Multidisciplinary

Intersections of Depth Psychology and Music Therapy

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.

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6 thoughts on “Intersections of Depth Psychology and Music Therapy”

  1. “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.”

    This is really resonating with me. It’s not uncommon to hear in our circles that how one lives is how they die, and to that point I’ve increasingly been considering the importance and relevance of those decades of relational patterns and cognitive/emotive constructs that patients bring with them. For better or for worse, those patterns and constructs were the means by which they survived life to this point. That process of survival requires our acknowledgement and respect, even when we can identify that survival as maladaptive to more healthy means of functioning. Except in rare instances it’s not realistic or ethical to expect a person to fundamentally alter or transform the means by which they interact with themselves or their environment, so we are challenged to roll with those defenses in the service of the best possible death. I’m finding this theoretical concept of psyche and ego helpful in explicating that clinical process.

  2. I’m so glad that point resonated with you, Noah. You probably would really enjoy Michael Kearney’s book (in your spare time, hahaha). There are lots of music therapists who talk about respecting defenses at this time of life, rather than trying to break them down, and I think the distinction with this is subtle but significant. In the way that I work, I wouldn’t defer to defenses or avoid working with them… but I wouldn’t look for them either. My focus is to respond to the patient in the moment, trying to stay grounded in psyche and focusing on affect and relationship content. For instance, with a patient who is using denial I would neither try to dismantle the denial nor try to “respect” it in a way that suggests not touching it or not examining it. But when content that is more depthful emerges, meaning affect, transference material, fantasies, dreams, etc., I follow that — not looking for meaning or logical understanding (what ego wants) but just to honor the content and see where it takes us. I have found that sometimes it can take us to talking about the denial, but almost from underneath the denial if that makes any sense. Often it is the music (often, in my experience, patient-selected songs) that leads us to that place. Thanks so much for the thoughtful comment.

  3. Agreed – respecting a defense doesn’t mean not acknowledging or working with it when it organically emerges. If anything, it’s disrespectful to act like it’s not there at all. That’s the pathway to superficial “kumbayah” therapy that can lead to an outright ignoring that death is pending. It’s good to air out the line between “acknowledging and working with” and “confronting and altering”. I find the “working underneath” to be a narrative interwoven throughout so much music therapy, but it so often goes silent and uspoken. It’s the narrative that we sought to uncover and explicate in our upcoming JMT publication about symptom management in cancer care. Symptoms and defenses are an interesting parallel in that each are expressions of deeper truths and experiences, and it’s at that depth more meaningful work has the potential to manifest.

  4. Interesting that that same particular section stood out for me also, Noah and Meghan. Obviously, since I work with a different group of people and not generally in end-of-life, the thoughts that were triggered for me were in another direction. An issue that often comes up for me, in supporting folks who seem to experience chronic trauma, is whether – and if so, when and how- it’s appropriate (or even ethical) to mess with someone’s defenses (unless the defense is being expressed in a way that is behaviorally disruptive, self destructive or aggressive that continuing in that particular way is truly creating an unsafe situation). The need for the defenses seems to be ongoing (since their life situations don’t change much), so I am struck by what you’re saying about working in a way that respects the necessity of defenses but allows a deep connection.

    I must admit that, because I work with folks who don’t use speech as their first language, I’m always rather paranoid about injecting/projecting my own perspective (as a mostly neurotypical person) into/onto the person of my clients. I think using music is one of the few ways I can have a deeper experience of “knowing with” (if that makes any sense).

    I also appreciate your comments about noticing the intersections between your work and your life, especially since I’ve had a similar experience. When I look back on session notes from 10 years ago I’m astonished by how much I’ve changed and, by extension, made space for my clients to grow in new ways over the years.

    I’m curious, Meghan, how you interpret/understand/work with (sorry for my slash obsession) people who avoid music.

  5. Thanks for those thoughts, Roia. Yes, I think the work must be very different when the people you are working with are mostly not able to tell you about their experiences. In end-of-life work obviously we do sometimes work with people who are less/not verbal, but my depth psychology training was for work that happens, for the most part, with the neurotypical patient. That said, I do think that when psyche leads the work these questions are much less important, because you just go where psyche leads you. Or you try to, anyway. I have found it easier said than done. But I don’t find that those questions about “should I do this or that” plague me so much anymore because I do know intellectually that it’s really not in my control.

    As for your question, over the years I have worked with lots of people who avoid music. I think that’s perfectly understandable because music connects us with very primitive parts of ourselves, and those primitive parts arouse anxiety. I actually think that direct avoidance of the music is healthier than what music therapists often do, which is to try to control it and make it something that’s supposed to lead to “outcomes” that are predictable or that fit into neat categories in some way. We like to pretend that the connection to primitive parts doesn’t happen (instead it’s all fun, or all catharsis, or all positive transformation) and that we are in control of how music affects the patient. Music psychotherapists are as guilty of this as those who espouse a biomedical/behavioral/positivistic model. Anyway, if a patient wants to see me but doesn’t want to use music together, I know they are looking for something that I offer that other members of the team do not, and that thing is probably at least in part the fact that I am a music therapist rather than a social worker or chaplain. (Brian Abrams’s 2010 article on music as a temporal-aesthetic way of being (in Arts in Psychotherapy) has been very useful and grounding for me in this regard, to feel that I offer something as a music therapist, something musical, even if we are not creating sound stimulus.) So I may eventually ask about why we aren’t using music, to try to open up the anxieties, or I may just sit with what emerges and follow the patient with whatever content he introduces.

    Of course, Roia, the fact that my music therapy training (which I think was excellent, by the way, and more comprehensive/depthful than most) really didn’t give me enough grounding in how to work verbally so much is a big part of why I went back to school. So while it may be true that “just talking” can also be music therapy, a music therapist who is “just talking” with a patient probably shouldn’t confuse that with verbal psychotherapy, because being trained in music psychotherapy isn’t the same thing as being trained in psychotherapy. And that’s where all of this becomes a bit cyclical, because the only way that I knew how to solve this problem was essentially to get 3 more years of training and a whole other degree. In the end, my answer is that when people don’t want to use music I don’t use music and I rely on my psychotherapy training. Before I had psychotherapy training, I would do my best to just be with them without music using my music psychotherapy training, but it frankly was not enough to responsibly provide verbal interventions that had any kind of real depth.

    You always know how to cut right to the quick of things. I hope some of that made sense.

  6. Loved reading this post and its comments. Thank you for sharing.
    I am wondering where you got your training, Meagan, as it seems to have taught more of a psychoanalysis standpoint than a behavioral one.

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