Music Therapy

1996, Vol. 14, No. 1, 44-60

Music Therapy-Holistic Model

DORIT AMIR

This article introduces a theoretical model that comes directly from

experiences in clinical work, yet is influenced by holistic principles
in other disciplines. The author describes existing theories in the
music therapy literature and explains the motivation for finding a
theoretical framework that focuses on music-therapy processes and
interactions, and allows for a deeper understanding of clinical
work. The principles from medicine, science, psychology and mu­
sic therapy that influence this model will be discussed. The Holis­
tic Model is presented and illustrated with clinical examples.

Introduction
When we look at music therapy from a scientific point of view, there are
three areas we need to consider: theory, practice and research. The
profession of music therapy has developed mainly around practice and
research. Until the late 1980s, the theories found in the literature were
not indigenous to music therapy (Aigen, 1991). It seems that music
therapists seek influences from outside the field of music therapy to help
understand the processes occuring in the practice of music therapy.
Even though there are many research articles in the literature, up until 10
years ago a substantial amount of music-therapy research was not
relevant to clinical practice, particularly to creative methods. In 1980
Nicholas and Gilbert investigated music therapists’ attitudes toward
research and found that most music therapists felt that the research
literature was not relevant to their practice.
Over the last 10 years music therapists have expressed a growing
need to find a theoretical framework that focuses on the therapeutic
process and allows for a greater understanding of clinical work (Ruud,
1978; Wheeler, 1981; Kenny, 1985, 1989; Hesser, 1988; Forinash &
Gonzalez, 1989; Aigen, 1991; Amir, 1992).
In the literature we see many attempts to connect music therapy with
theories of psychotherapy (Ruud, 1978; Wheeler, 1981; Bruscia, 1987;
Bruscia, 1991). In Bruscia’s book on improvisational models (1987) there
are also theories of speech therapy, occupational therapy, physiotherapy

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 Music Therapy-Holistic Model 45

and music education that serve as theoretical basis to understand music

therapy practice. Indeed, music therapy is a profession that requires vast
knowledge in psychology, psychotherapy and music. However, the
music gives music therapy its uniqueness and differentiates it from
verbal psychological treatments. Bruscia (1989) and Ruud (1978) agree
that the challenge in developing a theory in music therapy is to focus on
its uniqueness. It is not only adding music to psychological treatment,
but the combination of music and therapy. Therefore, creating a music
therapy theory that does not originate within any other discipline but
comes directly from experiences in clinical work may enhance our
understanding of the musical processes, interventions and interactions
in music therapy.
The key to finding meaning in music therapy is in the field itself: in
the interactions between its participants, the environmental elements,
and the music (Amir, 1992).

Principles Taken from Other Disciplines that Influence the Model

The Holistic Model in music therapy that will be described later
comes directly from my own clinical practice as a music therapist. In
creating the model I was influenced by principles and conceptions that
come from holistic approaches in medicine, physics and psychology. In
the field of music therapy I am mainly influenced by the theoretical
work of Bonny (1986), Broucek (1987) Eagle (1991), and Kenny (1989,
1985). It is beyond the scope of this article to describe fully the theories of
each of these people. A brief summary of the major princliples of each
theorist will be given.
In the field of holistic medicine, the person is seen as a whole human
being, and therefore the frame of reference is not only physiological but
also emotional, mental and spiritual. Chopra (1989) tells us that in order
to be effective in treating sickness there is a need “to focus on process, on
interaction, on behavior, nutrition, life-style, and on biological rhythms”
(P. 52).
Bonny, in her article “Music and Healing” (1986), says that the goal of
holistic medicine is to pursue the well-being of the total person. It means
“that the total person-mind, body and spirit-must be brought to the
‘healing table”’ (p. 3). Music, says Bonny, is ideal for treating the total
human being, since it is in both our inner and outer lives.
In modem science I am mainly influenced by the writing of Capra’s
systems view; Bohr’s principle of complementarity, and Bohm’s prin­
ciple of holonomy in the field of quantum physics as described in Eagle’s
article, “Quantum Therapy” (1991).

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According to Capra (1982), “the new vision of reality is based on the

awareness of the essential interrelatedness and interdependendence of
all phenomena-physical, biological, psychological, social and cultural”
(p. 265). “Systems are integrated wholes whose properties cannot be
reduced to those of smaller units” (p. 266). These wholes exist from the
interactions and interrelatedness of their parts.
Kenny (1987) builds a theory that is based on the whole-systems
view: “The Field of Play.” Kenny (1985) defines system as a whole that is
viewed as a complicated web of relations between its various parts.
Kenny’s theory is based on her own experience in clinical improvisation
in music therapy. She sees clinical improvisation as a field that contains
primary and secondary elements that are all interrelated with and
interdependent on each other.
Eagle’s “Quantum Therapy” (1991) is based on principles of quan­
tum physics, of which I will introduce only two that are relevant to my
model. Bohr’s principle of complementarity talks about the dual iden­
tity of matter. “At the sub-atomic level, all being can be described
equally as particle and wave at the same time” (p. 57). Bohm’s prin­
ciple of holonomy says that “a part of the whole contains all the
information of the whole. and changing a part of the whole changes
the whole” (p. 59).
Based on the above, in Eagle’s “Quantum Therapy” there is no
separation between process and product; the clinical material is process
and product at the same time. Any situation in therapy is holistic or
holonomic. “We must see the clinical whole, realizing that it exists in a
state of potentiality and probability ready to become either a product or
a process” (p. 60).
In the field of psychology, I am influenced by the fourth force,
transpersonal psychology. Transpersonal psychology sees everything in
nature as wholes, where each whole is part of a larger whole-“Fields
within fields within fields, stretching through the cosmos, interlacing
each and everything with each and every other” (Wilber, 1983, p, 83). It
unites Eastern and Western philosophies, while bridging and integrating
psychology and spirituality “It is concerned with the recognition, under­
standing, and realization of nonordinary, mystical or ‘transpersonal’ states
of consciousness, and with the psychological conditions that represent
barriers to such transpersonal realization” (Capra, 1982, p. 367). The
study of consciousness has been an integral part of the transpersonal
movement (Assagioli, 1991; Orenstein, 1986; Tart, 1983; Wilber, 1980).
Bonny (1975) explored the connection between music and different
levels of consciousness in her GIM model. She explains that when a
person is in a heightened state of consciousness, the mind is able to

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 Music Therapy-Holistic Model 47

contain many ideas and experiences. The person’s awareness seems to

be intensified and enlarged, while consciousness itself can become
multidimensional.
In an attempt to expand perspective beyond the traditional scope of
music therapy practice, Broucek (1987) wants us to focus attention on
the potential of music therapy beyond the boundary of healing to
“wholeing” (p. 50). “If healing is the process of restoring health, than
wholeing is certainly the process of restoring wholeness. And
wholeness...involves a creative self, a spirit which embraces the fullness
of life” (p. 58). She talks about the music therapy experience in terms of
“life spirit”, which is the creative spirit that has to be kept alive and
nurtured. Our challenge as music therapists is to revive, sustain and
nurture each client’s life spirit.
This Holistic Model is based on direct experience in the field. It looks
to discover and understand the structure and form of the musical
experience and its connections to human beings who are involved in the
music therapy process. The model includes most aspects of human
behavior and experience. It has a direct contact with the practice in the
field, and provides a bridge between art and science.

Holistic Model
Description of the Model
The music therapy process can be seen as a whole system that
includes three main forces: a therapist, a client and music. One can
imagine this system as having the qualities of matter and wave at the
same time (Bohr in Eagle, 1991). The basis of the system is built from
solid matter: two people (in an individual therapy), who have specific
personality structures, function in specific roles, and who meet in a
specific place for a specific time and for a specific goal. However, the
system can also be seen as a wave: it has music and sound vibrations as
well as inner and outer energies that are being created and recreated
from moment to moment. Within this system, many kids of relation­
ships start to develop: relationships between music and sounds, rela­
tionships between therapist and client, relationships between thoughts
and feelings, relationships between the external environment and the
internal world, and relationships between music and words. Each inter­
action can be seen as a whole and complete unit within itself, yet they are
interwoven and interlacing with each other. The whole becomes greater
than each unit and reaches a more complete form (Schwartz and Oglivy
in Lincoln & Guba, 1985; Eagle, 1991).

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The system is composed of internal and external realities. The experi­

ences in these two realities occur on intrapersonal and interpersonal levels
in active and receptive realms. These occurrences take place within a few
areas: physiological, cognitive, emotional, intuitive and spiritual.
It is important to say that many of the terms used to describe this
Holistic Model have been defied in music therapy and psychotherapy
literature, such as Winicott’s use of the terms internal and external
realities (1971) and May’s use of the term “being with” (1958). Yet, I am
asking the reader to postpone any familiar definition and to be open to
the definitions proposed in the model in order to understand the model
in a clear way.

External and Internal Reality

The External Reality encompasses the aesthetics of the immediate
environment-the therapy mom. The size of the room and how it is
organized; type, quantity and quality of musical instruments; the music
itself-sounds and voices; therapist and client. The therapist is part of
the client’s external reality and vice versa.
The Internal Reality is the internal world of the therapist and of the
client. Internal reality is composed of everything that happens con­
sciously and unconsciously in the inner existence. Sensations, feelings,
images, emotions, thoughts and internal music. In the internal reality
there are many things happening. It is a whole world within itself. The
relationships between the different forces in nature resemble what is
happening inside a human being. I have observed myself and my clients
use many images and metaphors from nature in an attempt to describe
our inner world (I feel like a stormy ocean; I am like a tree in the fall, etc.).

Active and Receptive Realms

The Active Realm is the realm of “doing” in which the therapist and
client actively express themselves. This expression can be created in
various forms: music making, movement, drawing, talking, playing,
writing, etc. In this realm we give expression to our internal voices and
bring them to life. This is done through activities and intervening
techniques.
The Receptive Realm is the realm in which we listen both internally
and externally. Internal listening is listening to one’s inner voices. Exter­
nal listening is listening to the outside: to the music, sounds and voices
that are being created in the room and sometimes outside the room. This
is a realm of “being with” without doing anything (Amir, 1995).

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Interpersonal and Intrapersonal Levels

The Interpersonal Level contains everything that happens between
the client and therapist. This is the level in which the relationship
between these two people starts to develop: the dynamics of the interac­
tion, projections, transference and counter-transference, trust, support,
love, acceptance and all the professional interventions that the therapist
does in music and words.
The Intrapersonal Level contains all the conscious communication
one has with oneself and the insights one gains during the process. It is
the “here and now”: What do I feel right now? What am I aware of?
What part of the gestalt is coming forward now? Imagine a whole circle
with a ray of light underneath it that turns around and around, lighting
different areas. Sometimes one area gets a very strong light, and at other
times there are two areas that are lighted simultaneously A moment
later, a third area beams all of a sudden with a very powerful and
celebratory light.

Physiological, Cognitive, Emotional, Intuitive and Spiritual Areas

The Physiological Area involves all body reactions: posture, internal
and external body movements, the function of the various body parts
that are involved with the music making, and the body different reac­
tions to musical stimulation (shivering, a feeling of being hot or cold,
slowness or acceleration in heart beats, increase or decrease in blood
pressure, etc.).
The Cognitive Area involves the learning process the client under­
goes: the ability to recognize one’s own musical symbols, patterns and
behaviors and understand their connection to one’s internal and exter­
nal reality. It is also the therapist’s knowledge and understanding of the
therapy process.
The Emotional Area includes moods, feelings, sensations and emo­
tions that the music creates within us. Music and sounds can be the voice
of sadness, joy, fear and anxiety, anger, etc.
The Intuitive Area is an open field where we can receive messages from
all levels, realms and areas. Insights are always intuitive (Amir, 1993).
In the Spiritual Area the person feels his/her soul, with the sense of
being connected to a higher power and to the whole universe. This
feeling may be experienced as mystical or religious. It can be expressed
through vocal or instrumental music that is being listened to or impro­
vised.

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 50 Amir

Relationships Among Realities, Realms and Levels

In reality, the relationships that occur in the therapeutic process are
more like a web. The connections are not linear, but multilevel and
multidimensional. They are inseparable and interrelated. In theory we
can examine these relationships in a more specific and clearer way. One
way to look at these connections is to divide the model into two systems
and to examine the relationships among internal reality, receptive realm
and intrapersonal level as one system and the relationships among
external reality, active realm and interpersonal level as the second
system.

1. Relationships among the internal reality, the receptive realm

and the intrapersonal level.
There are many movements in the internal reality. Some of them are
totally unfelt and unknown. These are inner, sometimes hidden pro­
cesses that clients and therapists go through during clinical work. Once
something moves from the internal reality to the intrapersonal level it is
called insight. The unconscious breaks through to the conscious. The
inner movement is felt, it becomes known. There is a shift in the inner
boundaries of the inner reality. Listening is the connecting unit between
the internal reality and the intrapersonal level and allows us to focus on
certain areas, sounds and images. Being in the receptive realm gives us
the opportunity to be with ourselves and with the external world
simultaneously. In this way a certain event, memory or association can
come forward to the intrapersonal level. There are moments when the
processes in this system are flowing that lead to insights and experiences
of breakthroughs from the unconscious to the conscious.

2. The relationships among external reality, active realm and

intrapersonal level.
Let’s examine now the second system: External reality-active realm­
interpersonal level. The key words here are the aesthetics of the environ­
ment, the relationship with the therapist, motivation, security, trust,
daring and doing. The variety and quality of musical instruments, the
quality of sounds and the aesthetics of the therapy room provide the
client with greater motivation for participation. This way the client
acceses his/her own creativity through exploration and expression. A
positive working relationship with the therapist develops trust and
security and allows the client to take risks and to explore new inner
territories and interpersonal relationships on a deeper level.

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 Music Therapy-Holistic Model 51

External Reality: the aesthetics of the immediate environment-the therapy room

Internal Reality: conscious and unconscious inner existence:

Interpersonal Level: everything that happens between client and therapist;

Intrapersonal Level: here and now, inner awareness, Insights;

Active Realm: active expression through music, words, etc.;

Receptive Realm: internal and external listening;

Physiological Area: all that has to do with the body;

Cognitive Area: learning process, knowledge and understanding;
Emotional Area: moods, feelings, sensations and emotions;
Intuitive Area: being open to receive insights;
Spiritual Area: spiritual self IS being alive.
active realm receptive realm interpersonal level intrapersonal level

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I will now explore the second system (the relationships among exter­
nal reality, active realm and intrapersonal level) through an example
from my clinical work. Danny is a 25 year-old man who came to me for
therapy because he had a poor self-image and low self-confidence. He
had been in psycho-therapy in the past but did not feel any change, and
decided to try music therapy. During the first session he discovered the
bongos in the room (external reality) and played very gentle and delicate
sounds. He tried different rhythmic patterns using all of his fingers in a
mezzo piano dynamic (active realm). At a certain point I asked him if I
could join him with the second pair of bongos and he agreed. I imitated
his drumming and slowly brought a little more energy, accelerating the
tempo and making louder sounds. He joined me and together we
created an improvisation that reached forte. With both of our hands we
drummed on the two sides of the bongos. There were arm movements,
too. The improvisation went back to piano and ended with a light
drumming with our fingers (interpersonal level). During the improvisa­
tion there was no eye contact between Danny and me, but I noticed that
from time to time he looked at my bongos (interpersonal level). At the end
he smiled and said: “I released some energy, a lot of energy, didn’t I? It
sure felt good!” I felt that some initial connections were made: a connec­
tion between Danny and the bongos he was using, a connectionbetween
Danny and his body-he moved his hands and arms and released some
energy, something that made him feel good; a musical connection be­
tween us-drumming together in a congruent way; and a beginning
connection between Danny and me through watching my bongos.

Using the Model for Diagnosis and Treatment Plan: Brian

Brian was five-year-old child when he was referred to me by his
psychologist. Brian had some verbal speech but could not express
himself well enough to communicate. He showed some hyperactivity
and very limited attention span. According to his parents, he liked to
sing and his attention span increased while listening to records at home.
Music therapy was the first choice of treatment. The psychological tests
suggested that Brian had intelligence, that he was creative, and that his
problems were emotional and not physiological.
In the first few sessions, Brian showed interest in all of the instru­
ments in the room (external reality). He tried one after the other. He took
the bongos, beat them, and after three seconds put them back and went
to the maracas. He played them for a few seconds, went to the piano,
tried it for a few seconds, and so on. This was his way of playing music
during the first five sessions (active realm). Brian did not make eye

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 Music Therapy-Holistic Model 53

contact with me and my feeling was that he was not even aware of my
existence in the room (interpersonal realm).
I listened to Brian’s sounds. They were short, sharp sounds with the
same dynamics of mezzo forte (active realm). I also paid attention to
Brian’s physiological area: his facial expression was frozen; his body
language showed a closed posture with no flow.
I noticed that I felt uncomfortable with Brian’s sounds and actions. It
made me feel restless and unable to focus well (internal reality). His
monotonous, mechanical sounds gave me an image of a body covered
by a plastic bag that made breathing almost impossible (intrapersonal
reality).

Reflections

Many questions arose for me during this time. Why did Brian play the
way he did? What does it give him? What does he need? In which reality
does he function? In what way? Of what did Brian’s existence in the
room and his music remind me? What is to be learned from the image
that came to my mind? Why did I feel this way in my body while
listening to Brian’s playing?
I realized that because Brian didn’t talk in a communicative way, I
had to come to certain assumptions and understandings on my own. I
had to draw attention to my internal reality in order to understand
Brian’s internal reality. I had to use my receptive realm and to let Brian’s
sounds penetrate my body. At the same time, I used my inner listening
in order to get to my intrapersonal level. I listened to the happenings in my
emotional, physiological, cognitive and intuitive areas. The listening
brought several insights concerning Brian. His actions seemed mainly
automatic and mechanical. They were not yet connected to the happen­
ings in the intrapersonal and interpersonal level. There was no flow in his
musical action. It was breathless. The way I felt made me think that
Brian’s music making expressed his restlessness but had no connection
to his inner creativity My image made me think that his creative ener­
gies in his inner world were blocked. My main assumption at this point
was that Brian was using the musical instruments as a block to his own
creative energy. He was too frightened to pause, to rest, to breathe. He
probably had to protect himself from his inner world.
As the therapist, I used the whole system of internal reality-receptive
realm-intrapersonal level. It allowed me to gain a better understanding
of Brian and to plan therapeutic strategies and goals. Within the context
of the model, my goal for Brian was to make a shift, to move his attention
back and forth from the external reality to his inner reality; to shift from

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 54 Amir

expressing himself in a mechanical way to a more dynamic-creative

way. I knew that I had to be there for him, in a steady manner. I had to
accept him and respect his being. How could I do this musically, or, in
the model’s terminology, in what way could I function in my active
realm? I could offer him a steady musical frame to contain him. I could
use the piano in order to provide a steady rhythmic pattern with a
melody that would open the way to Brian’s emotions, and with harmo­
nies that would contain the melody. My improvisation should be steady
but not imposing, present but not domineering, providing a container
that encourages creative exploration (active realm). When his trust in me
developed (interpersonal level), he would be able to be more open and
aware of his inner world (intrapersonal level). Once he is less defended
and scared, maybe his musical expressions would change and gradually
be more connected to his inner creative energies.

Using the Model for Treatment: Dalia

Dalia participated in one of my music therapy groups. The group was
working together for two years and met once a week for two hours.
Dalia is a 30-year-old woman. She was born in the USA. When she was
18 months old her family came to live in Israel. She was 11 years old
when her father was killed during the “six-day war” in 1967. She had
two younger brothers. Dalia is married and works as a teacher in an
elementary school. Her husband works as an architect.
In her initial interview, Dalia told me that for a long time she had
suffered from constant headaches and fatigue. She returned from work
and could not move. She went to bed early but awakened tired. Dalia
took all the necessary physiological tests and the results indicated no
pathological conditions. She told me that she felt a lot of anger and rage
inside of her, and she was unable to experience love, joy and satisfaction.
She started to feel distant from her husband and was afraid that the
marriage would come to an end.
When I asked her in one of the sessions “How do you feel today?” she
said, “I don’t know. There are many things happening within me, but I
don’t know what they are” (internal reality). I asked her to close her eyes
and to breathe, breath after breath, deeper and wider. After a few
minutes I asked her to listen to what was happening inside her (receptive
realm). She replied, “I feel many streams storming inside me and I hear a
cacophony of sounds: loud and soft, long and short, high and low,
coming and blending with one another. .” (intrapersonal level).
I asked her if she were willing to try to create the cacophony of sounds
that she heard in her inner world by using musical instruments. Dalia
chose a great variety of instruments, including bongos, two maracas,

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wind chimes, two drums, tibetan bells, kazoo and whistles. She put the
instruments near her on the carpet and tried to play several of them at
once. With the kazoo in her mouth she made sounds that went up and
down like sirens. In one hand she held two maracas, shook them
strongly and every once in a while hit them on the bongos. In her second
hand she shook the tibetan bells and created fast and loud sounds. After
a few minutes she put the maracas and the bells on the carpet and
created metal chaotic sounds with the wind chimes. This was not
enough for her, and she asked several group members to join her in the
music making.
The improvisation lasted ten minutes (active realm). As I listened to
the music, I felt myself shrinking inside, as though my ears asked me to
protect them (internal reality). Suddenly I felt fear, and imagined I was on
a battlefield with wounded and dead soldiers, sirens shrieking, bullets
flying, and bombs exploding around me. It reminded me of the feeling I
had during the 1967 six-day war, when I was 16 years old and couldn’t
really understand what was happening (intrapersonal level). Dalia ended
her improvisation and started to cry. “It is scary, but this is exactly what
is going on inside me,” she said (emotional area).
Other group members shared with the group how scared they felt
during the improvisation and that the sounds reminded them of their
feelings during previous wars. I shared with Dalia my own memory
from the war. Dalia realized that this was what she felt when she was 11
years old and her father went to the war, never to return. Dalia cried and
allowed herself to feel the pain. Later she understood that through the
musical sounds she reproduced and relived the event in which her
father was killed. She told the group that she never talked about the
circumstances of her father’s death because the subject was a taboo in
her family. It was too painful. Everytime the subject came up, her mother
said, “Let’s not talk about it, we have to go on living our lives.” The
group was very supportive and shared similar experiences that were
triggered by Dalia’s sounds and verbal sharing. The group encouraged
Dalia to share this experience with her husband.
In the next session she told the group that it was a very difficult and
painful week for her. The old wounds were reopened. She was having
nightmares and re-lived moments from the war time. She shared her
feelings with her husband and it was the first time she talked to him
about this in such an open way. She said that her husband was very
supportive and caring (interpersonal level).
In a subsequent session, I asked the group to close their eyes, to take
deep breaths, to listen inwardly (internal reality), and to focus on one
particular sound (intrapersonal reality). After a few seconds of quiet

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 listening, Dalia reported that she heard her heart beats (physiological
area). I suggested that she play this, and she picked up the drum and hit
it in a very steady beat and slow tempo (active realm). I noticed that she
was rocking her body forward and backward in the rhythm of her
playing (physiological area). The sound became softer as she kept on
rocking and started humming. The group gradually and gently joined
her humming and together we created a gestalt of gentle ohoouuu-ahaaaa
voices. The humming became stronger and transformed into a sort of a
Hasidic song. We swayed back and forth, humming a simple tune in an
a minor key with ya-ya-yayaay and ya-ba-bam sounds. Dalia put the drum
aside and added another rhythic element by tapping her hands on her
lap. I joined her and did the same. The whole group was humming and
became a background to Dalia and me (active realm). After the singing
reached its peak, we gradually lowered our voices and ended pianissimo.
This particular session ended without words.
The next session Dalia thanked the group and reported that it was a
very powerful and beautiful experience for her. She said that the session
connected her with a very spiritual feeling, and brought back memories
from her past. She remembered Sabbath dinners from her childhood,
when the whole family gathered together, eating and singing Sabbath
and Hasidic songs (spiritual area). The group suggested creating this
ritual again by singing some of the songs that formed a part of Dalia’s
childhood (active realm). Singing each song evoked memories of specific
events in Dalia’s childhood (intrapersonal level), accompanied by feelings
of sadness, longing, pain and joy (emotional area). Dalia mourned the loss
of her father and the loss of the family ritual of gathering together,
singing and celebrating the Sabbath. She realized how big the loss of
growing up without her dad was, and understood how it affected her
whole life (cognitive area). In one of the sessions, we sang “Avinu
Malkenu”-“Our God, who is our father and king.” This is a song that
Jews all over the world sing on Yom Kippur, the day they fast and ask
God for forgiveness. Dalia sang the song with her hands up. Her singing
felt like a prayer. I accompanied her on the piano. Dalia experienced
singing this particular song as cleansing and beautiful (spiritual area).
After the group ended, Dalia started individual music therapy with
me. We continued to work together for another year. The individual
work focused more on the present issues of Dalia’s concerns about her
marriage. The more she allowed herself to give expression to her inner
chaos via the use of music and sounds, the more she gained insights into
her life. Dalia said the music therapy room (external reality) was the only
place in which she could express her difficult feelings concerning her
marital crisis in an authentic and powerful manner. She told me that her

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 Music Therapy-Holistic Model 57

husband has slowly started to withdraw from her. She felt that he had
lost interest in her both physically and as a friend and partner. Even
though they were living under the same roof, they were living apart
from each other. She felt as if he did not love her any more, and she had
no idea why. “We don’t talk about these things.”
We worked on those issues musically, using several techniques and
therapeutic interventions. We used role playing in our improvisations.
We improvised separately and together on themes and titles which came
out of Dalia’s inner feelings and thoughts she discussed with me. We
improvised and later gave it a title when Dalia’s feelings and thoughts
were unclear.
At a later point Dalia told me that she had a talk with her husband. She
shared her feelings with him and asked him what was wrong with their
relationship. They were able to communicate with each other in a more
open way than before. Dalia began to feel calmer and more relaxed.
Toward the end of the therapeutic process she became pregnant and after
several months she called me up and told me that she gave birth to a
beautiful baby boy and that things were going really well with her.

Discussion
Dalia worked on both her internal and external realities, in all the
areas, in both active and receptive realms, on both intrapersonal and
interpersonal levels. In the group, in the first event I describe, there is a
very noticeable shift from one system (internal-receptive-intrapersonal) to
the other (external-active-interpersonal). First, Dalia visits her internal
reality. There is a movement from this reality (“There are many things
happening within me, but I don’t know what they are”) to her intra­
personal level (“I hear a cacophony of sounds: loud and soft, long and
short, high and low, coming and blending with one another”) through
her receptive realm (inner listening). I guide Dalia to the second system
(interpersonal level). By using the external reality (choosing the instru­
ments and arranging them on the carpet) in the active realm (creating
the improvisation) Dalia is brought back to her internal reality and gains
an insight about her life (intrapersonal reality). My intrapersonal level
(the feeling of fear and the image of the battlefield) helped me under­
stand what was happening in Dalia’s inner world.
This experience involved many areas: the physiological area (her
movements and the use of her body), the cognitive area (the under­
standing she gained about herself), the emotional area (her crying and

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 58 Amir

pain), the intuitive area (intuitive shifts in the music making from one
musical style to another) and the spiritual area (Hasidic melody that was
a very moving experience).
The example above illustrates that there has to be a flow between the
two systems and a connection among realities, levels, realms and areas
in order for the therapeutic process to be created and for changes toward
growth to occur. What happened in the external reality in the music
therapy room allowed changes to occur in Dalia’s external reality out­
side the music therapy room. The work in the music therapy group gave
Dalia the opportunity to trust other people and to open up and move
from her internal reality to her intrapersonal level. She expressed,
brought up and processed important unfinished issues from her past.
Individually, Dalia continued to work with me more deeply on her
present issues. The work was done in both active and receptive realms,
musically and verbally. The trust and security Dalia developed in me
(interpersonal level), encouraged her to gain more trust in other human
beings and especially to be able to trust her husband more.

Summary
This article introduces a new model to understand clinical music
therapy. The model is holistic in nature. The model contains internal and
external realities, which function in active and receptive realms on an
intrapersonal and interpersonal levels. The occurrences take place within
five areas: physiological, cognitive, emotional, intuitive and spiritual.
This model allows music therapy to be seen as a dynamic process that
improves health, opens paths to creative abilities and fulfills potentiali­
ties within therapists and clients. The process is created from connec­
tions and flow among all realities, realms, levels and areas.
We can look at the model as “Fields within fields within fields
interlacing each and everything with each and with other” (Wilber, 1985,
p. 83). It is possible to imagine this model as a kaleidoscope that has
specific colors and shapes and with each little movement something
changes in the gestalt of the colors and shapes and the picture is different
from before. We can feel it as a sea of vibrations and energies being
expressed and released, leading toward change. We can also view this
model as composed of moments. Each moment is a whole and complete
unit within itself, which interweaves and interacts with other moments.
Thus the whole becomes greater than each moment and becomes a more
complete form (Amir, 1992a).

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 Music Therapy-Holistic Model 59

This model gives the therapist a way to assess and diagnose the client
and to create treatment plans. Through the use of this model the thera­
pist can better understand the therapeutic process and design thera­
peutic strategies and directions. It can shed light on the changes in the
client’s reality and can help in evaluating the client’s progress and
growth during the course of therapy.

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Dorit Amir, D.A., ACMT, is the head of the Music Therapy Program at
Bar Ilan University in Israel. She maintains a private practice and works
with children and adults with various problems. Dr. Amir is the co­
editor of the new Israeli journal, Therapy Through the Arts.

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