‘New York Mining Disaster’

Abstract

This paper describes a four-and-a-half year period within the long-term music therapy treatment of a mentally ill forensic psychiatric patient. It charts the development from an exclusively music-based approach to one in which words played a key part, in the form of song material, the use of spoken interpretations by the therapist, and the patient's own verbal responses. Clinical descriptions are set alongside attempts to understand the material using a psychoanalytic model. In particular, it is suggested that the patient's emptying out and deadening of lively contact constitutes a psychotic defence against feelings of loss and dependency. The article also looks at issues of denial, specifically in relation to the patient's offence and his position within the institutional system, but also in terms of the therapeutic relationship: is the patient able to find a place from which to observe and acknowledge the relationship that is taking place? Or does his defensive organisation dictate that no third position can be admitted?