Clinical improvisation in creative music therapy: Musical aesthetic and the interpersonal dimension

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The Arts in Psychotherapy, Vol. 23, No. 5, pp. 397405, 1997 Copyright 0 1997 Elsevier Science Ltd P&ted in the USA. All rights reserved

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CLINICAL IMPROVISATION IN CREATIVE MUSIC THERAPY: MUSICAL

AESTHETIC AND THE INTERPERSONAL DIMENSION

SANDRA BROWN, RMT and MERCEDES PAVLICEVIC, RMT, PhD*

Many approaches to music therapy use music improvisation as a basis for therapy (See Bruscia, 1988, for an overview of Improvisational Models of Music Therapy). Creative Music Therapy (CMT), pioneered by Paul Nordoff and Clive Robbins (1977) differs from many of these approaches in suggesting that the client and therapist meet and get to know one another exclusively in the musical improvisation that is created jointly and spontaneously by them. This dynamic musical relationship, they suggest, can be the sole basis for treatment, and the intimacy and immediacy of the musical relationship render words, at best, un- necessary and, at worst, intrusive. Their assertions are entirely appropriate if we recall that they worked al- most exclusively with handicapped children, many of whom had no access to verbal language.

However, the past 20 years have seen CMT extend to embrace a wide spectrum of clients, ranging in age from infant to geriatric, who not only speak perfectly comfortably, but who often use words in sessions. Work with adult clients has brought an additional complexity to music therapists-some adult clients are professional musicians with finely honed musical skills. As both therapist and client are skilled musicians, can we be clear that in music therapy they are doing more than playing music together? Can we be sure that they are engaged in a clinical musical relationship, rather than a purely musical one?

Although this paper is concerned with exploring the nature of the musical event in the music therapy session, it is worth touching first on verbal material if only to clarify that, despite clients verbalizing in music therapy sessions, the primacy of the clinical musical relationship appears to remain unchallenged in CMT. It seems clear, from hearing numerous case studies, that music therapists who use CMT techniques will listen and respond to “the music behind the words,” as well as to their semantic content; while acknowledging words verbally, the response is usually within the context of the musical improvisation. This means, for example, that words may be woven into the music: they may be transformed into a poem, a song, a monologue which is supported by the therapist’s music, or a dialogue between therapist and client. The therapist may also simply continue to improvise in a way that meets and contains the music behind the words being spoken by the client or by them both. On the whole, therefore, the presence of words in CMT sessions does not seem to alter the emphasis on the musical process as the primary focus of therapist and client.

This paper focuses on that musical process and is concerned, in particular, with the distinction between purely musical improvisation (or improvisation as artform) and clinical improvisation (or improvisation as therapy), a distinction which we believe to be critical

Sandra Brown works as a music therapist at the Nordoff-Robbins Music Therapy Center in London and at a school for children with

communication disorders and autism. She is also a senior clinical tutor on the Master of Music Therapy degree course at the Nordoff-Robbins

Music Therapy Center. Mercedes Pavlicevic is based in Johannesburg, South Africa, where she works as a music therapist. She is also a researcher and academic

supervisor at the Nordoff-Robbins Music Therapy Center, London, UK.

397

BROWN AND PAVLICEVIC

if we are to assert that our skills as music therapists go beyond the purely musical. The following question is increasingly posed in discussions at the Nordoff- Robbins Centre in London: Is improvisation in an individual music therapy session with a self-referred/ non-impaired/verbal/adult client any different from improvisation in a context of two people making music? In answer, there seems to be a continuum of views, ranging from “It should and must be different” to “It is the same, as the musical experience and processes contain all the healing.” Our own intuitions have been that the clinical-musical relationship is different from a purely musical one, and this has led us into the exploration described in this paper.

It is our understanding that to envision and describe the therapeutic relationship in purely musical terms, did Lee in his meticulous musical analysis of clinical improvisations with HIV-sufferers (Lee, 1989, 1990), or to describe the end product of clinical improvisation as artform, (Ansdell, 1995; Lee, 1995) is not enough. Aldridge (1989, 1993) and Ansdell (1991) further suggested that the musical phenom- enon is purely an expression of the phenomenology of the self. We believe that all of these descriptive models, while offering clear and useful conceptual frame- works, do not totally address the complex and multi- faceted interaction between two persons. Further- more, we also sense that the aims of artform and therapeutic growth may. of necessity, be musically contradictory at points within the therapeutic process.

At the same time, we are not suggesting that artform or therapeutic improvisation differs only because of how we perceive and describe the improvisations in music therapy sessions. It is not our perception or descriptive language which determines the function of the improvisation, but rather, we suggest, that the difference between music as ‘art’ and ‘therapy’ is intrinsic within the improvisation itself. This is not to deny that clinical improvisation may well be heard as pure music--especially by a lay listener. Like Aigen (1991), we would argue that this is not so much because there is no difference between clinical improvisation and ‘art’ music, but rather because the lay listener was untrained to perceive and assess clinical, rather than aesthetic, import in music.

In this paper, therefore, we choose not to enter into the debate as to whether it is appropriate or not to use verbally-based theoretical models from other disci- plines in order to describe music therapy processes (Aigen, 1991), nor are we looking to make psycho- dynamically-based interpretations from the music

(Priestley, 1975, 1993). We are simply attempting to clarify our own understanding that there is a structural or intrinsic musical difference between pure musical improvisation and clinical musical improvisation as it is used in CMT.

We believe that the music therapist is a highly competent musician whose improvisational skills can be more than just musical-they are clinical improvisational skills. This mean that the therapist is trained in clinical musical techniques (pioneered by Nordoff & Robbins) which enable the client and therapist to form and work with a dynamic, interpersonal relationship through the music.

Here it is worth touching on the distinction between creativity in art, and creativity in life, clarified by Winnicott (197 1, 1988). His concept of Primary Creativity addresses our capacity as human beings to straddle, and shift between, our internal world of ob- jects and the external reality of the objective world. This fluidity of shift, of assimilating new images, of responding and initiating in the world in a coherent, integrated way is a necessary part of our capacity for Primary Creativity. This capacity is revealed and en- hanced within any play-full relationship within which both partners-in this case therapist and client- participate and reciprocate fully with one another as human beings. However, creativity is also the domain of the arts and, like all expressive arts therapists, music therapists need to consider whether artistic and human creativity are distinct from one another, whether they have anything at all to do with one another, or whether they are, in fact, the same phenom- enon, but viewed from different sides.

Our own understanding is that clinical improvisation techniques in music therapy enable the client’s (and the therapist’s) Primary Creativity to be sounded, and an interplay to take place that is jointly and spontaneously created by both players, but with a commu- nicative, rather than a musical agenda (Pavlicevic, 1990, 1995). However, the issues of artistic skills cannot be tossed aside, especially since the music therapist is operating both as musician and as therapist in the session. This is even more so when the client is also a skilled musician, where the therapist needs to monitor that aspiring to artform in sessions does not become a defense against clinical engagement, rather in the same way as intellectualizing may be a defense in verbal psychotherapy.

However, Kenny’s idea (Aigen, 1995) of a clinical aesthetic alerts us to the notion of beauty not only being the domain of the arts, but as also pertaining to

MUSICAL AESTHETIC AND INTERPERSONAL DIMENSION 399

seeing the human being as having the potential to be balanced, integrated, harmonious, engaging. The fluid and highly intimate engagement between therapist and client may, therefore, also be an event with a particular aesthetic quality, so that the idea of using art as a therapeutic medium can perhaps be extended to seeing the therapeutic process itself as an artform-a clinical artform.

Clinical improvisation techniques, therefore, enable clients to hear themselves in sound, within the context of a musical relationship, and the therapist to assess and work with the clients’ personal difficulties, as seen in their musical being. This relationship is a therapeutic one, rather than a purely musical one, although the end product might indeed be heard as artform.

Aims of Our Inquiry

In this exploratory project, we set out to examine some of these questions, using ourselves as guinea pigs by undertaking the roles of client/therapist/ music-maker and, of course, researcher. This is in keeping with thinking in the naturalistic or post- positivist inquiry paradigm, which encourages practi- tioners to bridge the schism that prevails in traditional scientific enquiry (Aigen, 1993; Reason & Rowan, 1981; Robson, 1993). There were several reasons for this: we found that our interest in the question was mutual and that our thinking travelled along similar lines. We felt that we know one another sufficiently well to contain the risk involved in taking turns at being client and therapist with one another, although at the same time we were aware that knowing each other professionally and socially might make objec- tivity more difficult. However, we felt that this could be a start in terms of generating some data and might point the direction for future study.

Our main aim was to answer the following questions:

1. Does the individual’s experience and perception of a session vary according to role difference- whether their role in a session is that of client/ therapist/music-maker? In other words, is there a difference in the experience of myself in a music therapy session as therapist or client, and as a musician in an improvisation session?

2. Is there a difference in the actual music of a music therapy session and that of a music-making session (i.e., is the music itself different? Could someone else, on listening to the music, differentiate be-

tween a music therapy session and a music-making session?

Our own understanding of the differences between the roles of the therapist and that of music-maker is that the nature of any healing process suggests a necessary emphasis on the needs of the client rather than those of the therapist. We could see the primary aim of therapy as being to bring some relief to the client in terms of her or his presenting difficulties. Although the therapist is necessarily involved in the therapeutic process and may well be changed in some way by the experience, this is not the purpose of the interaction. In contrast, in a music-making improvisation there is an assumed equality of focus between the improvis- ers, with the needs of the shared music being the paramount factor rather than the personal needs of the improvising musicians.

We represented the three possible roles and influ- encing factors as seen in Figure 1.

At this point, we felt that only the experience itself could clarify these thoughts and give us some actual data to work with, and so we decided to improvise with each other:

1. to examine the experience of each role (i.e., client/therapist/musician), and

2. to examine the recorded content of the sessions for any musical differences between them.

The Sessions

Method

We set up three experimental improvisatory sessions, each with a specific format:

1. both playing as musicians,

Me as improvising musician (the musk5 neeol /aesrhetrcs)

Fi,gure 1.

400 BROWN AND PAVLICEVIC

2. one playing as therapist and the other as client, 3. as in (2) but reversing the order.

The order of sessions was decided by pulling straws and was as follows:

Session 1 Mercedes as therapist and Sandra as client, Session 2 Sandra as therapist and Mercedes as client, Session 3 Sandra and Mercedes as improvising musicians.

We were aware, firstly, that each session might well influence the content and experience of the following sessions (order effect) and, secondly, of the artificiality of Session 1 and 2. These therapy sessions were not part of ongoing therapeutic treatment and neither party was engaged in the session for reasons of personal need, so that there was no clinical context in which to put each single session.

Format of the Sessions

The sessions were held in a room that accommo- dated two grand pianos, a wide variety of tuned and untuned percussion instruments and good audio recording equipment for recording each session. There was a week’s interval between each of the three 30- minute sessions. We agreed that for the two-week period in which the sessions were held we would not discuss them with one another or with anyone else and we would not listen to any of the recordings. We made written notes immediately after playing, at the end of each session, to record our immediate impres- sions of the music improvised and our personal feel- ings about each session. In the conventional Nordoff- Robbins approach, we kept verbal interaction to an absolute minimum during the sessions. Thus, once the session began, we simply played music, choosing whatever instrument we wanted to play.

Analysis

There were four stages of analysis plus a “blind” tape assessment carried out by independent music therapists.

Stage One

We listened to each tape independently and made a timed written analysis of the musical interaction in each. This is standard procedure, developed by Nor- doff and Robbins, which involves keeping track of

“what happens when” in the session, usually using real time-indexing (see Nordoff & Robbins, 1977, p. 93). On reviewing these analyses and our written post-session notes together, we were struck by several things:

1. There were similarities and differences in our experiences of each role (therapist, client, musician) at the time of the sessions. a. In our sessions as clients, we had different

responses. Mercedes felt a sense of daring, that she could do as she pleased, knowing that the therapist would be there for her and that here were no rules. Sandra, as client, felt that there were points in the session where it “felt right” and others when it “felt wrong ’ ’ -at times she felt met by Mercedes and at others she did not.

b. We found a common thread in how it felt to be the therapist-we needed to be there for the client, to listen and respond to the client’s needs through her music. We also had apprehensions to do with would we be good enough therapists; would our client feel met and supported by our music-and, because of our professional relationship, we each wondered what the other would think of our therapeutic skills.

c. In the music session we also had common experiences, delighting in the music’s play- fulness. For example, Sandra began an irre- sistible tango which Mercedes punctuated, defined, colored in, so to speak, on the untuned percussion; and, later in a two-piano duet, we simultaneously moved into an an- gular, tightly energetic Hindemith-like march. We both had a sense of having made good music together and were interested to note that this was the session in which we both felt the most relaxed. This may have been the effect of practice as it was the third and last session, but we suspect that it had to do with the less interpersonally intimate and potentially vulnerable quality of the experience.

2. The experience of indexing the audio recordings also presented challenges. Whereas we in- dexed and analyzed the music session (session 3) easily and enjoyed the lively, unexpected, aesthetically pleasing moments of the session, both of us found the sessions in which we were


client the most difficult to analyze and had to leave it and return to it later. Mercedes com- mented that she “couldn’t be bothered” to analyze this session and that she “lacked the vocabulary for what happens to the client.” San- dra remained in her experience of the session (where it felt right or felt wrong), initially being only able to judge the interaction by the subjec- tive experience rather than clinically-this was not a difficulty she experienced with analyzing her therapist role, or her music-making one.

While acknowledging the element of denial or dis- comfort in hearing ourselves as clients, and all that this implies, the lack of vocabulary was a surprising revelation. As therapists, we have a verbal facility for describing what happens in music therapy. As clients, we found ourselves unusually inarticulate: describing the session, beyond recalling the highly personal experience of playing, was difficult.

In analyzing the tape of ourselves as therapists, Sandra noted in her analysis deliberate musical steps she had taken in her role as therapist which were related to Mercedes’ therapeutic musical needs rather than that of the musical aesthetic. This was very different from the way she approached the music in the music-making session, where it was the music that dictated where the improvisation would go.

Stage Two

We felt it was important at this point to try to clarify whether our taking on of a role actually re- sulted in a difference in the way the musical interaction was structured: in other words, is the music in the musical session structured in the same way as the music in the therapy session? Does the music sound similar or different? We, therefore, decided that we would do a second analysis of Session 3 (Musicians) as if it had been a therapeutic session. We listened to the recording firstly as if Mercedes had been therapist and Sandra client and then we analyzed it again as if Sandra were therapist and Mercedes client, to see if this change of focus in our listening altered our perceptions of the music itself.

When we put the players in role of therapist/client, we found that we often judged their contributions as therapeutically inappropriate. For example, at times the “therapist” musically initiated or led the improvisation in a dominating way, which did not take the “client” into account-it was as though the “thera-

PERSON X PERSON Y

rl Dl Being Supported Being Supported I

cl D2 Mutuality Mutuality

supporting supporting

D = Possible dynamic behveen the players

Figure 2

pist” was putting her own musical satisfaction as a priority and, at times, it also seemed as though the “client” had to abandon her musical idea for the sake of the “therapist’s” musical idea, which again would not appear therapeutically appropriate. However, on several occasions, had we been listening as if two musicians were playing together, we would have found the music highly fluid, with a high level of interchange between the two players. From this, our first interactional model developed, which, although it initially seemed somewhat simplistic, proved a very useful tool (Figure 2).

This interactional model presents three simple modes of interacting between two people playing music together. In Dl, person X is leading, taking the initiative, while Person Y is supporting X-she may be doing this by accompanying, coloring, punctuating or highlighting what X is doing. In D3 the roles are reversed (i.e., Person Y is being supported by Person X). In D2 there is a mutuality between the two players.

Stage Three

Using this model, we re-analyzed the tapes of the three sessions, using the three dynamic constructs of the model to give a picture of general interactive trends within each improvisation. This, we hoped,


would clarify for us whether there was, in fact, any distinction between how we are in therapy sessions and in music sessions, as posed in question 2. As this analysis progressed, the first thing which became ap- parent was that in Session 3 (Musicians) all of the three dynamic constructs were used. At times one of us would be in leading mode (Dl), then the person would shift to accompanying the other (D3); the music would then move us both toward a mutuality (D2) with both players in equal balance.

In Sessions 1 and 2 (the therapy sessions), the interaction tended to be one where the client (say Person X) and the therapist (say person Y) would normally only use Dl and D2, (i.e., Mutuality or Client being supported/Therapist supporting). This fits in with our ‘felt’ experiences of the sessions, discussed in Stage One, where our intent was to be there for the client, to listen to the client’s needs, be supportive, responsive and so on. But this was not quite as simple-it seems that it does not follow literally that where the therapist’s intent is to be there for the client, this is necessarily translated into therapeutically appropriate music. This was confirmed by Sandra’s experience of feeling wrong-that she as client had changed to ac-

i MUSICAL MODEL

CLIENT THERAPIST

n

Leading cforeground)

q M2

Mutual Equilibrium

rl M3

Supporting (Background)

commodate the therapist’s music rather than the therapist playing as she would have liked her to. Thus, D3 appeared to be operating (i.e., Client supporting/ therapist supported,’ rather than Client being supported or Mutual equilibrium. So it seems that although Mercedes-as-therapist’s intention was to be there for the client, this was not who the music came across to the client.

It then began to appear that there were complica- tions and contradictions arising out of the use of the model-for example, what did being supported and supporting mean? In standard therapeutic terms, con- cepts such as holding (Winnicott, 1965), and contain- ing (Bion, 1967) come to mind, but what did this say about the music? Surely it was possible for a therapist to support a client therapeutically while taking the lead musically. In fact, this might well be desirable as part of the ongoing process.

Stage Four

It became clear, therefore, that it would be necessary to differentiate two parallel models (Figure 3). In considering these two models, we formulated the following thoughts:

THERAPEUTIC MODEL

CLIENT THERAPIST

Being Supported

Mutual Equilibrium

El Th3

Supporting

Figure 3.


1. In the Musical Interactive Model, “supporting” is equivalent to being “in background musically,” and “leading” is equivalent to being “in foreground, ’ ’ where leading has the stronger focus musically. In the Therapeutic Interactive Model, to think of supporting as only meaning background is not enough. The therapeutic elements of the dynamic Thl (therapist supporting/client supported) implied in the Therapeutic Interactive Model might require initiative, guiding, helping out-the equivalent to leading in the Musical Interactive Model.

2. In the Musical Interactive model, all three dynamics might be found productively in both therapy and music-making contexts. In the Therapy Interac- tive Model, Th3 (client supporting/therapist being supported) would not be considered good therapeutic practice, implying that the therapist may be inserting her own issues, thus clouding her receptivity to the client’s needs.

We thus re-analyzed the tapes of all three sessions, using each model in turn, in order to see whether a musical or therapeutic analysis would parallel each other, or if significant differences would emerge. It was clear on considering this analysis, that the two models did not necessarily parallel each other, although there were many points where they touched. In Sessions 1 and 2, the therapy sessions, what seemed consistent within the Therapeutic Interactive Model was the therapist’s holding of the client supportively, with intent toward their therapeutic needs (i.e., the Thl dynamic). There was hardly any moment when this was not there. We felt that this had parallels with what Bion (1967) called “maternal reverie,” and Winnicott (1958) called “maternal preoccupation.”

However, in the Musical Model analysis of Ses- sions 1 and 2, all three dynamics were used. Ml (client leading/therapist supporting) was the most frequent, with M2 (mutuality) next, and occasionally M3 (therapist leading/client supporting). In Session 3, the music-making improvisation, M2 (mutuality) was by far the most frequently used dynamic, (approximately 50% of the session), with Ml and M3 operating fairly equally the rest of the time.

Stage Five

In order to have an independent comparative assessment, we asked three experienced music therapists to listen to a recording of each improvisation blind, and place it in one of the following categories:

1. X as therapist, Y as client,

2. Y as therapist, X as client, 3. X and Y as two improvising musicians. The therapists were given a sheet with each ex-

cerpt, describing who was playing which instrument as the session progressed, as there were frequent changes of instruments in some sessions. We also asked them to note down their reasons for their choices plus any other relevant comments.

Two out of the three therapists categorized all three sessions accurately, whereas the third categorized one therapy session and the music session correctly, and the other therapy session incorrectly, as a music- making session. In selecting the music making session, one listener stated that this session had a totally different quality from the other two (therapy) ex- cerpts. The music in the music-making session unrav- eled in a spontaneous way and there was a quality of shared listening and musical equality. A second listener stated that there was a feeling of equality and oneness in this session, especially in the two-piano improvisation. However, she also felt that this could be the moment of peak experience between therapist and client in terms of relationship and communication, but what had decided her (correctly) against this being a therapy session was that there was no sense, throughout this excerpt, of one player being facilita- tive or supportive, or focusing on the needs/pathology of the other.

Reasons given for the correct selection of the therapy sessions included the therapist listening, joining, musically reflecting and supporting, making no musical assertion, at times offering musical altema- tives, being able to hear clear therapeutic thinking in the therapist’s improvisation and allowing the client space, at another point, to hear herself. Moreover, the moments of togetherness in the music lacked a mutuality that the listeners would expect from two improvising musicians.

On verbally questioning the listener whose selec- tions had some inaccuracies, she explained that she had realized that the same two persons were playing in each excerpt, and had become irritated with the idea that one could simply “swap roles” and be a therapist in one session, a client in another and then a musician in a third session. She felt that this was self-conscious and unnatural and that, moreover, therapy was not a one-off, but an ongoing process. She described herself on her sheet as “being resistive to committing herself,” and felt that none could be a therapy situation.

We then discussed whether we agreed with her


assertions. Had we, in fact, been presumptuous in sup- posing that we could take on roles such as therapist/ client/musician? On the contrary, we both felt that each of these roles was intrinsic to us: both of us are musicians, therapists and clients in our daily lives and regularly change from one mode to another without difficulty or superficiality.

We also are aware of how much we personally and professionally committed ourselves to the roles in the three sessions, taking the same risks of personal ex- posure and vulnerability in each of them as we do in other therapy or music-making situations. In the therapy sessions, neither of us had the feeling of “playing as,” but, given the limitations of the one-off situation, had moved into the roles with the same commitment to our own and to each other’s process as in our other therapy interactions.

Discussion

It seems very evident, from our exploration, that there is a difference between music-making that is geared simply to playing music with someone else and therapeutic improvisation. This was particularly clear in this context because we actually were the same two musicians improvising together in all three sessions, yet our experiences and perceptions de- pended on the roles (therapist, client or musician) un- dertaken, and the music made differed in content.

As therapists, we clinically observe and analyze the client’s areas of musical strengths and limitations, of avoidances and resistances, and the music we improvise is shaped to work with this, to help the client move into dealing with the areas of difficulty, as well as enabling a free expression and sharing through the musical interaction. The insights that emerge during the therapeutic process are not necessarily verbal insights, nor are they insights that need to be concep- tualized verbally. They may remain within the domain of musical experience and clinical thinking, which has its own value and significance. It is our understanding that therapeutic insights may be acted upon directly and nonverbally through the clinical improvisation, in which case the therapist’s music will be informed and shaped by them; or they may cross the line into verbal language, where verbal thought may also be used to shape their meaning. Purely musical insights, on the other hand, have less to do with clinical improvisation techniques, although, as stated earlier, they cannot altogether be dismissed in clinical improvisation. Rather, we suggest that the convergence between mu-

sical and clinical insights creates an ongoing, and to some extent necessary, paradoxical tension for the therapist.

As musicians, we can focus solely on the aesthetic of the music, using our musicianship to listen to the needs of the jointly made music. We can go with the patterns, tempi, dynamic, without needing to assess whether this is habitual, an avoidance by the other person of other, more uncomfortable tempi, dynamics, melodic phrasing and so on-we can give ourselves up to the here-and-now of the music. Of course, this purely musical experience can also be present in a therapy session and is perhaps what is noted by Ansdell, 1991; Lee, 1990; Pavlicevic, 1988. However, as in any therapy, the music therapist needs to focus on holding her or his internal supervisor (Casement, 1988) firmly in view, maintaining an objective and clinical viewpoint in order to preserve for the patient the creative potential of the therapeutic space.

Traditionally, it might seem that the role of the therapist is invested with substantial power by the client. The therapist is seen as being musically skilled, as representing a collective therapeutic and philosoph- ical authority and as having access to “mysterious” knowledge of the client through a form of music- making that may well divulge unmediated informa- tion (Ansdell, 1995; Pavlicevic, 1987). In putting ourselves in the roles of both therapist and client, our emergent anxieties and vulnerabilities highlighted, to some extent, the inequality inherent in the relationship. As therapists, our anxieties centered around whether we would be “good enough” in the Win- nicottian sense. We both felt vulnerable and acutely aware of wanting to be available to the client as best as we possibly could, given the impositions of a one- off session. We could say, therefore, that the role of therapist generated role anxieties, which, we suspect, is not that unusual or surprising. As clients our vulnerabilities were more personal and idiosyncratic. Mercedes, as client, experienced a flamboyant free- dom to be as she pleased, knowing that the therapist would be there; she grasped the music and was off, leaving the therapist to follow. This, we could say, was a splendid defense against a more mutual mode, in which Mercedes could have allowed a reciprocal engagement to develop between herself and the therapist, rather than setting the scene. As client, Sandra experienced an overwhelming need to be met in a certain way, which the therapist did not always do. This, of course, generated its own anxieties and frus- trations. Our experiences, perceptions, aims did in-


deed vary according to the role we undertook. But did this shift in focus make any actual difference to the music improvised?

From our analyses using the Musical Model in Stage 4, and from the comments of our ‘blind,’ independent listeners, there would appear to be important differences. It can be seen that there was much mutuality in the music-making improvisation; there were several points where our musicianship meant that we moved simultaneously into the same new musical experience-sometimes with a sense of awe!- and other times where there was a high degree of interplay and musical interweaving, with foreground/ background alternating very fluidly between us.

In the therapy improvisations, two modes seemed to predominate: on the one hand, there was a strong emphasis on the therapist attending to, and joining, the music initiated by the client; at other points, there would be a divergence between the music of the two players (e.g., in terms of tempo, rhythmic pattern, dynamic, mood) where either the therapist introduced and stayed with the material which the client resisted joining or else, after a shared moment, when the client returned to what she had previously played, neither of which was necessarily appropriate in terms of shared musical aesthetic or artform. That the differences between the therapy and the music mode can be seen in the music was affirmed by the 88% accuracy of the assessment of our “blind” music therapy listeners.

Conclusion

This exploration is clearly incomplete and provides pointers for future possible studies rather than con- clusive ideas. Perhaps in the light of our findings we might see the aims of music therapy as a progression:

1. toward enabling the client to fill out the whole of the Musical Interaction Model for themselves, in relation to the therapist-to be able to participate fully in all aspects of the musical relationship, all dynamic interplay, firmly supported by the therapeutic dynamic, where musical integration can bring a more general personal integration (Pavlicevic, 1990, 1995); and

2. toward a relationship without the constant need for Thl of the Therapeutic Interaction Model (the client being supported by the therapist), with the client being able to move into relation- ships of mutuality and supporting in both the models (Therapeutic and Musical), with an ul-

timate redundancy of the Therapeutic relationship as the client is able to take these diverse ways of relating into the outside world and the rest of her or his life.

References

Aigen, K. (1991). The roots of music therapy. Unpublished doctor of arts dissertation, University of New York: School of Educa- tion, Health, Nursing and Arts Professions.

Aigen, K. (1993). The music therapist as qualitative researcher. Music Therapy, 12(l), 16-39.

Aigen, K. (1995). An aesthetic foundation of clinical theory: An underlying basis of CMT. In C. B. Kenny (Ed), Listening, playing, creating: Essays on the Power of Sound. Albany, NY: State University of New York Press.

Aldridge, D. (1989). A phenomenological comparison of the orga- nization of music and the self. The Arts in Psychotherapy, 16. 91-97.

Aldridge, D. (1993). The music of the body: Music therapy in clinical settings. Journal of Mind-Body Health, 9(l), 17-35.

Andsell, G. (1991). Mapping the territory. Journal ofBritish Music Therapy, 5(2), 18-27.

Andsell, G. (1995). Music for life. London: Jessica Kingsley. Bion, W. R. (1967) Second thoughfs. Heinemann Medical Books.

(1993 reprint, Kamac Books, London) Bruscia, K. (1988). Improvisational models in music rherapy.

Springfield, IL: Charles C Thomas. Casement, P. (1988). On learning from the patient. London: Ta-

vistock!Routledge. Lee, C. A. (1989). Structural analysis of therapeutic improvisatory

music. Journal of British Music Therapy, 3(2), I l-19. Lee, C. A. (1990). Structural analysis of post-tonal improvisatory

music. Journal of British Music Therapy, 4( 1), 620. Lee, C. A. (1995). The analysis of therapeutic improvisatory music.

In A. Gilroy & C. A. Lee (Eds.), Art and music: Therapy and research, 35-50. London: Routledge.

Nordoff, P. & Robbins, C. (1977). Creative music therapy. New York: John Day.

Pavlicevic, M. (1987). Reflections on the pre-musical moment, Journal of British Music Therapy, 1 (I), 22-24.

Pavlicevic, M. (1988). Describing critical moments. In S. Hoskyns (Ed.), The case study as research: Proceedings of the Fourth Music Therapy Conference. London: City University.

Pavlicevic, M. (1990). Dynamic form in clinical improvisation. Journal of British Music Therapy. 4. 5-10.

Pavlicevic, M. (1995). Music and emotion. In A. Gilroy & C. Lee (Eds.), Art and music therapy and research. London: Rout- ledge.

Priestley, M. (1975). Music therapy in action. London: Constable. Priestley, M. (1993). Essays on analytical music therapy. Phoenix-

ville, PA: Barcelona. Reason, P. & Rowan, J. (1981). Human enquiry. New York: J Wiley. Robson, C. (1993). Real world research. Oxford: Blackn~ell. Winnicott, D. W. (1958) Collected papers. New York: Basic

Books. Winnicott, D. W. (1965). The maturational process and the facili-

tating environment. Hogarth. (1990, Karnac Books, London) Winnicott, D. W. (1971) Playing and reality. London: Tavistock

Books. Winnicott, D. W. (1988). Human nature. London: Free Association

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