BOOK REVIEW

Music Therapy—Intimate Notes

Mercedes Pavlicevic

(London and Bristol, CT: Jessica Kingsley Publishers, Ltd., 1999, 176 pages, $24.95, paperback)

This beautiful and moving book is a riveting col-lage of nine music therapy case histories, shared by agroup of music therapists who were interviewed byMercedes Pavlicevic. The author selected these ther-apists, who reflect a broad range of age and experi-ence, on the basis that they had not previously writtenabout their work, and well known to have had inter-esting clinical experiences. Pavlicevic intended thesepersonalized interviews to be experienced as directlyas possible, as oral texts in the first person. This groupof sensitive therapists speaks openly, not only of theirsuccesses; they are equally candid in sharing theirown frustrations and insecurities. As a result, these“stories” bring the reader much closer to the livingdynamics of exchange that occurs between therapistsand clients than would be possible in a more academicstyle of reporting.

The author saw her role as sculpting each inter-view into a cohesive whole, while trying to interfereas little as possible with each speaker’s individualvoice. Each “story” is followed by Pavlicevic’s re-flections that conclude each chapter with a helpfulkind of discussion and summary in response to thesediverse histories.

Each story is of equal interest. The first is relatedby Oksana Zharinova, at the time of writing still inher second year of training at the Nordoff-RobbinsCentre in London. Zharinova tells the story of Daniel,her very first music therapy client. He was a 6-year-old with cerebral palsy, learning difficulties, epilepsyand no speech. In trying, the therapist got no responsewhile working from the piano. Eventually she workedwith him at his level, seated on the floor, and initiatedsome vocalizations. At first she only matched his

singing, but later began to gradually extend his ex-pression to give the child a greater sense of his pos-sibilities. Their now connected musical relationshipstimulated the child, and he suddenly began to use hisvoice in a newly free and expressive way. In theterminology of the Nordoff-Robbins approach, the“music child” had been liberated. For this therapiststill in training, that was a pivotal moment in whichshe saw that contact with Daniel was possible. Shebuilt on this connection, introducing simple musicalinstruments, over a period of 21 sessions. Daniel be-came more independent, aware and physically capa-ble, and the therapist, Oksana, had found her ownvoice as well.

Jean Eisler is a music therapist with many years ofexperience. In telling the story of Wendy, she alsoreveals a lot about herself. It is interesting to see justhow much the therapist’s own life experience helpedher to empathize and connect with this child. Wendywas 9 years old at the time she began work with Eislerin a hospital psychiatric ward. Traumatized by ahighly dysfunctional family history, she was confusedand unstable. In her first music therapy session, sheselected the biggest drum available and played in anerratic way. The therapist, improvising at the piano,tried to meet her musically, and they soon shared acommon pulse. Eisler sensed that Wendy had felttruly held and supported for the first time in her lifethrough this music-making. The experience providedher with a new kind of expressive freedom that ex-panded into singing and playing with the therapist atthe piano. Eisler then reflects on her own life, ofliving in Prague for 25 years in difficult circum-stances and returning to London after the death of her

The Arts in Psychotherapy, Vol. 27, No. 3, pp. 219–221, 2000Copyright © 2000 Elsevier Science Ltd.Printed in the USA. All rights reserved

0197-4556/00/$–see front matter

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husband. It was only then that she discovered musictherapy as a new path in her life. Eisler had 10 yearsof music therapy work experience when she began herwork with Wendy. Over a period of 9 months, Wendybecame increasingly open in her expression, releasingdeep wells of trauma as she sang about never havingreceived her mother’s love and her sense of emotionalisolation. As Eisler gradually connected with thislonely child, it reminded her of her own past feelingsof aloneness and alienation when living in Prague.Somehow this countertransference helped her to bet-ter connect with the child’s pain and to successfullyrealize this intergenerational music therapy encounter.

Sinead was a 6-year-old brain damaged girl withcerebral palsy, who worked with Claire Flower.Flower began her work with a speech therapist as herpartner. In response to being presented with a choiceof instruments, the child would seem excited, andthen, at the critical moment, would refuse to playwithout direct physical prompting. Sinead was resist-ing her therapists’ efforts to realize their goals for her,and maintained her resistance until she was given thechance to find her own way. When the speech thera-pist left the team out of a sense of futility, Flowercontinued to work with Sinead alone. In her continu-ing search for a line of communication, she began toimprovise in synchrony with the child’s breathingpatterns. This finally realized a connection. The childbegan to perceive thatshewas controlling the music,and then began to express herself vocally as well.Over time, Sinead’s vocal expression became increas-ingly “dark” and seemed to provide an outlet for all ofher accumulated pain. At the end of the course oftherapy, Sinead was making a happy and successfuladjustment in school.

Giorgos was a 4-year-old non-English speaking,blind, Greek-Cypriot child, who suffered from osteo-petrosis, a thickening of the bones in the skull, whichis a life-threatening illness. His therapist, NickyO’Neill, took advantage of not understanding Greek,by focusing even more intently on his vocal sounds.This is another example where therapist and patientdeveloped a reciprocal relationship through vocal ex-change. Giorgos became increasingly liberated in hisexpression, and for the therapist this became a deeplyintimate and transcendent experience. Following thepredictable course of his illness, Giorgos died, but notbefore having realized this wonderful self-affirmationthrough music therapy.

Catherine O’Leary is a music therapist who trainedin the Bonny Method of Guided Imagery and Music.

Her client, Martha, was a middle-aged woman whorealized the source of some of her life difficultiesthrough insights gained in her imagery. These wererooted in past responses to anger that had been di-rected to her as a child, a transference from the pastthat had interfered with her present relationships.

Nigel Hartley is a music therapist who describessome deep and fascinating improvisational work withtwo adult clients, Mary and Steve. Mary, an elderlywoman, realized her last desire to write and sing asong that led her to a peaceful acceptance of herimminent death. Steve was an AIDS patient, whoseintense drumming expression seemed to summon allthat his therapist could offer just to keep up with him.This therapy continued for a period of 2 years. Nearthe end of Steve’s life, his therapist found new waysto musically connect with him, resulting in a truecommunion before Steve’s death.

Cathy Durham worked with Shireen, an adult pa-tient in her 30s, blind and severely brain damaged.She had little affect, and the therapist had almost noindication if she was reaching the patient or not. Thetherapist worked with Shireen weekly for 21⁄2 years.Shireen was given access to simple instruments at-tached to her wheelchair, and she did make somesounds with them. Shireen was seen in a group withtwo other severely handicapped individuals, and for 2years her level of involvement was limited to thisminimal participation on the provided instruments.The dramatic high point in her therapy occurred afterthe group had been running for 2 years, and the ther-apist had to inform the group that she would soon beleaving for a position in another part of the country.Shortly after this announcement, in the middle of theirmusic-making, Shireen suddenly cried out, a longpainful and arching sound, the very first vocal soundshe had made in 2 years of music therapy! Althougha nonverbal expression, it seemed to clearly indicatehow precious the music-making had been for her, aperson who could not verbalize, and who would or-dinarily be dismissed as not being able to benefit frommusic therapy support.

Claire Hobbs worked with Miriam and Seaun in aforensic psychiatric setting. Miriam, who had killedher own 3-year-old child, improved her ability to re-alize positive communication through music, andachieved a better understanding of herself. Seaun,who was musical, and able to express himself well onseveral instruments, learned to assert himself in amore positive way through group improvisation ses-sions.

220 BOOK REVIEW

Judith Nockolds, in the last history in the book,worked with Olive and Jim in a setting for elderlypersons with advanced dementia. Olive was a drivenwoman, and was almost constantly walking, as muchas 22 hours a day. The free time that she allowedherself to participate in music therapy was the onlytime she was ever able to find any moments of peace.Jim, while frail, loved to play the drums and gainedtremendous satisfaction and validation from this, atthe same time that he was enduring a gradual deteri-oration in his health. It was evident that both Olive

and Jim ended their lives enriched by their experi-ences in music therapy.

Through reading these wonderful stories, the rich-ness of which can only be hinted at in the context ofthis review, we clearly see how music therapy reachespeople at the deepest levels of their humanity.

Joseph Moreno, MT-BCDirector of Music Therapy

Maryville UniversitySt. Louis, MO

221BOOK REVIEW