Psychiatric Music Therapy in the Community
McGuire, Michael G. (Ed) (2004) Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson. Gilsum, NH: Barcelona Publishers.
Reviewed by Susan Hadley, Ph.D., MT-BC, Slippery Rock University, Slippery Rock, Pennsylvania, USA.

Introduction
Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson is an anthology (or reader) of published and unpublished writings, interviews, and conference presentations, by and about Florence Tyson. Tyson is a very significant early figure in music therapy in the USA, pioneering ideas in psychodynamic music therapy, community-based treatment, and qualitative research methodology in music therapy as early as in the 1950s.

Readers, such as this one edited by Michael McGuire, which bring together the major corpus of a single author’s works are relatively new in the music therapy literature. Others of a similar kind are Mary Priestley’s Essays in Analytical Music Therapy (1994), which was compiled by Priestley herself, and Music and Consciousness: The Evolution of Guided Imagery and Music, a compilation of published and unpublished writings by Helen Bonny, with biographical material included, which was edited by Lisa Summer (2002). To its credit, all three books have been published by Barcelona Publishers. Also noteworthy is that the three women who are the focus of these readers are all pioneers in psychodynamic music therapy. In my opinion, readers such as these are invaluable in that they provide us with the essential corpus of these writers over the course of their careers.

Michael McGuire is well-qualified to compile this collection of Tyson’s work. Not only did he know Tyson for 25 years as a friend and colleague, but as the founding editor of Music Therapy Perspectives (and editor for the first ten years) he prepared three of Tyson’s contributions for publication in 1982, 1984, and 1987. Following a foreword by Tyson’s long time companion, Saul Lishinsky, and a preface by music therapist, Christopher Bandini, McGuire organizes this book into seven parts, the first four being major themes about which Tyson wrote. After providing an introduction to each section, McGuire organizes Tyson’s writings within each theme chronologically. The seven parts are divided as follows: 1) The Music Therapy Relationship (theoretical foundations), 2) Case Studies (8 in all, one of which spans 3 chapters – and includes the patient’s perspective), 3) The Center (i.e., Creative Arts Rehabilitation Center), 4) Music for Healing (historical overviews), 5) Interviews, 6) Perspectives on Florence Tyson and Her Work (by McGuire and music therapist, Christine Stevens), and 7) Appendices (including Tyson’s CV and a bibliography of her works). The chapters hold together well within each theme. However, I suggest reading part 6 and the first chapter in part 3 first, as these chapters contain background information about Tyson and her community work which provides a helpful context before delving into her ideas and her clinical work.

The importance of this book cannot be separated from the importance of Florence Tyson as a historical figure in music therapy. Thus, instead of going through each of the seven parts and providing a short overview, I have decided to provide you with a glimpse of Tyson and her work by extracting examples from the writings that struck me as highly significant. Let me begin with some background information, which McGuire has largely presented in parts 6 and 3.

Tyson's Background
Florence Tyson was born in 1918. She began learning the piano at the age of 6 and the significant impact of this experience on her is evidenced in her claim that “it was her soul.” She graduated high school in 1935. Although she began college, due to financial constraints she never completed a college degree. Given her love of music, when she heard that there was a job available as a development officer with the Musician’s Emergency Fund (MEF) she was determined to get it and she did. The MEF was a very early and strong advocate of music therapy in the US. By 1952, Tyson became the director of the Mental Health Division of MEF. Her job was to supervise music volunteers working in hospital settings. In this position, she recognized the need for outpatient services for patients, and in 1956 conducted a pilot program implementing a community-based rehabilitation program. In 1958, only 8 years after the Music Therapy Association was formed in the US, the MEF opened the Music Rehabilitation Center under the directorship of Tyson. The philosophy was to help people stay in the community longer and reduce time in inpatient treatment. By 1962, with the MEF no longer able to fund the center, Tyson, determined to keep the center running, founded the Creative Arts Rehabilitation Center (CARC) in New York City with a dedicated staff of 10 therapists who were willing to work on a voluntary basis for the first year until sufficient funding was raised.

Although not formally trained in music therapy or psychotherapy, Tyson emphasized high standards of clinical practice. As early as 1963, she made sure that the music therapists working at the center were registered with NAMT (most of whom were registered based on experiential equivalency as was Tyson herself); she expected music therapists working in outpatient music therapy to undergo or to have undergone at least three years of psychoanalysis themselves (I am assuming Tyson underwent this herself, although this is not indicated in any of the writings); the staff at the center had regular supervision with a consultant psychiatrist; clients (or patient-members as they are referred to) at the center had to be referred by a mental health professional and remain in treatment with a mental health professional while attending CARC; and, regular communication was maintained between CARC and the referring agency/person.

As I read this book, I found myself continually inspired by Tyson’s vision and dedication. In the early 1960s, Tyson was on the cutting edge not only in the music therapy profession, but also in community mental health. As Christine Stevens states, when Tyson created CARC in 1963, she “showed tremendous foresight in identifying a need for a continuum of services” (p. 362). This is even more significant when one considers that the idea for this originated in 1956 and it was not until 1963 that the US “Congress enacted PL88164, which appropriated funds for the construction of community mental health centers” (p. 362). Furthermore, as late as 1988, the center was described as the first and only mental health agency in the US devoted solely to creative arts therapies. In her Eulogy (2001), Ken Aigen described Tyson’s thinking in terms of community-based treatment as being decades ahead of most (p.205). And, McGuire states that the guidelines for music therapy services in the community, although written in 1958, could serve as the basis for a programmatic proposal today (p.205). In it, she offers very helpful advice for music therapists working in private practice.

Although her vision and dedication in terms of creating and running CARC is impressive, Tyson’s historical significance in terms of utilizing a psychodynamic orientation to music therapy is unprecedented. She is the first music therapist, who I know of, to have written about a psychodynamic approach to music therapy (Hadley, 2003). McGuire describes her approach as eclectic (sometimes utilizing psychoanalytic, person-centered, behavioral, cognitive, gestalt, etc., concepts), although predominantly psychodynamic in orientation. The main influences on her work come from Balint, Freud, Erickson, Hartmann, Mahler, Langer, and Arieti. She wrote about transference and counter-transference in the therapeutic relationship. Furthermore, Tyson viewed the role of the music therapist in terms of object relations. She felt that regression was necessary before proceeding to higher achievements, based on Balint’s basic fault theory. Tyson believed that music is a symbolic language through its forms, not its contents. She wrote early on about the symbolic significance of music and of musical instruments. She posited a relationship between musical growth/arrestment and psychological growth/arrestment. She believed that music was the bridge between inner and outer worlds and that achievement of outflow was blocked by guilt, anxiety or self-destructiveness. Therefore, she encouraged “patient-members” to participate in music to encourage outflow of expressiveness. Yet, while she believed that unconscious processes shape behavior, she warned music therapists about imposing a single technique of a one-sided theoretical system as sometimes the cause of illness may be organic.

Telling Stories
Also noteworthy, and much in evidence in this reader, is Tyson’s qualitative approach to research at a time when experimental research was predominant in the US. Tyson utilized case studies to delineate her work. She felt that by telling stories that the message and meaning of the work could be considered. She was quick to point out in her conference presentations that she was not going to present techniques for general application. In fact, when one reads through this collection of her writings, there is a notable lack of description of musical techniques. Her approach was to provide “music instruction” (in a wide range of instruments, voice, and theoretical subjects), which functioned as the basis for the therapeutic relationship. However, the therapeutic intention always took precedence over music-learning considerations. This, for me, was a notable difference from the approach Mary Priestley developed. While Tyson and Priestley based their work on very similar constructs, Tyson places far less emphasis on the music or music techniques. What I also found interesting in my reading was that while both Tyson and Priestley were working with similar constructs at around the same time, neither make reference to the other’s work.

With my own interests in narrative therapy and feminist thought, I was fascinated by two other aspects that I noticed in Tyson’s work in the 1970s. Not only did Tyson “tell stories” about her work, but she often explored with her patient-members that they were trapped in someone else’s script of them and that they needed to re-write their own script, that is, to engage in the process of re-authoring their lives. Also, in terms of empowering patient-members, there are several examples, but what struck me was that she co-presented a case study with one of her patient-members (at two different periods of this patient-member’s treatment) at several music therapy conferences. This allowed the patient-member to have her voice heard and to further grow from the actual experience of presenting. From the words of this patient-member it would seem that there was some resistance from the music therapy community to the type of work that Tyson was doing. She said that there was tremendous hostility from the audience and a tidal wave of shock or anger. This gives a glimpse of how Tyson was received by many music therapists in NAMT in the 1970s.

Professional Hardship
Although Tyson had strained relations with some of the music therapy community, she maintained a good working relationship with music therapists from New York University, supervising many of NYU’s music therapy students. She also maintained strong ties with the MEF leaders and the New York community of psychiatrists. Furthermore, she had strong financial support from influential people, including famous people involved in the Arts. Also noteworthy is that Dr. Oliver Sacks served as a medical advisor to CARC from 1988 on.

Due to financial difficulties, CARC closed in the mid 1990s. It appears that with the closing of the center and the consequent reduction of responsibilities, Tyson’s health declined and she died in 2001. As a testament to her work, in 2002 a small group of creative arts therapists who had worked for Tyson opened the Creative Arts Therapy Space for private treatment in order to continue Tyson’s legacy.

Conclusion
While reading this book, I was struck by the descriptions of Florence Tyson. Integrity was a word that was used several times: the integrity of Florence the person, who was described as honest, direct, and someone you could believe in both as a person and as a therapist; the creation of CARC was also seen in terms of her integrity in that it was an emergency response to the needs of mental health patients at that time; and, the integrity of the staff was another indication of the integrity of Tyson. They believed in her vision, in what they were doing, and they did it with integrity.

Also included in the book is a description of the development of the music therapy profession in the US, the first part of which was written by McGuire and the second part by Tyson. This is a helpful resource and interesting from a historical perspective. While the material in this chapter was informative, it was not essential in the understanding of Tyson’s legacy.

Much of the material in this book can be found in the Florence Tyson Archive at Temple University, Philadelphia. Archives of music therapists are a relatively new phenomenon. However, Temple University houses the Mary Priestley Archive, the Helen Bonny Archive and the Florence Tyson Archive. These archives are of tremendous historical significance for the profession, as are the anthologies/readers of the work of these three psychodynamic music therapy pioneers. What the music therapy literature needs now is to have critical readers on the work of significant contributors to music therapy in which a cadre of scholars critically reflect on the primary works of these and other pioneers.

The most interesting parts of the book for me were the case studies and the perspectives on Tyson and her work. The part of the book on the center, while essential to the understanding of the legacy of Tyson, had several chapters which were very similar in content. While this is a compilation of Tyson’s work, there are instances in this part (part 3) where the material is replicated several times. It would not have taken away from the integrity of the book were some of these chapters omitted.

Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson is a solid contribution to the music therapy literature. Given that the writings span from the late 1950s to the early 1990s, there may be claims that can be contested, terminology that may be out of date, and practices that may be questioned on ethical grounds. However, what is fascinating about Tyson’s work is its relevance in terms of current issues being grappled with in music therapy. The book is engaging and informative. Today’s music therapists will gain much from engaging with the early groundbreaking work of Florence Tyson.

References
Hadley, S. (Ed.) (2003). Psychodynamic Music Therapy: Case Studies. Gilsum, NH: Barcelona Publishers.
Priestley, M. (1994) Essays in Analytical Music Therapy. Gilsum, NH: Barcelona Publishers.
Summer, L. (Ed.) (2002) Music and consciousness: The Evolution of Guided Imagery and Music - Helen Bonny. Gilsum, NH: Barcelona Publishers.

This book review was released March 4, 2005. ©2005 Nordic Journal of Music Therapy

Psychiatric Music Therapy in the Community: The legacy of Florence Tyson (2004)

Michael G. McGuire, Ed.
Barcelona Publishers. ISBN: 1-891278-15-0 398 pages
4 White Brook Road, Gilsum, NH, 03448 United States
Website: www.barcelonapublishers.com

Reviewed by: Nadine Elizabeth Cadesky, MMT
PhD. Student (Temple University)

Published in: Canadian Journal of Music Therapy (2007), Volume 13.

Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson chronicles the life work of Florence Tyson, who pioneered, and did ground-breaking clinical work in community-based psychiatric music therapy in the USA. This book serves as both a historical document and currently relevant resource. It includes many of Tyson’s published and unpublished writings, presentations, and interviews, along with commentaries and essays by key colleagues, friends, and “patient-members” (“Patient-member” is one of the terms Tyson and McGuire used to refer to individuals who attended her center for therapy. Patients were valuable members of the center’s community).

Editor McGuire, was Tyson’s friend and colleague for 25 years, and had great respect for her, calling her an “astonishing woman…an accomplished musician and printmaker, an extremely sensitive therapist, an advocate for justice and equal rights, and a person with a powerful intellect” (p. 354). I find it noteworthy that McGuire is donating the proceeds of the book to a research award in her name: The Florence Tyson Fund to Study Psychotherapy at the American Music Therapy Association.

McGuire organized the writings in this anthology into seven parts based on subject matter, which meant, for instance, separating Tyson’s 1981 Psychiatric Music Therapy, and placing particular chapters into different areas of the anthology. The overall sequencing and organization of parts make sense, though the material in chapter 2 and section 3 seemed easier to follow on a second read.

Part one: The Music Therapy Relationship outlines Tyson’s clinical approach, and the results of a study of 50 of her long term patient-members, and their conscious and unconscious motivations for seeking and engaging in music therapy. The case examples bring the material to life, and both theory and clinical material prove informative. Part one prepares the reader for the extensive case material presented in Part two.

Part two shows the range and depth of Tyson’s work, and includes an excerpt written by one of Tyson’s long-term patient-members, who also co-presented with Tyson, and fundraised for the center. In reading part two, the reviewer saw and felt the struggles and perspectives of clients, and the depth and complexity of therapeutic processes, Tyson’s clinical expertise and therapeutic use of self. It was a fascinating experience to really sit with how Tyson classified her work and why, and how I might classify it both in terms of depth and breadth.

Part three introduces Tyson’s work related to the Creative Arts Rehabilitation Center, the community center she founded. It includes writings associated with its creation, administration, and clinical approach, and an essay on the integrity of the center, by Joan Winer Brown. It also includes McGuire’s chapter on the center’s annual musicales. These writings underline what Bandini, one of the authors in the anthology, called Tyson’s “true legacy” (p. xvii).

Part four contains material from Tyson’s 1981 book, namely, the first four chapters, which address the origins of music, music and medicine, music therapy in hospitals, and the development of the field itself.

Part five presents transcripts from two interviews that Tyson and others gave to the media. Part six features two perspectives on Tyson, written by McGuire, and Christine Stevens. McGuire’s chapter focuses on Tyson the person, her vision for the center, and her role as executive director. Steven’s chapter traces Tyson from her early role with the Musician’s Emergency Fund to the creation of her Creative Arts Rehabilitation Center, while also providing interpretation of her clinical model. Part seven contains several appendices, including Tyson’s eulogy to a patient-member named Estelle, a bibliography organized by subject, Tyson’s Curriculum Vitae and the job description she embodied through her work at the center.

This is not the kind of book one reads at a safe distance. For this reviewer, it required active intellectual and emotional reflection. I found the clinical material inspiring, at times challenging, often provocative, and always real. I often felt challenged to put myself in Tyson’s shoes, and this was a valuable learning experience. Doing so raised important questions: How might another music therapist have handled the dynamics and boundary issues that Tyson met in her work? How might another therapist have classified the work, both independently and in relation to other therapies in the interdisciplinary context? If another music therapist were doing the work Tyson did, could she or he have fulfilled the therapist role described by Tyson?

Therapists may be surprised by the depth of clinical work Tyson did with some of her patients, and the interactions she had both in and out of sessions. They will certainly see the qualities she needed to have, in order to do that work. Brown believed, that “because Tyson existed for the patient alone, she could not be manipulated to the patient’s detriment. And she could not be frightened – not by anything that represented the patient’s courage in confronting his or her pain” (p. 286). Tyson herself wrote the following about her work with one particular client: “Only deep honesty offered her anything, and facing and naming together the depths of despair and loneliness, of hopelessness and injustice, and, finally, of love” (p. 74).

This reviewer came out of reading this anthology, with a greater understanding of the needs of people with psychiatric disorders, along with a better grasp of the kind of therapist that could provide for those needs. I was touched and inspired by Tyson’s capacity and willingness to acknowledge the struggles and strengths of her patients. She showed great respect for their personhood. I was also particularly influenced by Tyson’s therapeutic flexibility, and the evolutionary, developmental, and psychoanalytic orientations she articulated and employed in practice. Tyson’s ability to clearly and thoroughly articulate her clinical reasons for relating the way she did added to the depth and relevance of the anthology. And for this reviewer, Tyson’s substantive understanding of how to use voice with this population, and the depth of work that occurred in case examples proved especially interesting. Her Individual Singing Instruction: An Evolutionary Framework for Psychiatric Music Therapists, (chapter 11), gives considerable attention to roots and manifestations of communicative regression, and the efficacy of a vocal approach in counteracting it. She provides insight into the biological and psychological issues that affect communication, and relationship with self and others, and frames the material within an evolutionary and developmental perspective. She articulates clinical applications clearly and thoroughly. The material relates specifically to work with individuals with psychiatric illness, but much of the information could generalize to voice work in areas such as depth-oriented music psychotherapy with typical adults and trauma survivors. Thus, Tyson was also a pioneer for the handful of music therapists who have followed her interest in the use of voice in music therapy.

This anthology chronicles the context Tyson developed for the work she did; her Creative Arts Rehabilitation Center, a project her life partner Saul Lishinsky, called her radical statement. “Tyson had a deep, great social consciousness, [she was radical,] but not in the typical sense of the word. The center was Tyson’s ‘radical’ statement, and her social commitment was the root, the source of her career” (p. 210).

So readers will have the opportunity to find inspiration in not only Tyson’s clinical work, but the whole professional and clinical model she built to house that work. Tyson’s anthology will likely support and inspire music therapists in all areas of practice, but it will provide particular support to psychiatric music therapists who find themselves professionally undervalued for the work they do, to therapists looking for an opening into new clinical possibilities, and to therapists wishing to understand how to expand their use of voice in therapy. And Tyson herself will be a source of inspiration, for the courage and vision she had, and her great contribution to the field of music therapy and the lives of her patient-members and those lucky enough to work with and learn from her.