Benenzon music therapy

1. Introduction

Version followed: the classic Benenzon model of music therapy (musicoterapia / "musicopsicoterapia") as Rolando O. Benenzon set it out in his 2005 clinical paper on Alzheimer's disease (ISO typology, intermediary objects, holding/setting, energetic exchange cycle). His 2019 reformulation as "Terapia Benenzon" (identidad sensorial, contemplation instead of observation, "no-out" rules, nine ethical principles) is added and labelled where it differs. His books (Music Therapy Manual, 1981; Teoría de la musicoterapia, 1991; La nuova musicoterapia, with Wagner and de Gainza, 1997; Musicoterapia. De la teoría a la práctica, 2000; Aplicaciones clínicas de la musicoterapia, 2000) are not paraphrased here, and items that only the books would supply are marked [uncertain]. Book concepts (the ISO principle, the non-verbal complex, the intermediary object versus the transitional object, the GOI, the instrument classifications, proxemics) rest on secondary sources that cite the books (Buenos Aires residency exam 2010, Imbriani 2017, Pecourt 2012) and are tagged as such. No published fixed session-phase sequence (such as warm-up, sound dialogue, closing) was found in Benenzon's papers or in the secondary sources used, so none is given [uncertain].

• What it is. An active, mainly non-verbal psychotherapy developed in Buenos Aires from 1965 by the Argentine psychiatrist and musician Rolando O. Benenzon, who in 1966 founded the music therapy school at the Faculty of Medicine of the Universidad del Salvador [source: Paidós/Planeta author biography]. Name variants: his publisher and his own papers print "Rolando O. Benenzon" or "Rolando Benenzon"; the Bresolin thesis gives "Ronald Omar" and a 1939 birth year [uncertain: "Omar" and the birth year appear only in that thesis]. It uses sound, music, movement and "corporo-sonoro-musical" instruments to develop the bond between therapist and patient or group. It was built for people with communication and relational difficulties: psychosis, autism, dementia and severe disability. The publisher's synopsis also lists intellectual disability, motor disorders, terminal illness and coma [source: Benenzon 2005; Benenzon 2019; Bresolin 2022; Schwarcz, definitions 1976–1998; Rabal Millán 2023; Paidós/Planeta synopsis].
• How change happens. Each person has a sound identity, the ISO (later broadened to a sensory identity, ISE). Benenzon's "principle of ISO" describes it as the infinite set of sonic, acoustic and movement energies that belong to and characterise a person [source: Buenos Aires residency exam 2010, citing Benenzon]. Another summary of Teoría de la musicoterapia gives "energies formed by sounds, movements and silences" [source: Pecourt 2012, citing Benenzon]. He calls the sound, musical and movement elements and acoustic phenomena that produce regressive effects the "complejo no verbal" (non-verbal complex) [source: Buenos Aires exam 2010]. The therapist finds and meets the patient's ISO through intermediary objects (mainly instruments and sounds), which opens new non-verbal communication channels. Repeated cycles of tension-discharge and rest between the patient's ISO and the therapist's ISO build a bond and a stable (homeostatic) relational system. Regressive pathways are accompanied rather than interpreted. The aim is to look for "the place of health" in the patient, not to focus on the illness [source: Benenzon 2005]. By 2019 Benenzon framed the goal as transformation, not change: "Transformar no es cambiar" [source: Benenzon 2019, p. 99].
• Professional frame. This is a named school or model within music therapy and psychotherapy. It is not a separately regulated profession. Benenzon trains people through his own institutions. In 2019 the full route was described as five years in the online Benenzon academy, across seven levels, with personal individual and group Benenzon therapy and ongoing "co-corporeo-percepción" (group case work) [source: Benenzon 2019, p. 104]. In Italy, a Turin centre (Diversamente Arte) runs a six-level weekend course leading to "Tecnico nel modello Benenzon". Its teachers hold Benenzon technician, Magister and supervisor diplomas awarded in Buenos Aires [source: Diversamente Arte course page]. A Benenzon technician certificate is not a licence to practise psychotherapy or music therapy. Practise only within your own registration: HCPC-registered music therapist in the UK, MT-BC (CBMT) in the US, or your country's licensed music therapist or psychotherapist status [synthesis] [uncertain: registration routes]. Do not run the regressive or cathartic work below without Benenzon training, personal therapy and supervision, which the model itself requires [source: Benenzon 2019; Benenzon 2005].

2. Framework

No published phase model with numbered stages and transition criteria, and no fixed within-session sequence (warm-up, sound dialogue, closing or similar), appears in Benenzon's papers or the secondary sources used, so none is given here [uncertain]. The 2005 paper refers to a chapter titled "Los 15 pasos técnicos para realizar una sesión de musicopsicoterapia" but does not list the steps, and the 2019 paper mentions "15 fundamental rules" without listing them [source: Benenzon 2005; Benenzon 2019] [uncertain: the steps are probably set out in Benenzon's books and are not reproduced here]. What the 2005 paper does give is a three-step energetic sequence (see 4.7), rituals for opening and closing sessions, and, in dementia, treatment that "acompaña al paciente hasta el fin de sus días" [source: Benenzon 2005]. The table below orders the activities the 2005 and 2019 texts describe. It is a working frame, not a published protocol: session count, length and transition criteria are the writer's synthesis [synthesis].

Throughout: regular supervision is part of the setting itself ("una constante del encuadre o setting") [source: Marsimian 2024, citing Benenzon 2000].

Session format the sources describe [source: Imbriani 2017, citing Benenzon, Wagner & de Gainza 1997]: patient and therapist sit facing each other, surrounded by the instruments available to them, and play together. The room holds a plentiful, varied set of instruments that need no musical training, a way to play recorded material, and audio-visual recording of sessions. Each therapist assembles their own set of instruments, the GOI (see 4.20) [source: Buenos Aires exam 2010]. The sources used give no session length or frequency [uncertain].

3. Guiding principles

• Look for the place of health. Plan from what still works (the preserved universal ISO, emotional memory) rather than from deficits [source: Benenzon 2005].
• ISO before technique. You cannot choose an instrument, rhythm or song until you have some hypothesis about the patient's ISO. Know your own ISO too, because yours enters every exchange [source: Benenzon 2005; Rabal Millán 2023].
• Contact begins with imitation or repetition. Mirror the patient's sound or movement before offering anything new [source: Bresolin 2022, citing Manarolo 2011].
• The non-verbal context is primary. Sensation, rhythm, voice tone and body movement are the most sensitive channel. Talk is kept to a minimum [source: Benenzon 2005].
• The therapist's body is the main instrument. Your posture, breathing, distance and voice are interventions [source: Benenzon 2005].
• Four basic postures: "Esperar," "Estar atento," "Escuchar," "Percibir". Wait, stay attentive, listen, perceive. Initiative comes from the patient [source: Benenzon 2005].
• Non-directive stance. Observe and listen rather than lead [source: Bresolin 2022]. In the 2019 version, "observing" is itself dropped in favour of contemplation: attend to the surroundings and to your own inner landscape [source: Benenzon 2019, pp. 102–103].
• "No-out" (2019). In every bond, avoid invading, stimulating, seducing, suggesting, intervening, prejudging, provoking, interpreting, stigmatising, labelling, diagnosing, observing and ranking. Practical meaning: check each impulse to act against this list [source: Benenzon 2019, p. 102]. [uncertain: this is in tension with the more active 2005 techniques, such as stimulation; name which version you follow.]
• Horizontality. No hierarchy in communication. In 2019 the term "paciente" is replaced by "el-otro" [source: Benenzon 2019, p. 102].
• Ethics as listening to the other's desire. "la ética es la capacidad de escuchar el deseo del otro" [source: Benenzon 2019, p. 103].
• Stable container and ritual. Same space, holding and repeated sequences "que se vuelvan rituales" [source: Benenzon 2005]. Treat the setting as sacred [source: Benenzon 2019, p. 104].
• Holding is multi-layered. Institution, health team, building (ISO ambiental), therapist, co-therapist, family and community culture all shape the non-verbal system. Manage all of them, not only the session [source: Benenzon 2005].
• Work in a therapeutic pair. Use a co-therapist wherever possible [source: Benenzon 2019 (principle 2); Bresolin 2022].
• Active, not passive, music. Benenzon contrasts his method with "animación musical" and passive listening, which he warns can lead to immobility [source: Benenzon 2005].
• Accompany regression and keep your position. Go back with the patient while holding your own adult position (a deliberate dissociation), then return towards the prospective path [source: Benenzon 2019, p. 98].
• Therapist self-care and training. Protect your own health and prevent burnout. Undergo individual and group Benenzon therapy. Keep professional secrecy "hasta la muerte" [source: Benenzon 2019, p. 104]. Avoid acting out [source: Benenzon 2019, p. 104].
• Supervise the countertransference. Transference and countertransference in non-verbal exchanges are the main supervision material [source: Marsimian 2024, citing Benenzon].

4. Intervention inventory

This model is mostly non-verbal, so "example language" is often a gesture, a sound or a short sentence to family or staff. All wording is illustrative unless quoted. The setting comes first. The sources call for a stable, ritualised space and name water as a possible setting, with water instruments ("acuáfonos") [source: Benenzon 2005]. They give no physical specification of the room [uncertain]. Practical set-up [synthesis]: a quiet room with no through-traffic; instruments of graded loudness and texture laid out the same way every time, including drums, small percussion, string and wind instruments, and voice; a floor area for movement; and room for wheelchairs.

Music and sound safety (applies to every item) [synthesis]. Drums, gongs and cymbals in small rooms can easily reach harmful levels. Keep peaks moderate. Offer ear defenders to patients, staff and yourself. Limit loud improvisation time. Watch for hyperacusis, which is common in autism, and for people with hearing aids or cochlear implants. Remove sharp or small swallowable parts for people with dementia or severe disability. Clean shared wind instruments or keep them for one person only. Music is also a trauma trigger. Particular songs, anthems, religious or military music, a dead person's songs, and sudden loud sounds can bring on flashbacks or grief. Ask about "sounds and songs to avoid" during the ISO history, and keep a do-not-use list in the file.

4.1 Search for the ISO: sound and music history (family interviews, home visits)

• Purpose / when. Before treatment, and again whenever the work stalls. The aim is to identify the patient's ISOs as the 2005 paper defines them. The gestalt ISO is linked to the history of the person's intrauterine gestation. The cultural ISO holds the sounds, movements and analogical behaviours of the surrounding culture. The family ISO is the set of non-verbal energies that characterise a particular family. The universal ISO is tied to phylogenetic and ontogenetic inheritance [source: Benenzon 2005]: heartbeat, breathing, the mother's voice [source: Bresolin 2022]. The ISO in interaction arises each time a relationship is formed [source: Benenzon 2005]. The 2005 paper names the group, complementary and environmental ISO without defining them. Bresolin (citing Manarolo) gives the complementary ISO as the everyday adjustments of the gestalt and cultural ISO, and the group ISO as a group's own sound identity [source: Bresolin 2022; Rabal Millán 2023]. [uncertain: Bresolin defines the gestalt ISO as sound experience from birth to the present, not from gestation; this guide follows Benenzon 2005.]
• Steps. (1) Interview the family, and the patient if possible, over several meetings [source: Benenzon 2005]. (2) Visit the home where feasible and note the sound environment: TV, voices, street noise, household rhythms [source: Benenzon 2005 (home visits)]. (3) Collect songs from each life period: lullabies, childhood games, the music of their courtship and work, religious and regional music, dances [synthesis]. (4) Ask which sounds soothe, which agitate and which must be avoided [synthesis]. (5) Write a working ISO hypothesis and list candidate intermediary objects [synthesis]. Benenzon's structured history form ("ficha musicoterapéutica") is mentioned in the literature; its items are not reproduced here [uncertain].
• Example language (illustrative). To a daughter: "What did your father sing or whistle while he worked? Which sounds made him leave the room?"
• Watch for. Grief in relatives, and songs tied to trauma. Families tend to offer what is "good music" rather than what was actually lived, so ask for everyday sounds too [synthesis].

4.2 Family ISO work: training relatives as co-therapists

• Purpose / when. To continue the work between sessions and to repair family communication. Especially useful in dementia and childhood disability [source: Benenzon 2005].
• Steps. (1) Help relatives recognise their own ISO [source: Benenzon 2005]. (2) Show them the patient's responsive sounds and rhythms [synthesis]. (3) Agree on 1–2 simple home rituals, such as singing the patient's lullaby with their name at waking or bedtime [source on name-lullaby: Benenzon 2005; home use: synthesis]. (4) Review these at each family meeting [synthesis].
• Example language (illustrative). "When she starts tapping like this, tap back at the same speed before you try anything else."
• Watch for. Relatives turning it into performance or forcing it. Carer exhaustion. Relatives are "auxiliares y continuadores", not therapists, so keep the clinical work in sessions [source for term: Benenzon 2005; boundary: synthesis].

4.3 Relational assessment in the setting

• Purpose / when. At the start of treatment and periodically after that. Assess current relational capacity rather than diagnosis [source: Benenzon 2005]. Identifying the ISO, the intermediary object and the integrating object is treated as the diagnostic side of the method [source: Bresolin 2022, citing Manarolo].
• Steps. (1) Bring the patient into the prepared room. (2) Take the four postures: wait, stay attentive, listen, perceive [source: Benenzon 2005]. (3) Note the patient's rhythm, movement and pauses [source: Benenzon 2005], which instruments they approach or avoid, and their distance from you and the co-therapist [synthesis]. (4) Record or note the session straight afterwards. The co-therapist records what the therapist cannot see [synthesis].
• Example language. Mostly none. If needed: "This room is for sounds. You can use anything here, or nothing." (illustrative)
• Watch for. Do not read artwork-like "diagnostic" meaning into a single sound. No validated scale for this assessment was found in the sources [uncertain]. In the 2019 version Benenzon says "hemos dejado de observar" and replaces observation with contemplation, so decide which stance you are using [source: Benenzon 2019, p. 102].

4.4 Offering and working with intermediary objects

• Purpose / when. The intermediary object is a communication tool. It acts therapeutically through the relationship without causing intense alarm, so you can reach the patient past their resistance and anxiety. In music therapy these objects are mainly instruments and the sounds they make [source: Rabal Millán 2023, citing Benenzon 1981; Bresolin 2022]. Benenzon calls it an instrument of communication able to create new communication channels, and distinguishes it from Winnicott's transitional object [source: Pecourt 2012, citing Benenzon]. Unlike the transitional object, the intermediary object never becomes a fetish, and its use in the therapeutic bond is positive [source: Buenos Aires exam 2010]. The concept comes from psychodrama (puppets) [source: Rabal Millán 2023]. Unlike a puppet, whose voice is the therapist's, an instrument has its own sound [source: Pecourt 2012, citing Benenzon 2011].
• Steps. (1) From the ISO hypothesis, pick instruments closest to the patient's gestalt ISO, and to the universal and complementary ISO as well [source: Rabal Millán 2023]. Check each candidate against the qualities Benenzon lists for an intermediary object: easy to play, easy to move, strong sound, capacity to expand, clear rhythmic and melodic structure, and a presence that is itself a stimulus [source: Pecourt 2012, citing Benenzon]. (2) Introduce corporo-sonoro-musical instruments gradually rather than all at once [source: Benenzon 2019, p. 98]. (3) Use the instrument as a distance regulator: let the patient play to the instrument, then near you, then with you [synthesis based on Rabal Millán 2023: "distance between instrument and therapist"]. (4) Note which object the patient uses defensively (to block contact), cathartically (to discharge), totemically (keeps or carries it), experimentally, or in an "enquistado" (encysted, stuck) way, and which one integrates. These six labels are Benenzon's own (defensivo, catártico, totémico, experimental, enquistado, integrador) [source: Benenzon 2005], but the 2005 text does not define them. The functional readings given here are [uncertain/synthesis]. No source used describes an "incorporated object" [uncertain].
• Example language. Offer the object silently, at a distance. Do not explain it.
• Watch for. A patient "locking" onto one object for weeks (possibly encysted) [uncertain]. An object becoming a weapon, which means removing it calmly. Working signs: the patient plays towards you, or pauses to wait for your reply [synthesis].

4.5 Integrating object in groups

• Purpose / when. In group work, an instrument that gathers the group's energy and becomes the shared reference, carrying the group ISO [source: Bresolin 2022; Benenzon 2005 (ISO grupal listed)].
• Steps. (1) Watch which instrument the group repeatedly converges on [synthesis]. (2) Keep it at the centre of the space and stable from session to session [synthesis]. (3) Let the group's shared rhythm form around it rather than imposing a pulse [synthesis].
• Example language. None. Place the instrument and wait.
• Watch for. One member monopolising the object. If so, introduce a second or larger object that more people can play at once [synthesis].

4.6 Imitation and mirroring to make contact

• Purpose / when. The first contact with withdrawn, autistic or psychotic patients. Benenzon's starting observation was that contact needs imitation or repetition of the other's actions [source: Bresolin 2022, citing Manarolo].
• Steps. (1) Match the patient's sound, rhythm, tempo, breathing or rocking at the same intensity. (2) Keep it up until the patient shows they have noticed: a pause, a look, a change. (3) Only then add one small variation and wait [steps 2–3: synthesis].
• Example language. Non-verbal: echo the patient's three taps exactly, then stop.
• Watch for. Mimicry that feels mocking to verbal adults. Over-stimulation. Working signs: the patient tests you by changing the pattern to see whether you follow [synthesis].

4.7 The excitation–rest cycle (energetic exchange between ISOs)

• Purpose / when. The core mechanism of the bond. Through repeated cycles the patient-therapist pair becomes a homeostatic system [source: Benenzon 2005].
• Steps (sequence as given in source). (1) Through non-verbal expression the therapist helps release tension held in the patient's ISOs. (2) The patient's discharge affects the therapist's ISOs. (3) The therapist responds from their own bodily, sonic and non-verbal associations. (4) Repeat excitation-to-rest cycles until a bond forms [source: Benenzon 2005]. Practical rendering [synthesis]: meet the patient's intensity, follow it to its peak, then lead the sound down into quiet, hold the silence, and let the patient start the next cycle.
• Example language. None in session. In notes, record each cycle's trigger, peak, resolution and length.
• Watch for. Escalation that does not come back to rest (agitation, aggression, self-injury). If so, lower your own volume and tempo first, then end the cycle with a familiar ISO element [synthesis]. Your own countertransference reactions are data and belong in supervision [source: Marsimian 2024].

4.8 Singing and improvising with the patient's ISO material

• Purpose / when. To use the ISO directly once a channel is open, especially the cultural ISO, which is most useful in early dementia (CDR 0.5–1) [source: Benenzon 2005].
• Steps. (1) Bring in a rhythm or melody fragment from the ISO history, not a whole performed song [synthesis]. (2) Improvise on it with the patient's own rhythms and melodies [source: Benenzon 2005]. (3) Leave gaps for the patient to fill. (4) Go back to the fragment as a home base [steps 3–4: synthesis].
• Example language (illustrative). Sing a phrase from their regional song, leaving the last word open.
• Watch for. Grief or trauma triggers in personally significant songs (check the do-not-use list). Turning into entertainment, which Benenzon contrasts with "animación musical" [source: Benenzon 2005].

4.9 Body percussion and clapping ("palmeo")

• Purpose / when. To use the body as the first instrument, for patients who avoid objects or have limited mobility [source: Benenzon 2005 (lists body percussion and palmeo)].
• Steps [synthesis]. Start on your own body, by patting your chest or knees at the patient's tempo. Invite them by pausing. If they join, alternate turns.
• Watch for. Self-hitting that turns harmful. If so, redirect to a drum or a softer surface [synthesis].

4.10 Movement and dance adapted to the patient's rhythm

• Purpose / when. To widen the channel from sound into movement. Benenzon's example is adapting a tango to the patient's own rhythm [source: Benenzon 2005].
• Steps [synthesis]. (1) Follow the patient's gait or rocking. (2) Fit a culturally familiar dance rhythm to that tempo, not the reverse. (3) For wheelchair users, move arms or the chair itself, with consent.
• Watch for. Falls, dizziness and orthostatic drops in older adults. Keep the floor clear [synthesis].

4.11 Sensory stimulation and touch

• Purpose / when. For people with little response, such as advanced dementia. Benenzon lists smell, touch, moving the patient and "cenesthetic" (whole-body) sensations [source: Benenzon 2005]. In 2019 the ISO was widened to an identidad sensorial with sensory mediators: smell, temperature, texture, taste, waste, emptiness, and "the abyss" [source: Benenzon 2019, p. 101].
• Steps [synthesis]. (1) Get explicit consent for touch from the patient where possible, and agreement from the legal proxy and team where capacity is lacking. Write it in the plan. (2) Start with low-intensity, non-intimate contact: hands, forearms, shoulders. Never sexual or genital touch, and avoid areas the history flags. (3) Combine one sense with one sound. (4) Stop at any sign of withdrawal, grimace or agitation.
• Watch for. Trauma responses to touch. Cultural and gender norms. Allergies and asthma with scents. Choking risk with taste materials. Note that the 2019 "no-out" list warns against "estimulando" (stimulating), which conflicts with this 2005 technique [uncertain: choose and state your version].

4.12 Rituals: opening, closing and name-lullaby

• Purpose / when. To give a stable container through sequences "que se vuelvan rituales" [source: Benenzon 2005]. A repeated piece opens or closes each session. A lullaby sung with the patient's name helps orientation [source: Benenzon 2005].
• Steps [synthesis]. Choose one short opening sound or piece and one closing one from the ISO history. Use them identically each session. Signal the closing piece a few minutes before the end.
• Example language (illustrative). Sing the lullaby melody with "… [name], it's time to rest now".
• Watch for. Rituals becoming mechanical, or serving the therapist rather than the patient [synthesis, cf. Torres 2020 on opening/closing songs]. Tailor them to each case.

4.13 Accompanying regression, delusions and hallucinations

• Purpose / when. Music therapy follows "caminos regresivos". Delusions and hallucinations in dementia are treated as attempts to meet a need, to be accompanied rather than corrected [source: Benenzon 2005]. Historically (1965) Benenzon used music to open "regressive nuclei" in groups of severely ill psychiatric patients, then lead back to the prospective path [source: Benenzon 2019, p. 98].
• Steps. (1) Follow the patient's regressive material (infantile sounds, rocking, lullaby-like vocalising) with matching sound [source: Benenzon 2005; detail: synthesis]. (2) Keep your adult position while accompanying, a deliberate double position [source: Benenzon 2019, p. 98]. (3) Before the session ends, bring the sound back to present-day ISO material and the closing ritual [synthesis].
• Example language. Non-verbal. Afterwards, to staff (illustrative): "He was calling his mother; the lullaby settled him. Please don't correct him if he does it on the ward."
• Watch for. Regression in someone with psychosis, dissociation or trauma who cannot come back. Stop, ground them, and review the indication in supervision [synthesis]. Do not use deliberate regression without Benenzon training, supervision and a team.

4.14 Receptive (listening) music in groups: historical use only

• Benenzon began in 1965 with receptive music therapy for groups of severe psychiatric patients [source: Benenzon 2019, p. 98]. Later he warned that passive listening can lead to immobility, and he does not regard it as music psychotherapy [source: Benenzon 2005]. Use it only as a brief bridge into active exchange [synthesis].

4.15 Instrument and space adaptation

• Purpose / when. For wheelchair users and physical disability [source: Benenzon 2005 (adapting instruments for wheelchairs)].
• Steps [synthesis]. Mount instruments at reachable height. Use stands, lap drums, large beaters and switch-operated sound sources. Keep the layout the same each session.

4.16 Everyday and "essential" objects (water, earth, fire, waste, clepsydra)

• Purpose / when. After 1999 Benenzon added objects from daily life as intermediary objects: water, earth, fire, waste and the clepsydra (water clock) [source: Benenzon 2019, p. 99]. Water can also be the setting, with water instruments (acuáfonos) [source: Benenzon 2005].
• Steps. The sources used give no procedure [uncertain]. Use only after training [synthesis].
• Watch for (materials safety) [synthesis]. Fire: real flame is usually not allowed in clinical rooms, so use institutional policy and alternatives. Water: slip and electrical hazards, infection control, and drowning risk with pools for anyone with epilepsy or dementia. Earth and waste: hygiene, allergies, and swallowing in dementia or pica.

4.17 Co-therapy

• Purpose / when. Work as a therapeutic pair whenever possible [source: Benenzon 2019, principle 2; Bresolin 2022]. The co-therapist is part of the holding [source: Benenzon 2005].
• Steps [synthesis]. Agree on roles beforehand: one engages, one holds the space and notes. Debrief after every session, including both therapists' countertransference.

4.18 Supervision (four stages)

• Purpose / when. Supervision is a constant part of the setting. The main material is the non-verbal phenomena the therapist transmits, plus transference and countertransference [source: Marsimian 2024, citing Benenzon 2000].
• Steps. (1) Preparation: choose a supervisor and reflect on the patient. (2) The supervision itself, using words, audio-images, role-play and inner impressions. (3) Feedback, which the therapist translates into analogical, non-verbal communication with the patient. (4) The effect: the therapist understands their internal phenomena and points of conflict are clarified [source: Marsimian 2024]. Benenzon's later version calls for horizontal supervision and continuous group "co-corporeo-percepción", where the therapist brings and dramatises the history of the relationship, with contemplators, and all participants "ponen el cuerpo y su propia historia" [source: Benenzon 2019, pp. 103–104].

4.19 Contemplation and the "no-out" self-check (2019 version)

• Purpose / when. The therapist's in-session discipline in Terapia Benenzon [source: Benenzon 2019, pp. 102–103].
• Steps. (1) Replace analytic observation with contemplation, described as a state that lets you "estar y no estar, estando" (be and not be, while being) [source: Benenzon 2019, p. 103]. (2) Before any act, check it against the no-out list (invading, stimulating, seducing, suggesting, intervening, prejudging, provoking, interpreting, stigmatising, labelling, diagnosing, observing, ranking) [source: Benenzon 2019, p. 102]. (3) After the session, write down every no-out you noticed and take it to supervision [synthesis].
• Watch for. Passivity being mistaken for contemplation when a patient needs safety action. Clinical risk duties always come first [synthesis].

4.20 Building the instrumentarium (GOI) and arranging the space

• Purpose / when. Before treatment starts, and when reviewing a stuck case. Benenzon's GOI is the set of sound-musical instruments that makes up each music therapist's own therapeutic kit [source: Buenos Aires exam 2010, citing Benenzon]. Intermediary and integrating objects are found among these instruments (4.4, 4.5) [synthesis].
• Steps. (1) Assemble a varied set across Benenzon's classes: body, natural, everyday, self-made and musical instruments (conventional, non-conventional, folk and primitive), plus electronic sources [source: Imbriani 2017, citing Benenzon et al. 1997]. (2) Prefer instruments anyone can play without training [source: Imbriani 2017]. (3) Benenzon also classes instruments in an analytic-projective way, into fetal, maternal and paternal groups. The maternal group includes drums, timpani, guitar, tambourine, conga and metallophones [source: Buenos Aires exam 2010] [uncertain: the contents of the other groups and their clinical use are set out in the books and are not given here]. (4) Attend to proxemics, Benenzon's term for how people perceive and use space: set and vary the distance between patient, therapist and instruments deliberately [source for term: Buenos Aires exam 2010; application: synthesis]. (5) Seat patient and therapist facing each other with the instruments around them [source: Imbriani 2017], and keep the layout stable between sessions (see 4.12) [synthesis].
• Example language. None. The arrangement of the room is the intervention.
• Watch for. Do not read a patient's choice of "maternal" or "paternal" instruments as diagnostic evidence. No validation for this was found [synthesis]. Check loudness and hygiene (see the safety note at the start of section 4).

5. Handling problems

The sources used say little about problem management beyond the stance, supervision and passivity warnings. Everything here not tagged [source] is [synthesis].

• No response (stuck, "absent" patient). Do not read this as "psychic death". Benenzon frames dementia as an altered state of consciousness with emotional memory preserved [source: Benenzon 2005]. Responses: go back to universal ISO elements such as heartbeat-like pulse, breathing rhythm and a lullaby [source: Benenzon 2005]. Lengthen your waiting. Reduce what is on offer to one object. Repeat the ISO search with the family (4.1). Try another channel: touch, movement or water (4.10, 4.11, 4.16). Take it to supervision with recordings.
• Resistance or avoidance of instruments. In this model, intermediary objects exist to get round resistance and anxiety [source: Bresolin 2022; Rabal Millán 2023]. Increase the distance. Let the object sit there unplayed. Use your body or voice instead (4.9). Don't chase the patient, which would be "invading" in 2019 terms [source for term: Benenzon 2019].
• Overwhelm, agitation, catharsis that won't settle. Lower your own intensity first. Shift to a slow, binary pulse. Bring in the closing ritual early. Remove loud or sharp instruments. With a co-therapist, one of you holds the space while the other attends to the patient. Afterwards, review whether a cathartic object was used too early.
• Musical trauma triggers. Sudden distress at a particular song, anthem, religious or military music, or a deceased spouse's song. Stop the material straight away. Return to neutral rhythmic sound. Name it briefly if the person is verbal. Add it to the do-not-use list. Inform the team and family if it may recur elsewhere, for example the radio on the ward.
• Hearing safety problems. The patient covers their ears, or staff complain. Cap the volume. Offer ear defenders. Swap to softer instruments. Check for hyperacusis and hearing-aid feedback. Watch your own cumulative exposure across a day of drumming groups.
• Escalation to aggression or self-injury. Remove the object calmly. Follow the institution's de-escalation plan. Never restrain as part of "music therapy". Document it and review the indication.
• Ruptures. These include a patient leaving, a missed session, a change of room, a new co-therapist, or a family conflict entering the holding. The holding includes institution, building, team and family [source: Benenzon 2005], so repair the frame first: same room, same rituals. Prepare for any change with the ritual. Explore your countertransference in supervision [source: Marsimian 2024].
• Non-adherence: family or institution. Relatives who stop the home rituals, or staff who undo session gains, for example by correcting a patient's "delusion". Hold brief team and family meetings and show them the responsive sounds directly. Keep requests small (4.2).
• Sliding into entertainment. Group sing-alongs and requests for "concerts" pull towards "animación musical" [source: Benenzon 2005]. Say clearly to the institution what the sessions are for. Keep sessions small and closed.
• Therapist burnout and acting out. Benenzon's first ethical principle is protecting the therapist's own health, and principle 5 is avoiding acting out [source: Benenzon 2019, p. 104]. Watch for over-involvement, extra contact outside the setting, and taking objects home. Use personal therapy and group co-corporeo-percepción [source: Benenzon 2019].
• Version conflict (2005 active techniques versus the 2019 no-out stance). State in the care plan which version you follow. When in doubt, lean towards the less invasive option.
• End of life and frail patients. Benenzon's 2005 paper states that music therapy with terminal patients may hasten death, and notes cases of food refusal [source: Benenzon 2005; no data given, uncertain]. Practical response: in palliative care, keep sessions short, gentle and patient-led. Watch eating, fatigue and distress, and coordinate with the medical team. Music therapy is an adjunct and never replaces medical or nursing care.
• Children and young people (autism, disability). Get parental consent and the child's own assent, and include an easy way to stop, such as a stop-card or a sound signal. Usual safeguarding and mandatory-reporting duties apply. Sound, play or regressive material is not evidence of abuse or of any diagnosis. Report concerns through local procedures based on what the child says or shows, not on interpretation. Involve parents through the family ISO work (4.2). Avoid touch-based sensory work (4.11) without explicit agreement and a second adult present.
• Psychosis, dissociation, trauma. Regressive work (4.13) can destabilise. Screen for current crisis, recent trauma and dissociation. Agree a grounding plan. Use present-day ISO material more. Stop regressive work if reality-testing worsens, and liaise with the psychiatrist.
• Suicide or self-harm disclosures (verbal or enacted). Leave the non-verbal frame. Carry out a standard risk assessment and follow local safety planning.
• Scope. If you are not a registered music therapist and not Benenzon-trained, restrict yourself to the low-risk elements: the ISO history, the family ISO work, stable rituals and mirroring. Refer patients for the rest.

Sources

Sources used:

• Benenzon, R. (2005). Aplicación de la musicoterapia en el paciente Alzheimer según el modelo Benenzon. Interpsiquis 2005, psiquiatria.com (primary)
• Benenzon, R. (2019). La resistencia al no verbal: de la musicoterapia a la terapia Benenzon. Revista InCantare 10(1), 96–105 (primary)
• Bresolin, R. (2022). La musicoterapia con adolescenti con fragilità emotiva in comunità. Università di Padova thesis (citing Manarolo 2011) (secondary)
• Rabal Millán, M. (2023). Musicoterapia y autismo: apuntes para su comprensión en clave didáctica. Music Research Today 5(1), 155–166 (secondary)
• Marsimian, N. (2024). Reflexiones acerca de la supervisión en musicoterapia en el contexto del autismo. Voices 24(2) (secondary)
• Schwarcz López Aranguren, V. La musicoterapia: análisis de definiciones (year not shown) (secondary)
• Almansa Martínez, P. (2003). La terapia musical como intervención enfermera. Enfermería Global 2 (secondary; ISO definition)
• Torres, J. (2020). Outro: sobre canciones de apertura y cierre en musicoterapia. XII Congreso, Facultad de Psicología UBA (not Benenzon-specific)
• Diversamente Arte, Torino: Tecnico modello Benenzon (course listing)
• ECU library catalogue record: Benenzon, Music therapy manual (1981)
• Wagner, G. (2021). From an empirical approach to scientific evidence. In Volpe (ed.), Arts Therapies in Psychiatric Rehabilitation, Springer (abstract only)
• Gobierno de la Ciudad de Buenos Aires, Ministerio de Salud: residency entrance exam, Musicoterapia (2010) (secondary; Benenzon concepts with answer key)
• Imbriani, C. (2017). Le Tibetan Singing Bowls e l'intervento musicoterapeutico. G Ital Med Lav Erg 39(4), 273–277 (secondary; cites Benenzon, Wagner & de Gainza 1997)
• Pecourt, M. (2012). The role of a favorite music instrument to enhance communication in music therapy. Aalborg University master's thesis (secondary; cites Teoría de la musicoterapia)
• Paidós/Planeta: Benenzon, Musicoterapia (2011), synopsis and author biography (publisher page)

Books cited, content not paraphrased [uncertain on content]:

• Benenzon, R. O. (1981). Music Therapy Manual (trans. W. Grabia). Springfield, IL: C. C. Thomas (details from catalogue record).
• Benenzon, R. O. (1991). Teoría de la musicoterapia: aportes al conocimiento del contexto no-verbal (as cited by Schwarcz).
• Benenzon, R. O. (2000). Musicoterapia. De la teoría a la práctica (as cited by Almaraz Riesco 2022).
• Benenzon, R. O. (2000). Aplicaciones clínicas de la musicoterapia. De la supervisión a la autosupervisión. Lumen (as cited by Marsimian 2024).
• Manarolo, G. (2011), cited by Bresolin [uncertain: full title not given there].
• Benenzon, R. O., Wagner, G. & de Gainza, V. H. (1997). La nuova musicoterapia. Il Minotauro (as cited by Imbriani 2017).