. Using an altered state of consciousness, a simple induction focused upon his symptom paired with spontaneously programmed classical music and verbal guiding, Stan was "re-educated" and gained a different perspective towards his anxiety. For Stan, GIM yielded a new attitude of acceptance which reduced his anxiety and its effects on his daily life. Bebe came to therapy with a goal: to leave her abusive boyfriend, but without the ability to move towards her goal because of her depression. A transformative Bonny Method session uprooted her depressive symptoms at their core in the unconscious. Using an altered state of consciousness, an induction focused upon her symptom with an encouragement to “explore” during a predesigned program of complex, evocative classical music, Bebe was "reconstructed" when her unhealthy image was transformed into a healthier one, freed of depressive symptoms. For Bebe, the Bonny Method session yielded a dramatic transformation of her depression (a depression rooted in her brother's death) and altered Bebe's responses to life from passive acceptance to action. References Bonny, H.L. (2002). Music and consciousness: The evolution of guided imagery and music (L. Summer, Ed.). Gilsum, NH: Barcelona Publishers. Summer, L. (1988). Guided imagery and music in the institutional setting. St. Louis, MO: MMB Music, Inc. Summer, L. (2011). Music therapy and depression: Finding resources through music and imagery. In A. Meadows (Ed.), Developments in music therapy practice: Case study perspectives. Gilsum, NH: Barcelona Publishers. Summer, L., & Chong, H.J. (2006). Music and imagery techniques with an emphasis on the Bonny method of guided imagery and music. In H.J. Chong (Ed.), Music therapy: Techniques, methods, and models. (Korean language). Seoul, Korea: Hakjisa Publishing Company. Wheeler, B. (1983). A psychotherapeutic classification of music therapy practices: A continuum of procedures. Music Therapy Perspectives, 1(2), 8-12.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE SEVENTEEN Tools of Rediscovery: A Year of Guided Imagery and Music “T” and Jenny Martin Caughman Jenny’s Introduction In this narrative, “T,” a former client, presents excerpts from the journal he wrote as he engaged in music therapy. He had come to me to address issues of sexual abuse. During the fourth session, I suggested that we use Guided Imagery and Music (GIM), and he was open to this. I explained that I would guide him into a deeply relaxed state, choose music from classical music programs, and keep contact with him as he experienced and narrated his imagery. As is often the case in GIM therapy, there were also some sessions where we just talked. In his excerpts, he uses the phrases going under, came out, wake up, visited, and hypnosis. These are his terms that reflect his experience during the music and imagery process. We did not use hypnosis or an approach other than music and imagery. T had a total of 17 GIM sessions. As a GIM therapist, I have the honor of entering deeply into clients worlds, witnessing their unique strengths, struggles, innermost feelings, and beautiful creativity. In this narrative, T invites us all into his world. T’s Introduction What follows is a highly edited portion of over a year of my journal entries during Guided Imagery and Music therapy. I spare the reader a lot of detail about home and work, as well as some of the more jargon-encrusted philosophical musings of a relentlessly rationalizing mind trying to make sense of the experience. What are left are the sessions themselves, the highlights of what was truly a life-changing experience for me. When I began my course of treatment with J (the therapist), one of the first questions I asked her was if I was the oldest client she had ever heard of. I was assured that I was not. I would later recall that I was of prime age for the sort of Jungian insights that emerged. Early on, I exercised the convenience of labeling different aspects of my personality as I uncovered them. You will encounter references to the “controller” or “big guy” (my rationalizing instinct), the “middle guy” (my emerging emotional side), and the “kid” (the child that I was). T’s Journal April 29, 1993

I thought today would be just another therapy session; I would make some progress, get comfortable with J, and learn about Guided Imagery and Music therapy. We had covered a lot of core issues about how I coped with feelings, intellect, anger, denial, and other related issues. She had said last week that when the memories came I’d be surprised. They might not appear in an expected form but they’d be there when I was ready. I wanted them to come. I really did. I just wasn’t expecting them today. I thought I’d just do a little relaxation, free-association on a conscious level. The unconscious stuff slammed into me today like a sledgehammer and, two hours and two flashbacks later, I had drawn the first picture of my abuser on a shaky sketch pad. I still can’t believe that for the first time I left something behind with J and no longer have everything buried inside me. Stunned, incredulous, scared, angry, sad, happy, and confused, I didn’t lose control. Actually I lay there numb, cold, and tense while the visual memories just repeatedly slammed into the forefront and J gave me the choice of coming out of it or going back for more. She was there and I felt safe. I survived. My Thoughts on Saturday, May 1 I was angry at the well-intentioned but thoughtless “put it behind you” talk that I get from others. I was confused at the “let’s get it all over with at once” feelings. Here is a description of the session. It began with me lying on the couch, adjusting the pillow, relaxing, closing my eyes and focusing on each part of the body from my toes on up to my head, and, in J’s words, observing the state of each part but doing nothing about it. Quiet classical music was played. I was instructed to try to conjure up an image of somewhere I’d like to be. I tried to visualize an island in Canada and I was briefly successful, but the picture became cloudy almost immediately, swirling vortices of clouds. After a few minutes of clouds, I finally saw a stream and a tree-lined and sunlit embankment, not familiar but very pretty. The music was changing; it was getting fuller, swelling. I found myself walking in woods dense with foliage but still brightly sunlit. I looked up and saw the blue sky and indirect light on the tops of the branches. At ground level, I walked on a narrow dirt path not much wider than the width of my shoulders. Suddenly my field of vision was blocked by a sideways green face; it had little detail other than the eyes and nose. I was terrified, but it soon faded and I apprehensively resumed my wandering down the path. I was aware of a feeling of being led by someone to somewhere. The feeling grew and I reach the end of the path and saw a clearing with a little metal gate between two stone pillars. I was so apprehensive that I saw J’s office take shape around me, my eyes half opened, and I was asked if I’d like to return now. I said, “No, I’ll stay a little longer,” and immediately I was on the path again, facing the clearing. I could not go on, so J’s voice told me to turn around and retreat on the path, which I did. I came out into an enclosed valley with no apparent point of egress. I was momentarily puzzled as to how to leave, but then I remembered that I could levitate above the clouds, which I did. After a few minutes surrounded by clouds again, I gradually became aware that I was back in the office, but it was a full 10 or 15 minutes before I was sitting upright again, and my hands and arms felt strangely detached. I was shaky, confused, and elated. When offered a pad to draw on, I re-created the green face, and after staring at it for a minute, I realized I had drawn an impression of my abuser.

May 13 We talked about the May 7 session. The imagery was confusing to me; I had had unrealistic expectations of clear memories and I had merely managed to become aware of my two sides sizing each other up. I reordered my goals, placing first the necessity of unifying the personality over the recollection of memories. J was glad to hear me say this and told me that she was going to emphasize this if I hadn’t brought it up. “The process is the important thing, not the immediate result,” she said. She also said that she doubted my false personality thesis and reminded me that my one-sided analytical nature is a true part of my personality that has enabled me to survive by bolstering my self-confidence. Then I went under again. I thought I was unsuccessful. Try as I would, I could visualize nothing, only darkness, diffuse geometric patterns, and an occasional glimpse as if by strobe light of a small portion of something recognizable as an ear, an eye, the shape of a head. It began to feel like a cave, and I was frustrated that this session also was going to produce nothing in the way of visual enlightenment. Then it struck me like a thunderbolt. I was being watched. It was a child, my inner child, and the reason nothing could be seen was that this was what he saw. This was his hiding place so far away inside me that it was a world unto itself, unrecognizable, detached from anything I thought of as real. He was scared that I had found him, yet he reluctantly had allowed me to find him. We talked without words, a thought dialogue: I want to help you; please come out; I’m sorry about what happened to you; I could come again to visit. Then, I swear, I felt him — invisible and small — hug me. When it was time to leave, to come out, a part of this child came out with me, taking me by surprise. I was fearful that I was not up to the task of introducing him to my world. We had about a half hour of hugs, tears, and promises to give him time each day. He even wanted to hug J and the stuffed bear. This music and imagery is a most amazing tool. It seems to provide consistently in each session not necessarily what I want or am looking for but what I need for each new stage of growth. Although intellectually I know that the music stimulates the imagery, I am not always aware of the music in a session, and there are times when it feels as if the imagery is generating the music. Once again I am stunned by what is happening inside me and feel more real with each passing week than I have ever felt before. May 20 After the preliminaries, I found myself in the usual abstract cave. I was then transported into a steamy shower room and found myself looking through a fogged shower door. I wiped a hole and saw through it to a bright green wooded scene beyond. I became angry, shouting, “Where are you, where are you?” I had a sensation of being confused, of being fondled, and of its feeling good. I remembered being slapped and a glimpse of a mean face, of mean teeth. I didn’t like him. I told my mother I didn’t like him, but I was ignored. I felt more uncomfortable and told the therapist I wanted to come out. After I slowly came around, I was struck by the fact that the anger was a little anger, not the adult rage I was used to. My biggest surprise, overall, was being able to handle the little anger. May 27

I was asked to picture a child playing. Immediately I saw myself around four years of age, overdressed, playing alone in my room on the floor, very quiet and very alone as was usual. Quickly the image faded to be replaced by the familiar green path on which I was walking with a companion this time; my inner child was leading me to a deeper spot where I knew I would willingly be presented with further memories. When we got to the appointed place, he turned and faced me; he was waiting, looking at me, and ascertaining the moment when I was ready. After an uncomfortably long silence, I asked him to show me. Through the gloom, I was then presented with a series of freeze-frames, scenes of sexual abuse interspersed with long pauses. I didn’t want to re-experience them as he did, for to do so would be to experience them alone, so I merely watched each moment, although for one split second I felt each of them. What came out of it all was the sensation of being sad and sorry he experienced it all alone. Again, upon awakening, the memory became clearer but more detached. The adult anger was back: anger at the wasted years, at the aloneness, at my mother for not believing me. For quite a few moments, I couldn’t look at J because of my shame. I even asked her, “Why can’t I look you in the face?” She said it was because she was now a witness. I was uncomfortable with that and so sad. It is real. It did happen. June 10 J asked, “Why the ice cave?” “To hide, obviously,” I said. “But,” she reemphasized, “a large ice cave?” I entered the imagery looking for the ice cave and the kid. I found him, and he was angry and not interested in looking at memories. He told me I could do it without him today and promptly went to sleep. So I watched something get close, got scared, and stopped it on my own and I came out of it. I got the strength I wanted: my own ability to control what occurred. I also remembered stuff about [name deleted], the dirty records, and everything else questionable about him. July 1 I went deeper into the imagery state, into a black hole, where the eye — which was me, the eye that saw everything — and the kid took me back to relive the abuse vividly and more violently. I felt the six-year-old die inside and I let more of the anger out. There was still more. I told J that next time, I wanted to tear this stuff up. I drew a picture. It was a painful picture of a bleeding child being chewed by a large mouth, as in Goya’s Saturn. I told her that losing hope for one’s children was even worse than losing one’s religion or even losing faith in oneself, because losing hope in your children was losing hope in the future. The next day I asked myself if this was real. At first, I minimized it and said, “Well, something happened,” but then I reviewed everything I’ve lived with and the something became more tangible. I was hit full force again by yesterday’s experience: the anger, the depth of the imagery, the body memories, the shaking, the dissociation from my body, and the catharsis. Whatever happened with the abuse was becoming more and more real each week. No wonder I said that I died at six. I must tear it up and expose every last bit of it.

July 15 I don’t know how to write about the little one. Little Owl, I’ll call him, though his name is mine, of course. On Thursday he came out and pushed the big guy (my rationalizing self) out. After two weeks without therapy (J was on vacation), it took about 40 minutes of talking to feel safe again in her office. After a few carefully chosen questions by J, out he came. He played and drew pictures and wouldn’t answer big guy questions. He periodically looked over to where the big guy might be, like a kid who wants to play outside but is afraid of being called inside by his mother. The Little Owl was afraid because of the controller or big guy (my rationalizing self) and mad because he hadn’t received any attention the past two weeks. He didn’t want to talk to the big guy. This dissociation, if that’s what it was, occurred without music, guided imagery, or hypnosis [with only art and discussion]. I found this somewhat disturbing. August 12 After describing to J my current emotional exhaustion and my depression over future recovery, I asked her if I could go deeper into imagery to understand this middle guy, this bundle of undirected emotions. “It’s not up to me,” she said, and while I was wondering if this meant that she had to get some sort of permission from a supervisor, she said, “It’s up to you.” In other words, I could will myself deeper any time I liked. I was so upset that it took longer than usual to accomplish the entry or relaxation phase of the process. Then she asked me to visualize a knapsack and to reach in and pull out three objects. I pulled out, in succession, a child’s rubber ball, a frog, and a feather. I immediately saw glimpses of an owl’s face and felt as if I had a guide with me. J then asked me to go where I needed to go and to describe what I saw. I saw a deep, dark pool of warm, undulating water, and it was soothing and restful. I described watching the frogs, catching them, and then letting them go because it was their home. The ball gave me slight anxiety, and I figured it was a childhood memory of some sort. I then saw the sky through green treetops; the sky became clouded over with dark, moving shapes. I lay down, and the shapes surrounded me. They seemed friendly, nonthreatening, even caring. They looked like the light aliens from the movie Cocoon, and they were smoothing chunks of color on me, slapping and filling, adding stuff to me. I then went into an abstract wilderness I recognized as the cave. I couldn’t find anyone, so I called out and challenged the abuser to appear. I saw snarling dogs, snapping snakes’ heads, but no abuser. I realized he was afraid of me. I felt enveloped in a warm, powerful cocoon. Then it hit me. I felt anger, but it was my anger, mine, it belonged to me; the anger was a tool I could use, and I need not be afraid of it because it was mine to use to protect myself as I saw fit. I flew out of the cave, semi-aware of the swelling, heroic music. I was laughing and crying at the same time, exhilarated with this new discovery. I had found another part of myself. By the end of the week, I was feeling relentlessly uncertain. No sooner had I patted myself on the back for facing my anger and feeling strengthened by it than I felt an ominous buildup of something. It was like racing a train to an intersection or detecting an early tremor before a major earthquake. It was the real stuff, not just flashes and glimpses. I told myself to believe what therapists say: “It can’t hurt me now.” What they say is not true. It does hurt. It will hurt and it’s necessary. God, I hate this.

August 25 I worried about the kid not being able to grow along with me, but J reminded me that he’s a part of this process, that he’s gotten to hear me say, “I’m sorry.” This seemed pretty small and pathetically inadequate until J reminded me that the kid didn’t hear it the first time the abuse happened. A cosmic “oh” came from me. J suggested that the kid has also shared his experience with me. This I doubted, since I had experienced him as having faced it alone. J pointed out, “But you now remember it.” Another “oh” came from me. The kid was suddenly becoming as real as the memory. The old controlling side of me was becoming an annoying nuisance. J said I should treat the controlling side as I would the image of someone in a bear costume: “Oh, it’s just that guy in the bear costume.” I asked myself, “Why did you hide in the cave for so long? Why is the cave so big? Why were you afraid? Why did you choose not to feel? What happened to you that made all this necessary?” It is now safe to remember. September 10 I didn’t know what J was asking me today. I didn’t know the meaning of the imagery today. I was very confused. I visited a different cave today, one that captured my attention, an intense vision. It ended with a woman’s face suspended above me. I longed for the face, longed to reach up and pull it down and to kiss it, but I couldn’t. Was it a spiritual vision, a birth memory of my natural mother? Why did I have the irritation and anger about J’s questioning my motives, my desire to examine memories of my father? What happened today? What was going on? My Thoughts on September 16. Instead of waiting to heal before I tried to regain my spirituality, I should work on my spirituality to aid my healing, especially since its loss seems to be a background issue that keeps coming up. I am thinking more and more about that car ride in New Mexico when I was a kid. I’m feeling powerful enough not to be afraid to follow the fear trail. I’m beginning to get a clearer picture of what happened. September 22 My body was traced by a ray of soft light. The ray shone on a box. I opened the box, taking out a grapefruit-size lump of black crystal with sharp edges. It led me to the path and the cave, to a state of no fear and the realization of oneness: the smooth face, the old face, the mouths, the teeth, the patterns, the light. The imagery showed more strongly than before that everything — the fears, pain, personalities, memories, longings — is one vision. It is not to be analyzed but to [be held], to return to, to project with, to commit to. The imagery was wonderful, but it is a strain to think about it. I can’t analyze what was really an imaginary experience, but I can’t let it out of my sight either.

Later at home, the memories were very close; I could touch them. In my own relaxation session, I looked into the box again and took out a dirty rag. I had the choice of burying it or washing it, but I chose to carry it around. In the dark, I saw the teeth again, once sudden and clear, once more hazy. I was thinking that I have the choice to move forward with healing or look back for more memories to reexamine. This choice will always be there. Shame seems to be one of the emotions there today. I know I am depressed, feeling powerless and even afraid. I am afraid that, presented with the chance, I would end it quickly. I’m not in good shape. I’ll call J. [I did make the call and extended the contract with her not to hurt myself.] What does it mean that this is the first time I’ve ever had this thought? Do I have to remind myself that I have the power to take care of myself? October 8 Today I decided it was the kid who’s been slighted this past week. I found him, asked him about the teeth, and told him I was ready and not afraid. He was reluctant but not afraid and called me stupid. I told him I knew what it meant, but what did it signify? He showed me how it wasn’t fear of the actual abuse but of the repercussions if I told anyone what was the origin of the fear I’d been living with all this time. After examining it a bit, I decided it was time to leave. I’d had enough for one day, but then the kid went spinning off on a wild visual ride that was fun but heading back toward darker matters. I had to remind him that I had already decided to call it quits for the day and to take him firmly back. It was a matter of control and parenting. Considering that loss of control was one of my issues this past week, this was another interesting development. It was more than a minor insight and a little less than a major breakthrough. The lesson was to work with my kid and to not leave him out. He’s the smart one. Together we analyzed fear without being afraid, and he showed me something important: be firm but not authoritarian. We must work things out jointly. October 29 Today I experienced a feeling of falling, spinning, disorientation, and then rapid flight into the cave. It seemed uglier than I had remembered it and not wondrous at all. The kid let me know that there were still things I didn’t understand about the cave, not memories but connections. He said that he would show me more, teach me more at a later time. It felt good to be with him again. He also seemed to let me know that the cave wouldn’t go away, that it shouldn’t be forgotten. J materialized, full face and beautiful, and the kid then drifted over and curled up in her lap and went to sleep. After I awoke from the imagery, J and I discussed transference. I wondered why the kid had what I didn’t. I felt jealous that he could get the nurturing but that I couldn’t — the grownup me couldn’t. J has nurtured this kid. He feels safe with her and he trusts her more than me. He trusts my wife now, too. This jealousy is the first sign of real transference, anger at my mother for not being there to nurture and accept me. No matter how much I can detach and analyze what’s going on, the emotions are real and strong. I’m glad I trust J to understand this complicated state I’m in.

November 10 I visualized a table with a box on it. I pulled out three objects once again. The first was a ball, but a small, hard, blackened one. The second was a feather. The third was a piece of embroidered cloth. I clutched them tightly and I was nervous. I didn’t want to let them go. The ball is the abuse, the feather is the guardian or guide, and the cloth is the church. The Owl called me to fly. He wanted to take me aloft to a high place and have me drop the ball. I reluctantly went along. He said that after the ball was dropped, I was to drop the other two objects and that I would not fall. He said that I would become the Owl. Reluctantly, I did as he asked. I did not fall, but I did not become the Owl either. That, apparently, was for later. I thought that maybe the child would have a better idea of how to do this than I [did]. Then I was given a demonstration. The Owl wrapped himself around me like a coat, and I flew. I soared. I no longer had hands to carry things, but I had wings, a new life, and a new environment, the air. It was a complete change. It made me apprehensive, this newness, but I can’t go on living the old way. When I awoke from the imagery, I was irritated that I must wait for the child to figure this out. I didn’t want to leave the session room. I wanted to relive again and again what I’d just experienced. I thought that I must become my very own hero. I wanted to clutch a very powerful sword. I wanted to hear the music again that led to this vision. December 8 We talked about my son, and about grief and spirituality. Afterward, when I was asked to name my good qualities, I couldn’t and I was very uncomfortable. I got a homework assignment to ask my wife to write a list of my qualities and to name two on my own. As soon as I went under, I sensed that the light people were waiting in high spirits for me and were eager to see me. They told me that they wanted to show me something and escorted me into the cave. Their positive energy illuminated the ugliness and it was more like a picnic or a visit to a museum. They told me there was another center of power within me, not creative power but a stronger, different one that I was as yet unaware of. I could see it, a hard, green crystalline orb giving off rays of light, very strong, very powerful. I didn’t know what it was, but sensed it was spiritual power. They kept asking if I saw it. Soon I did see long filaments of light streaming from my fingers, dancing in long arcs out of control but not dangerous, rather harmless and untrained. They said I was beautiful, and I was uncomfortable with that comment. I felt extremely tired, so they let me go to sleep. I woke up aching, as if I had a bad night’s sleep. March 17 This is the one-year anniversary of this therapy. We talked about the progress I feel I’ve made over the last year. During the relaxation phase of the imagery, I was asked to describe an object I found in a small box. I saw a bunch of keys on a ring, the many keys for many doors in my possession, to be used whenever I wished to. I then saw the eyes and beak of the Owl, which caused me to giggle. He kept getting closer and closer, and I could see every detail on

every feather; I could feel the feathers. Then I realized I was merging with the Owl, becoming the Owl. We/I flew to a dark place. I felt myself being sodomized and felt the anger, disgust. I waited for it to be over and then I left my body and rapidly rose upward, higher and higher, until it was cold and the air was thin and it became harder to breathe. I felt so numb, so separated from my body that I wanted to come back. Even the rape was preferable to this feeling of total separation and numbness. When I opened my eyes, the light in the room was blinding. Mentally I woke up, but I still felt very detached and had a difficult time regaining the sense of my body. March 24 I visualized a childhood campsite at Deer Island in Ontario. I was alone, in the present, exploring this site of an early childhood experience. It was overcast, deserted, with no resonances of past experiences. It was not frightening but merely sad, a wistful dead memory. I left it by flying above the clouds. The scene faded into close-ups of pine needles and branches pulled back to light a path on a mountainside; it was a different path. I was alone on it, but it felt safe. The turns led around flanks of the mountain, with a brilliant glow always just around the next corner. Transparent, ghostly images of J and the kid appeared, there and yet not there. I knew I could still fly, but that tool was only to be used on special occasions. I belonged on the path on the ground in normal day-today life. I was suddenly aware of my physical body during the visualization. I felt it; I was not detached. My body was warm and comfortable. I woke up in J’s room, this time body first, with my mind lingering. T’s Conclusion When I first started therapy, the issue of memory seemed of paramount importance. I had a wall of fear separating me from memories of the abuse I sensed had taken place. Now, at the end of this process, the issue of memory is not so simple. I did indeed confront and overcome most of my fears. I did reclaim quite a few lost memories, some of specific sexual abuse. The specific memories came almost always after an imagery session. I re-experienced feelings and images of sexual abuse during the session itself, but they were rarely clear and often of a symbolic nature. I have doubts as to what happened and by whom, yet the process has led to new intrapsychic awareness and insights, and finally to a reintegration of personality. More important, an agenda that had remained unspoken at the beginning, the recovery of spirituality, revealed itself as if by happenstance halfway through the process. In the end, the vision of wholeness supplanted the need for clarity. In the deepest sense, I received not want I wanted but what I needed. It’s now been three years since I concluded therapy. I’ve stopped holding my breath. It’s not enough to state that these changes have taken hold. I seem to be an entirely new person, but not a stranger. Everything feels different, but very comfortable. I handle day-to-day stress differently. I enjoy not feeling compelled to analyze things to death, but instead reacting simply on an emotional level to things and letting them pass. Reason seems merely a helpful tool for occasional use, instead of a fortress to hide within. I find myself saying “it doesn’t matter” to a surprising number of external influences on my life.

I still get upset easily when confronted by reminders of sexual abuse, but I can simply feel these reactions and let go of them. I still prefer the company of my women friends and I feel no need to change this. I am increasingly comfortable around men. I no longer feel a twinge when reminded that I am an adult. It’s now safe to grow up. There do not appear to be separate compartments for the various elements of my personality. There is no separate little kid, no controller, no muse. Instead, there seems to be a well of energy that has a new focus. I’ve learned to access almost at will a creativity that interprets what’s going on inside and then allows me to project it into writing or play or work or meditation. It seems that the imagery I awakened in therapy is now just below the surface of my everyday life; in a way I am living on the level that I so recently had to dig deep to investigate. The anger is not gone and the losses are still here, but they are a part of the whole. They do not block off that inner self that used to hide in fear of them. The greatest gift of all is the realization that my new spirituality now consists of feeling the connections between my day-today living and the whole that I am a part of. The whole contains past, present, and future, joy and sorrow, the presence and absence of loved ones, growth, loss, anger, and inner peace. It is all part of the same fabric and this fabric is more than just my life. It contains all relationships, the world that I know and the world that I don’t know. Everything seems a part of my life and my life is a part of this greater whole. It is this awareness that feels, once again, like prayer: a source of deep peace and contentment and an acceptance of how strange and wondrous life really is.

Taken from: Hadley, S. (Ed.) (2003). Psychodynamic Music Therapy: Case Studies. Gilsum NH: Barcelona Publishers.

CASE EIGHTEEN The Voice from the Cocoon: Song and Imagery in Treating Trauma in Children Susan Bray Wesley Abstract This case describes a four-month course of treatment for a 10-year-old boy with a life history of physical, emotional, and sexual abuse. The treatment included singing, and music relaxation experiences based on a modified form of the Bonny Method of Guided Imagery and Music. By providing access to the sound of his own voice and creating a small repertoire of imagery skills, the patient was able to demonstrate initial signs of self-monitoring and selfcontrol over explosive behavior. Introduction This chapter describes one case from a project examining whether therapeutically based music interventions increase treatment efficacy for inpatient children at a psychiatric hospital when including ambient sound as a contributing psychological stressor. The purpose of psychiatric hospitalization is to stabilize, mediate and regulate, or change behavior. To that end, the interventions discussed, in the case which follows, were compliant with the hospital purpose but were unlike the traditional interventions used on the unit. Through the use of song and modified Bonny Method of Guided Imagery and Music, the patient demonstrated elementary acquisition of behavioral regulation by attending to his body’s cues related to his trauma history and auditory triggers. Background Information The Setting The setting of the study was The Acadia Hospital in Bangor, Maine. The hospital contracted for six hours of music therapy to serve children both in outpatient and inpatient treatment programs. Music therapy techniques employed with these children included large group music/movement, small group improvisation, and an evening lullaby time (inpatient only). The Ambient Sound Environment

Trauma literature is rich with information about what can/may trigger flashbacks and assaultive or withdrawal behaviors. Many of these triggers are sensory. After working on the unit for eighteen months, and experiencing such auditory assaults as doors slamming, overhead pages and codes in the midst of quiet-time, carpet scrubbers, vacuums, turbo carpet drying fans, shouts, and cries of distress and rage (all being part of that ambient sound space), a study with a focus on auditory triggers seemed logical to me. Seeing so many children (and staff as well) in a state of tension and operating almost from a startle mode piqued my curiosity about how much the ambient sound of the unit could be contributing to patients’ behavior. I felt I was on the right track when I further investigated what the research literature said, or more important did not say, about sound/acoustics relative to the impact of the design of healthcare facilities on patient outcomes. In particular, the 1998 meta-analysis of research on healthcare design for healthcare facilities, conducted by the Center for Healthcare Design, identified only twenty-five studies referencing noise and music, out of the 78, 761 titles that were examined for other design concepts such as way-finding and color (Rubin, Owens & Golden, 1999). The most powerful affirmation for me, however, came through some of the neurological research literature associated with trauma. Several researchers have documented that brain cells can be “recruited” for particular purposes as a result of strong interactive experiences; in other words, extra cells might be recruited for hearing rather than for seeing. Furthermore, deprivation or alteration of needed experiences can produce a range of deficits. It made sense that trauma could interrupt emotional development leading to deprivation or alteration of sensory experiences by shutting down, so to speak. Therefore, if auditory stimulation triggered flashbacks for some patients, primitive or developmentally delayed behaviors might result. This was what I believed I was seeing in several children and one in particular. The Patient Bruce was a 10-year-old boy admitted for hospitalization. He was removed from his parents early in his life due to severe physical and emotional abuse and neglect. He also had been subjected to repeated sexual abuse. During one of his foster-care placements, he again incurred sexual abuse by yet another caregiver. Bruce’s behavior became increasingly uncontrollable, assaultive, and destructive. He was given the diagnosis of post-traumatic stress disorder with dissociative features at the time of his admission. On the unit, Bruce became immediately known for “that look.” It was described by staff as “wild, terrified eyes,” and became the cue for a major meltdown which often led to a net restraint on his bed or a papoose and medication. Bruce arrived in the late summer and joined the weekly song/movement group with the rest of the milieu. Sessions are 45-minutes long in a large group format. All the children (census of 20) are expected to attend unless they are in visits, with clinicians, or unsafe. Bruce was extremely quiet and rigid in both posture and presence, but when he began to sing his affect softened. He had a rough, but potentially strong, boy soprano voice. Bruce did not attend the two sessions following his first session, because he was either asleep from medication or in restraint. The next couple of times that he did attend, he was only able to maintain appropriate behavior for a short time and would have to leave due to his silliness. I also tried to include him

in the small group music improvisation sessions but, once again, Bruce’s attendance was minimal. Because of assaultive behavior earlier in the day, he was often medicated and sleeping, restrained, or room-based. In many ways, Bruce was typical of most of the children on the unit in that his diagnosis of trauma was based on a history of severe abuse and neglect. It appeared to me that Bruce was one of the patients who might benefit most from auditory interventions based on what might be auditory triggers. My hypothesis was based on reports from his staff and clinician that his symptom of “the look” was the only available cue for when he would go into a major bout of assaultive and dangerous behavior. They also believed that his triggers were not visual, or at least visible, since there appeared to be “nothing going on in the room” when he decompensated. In addition, I noticed that he liked to sing, was good at it, and perhaps there was an auditory connection to his trauma, as well as possible therapeutic interventions. Treatment Bruce’s treatment consisted of two phases after his music therapy assessment. The first phase was 12 weekly 45-minute sessions held in the evenings. These sessions focused on active music-making for energy release and raising self-esteem, and relaxation skill development. The second phase consisted of daily 20- to 30-minute sessions planned for eight weeks. The focus of these sessions was to increase Bruce’s awareness of his behaviors that were stimulated by sounds generated basically from the unit milieu, and to increase his experience with therapeutic music exercises that could be used autonomously when Bruce recognized his anxiety being triggered. Music Therapy Assessment Bruce’s formal assessment was based on a modified form of the Multimodal Psychiatric Music Therapy assessment by Cassity & Cassity (1998), after which he was introduced to a series of music activities. The activities, after the formal assessment, included Bruce’s exploration of various percussion instruments and singing in order to assess such skills as ability to keep a steady beat, identification of basic rhythm instruments, and comprehension of music elements like dynamics, tempo, and melodic direction. Bruce agreed that he would like to continue to meet with me once a week to use music for “getting his sillies out” and for relaxation techniques. Treatment Plan and Process--Phase 1 Bruce’s treatment was designed for 45-minute sessions once a week during the 5:007:00 evening shift and began the week following his music therapy assessment. Bruce’s goals included demonstration of confidence in singing; identification of specific moods or emotions through the selection and playing of instruments; and relaxation using music and imagery. The goals were intended to help Bruce develop conscious awareness of his auditory triggers and how he could use music to interrupt the violent thought process that sprang from such triggers. This plan was followed for twelve consecutive weeks. My approach to each of Bruce’s sessions

depended on his psychological and emotional availability on any given evening or day, due to his overall volatility. Session 1. Bruce’s first priority was to build a song list and to sing as he built it. Bruce chose traditional children’s songs like “This Land Is Your Land,” “This Old Man,” and “Bingo.” He became relaxed and laughed at “silly” words as he sang. I introduced him to the song “Don Gato.” It is in a minor key and is about a cat that falls off a roof and supposedly dies, but then springs back to life when carried by the fish market. The song is usually sung fast but Bruce asked to slow it down and his affect became pensive. I asked Bruce to name some “feelings” and he said sad, upset, angry, and mixed-up. Then I asked him about what he did when he felt these. He described coping skills, not his behavior. He said self-time-out for upset; deep joint compression for angry; and blanket wrap for mixed-up. He had nothing to say for sadness. I noticed, too, that all the coping skills he provided isolated him from others and focused on “containing through pressure” any potential explosion resulting from feeling upset, angry, or mixed-up. Perhaps his inability to articulate clearly about what he felt during any of the emotions he named was a defense. If it was, it was quite unconscious. Having observed his “wild eyes,” and looks of terror when he entered a bout of assaultiveness, I had no doubt that he had few, if any, words to describe what indeed was coursing through him at those times. Bruce was quite willing to work with me. Perhaps his lack of resistance to my meeting with him, even at the start, had to do with the quiet space and the one-to-one interaction. We used a well-lit office with several windows at the end of the corridor. It was carpeted and not cluttered and I had many instruments nearby which Bruce found intriguing. Session 2. Bruce asked to use the large elastic band with me. He said that he had too much energy and wanted to “tug and pull.” So we did, to some hammered dulcimer jigs. Then he asked for the drums and “pounded.” At this point, Bruce asked about relaxation to music and if he could try it. I showed him a bag filled with large colored scarves and asked if he wanted to use any for a cover or pillow or blanket. He chose red and green. After a breathing exercise, I played Respighi’s “The Nightingale” using a voice-over that included clouds, birds, a big tree, and Bruce sitting on a big rock. I chose a setting that would be familiar and grounding to Bruce. He liked being outdoors and had talked about his backyard from time to time. His comment at the close of the session was that he felt calmer and liked the use of the colors and music. Bruce chose red and green, the colors of “stop and go” or “heat and growth,” and unprompted, he had asked to try the relaxation. Session 3. Bruce asked to do only the relaxation exercise. He chose a red scarf and explained that it would be his cape. I used new-age music infused with bird and stream sounds and suggested that he begin in his backyard again and let his imagination wander with the music. During the music, he reported, “a bear with cubs is playing around and catching something in a stream.” There was a gap in his comments and then he saw “a couple of birds-blue jays” and then nothing. Bruce used the music for imaging, without my guiding, without difficulty. Bruce chose red again and requested only the relaxation with music and imagery activity. The bear cubs (siblings) were with the mother and they were all at play but also “catching” something in the stream--perhaps this was something to nourish. The possibility that Bruce might feel at some level as if he was being nourished occurred to me briefly, but his reference of missing his

brothers, from an earlier conversation, made me wonder if he was recalling a playful time with his siblings. Session 4. Bruce chose hand drums and tambourines for improvised conversation and then wanted to sing. I asked Bruce if he had ever heard himself sing. He said no and added that he did not think he was a very good singer. I felt sad that Bruce did not know that he had a good voice. I wondered if that could be a reason that he had no named behavior or coping skill for sad. When he sang, his affect always brightened and that felt like a clue to some possible sense of security deep inside to which he might learn to connect. I felt more strongly that Bruce had “learned” the coping skills of choice on the unit, but none of these addressed sadness or ways of dealing with self-comfort, unless he was to “talk” to someone. Session 5. Bruce began with a lumi stick accompaniment to recorded music followed by a song and Bruce playing the Omnicord. He asked to do the relaxation next followed by the elastic band. However, before we settled into the relaxation, we were interrupted for his evening medications. Shortly after the nurse left, I noticed a very distant look on Bruce’s face, and I became aware of some commotion in the hallway. Then he looked right at me and asked if he could leave in order to go and use a coping skill in his room--“I feel unsafe.” My reaction to the session was one of anger and affirmation. I was angry about the interruption, but the observation of Bruce’s complete shift of attention and affect affirmed my belief that his auditory system was hyper-alert and affirmed the reality that our safe container could be easily invaded. Session 6. There was a scattered and somber feeling as Bruce had difficulty deciding what activity to start with. After wandering around the room, he asked to sing. His first choice was “Don Gato” and then “Silent Night,” followed by two more Christmas songs (it was two weeks until Christmas). Then Bruce asked for the elastic band and we did some relatively energetic tugging. When I offered the possibility of doing some imaging, he became very ambivalent and said no. It felt like the session was a rebound to Session 5 and we were back into the “getting to Trust you” stage. Considering his choices to sing and tug/pull it felt as if Bruce was struggling with a loss. Session 7. I suggested to Bruce that he try his hand at composing lyrics. I wanted to assess his emotions or moods through a story line. He chose dinosaurs for the subject. Although a primitive and potentially aggressive subject, Bruce’s dinosaur was a colorful (purple, green, blue, and yellow) plant eater by the name of Stevie. Stevie was “long” and “liked to eat leaves and ivy.” When I prompted the thought of a carnivorous dinosaur by asking “But does he eat the ants?” Bruce became very playful and exclaimed “No, I said PLANTS.” I noted that purple is the “mixed-up” color resulting from blue and red, sometimes considered “dragon fight” colors or colors of separation from the parents. Green was again included and perhaps as a sense of “re-”newal or potential like spring or the “go” of a traffic light. Then the colors of blue and yellow combine to make green but were named separately. Depending on the shade of blue, it can represent an engulfing maternal connection. Yellow can be interpreted as related to solar or masculine. My assessment was that Bruce was beginning to connect, albeit unconsciously, through his musical experiences, to additional means of expression and communication. Through my various trainings in color interpretation, my interpretation was that the yellow of the masculine was combining with the blue of the maternal and perhaps Bruce’s courage was

growing to connect with his own young masculine nature within a nurturing environment of the music with me. Session 8. Twenty minutes into the session, after playing a drum, bells, and triangle, Bruce suddenly asked to leave to go to his room to use a coping skill. It was three days after Christmas and the milieu was chaotic. Bruce’s affect that night was flat and his day had been uneventful. His lack of interest in the session felt odd. It was, however, another opportunity for me to encourage his decision-making process about coping skills that he could choose to keep him safe. It was also another opportunity for me to observe that with a highly stimulating environment (holiday visits, toys, candy, and “vacation-like” schedule), Bruce was seeking less stimulation not only in his instrument choices, but also overall in a shorter session. Session 9. Holidays were over and Bruce requested an imagery session and chose a lapis blue scarf. He asked to be wrapped up in it like the “blanket-wrap coping skill.” I called it his cocoon and used a voice-over about the image of a cocoon being warmed by the sun and held securely by its wrap while connected firmly to the limb of a big tree. The music was new-age piano music with nature sounds. It supported the concept of gentleness and security. Bruce drew a picture of his cocoon. From that session on Bruce referred to the “cocoon wrap” as a favorite place. With this comment, it felt as if he had made another connection. He integrated the use of music, a safe image, and a unit skill as a “cocoon wrap” and it was completely his. The color choice of lapis blue can be interpreted as resting in the arms of a kind and gentle mother figure. Session 10. Bruce began by playing lumi sticks to an upbeat recording. Then he requested the music and imagery relaxation. His colors were blue and green. He wanted to lie in the “grass” and have the “sky” above him. I used a 10-minute cut from a minimalist new-age CD (wind sounds included) with a voice-over that encouraged the stability of being supported by the earth in his grassy place and watched over by the bright blue sky. He stayed with that image and drew a “grass and sky” picture. The colors of bright green and lapis blue can be interpreted as healthy choices and the fact that Bruce designated them to be the grass and sky and he would lie in the grass was a grounding choice. The drawing of his imagery showed that he could attend for over ten minutes to a positive image. His affect was positive and pleasant throughout the session. Session 11. Bruce asked for the music and imagery with “the music I used last time.” He chose the lapis blue cloth, asked me to roll him up cocoon like, and off he went for the tenminute cut. When the music ended, he went directly to drawing. I had put out black paper for this session, as an introduction to the concept of brightness even in darkness, and Bruce did not question it. He drew stars in the sky, a tree, and a critter emerging from the cocoon. His cocoon and the emerging critter were rusty brown; however, on black paper it looked red. This did not seem to disturb him. His affect was positive and his demeanor quiet. He showed no signs of anxiety or tension building. The choice of a blue wrap and the resulting red cocoon and critter felt congruent with my sense of his inner struggle, red sometimes representing anger. Perhaps his awareness of his unconscious anger/rage was becoming conscious. Bits of starlight were shining on the cocoon, as it emerged under the night sky. The tree was only an outline, and although its roots appeared important since the ground bulged, the trunk ended definitively with a line drawn across the top with the canopy like a spiked head of hair coming out of the

top, simply sketchy green strokes. The canopy’s growth appeared to be stunted or at least delayed. I had a growing concern about the frequency and the possible dependency Bruce might be having on me. I was providing the music and some image suggestions and of course the breathing exercise. I decided it was time to increase my effort in guiding and encouraging Bruce’s awareness and use of his singing voice. My biggest concern was that if Bruce was discharged at anytime soon, would he be more or less vulnerable to the auditory onslaught of the “normal” world? When the auditory triggers caught his attention, instead of the assaultive responses he had learned from his inner voice that said “survive at any cost,” perhaps he could sing to calm himself. Session 12. I suggested to Bruce that we make a tape so that he could have a “sing-along” anytime he chose. He was fine with the idea and we used his song list to select tunes. His reaction to his own voice was “that’s me?” He was very pleased and even chose to add simple percussion instruments to his singing. Bruce’s reaction and sense of pride in his first efforts to construct his own tape were powerful. He sat taller, smiled, and even asked to run the tape machine. At the end of this session I decided to redesign his treatment plan and process. Treatment Plan and Process--Phase 2 Bruce’s psychiatrist and clinician were in full support of an increase in music therapy sessions. The schedule was for daily thirty-minute sessions for eight weeks beginning in the first full week of February. Bruce’s new goal was to practice consistent grounding and self-affirming music exercises. Bruce received a residential placement and left after four weeks. Session objectives were to demonstrate competence in (1) singing with his tape, (2) relaxation using music and imagery, and (3) drawing his imagery for concretization. Time and location for sessions was midafternoon in Bruce’s room. Bruce missed only three of the possible sixteen sessions, due to assaultive behavior, over the four weeks. Session 13. Bruce sang with his tape for the first ten minutes and then chose blue and green cloth for his imagery. At the close of listening selection, Bruce drew himself positioned between the green and blue colors of the cloths he chose. He titled the picture “Cocoona.” This appeared to be a reinforcement of Sessions 9 and 10, but the drawing was more chaotic and scribbled in appearance--much like a description of the auditory environment. Although Bruce’s door could be closed for our sessions, the transmission of sound was far greater than in the therapy room, due to the proximity of his room to the general activity on the unit. Session 14. Bruce sang using his headset and tape, but only for a few minutes, and then asked me to sing with him. After two songs, he was ready for the relaxation exercise. The picture he drew afterward, “Dream World,” showed a tree similar, but not the same, in design from an earlier cocoon picture. This tree was solid and appeared to be very firmly planted. The canopy, although still very stunted, was now colored in with firm strokes. Two birds were flying nearby and the round blue cocoon was suspended in space. It appeared that Bruce was feeling unsure about just where he was and that although the comfortable blue color of the cocoon could be taken as positive, the fact that the cocoon was unattached and in midair conveyed a sense of being ungrounded and a lack of security. The change of location and time seemed to be reflected in his picture.

Session 15. Bruce sang only three songs and then asked to move to the relaxation. I suggested a very tactile image of a sandy beach and the ocean. Bruce said he knew what it felt like to walk in the sand and wade in the water, and also talked about how bright the sun could be shining off the water. This seemed as if it could be the next positive image that could “ground” him, and the more grounded or concrete to his experience Bruce could be with his images, the less likely he would be to dissociate. I chose Respighi’s “The Nightingale” which offered sounds that can be interpreted as reflective, like sun reflecting off the water. It appeared to be an appropriate shift because Bruce placed himself standing next to a palm tree in his drawing that day. He called the picture “Palm Tree.” His palm tree had no coconuts like some children draw. It was simply a “palm” tree. The canopy offered more protection/shade than his cocoon picture trees and it was one of only three pictures in which Bruce drew himself. The representation was a stick figure, but this was the first time he placed a likeness to his human form in his drawings. Session 16. Prior to the session, Bruce’s one-to-one staff approached me to let me know that Bruce was to have a family visit (foster family) and had asked his staff to ask me if his session could be adjusted. I agreed. Bruce sang two songs and then asked for the relaxation. He chose a royal blue scarf “to be underwater.” He asked for the headset, instead of the boom box, since noise in the hallway had increased. (I reminded him of the time, but he did not want to end the session at that point in spite of the visit.) The music for this imagery was Respighi’s “Venus.” Bruce’s picture was of a turtle under the water and his imagery storyline was that he was on a raft on the water and dived in. He saw white and purple crabs and lobsters. He was swimming and then noticed three or four sea turtles swimming above him, so he swam up to join them. He said that the water felt good, but that it was hot coming up into the boat. He also said that he got some seashells and sand. He drew a green turtle under dark blue water. The perspective was as if looking down into the water. He called the turtle Harry and the picture simply “Sea Turtle.” Bruce’s descriptions and multiple images of creatures appropriate to the environment conveyed a sense of his feeling at home and, as he described the coming up into the boat as hot, I wondered if it felt like being a “fish out of water.” His visit was an “out of the routine” event for him and his desire to continue the music therapy session as planned rather than cutting it short felt like a means of acclimating himself, particularly as he included the bringing up of seashells and sand, very tangible images. Session 17. Bruce demanded, “You sing a couple” and asked that I add/sing a couple of songs for his tape, but he chose only “Michael, Row the Boat Ashore.” Bruce appeared fidgety and in a “clockwatching” mode. He chose the blue scarf again and also the use of the headset for the relaxation. The music was new age with nature sounds. His picture was of a whale jumping in the water. Although the color of the ocean he drew was not alarming, the fact that the whale was jumping and he was fidgety implied the possibility of the need for something to surface, and quickly and aggressively. Two hours later as I went by his room I saw he was in a restraint. He asked me if he could have his song tape, which was then placed in a boom box on the desk near him. Staff reported that this had a calming and positive effect on him as he sang along to some songs. The fact that the day before his session was canceled due to his being restrained and medicated after an especially difficult morning, and his fidgety behavior, added to my concern about the impact of his family visit. I also recalled how his desire to keep the session as planned the day of the visit felt to me like his effort to ground himself as much as

possible. But now he was in the “net” (restraint), the fish caught, and I reflected on his “fish out of water” and “jumping whale.” Session 18. “Can you play my tape?” Bruce was in a restraint when I arrived. He had had a very assaultive morning, but after fifteen minutes of singing, he asked if the restraint could be removed. I called the staff and Bruce was assessed as being safe. The restraint was removed. The session continued with the relaxation, but no colored scarf. Bruce also chose not to draw. He described the colors and shapes of his imagery as brown, blue, and white ovals, triangles, and rectangles. Reflecting on his drawing from the previous day, the “Jumping Whale” picture used the shapes that he reported (oval, triangle, and white for the whale; blue and rectangle for the ocean) in this session. It felt as if the whale was now broken into shapes or fragmented--triangle/tail and oval/body and the color of the water was blue-green and the rectangular shape of the ocean. What also surprised me was his sun, since this was the only sun he had drawn to date. Its color combination was yellow and brown or ochre, which is a color that can be interpreted as contamination and infection. Bruce also reported the color brown and my sense was that Bruce’s earlier assaultiveness and the resulting restraint were a continuation of the previous day’s inner events. Brown, the color of feces, ground, and deteriorating matter perhaps was something trying to be eliminated from a deep unconscious. Session 19. (Rescheduled for the following day due to Bruce being asleep as a result of restraint and medication.) It was poignant that on the following afternoon just as I arrived at his room, Bruce was receiving redirection from staff regarding some unsafe behavior. While one of the “techs” was on his way down the hall to get Bruce’s chart to check on the possibility of a PRN, I asked the staff if I could intervene and they gave the OK. I approached the doorway, and as I leaned into it rather casually I started singing “Blue-Tail Fly.” By the time I got to the end of the verse, he had joined in singing. At the end of the refrain, he asked me to bring my “stuff” in and sing some more. Bruce settled in to three more songs with his tape and then asked for the “other” music. He chose red and blue scarves this time. The music was again Respighi’s “The Nightingale.” I asked him to imagine standing on the shore feeling the sand between his toes and to look out over the ocean. Bruce drew two whales leaping out of the water. There was no sun this time and the water was sky blue. The whales were outlined in ochre and both whales’ tails were filled in with the blue ocean color. Bruce labeled the picture “Leaping Whales,” but talked about it as “two whales mating.” My interpretation of this session and this drawing was based on the colors he chose to wrap himself in--red and blue, which sometimes can be interpreted as the colors of the “dragon fight”--separation from the parents/authority. The reference to “whales mating” also raised the question of Bruce’s own struggle with sexuality given his early and lengthy abuse, particularly in his family of origin. Session 20. This was a Friday and I intended to make Bruce’s song tape and relaxation tape available for his use over the weekend. So the focus for this session was to evaluate his ability to operate the tape player with headset and for him to identify when he would ask for these as a coping skill. He demonstrated appropriate use of the tape player and identified his feeling to become silly or if he started feeling fearful as key to when he would ask for his tapes. He added that the beach scene would be his choice if he used the relaxation tape. We did a relaxation session for reinforcement of the beach scene and Bruce drew himself lying on the shore. The figure showed was half in the water and half on the sand with a big smile and three birds in the sky. His ocean was sky blue and the sand was the ochre again. This use of ochre

seemed appropriate since sand contains such colors, but metaphorically he was caught between the ocean where he previously swam with sea turtles and groundedness of the “sand between his toes.” One could also interpret it as the waters of the unconscious where the lower half of his body was drawn and of the conscious as his upper body and head rested on the sand. Session 21. (Rescheduled for Tuesday due to medication on Monday, although staff reported that he did successfully use the tape and player over the weekend.) When I arrived and asked if he wanted to meet, Bruce replied, “Yup.” (He had just come out of a restraint.) He took charge of the session immediately and chose three songs, then asked to use the relaxation tape. He wanted no colored cloth and asked that he use the ocean for his induction. After the music finished, he drew a picture of himself fishing from a sailboat. Three birds flew above in a blue-green sky and his figure smiled while holding on to the fishing pole at the back of the boat. He called the picture “Sunny Day--Caught a Bass.” Bruce appeared self-assured in this session. As we discussed the use of the tape, he proudly informed me that he had used it over the weekend. I reminded him that I would be gone a short time, leaving the next day, and that during that break, he should feel free to access his tapes and player just as he had the previous weekend. Session 22. Severe weather delayed my return, so when I finally got to see Bruce it was evening. He was interested in a few songs and although he appeared sleepy, his affect changed when he noticed an audience--a staff person--was listening, and he brightened considerably. Session 23. “Can we have a shorter session?” Bruce was very excited about a chess game with a peer. Although I was willing to accommodate his request, just as in a previous session that he had requested to be shortened, once we began to work, Bruce forgot about the time and the session went as usual. He chose two songs and then went on to the imagery. He appeared restless during the music and his drawing was of a turtle on its back floating above the water. The water and sky were the same sky-blue color and the green turtle was in the middle--sandwich-like but not tight. It reminded me of the cocoon in its color and the use of color both above and below the figure was also a theme in Bruce’s drawings. He called the picture “Swimming time.” As we concluded, Bruce told me he had been told that he was going to be discharged on the following Monday. This was big news. I was amazed, but now his antsy behavior made sense. Bruce asked if I could make more tapes for him, especially ones with nature sounds. Session 24. Bruce was looking particularly sad when I arrived and wanted “his music time.” “Jimmie Crack-Corn first,” he said and brightened. “Silent Night” followed and then the relaxation tape. He used an outdoor/nature scene for his setting during the seven-minute piece of music. When it concluded he asked if he could just tell me about what he saw and not make a picture. He described the “Titanic” and that he was in a cabin in the bottom looking out at eagles and sea turtles. When I asked him where the ship was, he simply replied, “You know the Titanic, it sank.” Bruce was at the bottom of a sunken ship but saw eagles and a sea turtle. The split between sky creature and sea creature was initially anxiety producing for me. No land in sight, in the bottom, at the bottom, looking out, yet both creatures are strong and powerful in their own habitat. Bruce had not used the image of an eagle in prior sessions and it was only in the first session that he had seen birds of any type, although he drew them in two of his pictures. The eagle is also a visionary figure and I hoped that it might mean Bruce’s “insight” may be submerged in the collective unconscious, but that given time and continued depth work

connecting his voice and imagination as we had been doing, his eagle would emerge like the butterfly from the cocoon. Session 25. The next day was Friday and this was the final session, since Bruce was scheduled to leave at 6:00 a.m. on Monday. He chose three songs to sing while he played Legos with his roommate. He chose his music for the relaxation session, being quite familiar with the options. He chose not to draw and reminded me that he would like more tapes to take with him. I assured him he would have tapes and the player with headset. Bruce made the choices to share his songs with his roommate, to name his music for the imagery, and to reiterate his desire to have additional music tapes. Although I felt it was too soon for him to go, I did realize that he had demonstrated the skills for choosing and using music through song and relaxation on some occasions as a means of redirecting his negative behavior. Discussion The Importance of a Depth Psychology Approach The 1998 Beech Brook study, “Music therapy with children with severe emotional disturbances in a residential treatment setting,” reported that studies demonstrating benefits of music therapy interventions with emotionally disturbed children are abundant, but that there is a lack of literature on music therapy interventions for the most disturbed children, particularly those in residential treatment (Hong, Hussey & Heng, 1998). Although a psychiatric hospital is not considered a residential treatment center, in Maine there are many patients who spend well beyond ninety days on the children’s unit because of lack of residential placements or the case becomes mired in the paperwork of bureaucracy. Six- to eight-month hospitalizations for some children are not uncommon nor are multiple readmissions. Having described and interpreted music, technique, pictures, and images from Bruce’s sessions, with attention to the auditory function as both trigger and path for intervention with his behavior, I will briefly discuss my rationale for what I believe were the important elements of Bruce’s treatment that increased his consciousness of his “voice.” I acknowledge that the primary modality for psychiatric treatment/therapy in residential care and hospitals is verbal. While language, either written or spoken, has been the mainstay of American communication, this form of language can also be a significant block for those who have no sense of control of their voice. Trauma literature is rich with examples of sensory inputs that can trigger negative reactions in trauma survivors. Although talk therapy might ultimately label or categorize in order to provide meaning for the individual, trauma experienced by children particularly prior to language comprehension remains sensory, symbolic, and primitive. For Bruce, this was certainly the case. His wild, terrified looks when starting a meltdown; his silliness that led to assaultiveness; and his drawings all communicated important information which “talk” could not contain. His choosing of specific music activities, and particularly his relationship to singing with himself on tape, validated my notion that he had much being “said” to him by his inner voice. But the language that the inner voice used was primitive and Bruce was unable to translate its needs and reactions into what the adults in the outer world were asking of him. The more Bruce tried to comply over the decade of his life’s experience, the more violations occurred until his behavior/inner voice got him hospitalized.

As the work with Bruce evolved over those four months, he began to speak differently with, and to, his inner voice. He began to demonstrate his sense of self worth and his desire to be safe. Bruce was not cured, he was not fully in control, but what he had was a growing awareness that he could dialogue with his inner voice and that the behavior could be a conscious choice and not just an automatic or reflexive response to what his ears perceived. Bruce’s family-of-origin history showed a lineage of abuse and neglect. He certainly was living according to the voice he learned from birth and the most likely the voice of his conception, perhaps even “incubated in terror.” With a hyper-alert sensory system and only a primitive (brain-stem based) means of communicating rage, fear, and sorrow, his behaviors were assaultive, silly, and self-destructive. As Bruce began to recognize his reactions to some of his auditory inputs, he began to express these emotions through singing, instrument playing, and imagery with supportive music. He also began to release and experience firsthand another way to communicate. Conclusions The following conclusions were included in the memo for Bruce’s new psychiatrist. · · · · · · · · ·

Bruce responded well to music therapy through two particular activities, singing and music with selected imagery relaxation techniques focused on “interrupting” then mediating dangerous and assaultive behavior. Bruce’s song tape contains songs he chose and sang and has been useful as a “singalong” coping skill. Bruce has also been able to de-escalate his potential aggressiveness by singing with staff on a few occasions. Bruce used the image of being at a beach or in a cocoon for his relaxation work. Bruce would usually draw after the relaxation, in order to concretize the imagery. Bruce has his own collection of song and relaxation tapes for use as coping skills. Bruce has demonstrated a growth in self-esteem and self confidence by his ability to now sing informally with one or two peers. Bruce received music therapy, not music education or “singing lessons.” Bruce works well with a logical approach that is collaborative in style.

As fate would have it, although Bruce’s tapes and player were packaged for his discharge, the staff failed to look in the proper place and his six-hour road trip to his placement was without music. I received a phone call three days later from his new psychiatrist who requested his tape package after reading his file and my memo. I assured her that there were en route. Nearly a month later, I heard from her again. She said that she had inadvertently phoned my office and after she apologized for the “wrong number” she told me that Bruce was doing well and the tapes were very useful. She may have consciously thought that she had dialed a “wrong number,” but I believe “there are no accidents.” References

Cassidy, J. W., & Ditty, K. M. (1998). “Presentation of Aural Stimuli to Newborns and Premature Infants: An Audiological Perspective,” Journal of Music Therapy, 35(1), 70-87. Cassity, M., & Cassity, J. (1998). Multimodal Psychiatric Music Therapy For Adults, Adolescents, And Children: A Clinical Manual. St. Louis, MO: MMB Music, Inc. Greenspan, S. I. (1997). The Growth of the Mind. Reading, MA: Perseus Books. Hong, M., Hussey, D., & Heng, M. (1998). “Music Therapy with Children with Severe Emotional Disturbances in a Residential Treatment Setting,” Music Therapy Perspectives, 16, 6166. Rubin, H. R., Owens, A. J., & Golden, G. (1999). Status Report (1998): An Investigation to Determine whether the Built Environment Affects Patients’ Medical Outcomes. Lafayette, CA: Center for Healthcare Design.

Taken from: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

CASE NINETEEN Review of Guided Imagery and Music Sessions: William’s Story William Alison Short Alison’s Introduction Two years ago, William, a midlife businessperson, experienced the beginnings of change in his relationship with his wife during his time with me in music therapy. Their relationship is reflected in his imagery and in subsequent discussion during sessions of Guided Imagery and Music (GIM). In a typical GIM session, we first talked about the issues he wanted to work on, then I helped him into a relaxed state and put on selected classical music, after getting his input about what music he felt he needed. As William experienced imagery in this altered state, he and I maintained an active dialogue. I took verbatim notes of his imagery and of my remarks, as well as of the discussion that we had after the music and imagery. Recently, we met again to discuss and review the imagery and the post-imagery discussion from the sessions to write this chapter together (two years later). I audiotaped and transcribed our recent meeting and incorporated William’s statements from that review into this narrative. We reviewed all the drafts of the narrative. In the GIM sessions, William’s relationship to his wife was often discussed but infrequently experienced in his imagery. In the sessions, there were only four instances when William directly imaged his wife during the music. We have chosen to present these particular instances (which occur in Sessions 2, 3, 5, and 22) in the first part of the narrative. For each session, we have included my description of the music, William’s reporting of his imagery during the music, plus my questions and comments, my summary of the discussion following the music, and William’s comments about that session from our recent review. In the last section, William talks about his experience of the therapy and of the therapy review in words transcribed from the tape of our recent meeting. Review of the Sessions Session 2 This was William’s first session with music; the initial meeting had been a short informational meeting. In this first experience of a GIM session, William imaged his wife as he first knew her. This imagery occurred near the end of the music programme; the selection was Turina’s La Oration del Torero. The latter part of this music features stringed instruments in high registers, with long notes and a slow, upward-rising figure combined with a slow rate of

harmonic change and piquant tonal harmonies. It ends with an extended chord in upper registers, potentially conveying an ethereal quality. NOTE: Throughout William’s narratives below, Alison’s words during the music are in italics and within parentheses; her comments in Discussion sections are indented. The Imagery. There are a few paddocks and trees, a bit of a rise, a few cows. I am with Sharon when I first knew her. There is a creek running through the paddock, so fragile and so substantial at the same time. (Is there something you would like to share with her?) I didn’t know she was going to have to go through so much pain. (Is there something she would like to say to you?) She would like to say, “Help me.” [End of music] (Is there anything else that you would like to say to her?) That I will help her. (Is there anything she wants to say back?) I don’t think so. Discussion. In the discussion following this music part of the original session, William commented that his wife appeared “as she was when I first knew her 26 years ago.” I asked how it felt, and he said, “It feels good and sad. Perhaps we both started out starry-eyed. Perhaps if we saw what [was] ahead, perhaps we wouldn’t have [hesitates]” Session 3 In the next session, William also had imagery that included his wife; it happened near the end of the last selection of music, Vaughan Williams’s Fantasia on Greensleeves. This orchestral arrangement of a popular English folk tune features broad sweeping melodic lines in the strings with a supportive bass line and potentially conveys a sense of spaciousness. The Imagery. I am just lying on the grass near the valley. [End of music] I think I am lying in the grass with Sharon. (Do you need more time, music?) No, I don’t think so. Discussion. Since the bulk of the session dealt with family and bereavement, this is also what dominated the discussion afterward. In our recent meeting, William said about that session: Even that session there, where I might not have said much, I can almost feel what it was like at the end of that--because that was one of the first times that I had approached that point [and] because it was very early in the number of sessions I did. Well, it’s a relaxation, and what I remember is the discovery that because of my openness to music, I could come here and just be really open with the music. Session 5 William’s wife appears near the end of the music programme. The music was the end of Wagner’s Lohengrin, Prelude to Act 1. Since William’s imagery sequence had not reached a natural close, additional music was then put on to extend the programme--Elgar’s Enigma Variations, number 8. The end of the Wagner selection features largely strings and is of an upward rising and ethereal nature, with the final chord disappearing from the bottom up so that one is left with a single upper note. The Elgar is orchestral but has mostly strings in the

beginning. It is slow, with long legato notes creating a thoughtful, reflective character with an uplifting sense of movement, and climaxing with full orchestra before dying away. The Imagery. My mind starts to wander. What is the lump that comes between me and Sharon? (What could the lump be like?) A stone, a rock. (What is the stone like?) It’s just stuck there. She’s got a stick, a lever. It’s grey like granite [end of Wagner, beginning of Elgar]; the music’s trying to tell me its soapstone--soft--that you can work easily. (Would you like to try?) Yes. Yes, I would. (Can you find a tool to work it with?) Yes, I’ve got a little rock chisel. (Can you try working the stone?) I don’t want to break it up to nothing--just take a bit off the sides. (Can you do that?) Yes, I have a mallet to take ridges off the sides; I can work a shape. (Can you do that?) Like a quarter of an orange. You can carve it out. (What’s Sharon doing?) I think she’s just looking at the moment. I think she likes the shape. The texture’s got scratch marks from the teeth, but it looks good. (How does it feel to do that?) It feels good; I like it. I’m capable of doing that. (You’re capable of doing that. [Pause] Is there anything else you would like to do with the rock?) Put it with some trees, grass, sand. (Is Sharon still there?) No, I don’t know where she is. (Do you have a sense of where she is?) No. (How do you feel about that?) I think she’s around somewhere. [End of music -- silence; the imagery continues.] (Is there something you would like to say to her?) I think she doesn’t trust me. I think she thinks she’ll get hurt. (Is there anything else you would like to say to her?) Not right now. Discussion. William commented in the discussion after the music that he was surprised that the rock or stone could be soft. In the discussion before the music, William had stated feelings of being “out of control.” He was now reminded of this in light of his subsequent statement during the music: “I am capable of doing that.” William’s comments and nonverbal cues, such as facial expression and voice tone, also indicated to me that he felt much more peaceful and focused. William comments, in our recent meeting, about that session: Oh, that’s interesting isn’t it? I mean, I’m just putting this together and thinking about where I was and what was happening then. I remember a lot of this coming up, and it seems really strange to be looking at it now. And I was doing therapy that was interesting because it was using music that’s significant for me. It’s something [soapstone] my wife has used a bit, and we have some lumps of it at home; we don’t do it now. You put your hands on it and it feels like you could almost rub it away; it is soft, easy to work. If I see something like that and I say it’s like granite, then that’s saying that it’s hard. But if I see it and I say that’s like soapstone, it’s something I can start to work with. Hmmm. [Reading] “Can you find a tool to work with? Yes, I’ve got a rock chisel.” Now then, I’m starting to do something to it. The reason that I was impressed with myself talking about actually doing something is that one of the major things that I’ve noticed about myself [is] [hesitates] I’ve found particularly in the last couple of years that it makes a big difference to me that I actually do something--act, rather than just talk. Even if I might even think it’s the wrong thing, it’s better for me to do something, rather than adopt the mode that I’ve spent most of my life: “I’ll hang back and let it all sort of happen.” And it’s significant that it is here [in the transcript from the session], and I mean I’m actually doing something! And I can remember what that felt like, too.

Session 22 There was now a long series of sessions in which William did not report imagery of his wife. In Session 22, eight months after the previous example, imagery of his wife again occurred for William during GIM therapy. The music was by Gounod, St. Cecilia Mass, Offertoire and Sanctus. This music came as a respite after the deeply extending Adagio for Strings by Barber. The two selections by Gounod are potentially sacred and nurturing in character. The Offertoire begins with strings playing gentle supportive melodic lines and predictable harmonies, later joined by the rest of the orchestra. The Sanctus starts with a very definite chord, followed by repetitive notes in the strings, and then the solo male voice enters, to be later joined by the choir. The climax of this piece of music follows an extended choral buildup of layer upon layer of voices on the dominant seventh chord, finally resolving to the tonic with a recapitulation of the main theme. The Imagery. I am just looking in a car. Sharon is with me; she is pointing to something in the car. I don’t know what it is. (Would you like to take a closer look?) No. I think it is just something [hesitates]. (Is there something you would like to say to Sharon?) There’s a lot, about “I’m sorry” [pauses]. There’s something she wants. (Can you ask her what that is?) I think she wants me to look inside myself because I forget me. (Is there something you would like to say to her about that?) I recognize that there’s pain involved, but I also recognize that I’ve got a lot of years of “past.” And I’m looking for change, for it not to be another year like the last 26. (Is there something you would like to ask her?) To work with me; I know it’s painful. (And does she respond to that?) She’s a bit guarded. I think that she really wants to, but she’s been disappointed. (Is there anything else that you need to say to each other?) Probably a lot. [Climax of the Sanctus; William’s voice is louder and stronger.] That we need to acknowledge each other as individuals. (Can she hear you say that?) I think that she hears, but she needs to protect herself because she’s been hurt. (Is there anything that you would like to give her?) Not now. Discussion. In the discussion after the music, I asked William how it felt to be talking to his wife in the imagery and at such depth. Was it strange? His reply was “Yes, but good!” The imagery seemed to indicate a fundamental shift: that William embraced a desire for change in the relationship. On reviewing that session, William comments: [I’m] going through it and it’s almost building up in me the possibility of change because of the looking at change in the imagery. I mean I’m not changing my relationship by saying these things in relationship to the music, but something’s happening inside me, and it’s almost something [pauses] -- I have a sense that I was that stuck. There was the talking therapy that I had had a few years before, but then at the time that I came to see you, I was in couples therapy. So there was talking there, and change started to happen there, but I was not free enough, and I know I wasn’t free. But I was detecting that I needed to, you know -- there was a message coming through to me -- that I needed to move. William’s Statements during our Review

About Relaxation Oh, I had done relaxation exercises, but it’s a different sort of thing, a different depth of relaxation, particularly with the connection with music. [As a] matter of fact, I can remember many years ago going to a very good GP [general practitioner], and he was trying to teach me progressive relaxation, and I tried to do what he said. I was in a situation where it was noisy and I was anxious about everything, and it just didn’t work for me. He didn’t put music on. And I am certain that even then if he had ...said, “Oh, I’ll just play a bit of music,” then that [might] have been enough for me to start to understand what he was on about and relax! Well, it’s a relaxation, and what I remember is the discovery that because of my openness to music, I could come here and just be really open with the music. About the Music I think that music for me has another sort of motherly connotation, especially classical music. I have to say that, thinking about my early childhood. I have images of being small, of my mother always having the radio on classical music. I was from a large family, and, see, when everyone else was there, of course the radio would be on something else -- and noise and stuff like that. But there were these times when there was classical music with my mother and if it was popular sort of classical music, she’d be singing along to it. Do you know what I mean? So there’s that sort of comfortableness with music that I had. And so I could stay with these images, perhaps, a lot easier than I would have had [I not had that experience]. I don’t know where the music goes to, but it certainly gets inside of me! It kicks around things. But I would deliberately not [analyze the music], not even think in terms of who was the composer or what style of music is it or even those general things. I would just say…it’s just music…its part of coming here. And I think that was probably the most effective session, when I was basically...relaxing. I know [in] some of them, I didn’t like the part where you started talking because [joint laughter] ...I was “down there,” and maybe in one sense ...I had not been able to relax like that before. Yes, I am sensitive to loud, rich music; in some sense, it can be overwhelming. Now, in a normal environment I would switch off from it, block it[s] getting through, but here [in the therapy], I was open. So I wanted to keep myself open and so I would need to go through and say “It’s a bit loud” at times. I like dynamic music; I just love it, but I’ve got to be careful. I’ve got to think a bit more about it because the other thing that that triggers for me again is my father, because there had to be quiet in the household for him. About Music and Energy States And the other night, I was doing some energy-flow healing work. You also relax a bit with it; it’s contemplative. And I was playing some [New Age] music and I knew the music. It started very quietly, and then the piano comes in with just this one note like that [indicates with a jab of a single pointed finger]--a real attack! And what it did [to me was that] I had a real burst in my head as a reaction to it. It was really loud, and I got a visual thing with it, which I normally don’t. It was like an explosion. So, I’ve still got the sensitivity! [Laughter]

About the Imagery Process I was also thinking, “Where does it come from?” Because after a while, I was getting images. I seemed to get more images when I was in a GIM session than I would in my dreams, and that surprised me. I wouldn’t have thought I could get images like that! Where is that coming from? It’s somewhere in there because it just feels right. About the Therapy The more I did here, the freer I got with what I would say without putting a heavy filter on, [like] saying it doesn’t make sense and it’s illogical and that sort of stuff. So I would try to get the words flowing freely. One of the things that strikes me now, as I think about it, is that I have had talking therapies and I achieved so much [indicates small amount with hands], but it wasn’t -- it has never been -- a real natural way of my communication. I know I have had to work at it, and coming to music therapy, that was something I trusted and that was what I think triggered the freedom. I was relaxed then. What I found is that the more I have done, the more I can see that I need to do. And also I can no longer escape from it; I can’t “cop out.” About Reviewing the Transcripts The focus [in my therapy experiences] has always been on “family of origin” and then secondarily [on] how it would affect my relationship or whatever else is happening. But this [material under discussion], this is directly on my relationship. It’s interesting the way and where it comes in, how it works. It’s a little bit spooky. I’m reading words that I said, and I read them [and] wonder why they are familiar. It’s not like something that I’ve only just said. It’s interesting: the words themselves have an effect on me -- rather than just words -- because I said them at a certain time and in a certain way, with a certain meaning. I know that I’ve said them; that’s what I’m just coming to grips with. It does stir up the feelings for me, seeing it down in black and white, because it has the power to take me back there.

Other E-books in this Series Available from: www.barcelonapublishers.com Case Examples of the Use of Songs in Psychotherapy Case Examples of Improvisational Music Therapy Case Examples of Guided Imagery and Music Case Examples of Music Therapy— For Alzheimer’s Disease For Autism and Rett Syndrome In Bereavement For Children and Adolescents with Emotional or Behavioral Problems For Developmental Problems in Learning and Communication At the End of Life For Event Trauma For Medical Conditions For Mood Disorders For Multiple Disabilities For Musicians For Personality Disorders For Schizophrenia and Other Psychoses For Self-Development For Substance Use Disorders For Survivors of Abuse

Barcelona Titles by Topic Available at www.barcelonapublishers.com Analytical Music Therapy · Essays on Analytical Music Therapy (Priestley) · Music Therapy in Action (Priestley) · The Dynamics of Music Psychotherapy (Bruscia) · Group Analytic Music Therapy (Ahonen-Eerikäinen) Case Studies · Case Studies in Music Therapy (Bruscia) · Inside Music Therapy: Client Experiences (Hibben) · Psychodynamic Music Therapy: Case Studies (Hadley) · Developments in Music Therapy Practice: Case Study Perspectives · Case Examples of Music Therapy: A Series of 16 e-books Children with Special Needs · Alike and Different: The Clinical and Educational Uses of Orff-Schulwerk – Second Edition (Bitcon) · The Miracle of Music Therapy (Boxill) · Music for Fun, Music for Learning (Birkenshaw-Fleming) · Music: Motion and Emotion: The Developmental-Integrative Model in Music Therapy (Sekeles) · Music, Therapy, and Early Childhood (Schwartz) · Music Therapy in Special Education (Nordoff & Robbins) · Therapy in Music for Handicapped Children (Nordoff & Robbins) Infancy and Early Childhood · Music, Therapy, and Early Childhood (Schwartz) · Music Therapy for Premature and Newborn Infants (Nöcker-Ribaupierre) End of Life · Music Therapy: Death and Grief (Sekeles) Feminism · Feminist Perspectives in Music Therapy (Hadley) Fieldwork and Internship Training · Clinical Training Guide for the Student Music Therapist (Wheeler, Shultis & Polen) · Music Therapy: A Fieldwork Primer (Borczon) · Music Therapy Supervision (Forinash) Group Work · Music Therapy: Group Vignettes (Borczon) · Music Therapy Improvisation for Groups: Essential Leadership Competencies (Gardstrom)

Guided Imagery and Music (Bonny Method) · Guided Imagery and Music: The Bonny Method and Beyond (Bruscia & Grocke) · Music and Consciousness: The Evolution of Guided Imagery and Music (Bonny) · Music and Your Mind: Listening with a New Consciousness (Bonny & Savary) · Music for the Imagination (Bruscia) Guitar Skills · Guitar Skills for Music Therapists and Music Educators (Meyer, De Villers, Ebnet) Improvisational Music Therapy · The Architecture of Aesthetic Music Therapy (Lee) · Essays on Analytical Music Therapy (Priestley) · Creative Music Therapy: A Guide to Fostering Clinical Musicianship – Second Edition with Four CDs (Nordoff & Robbins) · Group Analytic Music Therapy (Ahonen-Eerikäinen) · Healing Heritage: Paul Nordoff Exploring the Tonal Language of Music (Robbins & Robbins) · Improvising in Styles: A Workbook for Music Therapists, Educators, and Musicians (Lee & Houde) · Music as Therapy: A Dialogal Perspective (Garred) · Music-Centered Music Therapy (Aigen) · Music Therapy: Improvisation, Communication, and Culture (Ruud) · Music Therapy Improvisation for Groups: Essential Leadership Competencies (Gardstrom) · Paths of Development in Nordoff-Robbins Music Therapy (Aigen) · Playin’ in the Band: A Qualitative study of Popular Music Styles as Clinical Improvisation (Aigen) · Sounding the Self: Analogy in Improvisational Music Therapy (Smeijsters) Music for Children to Sing and Play · Distant Bells (Levin & Levin) · Learning Songs (Levin & Levin) · Learning Through Music (Levin & Levin) · Learning Through Songs (Levin & Levin) · Let’s Make Music (Levin & Levin) · Music for Fun, Music for Learning (Birkenshaw-Fleming) · Snow White: A Guide to Child-Centered Musical Theatre (Lauri, Groeschel, Robbins, Ritholz & Turry) · Symphonics R Us (Levin & Levin) Nordoff-Robbins Music Therapy (Creative Music Therapy) · The Architecture of Aesthetic Music Therapy (Lee) · Being in Music: Foundations of Nordoff-Robbins Music Therapy (Aigen) · Conversations on Nordoff-Robbins Music Therapy (Verney & Ansdell) · Creative Music Therapy: A Guide to Fostering Clinical Musicianship – Second Edition with Four CDs (Nordoff & Robbins)

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Healing Heritage: Paul Nordoff Exploring the Tonal Language of Music (Robbins & Robbins) · Here We Are in Music: One Year with an Adolescent Creative Music Therapy Group (Aigen) · A Journey into Creative Music Therapy (Robbins) · Music Therapy in Special Education (Nordoff & Robbins) · Paths of Development in Nordoff-Robbins Music Therapy (Aigen) · Playin’ in the Band: A Qualitative study of Popular Music Styles as Clinical Improvisation (Aigen) · Therapy in Music for Handicapped Children (Nordoff & Robbins) Music Psychotherapy · The Dynamics of Music Psychotherapy (Bruscia) · Essays on Analytical Music Therapy (Priestley) · Emotional Processes in Music Therapy (Pellitteri) · Group Analytic Music Therapy (Ahonen-Eerikäinen) · Guided Imagery and Music: The Bonny Method and Beyond (Bruscia & Grocke) · Music and Consciousness: The Evolution of Guided Imagery and Music (Bonny) · Music and Your Mind: Listening with a New Consciousness (Bonny & Savary) · Music Therapy: Group Vignettes (Borczon) · Psychodynamic Music Therapy: Case Studies (Hadley) Orff-Schulwerk · Alike and Different: The Clinical and Educational Uses of Orff-Schulwerk – Second Edition (Bitcon) Periodicals (Free Downloads Available) · International Journal of Arts Medicine · Qualitative Inquiries in Music Therapy: A Monograph Series Profound Mental Retardation · Age-Appropriate Activities for Adults with Profound Mental Retardation – Second Edition (Galerstein, Martin & Powe) Psychodrama · Acting Your Inner Music (Moreno) Psychiatry – Mental Health · Music Therapy in the Treatment of Adults with Mental Disorders: Theoretical Bases and Clinical Interventions (Unkefer & Thaut) · Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson (McGuire) · Psychodynamic Music Therapy: Case Studies (Hadley) · Resource-Oriented Music Therapy in Mental Health Care (Rolvsjord) Research · A Guide to Writing and Presenting in Music Therapy (Aigen) · Multiple Perspectives: A Guide to Qualitative Research in Music Therapy (Smeijsters) · Music Therapy Research: Quantitative and Qualitative Perspectives – First Edition (1995) (Wheeler)

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Music Therapy Research – Second Edition (2005) (Wheeler) Playin’ in the Band: A Qualitative study of Popular Music Styles as Clinical Improvisation (Aigen) · Qualitative Inquiries in Music Therapy: A Monograph Series (Free Downloads Available Here) · Qualitative Music Therapy Research: Beginning Dialogues (Langenberg, Frömmer & Aigen) Supervision · Music Therapy Supervision (Forinash) Theory · Culture-Centered Music Therapy (Stige) · Defining Music Therapy – Second Edition (Bruscia) · Emotional Processes in Music Therapy (Pellitteri) · Music and Life in the Field of Play: An Anthology (Kenny) · Music as Therapy: A Dialogal Perspective (Garred) · Music-Centered Music Therapy (Aigen) · Music Therapy and its Relationship to Current Treatment Theories (Ruud) · Music Therapy: A Perspective from the Humanities (Ruud) · Music Therapy: Improvisation, Communication, and Culture (Ruud) · Music—The Therapeutic Edge: Readings from William W. Sears (Sears) · The Music Within You (Katsh & Fishman) · Resource-Oriented Music Therapy in Mental Health Care (Rolvsjord) · The Rhythmic Language of Health and Disease (Rider) · Sounding the Self: Analogy in Improvisational Music Therapy (Smeijsters) Voice · Authentic Voices, Authentic Singing (Uhlig) · Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson (McGuire)