Smeijsters, Henk (2005). Sounding the Self: Analogy in Improvisational Music Therapy. Gilsum, NH: Barcelona Publishers. 215 pages. ISBN 1-891278-22-3.
Reviewed by Brian Abrams, Ph.D., MT-BC, LPC, FAMI, Immaculata University, Pennsylvania, USA.

In Sounding the Self: Analogy in Improvisational Music Therapy, author Henk Smeijsters provides a comprehensive account of his theory of analogy. This theory is a general theory of music therapy, as it is designed to explain how and why music therapy works in the treatment of psychopathology, in one particularly central and important way.

Summary of Content
The book is divided into two major parts, each consisting of a number of chapters. Part I (Chapters One through Three) provides the reader with important contextual foundations for the development of the theory of analogy. Part II (Chapters Four through Eleven) provides the actual basis of the theory of analogy itself, and its implications for music therapy practice and research.

In Chapter One, Smeijsters offers the reader an historical and multiperspective account of the development of evidence-based, psychotherapeutic music therapy. He describes a progression of distinct stages ranging from past to future, and submits that the success and public legitimacy of the music therapy field ultimately depend upon this progression eventually culminating in a theory explaining the types and degrees of effects that specific music interventions have on specific psychological conditions. The author also summarizes his own pursuit and contributions to this development, consisting of years of thought, dialogue, literature review, and research (both quantitative and qualitative).

In Chapter Two, the author provides a careful consideration of psychotherapeutic indications for music therapy, based upon empirical research findings and feedback through peer debriefing. He provides specific examples of particular populations with certain characteristic clinical needs. The author cautions against oversimplified views holding that music therapy is always indicated because of nonspecific health properties. Rather, he advocates for client-centered indications, involving the case-by-case consideration of whether (and in what specific form) music therapy is right for a given client. Although the theory of analogy is not yet discussed in depth at this point in the book, the implication is that analogy is not a vague, nonspecific health property of music, but rather a central principle that takes multiple forms, and which must be discerned carefully in each case.

In Chapter Three, Smeijsters overviews the significance of developing a general theory of why music therapy works. He summarizes the kinds of issues that arise in considering such a project, including specific responses from music therapy peers when presented with the idea (peer debriefing).

Chapter Four describes distinctions between the kinds of knowledge imparted through symbolic communication (such as verbal language) and the kinds expressed through music. Specifically, symbolic communication offers knowledge about something, whereas music offers direct, intimate knowledge in something (e.g., the lived experience of a client). This is the case because meaning in music is derived not by interpreting the musical form for its content, but by regarding its form that is its content. In other words, being in music with a client is being in the experience with a client, and while a therapist may not fully understand a client's inner life world, the therapist can share those elements of the client's experience that are sounded in her or his music.

In Chapter Five, Smeijsters summarizes the process and results of a qualitative "desk" study in which he analyzed the writings of many music therapists representing multiple theoretical orientations, in order to formulate a core category of what makes music therapy work. A core category as defined by the author is a metacategory, because it (a) is used by many music therapists from different theoretical orientations, (b) subsumes other categories, (c) occupies a central position between categories, and (d) applies to a broad range of clinical conditions. The author reports that the core category resulting from this study was that of analogy, or the relationship of sameness between the way a client feels/is and the sound of the client's music.

Chapter Six provides the reader with important foundations for the author's theory of analogy. Drawing upon the research and theory in the fields of developmental psychology and semiotics (particularly the work of Daniel Stern, whose work is art-based), the author shows that because vitality affects (the dynamic, kinetic qualities of emotion) are amodal (i.e., not tied to any specific manifestation), and because they are themselves expressions of what Stern terms protonarrative envelopes (i.e., deeper structures common to both inner feeling and perceptual forms), feelings expressed in the auditory modality as music are instantaneously meaningful as the feelings they express. In other words, musical expressions are morphologically analogous, and functionally linked, to feelings themselves. Thus, by working within and transforming musical forms, the client transforms her or his forms of feeling. Likewise, the therapist who works with the client through music is at the same time working with the client in the world of feeling forms, without having to perform any cognitive acts of interpretation across the two modalities. The author then offers a number of examples of these analogies in music therapy.

Chapter Seven provides a refinement of the definition of analogy as it applies to the author's theory. The chapter includes an exploration of an intermediary language that is musically and psychologically meaningful, simultaneously. Because this intermediary language is an amodal language of protonarrative envelopes (as described previously), it is thus a language of analogy.

In Chapter Eight, Smeijsters elaborates upon the analogous relationship between the musical and the psychological by demonstrating how musical interaction sounds the interpersonal process. He begins by describing the various, amodal parameters of two specific analogical devices, conservation and variation, as they apply both to musical and psychological phenomena. He then provides illustrations of conservation and variation operating in the case of Edward, from the Creative Music Therapy (Nordoff-Robbins) literature, and in the case of Ingrid, from the author's own clinical research.

In Chapter Nine, the author offers additional evidence supporting the theory of analogy, drawn from single-case research studies. Chapter Ten offers ideas about conducting qualitative research concerning the theory of analogy, through naturalistic inquiry. Chapter Eleven offers a conclusion to the book, in the form of a discussion of comments from the author's colleagues regarding his theory.

Context of Reviewer and Author
In formulating my comments and reflections about this text, I recognize that I am writing from my own particular cultural and professional context. I am an American music therapist, primarily oriented within psychodynamic and humanistic-existential psychological orientations. I have practiced music therapy since 1995, working with a wide range of clinical populations and methods. A significant part of my work has involved clinical improvisation, as well as receptive methods such as the Bonny Method of Guided Imagery and Music. I currently serve as Director of Music Therapy at a private university.

I also recognize that am writing in response to an author with his own particular cultural and professional context. The author's home of the Netherlands, centrally located in Northwestern Europe, have sustained a lengthy history of occupation by other cultures (Roman, Germanic, Spanish, etc.). In part because of this, it is a nation that is simultaneously influenced by many others (including languages, values, etc.), yet continually strives for its own unique identity and voice. It embodies a culture that deeply values progressive thought and the active exchange of ideas through dialogue, which has resulted in many of the great historical and present-day contributions to science, art, and philosophy (by Dutch natives as well as by welcome visitors).

Regarding Smeijsters himself, I understand him to be a music therapy scholar with a wealth of experience in the field, including extensive work with psychiatric populations and the use of clinical improvisation. From my orientation to his many writings, the author is clearly invested in the development music therapy theory. Specifically, his work seeks to bring parts together into meaningful wholes, and to make substantive connections between various perspectives and contexts that make up the mosaic discipline of music therapy. Examples include his work linking musical properties and categories of psychopathology, and his work identifying parallels between standards of integrity in quantitative and those in qualitative research. Moreover, he is committed to theory based upon the foundations of solid evidence and good reasoning, and expresses little tolerance for unsubstantiated, speculative, or emotionally-driven theory.

In many ways, the role of Smeijsters's work in relation to the music therapy discipline is analogous (to borrow his own term) to the challenges of Dutch culture. His work seeks to heal cultural fragmentation within the music therapy discipline by integrating multiple perspectives, and to make sense of the "noise" of the multiple cultures and languages involved (largely due to being "in the middle" of other disciplines, just as the Netherlands has had to contend with being "in the middle" of other European nations). Just as the Dutch have worked to create their own unique voice and a sense of their own firm ground safe from future conquest, so too has the author's theory work sought to create a voice that truly belongs to music therapy, and which is rooted on firm, evidence-based ground.

Commentary Upon Writing
This is a monumental work, and undoubtedly required enormous skill and vision on the part of the author. It is richly informative, and includes many resources and taxonomic charts that can guide music therapy practitioners and researchers through their work in psychiatric music therapy.

There is a poetic quality in the author's writing style, which draws upon multiple layers of meaning to communicate ideas to the reader. There is definitely a kind of beauty in that. The writing also seems to be presented in the style of a discourse—almost in the form of a scholarly lecture, with a sense that the author is speaking to the reader. In many ways, I enjoy this style, particularly as the author utilizes it. It invites the reader in, and establishes a kind of warm rapport. Moments of humor to express key ideas (like one subtle reference to Bob Dylan's lyric the times they are a-changin') show up brilliantly against the background of a predominantly serious theoretical work.

At times, I find that the author's ideas tend to "meander" a bit through his own musings, like a soliloquy. The result is that the ideas in the text do not always seem fully anchored in the topics of the chapters, the headings, and the subheadings as presented by the author. While I see the value of sharing the author's thought process with the reader to a certain extent, these sections feel somewhat unprocessed to me, and perhaps could have been further "metabolized" to help manage the reader's attention and to provide a greater sense of clarity.

As the reader, I am sometimes unclear about the relationship between the title of the text and its content. Although the title includes the phrase "improvisational music therapy," the author does not always remain within this domain when applying his theory. At times, he seems to apply it to music therapy in general; at other times, to all the creative arts therapies (perhaps this is in the spirit of inclusiveness—but I still feel the content should be reflected in the title as accurately as possible).

In addition, I find the writing to be repetitious about certain core points (particularly around the meaning of analogy). Perhaps the core points could be presented in a more consolidated, ordered, and clear way, so that their repetition would not be necessary.

Finally, although the author shares the story of how the theory of analogy was formulated, he does not provide the reader with very much information about the author's personal or cultural contexts, nor with very much about the author's own motives for establishing his theory (beyond certain professional bases). As the reader, I would be interested in all of these dimensions of reflexivity, as I believe they would provide me with greater insight into the work, as well as help further ground the theory itself.

Commentary Upon Content
Smeijsters's theory of analogy is undoubtedly a compelling one. It is comprehensive in its scope, and is vastly relevant across a wide range of clinical applications. The idea that music sounds the self is particularly consonant with the principle of music as therapy, or that changes toward greater health can occur within a music experience itself. It is important to note that in this theory, music does not only sound like the self, but actually sounds the self—it is not sheer resemblance (homology), but an actual affective-perceptual link on a real, functional level (supported by theory and evidence indicating that forms of feeling and forms of perception are interactive). While the client's deepening experience of this link enriches the therapy work (according to the author), the cognitive awareness of the analogy is not required in order for the principle to operate. In spite of the close connections between music and the self, the author does not venture as far as to claim that music itself is the self, as perception and feeling (while simultaneous and analogous) are not the very same thing (Chapter Eleven). This differentiation makes therapy possible, as the client can work within the creative/expressive medium of music, not subject to the constraints of the self's "native" psychological medium.

In a way, construing the musical as analogous to the psychological is certainly one of the essences of thinking like a music therapist, and is an expertise that sets music therapy distinctly apart from any other discipline. For many music therapists, it is core to their professional identities, yet many may be applying this principle without realizing it. On their behalf, Smeijsters has made the implicit explicit. Many music therapists accept Suzanne Langer's famous morphological assertion that music sounds the way feelings feel, as an appealing basis for why music therapy works, but do so on faith without subjecting that explanation to critical scrutiny. On their behalf, Smeijsters has taken that additional step, through the rigors of empirical verification, correlation with existing psychology theory, and interactive dialogue. In this sense, the text helps demystify the basis of why music therapy works, and pushes the field as a whole to grow beyond the developmental primitiveness of magical thinking.

Smeijsters places considerable stock in the legitimacy of categories of psychopathology as established by psychiatry, and demonstrates how, through the theory of analogy; one can organize musical responses and needs according to the psychological features of these categories. However, he demonstrates how the theory of analogy also permits one to organize psychological dimensions according to musical dimensions, yielding whole new constructs of clinical needs among persons with psychiatric disorders. This carries the encouraging implication that the theory of analogy has something to offer to the field of psychiatric assessment and treatment that is both unique to the music therapy discipline and that is rooted in psychological science.

The author has worked hard to ground his theory and to render it trustworthy through member checking (by consulting directly with research participants), peer debriefing (through interactive dialogue among other music therapists), and triangulation with many different sources of research data and scholarly writings. In grounding his work, he is gracious in his inclusion of others' ideas. At the same time, he is not falsely diplomatic, and is forthright about where his own ideas diverge from those of others (including his own music therapy colleagues). In a real sense, he communicates respect for the ideas of others by treating them as robust enough to sustain disagreement and critique. Moreover, he genuinely acknowledges the limits of his own theory, both in its scope and applicability. He is clear that, as a general theory of music therapy, analogy is widely meaningful, but is not equally relevant in every case.

A number of questions do arise for me regarding certain elements of the theory, as articulated in the text. For example, given the theory of analogy, what are the implications of music experiences in non-music therapy contexts for people in everyday situations, such as improvising with other musicians? I fully accept that a music therapist is uniquely competent in the psychological implications of music experiences, so that music experiences in music therapy can be used specifically to promote the client's health. But if the theory of analogy holds, then the very same underlying mechanism would have to be operating in non-clinical music experiences as well: The music could sound the psyche, and then one's forms of feeling would shift as one's music changes. After all, how would the psyche make the distinction between music in therapy and a friendly jam session among friends? Therefore, because the analogy principle could be technically operating anytime there is music experience, it would seem important to consider the non-clinical implications of music experiences carefully.

From the opposite side of this same issue, there seems to be a self-contradiction in the author's response to a proposed objection to his own analogy theory (Chapter Seven). The objection is that transformations in therapy may not generalize other contexts in the client's life outside of therapy. The author responds by describing the therapy as the client "learning" another way to be, yet due to the context-specific nature of learning, special attention may be needed to help the client transfer therapeutic changes to other life areas. To me, a self maintains an identity independent of particular contexts. By applying the principle of context-specific learning here, the author seems to be implying that the client would not really be sounding the self, but rather sounding the music as a learned behavior.

I would also like to challenge the author's assertion that the expression of the musical artist is "conditional" whereas the expression of the improvising client is "unconditional" (Chapter Eleven). We know that the central purpose of therapy can be to help a client become free from self-imposed, developmentally-imposed, and relationally-imposed conditions, but that in the process, the music will be quite conditional (e.g., the transition from condition child to music child in Creative Music Therapy). Likewise, many musical artists struggle against convention and conditions within their own work, an are not satisfied until the work is (to them) free from externally-imposed conditions. This may prove a significant issue with respect to the role of analogy in music therapy methods that utilize pre-composed music (i.e., listening and re-creation).

Finally, I would also like to offer a perspective in response to Smeijsters's assertions regarding the role of analogy with respect to receptive music therapy methods (Chapters Six and Eleven). It is merely a proposed corollary, and is only speculative, but perhaps worthy of further investigation.

According to the author, analogy only works when the form of feeling is sounded in the perceptual form of the music. Although the author does assert that the theory of analogy can apply equally to receptive methods, the direction of activation (self?music) clearly favors improvisation, since one would have to find just the right music to play in order to match the client's inner state. However, could the theory also accommodate the possibility of the reverse process: That the analogous link can be established when the perceptual form of music is heard as one's form of feeling—or, rather than music sounding the self, one hears the self in the music? That would reverse the direction of activation (music?self), and would truly accommodate receptive methods. Just as the way I play music through improvisation instantaneously expresses who I am, so too does the way I hear music instantaneously express who I am. The whole musical product, per se, may not reflect me—but as an active listener, I instantly hear those aspects of the music that do reflect me. Then, as my way of hearing changes, I change as well (whether or not this ever means fully embracing the whole piece of music as myself depends upon my particular case and the accompanying clinical indications).

This could offer an interesting theoretical foundation for a method such as the Bonny Method of Guided Imagery and Music. Understood this way, the method would represent a synergistic interaction between the way of hearing the music as one form of perception, my inner forms of feeling, and the imagery as second form of perception that serves as a cross-modal expression of my way of hearing the music and my forms of feeling. The guide, who listens to the music with me while remaining aware of verbal reports of imagery and feelings as well as my nonverbal responses, would help me use this interactive triad by encouraging me to shift (or not shift) any of these elements in accordance with my clinical needs.

This also raises issues around the role of artistic aesthetics with respect to analogy. The classical masterworks of music used in the Bonny Method are particularly well suited to the therapeutic process that unfolds through the method. They are works of such profound imagination, creativity, and structural beauty that they transcend the constraints of specific societal and historical conventions, and remain in tact down through the generations (which in part explains why we continue to listen to the work of certain composers, but not others, from all periods throughout history). Clinically, they sound our super-healthy potentials (as in Maslow's concepts of peak experience and self-actualization—both beyond the mere absence of psychopathology). They need not be individually matched to the client because they are collectively meaningful on cultural and human levels, and offer many points of entry as our individual selves. Put another way consistent with the theory of analogy, the masterworks of music embody protonarrative envelopes of an archetypically well-integrated self. By accessing that resource through music imaging, and through exploring through different ways of hearing in different terrains of the great masterworks, I access possibilities for my own super-health.

Conclusion
Sounding the Self is a work of major importance. It represents the culmination of a long history of intensive inquiry and dialogue on the part of the author, who utilizes the text to present principles core to the music therapy discipline. It is an original, creative work that courageously takes on a topic fraught with elusiveness and paradox. Moreover, it invites continued exploration of the theory itself, and of its various ramifications.

The text is certainly a valuable resource for music therapy researchers, advanced clinicians, and music therapy graduate students. In many ways, the ideas in the text can also be helpful (perhaps in a more selective manner) to those studying or practicing at a more rudimentary level. I, for one, thoroughly enjoyed reading it, and I consider it a most welcome addition to the scholarly music therapy literature.

This bookreview was released June 15, 2006. ©2006 Nordic Journal of Music Therapy