THE SPECIALIZED USE OF MUSIC AS A MODE OF COMMUNICATION IN THE TREATMENT OF DISTURBED CHILDREN

THE SPECIALIZED USE OF MUSIC AS A

MODE OF COMMUNICATION IN THE

TREATMENT OF DISTURBED CHILDREN

Evelyn Phillips Heimlich

It has been observed on the Children's Service at the New YorkState Psychiatric Institute that some children do not respond adequately to traditional methods of psychotherapy. Therefore, whenthe writer suggested a nonverbal mode of approach, i.e., the flexibleuse of music in its broadest sense, as a possible means of facilitatingcommunication, Dr. H. Donald Dunton, Director of Children's.Service, agreed to an exploration of its use in the treatment of disturbed children. Over a period of five and a half years, work in theuse of this new method was done with eighty-five children. Childrenranged in age from five years through twelve years. Both boys andgirls were seen.

Three main problems which resulted in the inability of these children to utilize traditional channels of treatment were: (1) mutism,pressure of speech, incoherent speech; (2) overaggressiveness andhyperactivity; or (3) if they were verbal, avoidance of discussion oftheir problems. For these children the open channel of music andits components with their inherent affective properties automaticallycommunicated something different to which the children could anddid both react and openly express themselves. Thereupon mutualnonverbal communication took place between the children and me.

The prime value of music in its broadest sense is in its structure.It is a medium comprising many expressive components that can be

Mrs. Heimlich is Research Assistant, Children's Seroice, New York State PsychiatricInstitute, New York, N. Y.

My profound thanks go to Dr. Harlow Donald Dunton for his superoision, his searching questions, and his helpful reading suggestions.

86

Music as a Mode of Communication 87

used separately or together. Reference is being made to such expressive components as timbre (in instruments and voice), tempo,rhythm, accent, pulse, dynamics, intensity, etc. With this variedflexible structure it becomes feasible to direct the music to the specificcommunication needs of the child. Simple or complex music can beimprovised by both therapist and child to which both can react. Composed music too can readily be adapted and manipulated spontaneously according to the indicated needs of the child from moment tomoment.

For example, in dealing with a timid child, the expressive components that I as the therapist may select can be the delicate timbreavailable on the tambourine, small cymbals, or bells. I sometimescombine this with a simple rhythm in a moderate tempo with slightchanges in dynamics but a strong accent; or if I am improvising asong on my guitar I can use the delicate timbre of my own voice,slight pitch changes, and word improvisations directed to the child'sexperiences including my kindly feelings about him. My accompaniment can consist of further components of music such as a flowingpulse and a contrasting rhythmic pattern. If I am dealing for thefirst time with an aggressive child, I can answer his likely vigorousimprovisations with other components of music, such as combinedtimbres on the piano, or if I use simple instruments, the timbres oftwo instruments such as drum and cymbal. I can stimulate him on thepiano by means of wide and varied pitch imitations, using thechild's own rhythmic pattern that he himself has improvised; or Imay improvise a song about the child and may add the componentof intensity to my voice in addition.

Traditional folk songs are also used in the broadest sense, andimprovisationally; that is, they are not chosen to be used as folk artexpression. Rather, each song is chosen, manipulated, and adapted,with the expressive needs of the child in mind.

In order to stimulate response, I as the therapist may use variousmusic components to emphasize the emotion or problem I want tohelp the child express. An example would be my use of the folksong, "Nobody Knows the Trouble I've Seen," The lyrics are: 1

1 Key to musical abbreviations which are used throughout this paper: D-very loud~

f-Ioud; mf-moderately loud; p·soft; pp-very soft.

88 Evelyn Phillips Heimlich

f p mf fslow Nobody knows the trouble I've seen,

D pNobody knows but Jesus.D mf

faster Nobody knows the trouble I've seen,moderate Glory Halleluia.

Dfaster Sometimes I'm up,

Dslower Sometimes I'm down,moderate Oh yes Lord,

mfslow Sometimes I'm almost to the ground,

pmoderate Oh yes Lord

When this song is directed to a lonely inarticulate child, I notonly use intense timbre in my voice, but exaggerate the accenton the "no" of "nobody" or the word "trouble." I also use contrastingdynamics in order to focus the child's attention on the prime expression of the song-that is, I start with the phrase "Nobody knows thetrouble I've seen," with a loud voice on "No" and swiftly descend toa murmur on "body knows the . . .," but when I get to the word"trouble" I increase the dynamic element or component, then amsoft again on the words, "I've seen." The same with the phrase,"Sometimes I'm up, sometimes I'm down." In addition to the use ofthe components mentioned for the "nobody" phrase, I change tempoand get faster in this phrase, once again to focus on the glad or sadrecurrent feelings of the troubled person.

The child has at his command the same music components for expressive use, but he may choose or need to use fewer of them forexpressiveness or he may use them differently. That is, he may usethe general idea of the therapist as an example of expressiveness. Yethe may feel there are other ways to express the same feelings. If heis an angry child, the timbre he may use for the word "up" may bethe rhythmic clash of two large cymbals struck together, hands highover his head, followed by a soft rhythmic accent on a drum. Or hemay give a rhythmic shake of the tambourine, keeping a tinkling


timbre and pulse all through the chorus. In other words, not onlyis the total combined organization of the music used in communication of the feelings which the song expresses, but selected componentsof the music intensify its individual expressiveness.

The same principle of the broadest use of music and its components is true when children chalk or paint to recorded symphonicmusic. Usually the child indicates his personal response not only tothe total composition but very clearly indicates the special stimulusof the various components of which the symphony is composed.

For instance, when the child is making a chalk or finger paintdesign response on paper to, for example, the March from "Peterand the Wolf," one child may press hard on the chalk at the markedaccents. Another child may find stimulation in the varied timbresheard. As the instruments change, he may be seen quickly to changecolors. Another may be more intrigued by the skipping rhythmicpattern and closely reflect this pattern in long and short strokes onthe paper. Children often combine and emphasize several of thecomponents and frequently verbalize the fantasy the componentsstimulate. For example, a child may move to a rapid tempo and sayof his rapid stroke response, "This is where the boy is running away."

This flexible use of music permits, as needed, moment to moment improvisations, manipulation, adaptation, and spontaneity inthe use of music for individual expression and communication. Thechild's responses are used as cues by which I observe and understandhis behavior. From these cues, I immediately direct to him the appropriate music in order further to develop and continue the communication.

When feasible, three children of approximately the same socialdevelopmental level are seen together at each session. When necessary, for example, with an autistic child, I see the child alone. Alsosome children benefit from one group session and one individualsession a week. Children are seen for one half to three quarters ofan hour twice a week in a room especially equipped for rhythmictonal expression.

The room contains a large variety of percussive instruments varying in size, texture, and timbre. There are such instruments as cymbals, Chinese temple bells and blocks, tambourines, maracas, andmany kinds of drums. There are also a guitar, an autoharp, and


piano, as well as a phonograph. Easels, chalk, and finger paints are4vailable for rhythmic tonal chalking or painting.

FOUR EXAMPLES OF WORK OF DIFFERENT

CHILDREN CHALKING TO THE SAME

MUSIC: "GAIETE PARISIENNE"

FIG. 1Girl. 8 years; childhood schizophrenia;blue chalk.

Flc.3Boy. 8 years; childhood schizophrenia;purple and orange chalk.

FIG. 2Boy. 8 years; primary behavior disorder;orange chalk.

Flc.4Boy, 7 years; atypical (possible schizophrenia); yellow. blue. green chalk.

The children enter the room and are free spontaneously to choosewhatever percussion instrument appeals to them. If they are timid,they choose small instruments. If they are aggressive, they selectlarge instruments. Their choice reflects their needs. They usuallybegin to explore the instruments immediately by spontaneously tap-


ping out a simple rhythmic pattern, such as: - - -j - - -j or- - - -j - - - -j. Sometimes only two or three beats of notmore than a few seconds duration are improvised. As soon as thechild makes his little improvisation, I recognize it by imitating it onthe instrument I believe to be appropriate at the moment.

Some children need the full support of the piano. In this case, Inot only imitate the child's improvisation, but considerably amplifyit by playing it up and down the gamut of the piano, in many keys, inmany harmonies showing it in new timbres, new pitches, and newdynamics. Some children require a simpler response to their improvisations. In such a case, I will imitate the child on the tambourineor a small drum.

There are children who like and need to be faced, when theirpatterns are imitated; some are more at ease if they feel they arenot being observed. For those children who need to be faced, Ieither turn toward them as I imitate them on the piano, or sit vis-avis as I use a percussion instrument, my guitar or the autoharp. Forthe children who do not like being observed, I usually use the piano,where I can appropriately turn my back as I imitate the improvisation. If I feel the simplicity of a percussion instrument is needed inresponse to the shy child, I keep my eyes on the instrument, and noton the child, as I use it.

When working with a group, as I imitate a child's pattern, I encourage his peers to imitate his pattern too, and to join me and himin a joint performance. I repeat the pattern over and over in strong,rhythmic, accented response. Especially if I am using the piano, Imay repeat it as much as sixteen times, each time varying the patternwith different chords, timbres, accents, etc. The length of time spentin repetition is gauged by the interest and pleasure in the activityshown by the children.

Each child gets a turn at improvisation, and each child has anopportunity to change instruments as he goes along. After ten orfifteen minutes of this activity (guided again by the children's interest and pleasure), I introduce another and more complex form ofmusic communication, i.e., the folk song, a form in which music isclosely wedded to words.

Before describing the procedure in the use of folk song, mentionshould be made of the procedure used with the occasional small


child who does not immediately go to the percussion instruments, butinstead goes to the guitar or autoharp. When this behavior is manifested (it usually occurs with a small child who needs to be seenalone), I begin by encouraging the child to strum the chosen stringedinstrument while I hold the instrument and change the chords. Withsuch a child, I usually simultaneously improvise a chant or song,about the child's personal experiences or about his belongings, suchas

What should we do when we all go out,All go out, all go out,We will ride a bicycle, etc.[or, we will roller skate, or fly aplane, or go see grandma, play house, etc.]

This evolves into an intimate situation as the child and I move ina rocking rhythm while we both use the same stringed instrument.

Now to continue with the group and the folk song procedure.Here again the choice of folk songs is guided by the special needs ofthe children in the group. For example, should one of the childrenneed to deal with feelings of rejection, I may introduce a song like"Sometimes I Feel Like a Motherless Child." The lyrics of the songare:

ppmoderate Sometimes I feel like a motherless child,

Sometimes I feel like a motherless child,pp

Sometimes I feel like a motherless child,p pp

A long ways from home, a long ways from home.pp p

Sometimes I feel like I'm almost gone,Sometimes I feel like I'm almost gone,

pSometimes I feel like I'm almost gone,

p ppA long ways from home, a long ways from home.

I present the song and exploit its expressive components to thehilt. Should I want to focus the child's attention on a special phraselike "motherless child," I will sing softly just before the phrase"motherless child" and then accent the focal phrase, or perhaps sing


it louder than the previous phrase to give it importance; or I mightslow down on the important phrase. Often nomore stimulus isneededthan this overlay of musical expression to help the child make aninitial comment on his problem. Sometimes, however, the stimulus for verbalization comes from a group member who can at thatmoment be articulate and respond verbally to the stimulus just because it is not quite as painful to him. Then comment arises fromthe child to whom the phrase was really directed. If no commentcomes from the group and I feel there is sufficient rapport, I sometimes directly ask what the whole song or a special phrase means.

If my observations on the group's response are that they are notready for verbalization, I may introduce the song two or three timesjust so the children and I jointly experience the emotional qualityof the song. As they become familiar with it, and as they imitate myemotional rendition, they either begin to question me on the song,or by their repeated requests for doing it, indicate that they areinvolved in it and may be ready to have me raise questions aboutthe content. Sometimes only ventilation ensues, sometimes historical material comes up, sometimes there is insight gained. Withsome children it is necessary to present many folk songs with thesame theme, in order to get them to articulate their feelings. Forexample, in dealing with the child for whom "motherless child" waspresented, it might be necessary to take a more oblique approach.In this case the song already presented may be followed by severalsongs of mother and child, in the form of lullabies like "Sleep MyLittle One."2 The lyrics of this song are:

pppmfppmfpp

ppmfpp

ppSleep my little one, close your drowsy eyes,Ay, Iu Iu Iu.Sleep in health, my child, under peaceful skies,Ay, lu lu lu.Mother's always near, so you need not fear,Ay, lu lu lu.

mfSleep and have sweet dreams, while you're young, life seemsFull of life and love,Ay, lu lu lu.

• Published with permission of Plymouth Music Co.


It may also happen that the child does little verbalizing, andmerely indicates the meaningfulness of the specifically chosen songby requesting that it be done over and over again. Changes in thechild's attitude are sometimes indicated by the increased sensitivityand emotional quality of his vocal expression and accompaniment.Changes in development can be observed in a still different way whena mute child begins moving his lips on song words especially meaningful to him; or sometimes he just makes throat grunts or other soundswhen some part of the song especially moves him. An importantpart of the work with a mute child is that great care be taken thatthe atmosphere of free and spontaneous expression be maintained.Also, that he feels no pressure is being brought on him to speak.

With some children the use of the improvised music story for theexpression of feelings is useful. When the child chooses to do musicstorytelling he is seen alone so that he can be free to express anything that comes to mind. In such a session, the child has beforehim a battery of percussion instruments which he can use to underscore, precede, or follow his words when he dictates to me. I beginby stimulating him with what I feel is an appropriate short improvisation on the piano. When the child is ready he usually starts with"Once there was a boy," or whatever other character his fantasydictates. After the child has made a statement of a happening a fewsentences in length, I repeat what he has said and translate it intoimprovised song and accompaniment. I always intensify whathas been given by a highly expressive rendition. I employ whatever components of music I think will augment and underscore thechild's experience. Then tum to him for approval of what I translated and encourage him to go on. Together we repeat musicallyeach statement of the child in a kind of on-the-spot, spontaneouslyimprovised opera duet. If the child gets stuck in the middle of amusic story, I stimulate him with piano improvisations until he isready to continue. Sometimes I question him on parts of the storiesif I think the moment propitious, at other times I just accept theoffering. Children create many mythlike stories that reveal deepfeelings that they had not heretofore expressed. These music storiestake an entire session, after which the children seem relaxed andcontented.

A further procedure is chalking or painting to the rhythmic music

Music as a Mode of Communication 95-

of the symphony. The procedure with the chalking to music is as·follows. The child is given a large box of 1" thick multicoloredchalk; he stands before an easel on which there is 16" x 24" blackdrawing paper. He is told to listen to the symphony and move hishands in the air or, if he chooses, to dance with what he hears. He istold to close his eyes and see what colors come to mind as he moves.Then after about a minute or less of this stimulation, he is told to·open his eyes, choose whatever colors he wants, and at the word "go"to begin moving with chalk on the paper. He is encouraged to makeany free spontaneous rhythmic strokes he desires. The idea of totalfreedom of expression in response to anyone or all of the components of the music is encouraged. All products are unique andtheir uniqueness is accepted with interest and gratification by me.There is no such thing as a "mistake"; there is only concrete responsewhich is enough in itself.

Some children at first respond only to the pulse, some to the accent,.some to high or low pitch, some to tempo only, some to timbre,some to rhythm, some to intensity, and some to a combination of anytwo or more of the music components. When really free and spontaneous, they respond to all the components of the music. Some children comment on feelings or fantasies during or after the experience. Most comment with satisfaction on their products. Competitivechildren sometimes want reassurance that their product is as good asothers'. Sometimes I need to reiterate that all products are of equalinterest, that judgment of good and bad does not enter into the experience, only process; the end product is not received as good orbad, but is of interest only because it is a unique expression.

Progress in expression in this area is sometimes commented onby the children themselves, sometimes by me, sometimes no comment on progress is made. The gauge for progress takes many paths,including greater variety in choice of color, response to more components of the music, sometimes as with the timid child, greaterpressure on the chalk and wider strokes, more paper covered. Withthe hyperactive aggressive child less angularity, closer response to therhythmic pattern, more rounded strokes, less violence in chalk pressure, etc., are noted as signs of development.

Finger painting to music is used most frequently with thetense, rigid, overly neat child, although all children can choose to·


chalk or finger paint. When this medium is used, the same procedure takes place as described with chalking to music, with one exception. With the painting, children have before them many bowls ofcolored paint which they are encouraged to apply to the paper atrandom in globs before actually beginning their rhythmic patterningto the music. Then at the word "go" they begin to pattern to themusic. At first, some children use only the tips of the fingers of onehand and cover only a small part of the paper.

It is difficult for such children to get finger paint all over theirhands. They usually fear spattering their clothes and the floor (seeFig. 5). These children are encouraged and stimulated. Sometimes,to help them, I chant the melody of the symphony in a loud voiceand strong accent and urge them to make running or skipping movements with the paint on the paper as they follow a running or skipping rhythmic pattern in the music. Sometimes, I anticipate a sudden crash in the music and tell them to sweep down with the paintfrom one end of the sheet to the other. Sometimes I paint right nextto them in a free and spontaneous manner.

If the child is shy I may not stimulate him further for manysessions. When the child is ready I give him the needed additionalstimulation just described. I encourage him to use both hands, thepalm, the knuckles, or the back of his hands. Once the child beginsto be free enough to cover the whole paper and to use all parts ofhis hands, he usually expresses intense pleasure and excitement.Sometimes he verbalizes his pleasure, sometimes he dances before theeasel as he paints to the music, sometimes he shows his pleasure byasking to repeat the experience right away (see Fig. 7).

After each session I keep a running record of the child's behaviorduring the session including any significant changes. I note such thingsas his response to all components of the music, his motions when reosponding to the music, his demeanor, his voice quality, his behaviorwith relation to all materials as well as to me and the children. If thechild makes verbal comments, they are noted. In addition, after thefirst session and every three months thereafter, I use a behavioralchecklist (see Appendix). The ward staff uses a similar one for com·parison of ward behavior.


ILLUSTRATIVE CAsEs

1. L. was an eleven-year-old, tall, slim, blonde, serious boy whenhe came to the hospital. He was totally mute and had multiple tics.His parents complained that he would not attend school and wasextremely ccntrolling and oppositional at home. He was the older oftwo siblings, the other being a sister ten years younger than he. He hada temporary manifestation of tics on entering school at age six, buthe outgrew these. The current mutism was gradual, coming on afterhe was ousted from his mother's room at the birth of his sister. Bythe time he entered the hospital, he had been totally mute for eightmonths. All communication even at the hospital interview tookplace by means of writing which he erased word by word as he wrote.

When L. began his music therapy sessions, he was placed with twopeers, one a hyperactive boy who, though verbal, would not dealwith his problems; the other, a withdrawn, nonverbal, rigidchild.

Part of the procedure was to permit the boys free choice of awide variety of percussion instruments--the only requirement being that they take turns if two boys wanted the same instrumentsimultaneously. In all respects every effort was made to give L. asmuch of a feeling of free choice and pleasure as possible. For example, he could choose not only his instrument but also the way inwhich he wished to express himself with it. In improvising rhythmictonal patterns, he could use larger or smaller motions, choose histempo, or use anyone of a combination of any or all of the components of music.

For months, on entering, he seized the largest drum in the room,placed it on a chair, turned his back to all of us and immediatelycommenced improvising in any manner that suited him. I respondedby imitating him on the piano at which time he did a curious thing.He always turned his head to look at me. As he did this, he continuedsimultaneously to play his own improvisation with all of us. Thenwhen I played each of his peers' improvisations, he would behave in the same way. When it came to the use of the folk song, L.was not so cooperative, although the procedure was one where he wasagain permitted great freedom. Instead of gearing the choice of


folk songs to his problem, as I would with a speaking child, I permitted him to choose songs from several folk song books byallowing him to point to those he wanted. The titles of the songs hechose were unique, for example: his first choice was "Do, DoPity My Case." It was followed by many more, all of which in somespecial way expressed his feelings. Two more typical exampleswere "Sleep, My Little One," and the calypso song, "Mama, Gimme.Gimme."

I sang and played all his choices with an appropriate expressionof emotion. While his rhythmic tonal patterns had no dynamicexpression when he was improvising solo and at first had even beenmonotonous, his rhythmic tonal percussion accompaniment to thesongs of his choice was always very varied and responsive to thestimulation of my varied expressive tone quality and body motions.However, it was months before he would join in their accompaniment if the other boys chose the song. For their songs he stood withhis hands at his sides and still showed his tic, although his feet keptperfect spontaneous rhythm.

In addition to giving him freedom of choice, I placed great emphasis on stimulating him to express himself freely as far as motorexpression was concerned. To help him. I used unusually strongaccents when imitating his pattern, and also made rapid tempochanges when presenting songs, or had him bounce the ball to myrhythmic piano playing.

I also made special efforts to stimulate him toward freer rhythmicmovements when he painted or chalked to music. I stood behindand chanted and accented the melody of the symphonies. With mysinging I intensified the dynamics and in addition always showedadmiration for his product.

It was in this area that he showed his first and freest bodily response as well as his first aggression. His strokes on the paper wereviolent, though rhythmic and heavily laid on to the point that thechalk often flaked as he made his pattern. His tics were less evidentas he chalked or painted to music.

I was careful never to ask him to speak, but just to have freedomin expressing himself when and as he chose. Finally, at the twelfthsession, he made an initial attempt at uttering a sound. He chose agame song that had a place where each child could utter a funny

Music as a Mode of Communication

CASE l-L

99

FIG. 5"Witches Dance." Light, uneven stroke.;blue and a little red finger paint.

FIG. 7"In the Hall of the Mountain King,"Broader, rounder strokes; green, yellow,red finger paint.

FIG. 6"Anvil Choru.... Slightly broader strokes:blue and a little green finger paint.

FIG. 8"Dance of the Buffoons." Broad, flowing.troke., better organized. whole paper freely covered; red, yellow predominating, anda little blue finger paint.

sound. The song was called "Come on Join into the Game."8 Thelyrics were:

mffast Let everyone clap hands like me,

Let everyone clap hands like me.tCome on and join into the game.You'll find that it's always the same.Let everyone ... [sneeze, yell, jump, laugh, etc.].

• Published with permission of Harper llc Row.


The lines then followed "Whatever I do, do the same"-sneeze,laugh, yell, etc. As usual, the boys and I jointly sang and accompanied. Only in this song, because of its structure, each one had tohave a solo turn. I made a violent explosive "Choo" for the sneeze,when my turn came. At the next rhythmic pause in the song, Iturned to each of the boys and encouraged them to make every expressive sound when it was their turn. I turned last to L. andwithout a word from me he came right in rhythmically on the beatwith a loud "Hahal" The two other boys turned to me and shouted,"He made a sound, he made a soundl" L. looked shy but pleasedand pointed to the song which was done again. This time, as at following sessions, I suggested roaring, yelling, and other explosivesounds, which everyone including L. emitted.

He showed progress in other ways too. He no longer stood withhis back to me, stopped hiding his face, and even tapped me by wayof greeting when he saw me on the ward.

At these signs of greater ease in communication, I took the chanceof introducing a folk song of my choice that had directly to do withone of L. 's problems-his unhappy relationship with his young sister.The song was called "Hush Little Baby, Don't Say a Word,"· thelyrics follow:

moderate pHush, little baby, don't say a word,Mama's gonna buy you a mocking bird.If that mocking bird won't sing,Mama's gonna buy you a diamond ring.If that diamond ring turns to brass,Mama's gonna buy you a looking glass.If that looking glass gets broke,Mama's gonna buy you a billy goat.If that billy goat don't pull,Mama's gonna buy you a cart and bull.If that cart and bull turn over,Mama's gonna buy you a dog named Rover.ppIf that dog and cart fall down,You'll still be the prettiest baby in town.

I sang the song tenderly, accenting and focusing on the words"Mama" and "Baby." L. permitted me to place the autoharp partly

• Published with permission of Ludlow Music.


on his lap and partly on mine, as we sat face to face. I pressed thebuttons and rhythmically strummed an accompaniment. For the firsttime (in his seventeenth session) there issued from his throat real,though sporadic singing which came on the phrases that had thewords "Mama's" in them. He wanted to do the song over and over.At the twentieth session, the two other boys each commented on howglad they were that they were only children and had no babies inthe family. This gave me an opportunity to confront L. with hisfeelings about his sister. He did not answer, but tears appeared inhis eyes; and he tried to hide in the closet when I said to him hehated his sister when she was born.

I immediately shifted the activity to painting to music where hecould be expressive and yet turn his back on me appropriately.Also, it relieved him from any anxiety he might have felt from theconfrontation.

During the next sessions he was permitted even greater freedomof choice than heretofore. He responded by being increasingly expressive in rhythmic areas; he continued from time to time to emitadditional single words in some songs.

At the twenty-fifth session he was seen alone. After ten minutes ofpleasureful instrumental improvisation, he pointed to a song hewanted. He had been so much more trusting and so much morespontaneous, that I decided to take a chance and ask him to speakup for what he wanted.

In a high squeaky voice he said, "I want Noah's Ark." I did notcomment, but immediately structured the performance of the songso he would have strong support from me and be rhythmicallystimulated to come in on the response phrase. The lyrics were:

pfast Old Noah once he built the Ark,

mf[Response] There's one more river to cross.pAnd patched it up with hickory bark,

mf[Response] There's one more river to cross.

ChorusfOne more river,


pAnd that's the river of Jordan,/One more river,pThere's one more river to cross.m/The animals went in one by one,/There's one more river to cross.The elephant chewing a caraway bun,There's one more river to cross.The animals went in two by two,There's one more river to cross.

[There are fourteen verses to this song.]

I started in with strong accent on the first phrase "Old Noah builthimself an ark." Then I stopped and gave him a chance to reply ashe chose either instrumentally or vocally on the next phrase, "There'sone wide river to cross." I nodded and leaned toward him, encouraging his reply. With drum accompaniment and in a high squeakyvoice he regularly and rhythmically came in at the appropriate beatthroughout all the verses. I became more and more expressive.Finally, the boy and I were singing together on the chorus.

He imitated my expressiveness and sang louder and louder. Hecame close to the piano and stood next to me, moving his bodyrhythmically as he sang. There was no sign of tics.

He showed much pleasure and was very relaxed after this experience, so I thought it timely to reintroduce the lullaby "Hush LittleBaby." He could now talk about his baby sister. After a joint, tendersinging of the song, I asked him directly how he felt about her aftershe was born. With some hesitance he was able to speak of his sadness at being removed from his lifelong berth in his mother's room.Once he began to talk, he voluntarily gave much historical materialabout his parents.

The following session was held jointly with his peers who weresurprised and pleased at his talking. Most sessions were joint ones,but from time to time he was seen alone. Some of the solo sessionswere held in order to give him an opportunity to dictate song stories.He used these as an additional way to communicate many hidden


feelings. In occasional ensuing discussion, he sometimes gained in·sight into a problem.

In reviewing L.'s material, the steps in his improvement becameclear. L. responded quickly to the wide choices available to him inthe use of specialized music and its components. He was immediatelyable to have pleasure in choosing an instrument, in choosing his owntempo, rhythm, etc., and he could express himself within the limitsof the instrument of his choice. It took some time for him to bereally varied and free in his choices, to be able to develop frommonotonous to dynamic expression. Real spontaneity, motor andvocal, was still longer in developing.

Although it was slow, progress first showed itself in motor expression. That is, he first participated and discharged feelings throughrhythmic motion. His multiple tics began to subside somewhat, longbefore he spoke.

It is now March, his mutism is gone. Tics are rarely seen andwhen he is involved in music activities he never tics. The plans arefor him to be discharged home in June. He will have been at thehospital two years. Until he is discharged work will continue to bedone with him to help him consolidate his gains and possiblyachieve further insight into some of his remaining problems.

2. K. was a six-year-old boy who was seen alone. He was the eldestof a family of four, and had great intellectual endowments. Hisparents seemed to have emphasized the intellectual at the expense ofthe social skills. He was referred to the hospital as possibly an autisticchild. He was a withdrawn child, a twirler, slow in social development.He cried easily, banged his head, bit himself, and crossed his eyeswhen frustrated. He was preoccupied with insects, unable to playwith children, sleepless, rigid, fearful, and mostly silent. He hadstopped speaking altogether from eighteen months to three years.Thereafter, his speech was fragmentary and often unrelated to reality. During the interview he refused toys and did not want to talk.

On entering the therapy room he was tense, ignored the percussion instruments, went right to the guitar and started plucking it. Ipicked it up and improvised a song about him-what he wore, how Iliked him. He showed swift attention and response to the timbre ofboth the instrument and the voice. This was evident as he looked atme as I sang and played and I placed his hand on various parts of


the guitar. On encouragement from me, he stroked the guitarrhythmically and with pleasure while I continued softly to improvisemore songs about him, his clothes, his siblings, and again how muchI liked him.

Whenever I changed the quality of my voice, he would look up.He nestled close as I improvised and changed chords and held theinstrument toward him so he could strum it. In order to free him Ithen introduced many songs with rhythmic motion-like clapping,stamping, and swinging songs. At first he had great difficulty doingthese. He would sing the songs but make only feeble though rhythmicmotions while I stimulated him by making big free motions. Onlyafter many repetitions and variations of these rhythmic motionsongs (about the twelfth session) did he develop freedom of motionsufficient to express what the songs indicated.

He had similar difficulty in using the drums. At first he would usethem only while he sat on the same piano bench with me. However, he did show immediate pleasure and gave me his first smilewhen I imitated his meager improvisations. Each session I kept playing his improvisations with full chords and loud tones: he respondedby making stronger and louder beats, gaining more and more freedom and spontaneity.

At the eighth session, I added Christmas songs to my regularlyimprovised songs. K. was sitting on the piano bench with me singingand clapping his hands; suddenly, without a word, he moved fromthe piano bench to my lap, and as I played, placed his fingers overmine while we were doing "Deck the Halls," The lyrics follow:

last mlDeck the halls with boughs of holly,pFa la la la la, la la la la,

I'Tis the season to be jolly,pFa la la la la, la la la la,

IDon we now our gay apparel,pFa la la, la la la, la la la,


fTroll the ancient yuletide carol,pFa la la la la, la la la la,

Every time I accented a measure, like "Deck the Hall," he wouldpress his back against my breasts and sway with my rhythmicmovements. He seemed to get much pleasure from this; intermittentlyhe would do this during subsequent sessions.

In order further to stimulate freedom and give him the experienceof rhythmic movement in still another area, I set him to fingerpainting and chalking to strongly accented and highly coloredcompositions like "Aida's March." He became very highly stimulatedand responsive. Once in the course of following the increasinglyrapid tempo as he painted, a blob of finger paint fell on the floor. Heyelled, "Oh, Mrs. Heimlich, Mommy will be very angry" and lookedfearful (see Fig. 10). Then he started to point to imaginary firefliesand said, "There's a firefly on your hand and it's biting you." Ireassured him about the blob and said I didn't mind the paint onthe floor as long as he had fun making the design. I also reassured himabout the fireflies, that they were just pretend. He was glad of thisand then continued happily painting to the rhythm of the music.Sometimes I painted alongside of him and occasionally paint wouldspill and he would giggle, "Mrs. Heimlich is bad, she spills paint."It took many sessions for him to be at ease and spontaneous with thepaint, but he finally got to enjoy it so that he danced before theeasel as he painted and moved with the music.

CASE 2-K

FIG. 9"Minuet." Rigid, straight strokes; red andblue finger paint.

IG. 10"Can-Can." Uneven combined straight andround strokes; all red finger paint.

106

FIG.ll"Irim Waaherwoman." Two banda wedto produce entirely round Itrokea inbright red. yellow. green.

Evelyn Phillips Heimlich

FIG. 12"1812 Overture:' Varied round atrokeamade with fingen. nail.. and palma; brightyellow. red. green. and a little blue.

Later on, much of his communication was through the little rhymeshe made up and chanted to his own instrumental improvisations.For example, he composed and sang, "There was a boy and he wasmad and he tinkled [urinated] on the Empire State Building,"

During his early sessions, his responses were most frequently to thetimbre of the instruments, my singing voice and my strongly accented rhythmic improvised songs. Gradually he was able to imitatemy rhythmic dramatizations of motion songs. He was also moreflexible in his responses to painting and chalking to music.

He looked on my free expression and encouragement to him withopen astonishment and joy, frequently commenting on it. He beganto use the materials with increasing freedom and gradually becamefreer in his behavior toward me. By the time he was dischargedafter thirty sessions, he was on completely friendly and affectionateterms with me.

His parents reported that he no longer was preoccupied with insects, that there was less fearfulness and rigidity, and no more sleepless nights. He was better able to play with other children.

From his development and from the pleasure he showed in bothhis own and my spontaneous use of the medium it would seem asthough the opportunity for communication provided through thismedium had much significance for him.

3. J. was an eight-year-old boy referred for placement by theJewish Board of Guardians because of his uncontrolled, aggressive


behavior. At home he fought; once he set fire to his younger brother.In school he was defiant, restless, quarrelsome, and used obscenelanguage. In summer camp he threw rocks at peers and counselors,and was asked to leave.

The family consisted of the mother and two boys. j. was two yearsolder than his brother. j.'s parents were divorced when he wasfour and a half years old. He was awarded to the father, who soonreturned him to the mother because of his disgust with j:s difficultbehavior. The father was never heard from thereafter.

At birth j. had a clubfoot, which was operated on twice, once atsix months and again at six years. His parents were ashamed of themalformation.

At the time of admission j.'s mother earned some money as acaterer. In addition, money came to her from men who paid her forhaving sexual relations with them.

j. was at the hospital nine months before work began with him inmusic as a form of communication. During these nine monthsprior, he was in individual psychotherapy and play therapy, butshowed little progress. On the ward and in school there was no consistent change in his destructive, distractible behavior. In psychotherapy, he avoided discussing his problems by inattentive listening, irrelevancy in discussion, appearing deaf or jumping up and down.

When music sessions began with j. he was placed with M., a timideight-year-old boy who was repressed and had pressure of speech.Later on, at his request, he was seen alone from time to time.

At his first session, he completely ignored both M. and me. Hepromptly chose the largest drum and improvised a loud rhythmicpattern. He showed immediate pleasure in the activity and was evenmore pleased as well as astonished when I imitated his pattern onthe piano. He was able to continue this activity with M. and me foras long as I chose-that is, for fifteen minutes. On my introductionof folk songs, he displayed interest and responded as well. His interest continued to be more on the rhythmic percussive improvisationallevel, with very little singing at first. His response to the chalking tosymphonic music was rhythmic, but tense, jerky, and angular. Heshowed no signs of destructiveness, restlessness, or obscenity. He wasconspicuously indifferent to both M. and me. His only interest wasin the use of the materials.

For three months he maintained almost complete verbal silence.

108 Evely" Phillips Heimlich

However, during this period there was much evidence of development. He experimented with many of the components of music,especially with timbre and dynamics. He used various parts of hisbody to elicit different kinds of sounds from the instruments as heinvented patterns on them. He thumped with his fists, scratched orstroked as he improvised. He experimented with the wooden, metal,or skin parts of the instruments. He was purposeful in his variedchoices and pleased with my obvious admiration of the results of hisinstrumental explorations. He learned to be expressive in many ways,with many sizes and shapes of instruments. One of his rare comments concerned his contentment when he observed how he keptperfect time with me. He said, "Boy, oh, boy, did you see how I wasable to put my right hand on the drum the exact same minute youplayed the beat on the piano?"

His development showed in another area too. Whereas he hadalways accompanied all songs with a loud monotonous even pulse, hebegan to respond to the variation and spontaneity expressed by mein the different types of songs I presented. For example, when Iexpressed sadness in "Sometimes I Feel Like a Motherless Child," heput down his big drum and gently, softly, and rhythmically strokedthe tambourine in accompaniment. Sometimes he was so stirred bya song that one instrument did not suffice for his expressiveness,and he would appropriately use two or even three instruments. Hisrhythmic patterns became more intricate too.

Change was also evident in the way he responded in chalking tothe symphony. In the beginning his designs were angular, jerky, andtense. They began to change in many ways. They became more flowing, though still firm, with more variation in color and shape. Just ashe showed greater sensitivity to my expressive singing, so did herespond to more expressive components of the symphony (see Fig. 16).

His behavior was never difficult, but in many of the sessions he didtest me in different ways. One was by unexpectedly changing histempo or his pattern as I imitated him. My immediate attentiveimitation of his subtle changes brought him great pleasure whichhe showed by nodding contentedly.

At his sixteenth session, for the first time, he paused to speak inthe midst of chalking to "In the Hall of the Mountain King." Without ever previously having articulated hostility and without pream-


CASE5-J

109

FIG.l!J"The Happy Fanner." Heavy randomstraight strokes; purple chalk.

FIG. 15"Anvil Chorus." Heavy straight strokes,and wide curved strokes; black, blue, andmuch yellow chalk.

FIG. 14"Fantasy." Heavy straight strokes with ad·dition of a few curves; black and a littledark purple chalk.

FIG. 16"In the Hall of the Mountain King." Manyflowing curved strokes and dots; well or·ganized; many bright colors, red, yellow,orange, green and a little purple.

ble he said, "There is no way to insult you-is there, Mrs. Heimlich?" This opening gave me my first brief opportunity to ask himwhat he meant, and to explain my compassionate feelings about helping the disturbed child.

However, it was many sessions later before he was willing or ableto speak directly of his feelings. Until then he showed his feelingsthrough the use of music components in different ways. Sometimeshe would reveal them by sensitive accompaniment. Sometimes hewould stop altogether and request M., the other child, to be silenttoo, so he could just listen. At these times, he would move his lips or


even sing along on an especially meaningful phrase. He would listenwhen the other child questioned me about the meaning of a song,but not until his twenty-sixth session did he himself comment on oneof M.'s questions. M. asked about "Lili Marlene," song of loneliness,that stimulated him to wonder about a lonely deserted girl on theward. The lyrics are: Ii

Pslow Underneath the lantern by the barrack gate,

Darling, I remember the way you used to wait.'Twas there that you whispered tenderlymfThat you lov'd me. You'd always beMy Lili of the lamplight, my own Lili Marlene.pResting in a billet just behind the line,Even tho' we're parted your lips are close to mine,You wait where that lantern softly gleams,fYour sweet face seems to haunt my dreams,pMy Lili of the lamplight, my own Lili Marlene.

I had been aware of ].'s increasing responsiveness both to thematerials and to me. On this account I thought it was the propitiousmoment to confront J. with the fact that he, too, was a lonely anddeserted child. My statement met with momentary silence. Thenwithout further ado, he asked me if I knew why he was in the hospital. He then proceeded to give a flood of material on his problems.At the end of this session, he touched me for the first time and saidI was reasonable.

He continued to be willing to discuss problems. However, hewould do this only after I stimulated him several times with variedpresentations of songs that had to do with problems similar to his.For instance, the song "]ohn Henry," the words of which are asfollows: 6

• Published with the permission of Edward Marks.• Published with the permission of the University of North Carolina Preas.


mffast John Henry said to his captain,

f PP"A man ain't nothing but a man,PPAn' before I'll let your steam drill beat me down,

fI'll die with the hammer in my hand, Lawd, LawdlPPDie with the hammer in my hand."mfJohn Henry got a thirty pound hammer,mfBeside the steam drill he did stand,fHe beat that stream drill three inches down,fAn' died with the hammer in his hand, Lawd, Lawdl

slow

PPDied with the hammer in his hand.pJohn Henry had a little womanPPAn' she was always dressed in blue,pShe went down track never looking back,Says if) "John Henry, I am always true to you,

Lawd, LawdlppJohn Henry, I am always true to youl!

ppLawd, Lawdl

PPJohn Henry, I am always true to youll"PPJohny Henry had a pretty little boy,Sittin in the palm of his hand,

111


ffHe hugged and kissed him an' bid him farewell,

ppOh son, do the best you can, Lawd, Lawd,ffSon, do the best you can,"They took John Henry to the graveyardAn' they buried him in the sand,

DAn' every locomotive come roarin' byppSays, "Dere lays a steel-driving" man, Lawd, Lawdl"ppDere lays a steel-drivin' man.

This song was presented with much dramatic expression, focusedon the love of the father, John, for his son. This evoked historicalmaterial about J.'s father's irresponsible and cruel behavior towardhim, and then about his mother's behavior in regard to her ownwedding ring (she gave it to J. to sell).

Following this period, he continued to use this highly structuredyet expressive means of communication advantageously. He graduallywas able to be spontaneous, sensitive and appropriate in relation tomaterials and people. Ward and school personnel reported a changefor the better. The severity of the behavior disorder was much relieved. He became an increasingly warm, trusting, well-eontrolled,and communicative boy. He gained some insight into his problemsand was eager to grow up.

4. G. was an eleven-year-old Negro boy from North Carolina. Hewas admitted to the New York State Psychiatric Institute fromBabies Hospital on July 31, 1959. In the previous February, he had afever of unknown etiology and subsequently developed loss of memory and progressive leg weakness. One month later he was removedfrom his home to Lincoln Hospital, North Carolina, from which institution he was soon discharged on crutches. Both legs were totallyparalyzed, and he was confined to bed in his mother's care. It wasthen that his thirty-one-year-old stepsister brought him to New York.


City to the Hospital for Joint Diseases, where he remained for sixweeks. Numerous studies, including EMG, were negative. He wasthereupon transferred to Babies Hospital where after a completeand negative neurological and physical study a diagnosis of conversion hysteria was made. On this account he was admitted to thepediatric service at the Psychiatric Institute.

The patient was the eldest child of his mother's second marriage.He had two brothers, one nine and one four years old, as well as astepsister thirty-one years old, and a stepbrother of twenty-nine.The mother was a preacher for a fundamentalist church, and wasaway from home much of the time. The father was a laborer for achemical concern. He was apparently a very stern man, and hadbeaten the boy numerous times. Because of the mother's preachingactivities, many of the household duties were left to G., including thecare of the two younger brothers.

G. was described as a shy, conscientious, religious boy who avoidedloud and rough boys. His classmates in North Carolina called himhomosexual names, such as faggot, but G.'s activities in this areawere unknown. The major area of conflict in G. was his anger at hisparents. He felt burdened and conflicted by the demands his parentsmade on him to care for his younger brothers besides having to assume household responsibilities. He had these tasks from the ageof eight years.

At the New York State Psychiatric Institute, when he was questioned or addressed on the subject of his problems, he was silent. Occasionally there would be an outburst during which he would expressthe wish to kick, crush the bones of or "stomp" on the doctor whotried to get him to discuss his problems. Then he would clam upagain. He was aloof with the ward staff as well as peers.

G. resolved his problem in symptomatic expression. Instead ofdirecting his anger toward his environment, he converted it to hysterical paralysis of his legs. He dared not use his masculine strength toexpress himself, so he reverted to a passive feminine role. His voicewas soft and high. His gestures were effeminate.

After a two-and-a-half-month period during which he sullenlyrefused to communicate with his psychotherapist as well as all otherstaff members, it was decided to give G. an opportunity to use musicand its components as a means for communication and possible


therapy. The opportunity for stimulation to motor expression wasespecially considered in view of G.'s paralysis. During the course ofhis sessions he used all aspects of this expressive mode at one time oranother. However, his rhythmic motor response and the use ofopportunities for expressing himself by improvising music storieswere outstanding.

At his first session, he had a secret, withdrawn facial expression. Heentered the room in his wheel chair. At later sessions, he kept hiswheel chair outside the therapy room and crawled out.

Once in the room he immediately and silently took a drum andtried out an improvisation. He showed pleasure when I imitatedhim. He responded to my free and vigorous improvisation on hispattern by an immediate show of increased vigor and variation in hisuse of his arms and upper body as he continued making new patterns. His early use of folk songs was guarded--his face was blandwhen he sang. The first communication in this area came with hisvariations in expressive percussion accompaniment. Changes in vocalexpression came later.

He was soon moved into a group with two other boys so that hissessions consisted of one solo session and one group session per week.He gained a great deal from the opportunity to exchange improvisations and instruments with the other boys. The boys on the otherhand were much impressed and stimulated by G.'s great inventiveness, sensitivity, and freedom in his use of the medium. The roomwas charged with his percussive inventions and later on with hisvibrant voice.

After several months, it finally seemed feasible for me to questionG. directly about the content of a folk song that was pertinent to oneof his problems. The song chosen was the "Blue Tail Fly." It hadbeen introduced several times before without content or phrasesbeing discussed. The song offered many elements for expressionrapid tempo, strong accent, much repetition as well as phrases thatcould readily be used for raising questions pertaining to some of G.'sas well as the other boys' problems. These are the lyrics:

fast mfWhen I was young I use' to wait,On Massa an' hand him his plate,An' pass de bottle when he got dry


An' brush away de blue tail fly.Chorus

p mfJimmy crack corn an' 1 don't care,pJimmy crack corn an' I don't care,pJimmy crack corn an' I don't care,pp01' Massa's gone away.mfOne day he ride aroun' de farm,De flies so num'rous they did swarm,One chanced to bite him on de thigh,fDe devil take de blue tail fly.

ChorusmfDe pony run, he jump, he pitch,He threw my master in de ditch,

slowHe died an' de jury wondered why,

fast De verdict was de blue tail fly.Chorus

ppThey lay him under a 'simmon tree,His epitaph is there to see-

slow Beneath this stone I'm forced to lie,fast Victim of de blue tail fly.

Chorus

115

Finally, after G. had sung and accompanied the song eloquently Iasked my first question. Other aspects of the song had been discussedbefore by the other boys. This was the first time I turned to G.directly. Since he never mentioned why he was in the hospital andnever directly commented on his parents as did his peers, I selecteda phrase from the song to elicit comment pertinent to these problems. The phrase was from the couplet "Beneath This Stone I'm


Forced to Lie, The Victim of the Blue Tail Fly," the followingdiscussion ensued:

I: G., do you understand what a victim is?It says here in the song "victim of the Blue Tail Fly"

G.: Well somebody that something bad happens to.I: I think it's more than that.G.: Oh, you mean like somebody who would get muscular dys

trophy?I: Possibly, or like the man on the horse who was thrown from

his horse and killed because a fly bit the horse and the horsereared. He was really a victim.

G.: Oh, you mean all kinds of people who get diseases.I: Possibly, can you think of any other kinds of victims?G.: Yes, children who have problems?I: What do you mean?G.: Well, parents.

There was no further comment and G. looked thoughtful. I suggested that he finger paint. When he was finished, he did somethinghe had never done before: he started as usual to crawl out of theroom on his hands and knees to his wheel chair. While crawling, hechanged to hitching on one knee and walking on the other foot.Then he swung onto his wheel chair. This was after two monthsof sessions in the use of specially directed music. Regular walkingdid not take place for another three months.

In the meantime he continued to develop, express himself andcommunicate further through the use of still other aspects of music.His chalking and painting to music became more colorful, freer, andfirmer in stroke (compare Fig. 17 and Fig. 20 and note differencesmore flowing and thicker, firmer strokes). His gestures as he workedwent from delicate gingerly ones to strong masculine movements.Then his voice changed from a soft soprano to a vibrant male quality. At this point of development I suggested that we jointly improvise music stories.

The stories he created were mythlike in character and dealt in adisguised way with his many problems and his attitude toward them.He underscored the stories by vivid instrumental accompaniment,sang them line by line with me, directed me as to means and


CASE 4-G

117

FIG. 17"In the Hall of the Mountain King." Light.delicate strokes, covering small portion ofpaper; blue and yellow chalk.

Flc. 19"Dance of the Buffoons." Delicate strokescombined with heavy strokes. Yellow.green, purple.

Flc. 18"Polonaise," Delicate but larger strokes,covering more paper; purple, green. orange.

FIG. 20"Gaiete Parisienne," Mostly heavy strokes.paper fUlly covered, well organized; mainly bright orange, yellow, green. purple.

ways for expression, and often acted out the parts of the differentcharacters.

The following improvised story is given because it is typical andalso because after this violent expression G. took his first four stepssince he became paralyzed. This is the story as dictated by G.

There was a man and a lady. They were very fine friends. Oneday the lady happened to have a child-the man decided to marryher. Then when they were married, the child grew up to a healthyyoung boy, but then they were very mean to him and they beathim and he had to go to a hospital because he was bleeding from


the beatings. When the child came back to the parents, theysaid that they would be good to him, but they only said that infront of the hospital. When he got home they were mean again.This child had a dream and he heard somebody say to him,"Tomorrow morning you will get up early before anybody so youwill be able to fix some cereal, and you will mix paint, turpentine,and gin in it. This is a magic formula and when they, the parents, wake up, you will sprinkle it over them and great blessingswill come to you:' He got up early and did what the dream toldhim-so then he sprinkled it on the mother and the father andthey turned into ants [he hesitated at the word ants]. They hadspots from the paint on them and were blind from the turpentine,and the oatmeal would always nourish them. Suddenly two goodparents appeared to him. He thought they were foster parentsand they were, and they kept him for good. He did an equalshare of work like any other kid and he felt happy from that dayon, but he was wondering who told him what was in that dream.

Mer G. finished the story he looked contented, as though he hadexecuted a satisfactory piece of work. The storm was temporarilyover. He then asked gently to sing a couple of favorite songs untilthe end of the session. Together he and I sang and played thesongs of his choice. When the session was over, G. swung himself asusual onto the floor, preparatory to crawling to his wheel chair. Onlythis time, when he got to the floor, he squatted. Then still squatting,he took four steps and went out of the room. He turned and lookedat me, but for fear of frightening him in this sudden movetoward health, I made no comment. The next session, G. walkedinto the room. He used the wheel chair on the ward for two moredays and then abandoned it.

All Go's movements in the therapy room and on the ward continued to be increasingly masculine. He occasionally had a fight with aboy when attacked. He joined the Boy Scouts. Whereas on admissionhe declined to permit the psychologist to test him, he now volunteered to be tested. As an aside on the testing, in one test of twentyunfinished sentences, he ended three of them with an expression oflove of singing. For example, in the unfinished sentences "I alwayslove to .. :' G. finished by saying "sing."

Since G. presented a case involving motor disability and since hewas unable to verbalize his anger, it was thought that music and itscomponents might be useful as a means of communication. Its


many components provided a wide choice from which he could makehis early expressive explorations. As he developed, he was able toextend his use of this mode to include more and more components.In the course of his development his symptoms disappeared, healso became more spontaneous in using materials and in his relationship to peers and me.

SUMMARY

The central problem dealt with in this article was communicationwith children who did not respond to traditional methods of psychotherapy. A possible solution was offered in the use of music in itsbroadest sense, i.e., music and its components used with the specificcommunication needs of the child in mind. The improvisational,adaptive, and manipulation functions of music and its componentswere then described and procedures detailed.

Cases illustrating the methods and various aspects of the use ofthis medium were presented. The cases involved one outpatient, sixyears old, and three inpatients ranging in age from eight to twelveyears. While the pathology of the children differed in many respects,they all had one problem in common-that of communication. Abrief description of the children's behavior at intake was followedby the use they and I as the therapist made of the medium in aneffort to have them communicate. All children described were ableto make progress in communication through the use of this method,although from time to time each one selected different aspects of themedium for his unique, current, expressive needs.

ApPENDIX

BEHAVIOR RATING SCALE FOR CHILDREN IN MUSIC THERAPYE. I. BURDOCK, PH.D., ANNE S. HARDESTY, M.S., and

EVELYN P. HEIMLICH, M.A.

Name of child Age .

Identification No .

Name and Title of Observer .

Narne of Institution .

Date .


The following statements provide for a description of the behaviorof a child during a music therapy session.

For each item the rater should record his judgment by:Circling T if the statement is true.Circling NT if the statement is not true.

All items should be answered.Corrections should be made by erasing or crossing out the incor

rect choice.If it is necessary to qualify an item, a word or phrase can be written

in on the dotted line following that item.

1. T2. T3. T4. T5. T6. T7. T8. T9. T

]0. T11. T12. T13. T]4. T15. T16. T17. T18. T19. T20. T21. T22. T23. T24. T25. T26. T

NTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNTNT

J .. d"oms m group lSCusslon .Does not gesture with music .Uses movement or gesture appropriate to music .Does not play drums at all .Uses only one color of chalk .Improvises words to familiar tunes .Comments favorably on other child's production .Associates own problem to words of song .Laughs or smiles when song or music is humorous ..Keeps resisting suggestions of other children .Interferes with the activities of other child .Has appropriate expression when song or music is sadComments on music .Is absorbed in his activities .Grimaces or gestures grotesquely .Dances during session .Bangs hard on instrument .Presses so hard on chalk that it breaks or flakes .Beats drum arhythmically .Shows pleasure in coming to music therapy .Asks for a particular song .Has a faraway look while beating drum .Converses with therapist .Converses with other child .Says he doesn't like to come to music therapy .Sings along with the music .


27. T NT Sits in, but does not participate in music therapy ..28. T NT Keeps asking for approval .29. T NT Is attentive to other child's music .30. T NT Touches, feels, or strokes contours of instruments ..31. T NT Beats drum mechanically " .32. T NT Chalks with disconnected jerky movements .33. T NT Expresses feelings aloud .34. T NT Performs alone without being urged " .35. T NT Moves restlessly about room .36. T NT Improvises rhythmic pattern on instrument .37. T NT Does not chalk at all .38. T NT Deliberately spoils own work .39. T NT Sings in almost inaudible voice .40. T NT Plays with instrument in a slow and uneasy manner41. T NT Chalk strokes are without design .42. T NT Is attentive when other child speaks .43. T NT Talks during or after chalking .44. T NT Keeps seeking attention .45. T NT Joins in group singing or playing .

Biometrics Relearch. N.Y. State Dept. Ment. Hyg.

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THE SPECIALIZED USE OF MUSIC AS A MODE OF COMMUNICATION IN THE TREATMENT OF DISTURBED CHILDREN