Nordisk Tidsskrift for Musikkterapi

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Dialogues on the study of Edward

Jacqueline Z. Robarts & Lutz Neugebauer

To cite this article: Jacqueline Z. Robarts & Lutz Neugebauer (1999) Dialogues on the study of
Edward, Nordisk Tidsskrift for Musikkterapi, 8:2, 192-203, DOI: 10.1080/08098139909477975

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Published online: 13 Jul 2009.

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 DIALOGUES

Dialogues on the study of

Edward
Introduction
We continue our series on the study of "Edward". In Vol. 7( 1) the original case study - as it first was
published in Nordoff and Robbins' (1977) Creative Music Therapy - was printed in our Series of
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classical articles. In Vol. 7(2) Randi Rolvsjord wrote 'Another Story about Edward' and in Vol. 8(1)
we presented Kenneth Aigen's 'Revisiting Edward: An Exemplar of Tacit Knowledge' and Carl
Bergstr0m-NieLsen's 'The Music of Edward, Session One, as Graphic Notation.'
In this issue we are happy to present two new contributions, written by Jacqueline Robarts and
Lutz Neugebauer. Robarts uses Edward as a point of departure for reflections upon clinical and the-
oretical perspectives on poietic processes in music therapy, while Neugebauer shares how this case
study has followed him in different stages of his professional life.
The paper version of this series will be concluded in our next issue (spring 2000), but we will
continue on the web if we receive more contributions. So you are all welcome to send us any com-
ment or reflection on this case. In Volume 9( 1) we will present a contribution from Michele Forinash
(USA), who will share how she uses "Edward" in her teaching of phenomenological analysis of
music therapy improvisations. In the same issue Gary Ansdell (UK) will write a meta-comment,
reflecting upon the contributions submitted so far in this series.

Clinical and theoretical perspectives on

poietic processes in music therapy, with
reference to Nordoff and Robbins' case
study of Edward
Jacqueline Z. Robarts

JACQUELINE Z. ROBARTS
is Research Fellow in Music Therapy at The City University, London. Her study investigates music therapy with
adolescents who suffer from anorexia nervosa. For nearly 20 years she has worked with emotionally disturbed young
people. She helped to establish two music therapy departments within an N.H.S. Child and Adolescent Mental
Health Service and within Community Health Services in London. She is currently a Senior Music Therapist and Cli-
nical Tutor at The Nordoff-Robbins Music Therapy Centre, London. Address: Jacqueline Z. Robarts, Music Depart-
ment, The City University, Northampton Square, London ECIV OHB. E-mail: j.z.robarts@city.ac.uk

1 9 2 Nordic Journal of Music Therapy, 1999, 8(2)

 DIALOGUES

Introduction don. Also, I have worked with many emotional-

Nordoff and Robbins' study of Edward (Nord-
off & Robbins, 1977, 1998) highlights some of
the central principles of music therapy. It exem-
plifies fundamental aspects of music as the pri-
mary medium and mediator of the therapeutic
relationship, and how such a relationship can
have a vital transforming, constructive effect
where a child's capacity for self-expression,
play and social interaction is impaired. The stu-
dy is memorable for its dramatic content, the
transition from Edward's crying and isolation
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ly disturbed children and adolescents, who have
been my main teachers about the potential of
music to construct or re-construct the symboli-
sing capacity of ego function1. In my experience
with children with many different aetiologies of
emotional disturbance, this has been the central
process in music therapy (Robarts, 1993a &
1993b, 1994, 1998, 1999). It is a process which
seeks to build the foundations of self and self-in
relation, the sense of continuity of the self in
time, developing trust, imagination and a heal-
thy autonomy, a capacity to have fun!

imposed by difficulties associated with autistic-
like psychopathology, to a fun-loving playful-
ness in musical relationship that carries essenti-
al developmental processes fostering a growth
of meaning and self-hood. The directness and
immediacy of Nordoff and Robbins' work with
Edward, its aesthetic, dramatic qualities, musi-
cal form and structure are particularly striking.
This study embodies universal and personal
experiences of meeting and resolving chronic
emotional, psychological disturbance in a child,
but in a unique and remarkable way.
In my contribution to this journal's 'Dialo-
gues on Edward' I have chosen to focus on cer-
tain clinical and theoretical aspects of the music
therapy process with him. First, I examine some
implications of Edward's given diagnosis and
the relevance of music as therapy for this child;
and, secondly, I consider the active poietic, cli-
nical properties of music, certain functions of
the tonal-rhythmic field, evoked response and
resistiveness in terms of emergent self-organisa-
tion and symbolisation.
The study of Edward holds for me a perenni-
al learning experience, bringing revelations and
fresh insights on each hearing. It is one of the six
or seven Child Studies of Paul Nordoff and Gi-
ve Robbins that I present to music therapy stu-
dents in Year 1 of the Masters course at the
Nordoff-Robbins Music Therapy Centre, Lon-
The work with Edward shows very clearly
certain features of these processes, which are
essentially poietic, in the sense that they con-
stellate and carry living creative power. This
activates sensibilities that support self-experien-
cing, reflecting, imagining and finding meaning
in relationship with people and the world. The
word 'poiesis' is derived from the Greek verb
'poiein', to make or construct, and indicates the
constructive inner workings of the creative arts.
We know the far-reaching influence of the very
properties of music, for instance, and their
power to synchronise, entrain sympathetic
responses at a neuromuscular, neurochemical
level - perhaps this is really the basis of a 'soul
experience', when our whole organism resona-
tes in deep sympathy with the universe.
Edward and his difficulties in finding
a sustained sense of self in a
sensational world
The description and diagnostic impression
given of Edward indicate that his difficulties lie
well within the autistic spectrum. This is impor-
tant to take into account when considering the
clinical work with this child. It seems worth rei-
terating some of the information given by Nord-
off and Robbins about Edward. He is described
as 'a 5 'A -year-old boy, fair-haired, lithe,

' Clive Robbins (personal communication, 24.10.99) refers to his colleague, Hep Geuter, regarding a definition of the term 'ego function', as
follows: "Geuter said there was a quality of ego, from an anthroposophical view, that is in you and everyone else, that is of a certain sustai-
ned identity. Hep often likened the ego to a child playing on a heap of sand, and what the child makes of the sand is the known self: 7 did that'.
This is really the vehicle for the ego, the emergent ego, and the emergence of this essence is the spirit that creates the self. 1 would use ego in
this sense. Emergent ego function which is autonomous, then creates that which lives, displays, exists in the executive expressive self. " I think
this describes very well what I mean by ego function and emergent sense of self.

Nordic Journal of Music Therapy, 1999, 8(2)

 DIALOGUES
robust...extremely physically active, his move-
ments directly expressing his feelings - jum-
ping vigorously, bouncing and swaying when
excited, pacing restlessly when distressed'
(Nordoff & Robbins, 1977, 1998). Whatever
communicative initiatives and abilities he
shows ('ten meaningful speech-like words, but
solely in imitation; he often spoke jargon')
were difficult to build on, as 'he quickly beca-
me overwhelmed by anxiety. He was easily
upset, outbursts lasting sometimes indefinitely,
and there could be several in a day'. Yet there
was 'a sweetness' and a 'tentative friendliness'
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about Edward. All of this provides vital infor-
mation not only about Edward's personality
and abilities/difficulties, but also the 'patch-
work' character of his ego functioning, revea-
ling his intermittent capacities to relate and
make sense of relationship, and the contexts in
which he can and does find meaning.
This is also displayed in his 'musical geo-
graphy'(a term used by Nordoff and Robbins,
1971, p 73) in the way he responds to musical
improvisation. Although it is reported that
music can calm as well as stimulate Edward,
but there is no indication prior to the music
therapy sessions that music has affected
Edward at a sufficiently deep level to bring
him more than temporary relief from distress,
or help him progress into communicative lang-
uage. From infancy he has shown 'panic reac-
tions', an 'uncontrollable screaming and cry-
ing tantrums'; feeding problems, prolonged
rocking, and head banging'. He avoided social
interaction and was 'extremely clinging and
dependent on his mother'. The difficulty of
working with such a child is that, while he is
robust in many respects, he is also fragile, in
terms of his emergent and core sense of self
(Stern, 1985).
This paradox presents many dilemmas and
second-to-second 'monitoring' of the child's
emotions. With such children it is extremely
difficult to work in a creative 'zone of proximal
development' that, while supporting the pro-
cess of maturation, also invites - even chal-
lenges - the child to new ventures, new emoti-
onal learning (Vygotsky, 1978, pp. 84-91). We
Nordic Journal of Music Therapy, 1999, 8(2)
are told Edward cannot sustain social encoun-
ters for any length of time, before he becomes
so over-excited and overwhelmed, that no
development of 'connectedness' in relationship
can take place. I am concerned to emphasise
the severe and chronic nature of Edward's con-
dition ('primary emotional disturbance...an
ego defect of psychotic proportions involving
both autistic and symbiotic features').
Donna Williams, in her book Autism - an
Inside-Out Approach (Williams, 1996), offers
valuable insights into the sensory or sensation-
dominated world in which she lives and her
ways of addressing her feelings and behaviour
in this respect. Her experiences can perhaps
help us to appreciate Edward's 'inside' sensati-
ons, although Williams emphasises that her
accounts may not apply to other 'autistic' peo-
ple. (She generally puts the words 'autism' and
'autistic' in quotation marks to show her wari-
ness, too, of labelling.). She considers her emo-
tional responses and behaviour as a 'system',
giving the impression of her tuning into its
organisational, cohesive/uncohesive, synchro-
nous/asynchronous aspects. "The effect that
emotion can have on a system which cannot
make meaningful sense of it can be much more
extreme than emotion would be for most people
who generally experience it meaningfully in
the context in which it is provoked"(m other
words, the lack of semiotic and symbolising
processes in someone puts great emotional
strain on the body-mind-emotion system). Wil-
liams adds, "Emotions are experienced physi-
cally. Without comprehension to help diffuse or
make sense of the emotions, the effect on the
body may be so extreme that it may feel that it
is too much for the body to sustain. These
extreme reactions can mean that even being
emotionally 'moved' in a minor degree may
result in severe tremors, palpitations and
hyperventilation" (Williams, 1996, p. 216).
She goes on to describe how her problems of
'connection' and 'information overload' bey-
ond her limits of emotional tolerance may be
resolved, describing 'systems dissociation' and
'switch to autopilot', and the 'acute anxiety of
overload with often painful sensory hypersen-
 DIALOGUES

sitivity' which precedes 'systems shutdown' like wild rages but for me tend to be more
(Willliams, 1996, pp.216/7). implosive than explosive" (Williams, 1996,
This is a formidable array of strategies p.302).
('defences') to maintain an emotional-physical Edward's rages seem to belong mostly to the
equilibrium. Donna Williams certainly has hel- explosive type. It is interesting to note that Wil-
ped me appreciate more deeply the psychophy- liams' own strategy for dealing with her rages is
sical agonies that some autistic, borderline and similar to Edward's hyperactive behaviour
traumatised children may experience in social when overwrought: running or jumping on the
interaction. It is these difficulties which may lie spot to avert 'self-violence', and she adds that
behind and give rise to 'defence mechanisms' she now uses a pogo-stick. In short, she has ing-
(sometimes from a very early age), making fri- eniously devised a means of self-regulating her
endship and other relationships very difficult. sensory-motor-affective system, recognising its
Both Donna Williams and Temple Grandin, primary deficiencies in this complex respect2. It
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another well-known writer who is autistic, des- may be interesting to consider, from Donna Wil-
cribe different sub-types of 'autism' (Williams, liams' and Temple Grandin's perspectives, the
1996; Grandin, 1996), who have different 'insi- directness of Nordoff and Robbins' approach in
de' experiences, and for whom intervention their work with Edward, in particular, the insi-
strategies may also differ greatly. 'As children stence of the music, which seems to intensify
get older they tend to separate into two groups. Edward's screaming in the first session. We
Children like me who can be 'jerked' out of the could conjecture that this helped Edward exter-
autistic world and asked to pay attention, and nalise his rage further and express more of the
individual like Donna Williams and Therese chaotic and disturbed aspects of himself, bring-
Jolijfe who require a gentler approach ...Both ing this into the dynamic and healing field of the
types of young autistic children must be preven- music-therapeutic relationship.
ted from shutting out the world. They have to be
kept engaged so that their brains can develop
more normally.' (Grandin, 1996). Edward, like
The intra- and inter-subjective
most children, is not easily categorised, and his temporal space for the emergence
emergence into relationship and into the world of self and self-in-relation
is developed both by clinically fine judgement
Time, space and the dynamic organisational
in Nordoffs penetrating use of music as well as
field of music that constellates in the music the-
the more gentle nurturing receptive approach
rapy process assume primary significance with
adopted by both Nordoff and Robbins. Through-
Edward. "Autistic children have difficulties with
out the work with Edward, there is evidence of
space, time and causality...an adequate sense of
intensely active listening on the part of both the-
these phenomena involves at least two fixed
rapists to Edward's internal state and to the
points of reference, and these two seem to arise
slightest impulses or more overt responsiveness,
from those two great organising principles, the
shown either vocally or in body movements.
'perfinking' self in relation to the 'perfinking'
On the subject of 'rages', Donna Williams parental object" (Alvarez, 1992, p 98). 'Perfin-
again provides useful insight into the difficulti- king' is a word coined to convey that simulta-
es of self-regulation that bear comparison with neity of perceiving, feeling and thinking, which
Edward's tantrums and self-harming behavi- characterises infant semiosis (Bruner, 1986,
our. "(Rages) are a bit like the sort of feelings cited in Alvarez, 1992, p 93), a process descri-
that drive self-abuse. For some people they may
be more outward-directed and for others they 2 Temple Grandin's 'squeeze machine' is another example of a
may be more inner-directed. Sometimes when I resourceful strategy relating to her need to be able to control the pres-
have an emotion that is too big for me, it can sure of hug and not have to undergo the unpredictability and sensati-
on 'overload' of a real human hug. While in the squeeze machine,
trigger a kind of emotional 'fit'. These can be she would then think of the people who she loved (Sachs, 1993).

Nordic Journal of Music Therapy, 1999, 8(2)

 DIALOGUES
bed so clearly in Rolvsjord's recent article on
Edward (Rolvsjord, 1998). This 'perfinking'
self implies a space within and space between,
that is, both an intra-personal and an interperso-
nal dynamic field. The dynamic organisational
and temporal-spatial field between two people
should automatically imply a representation of
this field within the child himself, which con-
stellates the child's symbolising, thinking capa-
city (Vygotsky, 1978, pp. 37, 57).This is a fun-
damental area of deficiency and idiosyncrasy in
the autistic child's development.
Elsewhere I have considered the role of music
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therapy in facilitating emotional communication
and symbolisation with a young boy with autism
(Robarts, 1993, 1998). I have become increa-
singly aware of the mental space that the form
and structure of music can create. Such a space
needs to be created inter- and intra-personally in
work with the screaming or traumatised child,
so that they have a temporal-spatial framework
in which to begin to think and mean. This dyna-
mic concept of inter-subjective space is descri-
bed by Norwegian sociologist and cybernetici-
an, Stein Braten, and is implicit in Trevarthen's
Theory of Innate Intersubjectivity (1979, 1993a,
1993b, 1994).
Braten describes an inherent biologically-
based, internal, ready-made circuit for dialo-
guing and a representation of an-other or 'Virtu-
al Other' within the infant brain. Braten's con-
cept indicates the infant's preparedness for
interpersonal communication and relationship:
"The virtual dance in the innate organisation of
the infant becomes a realised dance, when the
adult steps into the place of the Virtual Other,
maintaining one organisation of dialogic closu-
re, not two." (Braten, 1988). Music therapy
seems to set in motion the poietic processes that
are deficient in the case of Edward and other
autistic and disturbed children. In this respect,
music therapy offers an apt dynamically resona-
ting, sympathetic organisational field that under-
pins 'object-relatedness' (see Sabbadini, 1997),
developing a capacity to be and to be with, to
feel and to think within the context of a mea-
ningful sense of self and self-in-relation (Rob-
arts, 1993a, 1998, 1999).
Nordic Journal of Music Therapy, 1999, 8(2)
Comments on Edward, Session 1:
musical ground - musical architec-
ture (form and space) - musical
nourishment - musical provocation
- musical receptivity
Paul Nordoff is improvising in the Dorian mode
on F#, as Edward enters. We hear Edward's rat-
her tremulous vocal sounds falling into the tona-
lity of the music, a responsive 'connectedness'
brought into existence by the music, at a pre-
conscious level or at a level of 'pre-relating
acceptance' (Nordoff & Robbins, 1977, p. 181).
Clive Robbins, we are told, attempts to introdu-
ce Edward gently to the drum and cymbal, tap-
ping them, but Edward shows no particular inte-
rest. However, Edward's crying sounds intensi-
fy. Paul Nordoff gently sings 'Good morning',
and singing Edward's name, over a sustained
chord. Already, a musical architecture of a
tonal-rhythmic field is providing a structure, a
music space, a musical 'ground of being' for
Edward, with 'digestible' phrase structures (not
too on-going, but just enough for Edward to feel
a flow yet not 'overload'). The pauses allow
Edward to listen to himself in a relational con-
text, and to internalise this sense of space (this
perhaps assists the constellation of a 'Virtual
Other' according to Braten's intersubjective
schema). This is one of the most important expe-
riences for Edward, from a clinical point of
view, and a feature of clinical music therapy, to
which I have referred elsewhere (Robarts, 1994,
p 237).
Clive's gentle orientating of Edward in the
music room and the gentle accepting atmosphe-
re appears to be engaging Edward, to the extent
that he plays some brief clusters on the piano. It
is immediately after this brief encounter that
Edward "leaves the piano, begins to pace the
room looking bewildered, and starts to cry".
This brief active engagement in the music has
perhaps moved him, and unsettled him in the
way that Donna Williams describes. Edward
doesn't know quite what to do with this perhaps
uncomfortable, unfamiliar feeling. At this point,
we are told, Clive is now standing to one side
leaving Edward and the situation more open for
 DIALOGUES
developments. The pitch range of Edward's
sounds widen, but is still grounded in the tonali-
ty of the music. In this way, Edward's chaotic
emotions are being expressed into the intrinsic
organisation potential of a tonal-rhythmic field.
Here, an emergent organisation of self and self-
in-relation may arise and be held, sustained and
developed into more conscious, intentional
expression (the executive function of ego), lea-
ding to creatively autonomous interplay (which
we hear in later sessions).
As Edward's crying escalates and he begins
to jump in agitation, even throwing himself to
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the floor, Paul Nordoff accompanies him in a
short phrase, played marcato, not merely mat-
ching the rhythm of Edward's jumping, but
providing a supporting quality of emotion and
a clear structure. Once again, all of this musical
material matches or complements Edward's
mood and is on a scale that he can assimilate at
some level. I feel here that Paul's rhythmic
motif has a directness that seems to call out
'Hey there! Hold onto this!' - which, metapho-
rically, Edward eventually does. Paul has
begun to sing on an open vowel 'ah'. This too
adds to the musically supporting and sustai-
ning atmosphere - and this is a psychophysical
experience - even in listening to this on the
audio-tape.
Here we can learn much from Donna Willi-
ams and her awareness of her 'system'. It is a
worthwhile exercise to consciously tune into
ourselves at that level (semiotic) rather than
the more usual symbolic and referential level,
where we try to name feelings rather than just
experience their vital essence and effect on us.
The musical texture is intensified as Paul beats
the drum and cymbal in a steady tempo with
his piano playing - it sounds quite rough and
raw, but definitely grounding in a very physi-
cal way that contrasts with the volatile screa-
ming-crying of Edward. The musical architec-
ture continues building, this time with Paul's
singing a sustained C# , on which sensation it
seems that Edward's voice begins to entrain,
joining on the dominant G# above.
The skill of it all, the intertwining of clinical
intent, musical creative sensitivity and instinct
in an evolving clinical situation are remarka-
ble. Both Paul and Clive hear that Edward's
crying has changed in character and is taking
on some of the tonal-rhythmic structure of the
music. Clive then joins in the intensity of expe-
rience and jumps with Edward. In this sharing
of Edward's emotional-physical activity we
could say that Clive is identifying with
Edward's rhythmic (body-movement) music,
which has now come into the foreground of
Edward's (pre-conscious) experiencing of
himself, while Edward's tonal (vocal) expres-
sion is internalising (or identifying with) Nord-
off s music. The music and musical relations-
hip are following Edward's spontaneous emo-
tional responses, but, rather than leaving him
to find his way alone, Nordoff and Robbins are
providing a kind of musical-sensational living
'architecture' or 'house' appropriate to suppor-
ting and developing Edward's musically evi-
dent emergent ego or self-organisation.
Edward's habitual sounds become more self-
expressive and connected with Paul's music,
although still at an evoked level.
Finally, a comment on Paul Nordoff s musi-
cal 'provocation' of Edward eliciting intensifi-
cation of crying to screaming. It is quite harro-
wing to hear this episode. In my view, howe-
ver, this is also the pivotal moment in the stu-
dy, where Edward's habitual rage reaction and
'defences' are addressed uncompromisingly,
will meeting will, a moment of mutuality, ope-
ning the door to an opportunity for self-regula-
tion and allowing new creative forms of rela-
tedness to emerge. I have referred elsewhere to
the role of intrusive intervention (Robarts,
1994, 1998) and how sensitive, controversial
and 'tricky' an area this is, from all points of
view, clinical, professional and personal. Tus-
tin (1986), Williams (1996) and Grandin
(1996) refer to the positive help that a direct or
even intrusive approach can bring to the child
with autism, before they have acquired strate-
gies, of the kinds that Williams and Grandin
describe.
Nordoff and Robbins' early observations led
to a realisation that resistiveness was an area to
be worked with, actively, musically. Their clini-
Nordic Journal of Music Therapy, 1999, 8(2)
 DIALOGUES
cal experiences with children had shown them
that 'resistiveness was often a corollary to parti-
cipation - a progressive response was immedia-
tely preceded and/or followed by one that was
resistive in some way' (Nordoff & Robbins,
1977, p. 181). They carefully observed the inter-
connection between participation and resistive-
ness, particularly in terms of clinical direction
and the developing of ego function and healthy
autonomy in the music therapy process. This
developmental path is an interesting one to fol-
low in the case study of Edward. The later sessi-
ons show the extent to which Edward is able to
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identify more freely and readily with the music
and with his own strengths, with a capacity to
internalise and reciprocate playful spontaneity
of musical dialogue, which then develops the
beginnings of functional speech.
Conclusion
"It is the poetic or aesthetic aspects of the
musical communication...which give them
[music therapists] power to transform the
improvisation into a therapeutic tool."
(Ruud, 1995, p 94).
In the study of Edward we find a remarkably
creative, sympathetic, resourceful use of music,
evolving a finely structured musical relations-
hip, with a conscious yet intuitive clinical intent.
That is the genius of Paul Nordoff and Clive
Robbins' music therapy. I would like to suggest
also that both therapists' musical intuition and
the richness of their professional and personal
life experiences must surely be in themselves
communicative to Edward and inspire his trust
at some deep level. Such subtleties of feeling
have great significance and healing power in the
clinical setting and are part of that 'tacit know-
ledge' to which Aigen refers in his fine com-
mentary on this case study (Aigen, 1999). The
study of Edward reveals the poietic processes of
music as therapy, arising in a dynamic field of
musical-emotional relatedness, imbuing child
and therapists with the vitality of ever evolving
forms and structures, and laying the foundations
of meaning in relationship.
Nordic Journal of Music Therapy, 1999, 8(2)
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Nordic Journal of Music Therapy, 1999, 8(2)
 DIALOGUES
Meeting Edward - thoughts on case
study material at different stages of a
professional life
Lutz Neugebauer
In my professional life I have had several opp-
ortunities to meet Edward in his case study
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material. I will - in the following - describe
some aspects of those meetings.
as a Student - An introduction
to Music Therapy
My first meeting with Edward was at a lecture I
attended as a student. Merete Birkebaek gave an
introduction to music therapy using musical
examples from this case study. I still remember
LUTZ NEUGEBAUER
Dr., Professor at Institut fur Musiktherapie, Univer-
sitat Witten/Herdecke. Studied music at the Musik-
hochschule Aachen - a subdivision of the Rheinis-
che Musikhochschule. Completed the post graduate
training course at the Nordoff/Robbins Music The-
rapy Centre in 1982. Back in Germany he had the
opportunity to do his national service as a music
therapist in Herdecke, where he was employed
afterwards. Have been working with handicapped
children, in psychiatry - mainly with adolescents -
but also with patients with spine injuries, in neuro-
surgery, and inner medicine. Since 1988 co-director
of the Institut fiir Musiktherapie at the Universitat
Witten/Herdecke, combining clinical work with
student training and research. Completed his docto-
rate on physiological synchronisation during impro-
vising music. Publications in German, British and
American professional journals as well as sections
in the Book series "Kairos", edited by David Al-
dridge, will be sent on request. Address: Institut
fiir Musiktherapie, Universitat Witten/Herdecke,
Alfred-Herrhausen-Str. 50, 58448 Witten, Germany.
E-mail: lutzn@uni-wh.de
Web-address: www.uni-wh.de
Nordic Journal of Music Therapy, 1999, 8(2)
the impact of those musical examples. Since
then I myself have used excerpts from this mate-
rial several times to illustrate the potential of
music as therapy - as many colleagues have. In
the clarity of the music and the choice of exam-
ples one can clearly identify the potential for
personal meeting and growth in music therapy
and it makes it easy to convince people that
music therapy is worth while being offered to
clients.
In this respect I found this material most help-
ful in illustrating the concept of music therapy,
finding Brynjulf Stige's statement in his editori-
al to be true: "to present the study of Edward wit-
hout the music is almost like serving the menu
instead of the main dish" (Stige, 1998).
I would support this statement and even
expand it to a more general one: I am convinced,
that music therapy speaks best through musical
examples showing therapeutic impact. Case stu-
dy material is a solution to the problem of how to
present our work. The dilemma we have in our
profession is that developments may be obvious
in musical terms, but difficult to articulate in ver-
bal terminology (Aldridge, 1996). This raises the
general question, where are we to put our
emphasis in presenting music therapy: in our cli-
nical work or scientific work? Nordoff and Rob-
bins have answered this question for themselves
and published some of their clinical material. In
this way they have given access to their concep-
tual thinking in and about therapeutic work.
In terms of the relationship between clinical
practice, understanding, developing concepts
and reapplying them to clinical practice,
Edward might be a good example for the deve-
lopment of our own endeavors. All too often we
 DIALOGUES
may get stuck at the second or third stage, com-
municating our ideas, concepts on music thera-
py without bringing them back to their origin,
the clinical practice. Only if we bring our con-
cepts back into this clinical context, will they
enrich our work.
as a teacher to students
Again, Edward is a good example of the pro-
cess of applying knowledge to the clinical situ-
ation. Since I have been involved in teaching
music therapy students, I have used this case
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study material prepared by Paul Nordoff and
Clive Robbins (Nordoff & Robbins, 1977).
Using it over a long period of time, with vary-
ing groups of students, has generated two stre-
ams of thought.
First, this re-use revealed my own changes of
perspective over time, setting different empha-
ses, being able to answer or raise more questions
within the seminar contents, but also to relate to
what I hear in my own clinical work. I will come
back to this in my last section.
Secondly, it is very interesting to see stu-
dents in contact with this recorded material.
Most of our students will have heard the mate-
rial at least once before. Yet, in the teaching
situation, we listen and describe what we have
heard before. This provides an opportunity for
the students to realize what their individual
mode of listening is; e.g. do they relate more to
the emotional quality, to the musical aspects,
or to the musical interaction. At the same time,
they get to know each other's way of listening
and realize that there is more than one way of
listening, and that they can learn from each
other. In re-listening, they practice listening
from differing premises, and learn to describe
from different perspectives.
Later on in their studies, before they begin
their own practical work, we relate to this case
material in a completely different way, e.g.
what can we play in a first session? Knowing
that the students' first reaction will be, "Oh, I
know this material already, we have heard it
before", it is interesting to realize that what
they hear - or perceive from what they hear -
changes and differs. Very often I get the reacti-
on "Oh, I never heard that before"; and this is
true not only for the students, but also for
myself.
Coming back to listening to this material
again and again over the years reveals new
aspects, relating to my own knowledge and cli-
nical background. Coming back to what seems
to be familiar, going back to what I seem to
know is worth while, reveals changes in per-
ception, context and understanding. Compa-
ring notes from today with those from years
ago, or even to those from my own study docu-
ments, this change is striking.
as a teacher to the therapist
I remember very well the situation described
above: "What do I play in a first session?" Liste-
ning to the simplicity and openness of the first
musical excerpt, or bringing the music to my
mind, often makes me think of my first music. It
helps me to have the courage to play less and lis-
ten more.
But Edward has been important in another
aspect of my professional development. When I
finished my training, I was equipped with a
diploma. Yet, it was clear that experience and
self -confidence were lacking. When giving lec-
tures about music therapy, Edward (and other
material from "Creative Music Therapy") could
rescue me, but the question remained "What
about my own clinical practice?"
I was lucky enough to begin my professional
life in a team with colleagues to whom I could
ask questions. Within this environment at the
General Hospital Herdecke, the individual has
always been the center of interest, both in clini-
cal practice and in research. One of my teachers,
the psychiatrist Konrad Schily, always told us
that the single-case is representative, not only
regarding symptoms and clinical descriptions,
but also regarding the efficacy of therapeutic
endeavors. If an individual was typical or repre-
sentative of a clinical problem and the therapy
worked, then this same therapy would work
with other individuals who had the same condi-
tion.
Nordic Journal of Music Therapy, 1999, 8(2)
 DIALOGUES
Consequently, this would mean that what
happened with Edward in music therapy could
happen with other children as well. Edward
shows typical features of autism and is represen-
tative of other autistic children. The case study
gives evidence that music therapy is a means of
communication to those children. But we also
know, that it will not work with every child to
the extent it has helped Edward.
Bahman
For example, I was more than astonished, when
I met Bahman for the first time. When Bahman
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first came to us he was five and a half years old.
His doctor referred him to us after hearing about
our work at a talk we gave in the Institute of
Autism, Viersen. The medical diagnosis said
"Early Childhood Autism". Although Bahman's
bodily development was normal, his behavior as
an infant was abnormal. He cried a lot, he didn't
make eye contact and gave no response to a smi-
le. He was also late in learning to walk. When
we first got to know him, he didn't talk and was
uncoordinated.
His doctor wrote: "He does not respond to
speech when spoken to. There is no spontaneous
contact with other children and he has no abili-
ty to play spontaneously. He shows what he
wants by shrill cries and weeping. He is restless
and runs around without any apparent directi-
on. A neurological assessment is almost impos-
sible. Although he reacts to the sound of a bunch
of keys being rattled in a normal way, he lacks
any orientation to the sound. In February 1986
he began to bang his head and bite his hands for
longer periods of time. During these periods he
has bitten through an elastic bandage. His mot-
her says that he reacts to every little change
during the day, whether this is to new people or
new situations, with loud cries and outbursts of
rage ".
We were not surprised then when he came
crying to the first session. Because he was seve-
rely handicapped, we worked together as a team
of two music therapists. The goal of our work in
the first session was to make contact with him.
We took everything that he did - crying, run-
ning around, impulsively playing the instru-
Nordic Journal of Music Therapy, 1999, 8(2)
ments - and improvised a special music for him.
One of the music therapists stood closely behind
Bahman to prevent him biting and hitting him-
self and also to help him play the instruments.
Meanwhile, the other music therapist improvi-
sed at the piano. The session lasted about twen-
ty minutes. At no time did Bahman recognize us
or appear to have any awareness of the situation.
After listening to the tapes, which we do after
every session, it became clear that his crying
and weeping were tonally related to the music
but Bahman wasn't able to control this relati-
onship. Everything he did appeared to be ran-
dom. His reactions to the musical environment
appeared to be reflexive and sub-conscious.
However, by the second session of music the-
rapy a change had occurred. The most effective
music in the first session had been music played
in an oriental style which was very loud and dis-
sonant. This music became the central focus of
the work again. His crying and weeping were
heard musically and included in a common
vocal improvisation with the therapists . His
tension was reflected in dissonant and intensive
chords. Then the first eye contact happened.
After this Bahman began to be able to play an
instrument independently. The help that he had
needed until then was reduced little by little. For
a short time he was able to play alone, supported
by the music. This type of interaction, which
developed within the music, happened only bri-
efly and was difficult for him to sustain. In the
following weeks we worked at initiating com-
munication and the first steps towards a musical
relationship. Bahman was given a new horizon
of possibilities.
After the fourth session his mother wrote in
her diary: "On our way home after the music
therapy session he quietly fell asleep after a
quarter of an hour. For the whole afternoon,
and in the evening, he was much more balanced
than before, he was less harmful to himself and
was in a very good mood. Even his awareness
had developed".
In these later music therapy session he is
beginning to form words, which fit the music
and the situation. His initial reluctance has now
become active co-operation. We hope that this
 DIALOGUES
improvement will continue. It is possible, as has
happened with many children before, that the
experiences of social contact that he makes in
the music will be important for his whole life.
Having had one child so similar in his musi-
cal and personal development has changed my
approach towards the outstanding role of
Edward's case material. He presents typical fea-
tures and in a way a typical development. In
terms of the single case being representative for
broader populations, he has shown that using
case material is the most sensitive way of appro-
aching scientific work. I have been lucky
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enough to work together with David Aldridge,
who has developed a strategy for research, using
single case research designs, and who is suppor-
tive to our profession in many ways. (Aldridge,
1996). In the German edition of his book, a CD
ROM with case material will be enclosed, inclu-
ding the material of Bahman.
Bahman's course of therapy has taught me to
trust in music and rely on the idea of a Music
Child as presented by Nordoff and Robbins
(Nordoff & Robbins, 1977) and as described in
a broader sense of a musical identity (Aldridge,
1996). In comparing Edward's and Bahman's
case material, it becomes obvious that there is
something common to both children and to both
courses of therapy. It will be a valuable task for
the future to find, collect and compare case
material from different therapists and make
them available to each other - a task that we
have taken on at the Institute here at
Witten/Herdecke by publishing them on CD
ROM (Aldridge, 1998 ). As case study material
for research and teaching, the CD ROM allows
us to present and discuss our work with other
colleagues and make it available to interested
others. That was surely the impulse behind the
pioneering Edward case study and it is a privile-
ge for us to take this further forward using
modern media.
I think that it is important that we share our
case material as Paul Nordoff and Clive Rob-
bins did. Only by doing so we will be able to
demonstrate the growing expertise and clinical
knowledge in our profession.
References
Aldridge, David (1996): Music Therapy Rese-
arch and Practice in Medicine, Jessica
Kingsley Publishers, London.
Aldridge, David (1998): Music Therapy with
Children (CD ROM) Jessica Kingsley
Publishers, London.
Nordoff, Paul & Robbins, Clive (1977): Creati-
ve Music Therapy, John Day, New York.
(Revised edition in preparation: St. Louis,
MO: MMB).
Stige, Brynjulf (1998): Dialogues, Nordic Jour-
nal of Music Therapy, 7(1) p. 3.
Nordic Journal of Music Therapy, 1999, 8(2)