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Popular Musical Styles in Nordoff-Robbins

Clinical Improvisation

KENNETH S. AIGEN Nordoff-Robbins Center for Music Therapy, New York University

ABSTRACT. This article examines the specific functions and benefits mental challenges to the client; and, manifesting underlying
of using popular musical styles in improvisational music therapy. The
context for the clinical work is the Nordoff-Robbins approach which
emphasizes the importance for the music therapist of becoming fa- First implemented with developmentally-delayed and
miliar with the tonal, rhythmic, and timbral qualities of various styles, emotionally disturbed children, Nordoff-Robbins practi-
scales and idioms, and learning how to use these with clinical intent. tioners now work with adults as well, in medical, psycho-
Three areas of focus are noted in the context of a case study of a therapeutic, psychiatric and geriatric settings. The initial ra-
developmentally-delayed young man: the use of idiomatic conven-
tionale for the use of improvisation focused on its value in
tions of different styles to address clinical goals in the areas of motor
skills, cognition, and social interaction in a manner which draws creating communication and relationship with very isolated
upon the musically intrinsic qualities of these styles; how to interact individuals by bypassing areas of delay and disability.
musically within these styles in a way that promotes client autonomy Through improvisation, therapists could take up and work
and the development of identity; and, the unique value of partici- with client's natural expressions and create a context where
pating in the creation of music which has the social function of sup-
porting experiences of communitas and liminality, important com- these expressions could acquire meaning and communi-
ponents of rites of passage in the non-clinical sphere. cative significance. Currently, because the approach is im-
plemented in a variety of treatment contexts, the theoretical
foundations are expanding to include 1) the intrinsic psy-
Foundations of the Improvisational Approach chological and spiritual benefits of participating in the clin-
ically directed creation of music (Ansdell, 1995; Lee, 1996),
The Nordoff-Robbins approach to creative music therapy is
2) the ability of improvised music to facilitate the working
based upon the process of clinical improvisation. While cli-
through of conflicts of a psychological nature (Turry, 1 998),
ents move, sing, listen, and play their own musical instru-
3) the value of improvised music in stimulating physiolog-
ments, the therapist responds by improvising music suitable
ical and cognitive processes (Aigen, 1 995; Aldridge, 1996;
to these expressions. The therapist's music is oriented by a
Ansdell, 1995) and 4) a variety of eclectic theoretical po-
variety of tasks which vary according to clinical goals. Some
sitions as well (for example, Aigen, 1998; Pavlicevic 1997).
of these tasks include the following: creating a portrait in
Even within such a broad realm of application, two prin-
sound of the client's inner self; providing a musical context in
ciples are of universal significance. First, that through the
which the client's natural expression can be experienced as
use of improvised music clients are able to circumvent ar-
purposeful; reflecting the aesthetic quality of the client's ex-
eas of difficulty--be they physiological, motoric, cognitive
pressions; providing expressive, cognitive and other develop-
or emotional--and achieve a level of expression and social
participation not available outside of this medium. And sec-
Kenneth S. Aigen, DA, MT-BC, NRMT, is the Co-Director of the Nordoff-Rob-
ond, that this occurs most efficaciously when the impro-
bins Center for Music Therapy at New York University where he also does
clinical work and teaches in the Masters and Doctoral Music Therapy Pro- vised music is of an individualized nature, reflecting the
grams. This article is an abbreviated report of an ongoing research project client's preferences, strengths, needs, and overall sense of
into the use of popular styles in clinical improvisation and its content has self.
been presented at the first AMTA Conference in Cleveland in 1998 and at The Nordoff-Robbins approach emphasizes the value of
the AMTA Mid-Atlantic Conference in Rochester, NY in April, 2000. The full
research report is currently in press under the title Playin" in the Band: A improvising within musical form. Often, the form-giving el-
Qualitative Study of Popular Musical Styles as Clinical Improvisation. ement can be the use of a recognized musical style or scale.
© 2001, by the American Music TherapyAssociation The improvised creation of music, individualized as it may

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32 Music Therapy Perspectives (2001), Vol. 19

be, does not occur in a stylistic vacuum and is predicated music. Thus the scale is not naturally suited to creating or
on a belief that the objective properties which define mu- expressing moods of tension. Conversely, the Japanese pen-
sical styles and scales are of an archetypal nature. By this tatonic has two minor seconds and a tritone in it. Clearly,
it is meant that different kinds of music, from different cul- this second scale is better suited to creating a sense of mu-
tures and time periods, have essential, defining qualities sical, and therefore, psychological, tension, although how
which are derived from the experience and world view of it is ultimately experienced will result from an interaction
the original creators and performers of such music. These between the objective properties of the music itself and an
personal and communal experiences find expression individual's psychological and cultural background.
through the appropriate musical forms and tonal relation- Of course, how these styles are played is important as well
ships, and because they are archetypal experiences, the sig- in determining the character of the music. So one may choose
nificance can often transcend cultural boundaries. an idiom with the potential to express light-hearted playful-
ness--such as the Chinese pentatonic just described--and yet
The Role of Musical Styles, Scales, Idioms in Nordoff- play it with forceful dynamics and slow tempi so that it does
Robbins Music Therap/ not appear playful. But in so doing one would not be using
In light of these beliefs it can be seen that an important this particular scale in a stylistically consistent manner. It is
aspect of the Nordoff-Robbins approach to clinical improvi- not just using a particular set of scale tones which determines
sation is the ability to draw upon the full range of world mu- whether or not one is using a particular style; it is also im-
sical styles in creating music for clients. This includes styles portant to use the characteristic harmonies, rhythms, dynam-
which are the foundation of western classical music such as ics, and timbres. These characteristic qualities have not
the church modes and organum, the classical styles them- evolved arbitrarily, but instead form a coherent expressive
selves such as baroque and romantic, various Middle Eastern whole and function to define and manifest the essential nature
scales, Spanish scales, the various pentatonic scales charac- of the style.
teristic of the music of Japan and China, the church modes, The implication is not that there is anything inherently
and music characteristic of the 20 'h century such as whole- wrong with using uncharacteristic rhythms or harmonies, and
tone scales. in fact one may have clinical reasons for doing so, such as to
As was stated above, the use of these various styles stems introduce new expressive possibilities to a client who shows
from a belief that they each have an essential nature whose an inflexible preference for a limited range of music. Unique
elements can be directed with clinical intent. For example, moods and experiences can be created by juxtaposing musi-
a Chinese pentatonic scale built on the first, second, fourth, cal elements not normally combined, such as playing rock
fifth and sixth tones of the major scale can be playful; a music at a quiet dynamic level or using fast tempi with or-
Japanese pentatonic built on the first, second, minor third, ganum. But the ability to create such combinations presup-
fifth, and minor sixth tones tends toward introspection; or- poses a knowledge of, and an ability to create, musical ex-
ganum can be serious and grounding; and the Spanish and periences rooted in those musical conventions which char-
Middle Eastern styles can be stimulating and activate the acterize each style of music--this logically precedes the abil-
will2 ity to play against the musical expectations. The therapist's
These various experiential qualities arise from the inter- choice of how to form the improvised music is based on clin-
vals comprising each scale and the rhythms and harmonies ical focus and is moderated by empirically determining how
characteristic of each style. For example, compare the two successful this music is engaging the client and accomplishing
pentatonic scales just described. The Chinese pentatonic one's goals.
uses major seconds, fourths, fifths and octaves almost ex- Much of the practical training in the Nordoff-Robbins ap-
clusively in its melodic and harmonic constructions. There proach involves gaining skills in improvising in these various
is a sense of space and openness in such music and there world styles. Yet, Paul Nordoff the pianist/composer member
are no traditionally considered dissonant intervals in this of the original Nordoff-Robbins team--had a deep affection
for the popular song styles of his day as well. Nordoff's com-
, While the focus of this article is on particular styles or genres of popular positional and improvisational skills, and his affection for this
music, in this section, as a convenience, I am using the term "styles" in a type of music, enabled him to incorporate standard song styles
much more inclusive way to include the concepts of modes, idioms, and
scales as well. into his clinical work. So while there has been very little writ-
2 It is important to mention that while great emphasis is placed on exploring ten about the use of contemporary popular styles in this im-
and understanding the musical componentsof each style, the determination provisational form of music therapy, it is clear that they have
as to the nature of each style is made by clinicians individually. There is no been present from its inception.
lexicon linking musical styles to extra-musical descriptions. Instead, practi- The present article will consider contemporary popular
tioners undertake their own musical explorations and develop from experi-
ence their own senseof each styleand its clinical function. And, as discussed styles, such as rock and jazz, and explore how the idiomatic
by Forinash (1991), the music therapist's musical biography plays a strong conventions of these styles were used to address typical goals
role in the production of clinical music. of improvisational music therapy in the case study of a de-

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Popular Musical Styles . . .
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velopmentally-delayed young man. As well, we will look at client's connection to the music, adjusting it on a moment-to-
the unique communal feelings evoked by participating in the moment basis to ensure this connection. Sometimes, the cli-
group creation of this kind of music and discuss the impor- ent's musical responsiveness indicates the presence of the
tance of these experiences in achieving a greater degree of connection; at other times, this connection is inferred through
self integration. things such as eye contact, facial expression, body posture,
breathing 3 or movement. Thus, the nature of the therapist's
music is a legitimate source of information of what is hap-
The present article will consider contemporary pop- pening for the client because this music takes the form that it
ular styles, such as rock and jazz, and explore how does as a result of the client's ability to participate in it, wheth-
er actively or experientially.
the idiomatic conventions of these styles were used
to address typical goals of improvisational music Meeting the Client: Lloyd
therapy in the case study of a developmentally-de-
This article illustrates the use of popular styles as manifested
layed young man.
in the therapeutic process of Lloyd, a non-verbal develop-
mentally delayed young man who was 27-years-old when be-
ginning music therapy. He has seizures, mainly at night, and
The Nature of Goals in Nordoff-Robbins Work has had some neurological damage which has impaired his
physical coordination, primarily on the left side of his body.
In contrast to some other forms of music therapy practice, Lloyd has been extremely slow to develop, both physically
clinical goals are usually framed within musical parameters and cognitively, learning to walk when he was 8-years-old.
such as establishing a basic beat, developing flexibility in tem- He lives in a special residence and has a good relationship
po and dynamics, or increasing vocal range. This choice stems with his mother with whom he has weekly contacts.
from the overriding concern in this work which is to expand Lloyd has few functional skills in language, socialization,
the client's capacity for human experience and thereby foster or in the fine motor area, and can require assistance in many
self-actualization. daily tasks. He can also be quite unpredictable emotionally,
Establishing musical stability and flexibility facilitates this in and resists most efforts to teach him basic skills. However, he
three ways: it allows clients to convey the variety and subtlety has a nuanced musical sensitivity which he finds ways to ex-
of their inner lives, thus promoting self-awareness; it provides press in spite of limited physical coordination. And most im-
an enhanced communicative repertoire which becomes the portantly, Lloyd loves playing music and is able to circumvent
vehicle for the development of ever more varied and signifi- some fundamental physical and communicative limitations
cant musical relationships with others; and, it allows for ac- while engaged in the co-creation of improvised music.
cess to the intrinsic benefits of participating in the creation of Lloyd began music therapy in January, 1994. He has been
music with increasing degrees of subtlety, power, vitality, and in therapy continuously since that time, pausing each summer
beauty. The employment of musical-clinical goals is based for a two-month break, until the time of this writing (Decem-
upon the belief that musical expression, interaction, and ex- ber, 1999). The clinical examples in this article are taken from
perience is not a peripheral human activity but an essential the 158 sessions Lloyd has attended through June 1998.
one that can incorporate all of the motor, behavioral, cogni- The Nordoff-Robbins approach employs two therapists in
tive, affective, and spiritual concerns typically addressed in individual sessions when clinically warranted. The primary
therapy. therapist has the main responsibility for providing the music
In some forms of music therapy, the musical events may and establishing the clinical direction and focus; the co-ther-
have no intrinsic significance for the clinical process and must apist supports the primary therapist's efforts by intervening
be interpreted through another language--such as that of psy- physically or musically and assisting the client in achieving a
choanalysis, behaviorism, or neurology, for example~to have deeper level of participation in the music. From the outset,
their importance revealed. Because of a recognition of the Lloyd's primary therapist has been Alan Turry; Clive Robbins
broad range of human capacities involved in the co-creation served as the initial co-therapist and was replaced by the pre-
of improvised music, in the Nordoff-Robbins approach there sent author after the first few sessions because it was felt that
is a very real sense in which the musical process is the therapy Lloyd would benefit from having a co-therapist who played
rather than being something which must be reinterpreted the guitar.
through non-musical models of understanding. As the co-therapist, the present author was more musically
A core assumption here, and one that is highly relevant for active than was traditional for this role. Although this was
understanding the clinical illustrations in the present article,
is that in discerning the clinical process, license is given to
3 In fact, Gary Ansdell (1995) discusses Dagmar Gustorff's work with a co-
understand the music created jointly by client and therapist matose patient where the client's breathing is the only responsehe is capable
as a unified entity. The therapist endeavors to maintain the of making initially.

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34 Music Therapy Perspectives (2001), Vol. 19
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done initially to provide Lloyd with a role model on the guitar, around, or syncopate a melody. These are all examples of
eventually the more important clinical rationale became the Level 3 skills. On Level 4, a client can create, live in, or re-
feelings of camaraderie and participation in a musical ensem- spond to music which contains or is expressive of felt emo-
ble that this musical activity helped to support. As well, the tions. The ability to recognize music as representative of or
presence of a second therapist who was musically active congruent with one's inner state or experience manifests on
helped to reinforce the clinical direction established by the this level.
primary therapist's musical interventions and thus enhanced To better understand this framework, we can look at how
their efficacy. The fact that Alan Turry and the present author melody comes into play on each level.
shared a musical background and had a strong musical rela-
Table 2: Illustrations of the Model in Terms of Melody
tionship forged over many years in a variety of contexts facil-
itated this collaborative manner of working. Level 4--Affective Musical Expression
Infusing or recognizing aspects of one's affective self in
The Four-Level Model of Musical Interaction a melody
Level 3--Aesthetic Musical Awareness
The Nordoff-Robbins approach to creative music therapy is
Creating or perceiving the interesting or novel aspects
a comprehensive one and the treatment focus can vary, both of a melody or embellishing an existing one
among clients and within one client's course of therapy. Ther- Level 2--Dynamic Musical Intelligence
apy goals can focus on areas ranging from developing con- Perceiving the dynamic qualities of a melody and feel-
crete musical skills, e.g., beating a particular rhythmic pattern ing its resolution
on a drum, to enhancing emotional self-expression, e.g., being Level 1--Basic Musical Skills
able to create music of an emotional quality which may oth- Understanding that a melody exists as a unified entity
erwise be problematic for the client. Clients show a four-lev-
The various levels of this model are mutually supportive and
eled relationship to music, detailed in Table 1, and Lloyd's
do not necessarily reflect a chronological sequence of clinical
connection to music existed on all of these levels. A brief
focuses. However, expressions and experiences on the higher
examination of the distinction between these levels, and the
levels (toward Level 4) presuppose the presence of skills on
way in which they interact in the therapy process, will provide
the lower levels (toward Level 1). So, for example, a client
a more comprehensive understanding of the various functions
who is able to demonstrate aesthetic sensitivities or skills is
of popular idioms, particularly as they were employed in
necessarily considered to possess basic music skills. But the
Lloyd's therapy. 4
presence of these basic skills do not imply anything regarding
Table 1: Four Levels of Interaction With~In Music the client's aesthetic capacities.
Level 4 Affective Musical Expression Addressing goals on the lower levels facilitates work in the
Level 3 AestheticMusical Awareness/Creation higher levels of the model. For example, helping a client to
Level 2 Dynamic Musical Intelligence engage in sustained drum beating at a steady tempo, a clinical
Level 1 Basic Musical Skills focus characteristic of Level 1, can lay the foundation for drum
Level 1 processes involve the most basic operations in- beating which employs changes in tempo as a vehicle for self
volved in allowing us to experience music as music. For ex- expression, a focus characteristic of Level 4. Clinical work can
ample, the ability to link isolated tones into a unitary object, proceed on all four levels simultaneously as basic musical
a melody, or the ability to cohere successive drum beats into skills provide the client with the tools to engage in the aes-
the abstraction of a rhythmic pattern, are both examples of thetic and expressive processes characteristic of Levels 3 and
concrete musical skills. The musical intelligence which is ac- 4; concurrently, these affective experiences provide motiva-
tivated on Level 2 allows us to perceive the tonal, melodic, tion to meet the cognitive and motoric challenges character-
and harmonic forces present in music. Hence, the ability to istic of Levels 1 and 2. An important aspect of this model is
perceive a sustained dominant 7'" chord as a tension produc- the assumption that the capacity for musical expression--as
ing element in music is a Level 2 ability. Level 3 processes opposed to emotional discharge--presupposes the presence
are present when we can appreciate the value of music, or of mediating cognitive processes. Thus, the presence of ex-
when a client's musical expression has that intangible sense pression can indicate the presence of cognitive processes not
of "feel" which lends authenticity to it. Aesthetic appreciation demonstrated in any other way.
and the cognizance of musical form are present when a client Throughout his course of therapy, Lloyd's relationship to
can do things such as leave musically-meaningful spaces in music was manifest on all these levels as seen in these ex-
music, enter ongoing music on a pick-up beat or musical turn- amples:
Table 3: Lloyd's Musical Expressions on the 4-level Model
4This model is more fully explained in Aigen (1995) from which Tables 1 and
2 of the presentarticle are taken. In that publication, the levels are described Level 4--Affective Musical Expression
in detail and are linked to the specific cognitive processesinvolved in the Channeling joy, excitement, and anxiety into music;
processing of music as posited by Serafine (1988). learning to experience and enjoy unpredictability in

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Popular Musical Styles . . . 35

music; allowing himself to live in introspective musical the session room for Lloyd to play. Our decision to offer Lloyd
expression. a full trap drum set developed in the following way: In session
Level 3--Aesthetic Musical Awareness/Creation 17, Lloyd brought a chair over to his snare drum and cymbal
Creative playing with the timbres of the cymbals; cre-
ating extended melodies on the piano; strumming the and we re-arranged the drums so that he could sit and play
guitar with a country or folk feeling and technique; put- them. From his enjoyment of this, we both felt that he wanted
ting drum fills in spaces left for him in the music; en- an entire drum set to play and we set up a bass drum, snare,
gaging in crescendi at musical turnarounds. tom-tom, high-hat, and ride cymbal. In session 40, we decid-
Level 2--Dynamic Musical Intelligence ed to bring in the bass guitar for the present author, as co-
Vocalizing in the tonality and tempo of ongoing music; therapist, to play in order to create an idiomatically appropri-
switching between various drums when chord changes ate sound and firmer rhythmic support for Lloyd in the pop,
occur in the music; changing played intervals on the
piano to reflect predictable chord changes in a 12-bar rock, and jazz styles that became increasingly prominent in
musical form. his therapy. The basic structure of his session was thus estab-
Level 1--Basic/Concrete Musical Skills lished.
Strumming the guitar in rhythm; sustaining periods of What are the clinical benefits of working improvisationally
playing a consistent note value, such as eighth-notes on with contemporary musical styles? With Lloyd, the advantages
the bass drum; playing the basic beat on the drums; fall into two broad categories. The first relates to the way in
recognizing songs; maintaining strumming and beating which the conventions of each style were used to address
tempi when the therapists stop and then resume play-
ing; entering ongoing music in its tempo. clinical goals in an intrinsically musical way that did not mo-
bilize Lloyd's natural resistance to being challenged. This func-
This four-leveled model encompasses all areas of work in tion is highlighted in clinical examples 1-8. Second, it also
the Nordoff-Robbins approach and helps to explain how the created a vehicle for Lloyd to engage in a socially constructed
various areas of clinical focus fit together. Interventions can form of activity with meaning and relevance outside the world
represent rehabilitative practices when motor control is being of his therapy sessions. This type of activity is essential for
enhanced, educative practices when musical skills are being identity formation and clinical examples 9-11 best illustrate
developed, artistic practices when expressive skills are fo- this function.
cused on, and psychotherapeutic practice when the client's
affect is being addressed. However, none of these practices The Intrinsic Benefits of Employing Contemporary Musical
taken in isolation serve to define the approach; instead, it is Styles in Clinical Improvisation
the unique way that they are employed in a mutually sup- Many of the basic goals for Lloyd can be framed in concrete
portive way that characterizes Nordoff-Robbins clinical prac- terms such as increasing his ability to focus on a task, increas-
tice. ing his impulse control, enhancing his ability to take direction
from others, and expanding his capacity for tolerating--and
Deciding to Use Contemporary Musical Styles
even enjoying--new and unpredictable experiences. Over
The use of popular idioms as an important clinical vehicle time with Lloyd, we developed ways to address these goals
emerged within Lloyd's first 20 sessions and became con- completely within the idiomatic conventions of pop music
sciously established by the 40 'h session. Certainly, the fact that styles.
we had developed an ensemble feeling provided a fertile For example, in jazz music there is an interactional pattern
ground for this approach. Yet, the use of these idioms was not where the ensemble plays a set number of measures, typically
pre-planned; it rather emerged from the quality of Lloyd's two or four, and then the drummer answers, soloing over an
playing and presence in the session. In this way, our decision equal number of measures. This demands that the drummer
to employ these styles stemmed from our client-centered clin- sustain his participation as well as engage in an antiphonal,
ical stance which suggests that the musical forms of relating responsive expression. Including this structure in our jazz im-
chosen by the therapist should be drawn from musical and provisations provided Lloyd with an intrinsic opportunity to
motoric cues given by the client, especially with a non-verbal develop musical skills in the area of responsiveness and in-
client who cannot voice his preferences. dependence. The same type of goal was addressed in rock
For example, reflecting the way in which Lloyd strummed forms that involve four consecutive stops on the first beat of
the guitar--playing a single string on the first and third beats four consecutive measures on the I chord, before moving to
of a measure with fuller, emphasized strums on the second the IV chord, such as occurs in the song Johnny B. Goode by
and fourth beats--the therapist improvised a song in a country Chuck Berry.
style which became Lloyd's signature song. And swing Although it could be said that we were working on stopping
rhythms would be employed in the clinical improvisations to and starting and developing Lloyd's impulse control, what was
reflect the energy, timbre and syncopations which particularly really happening was that we were playing jazz or rock music
characterized Lloyd's cymbal playing. in a stylistically appropriate way. The heightened impulse con-
Initially, a single snare drum and cymbal were available in trol came about as a secondary consequence of Lloyd's in-

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36 Music Therapy Perspectives (2001), Vol. 19

volvement in making music. Lloyd's motivation was to partic- excerpt #2 (session 47), it does not vary dramatically from his
ipate in the music on a higher level. Rather than experiencing strumming to more emotionally-laden music with a strong
his therapists as placing demands on him--after all, why quality of introspection and melancholy in excerpt #9 (from
should he spontaneously stop and start in music?--he could session 113). But the reason that these two excerpts taken in
experience the demands as internal ones, driven by his own tandem represent such important growth for Lloyd is that he
expressive, aesthetic, and social needs. Expressively, he is able became able to participate in emotionally-laden music which
to channel his excitement and anxiety into the rock rhythms; he previously would not have identified with nor been able
aesthetically, he is able to participate in the creation of music to live in. A wider range of human experience--as represented
which he finds pleasing; and socially, he is able to participate by the novel affective content of the music in excerpt #9--
in the cooperative creation of music with personal value. The has become available to Lloyd. Thus, while we do not have
basic and concrete goals mentioned above--such as increas- access to Lloyd's experience, we infer its quality from the na-
ing Lloyd's ability to sustain participation in musical interac- ture of the musical context in which he actively and eagerly
tions-have motoric, cognitive, and emotional dimensions participates.
and music therapy treatment is most effectively implemented Last, many of the important changes for Lloyd are better
when all of the areas are considered in combination. captured through the use of videotape rather than audiotape.
It is not only that Lloyd eventually develops the ability to par-
Clinical Examples ticipate in music which initially he would have resisted be-
The excerpts from Lloyd's music therapy sessions have been cause of its unpredictability or affective content which is of
chosen primarily to illustrate how to work improvisationally clinical importance; it is that he engages in this participation
in pop music styles, not to chart the chronology of his devel- with commitment and investment. These qualities of his par-
opment. Nevertheless, it is recognized that determining the ticipation are ascertained through reading his body posture,
value of the clinical approach can not be divorced from its eye contact, facial expressions, and breathing patterns as
results, and therefore many claims are made in the ensuing much as through analyzing his musical contribution. And
examples concerning the beneficial results obtained. At times, clearly this visual information is not available to readers of
it may be difficult for even the careful reader and listener to this article. But they do represent the factors which help the
determine the validity of the these claims from the evidence therapists with access to the videotape records of the sessions
presented. The potential difficulties in assessing these clinical from which these audio excerpts are taken to determine when
benefits will be briefly addressed before moving on to the clinical progress is being made. S
clinical examples. One additional word on improvisation: Improvisation in a
First, it is essential to understand that when he first began music therapy setting can take place on many levels: 1) One
music therapy, Lloyd was rarely able to sustain focused mu- can play a pre-composed piece but improvise the tempo and
sical participation for more than a few seconds. When he did dynamics, embellish the melody, insert unpredictable stops in
manage to sustain this participation, the music had to be of the music, create a new melody over existing chord changes,
an emotionally neutral character with no variations in its in- or alter chord changes; 2) alternately, one can improvise a
tensity. Such harmonic, rhythmic, or dynamic changes as song form within a pre-existing musical structure such as a
might typically occur in most forms of music--whether com- 12-bar blues or otherwise use this form--or any other stylistic
posed or improvised--were difficult for him to bear. More- attribute, for that matter--in a spontaneous way; 3) or, one
over, he was very physically active, constantly moving from can create music without any pre-existing components. While
instrument to instrument and his pervasive affect was quite all of these choices warrant being described as improvisation-
excitable. In sum, it was enormously difficult in the initial al, because of the present focus on popular styles the clinical
stage of therapy to assist Lloyd in participating in any sus- examples in this article will be representative of the first two
tained and focused activity. Thus, his ability to eventually enter types of improvisational music therapy.
into musical improvisations extending for minutes at a time
was a highly significant developmental step, the importance Clinical Example 1, Session 47, 3/2/95
of which can not be overestimated. Additionally, allowing The primary therapist is playing rock and roll on the piano
himself to participate in music with affective content was also to Lloyd's vigorous drumming and the co-therapist is playing
something which represented significant growth as it dem- the electric bass. Clinical goals that are illustrated include in-
onstrated that he was acquiring the ability to live within a creasing the length of time Lloyd can sustain focused activity,
variety of emotions which previously had been closed to him. developing his independence, and developing his musical
Also, it is important to reiterate that with Lloyd, the clinical perception and expression.
focus was as much on changing what he was capable of ex-
periencing as it was on changing .what he was capable of s In order to address some of these issues, the fuller research report from which
doing. Thus, when we hear Lloyd's guitar strumming during the present article is taken will be published with an accompanying video~
relatively even and emotionally neutral rock and roll music in tape. See Aigen (in press).

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Popular Musical Styles . . . 37

On several occasions Lloyd is able to sustain eighth-note note on Lloyd's use of the guitar: Lloyd used his right hand to
playing in the tempo of the music, first on the cymbal and strum the guitar and supported the neck with his left hand,
then prominently on the bass drum which is played with a not fingering any of the tones on the neck. In order to provide
foot pedal. In fact, he was first able to play in a consistent some harmonic variety, we made two guitars available to him
tempo with the bass drum--had we not offered him this op- in each session: one was tuned in the standard manner and
portunity he may never have been able to develop his skill in we often played in the key of E minor when Lloyd chose this
this area. Through these consistent eighth-notes, Lloyd con- guitar; the other guitar was typically tuned in an open style,
nects musically with both therapists and participates in cre- often to a major chord. When Lloyd chose this guitar we often
ating the rock feeling. played in a basic rock or country style.
Clinically, we can see how the rock and roll style reflected In this example, Lloyd is playing the open tuned guitar. Our
and contained his excitement while providing a constructive tempo is slightly faster than in the previous excerpt, approxi-
outlet for it. In terms of the model discussed previously, we mately mm 150. Interestingly, on the drums, slower tempi are
can consider the ability to sustain consistent eighth-notes in a challenge for Lloyd because they involve inhibitory affect-
the form of a rock groove as a Level 1 skill. His ability to driven motor processes, while on the guitar the faster tempi
change from the cymbal to the tom-tom drum on the musical are more of a challenge requiring greater motor coordination
turnaround cued by the return to the dominant chord suggests and cognitive focus.
a Level 3 skill as he is hearing the harmonic significance of As the groove is being .established, the prominent snare
the V7 chord and reacting appropriately to it. And his ability drum on beats two and four help to support Lloyd's accented
to sustain the rhythmic playing through the natural excitement strums on these beats as well as to hold him in the groove. A
of the turnaround shows an incipient level of musical inde- series of idiomatically appropriate and predictable stops are
pendence: inserted in the music and Lloyd makes different choices about
CD Track 2 Index (:50) whether to play through these pauses or to stop with us. His
ability to play independently through the stops without the
:00--Lloyd starts playing vigorously on the tom-tom drum
in eighth-notes. The therapist responds by providing rhythmic support of the bass drums shows a growing level of
a rock pattern in the bass end of the piano. autonomy in the music. He plays lightly and accurately. When
:07--Lloyd changes to the snare drum and then the cymbal the stops occur, both therapists refrain from playing after the
in attempts to maintain rhythmic stability. first beat in the first two measures of the stops. We make the
:18--Lloyd finds this stability on the bass drum and main-
music a little more challenging each time through the form as
tains a series of eighth-note beats on the bass drum
for almost 14 complete measures (counting in 2/4) at in the third and fourth measures we fill in the return to the
a tempo of 240 bpm (mm 120). groove of the music with increasingly more complex musical
:22--After vamping on the I chord, the therapist moves to phrases. Throughout the excerpt Lloyd's vocalizations fit the
the IV chord to establish a 12-bar blues form. rock style.
:26--Lloyd adds the cymbal to his bass drum playing and
then plays the cymbal alone. This is a good example of how the conventions of popular
:36--On the turnaround of the 12-bar form, Lloyd changes musical styles can be employed with clinical intent. The clin-
back to the tom-tom in synchrony with the piano and ical goals that one might see in terms of impulse control (mak-
bass moving to the V7 chord. ing the stops in the music), motoric coordination (light, fluid
:42--Lloyd sustains the playing on the turnaround through guitar strumming), and physical and expressive autonomy
the return to the I chord.
(making decisions on whether or not to play through the stops)
It is important to make a brief comment here on the clinical were all completely contained within the realization of the
significance attributed to synchronous musical events, such as idiom as it exists as a nonclinical entity. Progress for Lloyd in
when Lloyd changes drums precisely with a harmonic change these areas came about as a secondary consequence of the
in the music. This is significant because it indicates that Lloyd primary focus of deeply involving him in a fun and aestheti-
is participating in the realization of music within an external cally and expressively rewarding experience.
form. While there is no claim that Lloyd is doing this con- It is also important to mention the profound communication
sciously, this does not mean that it is done accidentally. And that occurs among the three of us as we establish a tight,
his ability to participate in this way is seen as an indicant of rhythmic groove, a unique property of popular musical styles
clinical progress, regardless of whether or not he is conscious which are connected to dance rhythms. The unique properties
of his own ability in this area, although demonstrating inten- of this type of experience will be discussed further in the sec-
tionality and awareness is certainly an important indicant of ond set of clinical examples.
growth. CD Track 3 Index (2:09)
Clinical Example 2, Session 47, 3/2/95 :00--Lloyd's strumming is at a moderate tempo and the
music is briefly in a country feel.
Lloyd is playing the guitar, the primary therapist is playing :09--His strumming accelerates and the bass establishes a
the bass, and the co-therapist is playing the drum set. A brief rock and roll groove followed by the drums.

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38 Music Therapy Perspectives (2001), Vol. 19

:30--Both therapists stop in synchrony on the first beat of CD Track 5 Index (2:03)
the form when it returns to the I chord. Lloyd strums
:O0--Lloyd begins by playing the ride cymbal, snare and
through these stops. bass drum simultaneously. There is a sense of antici-
:48--Lloyd puts his guitar pick down in mid-phrase and
pation created by the piano.
the therapist encourages him to "keep going." :14--The building sense of musical anticipation is relieved
:50--Lloyd sustains his playing and we engage in the sec-
as we move into a straight swing rhythm.
ond series of stops which Lloyd again plays through. :18--Lloyd changes to the snare drum and we begin leav-
1:IO--A third series of stops and Lloyd again plays through ing spaces for him which last for two measures in
these. between the phrases of the melody.
1:28--A fourth series of stops and Lloyd plays through these. :32--Lloyd appears to sense the room left for him in the
1:49--On the final series of stops, Lloyd stops his playing music as he brings back the ride cymbal and incor-
and then resumes immediately with the groove when
porates into the snare playing in a way which has the
it is re-established. quality of a fill in the jazz style.
1:02--The rim of the snare drum is added by Lloyd in his
Clinical Example 3, Session 47, 3/2/95
fills which creates a chock tone which sounds stylis-
In another excerpt from session 47, Lloyd is at the drums. tically appropriate.
After some explorative playing, the therapists take a cue from 1:07--The spaces left for Lloyd are briefer, one measure in
the feel and timbre of Lloyd's playing on the ride cymbal-- duration.
1:22--Lloyd changes to the high-hat cymbal and the strong
indicants of a relationship to music on Level 3--to play in a swing feeling is dropped. The other instruments create
jazz style. The free jazz idiom provides an appropriate context a sense of increasing tension, again through the har-
for Lloyd's energetic and syncopated drumming. Lloyd is se- monic extensions and absence of straight ahead
rious and well-focused here, sustaining his intentional in- groove.
volvement in the music, and the growing intensity in the mu- 1:32--Lloyd begins playing the bass drum in a triplet feel
and this brings the tension to an impending release.
sic and subsequent release does not at all overstimulate him-- 1:39--We return to the form of the composition, re-estab-
he is able to live within the natural contours of the music's lishing the swing groove and Lloyd continues his
intensity and energy. playing through these changes in tension.
1:42--Lloyd continues to play through the spaces, the last
CD Track 4 Index (1:34) few times integrating three different instruments-the
:04--Lloyd plays approximations of syncopated jazz ride cymbal, bass drum, and snare drum-thus achiev-
rhythms near the bell of the ride cymbal. ing an extraordinarily high level of integration of mo-
:09--The therapists establish a jazz groove, first with the tor skills.
piano and then with the bass added. 2:02--Lloyd stops together with the therapists as the excerpt
:33--Lloyd plays a brief phrase on the tom-tom before re- ends.
suming his playing on the ride cymbal.
:40--Lloyd attempts to add the bass drum to his cymbal Clinical Example 5, Session 102, 11/8/96
:55~The bass changes from a walking to style to playing Here we are playing the Beatles' song Get Back with Lloyd
on the first beat of four consecutive measures and on the open tuned guitar. The therapists are playing piano and
Lloyd is able to sustain his rhythmic impetus through bass. The song was used to humorously direct Lloyd back to
this change in the groove. his instrument when he would abruptly stop playing to walk
l:O4--The walking style resumes and Lloyd plays closer to
the center of the bell of the cymbal producing a tight- around the therapy room. Again, the sense of ensemble play-
er sound. The therapists respond by increasing the en- ing is prominent. We put accents in the music which previ-
ergy and tension of the music. ously would have greatly disturbed Lloyd and disrupted his
l:15~The tension continues to build harmonically and playing. Here he is able to not only tolerate but actually enjoy
rhythmically as Lloyd sustains his playing. these unpredictable aspects of the music, while maintaining
1:24--There is a slight release of tension as Lloyd continues
his rhythmic musical support. his rhythmic center. Playing through these syncopated accents
is more challenging than playing through the unsyncopated
Clinical Example 4, Session 50, 3/23/95 stops in the previous excerpts and indicates Level 3 skills. This
In this example we are playing a swing version of Lloyd's ability to take pleasure in the unpredictability of human in-
welcome song. His tempo is slower, he plays fills and a teraction is one of the prime benefits that improvisational mu-
straight rhythm through the spaces left in the music for him. sic therapy has offered to Lloyd.
He seems to understand the jazz structure and uses different We also foreshadow some other work in this excerpt as
timbres, especially on the cymbal. Lloyd works very hard to there is a brief improvisational section in which we move
coordinate his arms and legs, a very difficult task. In just over away from the song structure. This unpredictable musical
one year, he has come from only being able to sustain musical event does not distract Lloyd and he stays in the music as we
involvement for a few seconds to being able to participate in return to Get Back. The therapist increases the musical tension
a working, musically collaborative relationship for minutes at in two ways: first, by the harmonic and rhythmic aspects of
a time. his playing and also by creating an improvisational section.

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Popular Musical Styles . . . 39

Moving away from the song form creates tension because the a new ability and when this is done it is better to support its
music is temporarily less predictable for Lloyd. As we return emergence rather than immediately challenge him to take it
to the song form at the end of the excerpt, both aspects of the further, something which introducing musical variety at this
tension are relieved. point would have done.
CD Track 6 Index (1:45) CD Track 7 Index (1:09)
:O0--The excerpt starts with Lloyd on guitar, therapist on :04--The therapist's piano establishes a rock and roll feel-
piano, co-therapist on drums. ing and the beginning of a rock form. The co-therapist
:15--There is a little rhythmic instability on Lloyd's part and enters on the drums.
the therapists adapt their tempo to his. :19--The rock feel becomes better established, Lloyd
:22--Both therapists cooperate in playing a rhythmic ac- brings out his piano playing in the right hand, and the
cent between the second and third beats of the mea- therapist drops his right hand out to play a steady rock
sure in between the repetitions of where the lyrics pattern only in the bass.
"get back" would normally be sung. :27--Lloyd alters his tones as the music moves to the V
:23--The second time the accent comes, the co-therapist chord.
emphasizes it with a cymbal crash. :45--Lloyd again makes a clear leap higher on the key-
:32--The accent is enhanced by the drums stopping the board as the music moves to the IV chord.
rock groove for one beat.
:36--The second repetition of the basic form of the song Music, Identity and Culture
begins and the piano plays improvised melodies.
:52--We return to the rhythmic accents and this time the The research of Norwegian music therapist Even Ruud
drums emphasize them further by playing a brief fig- (1998) has shown how being competent in a given style helps
ure leading up to the accent rather than just continu- establish meaning and identity by connecting a person to a
ing the rock groove. larger cultural sphere, to a social group of a particular type
1:O8--Where the third repetition would normally start, the whose values and aesthetics are expressed in the character-
piano instead leads into an improvisational section,
keeping the tempo steady. The drums emphasize the istics of the music.
fact that the music has changed by dropping the rock Ruud (1998) observes that "to be socialized into a specific
groove and playing only on the high-hat cymbal. musical competence is to master a . . . system in which sound
1:13--The tension is built further in three ways: with an as- represents memories, associations, histories, and traces of sit-
cending bass line in the piano, the rhythmic figure in uations in which other people's [experiences] are represent-
thepiano, and 'the change in instrumentation created
by the co-therapist playing only on the high hat. ed" (p. 92). Music is culturally organized sound which con-
1:24--By playing emphasized chords on the first beat of four tains a "dual code." There is the relation of musical signs to
consecutive measures the piano suggests an idiomat- one another, and then there is the set of references that "link
ically appropriate way of returning to the rock and to sound to social and cultural entities or to private life worlds"
the song form. These interventions increase the ten- (p. 92).
sion level of the music while also leading to a musical
resolution. For Lloyd, this observation can help explain some of the
1:32--The piano reintroduces the song form and the melody significance of using popular idioms. Through them he is able
of Get Back. to experience aspects of his internal world in an external form
that has cultural significance. It is that much more powerful
Clinical Example 6, Session 140, 12/16/97 for someone as socially isolated as Lloyd because it connects
Approximately three and one-half years into his therapy, him to the larger sphere of humanity, and shows him that his
Lloyd began working extensively at the piano. He soon de- emotional life is not completely idiosyncratic but something
veloped an ability to sustain eighth-notes for various lengths that can be realized through shared cultural forms of expres-
of time. In this example we incorporate Lloyd's new found sion and interaction.
ability into rock and roll music, and we can hear him form Our sense of self has cultural components as well as psy-
clear intervals of fourths, fifths, and sixths. He seems to be chological ones. We draw from our culture in creating our
developing a harmonic awareness of musical form as his me- sense of self and we manifest our self in the forms of activity
lodic movements seem to occur precisely at points in the mu- created and sanctioned by the culture. Disabled individuals
sic where the chords change. The ability to sustain eighth- such as Lloyd have no way of participating in the culturally
notes is a Level 1 skill, and the harmonic awareness indicated mediated forms of activity such as religion, politics, debates
by Lloyd changing his intervals at harmonically salient points over ethics, books, poetry, and painting. But in musical per-
in the music characterizes a relationship to music on Level 2. formance~particularly that of culturally significant, popular
Supporting rhythms and chords are played on the piano so idioms--Lloyd has the one opportunity to participate in a cul-
that Lloyd's contribution to the music can assume more prom- turally mediated form of activity whose meaning and signifi-
inence. In this example, both therapists keep their musical cance is available to him because of his musical sensitivities.
contribution at a steady dynamic and tempo without intro- The therapeutic triad in which Lloyd's therapy is imple-
ducing any unpredictable elements. Lloyd was demonstrating mented assumed some of the experiential qualities which

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40 Music Therapy Perspectives (2001), Vol. 19

characterize one's experience of being in a rock band in a of three consecutive measures. In contrast, the drums
non-clinical setting. The "band" established with Lloyd is the maintain the steady playing. Lloyd plays through
these semi stops.
one cultural institution whose creation he has participated in :32--Lloyd moves higher in the keyboard as the bass
and whose continuity can be seen and used a vehicle for changes from the I to the IV chord.
creating and expressing his sense of continuity as an individ- :36--On the drums, the therapist changes from the ride
ual. Again from Ruud who quotes Erikson: "The conscious cymbal to the high-hat, producing a tighter groove
feeling of having a personal identity is based on two simul- and overall sound which allows Lloyd's piano to
come out more prominently.
taneous observations: the perception of the self sameness and :46--Another series of stops to which the drums play slight-
continuity of one's existence in time and space, and the per- ly less. Lloyd again plays through these, vocalizing in
ception of the fact that others recognize one's sameness and joy as the groove resumes.
continuity." (Erikson, 1968, p. 50 cited in Ruud, 1998, p. 38) 1:08--Another series of stops which the drums do complete-
A sense of self and the individuation/maturation process is ly with the bass. Lloyd again demonstrates great au-
tonomy by playing through these stops alone.
not only concerned with "individuality, separateness, actions,
self-confirmation" (Ruud, p. 39) but instead incorporates de- Session 145, 2/3/98
veloping a sense of one self in relation to others. Think about
This excerpt shows Lloyd able to take the musical fore-
the various sub-cultures, subgroups, created by adolescents to
ground, as well as the long time he is able to sustain his fo-
achieve an adult sense of self and autonomy. It is about the
cused involvement. While Lloyd and the primary therapist are
self in relation to something. And the band provides this some-
both playing piano (there are two pianos in the room and
thing else, the cultural structure in which identity can be de-
Lloyd plays alone at his own piano in all excerpts with two
pianos) and the co-therapist is at the drums, we move into a
Information obtained from Lloyd's mother confirmed our
funk groove with the therapist assuming a supportive musical
sense that the group formed by the three of us was a special
role, playing a bass line in the left hand and chords in the
one for Lloyd: it was the one place in his life that he felt as if
right. Lloyd maintains his playing through syncopations and
he was relating to peers and which he did not experience
is able to play with and through them in an interactive way;
himself as being in the role of a student, client, patient, or
the rhythmic character of his phrases suits the music and they
someone otherwise in need of care. This recognition strength-
fall on emphasized beats. The syncopated stops here are more
ened the evolution of our clinical focus which was to grant
complex than in the previous examples and do not represent
Lloyd opportunities to express and experience greater auton-
a temporary stopping of the groove but more of an alteration
omy and mutuality through the music. We consciously at-
of it.
tempted to create musical experiences for Lloyd in which we
related to him more as musical equals, something which ne- CD Track 9 Index (1:34)
cessitated that we pull back from exercising a tighter control :O0--As the excerpt begins the primary therapist is playing
over the direction of the music. It thus also became important eighth-notes on the piano.
for Lloyd to assume a more prominent role in the music. :02--This changes to a bass pattern and isolated chords,
leaving more room for Lloyd's piano playing.
Example 7, Session 144, 1/27/98 :04--Lloyd senses this and moves to the treble end of his
piano, playing forcefully and with confidence.
In this excerpt from session 144, we have crossed a certain :18--Lloyd's playing becomes more prominent through
threshold and made a qualitative change in our relationship clear intervals higher in the treble.
with Lloyd and in his role in the therapy sessions. The primary :47--The therapist introduces syncopated stops which
therapist is at the drums and co-therapist is playing the bass Lloyd plays through showing confidence and en-
hanced autonomy.
leaving Lloyd at the piano with the only melodic/harmonic
1:00--After the turnaround, Lloyd again responds to the
instrument. This session occurred exactly four years after room left for him by continuing to play with authority
Lloyd's first session. He is much more prominent in the music in a way that leads the music.
than he has ever been, which also means that he is more
revealed in the music. Lloyd meets this challenge and does Liminality
not leave the music or the room. Instead, he plays indepen- Many anthropologists talk about the importance of rites of
dently with confidence and humor, even as we leave spaces passage. These are activities which mediate the transformation
in the music for him to play through. from one social role to another, such as occurs when adoles-
cents enter adulthood. The transitional time period between
CD Track 8 Index (1:36)
the states mediated by rites of passage is known as the liminal
:O0--As the excerpt begins, the primary therapist is singing state.
"Playing rock and roll!" while Lloyd plays a variety
of open intervals on the piano. Again, Ruud (1998) has applied some of these ideas to mu-
:24--On the second time through the form, the bass stops sic: "People experiencing the liminal state together tend to
playing a rhythmic pattern, emphasizing the first beat develop an intense comradeship in which their nonliminal

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Popular Musical Styles . . . 41

distinctions disappear or become irrelevant. Turner called this This mutuality is what makes the experience one that is au-
modality of social relationships c o m m u n i t a s . . . . Musical im- thentically shared among us. It is why it has been necessary
provisations may be thought of as part of a wide-ranging tran- to tap our own capacities for flow, groove, transcendence, and
sitional ritual--as an experience of liminality" (pp. 120-121). aesthetic expression in music. Although the clinical-musical
We can look at the profound change in therapy which in- focus is always on Lloyd, working in this way demands that
cludes a restructuring of one's being and self-image much as therapists allow greater expression to their own creative in-
a rite of passage which mediates between two states of being. sti ncts.
Lloyd is traversing the gap between his old (condition) self Ruud also says that
and new self. The process of therapy itself can be a liminal
"the emotional experience of music seems to help people
one, something which is most apparent in its most intense establish memories and integrate and formulate them in a
moments. metaphoric form that gives direction to their personal nar-
Some of the characteristics of liminality or transition time ratives. Contained within the musical emotional memory is
include timelessness, losing oneself in the experience; leaving a sense of continuity and sameness in life: sometimes a re-
behind symbols and practices of previous position; ambiguity, membered piece of music functions as a memory bank, as
a deposit box for a basic sense of self" (p. 66).
perceived danger, and the absence of roles; and a transcend-
ing of previously defined borders. "Flow" is also characteristic These considerations are relevant to the work with Lloyd,
of liminal experience. As Ruud (1998) puts it, "Incidences fol- especially as we consider something like the E modal theme
low each other in a united, organic way without our conscious in Excerpt 9. This theme was used many times as a basis for
participation . . . . We feel in control of the situation, yet we improvisations over a period of years. Our sense was that the
are fully absorbed by it . . . . Consciousness and behavior be- theme became representative of a certain part of Lloyd which
come one; life is expanded and full of meaning" (p. 122). was more mature, reflective, and grounded than was his typ-
As Lloyd's therapy progressed our musical interactions in- ical way of being. The improvisations based on the theme
creasingly took on these characteristics of liminality: the al- acquired increasing expressive subtlety and complexity, and
teration of roles can be seen in the way that our musical re- Lloyd appeared deeply involved in this music, as evidenced
lationships took on increasing degrees of equality as Lloyd's by his focused concentration and the ease and fluidity of his
independence and confidence facilitated a greater sense of breathing and overall physical countenance. The relaxed and
mutuality in the music; as the music became improvisational fluid quality of Lloyd's playing indicated to us that he recog-
and more unpredictable it became increasingly "dangerous" nized the theme and participated in its expressive nuances.
for Lloyd in the sense that unpredictability was so threatening Because the use of a recurrent theme is the very thing that
to him; and, the improvisations increasingly took on the qual- can establish and reinforce a sense of identity and personal
ity of flow. Our willingness to allow ourselves to live in the continuity, our hope was that he could experience the theme
liminal state with Lloyd facilitated the emergence of feelings as an extension of himself. Our intent was to communicate to
of communitas. The experience of being in a "band" is that Lloyd that we recognized and supported the mature, reflec-
much stronger when associated with such powerful experi- tive, even melancholy aspects of his being that seemed to find
ences. Excerpts 9 and 11 contain music which is expressive expression through this theme and the improvisations based
of this liminal quality. on it.
For Lloyd, giving over to unpredictability was threatening
because he could not then control or understand his feelings.
In his research study of a rock and roll group, Even Ruud Yet, through the use of a recurring theme in clinical impro-
has the following to say: visations, we can see that varied and novel emotional expe-
riences need not be a threat to the integrity of the self. The
"Music served as an entree to a social group in which to
experience communality and attachments to others. Being theme can provide the analogue for the enduring self which
with others through music may thus provide intense expe- undergoes the various experiences and transformations. Be-
riences of involvement, a heightened feeling of being in- cause the theme can be used to enter various realms and ex-
cluded, a deep relationship with others. Through the inti- periences that can be new and different each time, it holds
mate frame of musical activity, individuals are bound to-
within it the potential for ever further development and dif-
gether through common musical experiences." (1998, p. 64)
ferentiation of the self. With Lloyd, this was done within the
This was clearly a factor with Lloyd. We endeavored to es- context of the "band" which itself is the stable and ongoing
tablish an experience for him where he could be a meaningful element which allows for the novel exploration to take place.
part of something larger than himself. Because our goal was The theme, the band, and the basic style, provide the elements
to create a shared experience, we had to participate mutually of continuity, stability, security, and identity, while the spon-
in the experience. For this to occur, the experience must be taneous iterations of the music allow for the potential for
meaningful for us in a way that it is similar to its meaning for growth, change and development.
him, within the boundaries of ethical professional practice. And somewhat paradoxically, eventually the group defines

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42 Music Therapy Perspectives (2001), Vol. 19

itself as one in which exploration, risk taking, spontaneity, :41--Melodic playing by both piano and bass challenge
moving into unpredictable emotional realms, are all part of its Lloyd while also creating a unique and personalized
mood. The melodic line reflects Lloyd's rhythmic ac-
identity. Thus, the very thing which gives Lloyd stability, se- cents.
curity, and a sense of self and continuity, has within its own 1:05--Return to the motif at a slightly faster tempo.
essence a capacity for transformation, novelty, and unpre- 1:33--The piano again leads the music into an improvisa-
dictability. When the band itself acquires personal meaning tional section.
for Lloyd, he has begun to internalize its values and its mode 1:50--Flowing runs and melodies on the piano and bass
weave their away around the guitar as Lloyd again
of being, particularly those things which challenge his pa- strums confidently.
thology and disability. Through his identification with the band 2:38--The music becomes significantly quieter. The therapist
he begins to establish a new sense of self which incorporates vocalizes, personalizing the music.
those elements which promote and health and enhanced so- 3:03--Rather than return to the motif, the piano leads into
cial and psychological functioning. His basic primary need another improvisational section.
3:21--We all stop briefly and Lloyd brings us back to the
for communal experience is then used to overcome his fears motif with firm strumming.
and resistiveness. 4:01--The music ends as Lloyd stands and stops playing.
Clinical Examples Session 114, 3/14/97 (2:29)
Three years after beginning therapy, Lloyd's use of the ses- It is characteristic of Nordoff-Robbins work that clients
sions continued to expand and included experiences and ex- make significant breakthroughs through improvisational music
pressions which occupy areas on all levels of the model pre- and then have these significant gains solidified through the
sented at the outset this article. He continued to develop con- introduction of compositions which meet the new self which
crete skills in sustaining steady tempi in his strumming, drum- is established through the breakthrough (Aigen, 1998). The
ming, and soon added piano playing to the guitar and drums. client is changed and this new person is perceived as such by
His work proceeded on the cognitive, motoric, and aesthetic the therapist who then creates new musical forms which re-
levels and included expanding abilities to participate in music flect and consolidate the change.
of an increasingly wide expressive range. The new mood and way of making music together illus-
Excerpt 9, Session 113, 3/7/97 trated in the previous excerpt become more solidified when
the therapist improvises a song, Once Again We're Together,
In session 113 an E modal theme that was a recurring motif at the beginning of the following session, number 114. The
in Lloyd's therapy was used as the basis for an extended mu- "new guitar" being sung about is a steel string guitar that we
sical improvisation. The music is more flowing and less struc- began using to give Lloyd more possibilities for projection of
tured than anything else we had previously used with him. an adequate volume level.
He continues steady strumming throughout the improvisation, The music of Lloyd's therapy process began with a wide
even as it reaches its climax with rapid, flowing runs on the variety of styles in the area of country, jazz, swing and blues.
piano and melodic playing on the bass. By abandoning the In this song, we are developing an individualized musical id-
musical function of holding down the basic pulse of the mu- iom for Lloyd in which the jazz, blues, rock and country styles
sic, the therapists pass over to Lloyd a greater musical re- are influential but not dominant. Just as the various musical
sponsibility and challenge. styles are synthesized into a unique creation, we infer that
Throughout this improvisation, Lloyd remained fully ab- Lloyd's sense of self is being similarly integrated from its dis-
sorbed in this individualized and introspective musical expe- parate parts. No detailed index is provided for this excerpt as
rience, an ability which indicates a capacity to participate in it is the overall mood of the music which is of greatest clinical
musical experiences on Level 4. The music conveys a sense significance.
of introspection as the piano and bass parts are explorative
and spontaneous. Lloyd participates in this experience while CD Track 11 Index (2:26)

staring down at guitar throughout most of improvisation, a Emotional Differentiation and Identity

quite atypical way for him to focus his attention. Hence, it is

The capacity for emotional experience and expression is an
enhancing Lloyd's capacity for such an intense, involving, and
essential part of the development and maintenance of a
personal experience which is the primary clinical focus here
healthy self. And it is clear that music has a unique way of
as opposed to fostering subtle variations in his own musical
contributing to the ability to become aware of and express
expression. feelings. Ruud observes how this is due to
CD Track 10 Index (4:12)
"the ability to experience emotional nuances, to experience
:O0--The excerpt begins with a statement of the motif on and express various degrees of intensity, and to maintain
the piano as Lloyd strums to it. precise concepts about feelings. This may be considered as
:20--The piano leads into an improvisation established by having acquired the sense of a basic feeling of vitality-that
the mood of the motif. is, the ability to open oneself to the world, to other people,

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Popular Musical Styles . . . 43
~ ~ ~ ~ , ~ ~ ~ ~ :`:`:~:`:`:`:`:~:~:`:~:~:`:`:~:~`:~:~:`:~:`:~:~:~:`:`:~:`:~:~`:~:`:~:~:`:`:`:`:`:~:~:`:~:`:`:`:`:~:~:`:`:`:`:~:`:~:~:`:`~`:~:~:`:`:`:`:~:~:~:`:`:`:~:~:~:~:~:~`:`:~:`:~

and to oneself (Monsen, as noted in Ruud, 1998) an impor- [Brief pause in excerpt]
tant condition for good personal development" (p. 58). 1:38--Both therapist and Lloyd are audible on the piano.
Lloyd's playing is more prominent as the therapist
So the capacity for emotional experience and expression plays sparsely, only filling in Lloyd's phrases.
maintains health by keeping us in an open and flexible rela- 1:48--Now Lloyd is the only one playing the piano as the
tionship with our intra- and inter-personal environment. Being therapist plays the synthesizer bass. Lloyd begins a
open to the world means being open to the varieties and nu- long melodic climb into the high treble end of the
ances and varying degrees of intensity of emotional experi-
1:58--The drums change from the high hat to the ride cym-
ence. Clearly our work with Lloyd helped acclimate him to bal to match the timbre and mood of Lloyd's piano.
all of these aspects of feeling and thus helped him to bear the 2:01--Lloyd moves back to the midrange of the piano and
various types and intensities of emotion which accompany all continues playing within a more narrow range.
experiences in the world. 2:18--The therapist reenters on the piano marking the lon-
gest period of Lloyd's meaningful solo playing that he
Session 158, 6/23/98 had yet sustained. Therapist then plays a melodic
phrase in the treble end of the keyboard lasting 4
The final excerpt illustrates how Lloyd has been able to measures.
bring together many areas of work: the motoric, the cognitive, 2:28--After a brief glissando the therapist momentarily paus-
the affective, the social, and the purely musical. Lloyd is at es on the piano encouraging Lloyd to play in this spot,
the piano, the primary therapist is playing the synthesizer and thus supporting Lloyd's participation in musical dia-
logue. Lloyd again sustains his melodic phrases for
piano, and the co-therapist is on the drums. There is much approximately :30.
space left for Lloyd's piano melodies, with the synthesizer bass • 2:56--Lloyd stops playing, stands, claps four times in the
line and drums supporting his playing. Lloyd is clearly leading tempo of the ongoing music, moves to the guitar and
the music at times, which is based on a new greeting song, we alter the improvisation to reflect these changes as
Welcome to Lloyd. There is a fluid shifting of roles between the excerpt ends.
the therapist and Lloyd, with the former completing Lloyd's
phrases and Lloyd filling in between his melodies. The entire
piece is based on the Mixolydian mode being played on the Because of his disability, participation in the social struc-
white keys of the piano with " G " as the tonal center. tures and rituals which help all of us to mediate the transition
Near the end of the second half of the excerpt, Lloyd plays from one stage of development to the next is denied to Lloyd.
a long phrase that extends into the treble which then gets Yet he has the same needs for rebellion, peer identification,
repeated. As Lloyd has extended his awareness over the hor- self-expression, community, and transcendence which endow
izontal dimension of the keyboard to build longer phrases, he all of us with a sense of purpose and meaning in life, and
has experienced a concomitant enlarging of his temporal which give us the impetus to move through our own devel-
awareness and is able to sustain increasingly longer musical opmental stages. Through the improvised use of popular idi-
ideas. There is a remarkable level of relatedness and com- oms in music therapy, we have created a vehicle for Lloyd to
municativeness in his playing. participate in his own rite of passage, an essential step in any-
one's self development, disabled or not.
CO Track 12 Index (3:15)
:00--As the excerpt begins only Lloyd's piano is audible as
the therapist plays a synthesizer bass line with the co-
therapist playing the drums. Through the improvised use of popular idioms in
:06--Therapist enters on the piano, completing a phrase of
Lloud's and then playing a melodic figure. music therapy, we have created a vehicle for Lloyd
:20--A theme is developed on the piano which becomes to participate in his own rite of passage, an essential
the basis for the improvisation. step in anyone's self development, disabled or not.
:31--Therapist's piano playing moves up into the treble and
then temporarily pauses.
:34--Lloyd's piano playing is now more audible as he plays
up into the treble, back to the middle of the keyboard It is the feeling of mutuality and comradeship which has
and then higher into the treble. enabled Lloyd to make significant gains in music therapy in a
1:02--After Lloyd has sustained a melodic idea for over :20,
the therapist reenters on the piano reflecting the con- number of areas: he became more able to bear the intensity
clusion of Lloyd's phrase. of musical experience and live in music which expresses his
1:06--Lloyd again develops a melodic idea through a num- emotions and feeling state; although only able to focus on
ber of measures. music for very brief periods initially, he became able to sustain
1:14--The therapist responds musically to Lloyd's melodic interactive musical participation for many minutes on end; he
1:17--Lloyd takes the musical lead again. is able to express his will and intentionality through music;
1:26--And the therapist again responds to Lloyd's phrase and, he can hear and respond to subtle changes in the music
establishing a real sense of musical dialogue. around him.

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44 Music Therapy Perspectives (2001), Vol. 19

Lloyd's mother reports that all of these new capacities have

generalized to his life outside of music therapy. Every profes-
sional that works with Lloyd~from his neurologist to the
counselors at his supervised residence--reported that Lloyd
became a completely different person from who he was prior
to entering music therapy. He became less excitable, more
focused, more communicative, and better able to participate
in social activities. He is now able to do things that we take
for granted, such as go out to a restaurant with his mother,
something which she reports was not possible previously.
Lloyd's life was limited for his first 27 years because the
most effective means for him to commune with othersIim -
provised music therapyIwas not yet available to him. When
music therapy came into his life new capacities for expression
and experience were revealed that had lain dormant until
then. While it is difficult to draw a strict causal relationship,
the correlation of these events has convinced those around
Lloyd that it has been his experience in music therapy which
has caused these profound changes.

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uals with developmental delays: A preliminary model for contemporary Nordoff-
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Aigen, K. (1998) Paths of development in Nordoff-Robbins Music Therapy. Gilsum,
NH: Barcelona Publishers.
Aigen, K. (in press). Playin' in the band: A qualitative study of popular music styles
as clinical improvisation.
Aldridge, D. (1996). Music therapy research and practice in medicine: From out
of the silence. London and Bristol, PA: Jessica Kingsley Publishers.
Ansdell, G. (1995). Music for life: Aspects of creative music therapy with adult
clients. London: Jessica Kingsley Publishers.
Forinash, M. (1991). A phenomenological analysis of the Nordoff-Robbins ap-
proach to music therapy: The lived experience of clinical improvisation. Music Ther-
apy, 1/(1), 120-141.
Lee, C. (1996). Music at the edge: The music therapy experiences of a musician
with AIDS. London: Routledge.
Pavlicevic, M. (1997). Music therapy in context: Music, meaning and relationship.
London, Philadelphia: Jessica Kingsley Publishers.
Ruud, E. (1998). Music therapy: Improvisation, communication, and culture. Gil-
sum, NH: Barcelona Publishers.
Serafine, M.L. (1988). Music as cognition: The development of thought in sound.
New York: Columbia University Press.
Turry, A. (1998). Transference and countertransference in Nordoff-Robbins music
therapy. In Kenneth E. Bruscia (Ed.), The dynamics of music psychotherapy(pp. 161-
212). Gilsum, NH: Barcelona Publishers.
A u d i o Excerpts
2) Session 47, (:50)

3) Session 47, (2:09)

4) Session 47, (1:34)

5) Session 50, (2:03)

6) Session 102, (1:45)

7) Session 140, (1:09)

8) Session 144, (1:36)

9) Session 145, (1:34)

10) Session 113, (4:12)

11) Session 114, (2:29)

12) Session 158, (3:15)

Total Time: 21:43

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