Analytical music therapy

1. Introduction

Version followed: Mary Priestley's Analytical Music Therapy (AMT) as set out in Music Therapy in Action (1975; 2nd ed. 1985, reissued 2012) and Essays on Analytical Music Therapy (1994). Neither book is available in a legitimate full-text copy online; the technique list and its three-way grouping follow the publisher's contents for Essays, and procedures follow the secondary accounts listed under Sources. Verification: Kim (2016, Voices) confirms that talk before and after each improvisation is central to Priestley's method. MacRae (2019) and a Molloy University course entry confirm the current US training route, in which Inter Music Therapy is one of four required stages. Priestley's own step-by-step procedures for eleven techniques are not publicly available [uncertain]: emotional investment, somatic communication, guided imagery, mythical improvisations, dream work, Shells/Stones/Sand/Sounds, reality rehearsal, wholeness, exploring relationships, subverbal communication and patterns of significance. No published step-by-step protocol for these was found, so their steps are the writer's synthesis [synthesis]. Session length is unverified [uncertain]. Where a step is not documented in a cited source, it is marked [synthesis] or [uncertain].

AMT is a psychoanalytically informed, improvisation-based music psychotherapy. Priestley developed it in the early 1970s at St Bernard's Hospital, Hanwell (London), with Marjorie Wardle and Peter Wright. The three met weekly and took turns being each other's therapist before trying the methods with adult psychiatric patients. [source: Wikipedia, Mary Priestley; Bunt 2004]. Priestley defined it as the symbolic use of words and improvised music by client and therapist to explore the client's inner life and create the conditions for growth. In some European training contexts it was later called "explorative music therapy". [source: Pedersen, Musikterapiens start]. It draws on Freud, Jung, Adler and especially Klein. [source: Sobey 2017; Pedersen]

How change happens. In shared improvisation, unconscious and early relational material becomes audible and playable. The client can move between primary-process play and secondary-process reflection while the therapist follows empathically. Talking afterwards turns the musical experience into conscious understanding, and ego-strengthening work then consolidates new ways of relating. [source: Pedersen; Essays contents]. The 1999 World Congress of Music Therapy recognised AMT as one of five international models. [source: Wikipedia; Wheeler/Eschen 2012]

2. Framework

Basic unit: the AMT cycle (one improvisation episode). One secondary summary gives the cycle as follows: (1) identify an issue or theme in conversation; (2) define the roles for the improvisation; (3) agree a title and improvise to it; (4) talk about what happened. [uncertain: secondary, unverified]. Pedersen confirms that client improvisations are often prompted and guided by programmatic titles, and that a shared rule such as "we play what comes to mind" frames the play. [source: Pedersen]. Kim (2016) also describes Priestley's stress on verbal processing both before and after improvisation, to bring unconscious material into consciousness, and her view that joint client–therapist improvisation carries transference and countertransference. [source: Kim 2016, citing Priestley 1975, 1994 and Eschen 2002]. Several cycles can happen in one session [synthesis].

Course of treatment. The publisher's contents for Essays show this order of concerns. [source: Essays contents]

• Getting started. In the first sessions the therapist gathers biographical information (Essays ch. 2). The therapist may also map the client's "emotional spectrum" as a picture of their inner world (ch. 3).
• Probing the conscious. Techniques: holding, splitting, investigation of emotional investments, somatic communication (ch. 4).
• Accessing the unconscious. Techniques: guided imagery improvisations, mythical improvisations, dream work, and "Shells, Stones, Sand and Sounds" (ch. 5).
• Ego-strengthening. Techniques: reality rehearsals, wholeness, exploring relationships, affirmations and celebrations, subverbal communication, patterns of significance, programmed regression (ch. 6).
• Ending the session or treatment (ch. 30).

Cooper (2011) studied 96 recorded sessions with 31 adults (1975–1991). She grouped Priestley's 15 techniques by the same three purposes and found that Priestley chose among them according to the clinical moment. [source: Cooper 2011 abstract]. The groups are purposes, not a fixed sequence. Treating them as rough phases (conscious → unconscious → ego-strengthening) is the writer's reading [synthesis].

Criteria for moving on (not described in the cited sources) [synthesis]:

• Move from the conscious to the unconscious techniques once there is a working alliance, the client can use the cycle (play, then talk), and the client can tolerate and reflect on affect.
• Move to ego-strengthening work when insight is present but not yet used in life, or when the ego seems too fragile for deeper probing.
• With fragile clients, go back to holding and ego-strengthening at any point.

Format. Most of Priestley's documented work is individual adult sessions in hospital and private practice. She also ran ward groups, small improvisation and vocal groups, a music club, psychodynamic movement and relaxation sessions, joint sessions with art therapists, and couple work. [source: Music Therapy in Action contents (MCPHS catalogue); Essays contents; Bunt 2004]. She sometimes brought relatives, such as a parent or spouse, into the discussion, an idea she took from family therapy training. [source: Bunt 2004]. Scheiby, who trained with Priestley, later applied AMT in medical and rehabilitation settings, with people with chronic progressive neurological illness, in group work for pain management after medical trauma, and in training for caregivers. [source: Barcelona Publishers, contents of The Music Therapy Writings of Benedikte B. Scheiby]. The cited sources give no documented session length or number of sessions [uncertain]. Weekly sessions of about an hour, with an open-ended course, are a common psychodynamic default [synthesis].

Professional frame, training and credentials

• Who can practise. Practise AMT only if you are a qualified music therapist: HCPC-registered and usually a BAMT member in the UK, MT-BC (CBMT) with AMTA membership in the USA, or the national equivalent elsewhere [uncertain: credential routes not re-verified].
• Further training. Priestley held that a music therapy qualification alone is not enough to practise analytically. The therapist needs their own analysis, or at least supervision from an analytical psychotherapist. [source: Sobey 2017, citing MTiA p. 20]
• Intertherapy, the core training method. Two trainees alternate as therapist and client while an experienced analytical music therapist supervises (Essays ch. 29). [source: Essays contents]. In the Herdecke and Aalborg model it ran as 12 double lessons. The prerequisites were at least one year of individual and one year of group AMT in the client role. [source: Pedersen]. In the current US model it is called Inter Music Therapy (IMT). Two trainees alternate as therapist and client under the direct supervision of an AMT trainer. They work with lived experience, not role-play, and keep logs to integrate the learning. [source: MacRae 2019 abstract]
• Other requirements. Trainees were expected to have personal therapy. Priestley also urged therapists to keep performing live music themselves. [source: Bunt 2004]
• Current training. In the USA, AMT is taught as an advanced practice model after basic music therapy qualification. Training runs through four required stages, one of which is Inter Music Therapy (see below). [source: MacRae 2019 abstract]. Molloy University (New York) lists a 3-credit graduate course, MUS 5390 Analytical Music Therapy, covering Priestley's model, its development, its training practices and current research. [source: Molloy graduate catalogue 2022–23]. A Molloy continuing-education page titled "Analytical Music Therapy Certification Program" was found, but it showed no programme details [uncertain]. Scheiby, who trained with Priestley, taught AMT to music therapists for over 20 years. [source: Barcelona Publishers, Scheiby writings]. The other three US training stages, any current credential title, and the European (EAMT) route were not verified [uncertain].
• Not a stand-alone tool for other professions. A psychotherapist without music therapy training should not run AMT improvisations. Refer to or co-work with a qualified music therapist, preferably one with AMT training [synthesis].

Physical and hearing safety [synthesis]

• Loud instruments. Drums, gongs, cymbals and metallophones in small rooms can reach harmful sound levels for both client and therapist, and the therapist is exposed session after session.
  • Offer ear protection and keep loud instruments away from ears.
  • Agree volume limits and a "stop" sign before cathartic or loud playing.
  • Treat the therapist's own daily exposure as an occupational noise issue under local noise-at-work rules [uncertain].
• Hearing conditions. Screen for tinnitus, hyperacusis, hearing aids and sound-triggered seizures.
• Equipment. Check instruments for sharp edges and loose parts. Clean wind instruments and mouthpieces between users, or give each client their own. Keep heavy instruments stable.
• Movement work. Clear the floor before psychodynamic movement.

Musical trauma triggers [synthesis]

• Screen at intake. Ask about music, songs, instruments or sounds tied to trauma. Examples:
  • songs linked to an abuser or to a loss;
  • military, religious or political music;
  • music used during abuse, torture or detention;
  • sudden loud percussion, which can provoke startle.
• Set up safeguards. Agree a stop signal. Let the client choose instruments, and never force a named piece or genre on them.
• Watch your own playing. Your improvisations, especially in complementary countertransference, can unknowingly echo an abuser's style. Examples include a harsh, dominating rhythm or mocking imitation.

3. Guiding principles

• Three factors: client, music, therapist; the human relationship is essential [source: Sobey 2017, citing MTiA p. 1]. Practical meaning: the music is a medium of relationship, not a treatment applied to the client.
• Words and music together [source: Pedersen; Kim 2016]. Practical meaning: nearly every improvisation is framed before by talk and processed after it. Music alone is not AMT.
• The therapist is analysed or supervised [source: Sobey 2017; Bunt 2004]. Practical meaning: do not use countertransference clinically without your own therapy and analytic supervision.
• Warm alliance before interpretation. Priestley did not offer transference interpretations without a warm alliance and deep empathy for the client's conflicts. [source: Pedersen]. Practical meaning: interpret only once the client feels met. Lead with empathy and give interpretations sparingly.
• Disciplined subjectivity. The therapist enters the music subjectively while keeping a listening ear outside it [source: Pedersen]. Practical meaning: play with feeling, and keep noticing what the music is saying about the relationship.
• Empathic (E-) countertransference. This is resonance with the client's feelings, which Priestley compared to sympathetic strings vibrating when a nearby string is struck. It is used as an instrument for exploring the unconscious. [source: Pedersen]. Practical meaning: hold still inside, notice the feeling, and wonder what it means for the client. Give it back in musical or verbal form the client can accept, often later rather than at once.
• Complementary (C-) countertransference. Here the therapist unconsciously takes the role of a significant other, for example an over-protective mother or a strict father. Once recognised, the role can be (a) played out consciously as role-play, (b) gradually outgrown as the client matures, or (c) answered with the "opposite sign", an unexpected response. [source: Pedersen]. Practical meaning: keep asking yourself why you are playing like this and whose role you have taken.
• Kleinian splitting as a lens and a tool. Priestley used Klein's model of splitting between the good and bad object to understand clients and to design improvisations [source: Pedersen]. Practical meaning: listen for all-good and all-bad musical worlds and help the client play both.
• Primary and secondary process. Improvisation is a play space where early relational experience is re-enacted. The client may move between primary and secondary process while the therapist follows. [source: Pedersen]. Practical meaning: allow regression in the music, then help the client step back out of it through talk.
• Inner music. Priestley used the term for "the prevailing emotional climate behind the structure of someone's thoughts" [source: Sobey 2017, citing MTiA p. 189]. Practical meaning: tune your improvisation to the client's underlying emotional tone, not only to the words they use.
• Containment. Music can undermine defences. [source: Wooster, introduction to MTiA, via Sobey 2017]. Practical meaning: match the depth of the work to ego strength, and be especially cautious with psychotic clients.
• Defences are respected. Essays devotes a chapter to about thirty defences met in AMT [source: Essays contents]. Practical meaning: name and work with defences rather than breaking through them [synthesis on the application].
• The therapist stays a live musician; the artist should not be lost [source: Bunt 2004]. Practical meaning: keep your instrumental skill alive, because the quality of your musical response is clinical skill.
• Do not copy Priestley's case work literally. It reflects her personal style and depends on rigorous analysis and supervision. [source: Sobey 2017]. Practical meaning: adapt the techniques to your own musical and clinical style.

4. Intervention inventory

How to read this section. The 15 named techniques and their grouping come from the publisher's contents for Essays (chs. 4–6) and match the grouping in Cooper (2011). The short definitions of free association, holding, splitting and programmed regression rest on an unverified secondary summary [uncertain: secondary, unverified]. Priestley's own procedure text for eleven techniques (B3, B4, C1–C4, D1–D3, D5 and D6) is not publicly available [uncertain]; for these the steps are labelled [synthesis – working procedure inferred from the technique's name and AMT's general cycle, not Priestley's text]. Check them against Essays chs. 4–6, MTiA chs. 14–16, or Cooper (2011) before relying on them. All example language is illustrative.

A. Core frame interventions

A1. Titled improvisation (the AMT cycle)

• Purpose / when. This is the basic vehicle of AMT: it turns a verbal issue into something that can be played, then back into words. Use it in every session once a theme emerges. [source: Pedersen]
• Steps.
  1. Explore the current concern verbally until a "playable" theme appears.
  2. Agree roles: who plays what or whom, and on which instruments. The therapist may accompany, take a role, or hold a ground.
  3. Agree a title, for example the name of a feeling, a person, a scene or a conflict.
  4. Improvise under the agreed rule, such as "play what comes to mind". Play until the music ends naturally.
  5. Talk about it: what the client noticed, felt and imagined, and how the music relates to their life. [steps 1–4: Pedersen for titles and the shared rule; the four-step order from an unverified secondary summary, uncertain: secondary, unverified; detailing synthesis]
• Optional playback. Priestley recorded sessions; the Temple archive holds the tapes [source: Wikipedia]. Playing a recording back to the client before talking is a common later practice; whether Priestley treated it as a standard step is [uncertain].
• Example language (illustrative). "You've said 'trapped' three times. Shall we play 'Trapped'? Pick an instrument for the part of you that feels trapped, and I'll play the walls."
• Watch for.
  • A title the client imposes to please you.
  • Playing that politely avoids the theme.
  • Talk that intellectualises the music away.
  • Working signs: the music surprises the client, and the talk afterwards contains feeling and new associations.

A2. Free association in music

• Purpose / when. Use it when the client cannot yet put an issue into words. The therapist accompanies or reinforces what the client plays. [uncertain: secondary, unverified]
• Steps [synthesis]:
  1. Invite the client to play whatever comes, with no title.
  2. Follow and support their playing; do not lead.
  3. Afterwards, ask what images, memories or feelings came up.
  4. Use what emerges to find a title for the next improvisation.
• Example language (illustrative). "No title this time. Just start, and I'll come with you."
• Watch for.
  • Aimless playing that never turns into material.
  • Rising disorganisation in clients with psychosis. If it appears, add structure, for example a pulse or a fixed tonal centre.

A3. Using countertransference in the music

• Purpose / when. Use it throughout, to sense unconscious material [source: Pedersen].
• Steps.
  1. While playing, notice feelings that seem to arrive from outside you. Stay still inside.
  2. Classify the feeling as empathic (resonating with the client) or complementary (you have been cast as a significant other).
  3. With empathic countertransference, wonder what the feeling means for the client. Give it back in musical or verbal form the client can accept, often later rather than immediately.
  4. With complementary countertransference, choose a response: make the role conscious and play it as role-play, let it fade as the client matures, or respond with the opposite sign. [source: Pedersen]
  5. Take it to supervision [synthesis].
• Example language (illustrative). "When we played, I found myself holding everything very tightly and carefully. I wonder whether that is familiar to you."
• Watch for.
  • Acting out your own material.
  • Interpreting before there is an alliance.
  • Repeating an abusive dynamic in the music without noticing.

A4. Getting started: biography and emotional spectrum

• Purpose / when. Assessment in the first sessions. The therapist gathers biographical information and uses the "emotional spectrum" as a map of the client's inner world. [source: Essays contents, chs. 2–3]
• Steps. The content of Priestley's emotional spectrum is not publicly available [uncertain]. A working approach [synthesis]:
  1. Take a psychodynamic history: family, losses, relationships and patterns.
  2. Note which emotions the client expresses easily and which seem missing.
  3. Plan improvisations that approach the missing areas gradually.
• Example language (illustrative). "Which feelings come easily to you, and which ones do you rarely let yourself feel?"
• Watch for. Do not turn the spectrum into a scored test. No cited source suggests it has been validated as a measure [uncertain].

A5. Re-enactment of a past event through playing

• Purpose / when. To release blocked affect tied to a remembered event. Priestley described asking a mother who could not bond with her daughter to re-live that period on the drum. Anger displaced from her sister came out, and the mother then bonded with her daughter. [source: Bunt 2004]
• Steps [synthesis]:
  1. Identify the period or event.
  2. Check that the client has the ego strength and willingness to revisit it, and agree a stop signal.
  3. Invite them to play that time, with the therapist supporting.
  4. Process carefully afterwards and ground the client before they leave.
• Example language (illustrative). "Would you be willing to play what that time felt like? We can stop whenever you signal."
• Watch for.
  • Flooding and dissociation; this is an exposure-like method, so see section 5.
  • Hearing safety with loud drumming.
  • Contraindications: acute psychosis, active suicidality, unstable dissociative disorders, and recent unprocessed trauma without stabilisation [synthesis].

B. Techniques for probing the conscious [source: Essays ch. 4 contents; Cooper 2011]

B1. Holding

• Purpose / when. The therapist contains the client emotionally, providing a safe, structured musical environment in which the client can express difficult feelings. [uncertain: secondary, unverified]. Use it when the client is overwhelmed, fragmented or approaching strong affect.
• Steps [synthesis on the musical detail]:
  1. The client plays the feeling.
  2. You provide a steady, resonant container around it, for example a stable pulse, a sustained harmonic ground, or a register that surrounds the client's sound. Match intensity without escalating.
  3. Let the client's expression rise and fall within your frame.
  4. Close gently and talk about it.
• Example language (illustrative). "Play the panic as it is. I'll keep a steady ground underneath you the whole time."
• Watch for.
  • The client's playing gradually organising around your frame is a good sign.
  • Over-holding that smothers the client's expression is a problem.
  • So is a frame so loose that the client spirals.

B2. Splitting

• Purpose / when. To explore an internal conflict or ambivalence. The client plays both opposing sides in turn, with the aim of resolving the conflict between them. [uncertain: secondary, unverified]. The technique draws on Kleinian splitting. [source: Pedersen]. Use it when the client describes two incompatible parts or feelings ("I love her / I hate her").
• Steps [synthesis on the detail]:
  1. Name the two sides and give each a title.
  2. The client plays side A while you support it.
  3. The client switches to side B, ideally on a different instrument.
  4. Talk about each side.
  5. Optionally, play a third improvisation in which the two sides meet.
• Example language (illustrative). "Let's give each side its own voice. First play 'the part that wants to leave', then switch to the drum for 'the part that wants to stay'."
• Watch for.
  • One side that cannot be played at all may be strongly defended; do not force it.
  • A working sign is a later improvisation in which both sides coexist.

B3. Investigation of emotional investment

• Purpose / when. The name implies exploring where the client puts emotional energy, such as people, objects, roles or ideals [uncertain: Priestley's definition not available].
• Steps [synthesis – inferred from name]:
  1. List the client's main investments.
  2. Improvise each one by title, for example "My work" or "My mother's approval".
  3. Compare the energy and quality of each piece.
  4. Discuss whether the investments are balanced, and what each one gives and costs the client.
• Example language (illustrative). "Play 'my job', then 'my marriage'. Let's listen to how much of you goes into each."
• Watch for. A mismatch between the client's verbal claims and the musical energy is a useful thing to name.

B4. Entering into somatic communication

• Purpose / when. The name implies treating bodily symptoms, sensations or pain as communications and giving them musical voice [uncertain: Priestley's text not available]. This is an adjunct to medical care and never a substitute for medical investigation.
• Steps [synthesis – inferred from name]:
  1. Make sure the symptom has been medically assessed.
  2. Invite the client to locate the sensation and choose a sound or instrument for it.
  3. Let the client play it, or play it with them.
  4. Ask what the symptom "says" or needs.
• Example language (illustrative). "If the tightness in your chest could make a sound, what would it be?"
• Watch for.
  • Somatic amplification.
  • Never suggest that the music treats the physical illness.

C. Techniques for accessing the unconscious [source: Essays ch. 5 contents; Cooper 2011]

C1. Guided imagery improvisations

• Scenes. Essays names four: Cave Mouth, Ascending a Mountain, Pool in the Meadow, and Door in a High Wall. [source: Essays contents]
• Not GIM. These are improvised, so they are distinct from Bonny's receptive Guided Imagery and Music (GIM), which uses recorded classical programmes. [source: Pedersen on GIM]
• Purpose / when. To evoke symbolic, unconscious material through an imagined scene the client "travels" while music is improvised. Use it once the alliance is solid and the client can tolerate imagery.
• Steps [synthesis – Priestley's induction and scripts not available]:
  1. Help the client settle and breathe.
  2. Introduce the scene in a few neutral words.
  3. Improvise together while the client describes what they encounter, or improvise first and describe afterwards.
  4. Return the client to the room.
  5. Talk about the images as symbols of the client's own situation.
• Example language (illustrative). "Imagine you're standing at the mouth of a cave. Let the music take you in, and tell me what you notice."
• Watch for.
  • Frightening imagery that escalates: return to the room and add holding.
  • Dissociation.
  • Do not use with active psychosis or poor reality testing [synthesis; consistent with Wooster's warning about defences].

C2. Mythical improvisations

• Purpose / when. To use myths, fairy tales or archetypal stories as a symbolic frame for the client's conflicts. Essays names this technique; Priestley's own procedure is [uncertain]. [source: Essays contents]
• Steps [synthesis]:
  1. Choose a myth or story that resonates with the client's theme, or let the client choose.
  2. Assign roles.
  3. Improvise a key scene.
  4. Talk about the client's identifications with the characters.
• Example language (illustrative). "In this story, which character are you drawn to? Let's play that character meeting the dragon."
• Watch for. Material from another culture's sacred stories needs respect and the client's own choice.

C3. Dream work: intracommunication and dream resolution

• Purpose / when. To explore dreams musically. Essays lists "intracommunication" and "dream resolution" as sub-techniques. [source: Essays contents]. The procedures are not publicly available [uncertain].
• Steps [synthesis – inferred]:
  1. The client recounts the dream.
  2. For intracommunication, the dream figures "speak" to each other in music, with client and therapist taking roles.
  3. For dream resolution, improvise an ending or change to an unresolved dream.
  4. Process the result.
• Example language (illustrative). "Play the figure at the door, and I'll play you in the dream. Let's hear what happens between them."
• Watch for. Nightmares linked to PTSD need trauma-informed pacing (see section 5).

C4. Shells, Stones, Sand and Sounds

• Status. Essays lists this as a technique for accessing the unconscious [source: Essays contents]. Its procedure is not publicly available [uncertain]. The title suggests it uses natural objects and sounds as projective material, but this is an inference only.
• Use. Do not use it on the strength of this guide; consult Essays ch. 5.
• Materials safety if natural objects are used [synthesis]: clean shells and stones, keep sand contained, and keep small items away from young children because of choking risk.

D. Techniques for ego-strengthening [source: Essays ch. 6 contents; Cooper 2011]

D1. Reality rehearsal

• Purpose / when. The name implies rehearsing a real, upcoming situation in improvised music before facing it in life, such as a confrontation, an interview or a goodbye [uncertain: Priestley's text not available].
• Steps [synthesis – inferred]:
  1. Define the situation and who will be there.
  2. Assign roles. The therapist often plays the other person, which overlaps with the conscious use of complementary countertransference [Pedersen].
  3. Improvise the encounter.
  4. Talk about what worked.
  5. Replay it with a new stance.
• Example language (illustrative). "I'll play your manager. Play how you want to come across when you ask for the change."
• Watch for. Rehearsals that end in defeat. Repeat them with more support until the client can hold their position.

D2. Wholeness

• Purpose / when. The name suggests integrating fragmented parts of the self after splitting or regressive work [uncertain: procedure not available].
• Steps [synthesis]:
  1. Gather the parts that have emerged in earlier sessions.
  2. Improvise a piece titled for the whole self, in which all the parts can be heard together.
  3. Talk about what it is like to hold them together.
• Example language (illustrative). "Let's play 'All of me': the angry part, the frightened part and the capable part, together."
• Watch for. A forced or premature harmony that skips over real conflict.

D3. Exploring relationships

• Purpose / when. To explore significant relationships by playing them [source: Essays contents; detail uncertain].
• Steps [synthesis]:
  1. Choose a relationship.
  2. The client plays themselves while the therapist plays the other, or the client plays both in turn.
  3. Talk about the dynamics: who leads, who follows, who drowns out whom.
  4. Try a different way of relating in a new improvisation.
• Example language (illustrative). "I'll be your father. Play the two of you at dinner as it usually goes."
• Watch for.
  • Playing an abuser can be retraumatising. Obtain consent; the therapist should rarely, if ever, voice a perpetrator directly.
  • Watch for complementary countertransference.

D4. Affirmations and celebrations

• Purpose / when. To consolidate gains and mark achievements or positive qualities in music. Essays has a chapter on the topic. [source: Essays contents, chs. 6 and 21]
• Steps [synthesis]:
  1. Identify a strength or achievement.
  2. Title it.
  3. Improvise it fully and confidently, with the therapist amplifying.
  4. Optionally, repeat it at later sessions to anchor it.
• Example language (illustrative). "You stood up for yourself this week. Let's play 'I said no' and really celebrate it."
• Watch for. Hollow positivity, or the client feeling exposed when praised.

D5. Subverbal communication

• Purpose / when. The name suggests making contact through music below or before words, for clients who are withdrawn or unable to speak [uncertain]. A chapter in Eschen (2002) applies AMT techniques with a non-verbal client [source: Eschen 2002 contents].
• Steps [synthesis]:
  1. Match the client's sounds, breath or movement.
  2. Build a wordless musical dialogue.
  3. Keep verbal processing brief or skip it.
• Example language (illustrative). "We don't need words today. I'll answer whatever you play."
• Watch for. Do not mistake non-verbal for non-understanding. Sobey criticises dated passages in MTiA on non-verbal and learning-disabled clients. [source: Sobey 2017]

D6. Patterns of significance

• Purpose / when. The name suggests identifying and playing recurring meaningful patterns in the client's life [uncertain: Priestley's procedure not available].
• Steps [synthesis]:
  1. Name a recurring pattern, such as always rescuing others or leaving before being left.
  2. Improvise the pattern.
  3. Improvise an alternative.
  4. Talk about the costs of each and the choice between them.
• Example language (illustrative). "This is the third relationship that ended the same way. Shall we play the pattern, and then play a different ending?"
• Watch for. Insight without change. Link this work to reality rehearsal (D1).

D7. Programmed regression

• Purpose / when. The client uses music to return to an earlier age at which unresolved conflicts or events occurred. A secondary summary also lists "spontaneous regression" [uncertain: secondary, unverified]. Essays places this technique under ego-strengthening and includes chapters on the inner child and the "detour through phantasy". [source: Essays contents]
• Steps [synthesis on the detail]:
  1. Agree the age or period and its purpose.
  2. Agree a stop signal.
  3. Use simple, child-like instruments and textures.
  4. Let the client play "at that age", with the therapist in a nurturing role.
  5. Bring the client back to their present age explicitly, then talk about it.
• Example language (illustrative). "Let's go back to when you were about six. Play what that child felt. When we finish, we'll come back to you now, at forty."
• Watch for.
  • Malignant regression, dissociation, and clients with borderline or psychotic organisation.
  • Use only with clear structure and a strong alliance [synthesis].

E. Other formats Priestley described

E1. Psychodynamic movement and relaxation session

• Purpose / when. A group session combining movement to music with relaxation. Priestley ran these at St Bernard's, and a psychiatrist who watched one was struck by how fluently patients spoke afterwards. [source: MTiA ch. 9 contents; Bunt 2004]. Pedersen also has a chapter on psychodynamic movement in Eschen (2002). [source: Eschen 2002 contents]
• Steps [synthesis]:
  1. Warm up.
  2. Move to live or recorded music.
  3. Relax.
  4. Talk as a group.
• Safety.
  • Clear the space to prevent falls.
  • Offer chair-based options.
  • Do not touch without explicit consent; offer a no-touch default and an easy way to opt out. Never use sexual, genital or other intimate touch. [synthesis]
• Watch for. Agitation or disinhibition in acute wards.

E2. Joint sessions and family or couple involvement

• Purpose / when. MTiA covers joint sessions, including with art therapists (chs. 13 and 18), and Essays includes couple therapy (ch. 28). Priestley brought relatives such as a mother or husband into discussion, drawing on family therapy. [source: contents; Bunt 2004]
• Steps [synthesis]:
  1. Agree the purpose with the client.
  2. Invite the relative.
  3. Improvise the relationship together.
  4. Process it with each participant's consent.
• Watch for. Confidentiality, coercion and domestic abuse. Never do conjoint work where there is abuse.

E3. Group and ward work

• Formats. Big back ward, locked wards, small improvisation and vocal groups, record sessions, music club, therapeutic teaching and chamber music [source: MTiA chs. 6–12 contents]. Priestley took her violin onto the wards. Her music club was a place where people came to play and read poems. [source: Bunt 2004]
• Boundary [synthesis]. Music club and teaching are supportive activity, not analytic therapy. Keep the purpose of each group explicit.

E4. Intertherapy (training, not a client technique)

• What it is. Two trainees alternate as therapist and client under supervision [source: Essays contents]. In the Herdecke and Aalborg model it ran as 12 double lessons, after a year of individual and a year of group AMT as a client [source: Pedersen]. In the current US model, Inter Music Therapy is one of four required training stages. Trainees bring their own lived material, not role-play, under an AMT trainer's direct supervision, and keep written logs. [source: MacRae 2019 abstract]. Scheiby and Pedersen co-wrote a chapter on Inter Music Therapy in student training. [source: Barcelona, Scheiby writings contents]
• Use. It is part of the trainee's own development, not something to offer clients.

E5. Ending the session or treatment

• Essays ch. 30 covers endings [source: contents; detail uncertain].
• Steps [synthesis]:
  • End each session with a calming or grounding improvisation, or a verbal summary.
  • Plan the final phase of treatment ahead of time.
  • Improvise "the ending" itself, and review the journey, for example by listening back to recordings if the client consented to recording.

5. Handling problems

The cited sources say little about problem handling beyond countertransference, the warm alliance and containment. Most of what follows is [synthesis] unless tagged otherwise.

• Resistance and defences in the music. Signs include polite or repetitive playing, avoiding certain instruments, constant playing to fill silence, and refusing a title.
  • Treat these as defences to understand, not obstacles to break. Essays catalogues about thirty defences seen in AMT [source: Essays contents].
  • Name the pattern gently.
  • Make the defence itself the title, for example "Keeping it nice" or "The wall", so it becomes playable [synthesis].
• Stuck clients (insight without change, circular talk).
  • Shift group: move from conscious probing to an unconscious technique, or from insight to ego-strengthening such as reality rehearsal or patterns of significance (D1, D6) [synthesis].
  • Check for complementary countertransference that keeps you both in a fixed role. Try the opposite-sign response [source: Pedersen].
• Overwhelm, flooding and dissociation.
  • Stop and stabilise. Stop the improvisation or switch to holding: steady pulse, lower volume, a grounding tonal centre.
  • Orient the client. Bring them back to the room through their senses: feet, breath, what they can see.
  • Process gently. Talk only once they are regulated.
  • Rebuild. Make the next sessions more structured: shorter improvisations, clearer titles, ego-strengthening before going deeper again.
  • Wooster warns that music can undermine defences, so containment comes first [source: Sobey 2017].
• Psychosis and fragile egos. Priestley's hospital work included psychotic patients [source: MTiA contents; Sobey 2017].
  • Prefer structure, holding, reality-based and ego-strengthening work.
  • Avoid guided imagery, regression and dream work during active psychosis.
  • Keep interpretation minimal.
  • Liaise with the psychiatric team [synthesis].
• Retraumatisation and musical triggers.
  • Screen at intake (see section 2).
  • If a sound triggers the client, stop, name it, and offer an alternative instrument.
  • Do not play a perpetrator role in exploring relationships or reality rehearsal unless the client has explicitly asked for it and is stable.
  • Re-enactment and regression are exposure-like. They need consent, a stop signal, stabilisation skills in place, and grounding afterwards [synthesis].
• Non-adherence (missed sessions, refusal to play, wanting only to talk).
  • Explore what playing means to the client: shame about musical skill, fear of exposure.
  • Reassure them that no musical training is needed.
  • Start with small, safe instruments or voice, or begin with listening to you improvise.
  • Allow talk-only sessions without abandoning the frame [synthesis].
• Ruptures.
  • Watch for a client who stops playing with you, plays against you, or feels mocked by an imitation. Name it, take your share of responsibility, and invite them to play the rupture itself [synthesis].
  • Repairing within the warm alliance is central [source: Pedersen on the warm alliance].
• Over-interpretation. Never treat the content of an improvisation as diagnostic evidence of abuse or disorder. None of the cited sources offers a validated instrument for that. Use music as material for exploration, not as proof [synthesis].
• Therapist's own material. Strong, persistent countertransference, or playing that serves your own needs, calls for supervision and personal therapy. Priestley regarded both as essential. [source: Sobey 2017; Bunt 2004]. Priestley worked through her own bipolar episodes with team and analytic support [source: Wikipedia; Bunt 2004]. If you become unwell, use supervision and arrange cover [synthesis].
• Suicide and self-harm.
  • Follow your service's standard risk assessment and safety-planning procedures, including means safety and the involvement of the care team.
  • Do not use deep unconscious or regressive techniques while risk is acute.
  • Stay with holding and ego-strengthening [synthesis].
• Children and young people. Essays (ch. 27) and Eschen (2002, Mahns chapter) cover AMT with children; their procedures are not summarised here [uncertain]. [synthesis]:
  • Obtain parental or carer consent and the child's own assent.
  • Use shorter, playful improvisations with fewer verbal interpretations.
  • Involve parents or carers appropriately.
  • Follow local safeguarding and mandatory-reporting duties when there are disclosures or concerns, whether they arise in music or in talk.
  • Never use touch without consent, and never use sexual, genital or other intimate touch. [synthesis]
• Recording. Obtain written consent for audio recording, its storage and its use in supervision or training. Explain who will hear it and for how long it will be kept [synthesis].
• Hearing and physical safety problems. If a client keeps playing at harmful volumes, treat it as clinical material ("what needs to be this loud?") and also as a safety limit. Use softer instruments, beaters, or ear protection [synthesis].
• Cultural and spiritual material. Myths, sacred music or religious imagery belong to their traditions. Let the client lead, and do not perform another culture's ritual music or ceremony [synthesis].

Sources

Pages consulted

• Cooper (2011), A musical analysis of how Mary Priestley implemented the techniques she developed for AMT – Temple ScholarShare record (abstract only)
• Pedersen, I. N., Musikterapiens start inden for psykiatrien – lidt historie (Danish; Aalborg journals)
• Sobey, K. (2017), Book review of Priestley, Music Therapy in Action (2nd ed. reprint), Approaches
• Music Therapy in Action, 2nd ed. (2012) – table of contents, MCPHS library catalogue
• Pedersen (2002), Analytical music therapy with adults in mental health and in counseling work – Aalborg University record
• Eschen (Ed.) (2002), Analytical Music Therapy – e-bookshelf contents
• Mary Priestley – Wikipedia
• Wheeler, B. L. et al. (2012), Five international models of music therapy practice, Voices 12(1)
• Bunt, L. (2004), Mary Priestley interviewed by Leslie Bunt, Voices 4(2)
• Barcelona Publishers – Essays on Analytical Music Therapy (description and contents)
• CORE record 75004628 (excerpt on Intertherapy and the inner child)

Further pages consulted

• Kim, J. (2016), Psychodynamic music therapy, Voices 16(2)
• MacRae, A. (2019), A phenomenological inquiry into Inter Music Therapy – Temple ScholarShare record (abstract)
• Molloy University, MUS 5390 Analytical Music Therapy – graduate catalogue 2022–23
• Barcelona Publishers – The Music Therapy Writings of Benedikte B. Scheiby (description and contents)
• Cooper (2011) – ScholarShare metadata record (abstract)

Books cited

• Priestley, M. (1975; 2nd ed. 1985; reissued 2012). Music Therapy in Action. London: Constable; St Louis: MMB; Gilsum, NH: Barcelona.
• Priestley, M. (1994). Essays on Analytical Music Therapy. Gilsum, NH: Barcelona Publishers.
• Eschen, J. Th. (Ed.) (2002). Analytical Music Therapy. London: Jessica Kingsley.
• Cooper, M. L. (2011). A Musical Analysis of How Mary Priestley Implemented the Techniques She Developed for Analytical Music Therapy. PhD dissertation, Temple University.