Music Therapy-Holistic DORIT AMIR

Transcription

1 Music Therapy 1996, Vol. 14, No. 1, Music Therapy-Holistic Model DORIT AMIR This article introduces a theoretical model that comes directly from experiences in clinical work, yet is influenced by holistic principles in other disciplines. The author describes existing theories in the music therapy literature and explains the motivation for finding a theoretical framework that focuses on music-therapy processes and interactions, and allows for a deeper understanding of clinical work. The principles from medicine, science, psychology and music therapy that influence this model will be discussed. The Holistic Model is presented and illustrated with clinical examples. Introduction When we look at music therapy from a scientific point of view, there are three areas we need to consider: theory, practice and research. The profession of music therapy has developed mainly around practice and research. Until the late 1980s, the theories found in the literature were not indigenous to music therapy (Aigen, 1991). It seems that music therapists seek influences from outside the field of music therapy to help understand the processes occuring in the practice of music therapy. Even though there are many research articles in the literature, up until 10 years ago a substantial amount of music-therapy research was not relevant to clinical practice, particularly to creative methods. In 1980 Nicholas and Gilbert investigated music therapists attitudes toward research and found that most music therapists felt that the research literature was not relevant to their practice. Over the last 10 years music therapists have expressed a growing need to find a theoretical framework that focuses on the therapeutic process and allows for a greater understanding of clinical work (Ruud, 1978; Wheeler, 1981; Kenny, 1985, 1989; Hesser, 1988; Forinash & Gonzalez, 1989; Aigen, 1991; Amir, 1992). In the literature we see many attempts to connect music therapy with theories of psychotherapy (Ruud, 1978; Wheeler, 1981; Bruscia, 1987; Bruscia, 1991). In Bruscia s book on improvisational models (1987) there are also theories of speech therapy, occupational therapy, physiotherapy 44

2 Music Therapy-Holistic Model 45 and music education that serve as theoretical basis to understand music therapy practice. Indeed, music therapy is a profession that requires vast knowledge in psychology, psychotherapy and music. However, the music gives music therapy its uniqueness and differentiates it from verbal psychological treatments. Bruscia (1989) and Ruud (1978) agree that the challenge in developing a theory in music therapy is to focus on its uniqueness. It is not only adding music to psychological treatment, but the combination of music and therapy. Therefore, creating a music therapy theory that does not originate within any other discipline but comes directly from experiences in clinical work may enhance our understanding of the musical processes, interventions and interactions in music therapy. The key to finding meaning in music therapy is in the field itself: in the interactions between its participants, the environmental elements, and the music (Amir, 1992). Principles Taken from Other Disciplines that Influence the Model The Holistic Model in music therapy that will be described later comes directly from my own clinical practice as a music therapist. In creating the model I was influenced by principles and conceptions that come from holistic approaches in medicine, physics and psychology. In the field of music therapy I am mainly influenced by the theoretical work of Bonny (1986), Broucek (1987) Eagle (1991), and Kenny (1989, 1985). It is beyond the scope of this article to describe fully the theories of each of these people. A brief summary of the major princliples of each theorist will be given. In the field of holistic medicine, the person is seen as a whole human being, and therefore the frame of reference is not only physiological but also emotional, mental and spiritual. Chopra (1989) tells us that in order to be effective in treating sickness there is a need to focus on process, on interaction, on behavior, nutrition, life-style, and on biological rhythms (P. 52). Bonny, in her article Music and Healing (1986), says that the goal of holistic medicine is to pursue the well-being of the total person. It means that the total person-mind, body and spirit-must be brought to the healing table (p. 3). Music, says Bonny, is ideal for treating the total human being, since it is in both our inner and outer lives. In modem science I am mainly influenced by the writing of Capra s systems view; Bohr s principle of complementarity, and Bohm s principle of holonomy in the field of quantum physics as described in Eagle s article, Quantum Therapy (1991).

3 46 Amir According to Capra (1982), the new vision of reality is based on the awareness of the essential interrelatedness and interdependendence of all phenomena-physical, biological, psychological, social and cultural (p. 265). Systems are integrated wholes whose properties cannot be reduced to those of smaller units (p. 266). These wholes exist from the interactions and interrelatedness of their parts. Kenny (1987) builds a theory that is based on the whole-systems view: The Field of Play. Kenny (1985) defines system as a whole that is viewed as a complicated web of relations between its various parts. Kenny s theory is based on her own experience in clinical improvisation in music therapy. She sees clinical improvisation as a field that contains primary and secondary elements that are all interrelated with and interdependent on each other. Eagle s Quantum Therapy (1991) is based on principles of quantum physics, of which I will introduce only two that are relevant to my model. Bohr s principle of complementarity talks about the dual identity of matter. At the sub-atomic level, all being can be described equally as particle and wave at the same time (p. 57). Bohm s principle of holonomy says that a part of the whole contains all the information of the whole. and changing a part of the whole changes the whole (p. 59). Based on the above, in Eagle s Quantum Therapy there is no separation between process and product; the clinical material is process and product at the same time. Any situation in therapy is holistic or holonomic. We must see the clinical whole, realizing that it exists in a state of potentiality and probability ready to become either a product or a process (p. 60). In the field of psychology, I am influenced by the fourth force, transpersonal psychology. Transpersonal psychology sees everything in nature as wholes, where each whole is part of a larger whole- Fields within fields within fields, stretching through the cosmos, interlacing each and everything with each and every other (Wilber, 1983, p, 83). It unites Eastern and Western philosophies, while bridging and integrating psychology and spirituality It is concerned with the recognition, understanding, and realization of nonordinary, mystical or transpersonal states of consciousness, and with the psychological conditions that represent barriers to such transpersonal realization (Capra, 1982, p. 367). The study of consciousness has been an integral part of the transpersonal movement (Assagioli, 1991; Orenstein, 1986; Tart, 1983; Wilber, 1980). Bonny (1975) explored the connection between music and different levels of consciousness in her GIM model. She explains that when a person is in a heightened state of consciousness, the mind is able to

4 Music Therapy-Holistic Model 47 contain many ideas and experiences. The person s awareness seems to be intensified and enlarged, while consciousness itself can become multidimensional. In an attempt to expand perspective beyond the traditional scope of music therapy practice, Broucek (1987) wants us to focus attention on the potential of music therapy beyond the boundary of healing to wholeing (p. 50). If healing is the process of restoring health, than wholeing is certainly the process of restoring wholeness. And wholeness...involves a creative self, a spirit which embraces the fullness of life (p. 58). She talks about the music therapy experience in terms of life spirit, which is the creative spirit that has to be kept alive and nurtured. Our challenge as music therapists is to revive, sustain and nurture each client s life spirit. This Holistic Model is based on direct experience in the field. It looks to discover and understand the structure and form of the musical experience and its connections to human beings who are involved in the music therapy process. The model includes most aspects of human behavior and experience. It has a direct contact with the practice in the field, and provides a bridge between art and science. Description of the Model Holistic Model The music therapy process can be seen as a whole system that includes three main forces: a therapist, a client and music. One can imagine this system as having the qualities of matter and wave at the same time (Bohr in Eagle, 1991). The basis of the system is built from solid matter: two people (in an individual therapy), who have specific personality structures, function in specific roles, and who meet in a specific place for a specific time and for a specific goal. However, the system can also be seen as a wave: it has music and sound vibrations as well as inner and outer energies that are being created and recreated from moment to moment. Within this system, many kids of relationships start to develop: relationships between music and sounds, relationships between therapist and client, relationships between thoughts and feelings, relationships between the external environment and the internal world, and relationships between music and words. Each interaction can be seen as a whole and complete unit within itself, yet they are interwoven and interlacing with each other. The whole becomes greater than each unit and reaches a more complete form (Schwartz and Oglivy in Lincoln & Guba, 1985; Eagle, 1991).

5 48 Amir The system is composed of internal and external realities. The experiences in these two realities occur on intrapersonal and interpersonal levels in active and receptive realms. These occurrences take place within a few areas: physiological, cognitive, emotional, intuitive and spiritual. It is important to say that many of the terms used to describe this Holistic Model have been defied in music therapy and psychotherapy literature, such as Winicott s use of the terms internal and external realities (1971) and May s use of the term being with (1958). Yet, I am asking the reader to postpone any familiar definition and to be open to the definitions proposed in the model in order to understand the model in a clear way. External and Internal Reality The External Reality encompasses the aesthetics of the immediate environment-the therapy mom. The size of the room and how it is organized; type, quantity and quality of musical instruments; the music itself-sounds and voices; therapist and client. The therapist is part of the client s external reality and vice versa. The Internal Reality is the internal world of the therapist and of the client. Internal reality is composed of everything that happens consciously and unconsciously in the inner existence. Sensations, feelings, images, emotions, thoughts and internal music. In the internal reality there are many things happening. It is a whole world within itself. The relationships between the different forces in nature resemble what is happening inside a human being. I have observed myself and my clients use many images and metaphors from nature in an attempt to describe our inner world (I feel like a stormy ocean; I am like a tree in the fall, etc.). Active and Receptive Realms The Active Realm is the realm of doing in which the therapist and client actively express themselves. This expression can be created in various forms: music making, movement, drawing, talking, playing, writing, etc. In this realm we give expression to our internal voices and bring them to life. This is done through activities and intervening techniques. The Receptive Realm is the realm in which we listen both internally and externally. Internal listening is listening to one s inner voices. External listening is listening to the outside: to the music, sounds and voices that are being created in the room and sometimes outside the room. This is a realm of being with without doing anything (Amir, 1995).

6 Music Therapy-Holistic Model 49 Interpersonal and Intrapersonal Levels The Interpersonal Level contains everything that happens between the client and therapist. This is the level in which the relationship between these two people starts to develop: the dynamics of the interaction, projections, transference and counter-transference, trust, support, love, acceptance and all the professional interventions that the therapist does in music and words. The Intrapersonal Level contains all the conscious communication one has with oneself and the insights one gains during the process. It is the here and now : What do I feel right now? What am I aware of? What part of the gestalt is coming forward now? Imagine a whole circle with a ray of light underneath it that turns around and around, lighting different areas. Sometimes one area gets a very strong light, and at other times there are two areas that are lighted simultaneously A moment later, a third area beams all of a sudden with a very powerful and celebratory light. Physiological, Cognitive, Emotional, Intuitive and Spiritual Areas The Physiological Area involves all body reactions: posture, internal and external body movements, the function of the various body parts that are involved with the music making, and the body different reactions to musical stimulation (shivering, a feeling of being hot or cold, slowness or acceleration in heart beats, increase or decrease in blood pressure, etc.). The Cognitive Area involves the learning process the client undergoes: the ability to recognize one s own musical symbols, patterns and behaviors and understand their connection to one s internal and external reality. It is also the therapist s knowledge and understanding of the therapy process. The Emotional Area includes moods, feelings, sensations and emotions that the music creates within us. Music and sounds can be the voice of sadness, joy, fear and anxiety, anger, etc. The Intuitive Area is an open field where we can receive messages from all levels, realms and areas. Insights are always intuitive (Amir, 1993). In the Spiritual Area the person feels his/her soul, with the sense of being connected to a higher power and to the whole universe. This feeling may be experienced as mystical or religious. It can be expressed through vocal or instrumental music that is being listened to or improvised.

7 50 Amir Relationships Among Realities, Realms and Levels In reality, the relationships that occur in the therapeutic process are more like a web. The connections are not linear, but multilevel and multidimensional. They are inseparable and interrelated. In theory we can examine these relationships in a more specific and clearer way. One way to look at these connections is to divide the model into two systems and to examine the relationships among internal reality, receptive realm and intrapersonal level as one system and the relationships among external reality, active realm and interpersonal level as the second system. 1. Relationships among the internal reality, the receptive realm and the intrapersonal level. There are many movements in the internal reality. Some of them are totally unfelt and unknown. These are inner, sometimes hidden processes that clients and therapists go through during clinical work. Once something moves from the internal reality to the intrapersonal level it is called insight. The unconscious breaks through to the conscious. The inner movement is felt, it becomes known. There is a shift in the inner boundaries of the inner reality. Listening is the connecting unit between the internal reality and the intrapersonal level and allows us to focus on certain areas, sounds and images. Being in the receptive realm gives us the opportunity to be with ourselves and with the external world simultaneously. In this way a certain event, memory or association can come forward to the intrapersonal level. There are moments when the processes in this system are flowing that lead to insights and experiences of breakthroughs from the unconscious to the conscious. 2. The relationships among external reality, active realm and intrapersonal level. Let s examine now the second system: External reality-active realminterpersonal level. The key words here are the aesthetics of the environment, the relationship with the therapist, motivation, security, trust, daring and doing. The variety and quality of musical instruments, the quality of sounds and the aesthetics of the therapy room provide the client with greater motivation for participation. This way the client acceses his/her own creativity through exploration and expression. A positive working relationship with the therapist develops trust and security and allows the client to take risks and to explore new inner territories and interpersonal relationships on a deeper level.

8 Music Therapy-Holistic Model 51 External Reality: the aesthetics of the immediate environment-the therapy room Internal Reality: conscious and unconscious inner existence: Interpersonal Level: everything that happens between client and therapist; Intrapersonal Level: here and now, inner awareness, Insights; Active Realm: active expression through music, words, etc.; Receptive Realm: internal and external listening; Physiological Area: all that has to do with the body; Cognitive Area: learning process, knowledge and understanding; Emotional Area: moods, feelings, sensations and emotions; Intuitive Area: being open to receive insights; Spiritual Area: spiritual self IS being alive. active realm receptive realm interpersonal level intrapersonal level

9 52 Amir I will now explore the second system (the relationships among external reality, active realm and intrapersonal level) through an example from my clinical work. Danny is a 25 year-old man who came to me for therapy because he had a poor self-image and low self-confidence. He had been in psycho-therapy in the past but did not feel any change, and decided to try music therapy. During the first session he discovered the bongos in the room (external reality) and played very gentle and delicate sounds. He tried different rhythmic patterns using all of his fingers in a mezzo piano dynamic (active realm). At a certain point I asked him if I could join him with the second pair of bongos and he agreed. I imitated his drumming and slowly brought a little more energy, accelerating the tempo and making louder sounds. He joined me and together we created an improvisation that reached forte. With both of our hands we drummed on the two sides of the bongos. There were arm movements, too. The improvisation went back to piano and ended with a light drumming with our fingers (interpersonal level). During the improvisation there was no eye contact between Danny and me, but I noticed that from time to time he looked at my bongos (interpersonal level). At the end he smiled and said: I released some energy, a lot of energy, didn t I? It sure felt good! I felt that some initial connections were made: a connection between Danny and the bongos he was using, a connectionbetween Danny and his body-he moved his hands and arms and released some energy, something that made him feel good; a musical connection between us-drumming together in a congruent way; and a beginning connection between Danny and me through watching my bongos. Using the Model for Diagnosis and Treatment Plan: Brian Brian was five-year-old child when he was referred to me by his psychologist. Brian had some verbal speech but could not express himself well enough to communicate. He showed some hyperactivity and very limited attention span. According to his parents, he liked to sing and his attention span increased while listening to records at home. Music therapy was the first choice of treatment. The psychological tests suggested that Brian had intelligence, that he was creative, and that his problems were emotional and not physiological. In the first few sessions, Brian showed interest in all of the instruments in the room (external reality). He tried one after the other. He took the bongos, beat them, and after three seconds put them back and went to the maracas. He played them for a few seconds, went to the piano, tried it for a few seconds, and so on. This was his way of playing music during the first five sessions (active realm). Brian did not make eye

10 Music Therapy-Holistic Model 53 contact with me and my feeling was that he was not even aware of my existence in the room (interpersonal realm). I listened to Brian s sounds. They were short, sharp sounds with the same dynamics of mezzo forte (active realm). I also paid attention to Brian s physiological area: his facial expression was frozen; his body language showed a closed posture with no flow. I noticed that I felt uncomfortable with Brian s sounds and actions. It made me feel restless and unable to focus well (internal reality). His monotonous, mechanical sounds gave me an image of a body covered by a plastic bag that made breathing almost impossible (intrapersonal reality). Reflections Many questions arose for me during this time. Why did Brian play the way he did? What does it give him? What does he need? In which reality does he function? In what way? Of what did Brian s existence in the room and his music remind me? What is to be learned from the image that came to my mind? Why did I feel this way in my body while listening to Brian s playing? I realized that because Brian didn t talk in a communicative way, I had to come to certain assumptions and understandings on my own. I had to draw attention to my internal reality in order to understand Brian s internal reality. I had to use my receptive realm and to let Brian s sounds penetrate my body. At the same time, I used my inner listening in order to get to my intrapersonal level. I listened to the happenings in my emotional, physiological, cognitive and intuitive areas. The listening brought several insights concerning Brian. His actions seemed mainly automatic and mechanical. They were not yet connected to the happenings in the intrapersonal and interpersonal level. There was no flow in his musical action. It was breathless. The way I felt made me think that Brian s music making expressed his restlessness but had no connection to his inner creativity My image made me think that his creative energies in his inner world were blocked. My main assumption at this point was that Brian was using the musical instruments as a block to his own creative energy. He was too frightened to pause, to rest, to breathe. He probably had to protect himself from his inner world. As the therapist, I used the whole system of internal reality-receptive realm-intrapersonal level. It allowed me to gain a better understanding of Brian and to plan therapeutic strategies and goals. Within the context of the model, my goal for Brian was to make a shift, to move his attention back and forth from the external reality to his inner reality; to shift from

11 54 Amir expressing himself in a mechanical way to a more dynamic-creative way. I knew that I had to be there for him, in a steady manner. I had to accept him and respect his being. How could I do this musically, or, in the model s terminology, in what way could I function in my active realm? I could offer him a steady musical frame to contain him. I could use the piano in order to provide a steady rhythmic pattern with a melody that would open the way to Brian s emotions, and with harmonies that would contain the melody. My improvisation should be steady but not imposing, present but not domineering, providing a container that encourages creative exploration (active realm). When his trust in me developed (interpersonal level), he would be able to be more open and aware of his inner world (intrapersonal level). Once he is less defended and scared, maybe his musical expressions would change and gradually be more connected to his inner creative energies. Using the Model for Treatment: Dalia Dalia participated in one of my music therapy groups. The group was working together for two years and met once a week for two hours. Dalia is a 30-year-old woman. She was born in the USA. When she was 18 months old her family came to live in Israel. She was 11 years old when her father was killed during the six-day war in She had two younger brothers. Dalia is married and works as a teacher in an elementary school. Her husband works as an architect. In her initial interview, Dalia told me that for a long time she had suffered from constant headaches and fatigue. She returned from work and could not move. She went to bed early but awakened tired. Dalia took all the necessary physiological tests and the results indicated no pathological conditions. She told me that she felt a lot of anger and rage inside of her, and she was unable to experience love, joy and satisfaction. She started to feel distant from her husband and was afraid that the marriage would come to an end. When I asked her in one of the sessions How do you feel today? she said, I don t know. There are many things happening within me, but I don t know what they are (internal reality). I asked her to close her eyes and to breathe, breath after breath, deeper and wider. After a few minutes I asked her to listen to what was happening inside her (receptive realm). She replied, I feel many streams storming inside me and I hear a cacophony of sounds: loud and soft, long and short, high and low, coming and blending with one another.. (intrapersonal level). I asked her if she were willing to try to create the cacophony of sounds that she heard in her inner world by using musical instruments. Dalia chose a great variety of instruments, including bongos, two maracas,

12 Music Therapy-Holistic Model 55 wind chimes, two drums, tibetan bells, kazoo and whistles. She put the instruments near her on the carpet and tried to play several of them at once. With the kazoo in her mouth she made sounds that went up and down like sirens. In one hand she held two maracas, shook them strongly and every once in a while hit them on the bongos. In her second hand she shook the tibetan bells and created fast and loud sounds. After a few minutes she put the maracas and the bells on the carpet and created metal chaotic sounds with the wind chimes. This was not enough for her, and she asked several group members to join her in the music making. The improvisation lasted ten minutes (active realm). As I listened to the music, I felt myself shrinking inside, as though my ears asked me to protect them (internal reality). Suddenly I felt fear, and imagined I was on a battlefield with wounded and dead soldiers, sirens shrieking, bullets flying, and bombs exploding around me. It reminded me of the feeling I had during the 1967 six-day war, when I was 16 years old and couldn t really understand what was happening (intrapersonal level). Dalia ended her improvisation and started to cry. It is scary, but this is exactly what is going on inside me, she said (emotional area). Other group members shared with the group how scared they felt during the improvisation and that the sounds reminded them of their feelings during previous wars. I shared with Dalia my own memory from the war. Dalia realized that this was what she felt when she was 11 years old and her father went to the war, never to return. Dalia cried and allowed herself to feel the pain. Later she understood that through the musical sounds she reproduced and relived the event in which her father was killed. She told the group that she never talked about the circumstances of her father s death because the subject was a taboo in her family. It was too painful. Everytime the subject came up, her mother said, Let s not talk about it, we have to go on living our lives. The group was very supportive and shared similar experiences that were triggered by Dalia s sounds and verbal sharing. The group encouraged Dalia to share this experience with her husband. In the next session she told the group that it was a very difficult and painful week for her. The old wounds were reopened. She was having nightmares and re-lived moments from the war time. She shared her feelings with her husband and it was the first time she talked to him about this in such an open way. She said that her husband was very supportive and caring (interpersonal level). In a subsequent session, I asked the group to close their eyes, to take deep breaths, to listen inwardly (internal reality), and to focus on one particular sound (intrapersonal reality). After a few seconds of quiet

13 listening, Dalia reported that she heard her heart beats (physiological area). I suggested that she play this, and she picked up the drum and hit it in a very steady beat and slow tempo (active realm). I noticed that she was rocking her body forward and backward in the rhythm of her playing (physiological area). The sound became softer as she kept on rocking and started humming. The group gradually and gently joined her humming and together we created a gestalt of gentle ohoouuu-ahaaaa voices. The humming became stronger and transformed into a sort of a Hasidic song. We swayed back and forth, humming a simple tune in an a minor key with ya-ya-yayaay and ya-ba-bam sounds. Dalia put the drum aside and added another rhythic element by tapping her hands on her lap. I joined her and did the same. The whole group was humming and became a background to Dalia and me (active realm). After the singing reached its peak, we gradually lowered our voices and ended pianissimo. This particular session ended without words. The next session Dalia thanked the group and reported that it was a very powerful and beautiful experience for her. She said that the session connected her with a very spiritual feeling, and brought back memories from her past. She remembered Sabbath dinners from her childhood, when the whole family gathered together, eating and singing Sabbath and Hasidic songs (spiritual area). The group suggested creating this ritual again by singing some of the songs that formed a part of Dalia s childhood (active realm). Singing each song evoked memories of specific events in Dalia s childhood (intrapersonal level), accompanied by feelings of sadness, longing, pain and joy (emotional area). Dalia mourned the loss of her father and the loss of the family ritual of gathering together, singing and celebrating the Sabbath. She realized how big the loss of growing up without her dad was, and understood how it affected her whole life (cognitive area). In one of the sessions, we sang Avinu Malkenu - Our God, who is our father and king. This is a song that Jews all over the world sing on Yom Kippur, the day they fast and ask God for forgiveness. Dalia sang the song with her hands up. Her singing felt like a prayer. I accompanied her on the piano. Dalia experienced singing this particular song as cleansing and beautiful (spiritual area). After the group ended, Dalia started individual music therapy with me. We continued to work together for another year. The individual work focused more on the present issues of Dalia s concerns about her marriage. The more she allowed herself to give expression to her inner chaos via the use of music and sounds, the more she gained insights into her life. Dalia said the music therapy room (external reality) was the only place in which she could express her difficult feelings concerning her marital crisis in an authentic and powerful manner. She told me that her

14 Music Therapy-Holistic Model 57 husband has slowly started to withdraw from her. She felt that he had lost interest in her both physically and as a friend and partner. Even though they were living under the same roof, they were living apart from each other. She felt as if he did not love her any more, and she had no idea why. We don t talk about these things. We worked on those issues musically, using several techniques and therapeutic interventions. We used role playing in our improvisations. We improvised separately and together on themes and titles which came out of Dalia s inner feelings and thoughts she discussed with me. We improvised and later gave it a title when Dalia s feelings and thoughts were unclear. At a later point Dalia told me that she had a talk with her husband. She shared her feelings with him and asked him what was wrong with their relationship. They were able to communicate with each other in a more open way than before. Dalia began to feel calmer and more relaxed. Toward the end of the therapeutic process she became pregnant and after several months she called me up and told me that she gave birth to a beautiful baby boy and that things were going really well with her. Discussion Dalia worked on both her internal and external realities, in all the areas, in both active and receptive realms, on both intrapersonal and interpersonal levels. In the group, in the first event I describe, there is a very noticeable shift from one system (internal-receptive-intrapersonal) to the other (external-active-interpersonal). First, Dalia visits her internal reality. There is a movement from this reality ( There are many things happening within me, but I don t know what they are ) to her intrapersonal level ( I hear a cacophony of sounds: loud and soft, long and short, high and low, coming and blending with one another ) through her receptive realm (inner listening). I guide Dalia to the second system (interpersonal level). By using the external reality (choosing the instruments and arranging them on the carpet) in the active realm (creating the improvisation) Dalia is brought back to her internal reality and gains an insight about her life (intrapersonal reality). My intrapersonal level (the feeling of fear and the image of the battlefield) helped me understand what was happening in Dalia s inner world. This experience involved many areas: the physiological area (her movements and the use of her body), the cognitive area (the understanding she gained about herself), the emotional area (her crying and

15 58 Amir pain), the intuitive area (intuitive shifts in the music making from one musical style to another) and the spiritual area (Hasidic melody that was a very moving experience). The example above illustrates that there has to be a flow between the two systems and a connection among realities, levels, realms and areas in order for the therapeutic process to be created and for changes toward growth to occur. What happened in the external reality in the music therapy room allowed changes to occur in Dalia s external reality outside the music therapy room. The work in the music therapy group gave Dalia the opportunity to trust other people and to open up and move from her internal reality to her intrapersonal level. She expressed, brought up and processed important unfinished issues from her past. Individually, Dalia continued to work with me more deeply on her present issues. The work was done in both active and receptive realms, musically and verbally. The trust and security Dalia developed in me (interpersonal level), encouraged her to gain more trust in other human beings and especially to be able to trust her husband more. Summary This article introduces a new model to understand clinical music therapy. The model is holistic in nature. The model contains internal and external realities, which function in active and receptive realms on an intrapersonal and interpersonal levels. The occurrences take place within five areas: physiological, cognitive, emotional, intuitive and spiritual. This model allows music therapy to be seen as a dynamic process that improves health, opens paths to creative abilities and fulfills potentialities within therapists and clients. The process is created from connections and flow among all realities, realms, levels and areas. We can look at the model as Fields within fields within fields interlacing each and everything with each and with other (Wilber, 1985, p. 83). It is possible to imagine this model as a kaleidoscope that has specific colors and shapes and with each little movement something changes in the gestalt of the colors and shapes and the picture is different from before. We can feel it as a sea of vibrations and energies being expressed and released, leading toward change. We can also view this model as composed of moments. Each moment is a whole and complete unit within itself, which interweaves and interacts with other moments. Thus the whole becomes greater than each moment and becomes a more complete form (Amir, 1992a).

16 Music Therapy-Holistic Model 59 This model gives the therapist a way to assess and diagnose the client and to create treatment plans. Through the use of this model the therapist can better understand the therapeutic process and design therapeutic strategies and directions. It can shed light on the changes in the client s reality and can help in evaluating the client s progress and growth during the course of therapy. References Aigen, Ken (1991). The roots of music therapy: Towards an indigenous research Daradigm. (Doctoral Dissertation. New York University. 1990). Dissertation Abstracts International, 52(6), 1933A. Amir, Dorit (1992). Phenomenology as a basis for discovering meaning in the music therapeutic process. Therapy through the arts, l(1). The Israel Arts Therapy Journal, Amir, Dorit (1992a). Awakening and expanding the self: Meaningful moments in the music therapy process as experienced and described by music therapists and music therapy clients. Doctoral Dissertation, New York University, UMI order # Amir, Dorit (1993). Moments of insight in the music therapy experience. Music Therapy, 12 (l), Amir, Dorit (1995). On sound, listening, and music therapy. In Carolyn Kenny (Ed.) Listening. playing. creating: Essays on the power of sound. New York: SUNY Press. Assagioli, R. (1991). Transpersonal development. Great Britain: The Aquarian Press. Bonny, H. L. (1986). Music and healing. Music Therapy, 6A(l), 312. Bonny, H. L. (1975). Music and consciousness. Journal of Music Therapy, 12(3), Broucek, M. (1987). Beyond healing to whole-ing. Music Therapy, (2), Bruscia, K. E. (1987). Improvisational models of music therapy. Springfield, III: Charles C. Thomas. Bruscia, K. E. (1989). Defining music therapy. Phoenixville, PA: Barcelona Publishers. Bruscia, K. E. (1991). Case studies in music therapy. Phoenixville, PA: Barcelona Publishers. Capra, Frit] of (1982). The turning point. New York: Bantam Books. Chopra, D. (1989). Quantum healing. Yoga Journal, July-August 89, Eagle, C. T. (1991). Steps to a theory of quantum therapy. Music Therapy Perspectives, Vol. 9, Forinash, M. &Gonzalez, D. (1989). Phenomenology as research in music therapy Music Therapy, 8(l) Hesser, Barbara (1988). Creating a strong professional identity. Journal of the International Association of Music for the Handicapped, 4(l), Kenny, C. B. (1985). Music: A whole system approach. Music Therapy, 5(l), Kenny, C. B. (1989). The Field of Play: A Guide for the Theory and Practice of Music Therapy. Atascadero, CA: Ridgeview Publishing Company.

17 60 Amir May, Rollo (1958). Contributions of existential psychotherapy. In R. May, E. Angel & H. F. Ellenberger (Eds.) Existence: a new dimension in psychiatry and psychology. New York: Simon and Schuster. Nicholas, M. J. & Gilbert, J. P. (1980). Research in music therapy: A survey of music therapists attitudes and knowledge. Journal ofmusic Therapy, 27(4) Orenstein, R. (1986). The psychology ofconsciousness. Harisonberg, VA: Penguin Books. Ruud, Even (1978). Music therapy and its relationship to current treatment theories. St. Louis, MO: MMB. Tart, C. T. (1983). Transpersonal psychologies. El Cerrito, CA: Psychological Processes, Inc. Wheeler, B. L. (1981). The relationships between music therapy and theories of psychotherapy. Music Therapy, 1(l), Wilber, K. (Ed.) (1985). The holographic paradigm and other paradoxes. Boston and London: New Science Library. Wilber, K. (1980). The atman project. Wheaton, ILL: The Theosophical Publishing House. Winnicott, D. W. (1971). Playing and reality. London & New York: Routledge. Dorit Amir, D.A., ACMT, is the head of the Music Therapy Program at Bar Ilan University in Israel. She maintains a private practice and works with children and adults with various problems. Dr. Amir is the coeditor of the new Israeli journal, Therapy Through the Arts.