Case Examples of Music Therapy for Self-Development [1 ed.] 9781937440336

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Case Examples of Music Therapy for Self-Development Compiled by Kenneth E. Bruscia

Case Examples of Music Therapy for Self-Development 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: 978-1-937440-33-6 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

Table of Contents CASE ONE Case Study: Cheryl Helen Lindquist Bonny CASE TWO Emerging Through Music: A Journey toward Wholeness with Guided Imagery and Music Rebecca Buell CASE THREE Pivotal Moments in Guided Imagery and Music Denise Erdonmez Grocke CASE FOUR Experiencing the Music in Guided Imagery and Music Connie Isenberg-Grzeda CASE FIVE Preliminary Music Mary Priestley CASE SIX Music Therapy with a Private Client Mary Priestley CASE SEVEN Mia’s Fourteenth—The Symphony of Fate: Psychodynamic Improvisation Therapy with a Music Therapy Student in Training Benedikte Barth Scheiby CASE EIGHT Review of Guided Imagery and Music Sessions: William’s Story William Alison Short

Introduction 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 e-book describes various ways that music therapy has been used in self-development, that is, to promote wellness, to enhance developmental growth, to improve interpersonal relationships, and to address various problems in living that may interfere with one’s well-being.

Definition and Applications

About Music Therapy (Based on Bruscia, 1993)

In music therapy, the therapist and client use music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help the client improve or maintain his or her health. In some instances, the client’s needs are addressed directly through music and its intrinsic therapeutic properties; in others, they are addressed through the relationships that develop between the music, client, therapist, and other participants. Music therapy is used with individuals of all ages and with a variety of conditions, including psychiatric disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance abuse, communication disorders, interpersonal problems, and aging. It is also used for self-development purposes, such as improving learning, building self-esteem, reducing stress, supporting physical exercise, and facilitating a host of other health-related activities. Given its wide applications, music therapists may be found in general hospitals, psychiatric facilities, schools, prisons, community centers, training institutes, private practices, and universities. Basic Premises The thing that makes music therapy different from every other form of therapy is its reliance on music as the primary medium for promoting the client’s health. Every session involves the client in a music experience of some kind. The main ones are listening to, recreating, improvising, and composing music. These will be described in more detail in the next few paragraphs; however, it is important to explain immediately that clients do not have to be musicians to participate in or benefit from music therapy. In fact, because most clients have not had previous musical training, the music activities and experiences used in therapy sessions are always designed to take advantage of the innate tendencies of all human beings to make and appreciate music at their own developmental levels. Of course, in clinical situations, music therapists may encounter clients who have physical or mental impairments that interfere with one or more of these basic musical potentials. Therefore, care is always taken to adapt music therapy experiences to the unique musical capabilities and preferences of each client. Music

therapists also screen clients who may have adverse psychological or psychophysiological reactions to participation in music. Four Basic Music Experiences Used in Therapy To understand how music therapy works, it is necessary to examine the unique nature of each of the four types of music experience—listening to, recreating, improvising, and composing. In those therapy sessions that involve listening, the client takes in and reacts to live or recorded music in the style preferred by the client. The client may respond through activities such as relaxation or meditation, structured or free movement, perceptual tasks, freeassociation, story-telling, imaging, reminiscing, drawing, and so forth. Music listening experiences are used with clients who need to be activated, soothed, or further developed— either physically, emotionally, intellectually, and/or spiritually—as these are the kinds of responses that music listening elicits. In those therapy sessions that involve re-creating music, the client sings or plays precomposed music. This may include learning how to produce sounds, imitating musical phrases, learning how to sing, learning to read notation, participating in group sing-along’s, performing a song or piece, participating in a musical show or drama, and so forth. Re-creative experiences are most appropriate for clients who need to develop sensorimotor skills, learn adaptive behaviors, maintain reality orientation, master different role behaviors, identify with the feelings and ideas of others, work with others cooperatively, or merely share in the joy of making music—as these are the main aspects of singing or playing pre-composed music that have therapeutic implications. In those therapy sessions that involve improvising, the client makes up his or her own music extemporaneously, singing or playing whatever arises in the moment. The client may improvise freely and spontaneously or according to the musical or verbal guidance of the therapist. Sometimes the client is asked to improvise sound portraits of feelings, events, persons, or situations that are being explored in therapy. The client may improvise with the therapist, with other clients in a group, or alone, depending on the therapeutic objective. Improvising music is most appropriate for clients who need to develop spontaneity, creativity, freedom of expression, self-awareness, communication, and interpersonal skills—as these are the basic components of improvising. In those sessions that involve composing, the therapist helps the client to write songs, lyrics, or instrumental pieces, or to create any kind of musical product, such as music videos or audiotape programs. Usually the therapist simplifies the process by engaging the client in aspects of the task within their capability (e.g., generating a melody, or writing the lyrics of a song) and by taking responsibility for more technical aspects (e.g., harmonization, notation). Activities involving composing music are used with clients who need to learn how to make decisions and commitments, or find ways of working in an organized way toward a goal. Most often, clients create compositions (especially songs) around significant events, people, or relationships in their lives, or to express thoughts and feelings that they are exploring in therapy.

In addition to strictly music experiences, music therapists often engage clients in verbal discussions. Clients may be encouraged to talk about the music, their reactions to it, or any thoughts, images, or feelings that were evoked during the experience. Clients may also be encouraged to express themselves through the other arts, such as drawing, painting, dance, drama, or poetry. Music therapy sessions for children often include various games or play activities which involve music. About Case Examples For purposes of the present discussion, case examples can be divided into two main types: clinical cases, and research cases. A clinical case is a professional report written by the therapist, client, or observer to describe what transpired during and upon completion of the music therapy process with an individual client or group. The report is usually based on recordings of the session or notes and logs kept by the therapist and/or client. Efforts are made to present an accurate and unbiased account of the therapy process to the extent possible, and theories are often used to substantiate or contextualize the therapeutic approach. Objective data may or may not be provided to verify or document the report. In contrast, a research case is a data-based report, provided by the therapist or researcher, to document or verify the specific therapeutic effects of a particular music therapy protocol on an individual client or group. As such, a research case operationally defines and measures how the independent variables (e.g., treatment methods used by the therapist) act upon the dependent variables (e.g., targeted treatment outcomes for the client), when all other relevant variables and conditions are controlled. Perhaps the best way to derive the most benefits from a clinical or research 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. 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? Scientists or researchers can also glean other very important information from case studies. Because clinical cases provide rich descriptions of the therapy process, they 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. Of course, a research case can provide the same insights, to some degree, as a clinical case; they too offer valuable information on potential independent, dependent, and extraneous variables to consider. The greatest advantage of the research case is not only that it provides objective evidence of what works or doesn’t work in therapy, but also because it can reveal the “effect size” of the therapeutic change. That is, a single-case research study can show how big an effect the independent variable had on the dependent variable, or the extent to which the treatment protocol was effective in inducing therapeutic change in the client. Though this effect and its size cannot be generalized, careful replication of research cases and meta-analysis can begin to build a case for the establishment of clinical cause-effect relationships. Reading from a Personal Perspective By their 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 client: What must the client be thinking or feeling about the therapist, music, other clients, or loved one? If I were the client, would I think or feel the same? What does this client need and want from those involved in the therapy process, and would I need or want the same? These same questions can be posed for every client involved in the case. 2) Identifying with the therapist: What must the therapist be thinking or feeling about the client, the music, the other clients, or the client’s loved one? Would I think or feel the same? What kind of person would I be if I were working with this client? What is the therapist trying to do, and would I try to do the same? 3) Identifying with loved ones: What must the loved one be thinking or feeling about the client, the therapist, the music, and other clients? If I were a loved one, would I think or feel the same? What does this person need or want, and would I need or want the same? Does this person believe that music therapy will help, and would I? How does the loved one feel about the therapist, and how he or she is relating to the client? Does the therapist know what he or she is doing? The fascinating thing about taking an empathic position is that once one successfully steps into one 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 clinicians. Clinicians want to know what does and does not work when working with a client in music therapy. 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 clients? What client needs and resources do I have to address more in my own work? How can I assess these facets of the client in music therapy? 2) 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? 3) What is the role of music in working with this clientele? What types of music experiences are most therapeutically relevant and effective? What styles of music are most appropriate? 4) Based on this case, what are the best ways of responding to the client when he or she is acting out, abreacting, resisting, or not progressing? 5) Based on this case, what clinical criteria should be used in evaluating the client’s therapeutic progress? Other Writings on Music Therapy for Self-Development The case examples in this e-book were taken exclusively from various books published by Barcelona Publishers. Thus, these cases, though typical, may not comprise a representative sample of all clinical practices in music therapy for individuals working toward selfdevelopment. Below is a list of other publications that demonstrate how music therapy can be used in various forms of self-development. Abbott, E., & Avins, K. (2006). Music, Health, and Well-Being. In E. R. Mackenzie, B. Rakel (Eds.), Complementary and Alternative Medicine for Older Adults: A Guide to Holistic Approaches to Healthy Aging (pp. 97-110). New York, NY US: Springer Publishing Co. Azoulay, R., & Loewy, J. V. (2009). Music, the Breath and Health: Advances in Integrative Music Therapy. New York, NY US: Satchnote Press. Barry, P., & O’Callaghan, C. (2008). Reflexive Journal Writing: A Tool for Music Therapy Student Clinical Practice Development. Nordic Journal of Music Therapy, 17(1), 55-66. Bates, G. (2008). Music for Wellness & Bliss: Arvel Bird. Whispering Wind, 37(6), 31. Batt-Rawden, K. (2006). Music: A Strategy to Promote Health in Rehabilitation? An Evaluation of Participation in a ‘Music and Health Promotion Project’. International Journal of Rehabilitation Research. Internationale Zeitschrift Für Rehabilitationsforschung. Revue Internationale De Recherches De Réadaptation, 29(2), 171-173.

Batt-Rawden, K. (2010). The benefits of self-selected music on health and well-being. Arts in Psychotherapy, 37(4), 301-310. Batt-Rawden, K., DeNora, T., & Ruud, E. (2005). Music Listening and Empowerment in Health Promotion: A Study of the Role and Significance of Music in Everyday Life of the LongTerm Ill. Nordic Journal of Music Therapy, 14(2), 120-136. Bongard, S., Hodapp, V., & Rohrmann, S. (2008). Emotions and Health: The Impact of Emotions, Emotions Regulation, Music, and Acculturation on Health. Zeitschrift Für Gesundheitspsychologie, 16(3), 112-115. Boulanger, A. (2011). Music, Mind, and Health: How Community Change, Diagnosis, and NeuroRehabilitation Can Be Targeted during Creative Tasks. Dissertation Abstracts International Section A, 72. Briggs, T. (2004). Complementary Health Care: Using Music as a Healing Modality. Journal of Gynecologic Oncology Nursing, 14(1), 13-18. Chang, M., Chen, C., & Huang, K. (2008). Effects of Music Therapy on Psychological Health of Women during Pregnancy. Journal of Clinical Nursing, 17(19), 2580-2587. Chesky, K. S. (2004, January). Music, Health, and Education: Toward Greater Understanding. ITG Journal, 2842. Crowe, B. J. (2009). Music: Promoting Health and Creating Community in Healthcare Contexts. Music Therapy Perspectives, 27(1), 69-73. de l’Etoile, S. (2008). Applying Perry’s Scheme of Intellectual and Ethical Development in the College Years to Undergraduate Music Therapy Education. Music Therapy Perspectives, 26(2), 110-116. Edwards, J. (2011). A Music and Health Perspective on Music’s Perceived ‘Goodness’. Nordic Journal of Music Therapy, 20(1), 90-101. Edwards, J. (Ed.) (2007). Promoting Health and Creating Community in Healthcare Contexts. Newcastle upon Tyne, UK: Cambridge Scholars Publishing. Feingold, M. M. (1999, May 4). Music: Musical health plan. Village Voice. p. 125. Gideonse, T., & Westley, M. (1998). Focus on Health. Music Is Good Medicine. Newsweek, 132(12), 103. Giles, M., Cogan, D., & Cox, C. (1991). A Music and Art Program to Promote Emotional Health in Elementary School Children. Journal of Music Therapy, 28(3), 135-148. Gillam, T. (2003). An Isle Full of Noises: Enhancing Mental Health through the Music Workshop Project. Groupwork: An Interdisciplinary Journal for Working with Groups, 13(3), 45-64. Gold, S. (2008). Health in Harmony: Music Fights Stress, Ups Smarts, and Keeps You Sound of Mind -- and Body. Psychology Today, 41(1), 59. Grocke, D. (2009). Music Therapy Research and the Mental Health--Well-Being Continuum. Australian Journal of Music Therapy, 20, 6-15. Hanser, S. (1992). Creative Ways to Wellness: Music Therapy for Reducing Stress and Pain. Proceedings of the World Conference of the International Society for Music Educators, 347-353. Hanser, S. (2006). How Music Can Improve Your Health: New Research Confirms That It Helps Fight High Blood Pressure, Insomnia and Pain. Bottom Line Health, 20(10), 15.

Hanser, S. B. (2010). Music, Health, and Well-Being. In P. N. Juslin, J. A. Sloboda (Eds.), Handbook of Music and Emotion: Theory, Research, Applications (pp. 849-877). New York, NY US: Oxford University Press. Health Care Savvy. Calming Music to Heal Your Mind and Body. (2006). Consumer Reports on Health, 18(10), 10. Health News. “Without Music, Life Would Be a Mistake”. (1997). Emergency, 29(1), 26. Hoeft, L., & Kern, P. (2007). The Effects of Listening to Recorded Percussion Music on WellBeing: A Pilot Study. Canadian Journal of Music Therapy, 13(2), 132-147. Koga, M. (2006). The Music Making and Wellness Project. American Suzuki Journal, 35(1), 59. Krout, R. E. (2007). Music Listening to Facilitate Relaxation and Promote Wellness: Integrated Aspects of Our Neurophysiological Responses to Music. The Arts in Psychotherapy, 34(2), 134-141. Lau, M. (2000). Sound Health: Health Professionals Tuning in to Music Therapy. Nurseweek (10632859), 13(8), 27. Legge, M. (1999). Music for Health: The Five Elements Tonal System. IEEE Engineering in Medicine and Biology Magazine: The Quarterly Magazine of the Engineering in Medicine & Biology Society, 18(2), 80-88. Lin, S., Yang, P., Lai, C., Su, Y., Yeh, Y., Huang, M., & Chen, C. (2011). Mental Health Implications of Music: Insight from Neuroscientific and Clinical Studies. Harvard Review of Psychiatry, 19(1), 34-46. Lipe, A. (2002). Beyond Therapy: Music, Spirituality, and Health in Human Experience: A Review of Literature. Journal of Music Therapy, 39(3), 209-240. Logan, K. (1996). Music Is Key to Lifelong Wellness. Teaching Music, 3(4), 42. Maack, C., & Nolan, P. (1999). The Effects of Guided Imagery and Music Therapy on Reported Change in Normal Adults. Journal of Music Therapy, 36(1), 39-55. Mackenzie, J., & Hamlett, K. (2005). The Music Together Program: Addressing the Needs of “Well” Families with Young Children. Australian Journal of Music Therapy, 16, 43-59. Magee, W. L. (2011). Music Technology for Health and Well-Being: The Bridge between the Arts and Science. Music and Medicine, 3(3), 131-133. Mandel, S. E. (1996). Music for Wellness: Music Therapy for Stress Management in a Rehabilitation Program. Music Therapy Perspectives, 14(1), 38-43. Mandel, S. E. (1996). Music for Wellness: Music Therapy for Stress Management in a Rehabilitation Program. Music Therapy Perspectives, 14(1), 38-43. McCaffrey, T., Edwards, J., & Fannon, D. (2011). Is There a Role for Music Therapy in the Recovery Approach in Mental Health?. The Arts in Psychotherapy, 38(3), 185-189. McKinney, C. H., Antoni, M. H., Kumar, M., Tims, F. C., & McCabe, P. M. (1997). Effects of Guided Imagery and Music (GIM) Therapy on Mood and Cortisol in Healthy Adults. Health Psychology, 16(4), 390-400. Metzger, L. (2004). Heart Health and Music: A Steady Beat or Irregular Rhythm?. Music Therapy Perspectives, 22(1), 21-25. Meyer, R. (2003). The Sounds of Music: Music Can Have Remarkable Benefits for Your Health, or It Can Be Destructive. Vibrant Life, 19(6), 16-20. Montello, L. (2002, November). Healing Harmonics: Performance Can Facilitate Health (Music Therapy Research). International Musician, 10010.

Montello, L. (2010). The Performance Wellness Seminar: An Integrative Music Therapy Approach to Preventing Performance-Related Disorders in College-Age Musicians. Music and Medicine, 2(2), 109-116. Music for health. (1998). Pediatric Mental Health, 17(6), 6. Music Therapy: Rx for Physical and Mental Health. (1994). University of Texas Lifetime Health Letter, 6(8), 3. Neal, D. (2008). Music as a Health Patterning Modality for Preterm Infants in the NICU. O’Grady, L., & McFerran, K. (2007). Uniting the Work of Community Musicians and Music Therapists through the Health-Care Continuum: A Grounded Theory Analysis. Australian Journal of Music Therapy, 1862-86. Ovesen, L. (2004). Music and health. European Journal of Cancer Prevention: The Official Journal of the European Cancer Prevention Organisation (ECP), 13(2), 149-150. Palac, J. (2008). Promoting Musical Health, Enhancing Musical Performance: Wellness for Music Students. Music Educators Journal, 94(3), 18-22. Patients Use Music Therapy for Healing and Wellness: Can Be Used Individually, with Families, or in Groups. (2009). Patient Education Management, 16(6), 65-67. Pavlicevic, M. (2001). A Child in Time and Health: Guiding Images in Music Therapy. British Journal of Music Therapy, 15(1), 14-21. Rana, S., Akhtar, N., & North, A. (2011). Relationship between Interest in Music, Health and Happiness. Journal of Behavioural Sciences, 21(1), 48-67. Roskam, K., & Reuer, B. (1999). A Music Therapy Wellness Model for Illness Prevention. In C. Dileo (Ed.), Music Therapy and Medicine: Theoretical and Clinical Applications (pp. 139148). Silver Spring, MD: The American Music Therapy Association, Inc. Scheve, A. (2004). Music Therapy, Wellness, and Stress Reduction. Advances in Experimental Medicine and Biology, 546253-263. Shoemark, H. (1987). The Value of Music Therapy in Society. The Australian Music Therapy Association Bulletin, 10(3), 2-6. Smith, D., & Waugh, S. (2009). Music Therapy and Health Benefits. Kansas Nurse, 84(4), 3-5. Stige, B. (2005). Music as a Health Resource. Nordic Journal of Music Therapy, 14(1). The Sound of Healing: Create Your Own Music Program for Better Health. (1996). Jazz Educators Journal, 29(3), 76-77. Tsao, C. (1990). Health Communication: The Relationship of the Immune System to Relaxation, Music, Imagery and Emotional Affect. Dissertation Abstracts International Section A: Humanities & Social Sciences, 503537. VanWheelden, K., & Whipple, J. (2004). Effect of Field Experiences on Music Therapy Students’ Perceptions of Choral Music for Geriatric Wellness Programs. Journal of Music Therapy, 41(4), 340-352. References for Introduction American Psychiatric Association (APA) (2000). Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, Text Revision. Washington DC: American Psychiatric Association.

Bruscia, K. (1993). Music Therapy Brief. Retrieved from temple.edu/musictherapy/FAQ.

Case Examples of Music Therapy for Self-Development

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 ONE Case Study: Cheryl Helen Lindquist Bonny (Edited by Lisa Summer) Editor’s Introduction In her most extensive written case study of an early GIM client, Bonny reports on the music and imagery content of each of Cheryl’s nineteen GIM sessions and includes two posttherapy interview reports to validate GIM’s longstanding effects upon Cheryl. This case study was part of Bonny’s 1976 doctoral dissertation, “Music and Psychotherapy.” To add greater perspective to the manner in which Cheryl’s therapy progressed, I requested that Bonny supplement her summary descriptions of Cheryl’s sessions with information from her own contemporaneous personal notes. Additionally, Cheryl’s mandala drawings, and interpretations of the drawings by art therapist Joan Kellogg, are included for the first time in this publication. - L.S.

Case Study: Cheryl 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 self-doubt. 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 post-therapy followup 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; CosmicAstral 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 Affect-Release 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, self-conscious, 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 nonexistence, 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 self-punishment. 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 obsessive-compulsive 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 yellow-orange 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 selfesteem. 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-through’s” 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 pre-interview). 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 problemsolving 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: Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum NH: Barcelona Publishers.

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

CASE THREE Pivotal Moments in Guided Imagery and Music Denise Erdonmez Grocke Introduction I prefer the term pivotal to describe moments of insight or understanding in therapy. These moments are turning points in which a client understands an issue or problem from another perspective. Clients in Guided Imagery and Music (GIM) therapy experience these moments in different ways. GIM involves listening to prerecorded classical music in a deeply relaxed state so that a sequence of images that symbolically represent aspects of the client’s life experience is evoked; the therapist keeps verbal contact as the client narrates the ongoing imagery. In my study of pivotal moments in GIM, seven people who have been involved for differing lengths of time in GIM therapy have been interviewed. I interviewed four people who were clients of another GIM therapist, and a research assistant interviewed three clients of mine. An open-ended interview procedure was used so that the flow of the interview followed the person’s experience. The primary question was: “When you look back over your GIM sessions, does one stand out for you as being pivotal?” At some point during the interview, the people were asked if they recalled the music during the pivotal moment, if they recalled the therapist’s interventions during the pivotal moment, and whether the pivotal moment had had any impact on their life. The participants volunteered for this study by responding to a letter explaining the research. Each participant gave informed consent for the interview to be tape-recorded, and in accordance with phenomenological research procedures, they have been involved in validating the analysis, or “distilling” the interview material. The participants tell their own stories; their words are direct quotations from the interviews. In the last section, I analyze and distill from the content of the interviews “meaning units” or categories of experience and report these to clarify what is experienced as pivotal moments in GIM. Pivotal Moments in Guided Imagery and Music (In this section, Denise’s comments are italicized)

Sarah Sarah identified a session that had occurred three years earlier.

[There was] a lovely experience of a wise old man in a cave, of me sitting there holding his hand and being affirmed. The old man said, “What you’re doing is good work; do it with confidence.” [The second pivotal image was] being in the lion’s den. The lion smoothed out the floor where I could he down. He respected me and treasured me and prepared a place for me. He had a piano there and I played the piano. I played well, with confidence, and felt affirmed. I made friends with the lion, combing his mane, stroking his face, and resting with him. As Sarah described these images, she developed further insight into their meaning. The cave and the den are feminine images and inside them both is the masculine -- the wise old man and the lion. It feels like coming to know the masculine; I knew I was safe with both. I felt I belonged, like a home place where I can be myself. Sarah didn’t remember very much of the music of the session, just the first chords and the sense of marching and the heavy rhythm of the music. She was aware that the music “really moved me along.” The lion is the symbol of strength and courage. Meeting him 3 years ago has helped me in developing more masculine qualities in my own life. And in the last 12 months, I have found a wise old man to continue my therapy work. [The session was prophetic for me because] the wise old man has appeared in my life. Bernadette [My pivotal session was] the one where I found my voice. The music started. I was sitting at the piano in an orange dress. I have always hated orange. It was a strong dress. The orchestra and I were working together. They were giving me a sense of identity. I was able to play what I wanted to play, and this was a powerful experience. I had a wonderful feeling in my body, a tingling in my hands. I felt the stiffness in my body going -- my body was starting to loosen up. My mouth was very, very dry. I felt like running. I wanted to be free. It was a feeling of wanting to grow up. There was a feeling of strength in my body, of wanting to be in control, and I felt this [was] the moment to do it. There was something choking me in my throat, like something had to get out. The therapist said, “Can your throat make a sound?” It was a feeble sound to begin with, but the strength came into my voice. I remember just letting it come. It was a feeling of knowing “I do have a voice.” It was a freedom in my throat, a physical change. It was an incredible moment because I’ve always felt so powerless over my voice. I did not want to say anything for the next selection of music. I pictured myself with an orchestra and choir and I was the lead singer. It was a brilliant experience. I could stand out there in front and have enough faith in myself that I could do it. The beauty of it was that it went on for a while. It was not a fleeting thing. I was really living the moment and I could stay with it. My next image was being at a victory ball. I was able to celebrate finding my voice. An image of an old man said, “Well done.” Bernadette found that this session had a very significant effect on her life. Since the session, I have made wonderful decisions in my life. It has given me confidence that I can do things, that I can say things, that I can make decisions, that I have my own voice,

and I can go out and do what I want to do. It was life-changing, a turning point. I feel I have something to offer. I don’t think I will ever lose that image. I still feel the strength of that session in my body. It is right in my body, in my heart, in my soul, in every part of me. The singing voice in the music held me there and helped me really live the moment. In the imagery, I was asked to take the solo part, and I accepted. I was feeling, “Yes, I can do it.” It was the strength of the music [that] made the session pivotal. The singing, to me, was expressing the very core of me. Suzanne Not all pivotal sessions in GIM are enjoyable. Suzanne -- and, in the next section, Timothy -- described uncomfortable experiences. It seems that the sessions were pivotal because the uncomfortable images were resolved in some way. [The pivotal session was] the one in which there was a bad, negative memory of God as a pillar turning to rock. The pillar was a negative image, an immovable, solid, faceless, shapeless image. I didn’t like the image. I chiseled away at the rock and exposed a gold nugget. The nugget was beautiful, precious, and small. The significant image was the rock turning into lava, flowing from the pillar, and exposing a gold nugget underneath. The lava flowed out of my body, and with it, all the negative images of God. It was freeing, getting all the mountain of lava off. There was a feeling of letting go, of being able to move. My whole body was freed. And that freedom has stayed with me. I was able to breathe without a weight on me. There was a breaking away from old feelings [and] old ways of being, of needing more freedom in my life, a freedom of being. [The pivotal moment] was a powerful, explosive moment. I felt the awfulness of it and needed to feel the depth of that to break out. Suzanne explained that the session had had a significant effect on her life. Recurring bad dreams have weighed heavily on me. The lava flowing has changed that. I don’t have as many dreams about it. I can retrieve the memories without [their] destroying me. The images leading up to the pivotal moment were important. I need to have my body involved. The most powerful experiences are the complete ones where there’s sensation in your body and you are physically involved. The more the body is involved [in the experience], the more powerful the experience is. Timothy Timothy’s experience of pivotal moments in GIM was described as a recurring image that reappeared in several sessions. He did not think any one session stood out as being pivotal. There is an image that is significant: an image of a dead baby being carried on a barge in the underworld or underground. I am pushing the barge, [which is] like a Venetian gondola. There is a feeling of sadness. It relates to something which happened to me when I was younger. It is a recurring image. It lasts for different lengths of time. As the image comes back, it is a reminder that the issue is not resolved. Timothy describes in more detail that the experience is not a pleasant one. “It isn’t a happy experience coming to the image, and I don’t enjoy revisiting it. But it is alive and I take it

with me. It has its own life.” The recurring image, however, transforms from one session to the next. In recent sessions, there is a shift in the image. There are jewels imbedded in the boat and surroundings. A baby son, who is alive, is now in that image, on the boat with the dead baby. There is a shift in emotion. There is always a feeling of loss and sadness. But in the recent image, there is a lighter feeling, like an acknowledgment. The image stands apart from other images in that it recurs. It is deep inside me. The image is experienced emotionally, physically, and intellectually. It draws together all the images of the session up to that point. It stands the test of time. Pamela Pamela’s pivotal session was a childhood memory of isolation, loneliness, and not being cared for, at a time when the family house had been destroyed by fire. I almost relived it. I remember the physical feelings of being sick and crying. I was right back inside the experience, not as the little girl but with the insight of an adult. There were feelings of loneliness, fear, feelings of dislocation, that nobody understood what was happening for me. I was [an] isolated, terrified little girl, and my mother was preoccupied with so many other things. In her GIM sessions, Pam feels she is engaged with the music. It’s like being on another level. If the music is something I love, I just enjoy the music. Other music I may not recognise, but I’ll tune in to it; if I think it’s superb, I’ll say, “That’s beautiful, I’m going to listen to this.” [Yet] it amazes me that after a session, I often cannot remember any of the music at all. David David’s pivotal session was an experience of healing following the recall of traumatic experiences. It was a meeting of myself before I was traumatized. I was a happy, vibrant, chubby child. I felt proud that this 3-year-old boy was attractive. There was a feeling of coming home, of discovery, wonder, and recognition. [There was] a feeling I had discovered this vital part of me and that it hadn’t been destroyed after 30 years. I had found something that was lost. I felt something happening in my body; my body became active. There were noises in my abdomen as if something was moving. My breathing changed; warm breath filled every part of my body. The impact of this session had influenced many aspects of his life. There is an opening up of my mental horizon. There is future. I have put on weight; I stand differently, taller, more physically aware. In a situation where I was very nervous, I called to my mind the image of the boy, imagined holding his hand, and I felt powerful. My disposition has changed; I can let go of anger. Ken

Ken could not identify any one GIM session as pivotal for him; instead, he mostly remembers the music, not the imagery of the session. The meaning is in hearing the structure of the music, hearing it as a whole and having the emotional experience. In the Brahms Requiem (part 1), I was struck by the cooperation between the singers. It was a very, very, very powerful image; how beautiful it was and how uplifting. It was a strongly emotional experience. It sent shivers up and down my spine. There was strength and gentleness; it was controlled yet beautiful and powerful. In the Brahms Piano Concerto, number 2, slow movement, I felt the expression of passion and feelings and their resolution -- an expression of joy, yet gentle and embracing. The pianist was having a ball and sounded as though he was really involved in it. The Similarities and Diversities of Pivotal Moments Pivotal Moments Are Recalled in Vivid Detail All seven participants recalled in vivid detail the pivotal imagery, feeling, or body sensation of the experience. The colours and shapes of visual images were recalled in detail, and the feelings and body sensations were described in graphic detail. Some also described the mandala they had drawn from the session. The Image Lasts and “Stands the Test of Time” Sarah identified a GIM session that was pivotal for her and had occurred 3 years prior to the interview. For others, the pivotal session had occurred between 18 months to 3 weeks prior to the interview. It was Timothy who stated that the pivotal image “stands the test of time.” Bernadette said, “I don’t think I will ever lose that image.” Pivotal Moments May Be Unpleasant or Uncomfortable The session or moment within a session may involve imagery that is in a disliked colour or may be an unpleasant, uncomfortable, or a horrible feeling. For David and Bernadette, the pivotal moment had emerged after feelings of being uncomfortable, but their pivotal experience itself was quite wonderful. For Suzanne and Timothy, the experience itself was not at all comfortable and not enjoyable, yet the meaning of the moment affects their life in a very positive way. Pivotal Moments May Involve an Embodied Experience For many of the participants, the pivotal moment was experienced as body sensations or changes within the internal organs of the body. David, Ken, Suzanne, and Bernadette all experienced strong body sensations and emotions during their pivotal experience. They commented that the more the body is involved in the experience, the more powerful the experience is. The whole body may be involved, physically, emotionally, and intellectually.

The Experience of Pivotal Moments Is a Lived Experience Bernadette and Timothy described how the image is a lived experience. Bernadette said, “It was not a fleeting thing. I was really living the moment and I could stay with it.” For Timothy, the image “has its own life. It is deep inside of me.” Pivotal Sessions Have a Significant Effect on the Person’s Life There can be feelings of “coming home” (Sarah and David) and feelings of freedom, of room to move and grow, of expanding, and of growing up (Bernadette and Suzanne). Images Are “Building Up” Toward the Pivotal Moment Most participants wanted to describe the images and feelings that led up to the moment in the session that was pivotal, as if the pivotal moment comes out of the accumulated experiences from the beginning of the GIM session. Recurring Images May Be Pivotal For one of the participants, the image was a recurring one that appeared over several sessions and transformed itself. In this sense, the pivotal image seemed stored in a symbolic process, whereby it was reactivated in a further session but underwent change. Music Is an Important Aspect of the Pivotal Moments All the participants were invited to describe the experience of the music during the pivotal moment or pivotal session. For some, the music sustained the pivotal moment so that it could be felt fully. Sarah mentioned that the music moved her along. For Bernadette, the music helped to build up strength and to hold her in one place so that she “lived the moment.” For Ken, being with the music was like being on another level. He remembered the music and not anything else, and the meaning of the moment lay in the structure of the music and the emotional experience of it. In her GIM sessions, Pam felt she was engaged with the music. She said, “If the music is something I love, I just enjoy the music....If I think it’s superb, I’ll say, that’s beautiful; I’m going to listen to this.’” Suzanne did not remember the music at all. The imagery or emotion of the pivotal moment took all of her attention, so there was nothing left for the music. Clients’ Perceptions of the Therapist during the Pivotal Moments Vary Pam described the therapist as being there “only for her and for no one else.” Pam said her therapist is a symbol of survival for her because during the fire that destroyed her family’s house as a child, she had saved her doll, named Anna -- and her GIM therapist is also named Anna.

Ken found the therapist supportive when he was feeling very distressed and very guilty about something. “I felt bad about it. It was significant for me because the therapist was nonjudgmental. She was supportive of how I was feeling; she let me have the feeling. I was touched by her response.” He also said, “I feel I am with a kindred spirit, sharing the music.” Suzanne’s experience of the therapist was that she was quite directive in inviting Suzanne to search and explore the imagery that led to the pivotal moment. David described a strong positive transference to the therapist: “I felt safe with her. Allowing someone into the space is precious to me. I am not as guarded -- I give over.” Therapists Surmise Clients’ Pivotal Moments The second part of this study (not fully reported here) was to interview the two therapists of the participants, to ask them about their perceptions of the pivotal moments or sessions described, and to ask if they would have selected the particular sessions identified as pivotal to the participants’ therapy work. Suzanne’s pivotal experience was that the rock (representing God) turned into lava and flowed away. Suzanne’s GIM therapist assumed that the pivotal moment was finding the nugget of gold. In the interview, the therapist then said, “The process [of the rock disintegrating] was obviously more important to her than the reward [of finding the gold nugget].” Timothy had recurring images of the dead baby in the barge. Timothy’s therapist had expected that images from ancient times would have been the pivotal moments for Timothy, because he drew a lot of strength from those images. The chosen image, however, came from different sessions altogether, ones in which the image of the baby in the barge was transformed. Final Depiction of Pivotal Moments Pivotal moments in GIM may be unpleasant, uncomfortable, and disliked experiences, but they open up mental horizons and influence change in the person’s life. The experience of the pivotal moment is remembered in vivid detail over time. The more the body is involved in the experience, the more powerful the pivotal moment is. The embodied experience is felt as physical, emotional, and spiritual. The therapist may be a kindred spirit in this experience and the music may sustain the moment, giving it strength and moving it along. The imagery of the pivotal moment may take all of the person’s attention so that the music and the therapist’s interventions are not remembered. The experience stands the test of time, and there is a sense the moment will never be lost. References Aigen, K. (1997). Here We Are in Music: One Year with an Adolescent Music Therapy Group. St. Louis, MO: MMB Music. Colaizzi, P.F. (1978). Psychological Research as the Phenomenologist Views It. In R.S. Valle, M. King (Eds.): Existential-Phenomenological Alternatives for Psychology. New York: Oxford University Press.

Ely, M., Anzul, M., Friedman, T., Garner, D., Steinmetz, A.M. (1991). Circles with Circles: Doing Qualitative Research. New York: Falmer. Forinash, M. (1992). A Phenomenological Analysis of Nordoff-Robbins Approach to Music Therapy: The Lived Experience of Clinical Improvisation. Music Therapy 11:120-141. Forinash, M. (1995). Phenomenological Research. In B.L. Wheeler (Ed.): Music Therapy Research: Quantitative and Qualitative Perspectives. Gilsum, NH: Barcelona Pubhshers. Giorgi, A. (1985). Sketch of a Psychological Phenomenological Method. In A. Giorgi (Ed.): Phenomenology and Psychological Research. Pittsburgh: Duquesne University Press. Jordan, A.P., Cloninger, C. (1979). You Gave Me Love. Recorded by B.J. Thomas. Jack and Bill Music Co. & Word Music. Lee, C. (1996). Aspects of Improvisational Music Therapy for People with HIV and AIDS. Music Therapy International Report 10:24-29. Norbet, G. (1972). Wherever You Go. Weston, VT: Benedictine Foundation. Smeijsters, H. (1997). Multiple Perspectives: A Guide to Qualitative Research in Music Therapy. Gilsum, NH: Barcelona Publishers.

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

CASE FOUR 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: Priestley, M. (1985/2012). Music Therapy in Action (Reprint of Second Edition). Gilsum NH: Barcelona Publishers.

CASE FIVE Preliminary Music Mary Priestley I started Preliminary Music with the thought of giving intelligent “normal” children aged about four to six years the opportunity to explore sounds and rhythms on my forty different fairly primitive musical instruments before starting their formal instrumental instruction. Sessions are in half-hour periods once weekly. My instruments are quite simple and are mostly of the kind that has been used in religious and healing ceremonies all over the world for thousands of years. My deepest thought was that music is a language---a language of the emotions. From my own experience I had discovered that languages taught in the classroom in my childhood in meaningless lists of verb-conjugations to be learnt by rote with a perfect accent, do not stick in the mind as something that one can use. Whereas languages learnt in countries where even an approximation of their regional sounds produces meaningful results in the way of exchanges of goods, information or pleasant greetings, stick in the mind as useful tools free from inhibiting memories of boredom or embarrassment. Then why not let children find their own meaningful music, expressing their emotions through experimental self-created sounds and rhythms? Let them go back through a phylogenic experience discovering that “This sound is my own, it is what I mean or feel at this moment in time and I am with someone who understands it.” The idea was born when I started letting little violin pupils have a space for free-play on my instruments as a treat or carrot at the end of their lessons. The results were delightful and an obedient apathetic little pupil could sometimes suddenly turn into a master of dynamic and meaningful creativity. The key that opened this amazing door seemed to be creative play. I visualized the attraction for the fee-paying parent as a course of twelve weekly sessions with a written assessment of the child’s musical aptitude and preference of instrumental type at the end of this period. However, things worked out very differently. I had not reckoned with the deep and far-reaching power of self-creativity through playing. Nor had I reckoned with the thoroughgoing work done by Ben-Tovim and Boyd (1985) regarding the mental and physical requirements for professional success on a given instrument being weighed up with the emotional and symbolic satisfaction that a self-chosen instrument could give to a young child who was probably going to be a satisfied amateur musician. The children and their mothers came to me via a small advertisement in the local music shop. On my headed notepaper it offered Violin Tuition, beginners to advanced, Music Therapy

for emotional problems, and Preliminary music for children from four to six years of age. I did not have any prior interview with the parents when I began this work and so did not in every case know that some of the children had been quite seriously school phobic at the start of our work, beginning every school day with tears. However, I have subsequently instigated a short questionnaire to be filled in initially by the parent, with the child in the room either fiddling about with the instruments or sitting forlornly on the floor looking at them. The reaction to this situation, plus the information in the questionnaire, told me something about the parent-child relationship. It is followed by a short assessment session with the child, to see if we can get on with each other. A questionnaire sent to the mothers at the end of these sessions told me that, in fact, the mothers had sent their children to me because of my music therapy qualification in the advertisement. However, as in this country the greatest share of music therapy goes to mentally-handicapped children, many parents do not like it to be known that their brilliant child is going to “therapy.” But the title Preliminary Music was acceptable. As regards the therapeutic aspect of play, which in my opinion is equally valid for all ages, I will quote two excerpts from Dr. D. W. Winnicott’s book, Playing and Reality: “It is in playing and only in playing that the individual or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self” (p. 63). And later: “We find either that individuals live creatively and feel that life is worth living or else that they cannot live creatively and are doubtful about the value of living” (p. 83). Opposed to this creative living he saw a life of compliance and adaptation. The unexpected results of Preliminary Music certainly rendered me adaptive but the outcome was creative for the children, their parents and ultimately for me, because it made me think. In the afternoon session, I had no particular aims for the child but would try and help him to pursue his own aims and interests in an atmosphere of play. It is important to realize that play can also be deep seriousness with the “should’s” and “ought’s” taken out. Unlike some therapists I answered every question the child asked, as simply and as honestly as I could. I paid close attention to him in his activity and the thought and emotion inherent in it, for a concentrated half hour. It was exhausting, especially in the beginning when children’s concentration spans were so short and they jumped rapidly from one sphere of interest to another. Also I really do believe that, time wise, a small child’s half hour is much longer than the half hour of a person 50 or 60 years older. I did not regard my role as being a therapist in the usual sense of the word but did see our sessions as being therapeutic. My role was akin to being the Joker in a pack of cards. I was alternately observer, listener, audience, accompanist, cassette recorder operator, security officer for persons and property, teacher, pupil, playmate, the mirrorer of emotions and the introducer of the odd complementary or compensatory idea. Up to a point I could be manipulated and used in any way the child wanted. Beyond that point boundaries were reliably firm. Keeping the work within the half hour was one boundary and the other was the rule that the child should not damage the instruments, him/herself or me. The surprising result of the sessions with the three first intelligent, “normal,” children who I will later describe, was that they used these half hours to work out their own pressing problems, which in two cases were preventing their smooth development and educational progress. The first child used the time to adapt to her feelings about her mother’s pregnancy by her stepfather and the forthcoming arrival of her first sibling. The second used the time to let

both of us know that she had an artistic and creative self and that she felt miserable in her uncomfortable environment. This concluded with the alteration of these circumstances without any direct interference from me. The third child used the time to make the transition from being an anxious only son of a worried career-driven mother, to being a confident member of his male peer group, feeling that it was at last safe to allow himself to be taught a few basic skills, and happy now to have his mother at home. By their twelfth sessions I could see that important processes had started and it would be criminal just to tell the parents that we would break off the work there. Besides which, the children were so keen to come somewhere where they felt they were free to be themselves; and the mothers so glad to see their children happier, that it would have been difficult for the parents to stop the work at that point. Although the subsequent questionnaire showed that some parents would have liked an initial explanatory interview, I felt at the time that there can be an advantage in leaving things a bit vague inside and outside at times, and gave none. I have thought hard about what enabled these externally and internally creative and healing processes to happen. I put it down to three factors: the teleological (goal-seeking) child with his/her goal of wholeness; the presence of objects to play with; and the close personal attention of an adult who is willing to believe that the child’s activities have meaning and value even if she does not always know exactly what the meaning is at any given moment. The years around four to six have special value in this connection. According to Erich Neumann (1973), the first year is a post-uterine embryonic phase. For the next two years the child is emotionally and mentally very much contained by the mothering person. If she is cooking then he wants to cook, if she is crying then he will cry too. Her values are his credo, her moods his weather. Then, jumping to the age of seven, he is now largely contained by the peer group. He must look like them, talk like them, play like them and live like them. But in the years between, from roughly four to six, we have the Golden Years, a most valuable remedial and preventive period when the child can be in a free and flexible state. At this time he is able to play creatively through the less seriously traumatizing difficulties of his life which, however, could well produce a warped adaptation to life, taking years to remedy therapeutically at a much later date. It is in this Golden period that a child can show startling originality in thought and deed. If these clues are recognized and fostered they can be a vital pointer to the successful future navigation of his life’s journey. Sometimes a parent is so concerned about how she thinks the child ought to be that she fails to pick up these cues and even dampens the vital sparks that a teacher or near relative may be able to see. For example, the mother of the boy in the third case study complained that her son learned nothing in school but only daydreamed. In my flat he showed himself voraciously hungry for knowledge: “What is that? How does it work? May I see it? Touch it?” He wanted to explore everything. His mother would say “Not so many questions! His curiosity is terrible.” Her anxiety about the development of good manners scotomising the very springs of learning at source. The end of term reports of our progress were able to make some useful links for the parents who confirmed this in the questionnaire. However, perhaps I should have been more direct in putting my ideas to some of the parents. But I thought the danger of making the mothers distrust their own good feeling of parenthood (so easily undermined in these days of experts) and act at secondhand from outside advice, would be the greater danger and so said

nothing. Besides, being a parent and grandparent oneself produces a certain amount of healthy humility. Preliminary Music only caters for children on a one-to-one basis because the therapist must be so carefully attuned to the child’s feelings and ideas, often expressed through movement as much as through speech or musical activity. I, personally, have avoided seeing two children from the same family to avoid rivalry and jealousy, of which they usually have enough already. Katy Katy was just five years old when she came to Preliminary Music. She was a happy child with plump, red cheeks, and thick sandy-coloured hair. Her parents were divorced, father lived abroad and mother had recently re-married. Altogether Katy had 33 sessions over 13 months. In her first session she played with excellent rhythm, inventing a song about her relative falling off a donkey called Jose. In sessions two and three, her improvisations and songs became a bit longer. In four, I showed her the cards with note values and she played these correctly on the violin to her mother. I do not usually allow the mothers in, but Katy pleaded most earnestly for her mother to come in, so I allowed her in at half time. Katy explored more of the forty instruments as we progressed. In session nine, she came in hopping like a frog and I accompanied her with hopping music. She made mysterious footstep sounds with the wire brush on the drum and a story about a monster, perhaps her greedy-baby self. In session 11, playing the chordal dulcimer, she discovered, with interest and delight that she could play louder with her nail and could stop the vibration by touching the string. In our dyadic first half of the session I mirrored her pleasure at her discovery, so she showed her mother Jane this when we were the trio in the second half, clearly hoping for the same response. However, sad to say, Jane did not react at all to the excitement of the discovery. In fact throughout the session Jane looked a bit uncomfortable at Katy’s behaviour, probably not knowing what she should be doing, and feeling a bit guilty and responsible in case she was not doing the right thing. Perhaps I should have made some explanation on the phone afterwards, but I felt at the time like leaving things to develop in a natural way and not to try to make anything happen willfully. I felt instinctively that Katy knew the way forward if she was given a chance and the less I interfered the better. However, I did not feel that my belief was yet backed up by the kind of rational explanations that might convince her mother who was paying for this treatment. So I kept quiet. In session 13, Katy brought her doll Rosie for the first time. I thought this significant, and in fact Jane must have been planning her new baby at that time. In sessions 14 and 15, Katy became a hopping frog and squirming snake on the Turkish prayer rug while I accompanied her on the piano. Could she be in touch with the developing child in her mother’s womb, I wondered? After their next holiday abroad her behaviour to her mother changed. She was the mature little musician with me; and a very clinging baby when Jane came in. After session 18, I wrote in my diary, “I wonder if Jane is pregnant.” Katy had been hopping like a frog and then sat on Jane’s lap with her doll saying solemnly, “It wasn’t a frog.” She seemed aware, at a deep level, of the new life which took up some of her mother’s attention. From session 19, she

started to play known tunes by ear on the piano and melodica. She showed unusually powerful and lengthy concentration and determination. It was almost as if she were thinking “If there is going to be a new arrival in this family, he or she is going to find someone here to be reckoned with.” In session 23, she sat on her mother’s lap pretending to be a suckling baby. By this time Jane seemed to get some inkling of what was going on; and though looking a bit embarrassed, taking her cue from me, allowed Katy to express these thoughts in action with gentle understanding, either conscious or unconscious. Katy dismembered the xylophone to find the lost beater’s head which had flown off. What mother had inside her could not be investigated so easily. In a song she sung “my little brother comes to tea.” Her music became more ambitious. I was very glad when in one session her mother was with us and Katy did some really amazingly beautiful xylophone improvisations with my piano accompaniment. I did not have the cassette recorder going at the right moment, and recording all the sessions would have been too expensive for me at that time, so it remains only in our memories. By session 28, Jane’s belly was huge and Katy did a beautiful dance with her mother’s scarf. She began to show a feeling of loving responsibility for her mother, and in session 29, Katy involved all three of us in a chime bar improvisation for the first time. We made some cassette recordings and she became very squeaky and excited. On one tape I played for her maraca dance and when the bell went she sang a song she wanted me to hear, very fast to get it all in. (I use a timer for children’s sessions because of the intense involvement and the difference in the time-feeling in the different ages). Session 30 was important for Katy. She solemnly and deliberately took one instrument after another over to Jane and arranged them around herself until she was playing twelve instruments at once. Jane seemed somehow embarrassed and uneasy about this but I understood Katy as convincing herself, in a magical way, that if she could play 12 instruments at once then her mother could easily care for her, her stepfather and the new baby or babies that her mother contained. During the last three sessions, Katy showed tender maternal (or perhaps paternal) concern for her mother, involving her lovingly in our music, and organizing our trio on the chime bars as a farewell piece. Jane, for her part, was losing her social persona and merging into a more gentle and vulnerable state of mind. As Katy had been born after only half an hour’s labour, Jane dared not risk the car journey to my flat four weeks from the expected birthday, so we parted. Georgina was born four weeks later and Jane wrote that Katy had shown no disturbance or resentment at the arrival of her half-sister. Katy started piano lessons at the beginning of the next term and at the follow-up five years later she had taken her Grade 5 on the piano and 4 on the cello. And she had another little half-sister. Katy had had a good start experiencing the value of music as a conveyor of deep personal meaning and expression, and she had used it to help herself through a difficult adjustment and transition from being “only child” in one family to being the big sister in another. Zoe

Zoe was a blue-eyed, pink-cheeked little girl with long golden ringlets and the appearance of a disgruntled doll. Sometimes she came to her session with her Nanny, sometimes with her continental grandmother, sometimes with a family friend, once with her separated father, occasionally with her working mother, and sometimes in a huge limousine whose chauffeur waited for her in the car outside my basement flat reminding me of my own childhood. At the start of our work she was five years old and I found out later that she had been crying every day when it was time for her to go to her French-language school. The period of work discussed incorporated 33 sessions over 16 months. At the first session at 4:00 p.m., she refused to enter the flat and sat down on the stone steps leading down to my front door. Her mother came in and talked to me for ten minutes. After that time I suggested that she tell Zoe that we would sit there until 4:30 p.m. when she and her mother would go home but if she wanted to come in before that she could. The mother went out and Zoe came in to go to the toilet then sat outside my workroom in the passage. I began to play the piano in the sad and rather resigned Dorian mode. Zoe came in and offered me a peppermint which I accepted. After that she played on various drums accompanied by me on the piano, and I stopped the session sharp at 4:30 p.m. when the next child came. For the next two sessions Zoe explored the instruments and recorded some little French songs in rather a tense, neat fashion. She had learnt them at school. Her concentration span was short but she enjoyed a spell of our copying each other’s rhythms on drums. In session 4, she danced beautifully to my piano music and recorded a song with more expression using some instruments. She started to control me saying, “Don’t play the piano when I sing, it makes it more difficult.” So I didn’t! In Session 5, after playing the xylophone, melodica and bells, she drew a crenellated castle and asked me not to play the piano meanwhile. So I didn’t! Session 8 was very dramatic. She sat drawing but wanted me to sit motionless at the piano staring at the corner of the room. When I moved and played a note to see what she would do, she came and smacked me and said I was naughty, her little face contorted with rage. I said, “I wonder who did that to you.” “My Nanny,” she paused, “And my Mummy.” After that I was forbidden to move. “It seems like you want me to be dead,” I said. Then she came and played on the piano and allowed me to play. She wanted the television on but I said no, we made our own music in her time with me. Session 9 was the beginning of musical games in which she controlled me but in a more acceptable fashion. We played “Statues” and “Hunt the Bell.” In “Statues” she danced round till the music stopped and then froze immobile and I had to guess what she was pretending to be. In “Hunt the Bell” I played the xylophone with my eyes shut while she hid the bell and then I had to find it while she played. In Session 10, she clung to her mother in a fury and refused to come in. After a few minutes I said, “She’ll be all right now.” Her mother left, and Zoe kicked wildly and screamed. I held her gently but firmly. “When you are cross you feel like a little animal. What sort is it?” I asked. She talked about her pets. We had a good session after that, with singing and playing. In Session 11, she played the psaltery carefully and told me about her strict school teacher who gave them written instructions and would not answer questions. (Remember she was just 5). We played the piano and drums together. I found she responded more to minor keys. In Session 14, for the last time she sat in the car and refused to come out. I told her I had

something new in the room and she came in and chose colours on the new Hygeia colour lamp. The controlling musical games continued but now without any sadism. In Session 15, her hair was straight, the lovely ringlets gone. The Nanny had been sacked. The controlling games continued. In Session 17, a new Nanny came. In 18, she told a story of a man taking a girl from her school playground into a taxi and cutting her throat: “It is my little sister and Mummy doesn’t know and she will come and find her gone.” When her little sister did come to fetch her with the new Nanny I kept her out of our work room and later, when her mother asked for the little one to begin sessions, I said I only take one child from a family for Preliminary Music. Zoe needed someone to be just for her. The controlling games became more musical and more creative, Zoe became wonderfully sensitive to my loud or soft drumming as she approached or distanced herself from the hidden bell. In Session 25, she had an earache and was off school, but had insisted on coming to music. She saw me practicing my violin through the window of my basement flat and played on the quarter-sized violin, with me on the piano. In 27, she was very angry and demanding as a teacher who wanted me to copy her music. I had a strong countertransference experience of overwhelming fear and confusion at my inability to do it right, and told her this in simple words as I felt it was her unspoken reaction to her school situation which she could not communicate as forcefully in any other way. Between Sessions 28 and 29, she had her adenoids out and came straight back into the controlling games; but afterwards drew a picture, shouting out the subjects as she drew them so I could improvise to them on the piano. The games continued but one day she demanded different colours from the lamp in operatic singing, beautifully pitched (unlike her French songs) and I had to improvise “colour music.” This development continued until the end of our work. Session 33 was the last one. Her mother showed me the prospectus of a new school which seemed to offer a more gently artistic and progressive approach. Zoe had bashed the cymbal repeatedly singing, “I’m never, ever, ever going to that school again!” It was actually of impeccable reputation but more for the tough than tender-minded. I never mentioned the Nanny and the school to her mother and wondered what had taken place between them to release Zoe from that bondage. I felt that our work had gradually unfrozen the defenses of that castle, created by an unhappy situation, revealing a creative and artistic nature and a happier child and mother. Five years later she was still at the new school, happy and much more comfortable in her relationships. Frank Frank was five years and 10 months old when he came for Preliminary Music. He had over 47 sessions in 18 months. He was very sensitive, pale, fair, intelligent, and extremely interested in how the instruments were constructed and how they produced sounds. His concentration span at first was only a few seconds long and his mind was in a whirl. His mother was French, a teacher probably in her late thirties, who constantly warned him against damaging things. His father was a successful business man also from the continent. His mother said that he cried every day when he had to go to school and the teacher said that he dreamed all the time when he was there.

For the first six sessions he explored and played the violin, Chinese blocks, xylophone, raft zither, bells and cymbal. In the second session he dared to play the cymbal very loudly, seeming relieved to cause neither damage nor scolding. In 6, he asked me to work the bullroarer, an instrument originally shaped like a fish on a string, formerly used in manhood initiation rites for youths. This is an instrument which can cause damage to the player or the environment. Although I would trust giving it to my own children to play with under supervision, I have since taken it out of the workroom armory. Frank had a tentative try at it but could not make the bull-roaring sound and gave up. His mother asked whether I could now teach him something. I answered, “He needs a playground, he is very much alive and in reality here, not dreaming at all.” In Session 7, she said his reading was better and things were clearing up for him. From this time he began to tell me things that had happened at home and we improvised music to them as well as to his invented stories. For example: his friend had tadpoles; a dog bit him; and he lost his mother in the supermarket. In Session 16, his mother again asked if he was ready to learn, she meant be formally taught. I said not yet but we did do some drumming and violin playing to different note values. I asked him if he would like to learn a piece on the piano and he said “No.” He said he wanted to play from real music but in fact only wanted to choose some sheet music to put on the stand while he drummed. He started to think creatively about what he wanted to do in his half hour and would collect a battery of instruments round the cassette recorder with concentration and perseverance. Sometimes the time was up before he actually began to play. In Session 19, he chose yellow on my new colour lamp and from then on put it on at the beginning of every session. Before Session 23, his mother said that he was much happier at school and his reading had improved. In 25, he wanted to learn a piece on the melodica and I taught him the first phrases of Frere Jacques. After 27, his mother said his math grades were better. In 30, he said that he was going to Scouts now and that he wanted to learn the trumpet as his friend played it. I didn’t have a trumpet, partly because I was afraid the neighbors might complain, partly because I don’t like the sound, and partly because the modern trumpet is not primitive enough for the immediate satisfaction through sound expression that I want for the children in these sessions. At this time his rhythm was generally very poor and he took no delight in it; but he did enjoy our dyadic drum arguments and conversations. In Session 32, his mother said that all his grades were now Bs and Cs where they had been Ds. We had had a real battle to give him the freedom to play, and his ability to choose to reject teaching consciously and in words, seemed to set him free to ask to be taught when he did feel like it. He told me that he had been to Cubs and was frightened at first. He said he always squeaked on the violin and I showed him how to avoid this. In Session 36, he just sat still for several minutes and thought hard about what he wanted to do. He told me that he had been given 19 out of 20 for Biology. At last he could find somewhere where his curiosity about how things were made came in useful. He got out the chime bars and experimented alone very systematically and intelligently in releasing and stopping the sound. In 37, he said he didn’t want to go to boarding school as he would miss his Mum. In session 38, he again said that he wanted to learn the trumpet. I explained that I did not know how to play a trumpet and that I still did not have one.

After 40, his mother said that she would arrange for a half hour trumpet lesson at school but still wanted his Preliminary Music sessions to continue. In 42, he played the Chinese blocks, we had a conversation on triangles and afterwards he said that his first trumpet lesson had been “O.k.” In Session 43, he brought his trumpet and we recorded an improvisation. There was a lot of musical fumbling around and finally he triumphantly played a clear high note. By now he was a confident peer-group member, concentrated, decisive and purposeful. He told me anxiously that the teacher had played on his (Frank’s) trumpet and he was afraid of germs. We told his mother this after the session and she was shocked because Frank had said that the teacher had used a separate mouthpiece. Frank had been afraid that if he told the truth his mother would stop the lessons. His mother said that she would sort this out with the teacher. In Session 44, he played two string ostinatos on the violin and we played some pleasant duets. I think that by then he could distinguish the way the Preliminary Music session was conducted from the discipline of the trumpet lesson. By the 47th session, Frank showed curiosity and great pleasure in the process of exploring. To me, this seems to be the raw material for all learning, to the point at school where anatomical curiosity can pass into science and biology, curiosity about our forbears can be satisfied in history, of exploring by geography, of fondling and handling in art, woodwork and music. For me the moving thing about Preliminary Music is what powerful and preventive effects this one little half hour weekly of undivided attention can facilitate, through attempting to allow the child to find its own personal meaning through its musical play. Perhaps it can be explained also in another quotation from Erich Neumann (1973): “Only an individual embedded in this symbolic reality of play can become a complete human being. One of the main dangers implicit in this modern, occidental-patriarchal culture with its over accentuation of rational consciousness and its one-sided extraverted adaptation to reality, is that it tends to damage, if not destroy, this pregnant and sustaining symbol world of childhood.” The crucial thing for the music therapist doing this work is to have his own inner world of childhood and creativity acting daily as a nourishing force in his life.

Taken from: Priestley, M. (1985/2012). Music Therapy in Action (Reprint of Second Edition). Gilsum NH: Barcelona Publishers.

CASE SIX Music Therapy with a Private Client Mary Priestley It is difficult to construct a clear picture of the inner progress of a course of analytical music therapy from brief progress notes. The inability to share the vital experience of our musical improvisations and the music behind the talk and the silences is another problem. However, perhaps these notes on two cases, one of a private client in this chapter and the other of a hospital out-patient (whose improvisations were all taped) in the next, may give you some idea of how the work can develop. Case Notes Thelma was a small, attractive brunette of 23 married to an executive called Edgar; she was studying singing and piano. They had been married one year, her parents were alive; she had a poor relationship with her mother who was described as having fluctuating moods. There was an elder sister and a brother. Thelma had had moods of depression since she was at secondary school. She was a poor sleeper, waking early, and had bitten her nails since she was seven. She was referred to me by a colleague who knew her husband who said she was behaving in a disturbed manner. I asked her to see her G.P. for a general checkup but she declined. Session 1 Thelma seemed rather confused and excited, frequently breaking off sentences and changing the subject. She had made Edgar twist her arm by shouting that he had no feelings, and then experienced some relief of tension in hitting him. Fear of her anger being like her mother’s outbursts (she described one attempted attack on her, as a child, by her mother with a breadknife) had made her seek help. She cried, saying it was a pity for Edgar. She talked about a feeling of being “put down” by school, parents, and depressions. I tried to persuade her to improvise this feeling but she couldn’t. I tried to make her do a Door in the Wall improvisation on “Why I resent Edgar” which she said she did. She couldn’t. She said that when she was depressed she felt that static electricity came to her from everything. She was no longer freely expressive in singing, she said. Comment: When a patient absolutely cannot bring herself to play, the therapist can switch his attention to the music in the words--here desperation--and the rhythm which was jerky like the actions of a panicky trapped animal.

Session 2 (5 days later) Thelma came early as I was fitting a new electric plug. She launched into outer/inner reality experiences with electricity at home. Fuses were going bang all over the house and the ghost of her grandmother walked. Her face was very excited and strange when she spoke of this. She produced an interesting dream the initial association of which was the memory of being left alone on Sunday evenings while her parents were at church. (She was very much afraid of the dark and electric shocks.) In the dream the living-room light fused and went out with a bang. She lit two candles to light the room. She half-shut one window to prevent the candles being blown out, but the wind blew it open. It was eerie and dark and the window wouldn’t shut and latch. She opened the door, the hall light flickered, and she ran all over the house and saw that the lights were flickering. The house was somehow the present one and yet also her grandmother’s house. I asked her to be the Eerie Darkness in sound while I played her. She resisted doing this improvisation for some time but finally did and felt that the Eerie Darkness was chasing me (her) all over the house. During this music she had a vivid memory of being small, standing at the top of the stairs at her grandmother’s and hearing the heavy steps of someone terrifying coming up to get her. This made a very strong impression on her, she was “in it” like someone who has just woken from a dream. She overvalued her husband’s control and thinking, despising her own capacity for feeling too often used only for emotional explosions. I wondered if she were not carrying some of his feelings and overloading her fuses and letting him do her thinking. They needed to be two whole separate conscious individuals like the two lighted candles. She “killed” my sentences repeatedly by butting in fiercely. I asked her if she were trying to make me violent and twist her arm by not paying me the fee last week. She concentrated more this week, worked on herself, and looked better. Session 3 (A week later) Thelma felt energetic and her teacher had said that she hadn’t sung so well in years. She brought a dream about visiting her ex-boyfriend, Tom, in his council house, meeting his father who greeted her pleasantly but she felt he was not pleased. Children were having a sports day on a green surrounded by a wall two bricks high. Thelma’s mother was there and Thelma felt inhibited and foolish with her watching. I said I thought I was the inhibiting mother watching the music of her feelings. Next she told me that she felt that marriage was a weight, that she felt the responsibility for Edgar’s feelings. He was over a decade older than she. She had had an increase in sexual feelings for other men. We improvised with her being Freedom and me Marriage. She felt my sanctimonious music was stopping her from being free but her xylophone music was marvelous. We exchanged roles and she felt that her marriage was her conscience. Comment: This increase in sexual feeling is a frequent occurrence during music therapy, especially where the feeling towards the partner is blocked by an unconscious experiencing of him as a parent. Session 4

A very long session. Thelma had written down her thoughts about marriage which we discussed. She told me that Edgar had had a breakdown when his former girl-friend let him down. The dream about Tom, not sufficiently attended to, had continued in three more dreams in which he figured. In the third dream she had seen him and been titivating in a mirror and had found that only her sad eyes needed attention. I suggested that I was the mirror showing her her sad eyes whereupon she sobbed as if her heart would break and I let her experience this grief to the full. She had known Tom for three years, she had always loved him but pushed the feelings away and married Edgar for security when she was depressed. At first I felt real pain in her crying but after a while it was as if she were begging me to unlock the prison and I said it was she who had the key not I and she must act. She decided to talk to Tom about it. She came right through the experience of her grief and spent several minutes making up her face in the bathroom before leaving in a self-possessed manner. Comment: This was a tremendous cathartic experience. Had Thelma not been a musician I would have contained her emotion in music but as a musician this would probably have switched on her thinking and broken the complete experiencing of the emotion. As it was I relied on the holding power of my “inner music.” .

Session 5 Thelma had talked with Edgar and shown him her poems and writing for the first time saying how rotten she felt and, “Help! Help!” She had shown him a side of herself that she had not exposed before. She had seen Tom and talked about her feelings and decided that the only right thing was to separate from both men and find out about herself. I said that there was a rule of “no change under therapy” because it was difficult to work at change internally if there were radical external changes. She said it would not be for six weeks at least. I wondered whether the wish for outer separation was in place of the needed inner separation. We studied a dream where Edgar and she were in the back of a car driven by her parents and as Edgar talked she said, “Shut up! Don’t let the parents know what you are teaching me.” We discussed her lack of early sex instruction and how Edgar had taunted her saying, “You sing like a virgin.” We did two Emotional Investment improvisations. She improvised “Tom,” slim, one-sided manageable music, and then “Edgar,” very sincere, gentle, tender music with much more real emotion and a feeling of awe and “what comes next?” She said she was “very fond” of Edgar. She said that she had become more responsive to colour. Comment: The release of emotion often brings a clearer perception of the outer world and its beauties. At this session Thelma insisted on playing the piano and letting me play the instruments. Session 6 (A week delayed due to the strike.) She had been joking with Tom when their fellow students were there but alone with him she could not communicate until their music had dispersed some of the emotion. We spent some time on a dream in which she was in Machynlleth Station waiting for a connection to Barmouth. (Her father was Welsh.) It was a beautiful day with blue sky and fleecy white clouds.

At the top of the road running under the tracks Tom was coming towards her meaning to say it wouldn’t work but he couldn’t say it, instead he embraced her and she gave in. We then improvised two endings. In the first she tore herself away, got on the train for Wales with Edgar; they looked back and couldn’t see Tom. This left her with a feeling of peace. In the other Tom and she got on the train for London and embraced, this left her with feelings of courage and energy. We discussed the association of Edgar with her father and what the road under the tracks might mean. Session 7 Thelma happily talked about Edgar then said she partly wanted to leave him to find her own independence. We discussed the possibility of doing this while staying where she was. Tom had said that he would need time--at least two years--but thought that she should leave Edgar. I could not get her to play, she kept balking. Finally I said that she was making me feel like an impotent child and had anyone made her feel like that and was she passing on the message to me? Yes, she had come to a stop in the singing class and her teacher had told her exactly what to do and she felt terribly frustrated like a child. We discussed Up and Down parent/child pattern relationships. We tried to play Being Equals on xylophone and chime bars. But first she reacted by playing high when I played low then she got scared and became submissive and copied me. At the end she said that she always let Edgar work out her musical interpretations. As she was going she said anxiously that we had not decided what to do about Tom and Edgar. I said that I was sure that she was perfectly capable of making her own decision when she was ready but what we were doing now was to help her to experience her feelings about the whole situation. Session 8 Thelma was wearing a smock, looking quite pregnant and very happy and her face all of one piece. She had got on very well with Edgar and decided that she didn’t have to leave home to be independent. She had seen Tom and they had worked at some music together and she had made him a present of a tiny home-made animal for his birthday. We did an improvisation of a Door in a Wall marked “Independence” and she went through it into her music room at home and was looking through her diary and dates as if bringing the music into other areas. We improvised Child and she first played stereotyped childish music imagining that she was a boy with building bricks and then played more emotional music feeling the excitement of perhaps after all being able to be the mother of a baby with Edgar as the father. She was feeling capable and happy, Edgar was pleased too, and we arranged that she should have one further follow-up session in five weeks. Session 9 Thelma looked very attractive and more mature. The relationship with Edgar was good. She was still feeling love for Tom but had used too much energy in trying to compute what his feelings for her might be instead of talking about her own. She had bought herself a tape

recorder to hear her singing--possibly a resolute stand to be her own interpretive critic or even music therapist. We improvised on an old dream of insects getting into the bath which seemed to point to early guilt over body sensations. Her singing was now free and fine. She felt that she was aware of her feelings now and could pour them into the music. She had been back to her parents’ home with Edgar and felt how insecure her mother was, always trying to placate others instead of being real. We agreed that this should be the last session but that she could come back at any time and she asked me for a copy of the notes because she felt that so much had happened so quickly and she wanted to think it all through. Comment: I felt that there was plenty more that we could usefully look at but Thelma wanted to stop there and I agreed in spite of my feeling that she was avoiding something. Six weeks later Edgar wrote to me about the therapy: “I think the biggest difference that therapy has made is that Thelma knows herself much better or, as she puts it, she can better face up to herself. This has given her the confidence to discuss her feelings more fully (she always did say what she thought!) and has given us a much more realistic basis on which to face the other problems. Possibly as a result, the hysterical outbursts which punctuated our married life every two or three weeks seem to have vanished. Thelma adds that she is now much better able to make friends with people at [her place of study] than formerly. “The problem which therapy cannot answer is Thelma’s need for freedom, of which she seems to have become increasingly aware during your work together. This appears to go much further than a conflict of feeling between Tom and myself, but is rather a need to find a greater inner freedom. It looks as if we may decide to live apart, at any rate for the time being.” I was hoping that Thelma was going to be able to find this independence within the marriage, and indeed she may do this eventually. But the couple were seriously facing their real difficulties, able to talk more freely and honestly about feelings and to try to work something out together which had been completely impossible in the state in which Thelma was at the start of the sessions. Thelma’s music was rather timid and controlled in the sessions but it sufficed to allow her to get in touch with powerful inner images and feelings which she then used in between sessions in writing, discussing, and in her music which became much more of a real vehicle of her own individual expression. Her own work with her feelings and thinking in between sessions was a great help to her progress.

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

CASE SEVEN Mia’s Fourteenth - The Symphony of Fate: Psychodynamic Improvisation Therapy with a Music Therapy Student in Training Benedikte Earth Scheiby Abstract This psychodynamically based case study describes 22 individual music therapy sessions with Mia, a 27-year-old music therapy student in training. Free improvisations were used to facilitate her personal development while also imparting essential clinical skills. Mia’s experience of the process is conveyed through excerpts from her diary, comments during sessions, and the therapist’s notes. Introduction This case study is unique because the client was a music therapy student in training, and because the therapy was provided as an integral part of her training program. The purposes of this kind of training-therapy are many: to enable the student to experience the deepest potential of music therapy in addressing childhood traumas and other formative experiences crucial to the development of the personality, as well as more current personal issues; to provide the student with a deep understanding of the meaning of a client-therapist relationship in music therapy; to help the student discover the different ways music can be used as a tool in therapy; to reveal “blind spots” in the students self-awareness; and to help the student develop his/her own musical language, along with a framework for making musical and verbal interventions. This mode of training--practiced since 1982 at the four-year Master’s program at Aalborg University in Denmark--is intended to provide an experience for the student that is as near as possible to the clinical reality outside the university. In the first year of training, students are offered sixteen sessions of music therapy in groups of five. Here they encounter self-experiential work in a music therapy group for the first time, and gain the preparation they need for the deeper work that follows. During the second year, all students are required to take a minimum of 20 individual, weekly sessions, and if they choose, they may extend the therapy for a longer period. I have seen over 80 students in the eight years that I have been offering individual music therapy as part of academic training. I chose to write about Mia for several reasons. We both considered our work together successful; she was willing to share her notes on the experience,

which are in the form of a diary; and the process that she underwent in therapy was fairly typical of music therapy students in training. Having access to Mia’s diary was important because I believe that what a client expresses verbally about the nature of their experience in therapy must have the highest priority in providing an adequate account of the therapeutic process. In the music therapy literature, we are usually only offered the therapist’s interpretations, experiences and evaluations. This allows us to get only a glimpse at the therapeutic process and the music--and only through the therapist’s eyes and ears. As a clinician, I have often noticed that the client’s experience differs from mine, particularly with respect to how the music functions as a therapeutic agent. I therefore encourage all of my clients to write a diary after each session. Upon termination, they have the choice of whether or not to share it with me. Mia decided to share her diary with me, and she also gave me permission to use the tapes from her sessions. I have purposely changed some of the biographical material to maintain her anonymity. Since both Mia and I considered her therapy successful, I was most interested in analyzing how the work unfolded, and what implications I could gather for training purposes. I have deliberately used the word “unfold,” as I noticed that the sessions unfolded like a lotus flower, each session leading to a new layer of Mia’s inner life. This particular work made a deep impression on me because of the manner in which the music: stimulated memories, images, and emotions related to her parents; tapped Mia’s unconscious use of current relationships for continued parenting; and released a transformative process in her life. Method My clinical work is consonant with psychodynamic/psychoanalytic and humanistic theories, which reflects my own personal experiences in training-therapy. I am in debt to the inventor of Analytical Music Therapy, Mary Priestley (1980), with whom I trained and by whom my work is deeply influenced. The form of music therapy that I practice involves the symbolic use of improvised and composed music by the client and the therapist for the purpose of transformation, integration, enhanced self-awareness and self-exploration. In my verbal processing, I attempt to relate the music to the client’s present intrapersonal and interpersonal dynamic, to their emotional history, and to the reality outside the therapy room. I also believe that working with the music of the client’s “inner child” (its traumas and resources) is essential. In addition, when desired or needed by the client and only because I have the necessary training, I may also combine music therapy with bioenergetic body work. Many of my private clients, including adults and children with a wide variety of psychiatric diagnoses, demonstrate very little or no verbal abilities in the beginning of their therapy. By developing ways of communicating with them on a pre-verbal level, I have extended Priestley’s approach further so that the musical and body communication can stand alone without the medium of words, if necessary. I mention this aspect because Mia and I both felt that her transformations and deepest realizations tended to happen in those sessions characterized by an exclusive reliance on

improvised musical communication. In one of those sessions (the 14th), Mia named the music “Mia’s Symphony of Fate,” from which the title of this case study is derived. Her music was often based on programs such as this, and interestingly, I came to perceive every improvisation as separate movements in Mia’s “Life Symphony.” Mia’s weekly sessions lasted 50 minutes. The session room contained a large variety of instruments including: two pianos; gongs of different sizes and sound quality; orchestral string, wind, and percussion instruments; ethnic instruments from various cultures; and electric keyboards and guitars. Background Information Mia is a 27-year-old woman, the youngest of three children. Her father committed suicide when she was five years old. Her mother is alive, and in describing their relationship Mia says: “She is a mystery to me.” Mia lives with a boyfriend, Peter, with whom she became pregnant and then miscarried. She is currently under observation for cell changes in the uterus. Mia has been in massage therapy for two years before beginning her music therapy training. She experimented with different types of drugs when she was 21 years-old, but she is now trying to live a healthy life by meditating each day. She is often able to remember her nightly dreams. Mia is functioning well in the academic milieu and is content with her life, except for problems in her relationship with Peter. When given a choice of which music therapist to have, Mia selected me because of the trust she had developed in me during our academic contacts prior to therapy. Treatment Process In my approach, assessment and evaluation are not differentiated procedurally, but are an ongoing part of the treatment process. The sources of data include the client’s improvisations, compositions, body language and verbalizations. My experience has shown that the content of a client’s first session anticipates important themes and emotions that will be encountered later in the process. Therefore I have chosen to elaborate on Mia’s first session as the first source of assessment data, and as the first step in the treatment process. Afterwards, I will describe (in similar detail) subsequent sessions leading to Mia’s Symphony of Fate--a significant turning point in her process prior to termination. 1st Session: Warmth in My Sexual Organs The session consists of a therapeutic interview that leads to a mutual improvisation. From the therapeutic interview--which consists of open-ended questions like: “What would you like me to know?”--I gathered all the information contained in the previous section, except for Mia’s father’s suicide, a fact which Mia chose not to mention at that time. In this session, Mia states that her goal in therapy is to work with her sexuality, as it is a real problem for her in the relationship with her boyfriend. She feels that she cannot live out her sexuality, as he rejects her when she expresses her needs. Sometimes Mia feels like a

nuclear bomb, whose impact her boyfriend is being forced to absorb. She would like to be able to contain her sexual feelings better and avoid pressuring him so much. She also would like to be able to cope with his rejection of her sexual overtures. When she tells me this, I get an image of a little girl crying while her father walks away from her. I recognize this as a possible indication of my own countertransference. Mia would like to integrate body and dream work in the music therapy, when it is relevant. When she says that, I notice that Mia has a fair amount of awareness of her body, some difficulties in maintaining eye contact, and a habit of sitting with one foot near her sexual organs. Her diary describes her feelings during the interview: I gradually felt safer with B and was happy that she asked why I had chosen her, so I could say that I felt confident about her. It is good to be asked about things, to be questioned. In the beginning, I became afraid/nervous when I talked about my problems with a therapist. I recognize that. It is getting close to me. I am looking forward to the “work!” I also noticed that I become nervous, when B makes it clear that what happens is up to me. MY RESPONSIBILITY!! I will determine what I am going to do with my own therapy. She doesn’t want to be the mother that fixes and decides everything! Is never saying “good” or “bad!’ Gives me room to finish my talking, and asks if I have something to ask about. Towards the end of the session, Mia says: “I would like to play together with you. I can feel warmth in my sexual organs. I would like to let that be the theme for our improvisation.” Mia chooses the following instruments: wind chimes, marimba, shaker, big Tibetan bowl, a metal rattle and her voice. I choose the grand piano, a Chinese bell tree and my voice. The latter two make it possible for me to acknowledge Mia by choosing instruments of the same sound quality as hers. I chose the piano because of its variety of timbres (keys, strings, wood, pedal echo), and overall versatility as a percussive, harmonic and melodic instrument. I let Mia start the music, and she plays gentle sounds on the wind chimes, accompanied by breathy, pianissimo singing that contains an ascending and descending fourth from G to C and returning to G. While still singing, Mia changes to the marimba and plays a fast, running rhythm in C major. I join Mia with my voice on the C below hers, forming an octave accompaniment. On the piano I match her marimba rhythm. My intent is to create a holding environment that is not too intrusive. Through the quiet dynamic of the music, I get a feeling of withdrawn emotions. Images emerge for me from the music: of running water in a little stream, the wind blowing in the trees, and two people meeting and touching each other very gently and loving for the first time. Mia writes in her diary: 7 chose metal sounds-tones, a little like water.” Now the music changes as Mia loudly and clearly introduces the following motif on the marimba in C minor:

We begin to play together around this gestalt. In my right hand, I play the motif in different variations while providing a holding octave with my left hand. This continues for a long time and my image changes to a little girl who is all alone and sad, crying to be cared for. Mia leaves the marimba after a while and plays the metal rattle and the big Tibetan bowl, howling like a wolf in the high register of her voice. Here, I sense an intensification in the sound quality of her voice, and I accompany Mia with dramatic tremolos in the bass. After this passage, Mia finishes by playing fine delicate sounds with the metal rattle and breathing aloud. When I look at her after a while she seems very relaxed in her whole body, and she breathes rhythmically. Mia says, “I feel all quiet now. Thank you!” Later, Mia writes this in her diary about the music: I relaxed in the end, when we were finished - we ended in silence. I breathed!! And I felt relaxed in my neck and jaw. [Later] I am back home and I feel extremely well. Am enjoying the cat, the sunshine, the peace, the food. Thinking of B’s responsibility as being good. When I later heard the tape of the music, I again got the warm feeling in the sexual organs. The music is carrying it in itself. B chooses instruments made of metal just like mine. She lets me start and finish the improvisation, and waits a long time before she looks at me again. I will let Mia’s diary speak for itself and make just a few comments. Obviously, there is quite a lot of synchronicity between us, both in and outside the music. I think this is one of the reasons why the first session worked out so well. I have often experienced that the shared improvisation bears many of the same qualities involved in different aspects of love, with the music offering sound patterns that phenomenologically resemble this human expression. In this improvisational meeting, at least four different aspects of love were present. First was the genital love of lovers, which is one of the biggest transformative forces in life. The music produced a warm feeling in Mia’s sexual organs, and I had the image during the improvisation of two people making love to each other for the first time. Second, I noticed that most of the music in the section beginning with the motif in Example 1 had the quality of oral music--music that has the fusion and mutuality characteristic of the first phase of breast-feeding. I see this as a healthy element for Mia, and one that many clients experience at some point in their therapy. Third, the music seemed to help Mia love herself. Recall in Mia’s diary how she feels extremely well back at home enjoying everything around her. A fourth and very essential aspect of love that was evoked by the musical and verbal interaction was Mia’s transference love for me, expressed in her very positive perception of me and the loving quality of Mia’s music when we played together. This provided a basis for a strong therapeutic alliance.

The image of the little girl who is alone, sad, and cries to be taken care of, and that of the howling wolf, anticipated the manner in which Mia’s feelings regarding her father’s suicide would emerge in several subsequent sessions. The clinical technique that I utilized is one that Mary Priestley (1975) calls “Entering into Somatic Communication.” It is used for exploring material when the client’s emotions are manifested in physical symptoms which provide a means of keeping the underlying emotion outside awareness. 2nd Session: Fear of Losing Contact Mia discusses the conflict with her boyfriend and how it makes her tired and tense in the shoulders and arms. Through bioenergetic body work which involves Mia letting her shoulders and arms “speak” to her, the theme “Fear of Losing Contact” emerges. She decides to explore this theme musically. Mia plays the piano strings, hand cymbals and voice. I accompany her with my voice. She cries profusely while she dramatically and angrily tears the piano strings while holding down the sustaining pedal. I hear the voice of Mia’s “inner child” saying, “I am afraid, alone and angry.” Mia describes this music in her diary: Desperate anger and emptiness--am swimming in a deep, black ocean. MISS MY FATHER. Fall down in a well and it gets dark. Something gets torn to pieces. After the end of the improvisation Mia speaks more about her relationship to her boyfriend, saying: “I don’t want only half a heart.” In her diary she writes: Fear of losing contact–emptiness. I reach out and nobody is there. Fear and anger. But I can’t stand it on the long run. It is weighing me down too much. I chose not to connect the “inner child” feelings to her early relationship to her father, as she does not mention her father in the session, and I feel that the timing is not right. Clearly, Mia seems to be getting in touch with how much she misses her father through the improvised music that evokes her longing and tears. It is interesting that she chose not to discuss these feelings in the session, but rather to write about them in the diary. It is probably too painful for her to speak about yet. However, she realizes what her needs are in the relationship with her boyfriend. 3rd Session: The Unspeakable Mia wants to begin without a title today to see what will develop. She also wants me to play without any specific definition of my role. Mia chooses the following instruments: gongs of various pitches and sound quality, piano, Chinese bell tree and voice. I choose the steel drum, kettledrum, Tibetan bowls, wind chimes, metal rattle and voice. The session falls into three parts.

Part I. Mia begins by fiercely hitting the Chinese bell tree and gongs and vocalizing in a deep and loud voice. This triggers images in me of ritual ceremonies in Bali, especially music that is played at funeral ceremonies. I answer Mia by playing loudly on the Tibetan bowls, drumming in a quick running rhythm held in pianissimo and using my voice in the same, masculine manner. The music comes in big sound waves. Suddenly, Mia screams loudly and hits the biggest gong very hard, as if to punctuate her musical “sentence” with a period and provide a temporary stopping point. After this, there is a very long period of silence. Mia writes in her diary about this part of the session: Music--the unspeakable--the thing that only can be whispered or hissed out with the breathing. DEATH. EMPTINESS, ABANDONED, ALONE. I DON’T WANT TO SPEAK ABOUT IT. I DON’T WANT TO HEAR ABOUT IT EITHER [Her father Tom’s death]. FUNERAL -- Music for the dead -- TIBET-- Climax -- release, after that the sorrow, the silence. AS IF I SMASHED A WINDOW AND ENTERED THE ROOM OF SORROW. In this part of the music B was very supportive. Part II. While Mia cries silently, I breathe loudly and deeply like a blowing wind. She responds with “Shhhh!” I stop my breath sound. Mia moves to the piano and pulls violently on the strings. She writes about this phase: I am shushing B with an S-sound. I want peace. Then I pull the strings-ANGER...DESPERATION. I wanted to get the pain out through the fingers; therefore I pulled the piano strings with the fingers. After this Mia plays atonal, dissonant passages with a melancholy color on the piano. I play in the background on the steel drum, trying to illustrate the tears that are rolling down her cheeks. I allow Mia to finish the improvisation. She ends by playing handfuls of clusters in the deep register of the keys, letting the last cluster hang in the air. Mia writes about this part: Playing the keys - an attempt to do something about the condition - NO! - I DO NOT WANT TO! Nevertheless light sounds are sneaking in the piano improvisation. B. only played very little with me in the end. Perhaps she perceived that this time was about loneliness, emptiness - and therefore consciously stayed away. It had a reinforcing effect on my emotion. At one time I called to her and waited for her in the music and she did not come. Because of this, my situation or emotion became clearer. After the music Mia looks very unhappy, and I offer her my hands. She takes them and holds them very firmly during the whole conversation. She says: “There are some things that one cannot talk about,” and sobs very loud, “Like when people are dying.” There is a long break in the talking. She resumes: “My father died, when I was five years old. He went into psychoanalysis and committed suicide. Then I got a stepfather who hit his dogs.” She speaks about how she misses her father, what he was like, and says that her boyfriend reminds her of her father.

Mia’s voice gets gradually clearer and louder during this talk and she looks as if she is relieved. She writes about this verbal processing: I became a little happy, when I had been speaking with B and told her about the circumstances under Tom’s death. Peter is of course becoming the person that has to fill out the gaps after Tom, and therefore those enormously difficult situations arise, when he doesn’t want to, or isn’t able to fill up the hole. Part III. Mia asks me to play a piece of music for her on the grand piano while she lies on the mattress. I choose to improvise over the main theme from Chopin’s “Nocturne in D Major,” because I feel that it reflects her emotions, and also has a caring, holding quality. Mia looks satisfied when she leaves the room. In her diary, she writes that, in the session, “Time went so fast.” It also went fast for me, and I was very touched both by the intensity and ritual-like music in Part I, and by Mia’s story and tears. She touched my own “inner child’s” hurt and feelings of loss connected to my own father’s suicide, which occurred when I was three months old. I used the technique that Priestley (1975) calls “Subverbal Communication,” where client and therapist improvise together without title, focus, or specific roles. It is used to share feelings, when words fail or become meaningless. It is meant to strengthen the ego. 4th and 5th Sessions: My Resources In the fourth session, Mia makes a drawing that pictures her resources as she sees them. She does not want to improvise over the drawing, however. In the fifth session, Mia focuses on the feeling of not being good enough, and ends up improvising on the piano with the title “I am good!” I see this as a natural extension of the previous session. 6th and 7th Sessions: Mother-Daughter Projections In the sixth session, Mia begins to work on a nightly dream in which she is trying to integrate the mother and the girl in herself, thus allowing her to be her own mother. She decides to compose a song from the little girl to the mother about how the girl feels when the drunken mother leaves the girl alone. As a consequence of Mia coming in contact with her resources and benevolent side, she now has the strength to look at her own mother, take her in, and address the task of taking back the “mother projection” from me. The seventh session begins with Mia singing and playing her composed “Song to Mother” on the piano. I accompany her on the accordion. The plea of the song’s refrain is: “Stay by me, stay by me, because I love you.” Later I use Priestley’s (1975) “Splitting Technique,” which helps to explore experiences or situations that involve the exploration and integration of polarities. Mia improvises over the polarities of being a little girl versus being the mother. The musical sounds that Mia associated

with being a little girl were “little, ugly, angry and hard.” Sounds for being the mother were “big, soft, warm, and accepting.” 8th Session: Interplay Mia expresses a need to explore her interpersonal contact and relationship with me in a mutual improvisation without any title. This represents a progression in Mia’s awareness of the process from an intrapersonal to an interpersonal level. Mia writes about this: “The feeling in my chest area is changing. This hurt child is perhaps letting go, so that I can turn the energy outward.” I sense Mia’s resistance against verbalizing for the first time. I see it as a natural and important phenomenon in the therapeutic process. Here music serves as an excellent container and “waiting-platform,” offering possibilities of intrapersonal and interpersonal dialogues at the same time. Mia expresses it in this way in her diary: I am experiencing that I am losing some of the engagement in the therapy. Perhaps it is because the analyzing part of it doesn’t offer me anything right now. Too much analysis, too little being. I prefer to experiment with the possibilities and depths of the music than dig into my own past. I want to play together with B because that is where something is happening - it is in the INTERPLAY...[Later] As a therapist I, of course, have to be ready to contact on a deep level and stay there. It is my impression that in this session Mia starts the process of taking back her projection onto me as “the good mother.” She now perceives me as a playing partner. I see it as a product of the former session where she worked on containing both the little girl and the mother. Later, Mia also has an important realization regarding the value of this improvisation for her training. 9th and 10th Sessions: Finding the Musical Self We start out improvising together again without a title, and later listen to the taped music. In her diary, Mia describes this music as a crystallization of her needs: (1) to let go and give way to the unstructured, chaotic, and casual; (2) to meddle more directly in B’s music, and be a little more confronting; and (3) to draw her boundaries. I sense, that Mia now is trying out her ability to say YES and NO with force and directness, as a part of integrating “the adult” in her. The tenth session begins with Mia saying that she felt that her music contains many “redundant” tones. From that arose the theme for her solo improvisation: “Play One Tone, Wait and Listen, until You Play the Next Relevant Tone.” This improvisation marks the beginning of a greater focus and concern on Mia’s part for the musical material itself. This occurs naturally at certain stages in music therapy, when musical material takes precedence over emotional issues. I see this as a need to nourish the

creative “composer” of the client, and also as an expression of a need to be on “neutral ground” for a time. It also represents a time when the client is reflecting upon and consolidating what has happened in the therapeutic process. After the improvisation, we used the taped music for a guided imagery. Here is Mia’s description: The gongs were like healing. Their vibrations go deep inside the body. Became warm in stomach and sexual organs - combustion! I felt like under water for a time, while I listened to the music. It was very nice. 11th sessions: Finding the Feminine Part of My Self Mia wants to contact her feminine side through music. I take the role of an active listener. She begins on the piano, and searches for a long time. Mia writes: I didn’t like the keys. Couldn’t use them. All the time I had to force the fingers to go on. The music became abrupt - a hard stroke. All the time an attempt to hit something. I didn’t know if I just should stop it and say that I couldn’t; but then I started playing on the strings, then it began to flow. It was very beautiful. I really liked the sound-board that was there all the time. I didn’t know which tones I hit. I chose ONE TONE, THAT BECAME A BASIS. A very strong dissolution came and, after that, the music became much stronger and clearer. I see that I perhaps should pass old ideas and patterns to arrive at my feminine self. In processing the session, Mia says that she saw different types of female images in the end of the music. Mia realizes that she has to let go of old patterns to be able to truly be herself. The contact with the feminine parts of her Self, I see as a natural product of being in touch with her “inner mother.” I also see this session as a beginning step of integration in that one of Mia’s overall goals is to facilitate a balance between her feminine and masculine qualities. The first step in this process is to become aware of those qualities. 12th Session: Feelings toward Peter Mia speaks about not being able to express herself and her needs to her boyfriend. She wants to work with that. I begin by working with her body, using bio-energetic grounding and centering exercises aimed at helping her to “stand on her own two feet” without being overwhelmed by her emotions--in this case, tremendous anger. I then present a hand drum so that Mia can hit it while vocally expressing what she would like to tell Peter. It seems difficult in the beginning, but with my backing and reinforcing on the drum, she finally manages to hit the drum fiercely, and with conviction in her voice. In the end, I take the role as Peter so that Mia can practice what she wants to say to him. About this session, Mia writes: The doubt makes me weak! I lose myself when I flip out at home. I abandon my centering. I had to discover that! I practiced telling him what I wanted to say, clearly,

unambiguously and convincingly. I have just done that and he said yes at once. I hadn’t expected that. I have to work on staying clear and centered--to be in touch with my strength and sticking to my demands. In this session we used the technique of “Reality Rehearsal” (Priestley, 1975), where the client improvises how to take a needed step in her life, focusing on inner obstacles that are encountered--in this case the anger and fear of being rejected. 13th Session: Do I Want To Be Like My Mother? Mia gives positive feedback on the last session, and recounts a dream from the night following this session. The dream provided her a symbolic representation of what had happened in the session and afterwards. A long pause in the session follows the discussion of Mia’s dream. I notice that Mia looks irritated. She says that she does not feel like doing much today and I sense some resistance in the air. Silence occurs again. She uses the rest of the session to speak about negative feelings about her mother (Anna), and makes one improvisational attempt to find out what she would like to own or take over from her and what not. I take a mirroring role. This exercise does not seem productive. One particular sentence lingers in the air: “I remember when I was little--even when she held me, she smelled badly.” I end the session by telling her that I sense that she is irritated, that she has some resistance towards working with her image of the mother, and that it is OK to feel like that. Mia writes about the session: Bullshit! I was not able to get in touch with myself today. And I do not think that B offered me any help. I talked too much. I talked myself away. When I started thinking of Anna, I disappeared. I cannot use her femininity as a model. But I guess that’s OK too. 14th Session: The Symphony of Fate Mia expresses her need to play with me without any predetermined theme. She chooses the synthesizer and I play the grand piano, kettle drum and cymbal. There is a quality of preparing for something fateful in Mia’s broad, dissonant, and sustained sounds. I just listen. I get associations to programmatic or cinematic film music. Mia describes each part of the improvisation in her diary. Her descriptions are indicated below in italics. Entrance: A door is opened. The chords become louder and have a threatening quality. I accompany Mia gently in the background, drumming on the kettle drum in a quick rhythm making dampened beats, as if a thunderstorm is heard in the distance and is coming nearer. Dissolution: Violence, Anxiety.

Mia makes single tones jumping up and down the keyboard, and I answer them on the kettle drum and cymbal, as an offer to enter a dialogue. I hear that she is not answering me, but instead is self-absorbed in her own playing. I listen for a while without playing. Emptiness: No orientation point. The music consists of detached tones, atonality, and empty chords. Then Mia uses the pitch modulator on the synthesizer to bend single tones. They sound like a little child screaming constantly. Tears are running down her cheeks. Through my atonal playing on the piano, I try to portray feelings of desperation, loneliness and unhappiness, while wailing in tremolo passages to underline the mood. Lament--also angry--No! This last part is about my father’s death. I could not bear that he should have died detested and unwanted by all people. Totally lonely without any love. The music still makes me cry. This leads Mia to improvise a tonal elegy in a minor key that I underline with a simple ostinato bass line. Mia’s melody steps down note for note, like steps down a staircase, and ends on the deepest note of the synthesizer. I finish by allowing the A minor ostinato to slowly die out, repeating it more and more gently, like little sighs. After the improvisation ends, there is a long pause. To further process the music, Mia takes a piece of paper and draws a picture of a long line that points downward, ending in a little spiral. She calls it “Sorrow.” While she draws, I let the improvisation settle down into my consciousness, and I imagine that this music must have been about an important and dramatic part of Mia’s “inner child.” So important that, for now, it could not be expressed in words, but only on a symbolic level in music and drawing. Mia explains in her diary: I could not talk - I just wanted to play. It was good to play. It became long. Mia’s Symphony of Fate had a beginning and an ending with structure and melody. It was good that B was there and played together with me. She was backing up my expression. My teeth chattered. When I had been playing for a long time, I was able to think in mode, rhythm, and form without disappearing from the emotions in the music. Here Mia gets in touch with deeper feelings connected to her father: emptiness, lamenting, anger, sorrow. These feelings were also present as an undercurrent in the music of the first session. The session causes “after-pains” six days later. In her diary, she describes the following image that arose during one of her meditations. It was a big hole. I decided not to go in, but I wanted to light it up (there was a man next to the hole). It was a clammy cave. At the very end, a girl, twelve or thirteen years old, was sitting huddled up and bound. It was me who was being kept as a prisoner. I thought of entering the cave and picking her up, but was afraid of being caught myself. She became smaller and smaller. In the end she was a sack that got closed. The man had

it (my father). That is the truth from that time. The fragile, sensitive girl that is kept as a prisoner, that has to be liberated, but does not know how - with warmth and love. 15th Session: Entering the Cave Mia says that her teeth were chattering in the last session and that she cried over the image just described. She also says that the music was also about her relationship to her mother and step-father, who moved into her home when she was twelve years old. She expresses that it is very difficult for her to share this with anybody. She feels as if she has lost the little girl, as if she has hidden herself in the cave far away. I ask her about the connection to her daily life and Mia says that in her relationship with Peter, she sometimes becomes like the little girl in the cave, and he cannot handle that. It is also connected with a feeling of being unwanted, when she is too pushy and he rejects her. I suggest that we improvise being in the cave together. Mia can then explore being the little girl and contact me if she wants. I encourage her to use her voice and facial sounds (as she had mentioned that her teeth were chattering in the previous session also). She prefers to have me outside the cave at the edge, so that we can communicate with each other, if she needs that. I build a symbolic cave out of two quilts, and Mia takes the glockenspiel and triangle with her into the cave. I portray the cave on the grand piano with big hollow sounds made from pulling on the deep dampened strings while depressing the sustaining pedal. I take long breaks between each sound. I guide Mia into the cave through the music. I then hear Mia’s voice from the distance. It is withdrawn yet wailing: “Oh-ya-ya....Ooohh...Mmmmmmmm.” I now support her voice by playing the same tones as her. When I play louder, Mia’s voice becomes louder and more twisting. She now beats the glockenspiel. It sounds like stamping. I stamp with her on a deep string as a drone. Then she plays the triangle gently while humming with her voice. Her diary describes the improvisation so far: There were tears, but I also discovered other things. It was safe: I had chosen to go in the cave to protect myself. I liked communicating with B, then it became more joyful...I could play “princess music” in the cave and it could be heard outside. I felt like playing with this light music. As the improvisation continues, her voice glides up and down ending in various nasally aspirated sounds combined with facial grimaces. Suddenly, there is a big bang. Mia has thrown her instruments on the floor. I bang one time with the lid of the piano. It is over. After the improvisation, Mia realizes that, today, the “cave part” of her also represents something positive–a place she can chose to go to of her own will. The existence of the playful “princess music” leads her to that realization. Mia can break out of her “inner prison” (the big bang), if that is what she needs to do. Technically in this session, I used Mia’s symbols (i.e., cave, little imprisoned girl) as a starting scene for a guided imagery to improvised music. Instead of guiding verbally, however I guided through my musical expression on the piano. This technique is used to explore

unconscious material, and to find new solutions for persistent inner conflicts. Priestley (1975) states: “Symbols are accumulators and transformers of psychic energy. They have the relationship to ideas and action that an iceberg has to a waterfall. Using them, the therapist is dealing with the transformation of force.” (p. 129) In Mia’s case, her musical exploration of the symbols opened her eyes to the positive aspects of contact with her “cave-part.” It was a place where she could feel safe and protected, and where the playful and joyful side of her “inner child” could come forth. Final Sessions In the 17th session, Mia says that she has had a very positive dream about her father. In it, she was two years old, and he was sitting next to her. She was fascinated by him. She also had met him during a meditation where he had given her his love and held her, and afterwards had said good-bye to her. This experience had felt so real to her that Mia later wondered if it was something she was recalling from her childhood, or if it just came to her as an image. She says she is happy for the experience because it was an entrance–a channel–to get in touch with what she received from her father. I see these phenomena as a result of the music’s ability to establish contact with hidden emotions, memories, and experiences that are an important part of her existential being. The music therapy continued for five more sessions and, interestingly, the music in these sessions did not contain undercurrents of melancholy, loneliness, wailing and solitude that were so characteristic of many of her earlier improvisations. In the very last session, the improvisation theme was “Goodbye,” and it touched upon little sequences from most of the sessions, like a recapitulation or reprise. In the verbal evaluation that took place upon her termination, Mia expressed that she was satisfied with the work because her sexuality was more in balance and the cell changes in her uterus were now minor and declining. However, she felt that she still had some work to do on accepting herself and not feeling compelled to live up to other people’s expectations of her. I noticed that our musical and verbal contact was more of one adult to another, and that Mia was able to maintain eye contact as well as hold her own center. Her mood also seemed to have become more stable with less liability. Discussion and Conclusions How do I evaluate Mia’s progress? First, her diary and her specific comments on the sessions represent clear evidence about what progress she made, and the effectiveness of various techniques and interventions. Certainly, Mia had addressed traumas of “the inner child” as well as more current personal issues, and showed an ability to work in the music with this difficult material. Mia’s growth as a therapist has also provided a testament to the productive nature of the work we did together. As I was Mia’s clinical supervisor during the following half-year, I was able to closely observe her clinical development. She was able to establish therapeutic relationships through music, and one of her strengths was an ability to work effectively in both the verbal and musical realm. Mia was more aware of her own counter-transference and was

thus able to avoid many of the pitfalls common to beginning therapists. She had developed her own musical language, and was able to tune her body as an instrument and use her voice as an important tool--on equal terms with the instruments. She also showed the courage to experiment with her own techniques. Why did the music therapy work as it did? As I have previously discussed my methodological procedures and techniques, here I would like to offer my basic assumption concerning the structure in free improvisation, the technique used most prominently in this case. Any musical structure which a client presents in an improvisation is a mirror of the client’s psychological organization and dominant function. By musical structure I mean melody, rhythm, timbre, pitch, dynamic, mode, pulse and tempo--in short, any parameter or element in music that organizes or is organized. This is a variation of Priestley’s statement: “The musical structure as regards rhythm and pitch (less so timbre and dynamics which are more responsive to the mood of the moment) is governed by that mental institution [structure] or function which rules the patient’s psyche at the time” (1980, p. 120). Thus, when describing each improvisation, I have placed particular emphasis upon those musical structures that seemed to have significance in relation to Mia’s psyche at the time. A second important factor connected with the improvisations is their titles. Each one serves as a focus point for structuring the music, and certainly colors the content of the music. Naturally, our selection of the most relevant title for exploration is of central importance. From this case, we can see that the act of improvising in itself offers possibilities for intrapersonal and interpersonal dialogues--dialogues which, as we have seen in Mia’s case, can provide the basis for self-transformation and growth. The work with Mia also illustrates how music therapy, when used as part of training, can serve not only as a place for personal development but also as an experiential laboratory for gaining the insights and skills essential to becoming an effective music therapist. Glossary Analytical Music Therapy: “The symbolic use of improvised music by the therapist and the client to explore the client’s inner life and provide the proclivity for growth (Priestley, 1980, p. 18). Countertransference: The therapist’s unconscious reactions (in and outside of the music) to the client and his/her transference (Priestley, 1980, pp. 50-57). Mother Projection: The client attributes aspects of her mother to the therapist, other person, or object. Transference: “A process by which a patient attempts to relive with her therapist the unfinished business from former important relationships in her life. It can also be her attempt to come to terms with, or rid herself of, conflicting parts of her psyche by projecting them on to her therapist (Priestley, 1975, p. 238).

References Priestley, M. (1975). Music Therapy in Action. St. Louis: Magnamusic-Baton. Priestley, M. (1980). The Herdecke Analytical Music Therapy Lectures. Translated into German by Brigitte Stein (1983). Stuttgart: Klett-Cotta.

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

CASE EIGHT 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. 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. _______________ * Throughout William’s narrative, Alison’s words during the music are in italics and within parentheses; Alison’s comments in the DISCUSSION sections are indented.

Other E-books in this Series Available from: www.barcelonapublishers.com

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) • 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) • 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)

Voice

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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)

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Authentic Voices, Authentic Singing (Uhlig) Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson (McGuire)