Music therapy in France

The Arts in Psychotherapy,

vol.

13 pp. 301-305,

0

Ankho

International

MUSIC THERAPY

GAYLE

OWENS,

Inc.,

1986. Printed

in the U.S.A.

0197-4556186

$3.00 + .OO

IN FRANCE*

RMT-BCI

Leuret, a precursor of active music therapy, felt that it was more effective than passive music therapy. He formed choruses and orchestras with patients as the performers. In 1852 highranking administrators witnessed an orchestral performance by patients from an institution (Quatre-Mares) and were so impressed that they gave their approval for the use of music in institutions. Almost all such establishments thereafter organized choruses and orchestras, the beginning of a systematic use of music in group psychiatric settings. Between 1880 and 1914 interest centered on the psychophysiological effects of music, and research was based on the effects of music on pulse rate and respiration (Arveiller, 1980). The attempt was to render a scientific music therapy comparable to other therapies, susceptible of being described by its physical and chemical its physiological, therapeutic. and properties, toxic effects, its indications, its modes of application, its preparations, and its doses. Unfortunately, the experimental results were often contradictory, problematic, and not always based on scientific procedures. After 1911 many considered music an occupational therapy, its goal no longer to heal, but to help patients resocialize, and to prevent regression. There is still a place in France where this music therapy philosophy is practiced but, as will be described, it has taken on new qualities. Arveiller (1980) points out that when reviewing a history of the use of music in psychiatry it is

HISTORY Arveiller’s (1980) excellent summary of the history of music therapy in France cites the use of receptive (passive) music therapy as an interdisciplinary approach in treating melancholy as early as the 17th century (p. 45). In the 18th century a debate arose over the use of music as opposed to the use of physical treatment in the care For of psychologically disturbed persons. example, the 18th century philosopher, Rousseau, felt that music should have the same effect on the fibres of the human body as it had on an instrument placed next to the sound source. Intertwined in the debate was discussion of the effect of one’s physical state on the psyche and vice versa. This period experienced the birth of the theory in psychiatry of replacing a false idea with a correct idea and of sensation being the source of images which translate into ideas. The eliciting of sensations through music therefore played a role in this theory. The use of music with psychiatric patients increased in the 19th century and corresponded with generalized moral treatment in psychiatry. Philippe Pine], a philanthropist and psychiatrist of the time, employed passive music activity (musical instruments played by employees) in the psychiatric milieu. He believed that soft, harmonic music in the psychiatric hospital helped to create a calm, relaxing atmosphere that appealed to the healthy part of the patient as well as the premorbid personality.

*This article is the result of meeting with French music therapists J. Guiraud-Caladou, professor at the music therapy program in Montpellier; E. Lecourt, author of two books and many articles on music therapy. music therapy professor at Paris VII. and the Gaston of music therapy in France: D. Quintana. G. Silvestre, E. Vergnes; and J. Verdeau-Pailles. author of several books on music therapy. tGayle Owens was employed as music therapist at Community Mental Health Center and Psychiatric Institute in Norfolk, Virginia and did graduate study in psychology at I’Universite de Neuchatel in Switzerland. 301

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important to maintain a perspective on the goals and objectives of music in this setting. For example, in 1967 music at maximum volume was employed to mask the noises made by patients during the application of electric shock. Choruses and fanfares may be a way of “militarizing” institutions and aiding the process of creating an institutional hierarchy, of hiding misery, and of patient loss of identity in this type of collective treatment. MUSIC

THERAPY

PHILOSOPHY

Dupre and Nathan (1911) wrote about the importance to therapy of the emotions and the associations elicited by music. Most present day music therapy philosophy is based on this premise. The Association Francaise de MusicothCrapie (1984) states that music therapy is the utilization of sound and music in a psychotherapeutic relationship. It addresses itself to psychological and behavioral difficulties and mental pathologies. Guilhot, Jost. and Lecourt (1973) state that “Music therapy is not a form of psychotherapy but an instrument of psychotherapy” (p. 12).’ Music therapy is based on the effective power of music in psychotherapy and assumes the same characteristics of methodology as psychotherapeutic pedagogy (Guilhot, et al., 1973). Psychomusical techniques are regarded as an excellent and privileged means of exploring dreams and ideas, the conscious and the unconscious, the effective and emotional worlds of the individual, and for provoking catharsis. Carefully chosen music in psychotherapy is considered to have the capacity to create a calm, secure. relaxed atmosphere that allows the patient to spontaneously express anxieties and problems without reticence or resistance. The goals of psychotherapy are not only to explore problems, anxieties, etc.. but also to awaken positive energies, constructive feelings, the imagination, and creativity. as well as to reorganize the patient’s personality, desires, interactions. and objectives. Psychomusical techniques are seen as a means of creating and supporting this process. Music therapy in France is a specialization for psychiatrists, clinical psychologists, psychiatric nurses (L’Association Francaise de MusicothCrapie. 1984) and is not an independent profes‘Translation h) Gayle Owens.

OWENS sion. This specialization approach is reflected the education, practice. and organization music therapy in France. MUSIC

THERAPY

in of

TECHNIQUES

Probably the most researched and applied music therapy technique in France is receptive (passive) music therapy. Developed by J. and M. Guilhot, Jost, and Lecourt (1973), the technique is specifically indicated for individual psychotherapy and consists of having the patient listen to three selections of music. The first selection, chosen to correspond with the patient’s present psychological state, should evoke the difficulties experienced by the patient. The second should be melodic and harmonic in order to neutralize the effect of the first selection, and the third should express the desired state of being of the patient-relaxed, stimulated, etc. For the first selection the patient may be asked to think about his/her psychological and physical problems or the mysteries of the universe. For the second selection he/she may be asked to think about the marvels of nature, and for the third selection the patient is instructed to permit him/herself to be induced by the music into a more positive mood. Music in this case is considered an intermediary. The patient is often involved in the selection of the music, and the relationship between the patient and the therapist is centered on the selection of the music, listening to it, and the effects it produces. The choice of music vis-&vis the patient is very important and should not be generalized. The musical knowledge, taste. and culture. personality. and psychodynamics of the patient are considered when making the selection. Case examples are reported by Guilhot, et al., (1973) with examples of music selections, desired responses. and eventual observations of the patient. Following is one involving a psychopathic personality with schizoid behaviors. Lisrening order

Prescribed

Desired

music

response

I

hurried oppressed

anxiety

2

soft harmonic melodic

security

MUSIC energetic but soothing

3

THERAPY

enthusiasm calm liberation

Musical selections Session I

Symphony in F minor (Dittersdorf) 2. Nocturne Quator No 2 in 1.

D Major (Borodine) 3. Le Roi des Rois-Prelude (Miklos Rozsa) Session

II

1. Concerto No 2 for Piano (Rachmaninoff) 2. Cavalleria RusticanaIntermezzo (Mascagni) 3. New World Symphony No 5) (Dvorak)

Session

III

1. Nabucco-Slaves Chorus (Verdi) 2. Largo from the opera XerxCs (Handel) 3. Les Maitres Chanteursouverture (Wagner)

General observations after 30 sessions were that the patient had made progress in personal relationships, was able to express himself more easily, and had fewer nightmares, ruminations, and painful childhood memories. It is interesting to note that almost all music selections used in receptive music therapy are of a classical nature. Selections with lyrics are seldom used unless the text is in a language not understood by the patient. In recent years there has been an evolution from psychomusical techniques centered solely on receptive music therapy to the development and utilization of active music therapy techniques. The French often employ active music therapy techniques developed by Nordoff and Robbins, J. Alvin, C. Bang, and Orff. Active music therapy techniques are used to facilitate nonverbal communication (Ducourneau, 1977; Guiraud-Caladou, 1979; Lecourt, 1977), to allow and develop creativity (Azinala, 1983; Boegner & Inizan, 1983; Lecourt, 1977), and (particularly in the case of improvisation) to allow the patient to project his conscious and unconscious thoughts and feelings (Lecourt, 1977).

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TESTS

Guilhot, et al. (1973) have developed a psychomusical test using work by Cattell and Saunders (1954) as a reference base. Two functions are served by this test: to explore the personality of the patient and to permit a logical selection of music for receptive music therapy. Verdeau-Pailles (1981) elaborated on the above test, dedicating an entire book to the subject. The test, used with adult and adolescent psychiatric populations, has three parts-a questionnaire, a receptive listening test, and an active test. The questionnaire explores the patients’ musical background, music preferences and dislikes, favorite composer, and what different sounds in the environment mean to them. The receptive listening test is based on the results of 543 subjects’ responses and is a projective test. The patient listens to ten musical excerpts and writes his responses to each selection. The excerpts include classical music, popular music, noise (traffic or a storm), and oriental music. Each response is then categorized by the therapist into one or two of the following ten classes of responses: I. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Gustatory and olfactory-sensory Visceral and sensory such as hot and cold Motor Simple visual-seeing simple forms and colors Elaborate and complex visual images-seeing vivid scenes as in a dream Esthetic impressions and value judgments-often seen as a defense Pure affective and evoked feelings Evoked memory Intellectual Banal

The third part of the test, based on the results of 273 subjects’ responses, is an active test and consists of playing instruments with and without background music. The patient is observed for such things as choice of instruments, concentration, lateralization, and coordination. This test is borrowed from R. Benenzon (1971). a music therapist from Argentina. Verdeau-Pailles (1981) indicates characteristics to look for in the responses and combinations of responses that typify well-adapted normal subjects, organic pathologies, specific neurotic tendencies, psychotic pathologies, and

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borderline personalities. Verdeau-Pailles emphasizes that the test is not an aptitude test, but that it achieves a knowledge of the psychomusical personality as well as the general personality of the subject, and contributes elements that aid in making a diagnosis. EDUCATIONAL REQUIREMENTS MUSIC THERAPY

IN

There are four universities that offer music therapy certification. Three are located in Paris-Paris VII, Paris-Dauphine. and Paris X-and one-UniversitC “Paul Valery”-is located in Montepellier. Although some of their programs allow equivalencies. the training is basically offered as a specialization only to individuals who already possess a degree in a related field such as psychology. psychiatric nursing, or psychiatry. One issue that probably heavily influences this approach is that under French law only certain medical and paramedical professions are allowed to practice any form of therapy. Therefore. in order to practice music therapy one must meet the requirements of one of these medical or paramedical professions. Standardization and quality controls set by a national association do not exist. The Paris VII program, however. is organized by the Association Franfaise de Musicothtrapie. Intensity and length of the program. major focuses of the program, musicianship requirements, and standards for acceptance to the program vary from university to university. Music therapy programs are attached to clinical human science departments rather than music departments. In general. less emphasis is put on musicianship skills than on knowledge. skill. and sensitivity in psychotherapy. MUSIC

THERAPY ORGANIZATIONS FRANCE

IN

Francaise de In the Centre I969 Musicotherapie was formed by Jacques Jost, Maurice Gabai, Jean and Marie-AymCe Guilhot, and Edith Lecourt. This was so well supported that in 1972 they created The Association Franqaise de Musicothlrapie (Lecourt, p. 31). The AFM publishes a trimestral journal, LN RC\~UCdc for the music Mrrsic~otll~;r~ipi~~. is responsible therapy program at Paris VII, and organizes

OWENS meetings, seminars, and conferences. The AFM organized the first World Congress in 1974 (Paris) where about 20 countries were officially represented, and an International Congress in 1983 (Paris). According to the Intc~rnrrtiotlrrl Nc,c-slrttcr (1983), the AFM has 40 members and there are about 200 individuals in France practicing music therapy. organization, the Association Another d’Applications et de Recherches des Techniques Psychomusicales, researches and develops psychomusical techniques for relaxation, analgesia. music for stores, hospitals, etc. “functional” This organization has taken on commercial aspects. For example, it has made several commercial cassette tapes. A training program is also offered through this association.

MUSIC

THERAPY

LITERATURE

in music therapy is rich and varied, in theory. This is evident in Lrr Rcl-rrc tic Mlr.sic,otll(;rtrpil~ where theoretical research may include anything from music and medicine in ancient Greece (Jourdan-Hemmerdinger. 1984) to a metapsychological approach to music in therapy (Ledoux, 1983). Their work in methodology is more than complementary to the field of music therapy. What would be striking to most American music therapists is the marked absence of experimentally and statistically designed research, since French music therapy adheres to psychoanalytical philosophies. Arveiller (1980) states, however, that if music claims to be therapeutic, it needs to have controllable, constant, specific, and differentiated effects. At the same time he writes that the French are shocked by the behavior modification research and practices in the United States. The French are actively aware of music therapy theories, techniques, and research in other countries. Reference is often made to music therapy literature from Argentina, Austria, Canada, England, Germany, the United States, and Yugoslavia. It is, therefore, not from lack of knowledge or information, but from choice that the French have pursued their own course. This is not only true for its literature, but also for its philosophy, its organization, and its education in music therapy.

Literature particularly

MUSIC THERAPY CONCLUSIONS Music therapy is still struggling to prove to the world that it is a viable, valid, and reliable form of therapy. Different countries and different organizations within the countries use different strategies to meet this goal. One country may use statistics gathered from expe~mentaIIy designed research to prove a paint whereas another unofficially allies itself with medical and paramedical professions. Certain problems are automatically eliminated by allowing only psychiatrists, psychologists, or psychiatric nurses to be specialized in music therapy. Third-party insurance payments for music therapy and creating music therapy positions are not topics of issue in France. Despite the language barrier, geographica distance, and philosophical differences, information sharing between France and the United States is taking place. Nine music therapists from the United States presented their work at the 1983 World Congress of Music Therapy in Paris and the June issue of Lu RCWP dr ~~s~i.t~?~i;~~~i~~ by Richard Graham. pubfished an article Verdeau-Pailles presented her work at the 1983 National Association for Music Therapy Conference in New Orleans. Americans can profit particularly from the French literature on theories and practice of the use of music in psychotherapy and the psychomusical test developed by Verdeau-Pailles. Why not translate some of this vaIuable literature into English? Why not organize international exchanges of music therapy students and professionals? Language barriers can be overcome, and philosophical differences lead to interesting discussions. We have much to share and we have much to learn. REFERENCES AMERICAN ASSOCIATION FOR MUSICTHERAPY (1981) Inrernarionnl Newsletter of Mrrsir Therapy If 1): 16-17.

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ARVEILLER, J. (1980) &s Mrt.sic.r,rfii~cipi~l.~.Issy-fesMoulineaux, France: E.A.P.-Editions Scientifiques et Psychologiques. AZINALA, L. (1983) M~&/IIP Vi<, dc Torr.$ Lc.r ./orrrs. Aires: Editorial Paidos. BOEGNER. D. & INIZAN, Y. (1983) Activities musicales de woupe au Centre de ne~ropsychjat~e iufa~tiie de Fleury ies Aubrais. La Rerwr dc k&iwthirupk fII(4): 83-90. CATTELL. R. & SAUNDERS. D, (1954) Musical ureferences and personality diagnosis. .rt~~~r~~~~~ I$ Socicri Pv.vcholog?. 33: 3-24. DIDIER-WEILL, A. (1984) Breve remarque psychanalytique sur la musique. Lrt Rww Jr, ~~~wsic.frt~~tc;rcfpi~, IV{ f f: 1935. IfI It~t,otiwtiori il DUCOURNEAU. G. (1977) Mrrsic.otkc;ro~ic. Toulouse, France: Ed. Privat.

I’etude comparee de la culture de trois groupes ethniques annarent&. La R~~rrwde /~ff~.sic,otirc;tci~i~,IV(Z): 27-34. GUILHOT, J. and M. A.. JGST. R. & L&COURT, E. (1973 4th Ed.) Lrt iWtl.sic.r,/kr;t-npic~ (01 Irf.v Mc~/kotl~s J’Assnriuricm &s Tcc.kttiyrws. Paris: Les Editions ESF. GUIRAUD-CALADOU, J. ( 1979) IJn c‘hcrnt d’Ar~tio,l-Lrr C&rritit~. Couriay, France: J. M. Fuzeau. SA. JO~rRDAN-H~,~MERDINGER, D. (1984) Musique et medecine dam la Grece antique. I.0 IZc\,rtc, t/c

Musit,rlthi:tcr~ir 1Vt2): 14-16. LACAS, P. (1984) Questions aux musicoth~rapeuts sur l’eflicience du signe sonore: Points de vue epistemologique et psychanalytique succints. Ln Rcl,nc, de ktrisit.rrihi;rcl~i~~IV( I ): 26-4 I , L’ASSOCIATION FRANCAISE DE MUSICOTHFRAPIE ( 1984) Lrr Mt,sic,~i/h~:rrrpic~.Paris, France. L’FCHFVIN. P. f 1381f ~~/~.s~4~~f~ et M&iicin~. Paris: Stock Music.

LEDOUX,

M. (1983) Approche

metapsychologique

de la