A Humanistic Perspective on Intersubjectivity in Music
Psychotherapy
MEGHAN HINMAN ARTHUR, PhD, MT-BC
ABSTRACT: Contemporary psychoanalytic theory and practice focuses
on the concept of intersubjectivity, in which the therapist leans on
their subjective experience of being together with the patient as a
method of understanding the patient, their needs, and the work that
is being undertaken. Throughout the music therapy literature, authors
take various positions regarding the relevance of psychoanalytic think-
ing in music therapy treatment, sometimes eschewing its use because
of misconceptions about the purpose of attending to such phenomena.
This article attempts to describe some theoretical aspects of the appli-
cation of intersubjectivity and psychoanalytic theory to music psycho-
therapy practice, focusing on the inherent humanistic qualities of this
understanding of therapeutic relationship and healing. The music ther-
apist who attends to the dynamics of intersubjectivity is strongly con-
nected to humanistic concepts of selfhood, agency, relationality, and
aestheticality as the work focuses deeply on the here-and-now rela-
tionship and on the meaning co-created between therapist and patient
in each clinical moment. Attending to intersubjectivity positions the
music therapist for connecting to a patient’s whole self, for more
deeply understanding the work of therapy, and for finding grounded-
ness and confidence as a therapist. It also requires an awareness of the
additional psychological complexity that music brings to the clinical
space. This article draws upon literature from depth psychology and
from the findings of the author’s dissertation research studying music
therapists’ experiences in clinical relationship.
Keywords: humanism; psychoanalysis; transference; intersubjectivity
Introduction
Intersubjectivity, or “space shared by two separate con-
scious minds” (retrieved January 26, 2018, from https://www.
merriam-webster.com/dictionary/intersubjectivity), is essential
to understanding the therapeutic relationship in contempor-
ary psychoanalytic thought, and in music psychotherapy work
that aims to be depthful. While in the room with the patient,
the therapist experiences the intersubjective field, the affective
experience of being connected to the patient. Taking this inter-
subjective realm into account, one understands that the workings
of the clinical relationship, and the therapy process in general,
are made up of the thoughts, feelings, fantasies, and somatic
experiences of both patient and therapist. When approached
from this perspective, psychodynamically oriented music ther-
apy can only be seen as a deeply humanistic pursuit, in which
Meghan Hinman Arthur, PhD, MT-BC, is a depth psychologist and music therapist with
a private practice offering psychotherapy and clinical supervision in Denver, CO.
Address correspondence concerning this article to Meghan Hinman Arthur, PhD,
MT-BC. E-mail: MeghanArthurPhD@gmail.com.
© American Music Therapy Association 2018. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com
doi:10.1093/mtp/miy017
Advance Access publication July 10, 2018
Music Therapy Perspectives, 36(2), 2018, 161–167
161
Private Practice, Denver, CO
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selfhood, agency, relationality, and aestheticality are inexorable
elements of the process.
Within discourse and literature from the psychoanalytic
community, the phenomenon of clinical relationship, and the-
ories that acknowledge the projective elements that manifest,
are referred to by a variety of terms, including relational psy-
choanalysis (Benjamin, 2004; Maroda, 2004), intersubjective
systems theory (Atwood & Stolorow, 1984), the interactive field
in analytical psychology (Stein, 1995), Bion’s state of “reverie”
(Casement, 1997), and Ogden’s (1997) analytic third. When a
therapist attends to that space between herself and her patient,
she connects to her patient, and to the relationship that they
have built and are building together. When a therapist tunes in
to her own thoughts, experiences, feelings, and reveries in the
therapeutic moment, she also attunes to the thoughts, experi-
ences, feelings, and reveries of her patient. This connection,
relatedness and reliance on the deep interpersonal connection
between therapist and patient gives primacy to the humanity
of both parties, and to the relationship that develops between
them. Neither music therapist nor patient can be reduced to
predictable mechanisms or to the following of pre-established
therapeutic procedures when they are sitting with whatever
may arise in the co-created transferential space. Each is a sub-
ject, with their own conscious and unconscious processes
contributing to the therapeutic field. Each member of the
therapeutic couple exists in the mystery, and the humanness,
of the ongoing therapeutic encounter.
Working depthfully in relationship means attending to “the
experience of the interplay of individual subjectivity and inter-
subjectivity” (Ogden, 1994, p. 3), which Ogden calls the ana-
lytic third. All of the therapist’s experiences that occur in the
context of her relationship with the patient are a part of the
intersubjectivity created between patient and therapist. “No
thought, feeling or sensation can be considered to be the same
as it was or will be outside of the context of the specific (and
continually shifting) intersubjectivity created by analyst and
analysand” (p. 7). From this perspective, the therapist’s internal
experiences that might be seen as countertransference, rev-
erie, or even immaterial distractions are co-created psycho-
logical events that reflect the dynamics of the relationship
between the patient and therapist. The mutual projections that
create the analytic third are then the subject of the analysis.
Many music therapy authors have theorized about the clin-
ical relationship in music therapy, although how the clinical
relationship is understood varies widely, and literature from
the United States tends not to reflect contemporary psycho-
analytic understandings of the clinical relationship (Hinman
Arthur, 2016). A few authors in the United States (it is more
commonly discussed in Europe) have spoken to the relevance
162
of theories of intersubjectivity to music therapy practice.
Birnbaum (2014) focused on its context in developmental
psychology and its relevance and application to Nordoff-
Robbins Music Therapy practice. Scheiby (2005) wrote about
countertransference and music as a processing tool. Both sug-
gest that a music therapist’s work can deepen and expand
when attention is paid to the deep interpersonal and emotion-
ally laden connection with her patient.
The following consideration of the humanistic elements of
intersubjectivity in music psychotherapy will address human-
istic facets of selfhood, agency, relationality, and aesthetical-
ity, and is influenced by my training in depth psychology,
and my experience working as a music psychotherapist and a
depth psychotherapist. Writing from a depth psychology lens
assumes the existence and importance of the unconscious
mind, a leaning away from ego-led treatment, primacy of emo-
tional experience of both therapist and patient, and a therapeu-
tic relationship that relies on deep interpersonal connection. In
drawing primarily from psychoanalytic literature, throughout
this text I will refer to psychoanalytic literature and thought as
a theoretical grounding point, and to psychodynamic work and
phenomena to describe the work of music psychotherapists.
Humanistic Perspectives
As in humanistic approaches to music therapy (as cited
in Abrams, 2016), contemporary psychodynamic practice
emphasizes the selfhood (also known as personhood) of both
therapist and patient. Both have an identity, a name. In depth-
oriented work, this presupposition also makes space and cre-
ates safety, within which the therapist and patient can explore,
when necessary, the psychological experience of feeling like
one lacks an identity or name, or the significance of not seeing
the therapist (and/or other people in the patient’s life) as hav-
ing or being entitled to an identity or name.
Humanism asserts that all humans have agency, the capac-
ity to exert power, especially “the power to exist as a person”
(Abrams, 2016), and to act rather than to be acted upon. A core
understanding of therapeutic work that acknowledges intersub-
jectivity is the ability of therapist and patient to mutually impact
each other (Maroda, 2004; Stark, 2000). Not only does the
patient have the power to act, but the patient’s actions impact
the therapist in myriad ways, and vice versa. This is an impor-
tant aspect of contemporary psychodynamic work that is some-
times overlooked or even eschewed in music therapy literature.
Relationality, a key facet of humanistic music therapy
(Abrams, 2016), is intrinsic to music psychotherapy that
acknowledges the intersubjective field. Not only are the
patient’s relationships and socio-cultural context an important
part of understanding the patient and providing treatment, but
the patient’s place in relationships in general also comes alive
in the therapeutic encounter (Racker, 1957; Stark, 2000). The
individual relational contexts of patient and therapist inform
the connection that the two develop, and the entire course of
treatment. As Abrams says about humanistic music therapy, in
the intersubjective realm of music psychotherapy, “relation-
ship is not just a factor or component in therapy—it is the
therapy and is the basis for change” (p. 154).
Aestheticality is “the sensibility, embodiedness, quality, and
significance/meaningfulness of being” (B. Abrams, personal
communication, August 18, 2017). Carl Jung ([1958] 1973)
Music Therapy Perspectives (2018), Vol. 36
is known to have said that “a psychoneurosis must be under-
stood, ultimately, as the suffering of a soul which has not dis-
covered its meaning” (para. 497). Depth-oriented work that
attends to the intersubjective realm is, at its root, about thera-
pist and patient searching for meaning together.
Intersubjectivity and Psychoanalytic Thinking as Humanistic
Endeavor
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In the context of clinical practice that is grounded in psy-
choanalytic thinking, intersubjectivity is experienced or
framed through terms that have familiarity to music psycho-
therapists, including transference, countertransference, and
projective identification. Some voices in the music therapy
literature have eschewed psychodynamic approaches and
the consideration of transferential and projective phenomena
(for example, Ansdell, 1995; di Franco, 2003). One reason for
this rejection is described by Turry (1998): “Clinicians who
question the relevance of transference and countertransfer-
ence in the Nordoff-Robbins approach believe that these con-
cepts result from a reductionist philosophy that minimizes the
importance of the aesthetic power of music and the musical
interaction, placing an artificial barrier between the music
makers” (p. 163). However, I believe that this sentiment does
not reflect an understanding of contemporary psychoanalytic
thought or the humanistic qualities of psychodynamic work.
What follows is a summary of some descriptions of psy-
chodynamic phenomena (transference, countertransference,
and projective identification) taken from the music therapy
literature and from contemporary psychoanalysis and Jungian
analytic literature. I suggest that how a clinician understands
and frames psychodynamic phenomena impacts the degree to
which that work can be seen as humanistic.
Transference
As part of my doctoral dissertation research, I  conducted
phenomenological interviews with music therapists, many
of whom have advanced training and describe themselves as
having a psychodynamic orientation to their work. However,
most of these therapists related confusion about what transfer-
ence is, and not one talked about how tuning into transference
is part of connecting with or helping a patient (Hinman Arthur,
2016). Several of the participants described learning about
transference in school, but not developing an understanding
of how it manifests in practice, much less how transference
is part of the deep, human connection between therapist and
patient.
In American music therapy literature, transference is often
framed through the lens of drive theory and some of Freud’s
earliest conceptions of the phenomenon. Bruscia (1998c)
highlights Freud’s first, and later revised, understanding of
transference as a defense mechanism. He states that “certain
transferences are non-pathological and facilitate therapeutic
relationships and processes, and others are pathological and
hinder them” (p.  21). A  pathological transference, accord-
ing to Bruscia, is one that is resistant or negative—only when
the patient experiences positive feelings toward the therapist
is his transference considered healthy and nonpathological.
He also describes the transference, in some cases, as being
the patient’s conscious choice. Bruscia feels that all trans-
ferences can be classified as interpersonal or intrapersonal,
A Humanistic Perspective on Intersubjectivity in Music Psychotherapy
pre-Oedipal or Oedipal, neurotic or healthy, positive or nega-
tive, specific or generalized, involved or remote, and verbal or
nonverbal. While this approach does not explicitly negate any
aspect of a patient’s selfhood, the focus is on evaluation and
classification rather than the dynamic connection between
therapist and patient that is emphasized in contemporary psy-
choanalytic thought.
Other music therapy writers and theorists also speak to trans-
ference in a way that does not focus on, or in many cases even
mention, connection between music therapist and patient.
Summer (1998) writes about the goal of achieving the pure
music transference in the Bonny Method of Guided Imagery
and Music which, unlike transference to the therapist, affords
the therapist greater emotional freedom in the Bonny Method
process. Several authors write about the importance of “man-
aging” (Hadley, 2003, p.  14) or manipulating the patient’s
transference to a desired outcome. Priestley (1994) recom-
mends certain therapist behavior to evoke certain patient
transferences (see p. 78), and Bruscia (1998a) suggests that a
therapist should “do whatever possible to create positive rather
than negative transferences or to create positive ones that are
stronger than the negative ones” (p.  45). These perspectives
appear diametrically opposed to the humanistic principle of
agency, or “the power to exist as a person” (Abrams, 2016,
p. 151), and the capacity to act, not just be acted upon. While
it may be true that certain behavior from the therapist is likely
to invite certain reactions from the patient, I  have concerns
about the recommendation that a therapist should attempt to
manipulate a patient into having certain feelings and not oth-
ers, or be anything other than authentic in the clinical space.
Furthermore, placing an emphasis on positive transference
as more desirable for treatment contradicts the humanistic
belief that a patient is a whole person, who must be entitled
to their full range of emotional reactions, and their power to
impact the therapist (even in ways that the therapist may find
uncomfortable).
Psychoanalytic literature defines transference as an expres-
sion of the patient’s internal object relations that are uncon-
sciously projected onto the therapist (Racker, 1957). It is “a
story about the patient’s internal dynamics” (Stark, 2000,
p. 252). Although this material will have resonance with the
patient’s past (or, from a Jungian perspective, with archetypal
material that connects with the patient’s past [Sedgwick,
2001]), transferences are also a reality-based reaction to the
therapist (Maroda, 2004). As Stark (2000) states, they are “also
a story about the meaning the patient makes of the therapist’s
actual participation in the relationship” (p. 252). The therapist
affects the patient, and these effects can be seen in the trans-
ference— in fact, the patient’s material cannot be successfully
projected without a corresponding “hook” in the therapist,
a place in the therapist where that projection can “hang”
(Sedgwick, 2001). Additionally, as Jacoby (1984) notes, trans-
ference has “not only a cause but also a purpose” (p. 18); the
transference points to those aspects of the patient’s internal
structure that need to be worked on in therapy. The work on
the transference occurs as therapist and patient explore the
dynamics of their ongoing relationship. As Maroda (2004)
notes, any connections to the patient’s past can and will be
made by the patient themself once they can safely reflect on
what is happening in the here and now.
163
A contemporary psychoanalytic understanding of transfer-
ence connects strongly with the humanistic tenets of agency,
relationality, and aestheticality. The transference is not pure
projection; it is a reality-based response to the therapist and
how she participates in the session. When a patient’s transfer-
ence is understood in this way, the therapist is more connected
to the patient’s agency, to their power to see and impact the
therapist. Relationality is acknowledged, as the transference is
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part of the patient’s relationship with the therapist, alive in the
therapeutic encounter, and part of the patient’s life context.
Aestheticality may be the most important aspect of this work,
as tuning in to transferences without pathologizing, classify-
ing, or manipulating them frees energy for therapists to focus
on connecting with the significance and meaningfulness of a
patient’s story and humanity.
Countertransference
Countertransference refers to all of the therapist’s emotional
reactions to the patient (Heimann, 1950; Maroda, 2010). In
psychotherapy that is influenced by depth psychology, these
emotional responses are the therapist’s most important tool
(Heimann, 1950)—the “backbone of the work” (Sedgwick,
2001, p.  48). Countertransference seems to be addressed in
music therapy literature much more frequently than transfer-
ence, and in my interviews with music therapists, counter-
transference was a much more familiar term (Hinman Arthur,
2016).
The idea that countertransference refers explicitly and most
significantly to emotional experience is worth emphasizing.
The therapist’s deep emotional engagement with the patient
is part of depthful work, and of the humanistic principle of
relationality, an acknowledgment of the patient’s capacities for
relationship and their human condition of being situated in
relationship. As Jacoby (1984) notes, there is a basic human
need to fuse with an other—what Jung calls participation mys-
tique, which is a strong emotional tie felt between patient
and therapist. Countertransference feelings are a visceral
emotional expression of projections from the patient and of
the unconscious dynamics occurring between therapist and
patient. As Heimann (1950) states, the therapist’s countertrans-
ference is “the patient’s creation, it is a part of the patient’s
personality” (p. 83) in the therapist’s mind. The therapist must,
according to Freud (1912), “turn his own unconscious like a
receptive organ towards the transmitting unconscious of the
patient. He must adjust himself to the patient as a telephone
receiver is adjusted to the transmitting microphone” (p. 114).
Relationality, again, is an essential element of this aspect of
the intersubjective realm. The therapist tunes in to her own
reactions to the patient, with the understanding that the clini-
cal relationship and all that occurs in the intersubjective space
is “not just a factor or component in therapy—it is the therapy
and the basis of change” (Abrams, 2016, p. 154).
The music therapy literature offers a range of perspec-
tives on countertransference. Some music therapy theorists,
such as Bruscia (1998d), Nolan (1998), Priestley (1994), and
Scheiby (2005), emphasize that countertransference should
be minimized, managed, neutralized, or overcome. Contrary
to the psychoanalytic literature that focuses on the usefulness
of countertransference and the therapist’s emotional con-
tent (Heimann, 1950; Racker, 1957), Bruscia considers any
164
activation of a therapist’s personal content in sessions as a
contamination of the therapeutic process. He states that any
countertransference reactions that have their source in the
therapist’s own unconscious mind (what he calls “therapist
contaminations” and “therapist transferences”) “are grossly
distorted identifications that are extremely dangerous to the
client and the therapeutic process” (Bruscia, 1998d, p.  60).
Contemporary psychoanalytic views of the transferential field,
in which all countertransference is considered to be a com-
munication, not a contamination (see Maroda, 2004; Ogden,
1994; Sedgwick, 2001; Stark, 2000), are more consistent with
humanistic principles of relationality and agency.
When a music therapist believes that it is dangerous to have
emotional reactions to her patient and tries to mitigate them,
the patient’s agency and relationality, or power to act and
impact the therapist and be a connected and present partici-
pant in the relationship, are subordinated. As I observed in my
own research (Hinman Arthur, 2016), some music therapists
do believe that they should not have any feelings about their
patients, particularly not while they are in the room with the
patient, which leads to feelings of self-recrimination and self-
blame when these feelings naturally arise as part of their work.
Thus, it is not only the patient’s agency and relationality that
are at risk. The therapist’s agency and relationality are also cast
aside in this way of thinking, to the detriment of the therapist
and her ability to provide care.
Although she does not call upon psychoanalytic terms,
focusing instead on the applications of intersubjectivity to
developmental psychology and Nordoff-Robbins Music
Therapy practice, Birnbaum (2014) states, “[m]usic psycho-
therapists recognize that their own subjective emotional
responses, both conscious and unconscious, are expressed in
musical interactions and are a vital component of these inter-
actions” (p. 32). She continues, “How a therapist feels about
a client, both consciously and unconsciously, influences what
and how the therapist plays.... Making effective clinical inter-
ventions is not just about learning a new technique or acquir-
ing a new resource, but also discovering how we are feeling
about a client and how this is influencing our music” (p. 34).
Birnbaum is describing a clinical situation in which the thera-
pist tunes in to her own deeply felt affective state and considers
how she and the client are impacting each other in an ongo-
ing way, all the while improvising music together. The agency
and relationality of both members of the therapeutic couple
are acknowledged, here, and the music therapist’s emotional
reactions are not pathologized. Austin (2008) states, “I have
found that even when the countertransference is related to
my own unresolved issues, my feelings and reactions are inti-
mately involved with the therapeutic interaction and can be
extremely useful in understanding the client” (p. 331). These
voices challenge the narrative that there is any such thing as
a dangerous, “contaminating” form of countertransference,
and—consistent with more contemporary understandings of
intersubjectivity in psychodynamic work—advocate for the
view that all forms of countertransference are integral parts of
the therapeutic process that ultimately serve the client.
Projective Identification
Projective identification refers to the process in which “intense,
disavowed affects may be communicated unconsciously by
Music Therapy Perspectives (2018), Vol. 36
the client and received, consciously or unconsciously, by the
therapist” (Maroda, 2010, p.  249). Bion (1962) saw project-
ive identification (what he called “normal projective identifi-
cation”) as a way of establishing object relationships (see also
Maroda, 2004). The patient learns to contain and integrate his
emotional experience when his undigested “beta elements”
(affective states that are too threatening to feel consciously) are
received by the therapist, processed and metabolized in the
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therapist’s mind, and transmitted back to him via unconscious-
to-unconscious communication. Thus, projective identification
invites the therapist to see her own internal experience as a
reflection of the patient’s internal experience (Stark, 2000). The
patient’s hope is that the therapist will be able to tolerate and
respond to his disavowed affect (Maroda, 2004).
Perspectives from the depth psychology literature empha-
size the importance of projective identification as a means for
patients to communicate with the therapist. This is an essen-
tial aspect of understanding and then working with projective
identification; taking on the patient’s content together. Bion’s
perspective, which is shared by many authors (Grotstein, 1997;
Maroda, 2004; Ogden, 1994; Stark, 2000, among others),
implicitly encourages the therapist’s compassion for and deep
interpersonal connection with the patient. Important human-
istic principles of agency, relationality, and aestheticality are at
play when working with projective identification. Tuning in to
a projective identification acknowledges the patient’s power
to impact the therapist, their role as a participant in the clini-
cal relationship, and the meaning and significance of what is
frequently an intense and mysterious, but ultimately connect-
ing, clinical moment.
Some of the music therapy literature stands in sharp con-
trast with psychoanalytic literature on this topic. For example,
Bruscia (1998a) suggests that:
Projective identification is such a distorted and insidi-
ously powerful experience for both client and therapist
that it literally brings to a halt whatever was happening in
the interaction at the time, whether it be a more helpful
transference or a working alliance, effectively detouring
the therapeutic process itself. The chief aim of projective
identification is to keep repressed material from entering
consciousness by disrupting any aspect of the therapeutic
process that seems to be threatening. As such, it is always
a form of resistance. (p. 40)
Turry’s (1998) previously referenced concern that psycho-
dynamic constructs create “unnecessary barriers” between
music therapist and patient seems apt if one were to read
only Bruscia’s definition of projective identification. Bion’s
(1962) understanding of projective identification focuses on
relationality and aestheticality, and frames these same clin-
ical moments as times of profound connection, communica-
tion, and meaning that are essential to the therapeutic process,
rather than a detour from or resistance to it.
Stark (2000) states, “[t]he therapist who is able to accept
the patient’s projections, the therapist who is able to let the
patient have an impact on her and even change her, has
access to a very rich source of data about the patient’s internal
world” (pp.  264–265). Part of working depthfully as a ther-
apist is being “infected” by patients’ psychological material
(Sedgwick, 2001). The therapist’s availability for this level of
deep, emotional connection is imperative for depthful work.
A Humanistic Perspective on Intersubjectivity in Music Psychotherapy
More humanistic and depthful understandings of projec-
tive identification in the music therapy literature include Kim
(2009), who describes “musical projective identification,” in
which the therapist’s improvised music in the session can be
recognized by the client as having in some ways come from
what the client projected into the therapist. DeBacker and
Sutton (2014) describe how projective identification and Bion’s
conception of containment can come alive in the music:
Music therapy offers the patient a possibility to express
these fearful and unbearable experiences with and through
musical instruments... . The therapist can also react through
the musical interactions. The expression of the named sen-
sations is after all chaotic, confusing, fearful, or aggres-
sive. The patient himself is often caught off guard by this
emotional outburst and does not know how it will evolve.
The music therapist does not need to undergo all of these
passively, but will try to guide and structure these expres-
sions. It is as if he stretches a skin around the experience
of the patient—an acoustic skin—that holds together and
gives form to the expression of chaos. (p. 344)
Austin (2008) describes projective identification as a poten-
tially disturbing experience for the therapist, but she adds the
following:
It is also a way to learn about the client’s inner world on a
gut level, to walk in their shoes so to speak. More than a
defense, projective identification provides the client with
a means to communicate important information about
the self, information that is too unbearable to consciously
know about and express in any other way. (p. 91)
Other music therapy voices speak of the experience of lean-
ing into the chaos of deeply emotional, interpersonal work.
Jahn-Langenberg (2003) mentions the importance of music
therapist and patient experiencing together the affective sig-
nificance of the patient’s problem. DeBacker and Van Camp
(2003) discuss their experience of making music with patients
who are psychotic, feeling an inability to connect and at the
same time feeling drawn in by the “hypnotizing” repetitive
rhythm common for psychotic patients. This seems like the
kind of engagement that allows for the therapist’s emotional
connection with the patient, regardless of how vulnerable it
might make the therapist. Di Franco (2003) sums this up beau-
tifully: “If we say that music is a way to get in touch with the
inner world of the other, it is necessary to discuss the emo-
tional reactions between the therapist and the client” (p. 74).
In these descriptions of music therapists entering into a deeply
connected and emotional intersubjective space with their
patients, we see respect for the patients’ agency, for relational-
ity of both patient and therapist, and for the aestheticality of the
clinical moment, where deep meaning and significance is alive.
Applications
In my own work as a music therapist with depth psychol-
ogy training, I find that I do not “use” phenomena like trans-
ference, countertransference, or projective identification as
tools. These phenomena, and my attention to them, do not
come and go. Rather, my awareness of the intersubjective
field is constant. When I  sit with each patient, I  enter a dif-
ferent state of mind, trying to nurture what Bion called nega-
tive capability: an openness and comfort with not-knowing
that allows me to tune in to the ways that the psychological
165
material of each patient, as well as the music that we create
together, resonates or confuses or otherwise arises in my mind
and body (Casement, 1991).
Assessment
Throughout the course of music psychotherapy treatment, this
same stance serves my work with each patient. Although there
may be specific questions that I will ask during a first session, or
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nonverbal/musical information that I will be watching for as part
of assessment, the process of gathering that information takes a
backseat to the process of connecting with the patient and with
my own experience of what it means to sit with that person.
Additionally, my feelings, thoughts, and fantasies in an initial ses-
sion are just as important as any information that the patient pro-
vides verbally or nonverbally. For instance, if the patient speaks
during the session about feeling peaceful, and even appears to
be peaceful observationally, but I feel a subjective sense of dread,
my subjective experience is never dismissed as irrelevant. The
contrast between the peacefulness that the patient articulates and
the dread that comes to me in their presence is very important
information about the patient and the work ahead.
Therapy Goals and Process
An important part of ongoing treatment from a psychody-
namic orientation, in my experience, is that it is the patient,
not the therapist, who does the work of therapy. Goals may
exist—for instance, the patient may have stated a goal to feel
relief from their anxiety, or the medical treatment team may
have an established goal to help the patient move toward
acceptance about a new diagnosis—but my work, as the
music therapist, is not to choose music, conversation, or other
interventions that will decrease anxiety or increase accept-
ance. My job is not to “get” the patient to do anything. My
work is to sit with the patient and be present to what happens
in the interpersonal, clinical space. I may notice a variety of
feelings in myself. Sometimes, these feelings will lead me to
specific choices in music interventions, comments, or ques-
tions, as I  follow the patient and the wandering of my own
mind through the clinical space that we co-create.
It is very important that I allow myself to have a full range
of feelings about the patient, and that the patient be allowed
and encouraged to have, and express, a full range of feelings
about me. I  may find myself feeling immense love, rage, dis-
gust, sexual attraction, pity, admiration, jealousy, revulsion,
fear, or something else, and my job is to notice those feelings
and consider what their implications might be for my work with
the patient. The answer to this question is not necessarily clear
and concrete, and it rarely calls upon me to act in some way.
Meanwhile, I help the patient feel safe enough to identify and
articulate their feelings about me (the transference), with open-
ness to the same full range of emotional reactions. When these
feelings can be identified and claimed, we consider what it’s
like to feel them, express them, and acknowledge them together.
Role of Music
In approaching music psychotherapy from a psychodynamic
perspective that accounts for intersubjectivity, therapists must
be attuned to the ways that music stimulates primitive parts
of the unconscious mind. The idea of music as a window to
unconscious, primitive, and irrational impulses was proposed
166
by Schopenhauer (as cited in Kivy, 2001) in the early nine-
teenth century. Schopenhauer suggested that music taps into the
essence of human experience, which also gives it the capacity
to liberate us from reason. As music psychotherapists, we seek to
engage with those powers of music and use them to connect to
our patients. But this task is not without psychological dangers.
Music provides an exciting, but frighteningly deep and power-
ful, connection to primitive parts of the mind. Psychoanalyst
Michael Eigen expressed it this way: “Music can show, music
can hide. One can go further. Music can foster music or kill
music. By that I  mean, too, music can mediate psyche or kill
psyche” (in Bloch, 2010, p.  163). The potentially devastating
impact of music, when really acknowledged, can be chilling.
It thus seems important to acknowledge that music thera-
pists and music therapy patients may face an emotional land-
scape that is more treacherous than one that would necessarily
be traversed without the presence of music. In my research
(Hinman Arthur, 2016), I  found that the participating music
therapists (all of them caring and conscientious clinicians,
and many of them quite experienced) each told multiple sto-
ries of clinical situations in which they were not sure, or did
not know how to articulate, what they felt. A  therapist can-
not work intersubjectively when she is not able to identify her
own emotional state. It is possible that the music stimulates
affects that can be overwhelming, and that this has an impact
on how music therapist and patient experience their work.
The power of music may also impact the ways that music ther-
apists see and understand boundaries, which were an important
concern, and often an anxiety-provoking one, for participants
in my study (Hinman Arthur, 2016). Music intensifies emotion-
ality and also makes boundaries more porous. With music, the
inner and the outer blur. As Nass (1971) states, “The holding
and immersing power of music often results in an ambiguous
state of cognition in which the discrimination between inside
and outside becomes less precise” (p.  303). Music stimulates
these primitive parts of the mind not only in the client, but in
the therapist as well. The task of managing both at once is great.
Another important consideration of music from a psychody-
namic perspective is how the music therapist’s history or identity
as a music performer may impact the therapeutic relationship. In
my research (Hinman Arthur, 2016), an important theme among
the music therapy participants who spoke about their experi-
ences providing clinical services was a need for validation, often
from their patients. Sometimes this concern about validation was
connected to a confusion between music therapist and music
performer identities; for instance, in a wish for the patient to
admire the therapist’s musical skills. This important study theme
has already been documented in the literature. Austin (2008)
suggested that “therapists sometimes use musical communica-
tion to serve their own needs. This can be because the therapists
have a narcissistic need for recognition and validation that has
not been worked through” (p. 129). Turry (1998) states:
There is a part of the improvising therapist similar to that
of a performer that wants to be heard and acknowledged.
These needs are natural but must be brought to awareness
in order for the therapist not to be unconsciously influ-
enced by them, as they can detract from one’s focus on
the client. (p. 181)
My study suggests that even a conscious awareness of music
therapists’ personal needs does not change the struggle with
Music Therapy Perspectives (2018), Vol. 36
that need for validation, and the potential for acting in service
of that need rather than the client’s need.
The desire for admiration might be considered a natural
and even important motivating factor for a music performer.
The question of whether it’s possible to completely remove
one’s performer identity when making music in a clinical situ-
ation is an interesting one. But carrying the need or desire for
admiration into a clinical situation puts the therapist squarely
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in her own mind rather than allowing her to experience the
interpersonal space and/or the patient’s mind. This may be a
barrier that can stop music therapists from engaging deeply
with psychodynamic and intersubjective phenomena.
Conclusion
A music therapist who wants to practice with a psychody-
namic orientation that attends to the intersubjective field has
many complex dynamics to learn about, become aware of,
and attend to. These skills cannot be learned exclusively in
the classroom, however. Clinical supervision with an appro-
priately trained supervisor is essential for learning how psy-
chodynamic phenomena manifest, what a music therapist can
do in each moment to recognize what’s happening, and how
to be with the patient in the most helpful and authentic way.
An additional, necessary component of training to work with
transferential phenomena is the experiencing of those phe-
nomena as a patient. Although some music therapy authors
encourage personal work as part of professional development,
I have not seen it presented as a requirement for working psy-
chodynamically in music therapy. While AMT and GIM train-
ings may require or encourage personal work, the degree to
which individual clinicians’ practice is depthful or psycho-
dynamically oriented can vary. When recommendations for
personal therapy do exist, in literature or elsewhere, they do
not typically specify that therapists in training must pursue
long-term psychodynamically oriented therapy over other
types of personal work that might be available. This is trou-
bling, since experience as a patient in cognitive-behavioral
therapy, or any other therapy where transferential phenomena
are not addressed, provides the therapist-in-training with no
orientation as to how the psyche expresses itself through these
aspects of the intersubjective field. How could such a therapist
ever be expected to work effectively with transference, coun-
tertransference, or projective identification?
In highlighting and making explicit the humanistic princi-
ples that are already alive in contemporary psychoanalytic
thought, I  hope to provide a draw for music therapists who
have otherwise been underexposed to or turned off by psy-
chodynamic approaches as they are sometimes represented
in the music therapy literature. The demands on a music ther-
apist who wishes to explore intersubjectivity in her clinical
work are indeed great, but the rewards of deep connection,
found within respect for the humanistic principles of self-
hood, agency, relationality, and aestheticality, are impossible
to quantify.
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