KENNETH AIGEN, DIRECTOR OF RESEARCH, NORDOFF-ROBBINS CENTER FOR MUSIC THERAPY, NEW YORK UNIVERSITY

Transcription

1 Music Therapy 1995:Vol. 13, No. 1, Cognitive and Affective Processes in Music Therapy with Individuals with Developmental Delays: A Preliminary Model for Contemporary Nordoff-Robbins Practice KENNETH AIGEN, DIRECTOR OF RESEARCH, NORDOFF-ROBBINS CENTER FOR MUSIC THERAPY, NEW YORK UNIVERSITY Research on contemporary Nordoff-Robbins clinical practice suggests that developmentally-disabled children exhibit a wide range of musical and expressive skills, from the ability to beat a melodic rhythm on a drum to being able to transform an habitual, pathological stance to the outside world through musical interaction. This article incorporates Serafine s (1988) cognitive theory of music to support the notion that these skills, rather than learned in a rote manner, indicate instead the presence of highly developed cognitive capacities. A four-tiered model is presented in which these various skills are organized according to the particular psychological domain for which they are most relevant. The proposed model integrates work in what is traditionally considered developmental therapy with areas of intervention that are more characteristic of music psychotherapy. In this preliminary research report, clinical examples are offered to illustrate the underlying processes discussed in the model. Correlations to treatment will be pursued in subsequent reports.

2 14 Aigen Introduction Juliette Alvin (1965) was one of the first authors to systematically discuss the interaction of emotional, social, intellectual, and physical processes activated in disabled children by music therapy. From the observation that such children experience uneven maturation in these areas, she attributed the value of music therapy to the ability of clinically-directed musical experiences to effect integration of experience in these different realms. However, Alvin did not go into detail regarding specific processes, and her pioneering work did not make an explanatory connection between cognitive processes and affective, self-expressive ones. Alvin did, however, distinguish between musical sensibility and musical aptitude, with the former referring to the capacity to appreciate music as a listener and the latter to the potential to acquire skill in creating or performing music. The model presented herein builds upon her recognition that sensibility (as Alvin defined it) has physical, sensuous (and particularly) intellectual, and emotional components. She also noted that lack of aptitude can obscure a child s sensitivity because without either the verbal or musical means to express such sensitivity, i.e., performance skills, the child s sensitivity cannot be communicated to others. Edith Boxill (1985) argues that music therapy gains its efficacy as a primary treatment modality for developmentally-disabled individuals because music has direct effects upon all the domains in which they experience dysfunctions, including the motoric, communicative, cognitive, affective, and social. She further observes that music can bypass areas of cognitive deficit because its messages can be apprehended at autonomic levels [and they] do not require encoding or decoding to be beneficial (p. 18). Boxill, however, presents these ideas as general principles and does not link specific cognitive operations with musical expressions. The most in-depth study in the area of music therapy with developmentally-disabled children is that of Paul Nordoff and Clive Robbins (1977). Their work represents an overall approach to music therapy, encompassing theoretical psychological constructs, clinical techniques, exercises for training therapists, and two rating scales for initial and ongoing evaluation: ScaleI. Child-

3 Cognitive and Affective Processes in Music Therapy 15 Therapists Relationship in Musical Activity; and Scale II. Musical Communicativeness. The first scale consists of ten levels of participation that assess a child s capacity for interpersonal relating through music, and the second consists of ten levels of communicativeness that provide a means for charting the development of a child s ability to use music as a communication tool. Nordoff and Robbins (in press) created a third device, ScaleIII. Musical Response]. It provides separate hierarchic taxonomies for rhythmic and melodic forms, differentiated by their complexity. The scale for rhythmic forms was derived principally from work with drums, and the melodic forms were evaluated primarily as they emerged in therapy as products of vocalizations or singing. The authors emphasize that in neither can the clinical significance of a response be determined by its structural form alone-the degreeof activation or engagement expressed in it must be recognized as having at least equal importance. This engagement is discerned through the various expressive components of music, such as the accelerando, fermata, diminuendo, [and] rubato. The authors state that psychological processes activated through musical apprehension/expression include awareness, perception, attention, ideation, concentration, memory emotional responsiveness, emotional differentiation, receptive-expressive integration and self-expression. However, they do not relate these processes directly to individual acts-or classes--of musical expression. The present research relates to, and builds upon, these prior efforts in three ways. First, by discussing and analyzing the active and receptive musical abilities of disabled children in terms of the cognitive processes implied by, or embedded in, their demonstrated abilities, I hope to bring a higher degree of specificity to the important-but only generally stated-observation that creative music therapy accessesthe healthier and more intact aspects This scale, which has previously existed solely as an unpublished manuscript, will appear in the forthcoming revised edition of Creative Music Therapy (St. Louis, MO: MMB).

4 16 Aigen of these children. By linking these musical abilities to specific cognitive operations, I believe it is possible to get a better picture of musical intelligence and the overall functioning potential of developmentally-disabled children. For example, due to the level of detailed analysis afforded by high quality audio-video records of music therapy sessions, and the advanced training of the clinicians who analyze these records, we have begun to find ways to infer the presence of sensitivity, even though it may be expressed through extremely limited performance skills. Second, Nordoff and Robbins Musical Responsescale described above was drawn from a clinically rich, although musically limited (in terms of the types of instruments available to the children), variety of expressions. Because of the sheer amount of children who have received (and continue to receive) treatment in the intervening years, we have much more information regarding rhythmic and melodic skills on pitched percussion instruments as well. Further, experience has also demonstrated the complexity of harmonic abilities in these children (such as the ability to sing or play tones indicating the anticipation of cadences) in addition to the melodic and rhythmic ones detailed above. Hence, we are now in a position to correlate expressions of different musical elements with one another and group them according to the functional relationship to music that they demonstrate, as well as their complexity. Last, by placing emotional expression on a single continuum with cognitive abilities, I hope to bring a greater level of integration to the profession of music therapy that will allow us to understand developmentally-disabled individuals in a more complete and humane way. Other music therapy theorists in this area (Orff, 1974; Alvin, 1965) have emphasized that music stimulates integrative, cognitive capacities for those who typically have had deficits in this area. However, there have been relatively few examples of clinicians who have worked with, and theorized about, affect in a psychotherapeutic way through music with this client group. Yet a recently completed work (Aigen, in press) has shown that traditional group therapy processes were exhibited in a group of developmentally-disabled adolescents-including affective expressions. Because music therapists work directly with these individuals affective expressions, one of the goals of this

5 Cognitive and Affective Processes in Music Therapy 17 research is to codify and integrate the work that therapists are already doing, while laying some groundwork for developing connections between work on musical/cognitive skills and the more traditional goals of psychotherapy, such as enhanced emotional self-awareness and expressiveness. Moreover, it should be kept in mind that this model emerged from studying therapists implementing a particular approach to music therapy and is thus a reflection of the skills of the children involved as well as the Nordoff-Robbins approach. It is an important finding in understanding Nordoff-Robbins music therapy that we see work on the cognitive, aesthetic, and affective levels proceeding concomitantly. This multi-level clinical approach itself reflects the degree to which practitioners in this tradition believe in the importance of working with the whole person. Sample and Design Rationale Notes on the Research Method The current research consisted of two sequential case studies. The first was a preliminary study of a musically gifted, blind, autistic child named Nicole. From this case study, a model was developed that was then tentatively applied in a more limited fashion to a second, similar autistic child-joshua. The model was subsequently found to be readily applicable to the second child s therapeutic process as well. Too often, case studies have been criticized for their lack of generalizability. However, Robert Stake (1978) argues that in the study of human affairs case studies will often be the preferred method of research because they may be epistemologically in harmony with the reader s experience and thus to that person a natural basis for generalization (p. 5). The knowledge afforded by case study research leads to naturalistic generalizations that are arrived at by recognizing the similarities of objects and issues in and out of context and by sensing the natural covariations of happenings (p. 6). Such generalizations may be arrived at intuitively, yet they still must meet empirical constraints.

6 18 Aigen While case studies may not guarantee that the sample studied is representative of a given population, this representativeness is more important when one is seeking to generalize to a population. Administrators charged with policy decisions affecting large groups of individuals may require such a representative sample. Yet, when the realm of application is other similar individuals-and for clinicians, the realm of application is the individual rather than the population -the rich description characteristic of the case study is more important than is representativeness of the sample in determining into which contexts, or for which individuals, the original findings may be applicable. In order to take advantage of the highly developed expertise of the therapists participating in this research, the data-gathering procedures were kept as nearly as possible homologous to the practices in which these therapists typically engage while implementing treatment. Part of their treatment includes a painstaking review of video tapes of every session, focusing on (at times) subtle, minute changes in aspects such as facial expressions, body language, the tonality of nonverbal musical vocalizations, and fleeting moments of musical contact and coherence. Given that these therapists natural, tacit understandings develop through the meticulous analysis of single individuals over periods of years, the current research method conformed to this procedure in order to formulate findings, i.e., to create a model, that would be useful because it was constructed from procedures that mirrored those of the therapists, thus meeting Stake s criteria for naturalistic generalization. For the initial stages of this research, it was decided to employ what Lincoln and Guba (1985) refer to as purposive sampling. This is defined as sampling extreme or deviant cases to obtain information about unusual casesthat may be particularly troublesome or enlightening [emphasis in original] (p. 200). The children selected for this research are both visually-impaired, autistic, severely developmentally-disabled, yet musically-gifted. The rationale for choosing children with a high degree of musicality was that such children are more likely to display skills and sensitivities on a variety of levels and thus offer a more complete picture of how music is used within music therapy sessions. Because it was intended for this research to be

7 Cognitive and Affective Processes in Music Therapy 19 the incipient stages of model development, the decision was made to first apply it to those children most likely to provide a more general picture of the entire range of functioning, rather than look at one level in specificity, which might occur should a less purposive sample be employed. After studying the first child, Nicole, a second child, Joshua, who is also musically sensitive but who is of a minority group and a less advantaged socio-economic status, was selected for study. By studying children from different cultural backgrounds, I hoped to increase the probability that the resultant model would be less culturally-specific. In future development of this model, children whose musical sensitivity is more representative of the developmentally-delayed population will be considered to adjust it to broaden its realm of application. These considerations follow Lincoln and Guba (1985) who discuss the serial selection of sample units and continuous adjustment or focusing of the sample (pp ). In serial selection, each successive unity can be chosen to extend information already obtained, to obtain other information that contrasts with it, or to fili in gaps in the information obtained so far (p. 201). Further, as the researcher gains expertise in the area of study and begins to generate hypotheses, they suggest that subsequent casesfor study be chosen based upon their potential in addressing the researcher s ongoing concerns. Research Method and Protocol The primary method of data gathering, analysis and presentation is that of Naturalistic Inquiry as discussed by authors such as Guba and Lincoln, 1981; Lincoln and Guba, 1985; Ely, Anzul, Friedman, Garner, and Steinmetz, 1991; and, Erlandson, Harris, Skipper, and Allen, This approach offers several advantages: it employs constant movement among data gathering, analysis, and write-up; it encourages the use of a variety of data sources; it provides for descriptively rich accounts deemed suitable for this type of study; and, it encourages looking at individuals rather than impersonal processes. The research protocol was selected because it was found to allow for the flexibility characteristic of good qualitative methods

8 20 Aigen while still providing for systematic inquiry. This protocol was first applied to Nicole s course of therapy and led to the development of the model. Subsequently, the model-although not the research protocol-was applied to Joshua. It was found to capture the salient elements of his process, although the musical realizations differed from those seen with Nicole. The research protocol for Nicole was as follows: 1) A musically gifted child was identified who had received at least one full year of music therapy sessions. Her participation was contingent upon her therapists and parents willingness to participate in the study. 2) Video archives of Nicole s previous three-year course of therapy, maintained by the Nordoff-Robbins Center for Music Therapy, were viewed by the investigator in their entirety. 3) As the sessions were viewed, an observation log was maintained in which all significant musical interactions and expressions were recorded. 4) Analytic memos were written after each group of four to six sessions to discern categories in which the musical expressions might be organized; to compare these categories to the categories already identified and adapt the model to accommodate the new findings; to maintain a constant re-evaluation of the overall focus of the study and design; and to stay vigilant about the investigator s preconceptions and blind spots. 5) The music therapists for Nicole were consulted during the study and again at the final write-up to evaluate the investigator s interpretations. All of the tentative conclusions regarding the children s abilities were checked with these therapists, and they had the opportunity to evaluate the raw data, i.e., the session tapes, and determine how well the investigator s descriptions conformed to the information on

9 Cognitive and Affective Processes in Music Therapy 21 the tapes, and if the conceptual analyses of the investigator were warranted by the abilities demonstrated by the children. After the model was developed with Nicole, Joshua was identified as the second participant in the research. The researcher viewed a video tape compilation of Joshua s therapy that had been prepared for his mother s viewing at an annual conference at which Joshua s lines of development and areas of difficulty were detailed. Excerpts from this tape were selected by the researcher and subject to the same scrutiny as Nicole s, detailed in step (5) above. Description of the Model Perceptual, Cognitive, and Affective Considerations The proposed model presupposes, and is consonant with, the view of music (Meyer, 1956) that holds that the experience of music is something that we actively construct through the integration of a variety of processes: sensory, perceptual, cognitive, and affective. From this integrated stance, musical activity and understanding is explained by the order and affective content imbued onto the music by the individual, rather than through the perception of these qualities as being inherent in the music itself. Hence, when one displays competence as either a listener, performer, or composer of music (and in subsequent uses of the term competence, all three of these activities are included), a whole host of cognitive/affective processes necessary for musical competence are implicated. For example, a perceptual theory of music would attempt to explain how we detect and identify the melody of a piece of music through reference to the physics of sound waves and their impact on our physiological mechanisms of hearing; the melody exists out there, and as listeners we detect it through perceptual means. Our musical competence may presuppose perceptual processes, but these processes do not explain musical competence any more than theories of visual perception explain competence

10 22 Aigen at playing a game of chess, for example. Instead, just as chess competence can be explained through appeals to internalized rules and strategies, musical competence can be explained through internalized cognitive operations and abstract representations A cognitive theory would hold that the perceptual processes necessary for experiencing sound do not enlighten us as to how sound is heard as music. Mary Louise Serafine (1988) has developed a cognitive theory of music based on empirical studies in which she delineates the various cognitive processes underlying the ability to create and experience music. What makes this system so valuable is that it is generic rather than style-specific. For example, she describes the process of closure as the ability to understand that music is divisible by temporary resting points (p. 40). A particular style principle that follows from this generic process is that one rests at the tonic in a given phrase. But resting at the tonic is the way that one culturally specific style-western classical music-embodies this universal principle. It is the universal principle that is primary and explains our ability to learn the conventions of a given musical tradition. Table 1. Serafine Model of Fundamental, in Experiencing Music Generic Processes I. TEMPORAL PROCESSES A) Succession: Chaining, grouping or horizontally adding events (Serafine, p. 74). A short unit isconceived, successive units are added, two or more units are reconstituted into a new whole. 1. Idiomatic Construction: Sound events that are logically discrete and isolable are perceived or felt as a continuous gesture. earlier tones are tied to later ones. This table is a summary of the conceptual system presented in Music As Cognition:TheDevelopmentofThoughtin Soundby Mary Louise Serafine (New York: Columbia University Press), 1988.

11 Cognitive and Affective Processes in Music Therapy Motivic Chaining: Two or more units/motives combined successively into a longer one. 3. Patterning: When motives/units are chained repetitively, patterns result. 4. Phrasing: Grouping musical events into clusters or phrases. B) Simultaneity: Combining and synthesizing musical events vertically (Serafine, 1988, p. 77). 1. Tonal Synthesis: e.g., Combining notes to form a chord. 2. Timbre Synthesis: Combining multiple timbres into one. 3. Motivic Synthesis: Blending two melodies so that they retain their unity or combine to form a new melody. 4. Textual Abstraction: Organizing simultaneous streams of activity into figure-ground relationships, e.g., discerning the melody against a harmony. II. NON-TEMPORAL PROCESSES A) Closure: Understanding points of stasis and stability which imply cessation, e.g., cadences. B) Transformation: This process is the basis for similarity/difference judgments in music as these can be described by the steps that would be entailed to transform one event into another. 1. Relative Repetition: Exact repetition of a musical event with figurative changes, such as playing a melody in a different key or register. 2. Ornamentation: Alteration through addition. 3. Substantive Transformation: In which a transformed musical event is related to its original only in an abstract way, such as sharing a melodic contour. C) Abstraction: Some aspect of a musical event is removed or considered apart from its original context and a relationship/connection is implied. 1. Motivic Abstraction: e.g., Fragment of Theme (A) is used in Theme (B). 2. Property Abstraction: Rhythmic pattern, melodic contour, etc., is used elsewhere. D) Hierarchic Levels: Discerning tones which articulate a piece s structure. Imposing of a more simplified, reduced structure on the vast array of sounds in a piece.

12 24 Aigen Serafine (1988) considers music to be the activity of thinking in or with sound (p. 69) and notes that wherever a repeatable composition is conceived, there will be reflection upon it as to its salient and necessarily repeated features (p. 37). In other words, she is suggesting that to develop a relationship with a piece of music, to learn it, to learn to identify with it, to detect and recall those attributes that define it, all require a certain level of intellectual reflection and abstraction. Because music is such a transient phenomenon, it requires greater degrees of conscious reflection in assimilating its principles than do other art forms. The contribution of Serafine s model is to highlight the fact that the various musical skills and sensitivities imply underlying processes, some of which are present on more than one level of the clinical taxonomy. Why is this view of music of importance for music therapy in general, and for this model in particular? In the cognitive view of music, the presence of musical competence indicates abstract processes that may not beevidenced in any other way. Similarly, in the Nordoff-Robbins approach, it is believed that music bypasses areas of pathology or dysfunction to access an individual s healthy core (Nordoff & Robbins, 1977; Robbins & Robbins, 1991). Thus, to say that music accesses the healthy is to say that cognitive and affective processes not otherwise detected are activated in and through music. This supports the theory that the presence of musical competence alone is sufficient to postulate the existence of abstract and other cognitive processes that are not activated or detectable through other means, such as purely verbal ones. Structure of the Model The four levels of the model are listed in Table 2. For the time being, the receptive or purely cognitive aspects of these levels have not been distinguished from the active or performance aspects. The rationale is that musical skills are an example of what Schon (1983) defines as knowledge in action and that, in some cases, it may not be fruitful to distinguish doing from knowing.

13 Cognitive and Affective Processes in Music Therapy 25 Table 2. Four Levels of Interaction With/In Music LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1 Affective Musical Expression Aesthetic Musical Awareness/Creation Dynamic Musical Intelligence Concrete/Basic Musical Skills Some of the processes described by Serafine can be seen on all four levels of the clinical model and others are limited to specific levels. For example, the set in Group I-A, Successive-Temporal Processes, could be seen on multiple clinical levels. Consider a child who is playing the following sequence of notes at the piano: B-A-G, B-A-G, A-G-F, A-G-F.3 We might want to infer that the processes of idiomatic construction and motivic chaining are being exhibited as the child is (a) integrating isolated tones into a sequence, and, (b) building a chain as two sequences are combined to form a longer unit. This could be a paradigmatic example of Level 1 skills. However, if the therapist initiated the G and F chord pattern and the child responds with the tonal sequence, and perhaps emphasized (rhythmically or dynamically) the repetitions of the G and F notes, we might see this as an example of Level 2 skills. The difference is that in the former example, the notes are merely organized into units; in the latter, we can infer the musical logic behind the organization which implies that the child is aware of the tonal significance of the notes in the sequence. Thus, any of the cognitive processes on the lower levels can be displayed on the upper levels, if their musical manifestations reflect the dynamic, aesthetic, or affective content characteristic of that level. On the other hand, processes first appearing on a higher level cannot be applied to lower levels. As an example, consider a child playing two simultaneous notes on the piano. Unless they are heard as a forming interval-unless their musical function is apprehended-we would not want to attribute the ability of tonal This isnot a hypothetical example but is taken from my current clinical practice.

14 26 Aigen synthesis to the child. Merely playing two notes simultaneously is not enough to make an attribution of Level 2 skills. Hence, tonal synthesis is restricted to Levels 2 and above. To understand the relation between Serafine s theory and the preliminary model presented here, think of the model as a fourstory building with the processes discussed by Serafine as the bricks comprising the structure of each floor. Because this research is in its beginning stages, all of the connections between the two have not yet been made, but, wherever possible, their linkages are shown in the following description of the model and in the subsequent clinical musical illustrations. It should be noted that the processes identified by Serafine, which are linked to a given level, should be understood as emerging on that level and exhibited on the subsequent levels aswell. Also, it should be recognized that one limitation of Serafine s view in application to music therapy is that it does not address the role of affective processes in music. Regardless, it is applicable to the first three levels of the proposed model, although it is difficult to assess its utility for Level 4 where affective content isprimary. LEVEL 1: Concrete/BasicMusical Skills The Level 1 processes involve the most primary operations in how we understand and create music as music. They are the cognitive building blocks for our ability to understand, live in, and manipulate the other levels of musical activity. These primary, organizing processes are logically embedded or embodied in the other levels. This is not to suggest, however, that they are acquired developmentally as precursors of abilities in the other areas, but that they are activated as we function on these other levels. Musically, this first level involves the ability to do things such as (a) understand or recognize a succession of logically distinguishable tones as forming the unitary phenomenon of a melody; (b) recognize isolated beats on a drum as forming a rhythmic phrase; and (c) play or sing either an improvised or a pre-composed melody. The cognitive processes implied here include those that Serafine (1988) defines as idiomatic construction, motivic chaining, patterning, phrasing, and timbre synthesis (see Table 1). These are not to be considered rote skills, since even in the recognition of isolated tones as constituting a melody there is the beginning of

15 Cognitive and Affective Processes in Music Therapy 27 abstract thought, the concept that the melody is developed from discreet, concrete tonal events. Although, these Level 1 operations do not necessarily have expressive or aesthetic value, they do reflect a cognizance of the units of organization in music. LEVEL 2: Dynamic Musical Intelligence The concept of musical intelligence refers to our awareness of the forces present in themelodic, harmonic, and rhythmic impetus of music. Awareness on this level allows the listener/performer/composer to understand and utilize the various conventions of different musical idioms and styles. This involves the cognitive abilities Serafine (1988) identifies as tonal synthesis, textual abstraction, closure, relative repetition, and hierarchic levels (see Table 1). On a musical level, this intelligence includes the ability to understand, use, or develop expectations regarding such things as intervals, harmonies, and cadences. Being able to convey that we understand the directions a given melody or rhythmic pattern may take, as well as discerning the more relevant aspects of a multi-faceted musical event, such as distinguishing a melody from elements of the accompaniment, also belongs on this level. In general, the processes at this Level allow us to be able to organize the elements in Level 1 into greater degrees of abstraction and complexity. These Level 2 operations may not necessarily have aesthetic or expressive value, but they represent purely musical phenomena, as opposed to the skills in Level 1, which reflect generalized cognitive operations applied to music. LEVEL 3: Aesthetic Musical Awareness/Creation The Level 3 processes involve our considerations of valuation or quality in the music. They are implicated when we as therapists appreciate the character of musical expression, when a client s music has the more intangible elements of a feel, when a client shows cognizance or appreciation of musical forms, or creates music that complements the therapist s Manifestations of aesthetic processes reflect inner qualities, not capable of being mechanically reproduced, and they thus necessarily involve a novel

16 28 Aigen or creative contribution on the part of the client/musician. This awareness can involve the cognitive processes Serafine (1988) describes as motivic synthesis, ornamentation, substantive transformation, motivic abstraction, and property abstraction (see Table 1). Musically, these processes are manifest in creating a wellformed melody, playing music with an appropriate feel, entering music at significant moments such as on pick-up beats on the first beat of a measure, syncopating or otherwise varying melodies, leaving musical spaces, and understanding cadences and variations in the context of ongoing music. LEVEL 4: Affective Musical Expression This fourth level is the ability to create or live in music that contains felt emotions. It is the process that breathes life into music that may be otherwise simply well-organized and pleasing. What develops at this level is the ability to express oneself and relate to others on an emotional level by infusing aspects of one s affective life into the music. No novel cognitive-musical process are postulated as being specific to this level, although social and emotional processes are present that are not manifest on the other levels. It may not be immediately apparent that cognitive, musical skills are required for this fourth level of personal expression and interpersonal relating. One might argue that a client pounding clusters of dissonant notes on a piano is expressing him/herself without displaying any apparent skills. In this schema, however, one can see that if the clusters are self-expressive because of the dissonance, then the client isnecessarily (a) organizing thevarious tones into clusters, (b) hearing the clusters as dissonance, and (c) hearing the dissonance as a tension producing element which manifests his or her inner state. These three skills are implied. If the dissonance is not the self-expressive element, then the client might just as well pound a cushion and not engage in musical self expression. In other words, making the clinical judgment that the music is self-expressive means that we are necessarily attributing the presence of intervening, cognitive processes. If the pounding on the piano is pure emotional discharge, then it would not be self-expressive.

17 Cognitive and Affective Processes in Music Therapy 29 The crucial point is that hearing dissonance, tension, resolution, tonal direction, etc. is not a matter of perception but of cognition. Hearing the aspects of music that make it aesthetic or expressive necessarily involves internal, mediating processes. Elaborations on the Model To grasp all four levels at work, it might be helpful to think of an individual s experience and understanding of melody (see Table 3). When a child demonstrates an understanding that a melody exists as a unified phenomena, through either recognition of or the ability to reproduce a melody, this would fall within Level 1 (Concrete/Basic Musical Skills). Serafine s (1988) cognitive operation of idiomatic construction is implied because the child is able to understand perceptually discrete events (represented by isolated tones) as a created unity, i.e., the melody. When a child demonstrates an understanding of why a given melody is constructed as it is, by showing overtly or implicitly an understanding of its tonal motion, this would indicate a Level 2 (Dynamic Musical Intelligence) process. To be classified at this level, it is not enough for the child to reproduce a melody mechanically; instead, the child would need to sing, play, or otherwise respond with an appropriate dynamic or rhythmic emphasis, thus showing an awareness of the naturally stressed tones of given melody. Serafine s (1988) cognitive operation of closure is implicated as the child demonstrates an awareness of the natural points of stasis in music. A Level 3 (Aesthetic Musical Awareness/Creation) skill could involve the creation of a well-formed melody, one that incorporates intervallic leaps, is comprised of a patterned contour, or rests on significant tones. Cognitively, as novel melodies are created from pre-existing ones, Serafine s (1988) concepts of ornamentation and substantive transformation are implied. On Level 4 (Affective Musical Expression), children are able to infuse or recognize aspects of their emotions/feelings in a melody. Music becomes most personally self-expressive in this way.

18 30 Aigen Table 3. Illustrations of the Model in Terms of Melody LEVEL 4 LEVEL 3 LEVEL 2 LEVEL 1 Infusing/recognizing aspects of one s emotions or feelings in a melody. Creating or hearing the interesting or novel aspect of a melody. Hearing why a given melody is constructed as it is. Understanding that a melody exists. On Levels 1 and 2, the child is gaining knowledge of musical rules and conventions, such as the idea that discreet tonal events are grouped in certain ways and combinations (Level l), and that certain tones are more likely to proceed to certain others (Level 2). On Levels 3 and 4, the knowledge gained is more in the arena of knowing how to utilize the raw materials being mastered in Levels 1 and 2 in the service of creative self-expression. Thus, the knowledge gained transcends the implementation of rules and conventions. Expansion of the Model Initially, the research model consisted solely of these four hierarchical levels, with abilities in the higher levels being dependent upon the presence of lower level abilities. However, in the preliminary study with Nicole, and particularly in the application of the model to the second child, Joshua, we repeatedly encountered expressions on the lower levels that were more sophisticated than those encountered in the higher levels. These counter-examples suggested the development of a second dimension of the model, the dimension of complexity. By adding this dimension, it was possible to preserve themodel s basic hierarchical structure, while adapting to findings which at first seemed to challenge its utility. The model with the added degrees of complexity, including musical illustrations of each, is presented in Table 4. While all of the examples of musical expressions and responses within Table 4 have been seen in the research, they function here primarily as illustration, and not all of them are present in the

19 SKILL increasing complexity LEVELS Musical Expressions and Responses LEVEL 4 Affective Enjoying/responding to music that reflects present affect. Creating music from one s current feeling state Creating or allowing music to affect deep-seated or long standing growth inhibiting pat terns of thought or action Creating/allowing music to transform an inner conflict or problematic emotional state LEVEL 3 Aesthetic Ornamenting a melody Playing with a certain feel or syncopation Creating or responding to melodies that reflect awareness of-but are not bound by-standard rules of tonal motion Reacting to, playing off of, or otherwise showing cognizance of unusual cadences LEVEL 2 Dynamic Discovering intervals Discovering chords Showing preferences for the more stable tones of a key while improvising Anticipating cadential movement LEVEL 1 concrete Repeating brief rhythmic figures Playing the malodic rhythm of a known song on a drum Approximating the tonal contour of a known melody, whether sung or played Rendering a melody accurately Development can be see either in increasing complexity (horizontal axis) or movement to other levels (vertical axis) or in a greater consolidation of skills which would not appear as movement through the elements of this model.

20 32 Aigen clinical material in this study. Moreover, the examples chosen do not reflect an equivalent degree of complexity across the various levels. In other words, it is not claimed that the fourth example of Level 1 reflects the same degree of complexity as the fourth example on Level 4. This model should be considered taxonomic rather than developmental. There is no claim that the course of therapy or the development of musicality in children traces a movement through either dimension of this model.4 What is presented here is a way of organizing the various areas of clinical focus, with particular emphasis on showing the interdependency of cognitive and affective processes. When working on concrete or cognitive goals, an individual is also laying the foundation for work of a more expressive or affective character; similarly, when working with affective expression, one is by necessity engaging underlying cognitive processes. I am coming to believe that the strict demarcation between affective and cognitive processes in clinical work is more of an abstraction that, while useful for some purposes, does not truly reflect the way that human beings actually function. Working with cognitive, motoric, behavioral, and affective levels during one and the same course of therapy is characteristic of the Nordoff-Robbins approach. This four-level model comprises a structure for organizing these efforts according to the relationship to music they suggest. Clinical Examples5 Because of the preliminary nature of this research report, the clinical excerpts on the audio tape accompanying this journal 4See Briggs (1991) for a developmental model particularly suited for music therapy 5Both Nicole and Joshua have been seen in individual music therapy for a number of years. The clinical examples in this report were selected merely to illustrate this model, and no effort was made to capture all, or even most, of the salient factors in their courses of therapy. Only through detailed case studies could the actual nature of their development in music therapy be captured. Such a video study is currently under preparation by Nicole s therapists, Carol and Clive Robbins.

21 Cognitive and Affective Processes in Music Therapy 33 were chosen because of their value in exemplifying the model. In subsequent studies the model will be more fully developed and its implications for treatment will be more fully elaborated. Nicole s Music Simply put, Nicole embodies the word survivor. Weighing only 600 grams when she was born at 24-weeks gestation, Nicole has endured a number of life-threatening physical complications. She lived on a respirator until she was 12 weeks old, and severe digestive problems left her with only one-sixth of her small intestine. Nicole has never ingested food or drink by mouth: All of her nutrition is supplied by a gastrostomy tube and a catheter directly into her heart ventricle. Most of her early years were spent in and out of hospitals. She is autistic, severely intellectually impaired, and visually impaired. When she began music therapy at 4½ years of age, she exhibited few verbal skills. Her therapy has covered a wide range of musical, expressive, communicative, and inter-personal goals. Her musical intelligence and aesthetic sensitivity have helped her to make dramatic gains in all of these areas, and her therapists have worked tirelessly to invoke these strengths to help overcome her predilection for engaging in solitary activities. At the time this study was undertaken, Nicole had completed three years of individual music therapy with Carol and Clive Robbins, from November, 1990, through June, They see a side of Nicole that supersedes her difficulties: Despite her difficult and hazardous start in life-or perhaps because of it-she shows a strong will to live and to assert herself. Music is uniquely important in her life, and in musical activities she can manifest the strength of her personality actively and directly. She has made music her own and can live in it with self-determined motivation; our task has been to live in music with her in the attempt to make it a means of self-discovery and self-realization for her. We have also worked to make music into a field of interaction and communication that might open to her the possibilities of sharing more deeply in human relationships. (personal communication, August 1993)

22 34 Aigen Audio Excerpt #I (SIDE Al: Session 1 (11/29/90) Nicole enters the room for her first session, and Carol Robbins provides her with a clear musical idea and tonality while helping her to understand where she is by singing, Here we are in music. As Nicole approaches the piano, aided by Clive Robbins, Carol sees that she wants to play. Carol moves her right hand up an octave and stops singing to allow Nicole to relate clearly to the piano.6 Nicole begins with a descending melodic phrase at :19 into the excerpt; she is sensitive to tempo and phrasing and plays in the tempo of the ongoing music. Her melodic phrases end on notes in the harmony as when she stops on a G note while Carol is playing a Gsus4 chord at approximately :33. By beginning her playing on the first beat of the incipient song form, Nicole demonstrates her ability to discern the musically meaningful beat as well as to adapt her playing to suit the form. Her opening descending phrase contains and continues through a musical rest. This ability to sustain a melodic idea through a rest shows her melodic sensitivity, which, along with her entrance on pick-up beats, shows that she has come to music therapy already being able to function on Level 3 (Aesthetic). Audio Excerpt #2 (SIDE A): Session 2 (12/13/90) In this session, the melody for Here We Are in Music has evolved into a more assertive declaration that matches Nicole s exuberance in music. The drum and cymbal are being played by co-therapist, Clive Robbins, to enlarge the experience for Nicole. At :14, Carol takes Nicole s left hand and guides her in playing the melody in the piano s upper-middle register while Nicole plays the melodic rhythm with her right hand in the treble.7 At :38, Carol takes Nicole s right hand and repeats this hand-over 6Unless otherwise noted, Nicole is playing on the treble end of the piano along with Carol Robbins in all of the following excerpts. 7Nordoff-Robbins Music Therapy can, at times, include the teaching of melodies through hand-over-hand interventions in order to provide the child with the knowledge and experience that, through an act of will, she or he can recall and reproduce a melody.

23 CognitiveandAffectiveProcesses in MusicTherapy 35 hand intervention in a higher register, while Nicole keeps playing the melodic rhythm in her left hand, and at :59 it is repeated one more time in a still higher register. Nicole briefly starts to improvise at 1:20, and Carol employs the hand-over-hand technique one last time at 1:30 in the middle register while Clive sings to Nicole. From 1:44 to the end of the excerpt, Nicole plays approximations of the melody in the higher register, repeatedly finding the primary note of G matching Clive s whistling. She also plays other, complementary melodic lines, particularly eighth-notes, from 2:05 onward. Nicole is clearly listening and waiting for the melody to finish before adding her own countermelody. She again demonstrates an uncanny ability to find musically correct notes on which to begin, pause, and end her phrases. In the teaching of a melody we can clearly see a Level 1 clinical intervention oriented to a Level 1 process. Nicole obviously enjoys learning a melody. Her approximations of the melody are examples of simpler Level 1 (Concrete) abilities that should be distinguished from the ability to create variations of a melody, which belong on Level 3 (Aesthetic). Audio Excerpt #3 (SIDE A): Session 2 (12/13/90) In this excerpt, in addition to Nicole and Carol Robbins at the piano, Clive Robbins is playing two handbells. Nicole begins by reaching across Carol and playing freely in the lower-middle register of the piano, in a rapid tempo (eighth notes) with impressive precision. She thenmoves to the treble end. From :12 to :19, she adjusts her playing to twice as slow but in the same tempo, and then when Carol s phrase ends at :19. Nicole immediately shifts to the eighth notes with Carol. This same change occurs at :31when Nicole plays quarter and half notes and then returns to the eighth notes at :39, again precisely at the turnaround in the incipient song form. She responds to Carol s improvised melody, which was taken from a fragment of Nicole s playing. In this excerpt Nicole demonstrates her ability to rapidly internalize the musical form, which involves alternating phrases. She is aware of, and can shift between, the musical foreground and background, as her phrases (in the treble end) become the background when Carol plays eighth notes, thus indicating her capac-

24 36 Aigen ity for textual abstraction as Serafine (1988) defines it (see Table 1). All of these elements suggest skills being consolidated on Level 3 (Aesthetic) as Nicole demonstrates an ability to adjust her playing to function in a complementary way. Audio Excerpt #4 (SIDE A): Session 8 (2/28/91) Nicole joins Carol at the piano in what has become her song, Here We Are in Music. While improvising with this song, Nicole spontaneously segues into the melody of Little Drummer Boy at approximately :20. She plays in the key of G Major, and Carol modulates from C Major to G. Nicole patiently waits for Carol to finish the accompaniment pattern before starting the melody again. Clive Robbins plays the melodic rhythm on a drum to support Nicole, changing at 1:07 to off-beats to allow Nicole more autonomy. Nicole s accurate rendition of a melody, which includes appropriate waiting through musical rests, indicates a complex Level 1 (Concrete) skill. In the last few seconds of the excerpt, when she begins a phrase on the incorrect note, she is aware of this and adjusts her playing to finish the phrase on the correct note. This flexibility suggests that she maintains an internal representation of the melody, an important piece of evidence that her learning is not by rote but, instead, involves the capability for abstract thought. Audio Excerpt #5 (SIDE A): Session 25 (11/21/91) As the excerpt begins, Nicole is playing alone with D and E notes in the bass and a D-C#-D motif in the middle register. Then she moves her left hand to play an A note to form the interval of a fourth. Carol picks up Nicole s motif in the bass at :16 and then, a few seconds later, sings along. Carol gently grounds Nicole s playing to the tonal center D as Nicole explores the relationship between the leading tone and the tonic. She discovers the tritone interval forming the basis of dominant seventh chord to tonic chord. At :59, Carol sings a three-note phrase A-G-F, and Nicole pushes Carol s hands away from the piano. Nicole immediately responds to Carol s phrase with her own three-note phrase B-A-A on the piano. Nicole then listens meditatively from 1:03 to 1:16. Clive plays in the treble briefly at 1:26. Nicole

25 Cognitive and Affective Processes in Music Therapy 37 repeats her cadence at 1:37 with assertion, leading into it with three single A notes. This transitions into a Goodbye song as the excerpt ends. As Nicole discovers the forces in tonal and harmonic motion by examining the relationship between dominant and tonic-and the relationship within the intervals (tritone, perfect fourth) themselves--she presents a fairly pure example of musical interaction on Level 2 (Dynamic Musical Intelligence) and displays her capacity for tonal synthesis as described by Serafine (1988). Nicole is exploring the forces present in tonal and harmonic motion and is using this discovery in making a type of proto-music, that is, a sound exploration which is not yet music but contains aspects of that which we recognize as music. Audio Excerpt #6 (SIDE A): Session 31 (2/13/92) Nicole, standing at the piano, sways in time while playing sophisticated melodies that incorporate diatonic and chromatic aspects. Carol s accompaniment is even and soft, in order to allow Nicole s melodies to come out more fully. The melodies begin to show Nicole s evolving musical sophistication in her creative use of intervallic leaps and changes in melodic direction, all occurring within a well-patterned framework. Carol takes Nicole s exploration of minor seconds and introduces the idea of short trills (embellishments) in order to make them more musical. Nicole s melodies are framed by Carol s accompaniment, which provides a stable tonic to dominant movement in the bass. The shift of harmonies opens up the music, and Nicole, to new possibilities, Nicole s playing shows her deepening explorations on Level 3 as she is clearly working on melodic statements that go beyond the scalar runs typical of her early sessions. Her efforts in this area are more fully developed in the following excerpt. Audio Excerpt #7 (SIDE A): Session 39 (5/6/92) The musical context created by Carol in this session frames and enhances Nicole s expression. Nicole s playing takes on a clear melodic shape with the use of repeats, extensions by adding notes, and playing in different places (motivic abstraction), all of which exhibit complex Level 3 (Aesthetic) skills. Her improvised melodies suggest an incipient understanding of a classical cadenza and

26 38 Aigen indicate a beautiful aesthetic sensitivity, especially in the phrase beginning on a trill at :29 that concludes the excerpt. One can only speculate as to what degree this is self-expressive, although even in its fragmentary nature, Nicole s music appears to reach a level of sublime beauty and tenderness. Audio Excerpt #8 (SIDE A): Session 44 (9/24/92) This excerpt includes three portions from one continuous improvisation, separated by about 1 minute. a) After a brief descending, assertive phrase, Nicole begins precisely played, rapid chromatic phrases. At :20 she changes to assertive, well defined three-note phrases and returns to the chromatic playing at :30. She finds intervals of a dominant seventh, octave, and a fifth at :40, later seeming to establish a tonal center around A at 1:00. b) Nicole continues in chromatic playing with a lighter touch and resting on the interval of a fourth-her preferred notes of A and D -before ending temporarily on a double A octave. c) Throughout this excerpt, Carol sings strongly, gives Nicole the tonal center of A and a stable meter, and picks out a fragment of her melodic rhythm to help her relate to the music and organize her playing. Nicole s playing is alive and explorative and wildly chromatic. At the beginning, Nicole alternates chromatic playing with melodies on the white keys, Carol plays an ostinato and sings. From :13-:19 Carol plays a series of ascending chromatic chords. At :23 Nicole finds a double octave on A. She plays again chromatically with a lighter touch from :23-40 with Carol adding minor second trills. Nicole changes to white key melodies and again resolves them to A at :54. She reintroduces the chromatic melodies at :57, changes again to white keys at 1:15 and ends this series on the interval of a sixth which she plays ascending one

27 Cognitive and Affective Processes in Music Therapy 39 step-from C-A to D-B at 1:35. She returns to the chromatic playing before finding a double octave on A at 1:47 and ending the excerpt on a single A octave in the bass. There is a sense of tension and release in Nicole s alternation between chromatic playing and melodic playing with a tonal center. Her interest in minor seconds has progressed from (a) exploration of the dissonant quality of the interval, to (b) understanding its role in a dominant to tonic movement, to (c) its use as a trill for a diatonic melody, to (d) the basis of atonal, chromatic improvising similar to modern polytonal music or that of free jazz. Throughout this last excerpt, Nicole s skills at all levels of the model can be heard. Her ability to create melodies and to maintain a sense of rhythm and pulse are elements of Serafine s (1988) idiomatic construction characteristic of Level 1 (Concrete). By establishing a tonal center and maintaining it through time, combining discrete notes into intervals and changing her played notes but maintaining the interval, ending her melodies on notes in the tonal center, and showing a cognizance of the difference between chromatic and diatonic music, Nicole demonstrates Serafine s process of tonal synthesis, closure,and hierarchic levelsthat occur on Level 2 (Dynamic). Serafine s cognitive processes of patterning, relative repetition, and ornamentation-exhibited when Nicole repeats the pattern of diatonic playing in a stable tonality with chromatic playing, repeats an interval raised up one step, and repeats a melodic contour but moving higher in the keyboard s register with each repetition, respectively-are all elements that enhance the Aesthetic value of music, placing them on Level 3. Nicole s ability to be fully committed to her music, to create music that reflects her vitality and life spirit, and that appears to convey the sense of her inner life, all show her relationship to music on Level 4 (Affective).

28 40 Aigen Joshua s Music In some ways, Joshua and Nicole are very similar, although the circumstances of their respective lives could not be more different. Also autistic, visually and intellectually-impaired with little intentional use of speech, Joshua is nonetheless a creative, strongwilled, sometimes stubborn, child who manages to convey his inner intelligence and awareness primarily through music. Living in dangerous, inner-city neighborhoods for much of his life, this 8-year-old boy has none of the middle class comforts afforded to Nicole. In spite of substantial obstacles, Joshua s mother-who is raising him alone-has shown great resourcefulness in establishing a life for him. Music is Joshua s primary connection to the outer world and to other people. At the time this research was undertaken, Joshua had completed two years of individual music therapy. His primary therapist was Alan Turry, and his co-therapists were, first, Walter Stafford (sessions l-24) and then Clive Robbins (sessions 25-44). Audio Excerpt #9 (SIDE A): Session 17 (3/21/92) With Alan playing the piano, Joshua is attempting to play the melody of Jingle Bells on the resonator bells with Walter s assistance. At :12, he moves to the piano bench and plays a descending cluster of notes while Walter continues to play the bells. Joshua then accepts a hand-over-hand intervention to play the melody of Jingle Bells at the piano from :20 to :30, at which point he segues into an improvisation. While playing in the key of C Major at :40, he anticipates the harmonic movement and plays a dominant seventh (adding a B flat to the C chord) to move the progression to the subdominant chord, F. At :48, he subsequently hears the F# in the D chord-which functions as a dominant of the dominant-and adjusts his playing to include this note that is not in the key of C. He responds to the accompaniment rhythm even as he introduces his own melodic idea, a song not heard before this: Swanee River (Old Folks at Home) at :50. Even as he enters into a new song, Joshua adapts his phrasing to match the therapist s There is a complex Level 1 (Concrete) skill evident in Joshua s playing of the melody, and complex Level 2 (Dynamic) skill in his

29 CognitiveandAffectiveProcesses in Music Therapy 41 ability to anticipate harmonies and adjust his playing accordingly. When emphasizing the first beat of the song by leading into it with eighth-note runs, Joshua shows his cognizance of the importance of this beat as the beginning of the melody and his skill in having his fill musically climax here. These appear as relatively sophisticated Level 1 (Concrete) and Level 3 (Aesthetic) skills. Audio Excerpt #10 (SIDE A): Session 45 (10/2/93) In this excerpt Joshua is able to display flexibility within the song as phrases are extended and varieties in harmony are introduced. He plays the melody with both hands and shifts registers with ease, improvising from one to the other,. showing his cognitive abilities for relative repetition (see Table 1). At the end of the excerpt, Alan introduces the idea of accompanying the melody with a bass pattern in the left hand. Alan is firm, and Joshua enjoys this new musical element. As the music begins, Joshua is playing the Swanee River melody rubato style in the treble end of the piano accompanied by Alan. Alan makes a brief arpeggio on a diminished chord from :03 to :07, and Joshua waits for this to end before continuing the melody. Joshua plays a trill embellishing the melody at :19 and then continues the melody one octave higher at :24. At :48, he continues with the melody in his right hand and allows it to pass seamlessly to his left hand at :53. When the melody begins again at :58, Joshua again shifts to an octave higher in the middle of this phrase at 1:04. At 1:07, Joshua mistakenly plays an A note and then plays his way up to the correct note of C rather than frantically searching for it. In other words, he corrects himself with musical intelligence. Alan embellishes this with another diminished arpeggio moving into the treble end. Joshua again waits for this arpeggio to end-which seems to indicate that he understands its musical function as an extension of the dominant chord-and resumes the melody at 1:12. He concludes at 1:24, again playing a musically appropriate trill on the last note of the melody. Alan then implements a hand-over-hand intervention to teach Joshua the bridge melody, and Joshua resumes playing alone at 1:40. He plays the melody with his left hand in the bass. At 1:59,Joshua plays a C note in the treble, simultaneously with a D in the bass. He immediately corrects himself to play a C

30 42 Aigen octave and then moves both hands in unison to play a descending octave. Alan continues the accompaniment in the treble and bass in a more staccato style with Joshua now playing the melody in the middle octave. Joshua plays variations of the melody with a descending phrase at 2:26. Level 3 (Aesthetic) skills are clearly evident in Joshua s ornamentation of phrases. He also uses Level 1 (Concrete) skills to engage with the music and with Alan on a deeper level through the flexible use of melody and tempo. His ability to play the melody in different registers and to split it between two hands shows that Joshua has an internal representation of it, that it is not a mechanical skill learned by rote. Both his ability to improvise on the melody and his ability to stay with the shifting, undulating tempi demonstrate complex Level 3 (Aesthetic) skills. Audio Excerpt #11 (SIDE A): Session 47 (10/16/93) Joshua had previously hinted at his familiarity with gospel music by his style of singing, and so this idiom was introduced. Here, he uses his voice confidently, improvising melodies and recognizing the harmonic sequence. His melodies give clear indications of the harmonic direction. He understands and identifies with the idiom, singing in a manner consistent with the style. This excerpt includes two portions from one continuous improvisation, separated by 2 minutes. a) For the first :20, Joshua improvises vocally in the key of the ongoing music and follows the changes in harmony. He recognizes the function of the diminished chord at :20, laughs and waits briefly, and allows the build-up of suspense to move him to new territory, singing through the rests on his own. At :55, Joshua sings in a contextually appropriate falsetto voice with perfect vibrato. b) At :05, Joshua plays a brief cluster on the piano in answer to Alan s blues phrase and again laughs and plays over the diminished chord. At :22,he sings sing a clear bye on the tonic. From :30 to :45, Joshua s light, aspirated tones represent inner voices in the

31 Cognitive and Affective Processes in Music Therapy 43 harmony which lead to subsequent chords. He sings a tonal vocal trill between the notes of A and GW at :47and then a clear melody on D-C#-A at :55, and at 1:05, sings clear D-C# notes. At 1:25, Joshua concludes by singing bye with clarity and support, sliding down from C, and eventually ending on the tonic A slurring the notes in a way appropriate to the gospel blues style. In Joshua s ability to hear the tension in a diminished chord--or hear it as an extension of the dominant-and enjoy this tension, he shows Level 3 (Aesthetic) awareness. The ability to anticipate harmonic movement is a relative complex skill on this level, as is the inventiveness and spontaneity of his melodic, vocal improvising. The pure joy that Joshua shows suggests that he is capable of actively engaging in music on Level 4 (Affective). Conclusion Although the levels in this model refer to processes within the client, they can also provide a system for understanding therapist interventions. Hence, they can be understood as referring to a hierarchy of client abilities as well as to the scope of treatment goals. Carol Robbins ability to support the music s continuity, structure, aesthetic, and emotional essence,in a manner consistent with its significance for Nicole indicates her clinical interventions on the four levels respectively. The levels represent a hierarchy in the sense that an expression on one of the higher levels presupposes the existence of skills on the more primary levels. For example, creating a melody with an aesthetic character (Level 3) requires the existence of skills on Levels 1 (Concrete Skills) and Level 2 (Dynamic Musical Intelligence). On the other hand, as Table 4 indicates, any given expression on Level 1 may or may not be more complex than an expression on a higher Level. So while Level 4 (Affective) expressions, as a class, presuppose the existence of skills on the other three levels, it is not the case that every Level 4 expression is more complex than expressions on lower levels.

32 44 Aigen The model is hierarchical in a general sense, but not in terms of individual acts of expression. As one moves up through the levels, the musical manifestations of the inner processes become increasingly individualized and creative, and ascertaining their status becomes increasingly subject to the sensitivity of the person doing the rating. Yet structuring this model in terms of a competence hierarchy in no way implies a value hierarchy: Goals are pursued at all levels simultaneously, and the value of more primary processesis not seen merely in terms of their usefulness in facilitating expressions on higher levels. Because the music therapy process involves constant movement among levels, the hierarchy does not represent a developmental sequence, either for the course of therapy in general or for a given individual. Music therapy for developmentally-disabled individuals involves meeting their most pressing life needs and providing situations in which they can experience themselves as more fully human. This incorporates-and serves as the justification for-work on all of these levels aspart of music therapy. Although the work on the lower levels can resemble educational practice, the context of therapy imbues the skill training with clinical possibilities not inherent in a typical educational milieu. These possibilities include using the developing of skills to (a) create or strengthen the therapeutic relationship; (b) serve as a spontaneous entry point to deeper levels of emotional expression; and, (c) address typically psychotherapeutic goals, such as enhancing self-esteem. Thus, while music psychotherapy can occur more overtly on the upper levels as the affect and creativity of the individual become increasingly more important, work on all of the levels has a place in a music psychotherapeutic treatment model. This is determined more by the rationale behind a given intervention, and the quality with which it is enacted, than by a context-free description of the intervention. In this view, for example, asking a client, How did that feel? is not inherently more psychotherapeutic than is the teaching of a melody because the judgment as to what constitutes a psychotherapeutic intervention is context-dependent, with the relevant context consisting of things such as the present state and needs of the client, and the sensibility and sensitivity of the therapist.

33 Cognitive and Affective Processes in Music Therapy 45 Relationship goals, which are often of primary importance for the developmentally delayed, can be addressed at all of the levels. For example, it is possible that a resistive child who begins to allow the teaching of a melody through a hand-over-hand intervention is showing significant growth in interpersonal relating by tolerating or even enjoying this type of learning and physical contact. In this way, the intervention addresses a typically psychotherapeutic goal, although the means for achieving this goal appears purely educative. References Aigen, K. (in press). Here we are in music: One year with an adolescent, creative music therapy group. St. Louis, MO: MMB Music. Brig s. C. (1991). A model for understanding musical development. Music Therapy, 10(l), l-21. Alvin, J. (1965). Music for the handicapped child. London: Oxford University Press. Boxill, E. (1985). Music therapy for the developmentally disabled. Rockville, MD: Aspen. Ely, M., Anzul, M., Friedman, T., Gamer D., & Steinmetz, A. M. (1991). Doing qualitative research: Circles within circles. London: The Falmer Press. Erlandson, D., Harris, E., Skipper, B., & Allen, S. (1993). Doing naturalistic inquiry: A guide to methods. Newbury Park, CA: Sage. Guba, E., & Lincoln, Y. (1981). Effective evaluation: Improving the usefulness of evaluation results through responsive and naturalistic approaches. San Francisco: Jossey-Bass. Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. Meyer, L.B. (1956). Emotion and meaning in music. Chicago: University of Chicago Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day. Nordoff, P., & Robbins, C. (in press). Creative music therapy, (2nd ed.). St. Louis, MO: MMB Music. Orff, G. (1974). The Orff music therapy. London: Schott & Co. Robbins, C., & Robbins, C. (1991). Self-communications in creative music therapy. In K. E. Bruscia (Ed.), Case studies in music therapy (pp ). Phoenixville, PA: Barcelona Publishers. Schon, D. (1983). The reflexive practitioner. Basic Books. Serafine, M. L. (1988). Music as cognition: The development ofthought in sound. New York: Columbia University Press. Stake, R. E. (1978). The case study method in social inquiry. Educational Researcher, 7, 5-8.

34 46 Aigen Research and a clini-