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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Clare Hobbs who works in acute and forensic psychiatry in London.

Seaun is about thirty, he's had a fairly disruptive background, split-up parents, lots of truanting from school, he ran away from a step-father when he was sixteen and then lived alone. He shared flats with friends, had various odd jobs, had some training in computing, plays the guitar, and basically slipped into an existence of lots of street drugs, busking, hanging around...

When he was in his mid twenties he raped a woman at knifepoint in the East End at about ten at night... he may have been suffering from a drug-induced psychosis.

He was charged and transferred to an interim secure unit, was then moved out to a private hospital, and transferred back to the secure unit two years ago. After that he showed symptoms of a fairly long-term psychotic illness and a personality disorder and has been on anti-psychotic medication for some years now.

I have seen Seaun in three separate periods. He came for an assessment group and sat around and played Bob Dylan songs on the guitar. He let other people join him, was quite interactive but focused on playing the guitar which he could do. That was over a period of two months. I then suggested that he move into a closed music therapy group, that he commit himself to coming regularly, which he did.

He seemed to be manic at that stage: he would play very loudly for very long periods and then talk incessantly. I remember actually stopping him in mid-flow once, and saying' stop talking, stay quiet for a moment and try to listen to other people, because this group will be destructive if people don't listen to each other'. And he did - he responded to firm talking to - which I had to do to set boundaries.

He gradually became very withdrawn and then stopped coming altogether. I went to him and asked him to come, as he contributed so much to the sessions. His only response was 'No I'm useless' and walked out... that was the last time he actually spoke to any of us. That was in the January, and I went away from March until September of that year.

While I was away, he went through this period of being verbally aggressive to the staff. They were testing him out for re-engaging with therapy programmes. At that stage he was making some inappropriate comments to all the women... very sexual comments - and they wouldn't let any of the women work with him - and most of us are women!

He asked me whether he could come to music therapy again, and eventually the team agreed. He has been coming for the past three months, as part of a group, and what has struck me is the difference between when he comes on his own - because the others don't turn up - and when he is with the other group members.

When he is the only one who arrives for sessions, we have long improvisations, with him taking the lead either on guitar, drums, xylophone or whatever, and me joining in with him. He seems to know what he wants to do, and it can be something very simple: he once played a beautiful, very simple chord pattern on the guitar. He kept playing it for about fifteen minutes, and I made variations on this at the piano. Then he moved to the temple blocks and played a rhythm which included beating the guitar strings - it was very effective. Then he went back to the guitar and changed his tune altogether - from the major chords he went into a minor, and I played the recorder and wove this tune around his playing. There was this extraordinary feeling of intimacy of knowing where each other is, and of having met each other. . .. I said something to him about that, and he said 'that was really beautiful I really enjoyed that' and then he kept very quiet on the way back to the ward. He wouldn't talk about it any more once we'd left the room. It was as if he knew that once he was outside that room he had to be the patient again, and had to talk to me in a very careful way. That intimacy could not exist anywhere but in that room, in music.

When other members of the group came for sessions, he seemed to struggle. In the beginning, he would give up trying to be part of the group and become withdrawn, almost as though he didn't know how to fit in. In one session, one particular guy just played this incessant rhythm for fifty minutes. . . we all tried to break in, and Seaun was trying too - and eventually he gave up, and the other person just carried on.

Seaun gave up completely. And this would happen when the others took over, he would just withdraw, give up - as if he had lost both intimacy and autonomy in the group. And it was also as though he'd lost control and influence over his life in general, rather than just in the group.

But gradually, over the past weeks, he has become more able to assert himself. Like one week, it was about our fifth session, the others all came, and he played the guitar. I asked whether he wanted to start off and he did quite a strong rhythmic strumming and the others joined in with him. They had to pick up his rhythm because it was so clear. He led the others with this chord pattern that everyone could join in with easily and he seemed able to contain the whole group. It was as though he had translated his own instinct into 'I can fit with other people as well.... I can make other people do things the way that I want to do them. . .. I don't have to completely be a victim to their patterns'... he was surprised at how effective he was. . . his face lit up. He has quite a mobile, expressive face.

At another session, he got together a few drums, built his own drum kit - I think he took something from under someone's nose - and set up an invigorating rhythmic pattern - and again the others joined in with him. He was suddenly finding that he had this ability to lead other people. He seemed pleased and surprised by this!

He missed a few sessions because of medical appointments – he seemed disappointed when he missed sessions - and when I told the group that I was going to be on holiday he said, 'God, that's a racket!'

He seemed disappointed and annoyed. He asked me several times, that session and the next, what date I was going to be back on - it was as if he'd suddenly registered that I was going to be away, and when was I going to be back. Then he went into this complete dream, the session had a disappointed feeling - and I have always felt that with him when a session is shortened or missed for any reason... and that is where we've left it.

Every time we have had musical intimacy between us, he has been on his own. In an extraordinary way, it is as deep an intimacy as I've had in that setting. When there is a group of people, though, he finds it very difficult - but he is finding a way: when he takes it upon himself, he can really lead, he can do it. His personality seems... dreamy, spaced out... it is not a natural thing for him to be assertive.