Barcelona Publishers:Group Analytic Music Therapy

Group Analytic Music Therapy
Reviews

Group Analytic Music Therapy
Ahonen-Eerikainen, Heidi (2007). Group Analytic Music Therapy. Gilsum, NH: Barcelona Publishers.
Reviewed by Benedikte B. Scheiby, MA, MMEd., DPMT. CMT, LCAT.

" Music is the Royal Road to the Unconscious" (Ahonen-Eerikainen, 2007, p. iii)

The quotation opening this review indicates the focus of this book: this is the use of music in a framework of analytic, interpersonal and intersubjective theories. The title of this book indicates a text that will appeal to readers interested in group music therapy methods and in an approach that are psychodynamically oriented. As an Analytical Music Therapist (Priestley method) I welcome this book, particularly because there is very little literature in the area of group work.

The author has extensive clinical and academic experience and has developed an approach labeled GAMT (Group Analytic Music Therapy). The book does not contain a specific definition of GAMT. For the sake of clarity the author has provided a definition for the purposes of this review. Combining material from various places in the book, she offers the following description:

GAMT is a combination of group analysis, interpersonal theories, and intersubjectivity and can be understood at different levels of consciousness. The conscious level includes the level of social interactions. The three unconscious levels include the levels of transference, projection, and collective-unconsciousness. The different levels of the consciousness become visible in different musical images and dreams that clients experience during GAMT. Images created during GAMT have similar clinical value to dreams. Clients reciprocally help each other to look into the group mirror in which nonverbal communication and bodily presence are important elements of the experience.
The GAMT group can be either nondirective or theme-centered, depending on the character of the group and the therapeutic needs of the clients. Musical images take place during referential or nonreferential improvisations or therapeutic music listening.. The music therapist can focus on either the manifest content of the client's music (for example, improvisation, music itself) or the latent content (for example, client's associations, feelings, images, and body sensations). (Ahonen-Eerikainen, 2007, pp. 1, 51, 59-60, 63, 83, 103, 113)

The role of the music therapist in this approach takes many dimensions:

As a music therapist, I like the idea that GAMT can be compared to an orchestra. The therapist is the conductor and individual clients sound different, yet together they make music. Each instrument is needed to make the sections of the whole. The therapist/conductor facilitates the movement of the piece to allow a harmonious therapeutic atmosphere. The therapist adds to the level of social interaction by their interventions. The material rises from the unconscious, is verbalized and worked through at the conscious. When the unconscious is brought to the social interaction, dialogue and sharing takes place. It is now possible to experience corrective emotional experiences and empathy. (Ahonen-Eerikainen, 2007, p. 46)

The primary audience for this book is music psychotherapists, psychotherapists and psychoanalysts who are interested in using music as a tool of transformation. However, the book will also be inspirational for any music therapist interested in group music therapy methods.

The book does not represent a completely new approach. Mary Priestley and other music therapists have previously introduced this type of thinking (Priestley, 1975, 1977; Dvorkin, 1998; Scheiby, 1999). A number of AMT-trained music therapists and analytic music psychotherapists in Europe and the USA incorporate current psychoanalytic thinking and practice in their approaches.

However, there is an important contribution made by this book in gathering in one publication a number of practices and ideas that have not previously been considered as part of a single theoretical framework. In this regard, the author says that GAMT "is not an orthodox group analytic method but includes combined elements from other psychodynamic theories, as well as interpersonal and self-psychological, intersubjective theories" (p. 1). For analytic group music therapists the author has developed an interesting theoretical model for understanding musical images and the group matrix (the "group- as- a Whole" (pp.114-115) and levels of the group matrix in the Group Analytic Circle (p. 59) illustrated with examples from analytic group music therapy sessions.

In the first six chapters of the book (Part I) the author describes the philosophical foundation of GAMT. This provides a context for the explorations in Part II and Part III which address a description of the method and in-depth case study, respectively. The prevalence of such a large number group psychotherapy theories seemed to dilute the impact of the author's ideas by making it more difficult to discern the nature of her novel contribution. There are 30 chapters with each one containing many small numbered sections. This type of detailed hierarchical outline system might be appropriate for some philosophical texts, but in this case it did not seem to serve the reader's understanding.

In the present review, I will focus on material that has not been previously discussed in relation to analytic group music therapy or where innovative ideas are being described. Let us take a look.

In chapter 1 the author describes how being in GAMT can be experienced as being in a family. Here, one's archaic, primitive needs can be seen, heard and accepted at the same time as the therapist and the fellow clients resemble one's parental/authority figure (therapist) as well as peer and sibling figures (other clients). The author uses the term "footprints" to indicate the expression and remnants of symptoms and behaviors and she describes how insight is provided into why exactly these particular footprints come to expression. One can begin to form a connection between traumatizing past experiences and current problems with the goal of ending with feeling good enough as a person. Winnicott, Freud, Sanford, Yalom, Pines and Chazan are quoted in that connection.

Chapter 2 is devoted to the concept of empathic understanding or emotional resonance which the author says makes GAMT therapeutic. Her understanding is that clients that seek GAMT often have been traumatized. She starts the chapter with a powerful quotation:

Trauma is the absence of healing responses, What didn't happen afterward. (Sanford, 1990, p. 22).

This can partly explain why throughout much of the book there is a continuous focus on trauma. As such, this work will be very helpful for music therapists that work in this area. In chapter three (p. 14) the author describes three important experiential elements of the experience of the trauma survivor: a devastating physical and /or emotional pain (Winnicott, 1986, p. 243); a horrifying experience of total helplessness (Winnicott, 1986, p. 243); a lack of empathy (Sanford, 1990, p. 22; Harwood, 1998, p. 165). In GAMT the author writes that the client will receive a corrective, reparative emotional experience and experience with systematic reality testing that is needed for healing to take place for a trauma survivor.

The cure in GAMT is a process where the self-object needs of clients are replaced by an empathetic resonance with the therapist. To accomplish this resonance it is necessary for the music therapist to listen with a "third ear." As a music therapist I was looking for some examples of how this musical empathy (my wording) works in practice when one has to practice empathic listening to a whole group in comparison to practicing this phenomenon in individual music therapy. The text did not contain any elaboration on this capacity.

Chapter 3 addresses the importance of creating safety in a group so clients can trust, share and explore together. One of the strengths of the book is that many interesting new terms are coined, such as when the author writes about clients wearing "social antennae" that helps them "to know the weather of the group so that they can wear the right protection and not be rejected" (Ahonen-Eerikainen, 2007, p. 20). She also uses the story of the Little Prince to illustrate the importance for the therapist of learning to sit and wait in "the waiting room" in respect of the client's defenses. These observations may be common knowledge and not new to psychodynamic group music therapists, but they serve as important reminders.

In Chapter 4, the author discusses how GAMT provides a sense of fulfillment that was missing during the client's formative years such as a twinship (Kohut, 1984) experience, experience of universality and search for competence. In GAMT one learns to take time to take care of oneself and to experience symmetry as one can "receive through giving" (Yalom, 1995, p.12). One also practices living in the Here and Now.

Chapter 5 utilizes a variety of metaphors to shed light on the nature of the GAMT therapeutic process. For example, GAMT is compared to a picture frame, a container, an envelope where the clients send and store messages and letters, a laboratory with possibilities for different "chemical" combinations and potential explosions, a garden, a vineyard, a playground, like doing a jigsaw puzzle, or peeling an onion. The GAMT group can also be compared with a psychic network of communications, with a weather condition ("a really thick atmosphere"), a good or a bad group Mother that for example can be lifegiving, confirming, sustaining, accepting, overdemanding, devouring, lacking in reciprocity, and/or intrusive.

Chapter 6 introduces a combination of theories about group development that are not specific to GAMT but that reflect stages common to psychotherapy groups in general.

I found part II of the book to be the most engaging section. It describes how clinical improvisation and therapeutic music listening fits in to the group psychotherapy model and it seems like it is here where the original theories comes to light. Here is how the author describes leading a group as conducting:

In chapter 7, the author presents the principles underlying the GAMT music therapist's use of verbal interventions. She says that in GAMT the client can speak whatever they are thinking (free-floating discussion). A section is devoted to silences and their uses and interpretations for example as a point of rest, reflection, tension, apprehension, or release.

Chapter 8 presents the three different perspectives or "windows" that the group can be observed and analyzed from and it becomes clear that the GAMT approach is a combination of group analysis, interpersonal theories and intersubjectivity.

the individual in the group (the intersubjective window)
the members with one another (the interpersonal window)
the group-as-a-whole (the group matrix window. (Ahonen-Eerikainen, 2007, p.50)

Chapter 9 can be summed up in the model about the different communication levels of the group matrix:

the Conscious Social Interaction Level
the Unconscious Transference Level
The Unconscious Projective Level
The Collective Unconscious Level

Chapters 10, 11 and 12 are informative in terms of explaining how receptive and active music is used in GAMT sessions and the length and structure of sessions

The observations and images that emerge during the musical interventions are discussed through verbal analysis. What is not made clear are the guidelines for choosing the music that is listened to and when to use music listening or clinical improvisation. The choices of music are not described nor is the process for deciding who selects it. There is no discussion about the various type of improvisation or their clinical rationale. It would be helpful to clarify these issues and to illustrate some of the music, either with transcriptions or recordings when the different types of musical interventions are introduced in the text.

Chapter 13 concerns the use of images created during music which may be symbolic or concrete, personal or archetypal, or emotional or cognitive. Working with the images can promote conscious and unconscious communication of messages, informing clients about the image sender's inner state while having a transformative power on both the image receiver and the sender.

In Chapter 14 the author writes that "in GAMT, music is the Royal Road to the Unconscious. In a way there are two equal lanes: one is the manifest content of the music, and the other one is the latent content of the musical image. It is significant to understand that both lead to the unconscious." (Ahonen-Eerikainen, 2007, p. 83). The term manifest content of the music refers to the concrete musical parameters and with the latent content refers to feelings, body sensations and images that may arise during the music. "The manifest lane to the unconscious uses music as psychotherapy, and the latent lane to the unconscious uses music in psychotherapy" (Ahonen-Eerikainen, 2007, p. 84).

These levels are later on exemplified in Chapters 19-23 with examples from clinical work. In Chapter 23 the author discusses the interpretation of images and what to avoid in that context. The third section of the book is a case study of 24 sessions with an individual client suffering from trauma. The narrative is supplemented with illustrations of images that arose during music listening and the narratives of the clients in the group. This is an interesting journey that is described. In Chapter 30 the author discusses who can practice GAMT. Music therapists conducting GAMT must have completed group psychotherapy education and their own psychotherapy, and have ongoing music psychotherapy supervision. I am curious to know why the music therapist does not need to have experienced a full group music therapy analysis. In contrast to AMT, there is no requirement that the practitioner have experienced the form of treatment in which she/he is being trained.

I will conclude by sharing some general thoughts about this book. After reading it, I felt a bit disintegrated and interrupted in my thinking process by far too many quotations on many pages. It is like getting a meal with too many ingredients: each one alone is valuable but the total is less than the sum of the parts. I am left wondering where the authors' own thinking is as it can get lost in the large number of quotations.

The book offers a peek into the author's clinical practice and it contains many theoretical constructs and references that, at times, can be a bit overwhelming. When music therapeutic music listening is the basis of the therapeutic outcome the reader is not informed about the piece of music to which the group has listened. If the therapeutic music listening is based upon a group improvisation, the parameters and the aesthetic qualities of the music are not described. That keeps the reader left hanging. Without any musical recordings or description it feels like an essential aspect of this approach is not being conveyed. Additionally, in parts one and two there were many very brief sections with a variety of topics dealt with in a cursory way. This served to stop the flow of reading. The author writes that the book is a journey into the world of dreams and images and I agree.

The book is very inspiring in terms of getting to know the theoretical and clinical basis of GAMT. In a way, it is inspiring to consider the number of models to interpret, analyze and process sessions from an organized group analytic perspective. I appreciate the many personal expressions such as "There is no such things as 'rush hour' in therapy" (p.23) and the personal writing style and openness about the process of the author. The author is clearly coming from a creative inclusive place inserting poems and drawings along the way of the text to illustrate points. Let me finish with a quote from a communication with the author that expresses a value that supports the approach: "I learned the most from my clients."

References

Dvorkin, Janice M. (1998). Transference and countertransference in group improvisation therapy. The dynamics of music psychotherapy. Barcelona Publishers, Gilsum, NH 03448
Priestley, Mary (1975). Music therapy at Camberwell Day Training Center for recidivists. British Journal of Music Therapy, 6 (1), 13-19.
Priestley, Mary (1977). Music, Freud and Recidivism. Journal of the British Society for Music Therapy, 8, (3), 10-13.
Scheiby, BB. (1999). Music as symbolic expression: Analytical Music Therapy. In D. J. Wiener (Ed.), Beyond talk therapy. APA, Washington DC

This book review was released May 20, 2008 ©2008 Nordic Journal of Music Therapy

Group Analytic Music Therapy, (2007)
Author: Heidi Ahonen-Eerikäinen, PhD, MTA
ISBN 13:978-1-891278-50-1
Barcelona Publishers
Website: www.barcelonapublishers.com
Reviewer: Elizabeth Moffitt, MA, MTA, FAMI (Capilano College)

This book offers a unique contribution to the field of music therapy. It is all about music psychotherapy in groups. Written by a highly experienced and wise clinician, this book offers a new theoretical framework which increases our understanding of client experiences in Group Analytic Music Therapy (GAMT). It is full of stories, images, metaphors, and poetry, and it shows Ahonen-Eerikäinen’s deep connection to group work and to her clients. She writes of tuning to the heart, of courage on both the client’s and therapist’s parts, of creativity, and of a deep respect for the natural healing process available to everyone, given the right conditions.

In the Introduction, she summarizes how GAMT works: “...images created during improvisation or therapeutic music listening…can be seen as a part of unconscious intersubjective and interpersonal processes within the group….crucial not only to the individual’s inner life, but also as a means to communicate information about the force and impact of the dynamics of the group” (p. 1). “The therapist adds to the level of social interaction by their interventions. The material rises from the unconscious…and is brought to social interaction, dialogue and sharing. It is now possible to experience corrective emotional experiences and empathy” (p. 46).

Having participated in two of her powerful workshops in Group Analytic Music Therapy for practicing music therapists in Vancouver, B.C., I eagerly awaited the birth of this book in order to understand more of the theory underpinning her practice. This text has both informed and inspired me.

The book is organized into three main segments: Part I, “Foundation,” explores the philosophical foundations of GAMT; Part II, “Group Analytic Therapy,” which examines various theories and methods of GAMT; Part III, “Too Scared To Cry: Mary, A Case Study.”

As both a group analyst and a music therapist trained in Finland, and with many years of experience there and in other places in Europe, Dr. Ahonen-Eerikäinen moved to Canada to teach at Wilfrid Laurier University in Waterloo, Ontario, in 2001. She now describes herself as working from an eclectic model. Her practice has been influenced by many theorists from the European group analytic community, and by North American interpersonal and intersubjectivity theories. She has also been influenced by individual theories of development from writers such as Winnicott and Stern, and of course—as a music therapist—she is deeply influenced by the creative arts therapies. Her cultural foundation is evident throughout the book. We are treated to delightful Finnish folk tales, and creative chapter titles in the first section like, “Footprints Lead to the Sausage Factory,” “Elephants in the Therapy Room,” and “Home from Never-Never Land.”

This first section also addresses topics such as empathy, trust, the role of defenses, the use of metaphors, e.g. the group as mother, and it summarizes various theories of group development.

In Part II, the largest section of the book, Ahonen-Eerikäinen proposes her framework for organizing and understanding client responses to the group music therapy experiences. She first begins with a summary of various theories of group psychotherapy, including Foulkes (the originator of group analytic therapy), Salminen (her group analytic trainer), Yalom, and others. From Foulkes and Salminen the author uses their four levels of group functioning to organize client responses. The four levels are: 1) social/interpersonal; 2) transference; 3) projective; and 4) collective unconscious. The goal is to assist with bringing unconscious material more and more to conscious awareness.

Drawing upon the above four-stage group matrix, the author conducted her own research in music psychotherapy, and discovered that it was very useful to organize clients’ experiences in group music psychotherapy sessions into these four categories which at times overlap with each other, and at other times occur separately. She found that dividing into the levels assisted with ascertaining the differing role of music at the various levels.

In Level 1, the social interactive level, music is a communication tool within the group. Issues regarding the use of music and the instruments as means for communication with self and with others in the group, are examined. The material here is usually in conscious awareness.

Level 2, the transference level, is largely based on unconscious material that the music can express, and also the music can be the object of projections, for example, “This music reminds me of my mother.”

Level 3, the projective level, represents deeply split off unconscious material that can often emerge as bodily and mental images. They can represent wishes, sometimes archetypal images, and self images. This level is similar to Level 2, but is more deeply unconscious. The projection onto the music can be expressed as, “This music sounds as my feelings feel.”

Level 4, the collective unconscious level, is the level of group dreams, collective metaphors, and images. In music this level is often connected to rhythm, and dynamic and tempo changes, however all the various elements of music, including melody, harmony, and timbre, can express the collective and usually it has transformative qualities.

In all of the levels, images are evoked by the music as messages from the conscious or the unconscious of the group members, to be freed, acknowledged, and expressed, leading to corrective experiences and transformation. Her vast clinical experience is evident and so helpful as she describes many, many vignettes that give clear examples of this four-stage matrix in the GAMT sessions.

In this section she also discusses the issues of image interpretation on the part of the therapist. She shares a personal story from her own training, in which she was advised to “sit on her wisdom,” and to focus on the clients’ responses, feelings and associations. Countertransference is also addressed in this section.

This section contains very useful, practical chapters, exploring the structure of a GAMT session, types of clinical improvisations based on themes, on art, or completely freely based, or based on therapeutic listening. Rules of group process, room set-up, seating arrangements, instrument choices, and possible goals are included, as are questions a therapist might ask the group at the various stages and levels of functioning.

Part III begins with a wonderful Finnish folk tale about Moomin-Troll and Ninny which speaks of the issues of becoming visible and relates perfectly to the case study of Mary, “Too Scared to be Visible.” Over a series of 26 sessions of group music psychotherapy, the author documents Mary’s process to becoming visible and relates each step on the way to the four-stage matrix as described above. It is a moving and inspiring story, and clearly demonstrates how the matrix works.

Towards the end of the book she states the necessity for each music therapist to do their own personal work, to have many experiences of self in group music psychotherapy. As she says, we cannot teach skydiving by learning about it in a book! Dr. Colin Lee, the author’s friend and colleague at Laurier University, states in his forward to this book, “group music psychotherapy is dependent upon a complexity of knowledge that the therapist must learn and be aware of through supervision and reflection. There are no quick fixes…here” (p. xx). In GAMT the role of the therapist, their knowledge, skill, experience, personal awareness, presence, depth of human compassion, and intuition are never more important.

Heidi Ahonen-Eerikäinen begins and ends the book with a poem about jumping and flying. She likens this to the task of group members in GAMT and to the therapist as well, who also must jump into the unknown with the group, allowing the music, the imagination and the associations to flow freely, to be open, to trust the music, the process, oneself, and the potentials for human healing and transformation.

Each time I read this book I have been challenged and inspired. I’m very grateful to her for writing it, for this book goes a long way to help fill the void of literature available in group music psychotherapy. In her next book I would be interested to learn more detail about the improvised music that evoked the various clients’ images. I will be sure to share this book with students and colleagues for there is learning here for all levels of experience in our field. I hope you, too, will read this book and discover what inspires and challenges you.