MUSIC-THERAPY IN DYNAMIC PSYCHIATRY

The author names three different ways of music therapy: a) music pedag ogics for medical, psychosomatic, psychiatric indications (Gertrud Orf f school of music therapy, anthroposophes), b) social psychiatric and depth psychological schools (American schools of music therapy), c) de pth psychologically oriented schools (Pontvik) and analytical music th erapy (Mary Priestly). Most music therapists define their work only on a functional base, e.g. music therapy is >>the controlled application of music in therapy and rehabilitation of persons with mental, physic al or emotional diseases<< (Juliette Alvin 1971). Music is used as an accompanying therapy, sometimes even as makeshift solution and not as an original and psychotherapeutic method. With Verena Kellner (1979) t he author understands music therapy as a holistic therapy, which promo tes a patient's self-esteem and enables him to experience his creativi ty, body, breath, voice, detension, activity, sensibility, to discover and accept himself, to train concentration and perseverance. Moreover , Schmidts emphasizes the groupdynamic and unconscious aspects of musi c therapy. He refers to Ammon (1976) who writes that >>a group is the primary and fundamental entity of all human life processes and that th e individual identity of a single person is the result of a process, a t which the whole group takes part<< in different functions. A group b ecomes a group when it can experience, discover and accept itself, whe n there are boundaries of the group which create the >>interpersonal r oom inside<<. For creating a group identity, a central person, a leade r, is indispensable; he has to concentrate the destructive potential o f blocking conflicts onto himself, thus setting free the creative and constructive aggression as the basic energy for building groups that a re conscious of their own identity. Here lies a singular instrument fo r analyzing the dynamics of transference and countertransference in re lation to the leader, the group members and the group as a whole and t o integrate it conceptually to differentiated models of psychoanalytic treatment techniques (Ammon 1979). Appropriately music in general and music therapy in particular is >>sounding group dynamics<<, as it obl iges to communicate by music as a >>third object<< (Winnicott). In his music a patient will bring to hear his life history and concept, for all groupdynamic experiences in existential relations find their expre ssion in his living and development of identity (Ammon 1979). Necessar ily, identity is connected with judgements and values, because they de fine the relations between persons that are defined by closeness and d istance and by harmony and disharmony in the actual here and now of th e group. In European music history different ethnic music such as afri can and oriental traditions have been adapted and integrated (e.g. by Debussy, Bartok, Rachmaninov, Mussorgski). Free improvisation as it is used in the music therapy also includes and reflects the different el ements of music such as atonality, polyrhythm, melismatic improvisatio n, gregorian scales, asiatic tonalities besides the well-known major a nd minor scales. Instinctively, the patients avoid the popular exploit ed music. Also therapeutic music playing needs an objective validity, a musical evidence or resonance in the group. Only by this evaluation a subjective improvisation is confirmed in its cultural significance. A verbal interpretation therefore is therapeutically necessary and hol ds on to what was understood in the groupdynamic process and thus coun teracts the massive tendency of the mentally ill to deny and to undo ( see also Anna Freud 1936). The author mentions that music therapy help s to differentiate and to individualize the single patient within a gr oup and thereby enhances his self-esteem and autonomy. In this sense h e conceptualizes music therapy as a humanstructural identity therapy i n the sense of Ammon (1979). Usually 20 to 26 patients take part in th e in-patient music therapy, sitting like an antique chorus in a big se micircle, therapist and his co-therapists included. Most of the instru ments in the middle have an archaic character, e.g. african djembas, l atin congas, indian tablas, a symphonic gong, a steel drum, burmesian gongs and Orff's xylophones. There is also a piano and some patients b ring their own instruments. The most important one, however, is the hu man voice. Single or in little subgroups the patients go into the cent re and improvise, while the chorus listens attentively. They give an e motional resonance, reduce anxiety, inspirate and appreciate by applau ding the creative psychic and/or musical performance. Sometimes they e ven intervene, for example when a patient gets lost in his fear and so litude or when the music is rousing. Schmidts describes a session of m usic therapy: In the beginning there is often a solistic improvisation which mostly takes as a theme the actual unconscious problem of the w hole group or anxieties of the beginning situation itself. He describe s a young woman,who sings towards another female patient, climbing a m ajor scale and moving rhythmically towards her. The latter one refuses with shame, the young woman walks backwards, singing the scale downwa rds. Once more and again once more she tries, each time higher and mor e impressive. Finally she resigns, her singing changes into a shrill y elling, she turns around herself. The therapist intervenes; somebody e lse cries. This person afterwards sings a minor-scale improvisation, s ort of a song of pain, finally turning into a lullaby. The first prota gonist quietens, her desire and need for security, her tendency to qui ck disappointment and shutting herself off, being understood and answe red by the second patient. Needs for love and attention, as well as ri valristic duels are expressed in duets. The author describes the aggre ssive argument on drums of two male, latently homoerotic patients, whi ch changed while playing and ended in a open and friendly approach sho uting >>Hey, Hey, Ho, Ho.<< The trio is expected to be the platform of feelings of jealousy, fear of it and desolation. A female patient sta rted playing xylophone in recurring phrases up and down the scale. Ano ther patient went in and drummed a march rhythm, a third one joined hi m. The first patient's folk song was drowned out by the rivalristic dr ums of the men, so she left the centre. This portrayed the group dynam ics in her family, her parents having no contact with her. Q