Improvisation in Psychiatric Adolescence Music Therapy
Based on my personal clinical experience, I have divided adolescent music therapy into three stages; interest, learning and improvisation (Tervo, 1985, 2001, 2003).
1. The Stage of Interest
A new adolescent on the ward becomes interested in music through other adolescents and through the support of both the music therapist and the atmosphere on the ward which supports self-expression and youth culture. The stage of interest is both very important but at the same time difficult to study due to the relatively short period of time the therapist has to work with the adolescent. The unconscious fantasies and hopes of the adolescent to discover a new developmental object to aid in adolescent growth and development and/or search for a person to complete relationships which have been interrupted due to his childhood traumas are central to this stage.
These two elements, the wish to develop and the trauma(s) - usually hidden - i.e. internal obstacles to growth, are present at all times in music therapy for adolescents and will force both the therapist and the adolescent into intense emotional interaction (Tervo 1996).
2. The Stage of Learning
In the learning stage, the adolescent begins to understand and master playing different instruments together with the music therapist. This may lead him to a feeling of being small and a very amateur player. This is usually a very difficult feeling in adolescence as one must face so many fundamental developmental issues which can't immediately be mastered or understood. If the therapist is able to find some means to help him with that experience, the adolescent will begin to have faith in the therapist.
More importantly this makes it possible for the adolescent to invest his fantasies in the music therapist as a good object, as well as in the music and instruments. Learning music provides new media to define new, even never before experienced emotions and fantasies and to cope with and express them. Well known musical structures create a feeling of safety as well as providing a frame for adolescent regression. As time goes on, the adolescent who is capable of playing common and well known musical themes might find the courage to play music with others.
3. The Stage of Improvisation
Improvisation is to music therapy what free association is to psychotherapy (Tervo, 1985). The secure and supportive atmosphere provided by music therapy allows the adolescent, even those with a limited musical ability, to freely experiment with instruments and sounds. Thus, the adolescent takes part in creating music with other adolescents. It is this which allows them to work spontaneously together.
In a dynamic sense, music therapy becomes more personal and intense as it progresses towards improvisation. The stages of interest and learning, the length and contents which vary with each adolescent, prepare them for actual improvisation. The improvisation discussed here is not jazz-improvisation in which chords, keys, scales and rhythmical changes are of great importance. The improvisation in question is a musical game in which the adolescents - or the music therapist - invent a drum beat, a series of chords or the phrase of a melody which is then worked on together. The improvisation is always new and different and expresses the feelings of the adolescents at the time. It can be free and furious "noise," a search for a gentle, common theme, or it can simply lead to listening to music and discussion.
Once the adolescent becomes really interested in music therapy, he begins to cooperate more with the therapist himself. When situations arise and develop naturally, and the therapist is teaching less and less, the therapy has reached the improvisation stage. It is at this stage when internal conflicts become apparent, with moments of anxiety, withdrawal, quiet sadness and anger. At first the adolescent attempts to avoid pondering his internal conflicts, but later might be able to better cope with them with the support of the therapist. During this time the playing becomes more instinctive and the players learn to anticipate each other, which are the essential elements of playing together. A shared sense of humour, the songs and the musical language created together all make for improved co-operation. The music no longer acts merely as a defence or as a performance, but rather becomes a deeper shared experience.
During the interest and learning stages, the therapist guides and supports the adolescent to the gates of self expression and creativity. When improvisation becomes possible, the roles change; the adolescent then shows the therapist and finds the way to the world beyond the gate, in other words, his own inner world. The music therapist must follow, to the best of his abilities, and explore this world with the adolescent by sharing it. To the best of my understanding, this is the area which the psychoanalyst Donald W. Winnicott describes as the "potential space." "The potential space happens only in relation to a feeling of confidence on the part of the baby, that is, confidence related to the dependability of the mother-figure or environmental elements, confidence being the evidence of dependability that is becoming introjected" (Winnicott, 1971, p. 118). One of the great challenges facing the music therapist and other members of the therapy team is the achievement of trust leading to a stable therapist-adolescent relationship. Through this the "potential space" can then be achieved and the inner process of change in the adolescent is allowed to be freely expressed.
Some adolescents find their inner world safe enough to allow interaction to occur naturally and they are able to express feelings ranging from rage to deep sorrow. To others, this world may be very traumatic and full of loss, disappointment and rage. However, music created together with the music therapist can provide a means to express all of this. Beyond the gate some adolescents may find the emptiness which has been with them all their lives. On the other hand, they may find a place filled with the kind of fantasies which they may find impossible to accept due to the psychic pain they cause. This may prevent deeper interaction.
The following example illustrates how a phobic and depressive boy used phallic identification with the music therapist to find a new path in his adolescent development and how, with the support of the music therapist, he was able to express himself and begin to interact with other youngsters. The example also provides the possibility to observe a group of restless and anxious youngsters using music to get in touch with their hidden emotions. Some personal facts have been changed to prevent identification of the adolescents involved.