OCD Treatment with Music: Notes from “Case Studies in Music Therapy”

A Co-op’s Post: Taking a Closer Look at Music Therapy
Written by Britney McNeilly, Northeastern Co-op Student at RMTS

Recently I read an interesting study about a thirty-one year old man with Obsessive Compulsive Disorder.  This condition caused him feelings of doubt, unrest, and panic, and resulted in emotional and social issues that affected his every day life.  Characteristic to OCD, John* (as I will refer to him for privacy purposes) had a strong need for order and was afraid and overwhelmed by irregularities.   Though he had been working with a psychotherapist for years, there had been no notable improvements in John’s condition.  On a whim, John’s therapist decided to refer him to music therapist Jose Van Den Hurk.  After a brief assessment, the music therapist decided that he would use improvisation as his primary therapeutic tool.

“John* had an intense need for security, predictability, and set rules,” said Van Den Hurk.  “From the very first contact, it was obvious that my client did not want to take any risks.  He was afraid of the unknown.” (pg 329)  During his early music therapy sessions, John’s fears were reflected in his improvisation– he was passive, submissive, uncreative, and showed no spontaneity.  He selected instruments which were familiar to him, and he did not experiment with them.  John had low self-confidence and required validation, approval, and reassurance.  Because of this, he found it difficult to make decisions, often second guessing himself or asking others for advice.  This attitude could be seen in his hesitance to choose musical instruments and to improvise.

John was a very intellectual person; however his emotions were lacking and unaccessible.  He would play music mechanically, interjecting no feeling into his play through the manner or dynamics or tempo.   Because of his low-self confidence, John was afraid of being hurt.  Rationalizing his emotions and focusing on his intellectuality, he defended himself from any possible rejection or betrayal.  John also feared intimacy.  This was demonstrated in his therapy sessions by his lack of musical contact with his therapist.  It was as though the act of playing together and connecting musically scared him.

From his initial observations and discussions with John, Van Den Hurk devised a treatment plan.  First, he selected two different but familiar instruments for John and himself (guitar and percussion).  In this scenario, John was playing a familiar instrument, did not have to make the decision of choosing an instrument, and was using an instrument different from the therapist (in order to eliminate any possibility for an intimate musical connection)– the ultimate safe haven.

At the next stage, the music therapist selected two identical, familiar instruments.  Though John did not have to make a choice or play an unfamiliar instrument, he was forced to risk intimacy with the therapist.  He began by refusing to look at the therapist when playing, concentrating solely on his own mechanical technique and rhythm and ignoring any means of connection.  However as time passed, it was noted that John paid more attention to the therapist, especially when playing piano.  This newfound emotional connection was created because John felt more at ease on the piano, and therefore his self confidence was boosted.  Feeling worthy and confident, he was less hesitant to look the therapist in the eye and sync his rhythms with him. John’s improvisations became more dynamic and expressed more emotions as he improved musically– an important step forward.  Emotionally reserved, music was a safe way for John to acknowledge his feelings and release them.

To work on John’s decision making, the therapist encouraged him to now choose his own instrument.  He was forced to deal with the difficulty of decision making, but had control over which instrument he picked (familiarity) and whether it was similar or different to that of his therapist’s (intimacy).  This focused on a different aspect of John’s OCD, but allowed him to integrate his previous progress of playing with the therapist.  He was no longer afraid of selecting similar or identical instruments, and

The last stage worked on John’s lack of spontaneity and incessant need for routine.  When improvising with John, the music therapist initially used a technique called “empathy” (Bruscia 1987) in which the therapist works on imitation, synchronization, and pacing and reflecting.  Once noted progress had been made in other areas, this technique was exchanged with that of “elicitation” and “redirection.”  These strategies include repeating, making spaces, interjecting, and introducing change.  Through this style of improvisation, John was forced to experiment, take initiatives, and react spontaneously.

John’s progress in music therapy was notable, but the real challenge was applying the concepts he’d mastered in class to his life. Music therapy was an important transitory step for John, and through continued music and psycho therapy, his Obsessive Compulsive Disorder has become easier to manage.