THE SPECIALIZED USE OF MUSIC AS A MODE OF COMMUNICATION IN THE TREATMENT OF DISTURBED CHILDREN

Transcription

1 THE SPECIALIZED USE OF MUSIC AS A MODE OF COMMUNICATION IN THE TREATME OF DISTURBED CHILDREN Evelyn Phillis Heimlich It has been observed on the Children's Service at the New York State Psychiatric Institute that some children do not resond adequately to traditional methods of sychotheray. Therefore, when the writer suggested a nonverbal mode of aroach, i.e., the flexible use of music in its broadest sense, as a ossible means of facilitating communication, Dr. H. Donald Dunton, Director of Children's. Service, agreed to an exloration of its use in the treatment of disturbed children. Over a eriod of five and a half years, work in the use of this new method was done with eighty-five children. Children ranged in age from five years through twelve years. Both boys and girls were seen. Three main roblems which resulted in the inability of these children to utilize traditional channels of treatment were: (1) mutism, ressure of seech, incoherent seech; (2) overaggressiveness and hyeractivity; or (3) if they were verbal, avoidance of discussion of their roblems. For these children the oen channel of music and its comonents with their inherent affective roerties automatically communicated something different to which the children could and did both react and oenly exress themselves. Thereuon mutual nonverbal communication took lace between the children and me. The rime value of music in its broadest sense is in its structure. It is a medium comrising many exressive comonents that can be Mrs. Heimlich is Research Assistant, Children's Seroice, New York State Psychiatric Institute, New York, N. Y. My rofound thanks go to Dr. Harlow Donald Dunton for his sueroision, his searching questions, and his helful reading suggestions. 86

2 Music as a Mode of Communication 87 used searately or together. Reference is being made to such exressive comonents as timbre (in instruments and voice), temo, rhythm, accent, ulse, dynamics, intensity, etc. With this varied flexible structure it becomes feasible to direct the music to the secific communication needs of the child. Simle or comlex music can be imrovised by both theraist and child to which both can react. Comosed music too can readily be adated and maniulated sontaneously according to the indicated needs of the child from moment to moment. For examle, in dealing with a timid child, the exressive comonents that I as the theraist may select can be the delicate timbre available on the tambourine, small cymbals, or bells. I sometimes combine this with a simle rhythm in a moderate temo with slight changes in dynamics but a strong accent; or if I am imrovising a song on my guitar I can use the delicate timbre of my own voice, slight itch changes, and word imrovisations directed to the child's exeriences including my kindly feelings about him. My accomaniment can consist of further comonents of music such as a flowing ulse and a contrasting rhythmic attern. If I am dealing for the first time with an aggressive child, I can answer his likely vigorous imrovisations with other comonents of music, such as combined timbres on the iano, or if I use simle instruments, the timbres of two instruments such as drum and cymbal. I can stimulate him on the iano by means of wide and varied itch imitations, using the child's own rhythmic attern that he himself has imrovised; or I may imrovise a song about the child and may add the comonent of intensity to my voice in addition. Traditional folk songs are also used in the broadest sense, and imrovisationally; that is, they are not chosen to be used as folk art exression. Rather, each song is chosen, maniulated, and adated, with the exressive needs of the child in mind. In order to stimulate resonse, I as the theraist may use various music comonents to emhasize the emotion or roblem I want to hel the child exress. An examle would be my use of the folk song, "Nobody Knows the Trouble I've Seen," The lyrics are: 1 1 Key to musical abbreviations which are used throughout this aer: D-very loud~ f-ioud; mf-moderately loud; soft; -very soft.

3 88 Evelyn Phillis Heimlich slow f mf f Nobody knows the trouble I've seen, D D Nobody knows but Jesus. mf faster Nobody knows the trouble I've seen, moderate Glory Halleluia. faster D Sometimes I'm u, D slower Sometimes I'm down, moderate Oh yes Lord, mf slow Sometimes I'm almost to the ground, moderate Oh yes Lord When this song is directed to a lonely inarticulate child, I not only use intense timbre in my voice, but exaggerate the accent on the "no" of "nobody" or the word "trouble." I also use contrasting dynamics in order to focus the child's attention on the rime exression of the song-that is, I start with the hrase "Nobody knows the trouble I've seen," with a loud voice on "No" and swiftly descend to a murmur on "body knows the...," but when I get to the word "trouble" I increase the dynamic element or comonent, then am soft again on the words, "I've seen." The same with the hrase, "Sometimes I'm u, sometimes I'm down." In addition to the use of the comonents mentioned for the "nobody" hrase, I change temo and get faster in this hrase, once again to focus on the glad or sad recurrent feelings of the troubled erson. The child has at his command the same music comonents for exressive use, but he may choose or need to use fewer of them for exressiveness or he may use them differently. That is, he may use the general idea of the theraist as an examle of exressiveness. Yet he may feel there are other ways to exress the same feelings. If he is an angry child, the timbre he may use for the word "u" may be the rhythmic clash of two large cymbals struck together, hands high over his head, followed by a soft rhythmic accent on a drum. Or he may give a rhythmic shake of the tambourine, keeing a tinkling

4 Music as a Mode of Communication 89 timbre and ulse all through the chorus. In other words, not only is the total combined organization of the music used in communication of the feelings which the song exresses, but selected comonents of the music intensify its individual exressiveness. The same rincile of the broadest use of music and its comonents is true when children chalk or aint to recorded symhonic music. Usually the child indicates his ersonal resonse not only to the total comosition but very clearly indicates the secial stimulus of the various comonents of which the symhony is comosed. For instance, when the child is making a chalk or finger aint design resonse on aer to, for examle, the March from "Peter and the Wolf," one child may ress hard on the chalk at the marked accents. Another child may find stimulation in the varied timbres heard. As the instruments change, he may be seen quickly to change colors. Another may be more intrigued by the skiing rhythmic attern and closely reflect this attern in long and short strokes on the aer. Children often combine and emhasize several of the comonents and frequently verbalize the fantasy the comonents stimulate. For examle, a child may move to a raid temo and say of his raid stroke resonse, "This is where the boy is running away." This flexible use of music ermits, as needed, moment to moment imrovisations, maniulation, adatation, and sontaneity in the use of music for individual exression and communication. The child's resonses are used as cues by which I observe and understand his behavior. From these cues, I immediately direct to him the aroriate music in order further to develo and continue the communication. When feasible, three children of aroximately the same social develomental level are seen together at each session. When necessary, for examle, with an autistic child, I see the child alone. Also some children benefit from one grou session and one individual session a week. Children are seen for one half to three quarters of an hour twice a week in a room esecially equied for rhythmic tonal exression. The room contains a large variety of ercussive instruments varying in size, texture, and timbre. There are such instruments as cymbals, Chinese temle bells and blocks, tambourines, maracas, and many kinds of drums. There are also a guitar, an autohar, and

5 90 Evelyn Phillis Heimlich iano, as well as a honograh. Easels, chalk, and finger aints are 4vailable for rhythmic tonal chalking or ainting. FOUR EXAMPLES OF WORK OF DIFFERE CHILDREN CHALKING TO THE SAME MUSIC: "GAIETE PARISIENNE" FIG. 1 Girl. 8 years; childhood schizohrenia; blue chalk. FIG. 2 Boy. 8 years; rimary behavior disorder; orange chalk. Flc.3 Boy. 8 years; childhood schizohrenia; urle and orange chalk. Flc.4 Boy, 7 years; atyical (ossible schizohrenia); yellow. blue. green chalk. The children enter the room and are free sontaneously to choose whatever ercussion instrument aeals to them. If they are timid, they choose small instruments. If they are aggressive, they select large instruments. Their choice reflects their needs. They usually begin to exlore the instruments immediately by sontaneously ta-

6 Music as a Mode of Communication 91 ing out a simle rhythmic attern, such as: - - -j - - -j or j j. Sometimes only two or three beats of not more than a few seconds duration are imrovised. As soon as the child makes his little imrovisation, I recognize it by imitating it on the instrument I believe to be aroriate at the moment. Some children need the full suort of the iano. In this case, I not only imitate the child's imrovisation, but considerably amlify it by laying it u and down the gamut of the iano, in many keys, in many harmonies showing it in new timbres, new itches, and new dynamics. Some children require a simler resonse to their imrovisations. In such a case, I will imitate the child on the tambourine or a small drum. There are children who like and need to be faced, when their atterns are imitated; some are more at ease if they feel they are not being observed. For those children who need to be faced, I either turn toward them as I imitate them on the iano, or sit vis-avis as I use a ercussion instrument, my guitar or the autohar. For the children who do not like being observed, I usually use the iano, where I can aroriately turn my back as I imitate the imrovisation. If I feel the simlicity of a ercussion instrument is needed in resonse to the shy child, I kee my eyes on the instrument, and not on the child, as I use it. When working with a grou, as I imitate a child's attern, I encourage his eers to imitate his attern too, and to join me and him in a joint erformance. I reeat the attern over and over in strong, rhythmic, accented resonse. Esecially if I am using the iano, I may reeat it as much as sixteen times, each time varying the attern with different chords, timbres, accents, etc. The length of time sent in reetition is gauged by the interest and leasure in the activity shown by the children. Each child gets a turn at imrovisation, and each child has an oortunity to change instruments as he goes along. After ten or fifteen minutes of this activity (guided again by the children's interest and leasure), I introduce another and more comlex form of music communication, i.e., the folk song, a form in which music is closely wedded to words. Before describing the rocedure in the use of folk song, mention should be made of the rocedure used with the occasional small

7 92 Evelyn Phillis Heimlich child who does not immediately go to the ercussion instruments, but instead goes to the guitar or autohar. When this behavior is manifested (it usually occurs with a small child who needs to be seen alone), I begin by encouraging the child to strum the chosen stringed instrument while I hold the instrument and change the chords. With such a child, I usually simultaneously imrovise a chant or song, about the child's ersonal exeriences or about his belongings, such as What should we do when we all go out, All go out, all go out, We will ride a bicycle, etc. [or, we will roller skate, or fly a lane, or go see grandma, lay house, etc.] This evolves into an intimate situation as the child and I move in a rocking rhythm while we both use the same stringed instrument. Now to continue with the grou and the folk song rocedure. Here again the choice of folk songs is guided by the secial needs of the children in the grou. For examle, should one of the children need to deal with feelings of rejection, I may introduce a song like "Sometimes I Feel Like a Motherless Child." The lyrics of the song are: moderate Sometimes I feel like a motherless child, Sometimes I feel like a motherless child, Sometimes I feel like a motherless child, A long ways from home, a long ways from home. Sometimes I feel like I'm almost gone, Sometimes I feel like I'm almost gone, Sometimes I feel like I'm almost gone, A long ways from home, a long ways from home. I resent the song and exloit its exressive comonents to the hilt. Should I want to focus the child's attention on a secial hrase like "motherless child," I will sing softly just before the hrase "motherless child" and then accent the focal hrase, or erhas sing

8 Music as a Mode of Communication 93 it louder than the revious hrase to give it imortance; or I might slow down on the imortant hrase. Often nomorestimulusisneeded than this overlay of musical exression to hel the child make an initial comment on his roblem. Sometimes, however, the stimulus for verbalization comes from a grou member who can at that moment be articulate and resond verbally to the stimulus just because it is not quite as ainful to him. Then comment arises from the child to whom the hrase was really directed. If no comment comes from the grou and I feel there is sufficient raort, I sometimes directly ask what the whole song or a secial hrase means. If my observations on the grou's resonse are that they are not ready for verbalization, I may introduce the song two or three times just so the children and I jointly exerience the emotional quality of the song. As they become familiar with it, and as they imitate my emotional rendition, they either begin to question me on the song, or by their reeated requests for doing it, indicate that they are involved in it and may be ready to have me raise questions about the content. Sometimes only ventilation ensues, sometimes historical material comes u, sometimes there is insight gained. With some children it is necessary to resent many folk songs with the same theme, in order to get them to articulate their feelings. For examle, in dealing with the child for whom "motherless child" was resented, it might be necessary to take a more oblique aroach. In this case the song already resented may be followed by several songs of mother and child, in the form of lullabies like "Slee My Little One."2 The lyrics of this song are: mf mf mf Slee my little one, close your drowsy eyes, Ay, Iu Iu Iu. Slee in health, my child, under eaceful skies, Ay, lu lu lu. Mother's always near, so you need not fear, Ay, lu lu lu. mf Slee and have sweet dreams, while you're young, life seems Full of life and love, Ay, lu lu lu. Published with ermission of Plymouth Music Co.

9 94 Evelyn Phillis Heimlich It may also haen that the child does little verbalizing, and merely indicates the meaningfulness of the secifically chosen song by requesting that it be done over and over again. Changes in the child's attitude are sometimes indicated by the increased sensitivity and emotional quality of his vocal exression and accomaniment. Changes in develoment can be observed in a still different way when a mute child begins moving his lis on song words esecially meaningful to him; or sometimes he just makes throat grunts or other sounds when some art of the song esecially moves him. An imortant art of the work with a mute child is that great care be taken that the atmoshere of free and sontaneous exression be maintained. Also, that he feels no ressure is being brought on him to seak. With some children the use of the imrovised music story for the exression of feelings is useful. When the child chooses to do music storytelling he is seen alone so that he can be free to exress anything that comes to mind. In such a session, the child has before him a battery of ercussion instruments which he can use to underscore, recede, or follow his words when he dictates to me. I begin by stimulating him with what I feel is an aroriate short imrovisation on the iano. When the child is ready he usually starts with "Once there was a boy," or whatever other character his fantasy dictates. After the child has made a statement of a haening a few sentences in length, I reeat what he has said and translate it into imrovised song and accomaniment. I always intensify what has been given by a highly exressive rendition. I emloy whatever comonents of music I think will augment and underscore the child's exerience. Then tum to him for aroval of what I translated and encourage him to go on. Together we reeat musically each statement of the child in a kind of on-the-sot, sontaneously imrovised oera duet. If the child gets stuck in the middle of a music story, I stimulate him with iano imrovisations until he is ready to continue. Sometimes I question him on arts of the stories if I think the moment roitious, at other times I just accet the offering. Children create many mythlike stories that reveal dee feelings that they had not heretofore exressed. These music stories take an entire session, after which the children seem relaxed and contented. A further rocedure is chalking or ainting to the rhythmic music

10 Music as a Mode of Communication 95- of the symhony. The rocedure with the chalking to music is as follows. The child is given a large box of 1" thick multicolored chalk; he stands before an easel on which there is 16" x 24" black drawing aer. He is told to listen to the symhony and move his hands in the air or, if he chooses, to dance with what he hears. He is told to close his eyes and see what colors come to mind as he moves. Then after about a minute or less of this stimulation, he is told to oen his eyes, choose whatever colors he wants, and at the word "go" to begin moving with chalk on the aer. He is encouraged to make any free sontaneous rhythmic strokes he desires. The idea of total freedom of exression in resonse to anyone or all of the comonents of the music is encouraged. All roducts are unique and their uniqueness is acceted with interest and gratification by me. There is no such thing as a "mistake"; there is only concrete resonse which is enough in itself. Some children at first resond only to the ulse, some to the accent,. some to high or low itch, some to temo only, some to timbre, some to rhythm, some to intensity, and some to a combination of any two or more of the music comonents. When really free and sontaneous, they resond to all the comonents of the music. Some children comment on feelings or fantasies during or after the exerience. Most comment with satisfaction on their roducts. Cometitive children sometimes want reassurance that their roduct is as good as others'. Sometimes I need to reiterate that all roducts are of equal interest, that judgment of good and bad does not enter into the exerience, only rocess; the end roduct is not received as good or bad, but is of interest only because it is a unique exression. Progress in exression in this area is sometimes commented on by the children themselves, sometimes by me, sometimes no comment on rogress is made. The gauge for rogress takes many aths, including greater variety in choice of color, resonse to more comonents of the music, sometimes as with the timid child, greater ressure on the chalk and wider strokes, more aer covered. With the hyeractive aggressive child less angularity, closer resonse to the rhythmic attern, more rounded strokes, less violence in chalk ressure, etc., are noted as signs of develoment. Finger ainting to music is used most frequently with the tense, rigid, overly neat child, although all children can choose to

11 96 Evelyn Phillis Heimlich chalk or finger aint. When this medium is used, the same rocedure takes lace as described with chalking to music, with one excetion. With the ainting, children have before them many bowls of colored aint which they are encouraged to aly to the aer at random in globs before actually beginning their rhythmic atterning to the music. Then at the word "go" they begin to attern to the music. At first, some children use only the tis of the fingers of one hand and cover only a small art of the aer. It is difficult for such children to get finger aint all over their hands. They usually fear sattering their clothes and the floor (see Fig. 5). These children are encouraged and stimulated. Sometimes, to hel them, I chant the melody of the symhony in a loud voice and strong accent and urge them to make running or skiing movements with the aint on the aer as they follow a running or skiing rhythmic attern in the music. Sometimes, I anticiate a sudden crash in the music and tell them to swee down with the aint from one end of the sheet to the other. Sometimes I aint right next to them in a free and sontaneous manner. If the child is shy I may not stimulate him further for many sessions. When the child is ready I give him the needed additional stimulation just described. I encourage him to use both hands, the alm, the knuckles, or the back of his hands. Once the child begins to be free enough to cover the whole aer and to use all arts of his hands, he usually exresses intense leasure and excitement. Sometimes he verbalizes his leasure, sometimes he dances before the easel as he aints to the music, sometimes he shows his leasure by asking to reeat the exerience right away (see Fig. 7). After each session I kee a running record of the child's behavior during the session including any significant changes. I note such things as his resonse to all comonents of the music, his motions when reo sonding to the music, his demeanor, his voice quality, his behavior with relation to all materials as well as to me and the children. If the child makes verbal comments, they are noted. In addition, after the first session and every three months thereafter, I use a behavioral checklist (see Aendix). The ward staff uses a similar one for com arison of ward behavior.

12 Music as a Mode of Communication 97 ILLUSTRATIVE CAsEs 1. L. was an eleven-year-old, tall, slim, blonde, serious boy when he came to the hosital. He was totally mute and had multile tics. His arents comlained that he would not attend school and was extremely ccntrolling and oositional at home. He was the older of two siblings, the other being a sister ten years younger than he. He had a temorary manifestation of tics on entering school at age six, but he outgrew these. The current mutism was gradual, coming on after he was ousted from his mother's room at the birth of his sister. By the time he entered the hosital, he had been totally mute for eight months. All communication even at the hosital interview took lace by means of writing which he erased word by word as he wrote. When L. began his music theray sessions, he was laced with two eers, one a hyeractive boy who, though verbal, would not deal with his roblems; the other, a withdrawn, nonverbal, rigid child. Part of the rocedure was to ermit the boys free choice of a wide variety of ercussion instruments--the only requirement being that they take turns if two boys wanted the same instrument simultaneously. In all resects every effort was made to give L. as much of a feeling of free choice and leasure as ossible. For examle, he could choose not only his instrument but also the way in which he wished to exress himself with it. In imrovising rhythmic tonal atterns, he could use larger or smaller motions, choose his temo, or use anyone of a combination of any or all of the comonents of music. For months, on entering, he seized the largest drum in the room, laced it on a chair, turned his back to all of us and immediately commenced imrovising in any manner that suited him. I resonded by imitating him on the iano at which time he did a curious thing. He always turned his head to look at me. As he did this, he continued simultaneously to lay his own imrovisation with all of us. Then when I layed each of his eers' imrovisations, he would behave in the same way. When it came to the use of the folk song, L. was not so cooerative, although the rocedure was one where he was again ermitted great freedom. Instead of gearing the choice of

13 98 Evelyn Phillis Heimlich folk songs to his roblem, as I would with a seaking child, I ermitted him to choose songs from several folk song books by allowing him to oint to those he wanted. The titles of the songs he chose were unique, for examle: his first choice was "Do, Do Pity My Case." It was followed by many more, all of which in some secial way exressed his feelings. Two more tyical examles were "Slee, My Little One," and the calyso song, "Mama, Gimme. Gimme." I sang and layed all his choices with an aroriate exression of emotion. While his rhythmic tonal atterns had no dynamic exression when he was imrovising solo and at first had even been monotonous, his rhythmic tonal ercussion accomaniment to the songs of his choice was always very varied and resonsive to the stimulation of my varied exressive tone quality and body motions. However, it was months before he would join in their accomaniment if the other boys chose the song. For their songs he stood with his hands at his sides and still showed his tic, although his feet ket erfect sontaneous rhythm. In addition to giving him freedom of choice, I laced great emhasis on stimulating him to exress himself freely as far as motor exression was concerned. To hel him. I used unusually strong accents when imitating his attern, and also made raid temo changes when resenting songs, or had him bounce the ball to my rhythmic iano laying. I also made secial efforts to stimulate him toward freer rhythmic movements when he ainted or chalked to music. I stood behind and chanted and accented the melody of the symhonies. With my singing I intensified the dynamics and in addition always showed admiration for his roduct. It was in this area that he showed his first and freest bodily resonse as well as his first aggression. His strokes on the aer were violent, though rhythmic and heavily laid on to the oint that the chalk often flaked as he made his attern. His tics were less evident as he chalked or ainted to music. I was careful never to ask him to seak, but just to have freedom in exressing himself when and as he chose. Finally, at the twelfth session, he made an initial attemt at uttering a sound. He chose a game song that had a lace where each child could utter a funny

14 Music as a Mode of Communication 99 CASE l-l FIG. 5 "Witches Dance." Light, uneven stroke.; blue and a little red finger aint. FIG. 6 "Anvil Choru... Slightly broader strokes: blue and a little green finger aint. FIG. 7 "In the Hall of the Mountain King," Broader, rounder strokes; green, yellow, red finger aint. FIG. 8 "Dance of the Buffoons." Broad, flowing.troke., better organized. whole aer freely covered; red, yellow redominating, and a little blue finger aint. sound. The song was called "Come on Join into the Game."8 The lyrics were: fast mf Let everyone cla hands like me, Let everyone cla hands like me. t Come on and join into the game. You'll find that it's always the same. Let everyone... [sneeze, yell, jum, laugh, etc.]. Published with ermission of Harer llc Row.

15 100 Evelyn Phillis Heimlich The lines then followed "Whatever I do, do the same"-sneeze, laugh, yell, etc. As usual, the boys and I jointly sang and accomanied. Only in this song, because of its structure, each one had to have a solo turn. I made a violent exlosive "Choo" for the sneeze, when my turn came. At the next rhythmic ause in the song, I turned to each of the boys and encouraged them to make every exressive sound when it was their turn. I turned last to L. and without a word from me he came right in rhythmically on the beat with a loud "Hahal" The two other boys turned to me and shouted, "He made a sound, he made a soundl" L. looked shy but leased and ointed to the song which was done again. This time, as at following sessions, I suggested roaring, yelling, and other exlosive sounds, which everyone including L. emitted. He showed rogress in other ways too. He no longer stood with his back to me, stoed hiding his face, and even taed me by way of greeting when he saw me on the ward. At these signs of greater ease in communication, I took the chance of introducing a folk song of my choice that had directly to do with one of L.'s roblems-his unhay relationshi with his young sister. The song was called "Hush Little Baby, Don't Say a Word," the lyrics follow: moderate Hush, little baby, don't say a word, Mama's gonna buy you a mocking bird. If that mocking bird won't sing, Mama's gonna buy you a diamond ring. If that diamond ring turns to brass, Mama's gonna buy you a looking glass. If that looking glass gets broke, Mama's gonna buy you a billy goat. If that billy goat don't ull, Mama's gonna buy you a cart and bull. If that cart and bull turn over, Mama's gonna buy you a dog named Rover. If that dog and cart fall down, You'll still be the rettiest baby in town. I sang the song tenderly, accenting and focusing on the words "Mama" and "Baby." L. ermitted me to lace the autohar artly Published with ermission of Ludlow Music.

16 Music as a Mode of Communication 101 on his la and artly on mine, as we sat face to face. I ressed the buttons and rhythmically strummed an accomaniment. For the first time (in his seventeenth session) there issued from his throat real, though soradic singing which came on the hrases that had the words "Mama's" in them. He wanted to do the song over and over. At the twentieth session, the two other boys each commented on how glad they were that they were only children and had no babies in the family. This gave me an oortunity to confront L. with his feelings about his sister. He did not answer, but tears aeared in his eyes; and he tried to hide in the closet when I said to him he hated his sister when she was born. I immediately shifted the activity to ainting to music where he could be exressive and yet turn his back on me aroriately. Also, it relieved him from any anxiety he might have felt from the confrontation. During the next sessions he was ermitted even greater freedom of choice than heretofore. He resonded by being increasingly exressive in rhythmic areas; he continued from time to time to emit additional single words in some songs. At the twenty-fifth session he was seen alone. After ten minutes of leasureful instrumental imrovisation, he ointed to a song he wanted. He had been so much more trusting and so much more sontaneous, that I decided to take a chance and ask him to seak u for what he wanted. In a high squeaky voice he said, "I want Noah's Ark." I did not comment, but immediately structured the erformance of the song so he would have strong suort from me and be rhythmically stimulated to come in on the resonse hrase. The lyrics were: fast Old Noah once he built the Ark, mf [Resonse] There's one more river to cross. And atched it u with hickory bark, mf [Resonse] There's one more river to cross. f One more river, Chorus

17 102 Evelyn Phillis Heimlich And that's the river of Jordan, / One more river, There's one more river to cross. m/ The animals went in one by one, / There's one more river to cross. The elehant chewing a caraway bun, There's one more river to cross. The animals went in two by two, There's one more river to cross. [There are fourteen verses to this song.] I started in with strong accent on the first hrase "Old Noah built himself an ark." Then I stoed and gave him a chance to rely as he chose either instrumentally or vocally on the nexthrase, "There's one wide river to cross." I nodded and leaned toward him, encouraging his rely. With drum accomaniment and in a high squeaky voice he regularly and rhythmically came in at the aroriate beat throughout all the verses. I became more and more exressive. Finally, the boy and I were singing together on the chorus. He imitated my exressiveness and sang louder and louder. He came close to the iano and stood next to me, moving his body rhythmically as he sang. There was no sign of tics. He showed much leasure and was very relaxed after this exerience, so I thought it timely to reintroduce the lullaby "Hush Little Baby." He could now talk about his baby sister. After a joint, tender singing of the song, I asked him directly how he felt about her after she was born. With some hesitance he was able to seak of his sadness at being removed from his lifelong berth in his mother's room. Once he began to talk, he voluntarily gave much historical material about his arents. The following session was held jointly with his eers who were surrised and leased at his talking. Most sessions were joint ones, but from time to time he was seen alone. Some of the solo sessions were held in order to give him an oortunity to dictate song stories. He used these as an additional way to communicate many hidden

18 Music as a Mode of Communication 108 feelings. In occasional ensuing discussion, he sometimes gained in sight into a roblem. In reviewing L.'s material, the stes in his imrovement became clear. L. resonded quickly to the wide choices available to him in the use of secialized music and its comonents. He was immediately able to have leasure in choosing an instrument, in choosing his own temo, rhythm, etc., and he could exress himself within the limits of the instrument of his choice. It took some time for him to be really varied and free in his choices, to be able to develo from monotonous to dynamic exression. Real sontaneity, motor and vocal, was still longer in develoing. Although it was slow, rogress first showed itself in motor exression. That is, he first articiated and discharged feelings through rhythmic motion. His multile tics began to subside somewhat, long before he soke. It is now March, his mutism is gone. Tics are rarely seen and when he is involved in music activities he never tics. The lans are for him to be discharged home in June. He will have been at the hosital two years. Until he is discharged work will continue to be done with him to hel him consolidate his gains and ossibly achieve further insight into some of his remaining roblems. 2. K. was a six-year-old boy who was seen alone. He was the eldest of a family of four, and had great intellectual endowments. His arents seemed to have emhasized the intellectual at the exense of the social skills. He was referred to the hosital as ossibly an autistic child. He was a withdrawn child, a twirler, slow in social develoment. He cried easily, banged his head, bit himself, and crossed his eyes when frustrated. He was reoccuied with insects, unable to lay with children, sleeless, rigid, fearful, and mostly silent. He had stoed seaking altogether from eighteen months to three years. Thereafter, his seech was fragmentary and often unrelated to reality. During the interview he refused toys and did not want to talk. On entering the theray room he was tense, ignored the ercussion instruments, went right to the guitar and started lucking it. I icked it u and imrovised a song about him-what he wore, how I liked him. He showed swift attention and resonse to the timbre of both the instrument and the voice. This was evident as he looked at me as I sang and layed and I laced his hand on various arts of

19 104 Evelyn Phillis Heimlich the guitar. On encouragement from me, he stroked the guitar rhythmically and with leasure while I continued softly to imrovise more songs about him, his clothes, his siblings, and again how much I liked him. Whenever I changed the quality of my voice, he would look u. He nestled close as I imrovised and changed chords and held the instrument toward him so he could strum it. In order to free him I then introduced many songs with rhythmic motion-like claing, staming, and swinging songs. At first he had great difficulty doing these. He would sing the songs but make only feeble though rhythmic motions while I stimulated him by making big free motions. Only after many reetitions and variations of these rhythmic motion songs (about the twelfth session) did he develo freedom of motion sufficient to exress what the songs indicated. He had similar difficulty in using the drums. At first he would use them only while he sat on the same iano bench with me. However, he did show immediate leasure and gave me his first smile when I imitated his meager imrovisations. Each session I ket laying his imrovisations with full chords and loud tones: he resonded by making stronger and louder beats, gaining more and more freedom and sontaneity. At the eighth session, I added Christmas songs to my regularly imrovised songs. K. was sitting on the iano bench with me singing and claing his hands; suddenly, without a word, he moved from the iano bench to my la, and as I layed, laced his fingers over mine while we were doing "Deck the Halls," The lyrics follow: last ml Deck the halls with boughs of holly, Fa la la la la, la la la la, I 'Tis the season to be jolly, Fa la la la la, la la la la, I Don we now our gay aarel, Fa la la, la la la, la la la,

20 Music as a Mode of Communication 105 f Troll the ancient yuletide carol, Fa la la la la, la la la la, Every time I accented a measure, like "Deck the Hall," he would ress his back against my breasts and sway with my rhythmic movements. He seemed to get much leasure from this; intermittently he would do this during subsequent sessions. In order further to stimulate freedom and give him the exerience of rhythmic movement in still another area, I set him to finger ainting and chalking to strongly accented and highly colored comositions like "Aida's March." He became very highly stimulated and resonsive. Once in the course of following the increasingly raid temo as he ainted, a blob of finger aint fell on the floor. He yelled, "Oh, Mrs. Heimlich, Mommy will be very angry" and looked fearful (see Fig. 10). Then he started to oint to imaginary fireflies and said, "There's a firefly on your hand and it's biting you." I reassured him about the blob and said I didn't mind the aint on the floor as long as he had fun making the design. I also reassured him about the fireflies, that they were just retend. He was glad of this and then continued haily ainting to the rhythm of the music. Sometimes I ainted alongside of him and occasionally aint would sill and he would giggle, "Mrs. Heimlich is bad, she sills aint." It took many sessions for him to be at ease and sontaneous with the aint, but he finally got to enjoy it so that he danced before the easel as he ainted and moved with the music. CASE 2-K FIG. 9 "Minuet." Rigid, straight strokes; red and blue finger aint. IG. 10 "Can-Can." Uneven combined straight and round strokes; all red finger aint.

21 106 Evelyn Phillis Heimlich FIG.ll "Irim Waaherwoman." Two banda wed to roduce entirely round Itrokea in bright red. yellow. green. FIG. 12 "1812 Overture:' Varied round atrokea made with fingen. nail.. and alma; bright yellow. red. green. and a little blue. Later on, much of his communication was through the little rhymes he made u and chanted to his own instrumental imrovisations. For examle, he comosed and sang, "There was a boy and he was mad and he tinkled [urinated] on the Emire State Building," During his early sessions, his resonses were most frequently to the timbre of the instruments, my singing voice and my strongly accented rhythmic imrovised songs. Gradually he was able to imitate my rhythmic dramatizations of motion songs. He was also more flexible in his resonses to ainting and chalking to music. He looked on my free exression and encouragement to him with oen astonishment and joy, frequently commenting on it. He began to use the materials with increasing freedom and gradually became freer in his behavior toward me. By the time he was discharged after thirty sessions, he was on comletely friendly and affectionate terms with me. His arents reorted that he no longer was reoccuied with insects, that there was less fearfulness and rigidity, and no more sleeless nights. He was better able to lay with other children. From his develoment and from the leasure he showed in both his own and my sontaneous use of the medium it would seem as though the oortunity for communication rovided through this medium had much significance for him. 3. J. was an eight-year-old boy referred for lacement by the Jewish Board of Guardians because of his uncontrolled, aggressive

22 Music as a Mode of Communication 107 behavior. At home he fought; once he set fire to his younger brother. In school he was defiant, restless, quarrelsome, and used obscene language. In summer cam he threw rocks at eers and counselors, and was asked to leave. The family consisted of the mother and two boys. j. was two years older than his brother. j.'s arents were divorced when he was four and a half years old. He was awarded to the father, who soon returned him to the mother because of his disgust with j:s difficult behavior. The father was never heard from thereafter. At birth j. had a clubfoot, which was oerated on twice, once at six months and again at six years. His arents were ashamed of the malformation. At the time of admission j.'s mother earned some money as a caterer. In addition, money came to her from men who aid her for having sexual relations with them. j. was at the hosital nine months before work began with him in music as a form of communication. During these nine months rior, he was in individual sychotheray and lay theray, but showed little rogress. On the ward and in school there was no consistent change in his destructive, distractible behavior. In sychotheray, he avoided discussing his roblems by inattentive listening, irrelevancy in discussion, aearing deaf or juming u and down. When music sessions began with j. he was laced with M., a timid eight-year-old boy who was reressed and had ressure of seech. Later on, at his request, he was seen alone from time to time. At his first session, he comletely ignored both M. and me. He romtly chose the largest drum and imrovised a loud rhythmic attern. He showed immediate leasure in the activity and was even more leased as well as astonished when I imitated his attern on the iano. He was able to continue this activity with M. and me for as long as I chose-that is, for fifteen minutes. On my introduction of folk songs, he dislayed interest and resonded as well. His interest continued to be more on the rhythmic ercussive imrovisational level, with very little singing at first. His resonse to the chalking to symhonic music was rhythmic, but tense, jerky, and angular. He showed no signs of destructiveness, restlessness, or obscenity. He was consicuously indifferent to both M. and me. His only interest was in the use of the materials. For three months he maintained almost comlete verbal silence.

23 108 Evely" Phillis Heimlich However, during this eriod there was much evidence of develoment. He exerimented with many of the comonents of music, esecially with timbre and dynamics. He used various arts of his body to elicit different kinds of sounds from the instruments as he invented atterns on them. He thumed with his fists, scratched or stroked as he imrovised. He exerimented with the wooden, metal, or skin arts of the instruments. He was uroseful in his varied choices and leased with my obvious admiration of the results of his instrumental exlorations. He learned to be exressive in many ways, with many sizes and shaes of instruments. One of his rare comments concerned his contentment when he observed how he ket erfect time with me. He said, "Boy, oh, boy, did you see how I was able to ut my right hand on the drum the exact same minute you layed the beat on the iano?" His develoment showed in another area too. Whereas he had always accomanied all songs with a loud monotonous even ulse, he began to resond to the variation and sontaneity exressed by me in the different tyes of songs I resented. For examle, when I exressed sadness in "Sometimes I Feel Like a Motherless Child," he ut down his big drum and gently, softly, and rhythmically stroked the tambourine in accomaniment. Sometimes he was so stirred by a song that one instrument did not suffice for his exressiveness, and he would aroriately use two or even three instruments. His rhythmic atterns became more intricate too. Change was also evident in the way he resonded in chalking to the symhony. In the beginning his designs were angular, jerky, and tense. They began to change in many ways. They became more flowing, though still firm, with more variation in color and shae. Just as he showed greater sensitivity to my exressive singing, so did he resond to more exressive comonents of the symhony (see Fig. 16). His behavior was never difficult, but in many of the sessions he did test me in different ways. One was by unexectedly changing his temo or his attern as I imitated him. My immediate attentive imitation of his subtle changes brought him great leasure which he showed by nodding contentedly. At his sixteenth session, for the first time, he aused to seak in the midst of chalking to "In the Hall of the Mountain King." Without ever reviously having articulated hostility and without ream-

24 Music as a Mode of Communication 109 CASE5-J FIG.l!J "The Hay Fanner." Heavy random straight strokes; urle chalk. FIG. 14 "Fantasy." Heavy straight strokes with ad dition of a few curves; black and a little dark urle chalk. FIG. 15 "Anvil Chorus." Heavy straight strokes, and wide curved strokes; black, blue, and much yellow chalk. FIG. 16 "In the Hall of the Mountain King." Many flowing curved strokes and dots; well or ganized; many bright colors, red, yellow, orange, green and a little urle. ble he said, "There is no way to insult you-is there, Mrs. Heimlich?" This oening gave me my first brief oortunity to ask him what he meant, and to exlain my comassionate feelings about heling the disturbed child. However, it was many sessions later before he was willing or able to seak directly of his feelings. Until then he showed his feelings through the use of music comonents in different ways. Sometimes he would reveal them by sensitive accomaniment. Sometimes he would sto altogether and request M., the other child, to be silent too, so he could just listen. At these times, he would move his lis or

25 110 Evelyn Phillis Heimlich even sing along on an esecially meaningful hrase. He would listen when the other child questioned me about the meaning of a song, but not until his twenty-sixth session did he himself comment on one of M.'s questions. M. asked about "Lili Marlene," song of loneliness, that stimulated him to wonder about a lonely deserted girl on the ward. The lyrics are: Ii slow P Underneath the lantern by the barrack gate, Darling, I remember the way you used to wait. 'Twas there that you whisered tenderly mf That you lov'd me. You'd always be My Lili of the lamlight, my own Lili Marlene. Resting in a billet just behind the line, Even tho' we're arted your lis are close to mine, You wait where that lantern softly gleams, f Your sweet face seems to haunt my dreams, My Lili of the lamlight, my own Lili Marlene. I had been aware of ].'s increasing resonsiveness both to the materials and to me. On this account I thought it was the roitious moment to confront J. with the fact that he, too, was a lonely and deserted child. My statement met with momentary silence. Then without further ado, he asked me if I knew why he was in the hosital. He then roceeded to give a flood of material on his roblems. At the end of this session, he touched me for the first time and said I was reasonable. He continued to be willing to discuss roblems. However, he would do this only after I stimulated him several times with varied resentations of songs that had to do with roblems similar to his. For instance, the song "]ohn Henry," the words of which are as follows: 6 Published with the ermission of Edward Marks. Published with the ermission of the University of North Carolina Preas.

26 Music as a Mode of Communication 111 fast slow mf John Henry said to his catain, f PP "A man ain't nothing but a man, PP An' before I'll let your steam drill beat me down, f I'll die with the hammer in my hand, Lawd, Lawdl PP Die with the hammer in my hand." mf John Henry got a thirty ound hammer, mf Beside the steam drill he did stand, f He beat that stream drill three inches down, f An' died with the hammer in his hand, Lawd, Lawdl PP Died with the hammer in his hand. John Henry had a little woman PP An' she was always dressed in blue, She went down track never looking back, Says if) "John Henry, I am always true to you, Lawd, Lawdl John Henry, I am always true to youl! Lawd, Lawdl PP John Henry, I am always true to youll" PP Johny Henry had a retty little boy, Sittin in the alm of his hand,

27 112 Evelyn Phillis Heimlich ff He hugged and kissed him an' bid him farewell, Oh son, do the best you can, Lawd, Lawd, ff Son, do the best you can," They took John Henry to the graveyard An' they buried him in the sand, D An' every locomotive come roarin' by Says, "Dere lays a steel-driving" man, Lawd, Lawdl" Dere lays a steel-drivin' man. This song was resented with much dramatic exression, focused on the love of the father, John, for his son. This evoked historical material about J.'s father's irresonsible and cruel behavior toward him, and then about his mother's behavior in regard to her own wedding ring (she gave it to J. to sell). Following this eriod, he continued to use this highly structured yet exressive means of communication advantageously. He gradually was able to be sontaneous, sensitive and aroriate in relation to materials and eole. Ward and school ersonnel reorted a change for the better. The severity of the behavior disorder was much relieved. He became an increasingly warm, trusting, well-eontrolled, and communicative boy. He gained some insight into his roblems and was eager to grow u. 4. G. was an eleven-year-old Negro boy from North Carolina. He was admitted to the New York State Psychiatric Institute from Babies Hosital on July 31, In the revious February, he had a fever of unknown etiology and subsequently develoed loss of memory and rogressive leg weakness. One month later he was removed from his home to Lincoln Hosital, North Carolina, from which institution he was soon discharged on crutches. Both legs were totally aralyzed, and he was confined to bed in his mother's care. It was then that his thirty-one-year-old stesister brought him to New York.

28 Music as a Mode of Communication 113 City to the Hosital for Joint Diseases, where he remained for six weeks. Numerous studies, including EMG, were negative. He was thereuon transferred to Babies Hosital where after a comlete and negative neurological and hysical study a diagnosis of conversion hysteria was made. On this account he was admitted to the ediatric service at the Psychiatric Institute. The atient was the eldest child of his mother's second marriage. He had two brothers, one nine and one four years old, as well as a stesister thirty-one years old, and a stebrother of twenty-nine. The mother was a reacher for a fundamentalist church, and was away from home much of the time. The father was a laborer for a chemical concern. He was aarently a very stern man, and had beaten the boy numerous times. Because of the mother's reaching activities, many of the household duties were left to G., including the care of the two younger brothers. G. was described as a shy, conscientious, religious boy who avoided loud and rough boys. His classmates in North Carolina called him homosexual names, such as faggot, but G.'s activities in this area were unknown. The major area of conflict in G. was his anger at his arents. He felt burdened and conflicted by the demands his arents made on him to care for his younger brothers besides having to assume household resonsibilities. He had these tasks from the age of eight years. At the New York State Psychiatric Institute, when he was questioned or addressed on the subject of his roblems, he was silent. Occasionally there would be an outburst during which he would exress the wish to kick, crush the bones of or "stom" on the doctor who tried to get him to discuss his roblems. Then he would clam u again. He was aloof with the ward staff as well as eers. G. resolved his roblem in symtomatic exression. Instead of directing his anger toward his environment, he converted it to hysterical aralysis of his legs. He dared not use his masculine strength to exress himself, so he reverted to a assive feminine role. His voice was soft and high. His gestures were effeminate. After a two-and-a-half-month eriod during which he sullenly refused to communicate with his sychotheraist as well as all other staff members, it was decided to give G. an oortunity to use music and its comonents as a means for communication and ossible

29 114 Evelyn Phillis Heimlich theray. The oortunity for stimulation to motor exression was esecially considered in view of G.'s aralysis. During the course of his sessions he used all asects of this exressive mode at one time or another. However, his rhythmic motor resonse and the use of oortunities for exressing himself by imrovising music stories were outstanding. At his first session, he had a secret, withdrawn facial exression. He entered the room in his wheel chair. At later sessions, he ket his wheel chair outside the theray room and crawled out. Once in the room he immediately and silently took a drum and tried out an imrovisation. He showed leasure when I imitated him. He resonded to my free and vigorous imrovisation on his attern by an immediate show of increased vigor and variation in his use of his arms and uer body as he continued making new atterns. His early use of folk songs was guarded--his face was bland when he sang. The first communication in this area came with his variations in exressive ercussion accomaniment. Changes in vocal exression came later. He was soon moved into a grou with two other boys so that his sessions consisted of one solo session and one grou session er week. He gained a great deal from the oortunity to exchange imrovisations and instruments with the other boys. The boys on the other hand were much imressed and stimulated by G.'s great inventiveness, sensitivity, and freedom in his use of the medium. The room was charged with his ercussive inventions and later on with his vibrant voice. After several months, it finally seemed feasible for me to question G. directly about the content of a folk song that was ertinent to one of his roblems. The song chosen was the "Blue Tail Fly." It had been introduced several times before without content or hrases being discussed. The song offered many elements for exressionraid temo, strong accent, much reetition as well as hrases that could readily be used for raising questions ertaining to some of G.'s as well as the other boys' roblems. These are the lyrics: fast mf When I was young I use' to wait, On Massa an' hand him his late, An' ass de bottle when he got dry

30 Music as a Mode of Communication 115 fast He died an' de jury wondered why, De verdict was de blue tail fly. Chorus They lay him under a 'simmon tree, His eitah is there to seeslow fast An' brush away de blue tail fly. Chorus mf Jimmy crack corn an' 1 don't care, Jimmy crack corn an' I don't care, Jimmy crack corn an' I don't care, 01' Massa's gone away. mf One day he ride aroun' de farm, De flies so num'rous they did swarm, One chanced to bite him on de thigh, f De devil take de blue tail fly. Chorus mf De ony run, he jum, he itch, He threw my master in de ditch, slow Beneath this stone I'm forced to lie, Victim of de blue tail fly. Chorus Finally, after G. had sung and accomanied the song eloquently I asked my first question. Other asects of the song had been discussed before by the other boys. This was the first time I turned to G. directly. Since he never mentioned why he was in the hosital and never directly commented on his arents as did his eers, I selected a hrase from the song to elicit comment ertinent to these roblems. The hrase was from the coulet "Beneath This Stone I'm

31 116 Evelyn Phillis Heimlich Forced to Lie, The Victim of the Blue Tail Fly," the following discussion ensued: I: G., do you understand what a victim is? It says here in the song "victim of the Blue Tail Fly" G.: Well somebody that something bad haens to. I: I think it's more than that. G.: Oh, you mean like somebody who would get muscular dystrohy? I: Possibly, or like the man on the horse who was thrown from his horse and killed because a fly bit the horse and the horse reared. He was really a victim. G.: Oh, you mean all kinds of eole who get diseases. I: Possibly, can you think of any other kinds of victims? G.: Yes, children who have roblems? I: What do you mean? G.: Well, arents. There was no further comment and G. looked thoughtful. I suggested that he finger aint. When he was finished, he did something he had never done before: he started as usual to crawl out of the room on his hands and knees to his wheel chair. While crawling, he changed to hitching on one knee and walking on the other foot. Then he swung onto his wheel chair. This was after two months of sessions in the use of secially directed music. Regular walking did not take lace for another three months. In the meantime he continued to develo, exress himself and communicate further through the use of still other asects of music. His chalking and ainting to music became more colorful, freer, and firmer in stroke (comare Fig. 17 and Fig. 20 and note differencesmore flowing and thicker, firmer strokes). His gestures as he worked went from delicate gingerly ones to strong masculine movements. Then his voice changed from a soft sorano to a vibrant male quality. At this oint of develoment I suggested that we jointly imrovise music stories. The stories he created were mythlike in character and dealt in a disguised way with his many roblems and his attitude toward them. He underscored the stories by vivid instrumental accomaniment, sang them line by line with me, directed me as to means and

32 Music as a Mode of Communication 117 CASE 4-G FIG. 17 "In the Hall of the Mountain King." Light. delicate strokes, covering small ortion of aer; blue and yellow chalk. Flc. 18 "Polonaise," Delicate but larger strokes, covering more aer; urle, green. orange. Flc. 19 "Dance of the Buffoons." Delicate strokes combined with heavy strokes. Yellow. green, urle. FIG. 20 "Gaiete Parisienne," Mostly heavy strokes. aer fully covered, well organized; mainly bright orange, yellow, green. urle. ways for exression, and often acted out the arts of the different characters. The following imrovised story is given because it is tyical and also because after this violent exression G. took his first four stes since he became aralyzed. This is the story as dictated by G. There was a man and a lady. They were very fine friends. One day the lady haened to have a child-the man decided to marry her. Then when they were married, the child grew u to a healthy young boy, but then they were very mean to him and they beat him and he had to go to a hosital because he was bleeding from

33 118 Evelyn Phillis Heimlich the beatings. When the child came back to the arents, they said that they would be good to him, but they only said that in front of the hosital. When he got home they were mean again. This child had a dream and he heard somebody say to him, "Tomorrow morning you will get u early before anybody so you will be able to fix some cereal, and you will mix aint, turentine, and gin in it. This is a magic formula and when they, the arents, wake u, you will srinkle it over them and great blessings will come to you:' He got u early and did what the dream told him-so then he srinkled it on the mother and the father and they turned into ants [he hesitated at the word ants]. They had sots from the aint on them and were blind from the turentine, and the oatmeal would always nourish them. Suddenly two good arents aeared to him. He thought they were foster arents and they were, and they ket him for good. He did an equal share of work like any other kid and he felt hay from that day on, but he was wondering who told him what was in that dream. Mer G. finished the story he looked contented, as though he had executed a satisfactory iece of work. The storm was temorarily over. He then asked gently to sing a coule of favorite songs until the end of the session. Together he and I sang and layed the songs of his choice. When the session was over, G. swung himself as usual onto the floor, rearatory to crawling to his wheel chair. Only this time, when he got to the floor, he squatted. Then still squatting, he took four stes and went out of the room. He turned and looked at me, but for fear of frightening him in this sudden move toward health, I made no comment. The next session, G. walked into the room. He used the wheel chair on the ward for two more days and then abandoned it. All Go's movements in the theray room and on the ward continued to be increasingly masculine. He occasionally had a fight with a boy when attacked. He joined the Boy Scouts. Whereas on admission he declined to ermit the sychologist to test him, he now volunteered to be tested. As an aside on the testing, in one test of twenty unfinished sentences, he ended three of them with an exression of love of singing. For examle, in the unfinished sentences "I always love to.. :' G. finished by saying "sing." Since G. resented a case involving motor disability and since he was unable to verbalize his anger, it was thought that music and its comonents might be useful as a means of communication. Its

34 Music as a Mode of Communication 119 many comonents rovided a wide choice from which he could make his early exressive exlorations. As he develoed, he was able to extend his use of this mode to include more and more comonents. In the course of his develoment his symtoms disaeared, he also became more sontaneous in using materials and in his relationshi to eers and me. SUMMARY The central roblem dealt with in this article was communication with children who did not resond to traditional methods of sychotheray. A ossible solution was offered in the use of music in its broadest sense, i.e., music and its comonents used with the secific communication needs of the child in mind. The imrovisational, adative, and maniulation functions of music and its comonents were then described and rocedures detailed. Cases illustrating the methods and various asects of the use of this medium were resented. The cases involved one outatient, six years old, and three inatients ranging in age from eight to twelve years. While the athology of the children differed in many resects, they all had one roblem in common-that of communication. A brief descrition of the children's behavior at intake was followed by the use they and I as the theraist made of the medium in an effort to have them communicate. All children described were able to make rogress in communication through the use of this method, although from time to time each one selected different asects of the medium for his unique, current, exressive needs. APENDIX BEHAVIOR RATING SCALE FOR CHILDREN IN MUSIC THERAPY E. I. BURDOCK, PH.D., ANNE S. HARDESTY, M.S., and EVELYN P. HEIMLICH, M.A. Name of child Age. Identification No. Name and Title of Observer. Narne of Institution. Date.

35 120 Evelyn Phillis Heimlich The following statements rovide for a descrition of the behavior of a child during a music theray session. For each item the rater should record his judgment by: Circling T if the statement is true. Circling if the statement is not true. All items should be answered. Corrections should be made by erasing or crossing out the incorrect choice. Ifit is necessary to qualify an item, a word or hrase can be written in on the dotted line following that item. 1. T 2. T 3. T 4. T 5. T 6. T 7. T 8. T 9. T ]0. T 11. T 12. T 13. T ]4. T 15. T 16. T 17. T 18. T 19. T 20. T 21. T 22. T 23. T 24. T 25. T 26. T J oms.. m grou d" lscusslon. Does not gesture with music. Uses movement or gesture aroriate to music. Does not lay drums at all. Uses only one color of chalk. Imrovises words to familiar tunes. Comments favorably on other child's roduction. Associates own roblem to words of song. Laughs or smiles when song or music is humorous.. Kees resisting suggestions of other children. Interferes with the activities of other child. Has aroriate exression when song or music is sad Comments on music. Is absorbed in his activities. Grimaces or gestures grotesquely. Dances during session. Bangs hard on instrument. Presses so hard on chalk that it breaks or flakes. Beats drum arhythmically. Shows leasure in coming to music theray. Asks for a articular song. Has a faraway look while beating drum. Converses with theraist. Converses with other child. Says he doesn't like to come to music theray. Sings along with the music.

36 Music as a Mode of Communication T Sits in, but does not articiate in music theray T Kees asking for aroval. 29. T Is attentive to other child's music. 30. T Touches, feels, or strokes contours of instruments T Beats drum mechanically ". 32. T Chalks with disconnected jerky movements. 33. T Exresses feelings aloud. 34. T Performs alone without being urged ". 35. T Moves restlessly about room. 36. T Imrovises rhythmic attern on instrument. 37. T Does not chalk at all. 38. T Deliberately soils own work. 39. T Sings in almost inaudible voice. 40. T Plays with instrument in a slow and uneasy manner 41. T Chalk strokes are without design. 42. T Is attentive when other child seaks. 43. T Talks during or after chalking. 44. T Kees seeking attention. 45. T Joins in grou singing or laying. Biometrics Relearch. N.Y. State Det. Ment. Hyg. REFERENCES BENDER, L. (1956). Psychoathology of Children with Organic Brain Disordef's. Sring field. Ill.: Thomas,. 25. BUUD, J. &: FOUD, S. (1895). Studies on Hysteria. New York: Buic Boob, BUCHENHOLZ, B. &: NAUMBEaC. G. W. JR. (1957). The leasure roceu. ]. Nero. 0 Ment. Dis. 125:!l CALLAWAY, E. &: DEMBO. D. (1958). Narrowed attention: a sychological henomenon that accomanies a certain sychological change. Arch. Neurol. 0- Psychiat., 79: CHURCH. J. C. (1961). Language and the Discovery of Reality. New York: Random HOUle DARWIN, C. (1859). The Origin of Secies. New York: Modem Library. -(1871). The Descent of Man. New York: Modem Library. DEWEY. J. (19M). Art as Exerience. New York: Ninton, Balch Be Co FARNSWORTH, P. R. (1958), The Social Psychology Of Music. New York: Dryden Press, FUUD, A. (1946). The Psycho-Analytical Treatment of Children. New York: Interna tional Universities Preas, 1959,. 69. GlU.Js. A., 1.AscELLEs, C. F., Be CRONE. N. (1958), A comarison of rhythmic and nonrhythmic music in chronic schizohrenia. Amer.]. Psychiat., 114: GRODDEC&, G. (19!l3). Exloring the Unconscious. New York: Funk Be Wagnalls, GROTJAHN. M. (1957), Beyond Laughter. New York: McGraw Hill,

37 122 Evelyn Phillis Heimlich ILu'rMANN, H. (1959), Ego Prychology and the Problem of Adatation. New York: International Universities Pre., 1958,. 18. HENDJ.la, I. (19M Ie 1959), F4CU and Theorie, of Prychoanalyril. New York: Knof,.I (1951), Early develoment of the ego: identification in infancy. Prych04nal. Quar,., 20: LEvY, D. M. (1944), On the roblem of movement restraint (tics, stereotyed movementa. hyeractivity). Amer. ]. Orthorychi4t., 14: LoMAX, A. (1959), Folk long.tyle. Amer. Anthroologist, 61: MAHLER, M. S. (1945), P.ychOlDmatic.tudy of maladie des tics. Prychoanal. Quart., 17: MEULOO, J. A. M. (1961), Rhythm in babies and adults. Arch. Gen. Prychi4t., 6: MEYEIl, A. (1952), Mental hygiene. Collected Paer, of Adolf Meyer, 4:464. Baltimore: John. Hokin. Preu. MITJ'ELMANN, B. (1958), Psychodynamics of motility. Inter. ]. Prycho-Anal., 59: MURPHY, L. B. ET AI.. (1962), The Widening World of Childhood. New York: Basic Books, PAUL, R. Be STAUDT, V. M. (1958), Music theray for the mentally U1: a hi.torical sketch. ]. Gen. Prychol., 59: PlACET, J. (1925), The LAnguage and Thought of the Child. London: Routledge Ie Kegan, 1952,. 77. RUEICH, J. Be BATESON, G. (1951), Communication: The SOcUll Matrix of Prychi4try. New York: Norton,. 85. SCHACHTEL, E. G. (1959), Metamorhosis: On the Develoment of AfJect, Percetion, Attention and Memory. New York: Basic Books, SHAllN L Ie KOTrEa W. (1955) Rhythm grou' in the rehabilitation of mental atients. Amer. Arch. Rehabil. Ther. 5: SoIBELMAN, D. (1948), Theraeutic and Indwtri41 Uses of Mwic. New York: Columbia University Prell SPrrz, R. A. (1957), No and Yes: On the Genesis of Human Communication. New York: International Universities Pre StJU.lVAN, H. S. (1955), The Interersonal Theory 01 Prychiatry. New York: Norton,.45. TAUBE&, E. S. Be GREEN, M. R. (1959), Prelogical Exerience. New York: Basic Boob VAN DU WALL, W. (1946), Music in Hositals. New York: Ruaaell Sage Foundation,. 86.