Psychotherapeutic facilitation of musical creativity

The distinction between musical composition and performing is an historical artifact. Both activities have creative components, expressed by composers through the originality of their scores, and by performers through their unique and stirring interpretations. Music represents an artistic refinement of biologically driven activities, serving the need for communication, self-orientation, social contact, and emotional expression through soundmaking. Developmental factors--attachment to a soundmaking object, parental influence, the role of teachers, and supportive environments--have been reviewed in connection with the choice of music as career or avocation, and in the assessment of talents and handicaps presented by musical patients. Some historical examples serve to show that psychotherapy has traditionally been modified to fit the special needs of musicians. Familiarity with the musical culture and community can be helpful in treating these patients, and special clinics or health programs for performing artists have been established over the past few years. Three case examples are presented, based on experience with musician-patients in San Francisco, to illustrate different ways of providing psychotherapy that enhances musical creativity.