The subject's early childhood had been so marked by destructiveness, rejection and deprivation that she had recoiled from all contact into a self-protective seclusiveness. Since age 17, there had been twenty hospitalizations in mental institutions.
This patient's response of massive self-rejection included the music she so desperately wished to pursue. Despite the adjunctive role of music theraphy, problems of denial, “splitting.” withdrawl and overwhelming guilt had to be dealt with, along with music, as they arose in music theraphy sessions. Following the patient's cues, the music therapist encourages the safe unleashing of repressed rage on the piano keyboard; this eventually makes it possible for tender felings to be communicated through music. Other forms of symbolic communication are accepted, understood and responded to by the therapist.
As music-related events are uncovered in connection with repressed traumatic experiences, this patient's musical and expressive capabilities improve, as does her contact with reality. Both interpersonal and music theraphy approaches take place at the level of the pre-verbal, pre-Pedipal primary relationship; they take into account the sequential development of personality and the role of unconscious factors in influencing it.
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