The Arts in Psychotherapy, vol. 13 pp. 301-305, 0 Ankho International Inc., 1986. Printed in the U.S.A. 0197-4556186 $3.00 + .OO MUSIC THERAPY IN FRANCE* GAYLE OWENS, RMT-BCI HISTORY Arveiller’s (1980) excellent summary of the history of music therapy in France cites the use of receptive (passive) music therapy as an inter- disciplinary approach in treating melancholy as early as the 17th century (p. 45). In the 18th cen- tury a debate arose over the use of music as op- posed to the use of physical treatment in the care of psychologically disturbed persons. For example, the 18th century philosopher, Rous- seau, felt that music should have the same effect on the fibres of the human body as it had on an instrument placed next to the sound source. In- tertwined in the debate was discussion of the ef- fect of one’s physical state on the psyche and vice versa. This period experienced the birth of the theory in psychiatry of replacing a false idea with a correct idea and of sensation being the source of images which translate into ideas. The eliciting of sensations through music therefore played a role in this theory. The use of music with psychiatric patients in- creased in the 19th century and corresponded with generalized moral treatment in psychiatry. Philippe Pine], a philanthropist and psychiatrist of the time, employed passive music activity (musical instruments played by employees) in the psychiatric milieu. He believed that soft, har- monic music in the psychiatric hospital helped to create a calm, relaxing atmosphere that appealed to the healthy part of the patient as well as the premorbid personality. Leuret, a precursor of active music therapy, felt that it was more effective than passive music therapy. He formed choruses and orchestras with patients as the performers. In 1852 high- ranking administrators witnessed an orchestral performance by patients from an institution (Quatre-Mares) and were so impressed that they gave their approval for the use of music in in- stitutions. Almost all such establishments there- after organized choruses and orchestras, the be- ginning of a systematic use of music in group psychiatric settings. Between 1880 and 1914 interest centered on the psychophysiological effects of music, and re- search was based on the effects of music on pulse rate and respiration (Arveiller, 1980). The at- tempt was to render a scientific music therapy comparable to other therapies, susceptible of being described by its physical and chemical properties, its physiological, therapeutic. and toxic effects, its indications, its modes of appli- cation, its preparations, and its doses. Unfortu- nately, the experimental results were often con- tradictory, problematic, and not always based on scientific procedures. After 1911 many considered music an occupa- tional therapy, its goal no longer to heal, but to help patients resocialize, and to prevent regres- sion. There is still a place in France where this music therapy philosophy is practiced but, as will be described, it has taken on new qualities. Arveiller (1980) points out that when review- ing a history of the use of music in psychiatry it is *This article is the result of meeting with French music therapists J. Guiraud-Caladou, professor at the music therapy program in Montpellier; E. Lecourt, author of two books and many articles on music therapy. music therapy professor at Paris VII. and the Gaston of music therapy in France: D. Quintana. G. Silvestre, E. Vergnes; and J. Verdeau-Pailles. author of several books on music therapy. tGayle Owens was employed as music therapist at Community Mental Health Center and Psychiatric Institute in Norfolk, Virginia and did graduate study in psychology at I’Universite de Neuchatel in Switzerland. 301
Transcript
The Arts in Psychotherapy, vol. 13 pp. 301-305, 0 Ankho International Inc., 1986. Printed in the U.S.A. 0197-4556186 $3.00 + .OO
MUSIC THERAPY IN FRANCE*
GAYLE OWENS, RMT-BCI
HISTORY
Arveiller’s (1980) excellent summary of the history of music therapy in France cites the use of receptive (passive) music therapy as an inter- disciplinary approach in treating melancholy as early as the 17th century (p. 45). In the 18th cen- tury a debate arose over the use of music as op- posed to the use of physical treatment in the care of psychologically disturbed persons. For example, the 18th century philosopher, Rous- seau, felt that music should have the same effect on the fibres of the human body as it had on an instrument placed next to the sound source. In- tertwined in the debate was discussion of the ef- fect of one’s physical state on the psyche and vice versa. This period experienced the birth of the theory in psychiatry of replacing a false idea with a correct idea and of sensation being the source of images which translate into ideas. The eliciting of sensations through music therefore played a role in this theory.
The use of music with psychiatric patients in- creased in the 19th century and corresponded with generalized moral treatment in psychiatry. Philippe Pine], a philanthropist and psychiatrist of the time, employed passive music activity (musical instruments played by employees) in the psychiatric milieu. He believed that soft, har- monic music in the psychiatric hospital helped to create a calm, relaxing atmosphere that appealed to the healthy part of the patient as well as the premorbid personality.
Leuret, a precursor of active music therapy, felt that it was more effective than passive music therapy. He formed choruses and orchestras with patients as the performers. In 1852 high- ranking administrators witnessed an orchestral performance by patients from an institution (Quatre-Mares) and were so impressed that they gave their approval for the use of music in in- stitutions. Almost all such establishments there- after organized choruses and orchestras, the be- ginning of a systematic use of music in group psychiatric settings.
Between 1880 and 1914 interest centered on the psychophysiological effects of music, and re- search was based on the effects of music on pulse rate and respiration (Arveiller, 1980). The at- tempt was to render a scientific music therapy comparable to other therapies, susceptible of being described by its physical and chemical properties, its physiological, therapeutic. and toxic effects, its indications, its modes of appli- cation, its preparations, and its doses. Unfortu- nately, the experimental results were often con- tradictory, problematic, and not always based on scientific procedures.
After 1911 many considered music an occupa- tional therapy, its goal no longer to heal, but to help patients resocialize, and to prevent regres- sion. There is still a place in France where this music therapy philosophy is practiced but, as will be described, it has taken on new qualities.
Arveiller (1980) points out that when review- ing a history of the use of music in psychiatry it is
*This article is the result of meeting with French music therapists J. Guiraud-Caladou, professor at the music therapy program in Montpellier; E. Lecourt, author of two books and many articles on music therapy. music therapy professor at Paris VII. and the Gaston of music therapy in France: D. Quintana. G. Silvestre, E. Vergnes; and J. Verdeau-Pailles. author of several books on music therapy. tGayle Owens was employed as music therapist at Community Mental Health Center and Psychiatric Institute in Norfolk, Virginia and did graduate study in psychology at I’Universite de Neuchatel in Switzerland.
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important to maintain a perspective on the goals and objectives of music in this setting. For example, in 1967 music at maximum volume was employed to mask the noises made by patients during the application of electric shock. Choruses and fanfares may be a way of “militarizing” institutions and aiding the process of creating an institutional hierarchy, of hiding misery, and of patient loss of identity in this type of collective treatment.
MUSIC THERAPY PHILOSOPHY
Dupre and Nathan (1911) wrote about the im- portance to therapy of the emotions and the associations elicited by music. Most present day music therapy philosophy is based on this premise. The Association Francaise de Musico- thCrapie (1984) states that music therapy is the utilization of sound and music in a psy- chotherapeutic relationship. It addresses it- self to psychological and behavioral difficulties and mental pathologies. Guilhot, Jost. and Lecourt (1973) state that “Music therapy is not a form of psychotherapy but an instrument of psychother- apy” (p. 12).’ Music therapy is based on the ef- fective power of music in psychotherapy and as- sumes the same characteristics of methodology as psychotherapeutic pedagogy (Guilhot, et al., 1973). Psychomusical techniques are regarded as an excellent and privileged means of exploring dreams and ideas, the conscious and the uncon- scious, the effective and emotional worlds of the individual, and for provoking catharsis. Carefully chosen music in psychotherapy is considered to have the capacity to create a calm, secure. re- laxed atmosphere that allows the patient to spon- taneously express anxieties and problems with- out reticence or resistance.
The goals of psychotherapy are not only to explore problems, anxieties, etc.. but also to awaken positive energies, constructive feelings, the imagination, and creativity. as well as to re- organize the patient’s personality, desires, in- teractions. and objectives. Psychomusical tech- niques are seen as a means of creating and sup- porting this process.
Music therapy in France is a specialization for psychiatrists, clinical psychologists, psychiatric nurses (L’Association Francaise de Musico- thCrapie. 1984) and is not an independent profes- ‘Translation h) Gayle Owens.
sion. This specialization approach is reflected in the education, practice. and organization of music therapy in France.
MUSIC THERAPY TECHNIQUES
Probably the most researched and applied music therapy technique in France is receptive (passive) music therapy. Developed by J. and M. Guilhot, Jost, and Lecourt (1973), the technique is specifically indicated for individual psycho- therapy and consists of having the patient listen to three selections of music. The first selection, chosen to correspond with the patient’s present psychological state, should evoke the difficulties experienced by the patient. The second should be melodic and harmonic in order to neutralize the effect of the first selection, and the third should express the desired state of being of the patient-relaxed, stimulated, etc. For the first selection the patient may be asked to think about his/her psychological and physical problems or the mysteries of the universe. For the second selection he/she may be asked to think about the marvels of nature, and for the third selection the patient is instructed to permit him/herself to be induced by the music into a more positive mood.
Music in this case is considered an inter- mediary. The patient is often involved in the selection of the music, and the relationship be- tween the patient and the therapist is centered on the selection of the music, listening to it, and the effects it produces. The choice of music vis-&vis the patient is very important and should not be generalized. The musical knowledge, taste. and culture. personality. and psychodynamics of the patient are considered when making the selec- tion.
Case examples are reported by Guilhot, et al., (1973) with examples of music selections, desired responses. and eventual observations of the pa- tient. Following is one involving a psychopathic personality with schizoid behaviors.
Lisrening order
I
2
Prescribed music
hurried oppressed
soft harmonic melodic
Desired response
anxiety
security
MUSIC THERAPY IN FRANCE 303
3
Musical selections
Session I
Session II
Session III
energetic but soothing
enthusiasm calm liberation
1.
2.
3.
1.
2.
3.
1.
2.
3.
Symphony in F minor (Dittersdorf) Nocturne Quator No 2 in D Major (Borodine) Le Roi des Rois-Prelude (Miklos Rozsa)
Concerto No 2 for Piano (Rachmaninoff) Cavalleria Rusticana- Intermezzo (Mascagni) New World Symphony No 5) (Dvorak)
Nabucco-Slaves Chorus (Verdi) Largo from the opera XerxCs (Handel) Les Maitres Chanteurs- ouverture (Wagner)
General observations after 30 sessions were that the patient had made progress in personal relationships, was able to express himself more easily, and had fewer nightmares, ruminations, and painful childhood memories.
It is interesting to note that almost all music selections used in receptive music therapy are of a classical nature. Selections with lyrics are sel- dom used unless the text is in a language not understood by the patient.
In recent years there has been an evolution from psychomusical techniques centered solely on receptive music therapy to the development and utilization of active music therapy tech- niques. The French often employ active music therapy techniques developed by Nordoff and Robbins, J. Alvin, C. Bang, and Orff. Active music therapy techniques are used to facilitate nonverbal communication (Ducourneau, 1977; Guiraud-Caladou, 1979; Lecourt, 1977), to allow and develop creativity (Azinala, 1983; Boegner & Inizan, 1983; Lecourt, 1977), and (particularly in the case of improvisation) to allow the patient to project his conscious and unconscious thoughts and feelings (Lecourt, 1977).
PSYCHOMUSICAL TESTS
Guilhot, et al. (1973) have developed a psychomusical test using work by Cattell and Saunders (1954) as a reference base. Two func- tions are served by this test: to explore the per- sonality of the patient and to permit a logical selection of music for receptive music therapy.
Verdeau-Pailles (1981) elaborated on the above test, dedicating an entire book to the sub- ject. The test, used with adult and adolescent psychiatric populations, has three parts-a questionnaire, a receptive listening test, and an active test. The questionnaire explores the pa- tients’ musical background, music preferences and dislikes, favorite composer, and what differ- ent sounds in the environment mean to them. The receptive listening test is based on the re- sults of 543 subjects’ responses and is a projec- tive test. The patient listens to ten musical ex- cerpts and writes his responses to each selection. The excerpts include classical music, popular music, noise (traffic or a storm), and oriental music. Each response is then categorized by the therapist into one or two of the following ten classes of responses:
I. 2. 3. 4. 5.
6.
7. 8. 9.
10.
Gustatory and olfactory-sensory Visceral and sensory such as hot and cold Motor Simple visual-seeing simple forms and colors Elaborate and complex visual images-seeing vivid scenes as in a dream Esthetic impressions and value judgments-often seen as a defense Pure affective and evoked feelings Evoked memory Intellectual Banal
The third part of the test, based on the results of 273 subjects’ responses, is an active test and consists of playing instruments with and without background music. The patient is observed for such things as choice of instruments, concentra- tion, lateralization, and coordination. This test is borrowed from R. Benenzon (1971). a music therapist from Argentina.
Verdeau-Pailles (1981) indicates charac- teristics to look for in the responses and combi- nations of responses that typify well-adapted normal subjects, organic pathologies, specific neurotic tendencies, psychotic pathologies, and
304 GAYLE OWENS
borderline personalities. Verdeau-Pailles em- phasizes that the test is not an aptitude test, but that it achieves a knowledge of the psychomusi- cal personality as well as the general personality of the subject, and contributes elements that aid in making a diagnosis.
EDUCATIONAL REQUIREMENTS IN MUSIC THERAPY
There are four universities that offer music therapy certification. Three are located in Paris-Paris VII, Paris-Dauphine. and Paris X-and one-UniversitC “Paul Valery”-is lo- cated in Montepellier. Although some of their programs allow equivalencies. the training is basically offered as a specialization only to indi- viduals who already possess a degree in a related field such as psychology. psychiatric nursing, or psychiatry. One issue that probably heavily in- fluences this approach is that under French law only certain medical and paramedical professions are allowed to practice any form of therapy. Therefore. in order to practice music therapy one must meet the requirements of one of these med- ical or paramedical professions.
Standardization and quality controls set by a national association do not exist. The Paris VII program, however. is organized by the Associa- tion Franfaise de Musicothtrapie. Intensity and length of the program. major focuses of the pro- gram, musicianship requirements, and standards for acceptance to the program vary from univer- sity to university. Music therapy programs are attached to clinical human science departments rather than music departments. In general. less emphasis is put on musicianship skills than on knowledge. skill. and sensitivity in psychother-
apy.
MUSIC THERAPY ORGANIZATIONS IN FRANCE
In I969 the Centre Francaise de Musicotherapie was formed by Jacques Jost, Maurice Gabai, Jean and Marie-AymCe Guilhot, and Edith Lecourt. This was so well supported that in 1972 they created The Association Fran- qaise de Musicothlrapie (Lecourt, p. 31). The AFM publishes a trimestral journal, LN RC\~UC dc Mrrsic~otll~;r~ipi~~. is responsible for the music therapy program at Paris VII, and organizes
meetings, seminars, and conferences. The AFM organized the first World Congress in 1974 (Paris) where about 20 countries were officially represented, and an International Congress in 1983 (Paris). According to the Intc~rnrrtiotlrrl Nc,c-slrttcr (1983), the AFM has 40 members and there are about 200 individuals in France practic- ing music therapy.
Another organization, the Association d’Applications et de Recherches des Techniques Psychomusicales, researches and develops psy- chomusical techniques for relaxation, analgesia. “functional” music for stores, hospitals, etc. This organization has taken on commercial as- pects. For example, it has made several com- mercial cassette tapes. A training program is also offered through this association.
MUSIC THERAPY LITERATURE
Literature in music therapy is rich and varied, particularly in theory. This is evident in Lrr Rcl-rrc tic Mlr.sic,otll(;rtrpil~ where theoretical re- search may include anything from music and medicine in ancient Greece (Jourdan-Hemmer- dinger. 1984) to a metapsychological approach to music in therapy (Ledoux, 1983). Their work in methodology is more than complementary to the field of music therapy. What would be striking to most American music therapists is the marked absence of experimentally and statistically de- signed research, since French music therapy adheres to psychoanalytical philosophies. Arveil- ler (1980) states, however, that if music claims to be therapeutic, it needs to have controllable, constant, specific, and differentiated effects. At the same time he writes that the French are shocked by the behavior modification research and practices in the United States.
The French are actively aware of music therapy theories, techniques, and research in other countries. Reference is often made to music therapy literature from Argentina, Austria, Canada, England, Germany, the United States, and Yugoslavia. It is, therefore, not from lack of knowledge or information, but from choice that the French have pursued their own course. This is not only true for its literature, but also for its philosophy, its organization, and its education in music therapy.
MUSIC THERAPY IN FRANCE 305
CONCLUSIONS
Music therapy is still struggling to prove to the
world that it is a viable, valid, and reliable form of therapy. Different countries and different organizations within the countries use different strategies to meet this goal. One country may use statistics gathered from expe~mentaIIy designed research to prove a paint whereas another unof- ficially allies itself with medical and paramedical professions. Certain problems are automatically eliminated by allowing only psychiatrists, psy- chologists, or psychiatric nurses to be special- ized in music therapy. Third-party insurance payments for music therapy and creating music therapy positions are not topics of issue in France.
Despite the language barrier, geographica dis- tance, and philosophical differences, information sharing between France and the United States is taking place. Nine music therapists from the United States presented their work at the 1983 World Congress of Music Therapy in Paris and the June issue of Lu RCWP dr ~~s~i.t~?~i;~~~i~~ pubfished an article by Richard Graham. Verdeau-Pailles presented her work at the 1983 National Association for Music Therapy Confer- ence in New Orleans. Americans can profit par- ticularly from the French literature on theories and practice of the use of music in psychotherapy and the psychomusical test developed by Ver- deau-Pailles. Why not translate some of this vaI- uable literature into English? Why not organize international exchanges of music therapy stu- dents and professionals? Language barriers can be overcome, and philosophical differences lead to interesting discussions. We have much to share and we have much to learn.
REFERENCES
AMERICAN ASSOCIATION FOR MUSICTHERAPY (1981) Inrernarionnl Newsletter of Mrrsir Therapy If 1): 16-17.
ARVEILLER, J. (1980) &s Mrt.sic.r,rfii~cipi~l.~. Issy-fes- Moulineaux, France: E.A.P.-Editions Scientifiques et Psychologiques.
AZINALA, L. (1983) M~&/IIP Vi<, dc Torr.$ Lc.r ./orrrs.
Aires: Editorial Paidos. BOEGNER. D. & INIZAN, Y. (1983) Activities musicales de
woupe au Centre de ne~ropsychjat~e iufa~tiie de Fleury ies Aubrais. La Rerwr dc k&iwthirupk fII(4): 83-90.
CATTELL. R. & SAUNDERS. D, (1954) Musical urefer- ences and personality diagnosis. .rt~~~r~~~~~ I$ Socicri Pv.v- cholog?. 33: 3-24.
DIDIER-WEILL, A. (1984) Breve remarque psychanalytique sur la musique. Lrt Rww Jr, ~~~wsic.frt~~tc;rcfpi~, IV{ f f: 1935.
DUCOURNEAU. G. (1977) It~t,otiwtiori il If I Mrrsic.otkc;ro~ic. Toulouse, France: Ed. Privat.
I’etude comparee de la culture de trois groupes ethniques annarent&. La R~~rrw de /~ff~.sic,otirc;tci~i~, IV(Z): 27-34.
GUILHOT, J. and M. A.. JGST. R. & L&COURT, E. (1973 4th Ed.) Lrt iWtl.sic.r,/kr;t-npic~ (01 Irf.v Mc~/kotl~s J’Assnriuricm &s Tcc.kttiyrws. Paris: Les Editions ESF.
GUIRAUD-CALADOU, J. ( 1979) IJn c‘hcrnt d’Ar~tio,l-Lrr C&rritit~. Couriay, France: J. M. Fuzeau. SA.
JO~rRDAN-H~,~MERDINGER, D. (1984) Musique et medecine dam la Grece antique. I.0 IZc\,rtc, t/c Musit,rlthi:tcr~ir 1 Vt2): 14-16.
LACAS, P. (1984) Questions aux musicoth~rapeuts sur l’eflicience du signe sonore: Points de vue epistemo- logique et psychanalytique succints. Ln Rcl,nc, de ktrisit.rrihi;rcl~i~~ IV( I ): 26-4 I ,
L’ASSOCIATION FRANCAISE DE MUSICOTHFRAPIE ( 1984) Lrr Mt,sic,~i/h~:rrrpic~. Paris, France.
L’FCHFVIN. P. f 1381 f ~~/~.s~4~~f~ et M&iicin~. Paris: Stock Music.
LEDOUX, M. (1983) Approche metapsychologique de la
