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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
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).
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.
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
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
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
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).
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.
References
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music therapeutic process. Therapy through the arts, l(1). The Israel Arts
Therapy Journal, 17-22.
Amir, Dorit (1992a). Awakening and expanding the self: Meaningful moments in the
music therapy process as experienced and described by music therapists and music
therapy clients. Doctoral Dissertation, New York University, UMI order #
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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.