(Original title: Zur Indikationsfrage anthroposophisch orientierter Musiktherapie. Merkwstab 1995.48:255-60. English by A. R. Meuss, ETL, MTA.)

Preliminary Remark

This paper is intended to present some thoughts on the indications for art therapy - in this case, music therapy, a field where there is an urgent need for physicians and art therapists to find a common base.

The Problem

The demands on physicians and therapists who are fully engaged in their professional work as well as seriously committed to Anthroposophy are enormous, yet it is essential to discuss the indications for music therapy, which at present are far from being met in anthroposophic hospitals, clinics, sanatoria or treatment centers, let alone in physicians' offices and outpatient care.

Every art therapist depends on the physician, and every physician who prescribes art therapy needs to have at least a basic understanding of the potential contribution art can make in the healing process. Our first question, therefore, must be: why music therapy and who should receive it?

There are some very simple and perfectly correct principles concerning admission to individual music therapy which can be adopted with a clear conscience.

The first golden rule is: what are the patient's inclinations? Where does he feel he needs to, and is able to, express himself in art and thereby support the healing process? If a patient states that he prefers music therapy to all other therapies available, we believe this must be accepted. The risk of making the wrong decision has to be borne for it will always be possible to change to another therapy within the anthroposophic context.

I knew an hysterical woman patient whose longing for music therapy was, in fact, a longing to enter into somnambular states on hearing a lyre played! Here music therapy, initiated at the patient's wish, proved an important element in defining her problem and making a diagnosis. Music therapy could only take this to a certain point, after which modeling proved to be the right route. Another patient also expressed a clear wish for music therapy. He was undoubtedly gifted in this direction, especially in singing. He had, however, achieved regrettable notoriety as a spectacular destroyer of paintings, and had, among other things, a severe neurosis. After 6 months of intensive music therapy, it actually proved possible to introduce him to painting therapy where he learned to use color and a paintbrush himself and work with therapeutic color exercises.

We tend to take a patient's clearly-expressed wish seriously. In most cases, however, patients tend to be unsure as to the art in which they want to find expression. Here the physician may advise, with due care, or patients may have some "trial sessions" with the therapist. Basically it is a matter of overcoming the inhibitions most people feel when it comes to creative work. To begin with, it does not really matter if they start with color, clay, movement or music. Experience has shown that it is often the "nice therapist" who helps the patient to venture into something that is entirely new to him.

Psychosomatic Aspects

Taking the question of the indication a bit further we come to the field of psychosomatics, which ultimately plays a role in every syndrome. Music therapy offers a wide range of opportunities in this respect. A music therapist may not have a full concept of the diagnosis "diabetes mellitus", for example, but he will be able to help the woman aged with her tension, irritability and anxiety, and above all the shock of having an incurable disease. Music therapy can help patients with asthma, Crohn's disease, ulcerative colitis, migraine, chronic constipation, essential hypertension or hypotension, cardiac arrhythmias, etc., both specifically and in relation to the psychosomatic aspect, using a wide range of instruments and musical activities.

Three Criteria for Treatment

Music therapy always has three aspects, used with variable emphasis: - music work with hygienic aspects

- music therapy with an educational aspect

- work relating to the specific diagnosis.

The therapist must always be clear of his reasons for everything he does. In his discussion with the physician, it may sometimes be important to reach agreement on the weight to be given to each of the three criteria and the question of active or passive exercises.

Role of the Constitution

If we base ourselves on the constitutional type, general strengthening and support of the metabolic pole - bringing this to awareness - may in itself help a leptosome individual to gain a better psychological balance. (It is a common experience that this kind of support is increasingly needed today, when most people are under considerable nervous strain.) If someone is too much caught up in the lower pole, lacking in powers of awareness and structure in the soul sphere, music therapy can help by using suitable instruments and pieces of music. Again, the work is more than just "making music"; it involves a specific therapeutic concept with a definite goal, which determines the choice of key, meter, alternation between instrumental and vocal work, and so on. The music therapist will be able to tell the physician exactly why any particular step is taken in the work.

It is not normally helpful to inform the patient in detail of the treatment strategy. He should be as open-minded and happy to come to his music therapy as possible and feel (perceive) that the music helps.

Music Therapy for Specific Diagnoses

The above opens up a wide field of activity. However rich the potential we, as anthroposophically-oriented therapists, should not limit ourselves to the sphere of psychosomatic medicine. It is worth noting that anthroposophic music therapy is clearly superior to the techniques used in conventional music therapy which have been developed on the basis of psychotherapy and psychoanalysis. (A paper on Rudolf Steiner's musical impulse is planned to show the true nature of the anthroposophic approach to music.) Readers will understand that in music therapy - as in medicine generally - there are intimate spheres that can only be reached once a considerable body of experience has been gained in phenomenologic study. (The author will be pleased to reply to specific questions in this area.) All that can be said is that music therapy for specific diagnoses makes demands on the music therapist, for which it is necessary to know the standards expected by Rudolf Steiner and the suggestions he made concerning esoteric, musical and medical aspects. Below, some aspects of this will be merely touched on.

The Arts and Aspects of the Human Being

Music cannot really be described. It has to be heard and leads to the wordless realm as we experience it more deeply. It "speaks" with such power itself that words inevitably seem impoverished in comparison. Below, some results of lifelong studies in music therapy and collaboration with physicians may offer the first, cautious certainties. On one hand, Rudolf Steiner said it was possible to see the different arts in connection with the different aspects of the human being.(1) In the same course of lectures, however, he upset the applecart by relating the aspects to the intervals, which means at least 49 different possibilities.(2) This is difficult for musicians, let alone lay people. It is also a challenge to be less hidebound and get at least a notion that in music the dimensions are infinite and certainly cannot be grasped if we take a philistine approach.

Rudolf Steiner frequently suggested that we should patiently listen and practice the individual elements of music in the Goethean phenomenologic sense, so that their primary qualities gradually emerge. This applies to single tones, intervals, rhythm, melody, and harmony, to mention just a few of the many potential elements for study. Rudolf Steiner considered such phenomenologic studies essential, as is evident from his discussions on musical themes where he speaks of these basic elements over and over again, describing their qualities.

The lyre, greatly esteemed in anthroposophic circles, was not introduced as an instrument for music making by Steiner but as "a kind of learning tool" for phenomenologic studies, so that these might be as objective as possible (he clearly did not think any of the commonly-used instruments suitable for this).

Vitalizing the Ether Body

In a lecture given on 8 March 1923, Rudolf Steiner said,".. .if you focus your attention mainly on the rhythm, the rhythmic element is what really brings forth the music because it is related to will nature, and human beings must inwardly activate the will if they want to be alive to music."(3)

In this reference to the will which must be activated, Rudolf Steiner was not speaking of the aspects of the human being, specifically the etheric aspect, but to the threefold human being. In the anthroposophic approach to medicine one soon realizes, of course, that the etheric is, to all intents and purposes, the origin of life and why this is so. There we have the origin of pulsation and ultimately all rhythmic processes in the whole human organism. Like the melodic and harmonic elements, the rhythmic element has to be seen to originate in the "middle" human being. Even embryonic development proceeds to the "musical accompaniment" of the maternal heart and breathing rhythms. (A. Tomatis has published interesting work on this.)

Pulsation, diminuendo and accelerando thus accompany the life of the developing human being. They also provide stimulation or have a calming influence on psychologic processes. With the whole of music based on pulsation, rhythm, and movement and because movement always means life, we realize that music - contrary to frequent lay opinion - does not exist to soothe but to vitalize.

Sentient Soul, Intellectual Soul, Spiritual Soul, Spirit Self

The choice of instrument and the piece of music as well as the choice of tempo and sound volume determine if the music tends to stimulate or make us reflective. It is also a fact that in states of extreme exhaustion music can be such a strain on the patient that at such times a music therapist must chose low-volume music and little of it (generally only the melody in such a case) so that he presents not so much the music itself but the "in between", the sound that lingers, or the interval between sounds. It is possible to enhance the quality of silence with music, an art that is particularly important when working with the dying.

The melody takes our inner response, the arc of tension that influences our breathing, into the realm of ideas. The pain of the world, lament and jubilation, acceptance and struggle are feeling responses that can be presented in melody - almost unnoticeably or quite strongly - supported by a rhythm that is no longer to the fore. Music is then experienced as rich and varied, its colors enhanced by the broad, colorful element of harmony. In music therapy, it matters if the melody rises or uses large intervals, thus demanding a lot of the patient, or if it creates a relaxed working atmosphere for the patient by using small ranges and light, undemanding melodies.

A vast field can be opened up in the sphere of singing where music therapy can establish a connection with the physical body, e.g. bringing air into the resonance spaces of the body with reference to the soul element, awakening or supporting greater powers of being alive to things and of fantasy with reference to the spirit, giving insight and self-knowledge through perception and reflection.

Readers should remember that the study of music therapy is continuous, and therapists must first have studied music. The few initial points made here may, however, encourage medical practitioners to join the music therapist and share in further training, for much can also be contributed to musical topics from the medical side. Physicians need not be qualified musicians to understand the approach to music therapy. Music offers many possibilities even to lay people, and first levels of shared understanding for the potential use of music therapy can be reached very quickly.

Consequences

All anthroposophic studies are difficult and complicated, but it is worthwhile to dedicate one's life to these complexities and receive their open secrets from them. Is it not wonderful to think that we clever anthroposophists, with all our skills and knowledge, have to experience ourselves as raw beginners over and over again and that there is no end to our learning? Dialogue with your music therapist is indicated, and music therapists should never tire of offering opportunities for further learning.

Prospect

Anthroposophically-oriented music therapy should always involve the ambition to find disease-specific treatment concepts that can be developed by working with the physician in following the phenomenological evolution of the medical problem.

We owe this to Rudolf Steiner and Ita Wegman, both of whom must surely have hoped that Anthroposophy would not become history but develop further, that there would be people who learn from the Steiner texts, gaining the ability to develop further approaches that have their roots in Anthroposophy. Anthroposophic music therapists can and must learn to develop qualities in their work that enable them to help physicians gain insight into musical aspects of healing. During the night we all live in the source and origins of music, an art which ultimately allows every human being to discover its healing secrets.

Rita Jacobs, Music therapist Army von Lange School Alfredstr. 37 D-20535 Hamburg Germany

References

1 Steiner R. Art As Seen in the Light of Mystery Wisdom (GA 275), 28 Dec 1914,4 Jan 1915. Tr. P. Wehrle, J. Collis. London: Rudolf Steiner Press 1984.

2 Ibid. 29 Dec 1914.

3 Steiner R. Art in the Light of Mystery Wisdom, 7 & 8 Mar 1923 (in GA 283). Tr. J. Collis. London: Rudolf Steiner Press 1970.