This post is our next in the new series of posts focused on music therapy and interdisciplinary work in end-of-life care. I’m bringing you my contribution as a music therapist who is also trained as a depth psychotherapist.
I decided to pursue doctoral work in depth psychotherapy because of my private practice. I had my bachelors and masters in music therapy, and I also had done post-grad training with Diane Austin, but I didn’t feel like any of these prepared me for the range and depth of material that emerged when I started working one-on-one with the group that is sometimes known as “the walking wounded,” people like all of us who are living life, negotiating relationships and meeting life’s responsibilities, but suffering deeply underneath. I have grown and changed immensely as a private practice psychotherapist from my depth coursework and supervision, but I feel that depth psychology has been a helpful contributor to my end-of-life music therapy work as well.
Psyche and Ego
In some ways, depth psychology is a philosophical stance and life approach, more about the way you think and “are” than something particular that you do with patients. It’s probably that quality that allows it to be so applicable to multiple areas of clinical practice (and honestly, to life). If I had to distill it down to one thing, I think the most important part of my depth psychotherapist identity to clinical work is the philosophy of psyche- versus ego-led practice.
The terms “ego” and “psyche” are sort of synonyms for “conscious mind” and “unconscious mind,” which I have written about in the past. The ego is everything we know about ourselves, and our egos like to think that they are in control, that their way of knowing is “the” way. Life according to the ego is logical, explainable. With psyche, on the other hand, everything is much more mysterious. Logic is immaterial, and many things are unknowable. What ego thinks is fact, psyche may disagree.
In depth psychology, the work is psyche-led. What this means, first of all, is that psyche literally leads the work. I show up and I bring myself, and my knowledge and experience, but I don’t control what goes on between me and the patient; nor does the patient. Our individual psyches mix with all of our individual wounds and areas of weakness and strength, and Psyche, the greater psyche (what used to be known as the collective unconscious), holds us and directs our work. Sometimes this is very hard to remember — my ego often wants to feel like it is in control. I have to remember that this is what my ego wants, but my ego is not the whole story.
When I am aware that my work is led by psyche, I try to focus only on being present, both to what is happening in me and in my body and also to what is happening for the patient. I try to approach each session without “memory or desire,” when that’s possible — I don’t arrive with an agenda or a pre-set goal for the patient (or even the goal of looking for a goal). My goal for myself is to connect with the patient, however that might happen. I speak very little in many sessions, because I am attending to what emerges rather than facilitating an emergence. I value silence, because this can give the patient space to experience his own internal world. I also value affect, and know that no one can control their feelings beyond repressing or dissociating them (although we can control how we behave as a result of our feelings).
Music Therapy and Depth Psychology
There are no real “rules” or procedures with these ways of approaching a session — rules and procedures are what ego wants, not what psyche wants — but to provide illustration, I will say that many of my music therapy sessions involve me entering the room and introducing myself and saying nothing else until the patient initiates what might happen next. I don’t know in advance what their response to me might be… frequently they see the guitar and are interested in music, but other times the lack of direction from me leads them to begin with a feeling, thought, or fantasy that allows us to go much deeper when we do begin to use music. Going deep is, of course, a big part of this kind of work. I don’t push the patient toward his depths, but I do follow him there, and try to draw his attention to his own experience in that place, namely, his emotions and fantasies.
I tend to think in terms of the transference and talk about it regularly with patients. If I go in to see the patient and he tells me about how the doctors are lying to him, I understand that as part of the attitude that he has towards me right now, probably unconscious. I am likely to eventually respond with something along the lines of “it must make you wonder about whether you can trust me, too.” If the patient is able to speak to that part of their experience (and my experience has been that they often are), then we have a way to process the experience of feeling mistrustful right in the moment, and to metabolize the emotions attached to that experience. When I allow the patient to implicate me in his feeling experience, we get to go through it together, which is different than what happens when the patient says the doctors are lying to him and the therapist responds with “That must feel terrible” and no transference interpretation.
Depth psychology has provided me with a meaningful paradigm for understanding, and feeling the deep significance of the phenomena that occurs between me and the patient in moments of music making. Singing “to” a patient in this setting has never felt like a real “singing to” in a performance sense for me — the feeling of connection that happens in these moments is nothing like a performance. I can feel that the patient and I are communicating, unconscious to unconscious, and that our mutual libidinal investment in the music is part of what holds and seals our connection, as well as the patient’s connection to the primitive parts of his mind that music can access. (And me to the primitive parts of my mind, as well.)
End-of-Life Perspectives from Depth Psychology
Michael Kearney is an end-of-life physician and depth psychotherapist who has written beautifully about depth psychology (particularly Jungian thought) in the end-of-life space, and he writes about the importance for the dying patient of going past the ego (which constructs defenses such as denial, as well as our fear of dying) to the level of psyche, or soul. That when the patient can find what is meaningful for his psyche, and connect on a soul level, there is a psychological healing that can happen without “breaking through” the ego. The defenses can stay intact while the caregiver and patient interact on the level of psyche, with willingness to confront the powerlessness and unknownness that lurks there. Music can help us do exactly this kind of work when the therapist is able to let go of the ego need to control and foster an openness to whatever content might surface (be it inspiring and beautiful or dark and frightening, as the numinous can take both forms).
Training in depth psychology has deepened and pivoted my perspective on life in general, and also helped me to see how deeply my own life stance is inextricable from my work stance. If I want to work deeply I need to develop my own comfort with unpredictability in the beautiful, invigorating light and the ugly, terrifying darkness as it manifests in human experience, including in relationships with others and with self. Making space to allow these things to emerge out of silence or out of the transference relationship or out of the music has deepened my work and my understanding of the world in ways that I could never fully articulate. But I am grateful to have had an opportunity to try and to share that here.