CASE SlXTBBN

( Creative Music Therapy

In Bringing Order, Ch:mge and Communicativeness

To the Life of A Brain-Injured Adolescent

a.IVE E. ROBBINS, D.M.M., CMI'IRMT-BC

CABOL M. ROBBINS, M.S., CMI'IRMT-BC

Professors and Co-Directors

Nordoif-Robbiru Musle 71u!rapy CIinic

New York University

New York. New York

Abstract. 1Wo therapisls work as a teom, using improvised music 10 engage Hilary, an acring-oUl adolescenl girI with brain ínjury. Through 1M crearive process, Hilary learns 10 channel heT na/ural impulses in/o musical expression and interaction. As this occurs, she is ab/e 10 bring order, change, and communicativeness ;1110 O/heT aspeCIS o/her lije.

Robbins &: Robbins 233

INTRODUCTION

Music is aboye all a means Cor bringing about changes: changes oC mood, changes in relationship, changes oC atti tude, ~ges in attentiveness. One hasonly to consider how, in a lively, entbusi~tic group sing-along, songs in vanous moods directly influence tbe participation oC tbe singers. As an agent for!he transmission oC energy, stimulation, joy, wanntb--and order--music is unique. In contrast to tbe melodic-conceptual experience oC singing, consider moving te music, as, Cor example, responding to tbe compelling impact oC tribal African drumming. How physica1ly animating tbe beat and polyrhytbmns are! How tbe timbres of lhe drums speak lhe rhylhms directly into our bodies! And yet how directional such drumming is, what purpose it has! How il communicates lhe power oC lhe body 's need te move rhylhmica11y!

In considering the kinds oC changes that we work to bring about in a client in Iherapy, it is important te reaBze that sometimes our wish to bring about a particular change can be misplaced. We can only change what is inherent in lhe functional possibilities of the organism--te the extent that !bese make changes possible. Should lhe damage or the disturbance be extensive, such changes as may be achievable must lie within these p.mibilities. However, we must not underestirnate what changes could become }Xlssible through a creative approach, especially when tbe explorative nature oí music therapy based on improvisation disc10ses areas of ability and tensitivity which would olherwise remain undiscovered.

The aH-important area in which we can bring about change, is petSOnality development. Here we can, tbrough music, ofien bypass sorne oC lile organica11y-based dysfunctions that hinder competent functioning in life. This is where improvised music can play such a vital role in treatment. In working interactively with a c1ient, a therapist can improvise ways around Ihe lrmiers, around tbe difficulties, to reach Ihe living sensitivities, lhen work mIO !he problem areas, where creative work has the possibility of releasing p¡tentials Cor resolution and development.

l.et us consider tbe act of creation or creativity, which is so intrinsic to die leve! oC clinical musicianship we are considering. Those who consume IIIlsic passive!y tend to Ihink of creativity as something ephemeraJ, arbitrary, perhaps haphazard and undependable, and lacking in substantial reaIity. But a ¡lance at the world of music will quickIy demonstrate that Ihe products of cra.tivity are anything but insubstantial . Every piece oC music lhat is imp:lrtant 10 US, that we are swept aJong by, enjoy in a particular personal 111, has been created. Before it existed it was inconceivable. But sorne IUsician, or group of musicians, has a musical idea, and Ihen begins Ihe ¡rocess oC creation. It might last three minutes, it might last Ihree years, bit through Ihis process an experience is reaJized that becomes part of lhe 'ICIy fabric of life. Recognize Ihat once all the music we respond to did not aist, and then through countless acts of musical creation, carne into

234 Case Studies in Music Therapy

existence. And from being nathíng befare, now it exisu. Realize how firmly it stands in OUT consciousness: how we carry it around with us, what a vehicle it i5 for us to share in, what strength it has in oue emotional lives, our mental lives, oue spiritual lives. It i5 extraordinary! The rich musical fumiture of oue lives, everything from folk music to film musíe, Scott Joplin to Bartok, all has come into being through this process of creatioR.

The potential ¡mpact of musical creativity transfers directIy ioto the processes of musie therapy. When a lherapist works individually with a client through improvisation, he or she will be called UpoR 10 create, oc adapt, in response 10 c1inica! situations, themes wilh which lhat individual comes 10 identify positively . These themes theo become sources of nourishment for individuation, express much of lhe content of the client-therapist relationshjp, and provide significant opportunities for interaction and intercommunication. Such music, generated spontaneously in response to c1inica! events and needs, becomes uniquely substantial to the person in therapy.

MlITHOD

This clinical narrative provides an illustration oE "Creative Music Therapy," an approach originally developed for handicapped children in 1959 by Paul Nordoff and Clive Robbins (1971) . In its individual application, the approach involves two therapists working as a team with a single child, with improvisation as the focus of the creative therapy process. One therapist improvises at the piano, creating music to engage the child in a therapeutic experience, while the other works directIy with the child, helping him or her to respond , either instrumentally or vocally, to the improvised music and to the clinicaI intentions of the therapist at the piano. The therapists work as partners with clearly defined and equal roles and responsibilities.

Each session involves creating an individualized musical repertoire for the child·-one that capitalizes on the child's innate musicality and reflects the child's unique personality. This musical repertoire is created by the therapist cumulatively, session by session, motif by motif, Jine by lineo Severa! basic concepts are involved.

First and foremost, the therapist improvises music which accepts and meets the child's emotional state, while also matching, accompanying, and enhancing how the child is expressing it. It is important for the therapist to respond to the child from moment to moment, often supporting every musical response the chitd makes, no matter how fleeting or incipient, and musically seizing upon every opportunity to explore its expressive possibilities. The therapist works to evoke either a vocal or instrumental response, depending on the natural propensities of the child. As the child formulates each response, the therapist creates musical situations and activities that encourage the child to further develop the response··to gain some measure of mastery over the music. In doing so, the therapist motivates the child to acquire

& Robbins 235

skills needed to participate more fully. improvisation the therapist is constantIy "sounding out" the

.. ,,"" añdexI'nll 01 the child' s responsiveness, and stimulating, answering stabilizing the child's activities as clinica1ly appropriate. With the ~:~~~; of each skill, the child is musically guided to discover new ir,¡ options and choices that the skill has made possible. In the

oC discovering musical possibilities and gaining musical skills, the also engages the child in communicative dialogues, thereby showing ways that the child can relate his/her musical expression to that of

persono The child, increasingly confident in personal musical icxpression" learns how to be inter-responsive.

JI is essential to the practice of this approach that each session be ful1y documenled with the aid of an audio or video recording, thus ensuring

~~;~'r of clinica! technique and a c1ear perception of aH phenomena

lo the child' s response process. This gives essential clínica1 for subsequent sessions. Any improvised music that has been is transcribed so that it can retum as an ongoing theme in therapy.

We would like te illustrate creative music therapy by describing our work with a sixteen-year-old girl at "Tnala", a Rudolf Steiner special school in Sydney, Australia. ("Inala" is an Aboriginal word for "peace"). To know this young lady, and the severity of her disabilities, is to rea1ize that the only way you can do anything for her--apart from entertain her and perhaps lighten her mood--the only way you might bring aboul a significant change is tbrough improvisation. This means a leap into the unlcnown from the first moment of the first session, to find out what responses music can stimulate-­and tben support to foster and advance communication. How will a therapist achieve musical interaction with her7 She is a multihandicapped person--¡t quickly became evident that how she manifested in music was symptomatic of lIer condition.

BACKGROUND INFORMATION

We want to introduce Hilary nol as a "case study" but as a human being who is following a path. And we, as her therapists, are about te find and take a new path with her. We cannot lcnow where the bends will be, where IIlaI palh willlead us. When working with improvisation, working creatively, there is no recipe--as tha! would remove the spontaneity, the livingness, the creativity, and the wonderful unexpected moments of unfolding and discovery.

When we first began working with her, we did ask for case material, but inquired only about relevant medica! problems, such as severe epilepsy . We wanted te meet her as she would be in music with us--to form and work freely from our own uninfluenced perceptions. Once our independent clinica1 assessment was made, then would be the time to study her case material.

Hilary was bom in 1966. She was very much a wanted child as a long

236 Case Studits in Musit Therapl

series of miscarriages and misfortunes preceded her birth. Pregnancy was difficult, birtb was induced, and delivery was instrumental. Though difficult to diagnose with any certainty in ¡nfaney. it was Jater to be evident that Hilary had sustained brain damage. There were early breathing problems. Abnormality was noted al fifteen months, and a11 the developmental milestones were late. She did nol develop speech. There were sorne physical disabilities: she had poor balance and was unsteady on her feet, walking in Hule shuffling steps a good deal of the time. She was frightened of heights and stairs. Generally, she was placid bul overreacted to loud noises. When she was three, she began to Teact adversely toward other children and became withdrawn roe long perlods. She firsl attended InaIa School as a day student. As she gOl older, her behavior problems worsened with tantrums and the pulling of other children's hair. Al six her parents requested that she become resident at the school. Her behavior problems continued.

When Hilary was sixteen, her future became uncertain. She was uncooperative, stubborn and disruptive in the classroom. Her behavior was threatening to prevent her admittance to the Activity Therapy Centre (a sheltered workshop for moderately to profoundly disabled adolescents and adults) and she faced the real possibility of institutionalization. At this time we were asked to take her in the hope that music therapy could effect a positive change. Once weeldy sessions were scheduled. We will describe the first four sessions in sorne detail, because this is where the major changes began to take place.

TREATMENT PROCESS

First Session

Hilary comes willingly to her first session, but is very tense; Carol repeats a -Good Moming Hilary" phrase to her, trying to put her more at ease. 1 notice her fingers trembling , and when 1 give her drumsticks, there are short bursts of fast, tense beating, most of it around 260 beats per minute (bpm). On the cymbal she beats forcefully at 190-220 bpm, drowning out the music that Carol is improvising to meet her.

As part of the exploration, 1 sit Hilary on the piano bench. She touches the piano keys twice then attacks Carol, grabbing her hair, pulling her head down. Carol goes with the pull, singing gently while undoing Hilary's grip. Hilary then grabs at Carol's skirt and knees. She is strong.

She yells once as we try to calm her. 1 retum her to her chair, near the piano but not c10se te it. She listens quietly as music is played and sung to her. Her agitation diminishes over the next several minutes and she is calm when taken back to her classroom.

We noted in detail all aspects of Hilary's reaction and response. Most of the music had been improvised to meet her disturbed state, but because

237

did not recur (she never attacked Carol again) and the music was not lIJPI<'priate to the coactivity that subsequently developed, it was not used

However, the melodic phrase with which Caral greeted her al the boginni"g oC the session did become part of her repertoire, becoming extended

It was in a Mixolydian mode:

Musical Excetpt 1

mor"IrI<), HIl - t -rv_

HU -1- r~ elc.

Hilary is noticeably happy to come lo the session with me. She still much tension, but 1 also see a spark of anticipation. 1 bring her to

as in the first session and again she beats in a fast, driven tempo, beats per minute (bpm). She is aware of Carol 's improvising, and her

becomes responsive lO the music at times, as when she stops beating • ~eends of phrases.

that Hilary gaios support from the music, she beats more .. fi.den,Uy when the music is stronger--and aften stops when the music is

obviously ¡otent 00 having Carol make music for and with her. a sound of pleasure when Carol begins to sing. We perceive her

Experimentally, 1 place a large timpani before her. At first, her listening, Carol plays gent1y using arpeggiated chords.

impresses us with her self-restraint as she holds back her beating to

238 Case Studies in Munc 1heropJ

this soft music. After a minute or so Carol introduces vigorous, forceful music to release Hilary into free strong beating. She needs to do this and

Musical Excerpt 2

J ~ 200

(Fermata 2nd tim~)

",

239

the opportunity immediately, beating the timpani energetically in the or Carol's bass octaves al 200 bpm. (See middle of Excerpt 2).

As Carol brings tbe vigorous music 10 a close and retums to softer · , Hilary finishes her beating with a flourish which contains a clear.

. It seems 10 originate unconsciously, but it tells us that ,,~mic ability is latent within her. She is keen to continue and chuckIes

lile beau. Late in the session she spontaneously beats to 50ft music at 200 bpm

p .IOIIOWS a ritardando to 170 bpm. In an improvised MGoodbye song- her · shows her sensitivity to dynamics. She smiles a number oí times.

the session ends, 1 escort her to the girl's toilet and, while outside, 1 hear her screaming. Questions leap into my mind : Why,

such a promising session? Was she angry that she had to leave the "'croon,? Could it be that in the improvised music and in beating with it,

had experienced a special kind oí release and freedom that carried this letting go of sorne of her feelings? The kind of Iiveliness of

that she felt in the music was definitely unattainable in her daily Io-.here else in the normal circte of her tife could she be this activated-

though she was in a fine school? She must have found the session and satisfying; perhaps then, the screaming arose as a way of lO the norm. It occurred to me that there was something quite

· . aoout Hilary finding a private place to scream! In a IitUe while she quieUy to the classroom.

Further in5ight can be gained from studying Hilary's way of malóng against the background of a comprehensive examination of the clinica1

. significance of tempo and dynamics. Figure 1 (See page 241) a "Tempo-Dynamics Schema" derived from studying the responses of

2001 V¡~~~~:::Y handicapped children in improvisational individual music (l' & Robbins, 1977, p. 158-159). When a fast tempo is

pathologica11y by the present condition of the child, one finds that M~:::.::, in nervousness, tenseness, hyperaetivity, overexcitation, ~ , or in resistiveness, in whieh the ehild is "running away" to

contaet through the musie with the therapist. For the improvisational these reactions are mueh more vividly real than the words can

is a directness and c1arity of emotional communication when the is ereating musie with the ehild. There is an immediacy of

!Ier" .. ding if one follows and Uves in the ehild's sounds moment lO

In contrast to the pathology driven fastness is a fast tempo whieh normal musical experience. TIte normal range of fast tempos can

activation and alertness, buoyancy--and a host of qualities that can up musical enjoyments such as joyfulness, gaiety, playfulness, happy

and fervor . It is interesting to note how all of the palhologica1 assoc:iated with fast tempos are self-isolating, whereas the normal

240 Case Studies in Music Therapy

musical experiences of fast tempos bring sharing and uniting with athers. When seen in this way, the schema provides a map oí musical terrains

that can guide the therapist in bringing about change. Through the give~and· take of improvisation, changes in tempo can bring the condition that is en the pathologica1 side over, as this is possible, into the area oí normal musical experience: to take what the child is driven to do, and through putting music to it, make it a shared experience in which new, more satisfying emotional experiences can be generated.

The dynamics of music can be used in the same way. When a drum or any instrument is beaten loudly. and when this originates in a pathologica1 state 0[.. being, ene hears aggression, frustration or anger; or as so afien observed in emotionally disturbed children, adolescents, and adults, the sounds reflect a lack of impulse control, emotional-motor discharge, nonresponsive assertiveness, and the resistiveness of "shutting the other person out." In contrast, the loud dynamic in normal musical experience conveys animation and eagerness, exuberance, assertive freedom--all very positive qualities-­confidence, and climactic fulfillment.

The universal significance of musical tempo and dynamic is nicely illustrated by the true story of an African drummer from Zambia. Whenever he became burdened with a certain emotional disturbance, he would get up in the night, awaken his two wives (both of whom were competent drummers), and then work through his disturbance rhythmically. The drumming allowed him to discharge his emotional tensions with the empathic support of his musicianly wives, who altemately followed and led him through various modes of rhythmic experience: from fast to slow and back, and from loud to 50ft and back. In terms of the schema, the man needed an emotional-motor discharge, in which he could assert himself and determine his own course of action, while still being supported by others beating with him. This shared release helped his drumming to become expressive and communicative. He could somehow "objectify" his feelings and their transformations--and therein be hea1ed.

In Hilary's first session, her loud cymbal beating had the character of aggression, even anger. In the second session, she moved into loud drum beating, which seemed to come more from frustration. But as Carol took it up with minor, purposeful music , you could hear animation and eagemess coming to expression in her beating. Already a change was beginning.

Third Session

Hilary is eager and excited as she enters, but inhibited at fírst, unable to respond freely. When 1 give her the drumsticks, they tremble rapidly in the airo Her initial beating comes about as she tentatively brings the trembling drumsticks into contact with the drum--it is soft and fast, 360 bpm. It suggests tenseness possibly compounded with fear. Carol plays to match

241

Frgunl

TFMPO AND.DYNAMIC SCHEMA IN CREA.71VE MUS1C TllERAPY

Nomud Musigd &perú""

FAST TEM POS

Unreslrained drive Illnning away

Activation Alet1ness

Joyfulness Gaiety, Playfulness

Happy excitement Fervor

SLOW TEM POS

,""%rvi •. or. weak drive ~sti"m",,: avoiding "activily~contactH

Attentiveness Calmness, ease

Seriousness Thoughtfulness, earnestness

Deliberoteness, certainty A/finnation, wannth

LOUD DYNA MIC

anger control

assertiveness shutting out theropist, music

SOFT DYNA MIC

~::::::~;unawareness ¡ avoiding self-declaraJion

Animation Eagerness

Exuberance Assertive jreedom

Confidente Climactic fulfillment

Ughtness Delicacy

Gentleness Carefulness

Suspense lntenlness

242 Case Studies in Musie Therapy

and meet her mood, and when she begins to sing, Hilary makes a sound oí pleasure~·in the same key. After much encouragement, Hilary begins to beat with a liule more ¡ntention at 285 bpm. Carol carefully improvises 10 support her, and Hilary's beating becomes sustained. Her face relaxes.

A lightness and delicacy emerge in the shared musie. Hilary's tempo comes down to 250 bpm. When Hilary has faund her confidence and Carol feels she i5 in secure contaet with her, she improvises a song to bring in the experience of a slower beat (See Musical Excerpt 3). The song is in waltz time and begins at 90 bpm: ~Let's playa song, Hilary's song, Let's playa song, together. Hilary can playa slow song, together, together, together. K

Musical Excerpt 3

Let's plcy ti s~ng w1th Cl!\'e. len plcy ti $009 wHh Cl1ve, HlI-c-ry's

50n9 te - ge - ther •

Hil - ~ ry's song, •

etc.

I "'¡¡ins '" Robbins 243

the song is repeated Hilary beats the cymbal rapidly several times. Her impulses seem to begin in double tempo , two beats to Carol's ane, but

I~,!~:~~'~ into cymbal tremolos. Te give her an experience of beating in tempo, Carol asks me to guide her, and adapts the song to ¡nelude

name. 1 take Hilary's left hand and beat with it to the song, now at 75 bpm; makes an exclamation of pleasure. When 1 release her hand she

1.,.1""., until she is beating at 300 bpm--subdividing the beat exactly by

Hilary feels the pulse of the music, and is drawn to unite with it. Yet her is tenseness thal she can only discharge in fast tempi. Bul also her is musical' sensitivity and a sense of rhythm which, in a way we

not yet fully understand, somehow take over and arder her ~discharge· I"',w' "by bringing it into a 4: 1 relationship with the slow tempo. She does

this consciously by deciding: "Now 1 will beat four beats to one. M Iom,,'thio' 19 much more primal takes place: as the internal pressure accelerates

toward the rapidily il needs for discharge, her hearing, musical sense of rhythm bring about this concurrence, in this example

..... 'ghbeatin¡1 ,sixteenth notes. This orderlng must happen al a subconscious once has happened she is able to hear and feel the concurrence,

feel the release of the discharge within the secure pulse of the music. , earlier improvising in the tempo of her fast beating must have given personal feeling of being accepted--while, at the same time, Mmaking

sense- of her need 10 beat fasto This imparting of musical meaning !he fast beating would have already contributed to the awakening of her . i and so, 10 sorne extent, have prepared the ground for lhe beating

. of the basic beato This now becomes part of her way of it is just beginning; she will go on 10 do more of it.

As the session continues, 1 take her len arm again and beat 10 the song pt) bpm; Hilary joins in with her right arm , beating in the same tempo.

this is her beating impulse-I am only guiding. Again she enjoys the "';~~: tegether and laughs. 1 let her arm go free and very steadily she ~ te exactly two 10 the beat, stays with this for sorne moments, and

accelerates further. At the piano, Carol goes with the accelerated until a ritardando seems musicaJly inevitable: as if it is the right

a repeat of the songo Hilary stops immediately--the ritardando her awareness of the music. She waits as Carol's momentum

lo a natural conclusion, then recommences Ma tempo,· beating with al 85 bpm. She stays in the tempo lO the end .

.. ~:::;~::control in the accelerando was remarkable! She was nol letting

-ron away.· When the music paused she stopped and waited con'tinu,ed. An inner control is beginning to show.

The session draws 10 a close with lhe MGoodbye Song, - after which 1 . invite Hilary to sing--something we have never heard her do.

244 Case Sludies in Music Therapy

As 1 sing freeIy, Hilary laughs in a musical voice.

Fourth Sess:ioo

Hilary is very keen to come to music, and enters the room stamping her feet in excitement and humming with pleasure. Carol sings -Good morning- to her--this time introducing considerable rubato--Hilary watches and listens with total attention; the rubato brings the element of suspense into the song and she smiles as she receives the greeting.

It is so important in therapy to get out of a metronomic beat whenever it no ¡ooger serves its purpose--that of keeping the music or the music­makefs together. Certainly a metronomic ar fixed beat is absolutely necessary whenever rhythmic regularity is required or, for example, in group singing, when everyone has 10 know where they are in the music in arder to stay together, similarly in movement to music. But the momeot an improviser or perfonner brings in a pause, a fermata, or a ritardando, an expressive element is introduced. This arouses keener listening--one listens not because the music takes place on a predictable beat, but because a melodic statement is being made in its own time. The melody or musical statement does not have to move for any other reason than that the musician wants it that way. It is not driven by a beat, and this makes one much more attentive to it. This can add a living sense of immediacy to a song, especially when you are singing 1Q a child. Thus, there are times in therapy when you need the predictability of the beat, and times when it is important to get away from it.

As the session continues, Hilary starts to beat confidently in tempo with the song, 120 bpm, then accelerates with impressive and steady control to 265 bpm. Carol accelerates all the way with her.

Hilary seems to be bridging something in herself. She made this measured accelerando from the tempo of Carol' s music--in which she began because she is musically sensitive--to the fast beating which she still needs to do. What inner process is involved in this? This is the second time Hilary has presented this kind of response: she did not jump from one tempo to the other, but accelerated gradually across a range of tempos. She was linking her response to the music we were presenting with what she needed to do out of her state of self. She was connecting and integrating. There was something moderating at work--she was filling in a gap between sense impression and the tenseness and energy that comes to expression in fast beating.

Often, in this kind of work, it happens that a therapist has an intuition. At this moment, Carol decided not to go with Hilary's fast beating, but to hold a constant tempo and see what would happen. As Carol sets a tempo of 75 bpm, Hilary immediately beats multiples of the beat: 3: 1 (225 bpm); a sequence follows in which she changes quick1y from 3: 1 to 2: 1 and back to

245

When Carol sin gs and the tensian of the music ¡ncreases, Hilary's goes up to 4: 1 (300 bpm):

Musical Excerpt 4

o mi ,lID cm I ,lID ,cm I ,cm ,m I

She stops, waits, recommences al 4:1 , Ihen drops to 3:1. She pauses Caro! makes a diminuendo; as the dynamic 1S increased she beats

a13:1. Carol now plays with her fasl beating. This happens ayer a ay·",:ond periodo

Carol decides to go further into structure by introducing an eight phrase in 3/4, in G minar, ending with a clear cadence. (See

Excerpt 5). We had heard Hilary stop beating many times al the ends we now use Ihis perception deliberately in a short piece of

i structure as a basis for work together? Carol this phrase, stopping on the lonie and raising her hands off

a clear visual signal lo stimulate Hilary's control; Hilary . the lempo, 165 bpm, and stops five beats after Carol. Te a repeat,

510ps three beats after Carol. The third time she beats faster than the and stops about two beats early··she looks cheekily at Carol as if to made you stop this time! " We all laugh. The fourth time she again

fast and deliberately continues long after the therapist has stopped, in a spirit of devilment. The fifth time she ·overbeats" by about six

Later in the session when we come back to this activity, Hilary pieles up more sureIy and responds attentively. This time Carol plays the

and Hilary beats in tempo, 160 bpm, adding only two beats beyond the To a repetition, she beats three beats beyond the stop. The

takes this principie of coactivity into "Hilary 's Song." beats at 3: 1 to the slow tempo. She stops one beat after the end the first two phrases. She stops before the end of the nex! of her keenness to participate, for she is watching Carol closely.

246 Case Studies in Mune Theropy

Musical Excerpt S

J = 150 Detsched

As the song leads ioto a climax Hilary beats vigorously; Carol accompanies her fast beating with the accompaniment while singing the songo Although she is animated, Hilary stops precisely at the end of the next phrase. Carol then begins the next phrase in a soft dynamic, Hilary beats quietIy. The phrase is short hut she is concentrating and stops exactly again. She laughs with recognition at the musical humor in what they are doing. She sustains her aUentiveness.

1 theo stand behind Hilary and, holding her arros, guide her in beating al 55 bpm. She enjoys the assertiveness of the slow tempo and the accompanying music. As she beats, 1 move my hands up her arm until she is beating aJone hut can feel the support of rny hands resting on her shoulders. She begins an extremely well controlled accelerando that reaches 125 bpm and holds it for eight measures. Her tempo then gradually rises to 210 bpm, where it stays for over 30 seconds. Throughout the accelerando she watches Caro! keenly , obviously aware that they are making this musical adventure together--and enjoying the freedom of being a co-creator. The accelerando is led to its climax at 300 bpm, then Carol and 1 take her back to sJow beating at 70 bpm.

RtJbbins & Robbins 247

As Carol begins the MGoodbye SongM Hilary joins in the singing. She does not have the language or the vocal control but the quality of her oommitment is unmistakable. She sings through the first two phrases; her voice is soft and breathy but she sustains her tones and sorne are on pitch.

Musical Excerpt 6

J ' 100 (wll rmly, with ru b ll to t hroughout)

Good -

r f

good - bye 1111 - ti - ry good - bye

good - bye, good - bye, good - bya, good by.

'" good

ale.

248 CAse Sludies in Music 17zeropy

It was in this session that Hilary began to consolidate her involvement and abilities in music: she brought more control to bear on her urge to accelerate into faster beating; the compulsion to beat fast was becoming increasingly ordered by the rhythmic responsiveness of her multiple beating; she was gaining lhe control required lO beat in a soft dynamic ; slow and moderate tempos were coming into her tempo range; and she could participate closely with the therapist in a recognized goal in rhythmic structure.

As musíc was now 5uch a uniquely important area of activity, experience and relationship for her, consolidation in musical participation would mean, in an intimately real sense, consolidation of self . It is no1 surprisiñg lhat with this positive feeling of her own seIf, and her living pleasure in the musíc, Hilary should spontaneously attempt to sing-·and sing a song lo which she feIt attached ,

Subscquent Sessions

This brief singing apparently brought Hilary to the limit of her abilities. She did not sing agaln in music therapy until her thirteenth session, and then not unlil two years later, although vocal expressions of pleasure were numerous. Her individual sessions, averaging abaut 17 minutes in length, continued on a weeldy basis.

On the afternoons of the days she had her individual sessions, she, together with several older girls, sat in on a group activity with a class of eighl 10 ten·year-olds. These sessions brought her much enjoyment. She was included in greeting songs, and sometimes taken round to greet the children. She was gentle with them, and they were unafraid of her. While watching and listening 10 the singing games she could be seen hugging herself with pleasure. She was an ebullient -dancer- but, being unsteady on her feet, needed support. Even so, she could overwhelm her partner with the vigor of her movements. Al this time, she also became an enthusiastic member of an adolescenl music group.

Mosl of the effects of music therapy became evident in her school and hostel Jife by the twelfth session. She was lighter in mood, happier , more amenable and receptive. She seemed fulfi lled, more complete as a persono It was noticed that she walked more purposefully. The aggressive behavior almost completely stopped, and only reappeared when she was unusually stressed or upset. Later it ceased entirely. Her teacher, an oIder woman with considerable experience with the handicapped, was outspoken about the positive changes in Hilary since beginning music therapy.

Her individual work continued 10 be essentiatly rhythmic. Her slowest tempo carne down 10 7S bpm, which madea wider rangeof musical experience possible. She spent abaut hatf her sessions al the piano, playing single tones in each hand with Carol's supportive, responsive improvisations. She reached

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stage of freedom in her playing which, to any one who knew her tine of ress in music, would be recognized as being creative. We continued

'ng her Qver the next two years as the staff of the school felt that her ividual sessions were especially important 10 her. Ayear later, when she

ed 10 the Activity Therapy Center. her sessions were reinstated foc sorne lbs to support her during the transition. Altogether she had fifty-five 'ons of individual therapy. She went on 10 join a music group of adul15

m the Activity Therapy Centre.

ACKNOWLEDGEMENT

The authors would Iike to thank the Australian Music Therapy iation for its permission to revise and reprint this case study. which was

'ginally published in its proceedings of Thirteenth Natianal Conference of AMTA (1988).

REFERENCE

ofr, P & Robbins, C. (1977). Cceatjye Musjc Thera~y. New York: John y.