Often through the course of work with a patient, issues arise which challenge one' role as a music therapist, and which lead one to question the limits of the experiences being offered to the patient. In this paper I describe by work with a woman who initially avoided and resisted shared music-making, and who gradually became more able to be involved in spontaneous activity. I tried to find ways of understanding the issues at the root of our relationship, in order to build on the musical interactions. From this case, I intend to illustrate the deeper questions which, I believe, are pertinent to be asked more generally about the limitations attending the role of the music therapist.

This paper illustrates how pre-composed songs which have special meaning for the client can serve as an intermediary phenomenon in psychoanalytically-informed individual music therapy, providing opportunities for the therapist and client to develop shared meanings within the therapeutic boundaries. The client is a teenage boy with moderate learning difficulties who has suffered abuse and deprivation. He is seen as highly defended, presenting an 'opportunist' secondary handicap (Sinason 1986) in response to earlier traumas, and as having a limited potential space (Winnicott 1971). Pre-composed songs which had special meaning for him were able to contain his emotions in a structure that was not seen as a substitute for free improvisation, but as a necessary precursor. After an introduction, the first five music therapy sessions will be described, followed by a conclusion discussing the underlying therapeutic processes. The setting is a secondary special school in north London. Music therapy is the only formal therapy offered for children who have been deprived, neglected, and/or abused, and who struggle with the reality of handicap every day.

A relatively unknown view that autism may in some cases be of a psychogenic origin is outlined, and elements of it applied in a group case study of six autistic children. The nature of the group's music and its development during a five-month period is described and the music therapy setting examined as a situation in which such children began to overcome some of their difficulties.

There are two distinct traditions of Music Therapy. One is of ancient origin whilst the other is the modern approach. There are some major difficulties between them, but they have a great deal to teach each other. The older tradition, however, is not as well known to the modern approach as it should be, for it is based upon its own distinct assumptions. These have arisen from its foundations in shamanism and religious philosophy, which have produced a wide variety of techniques in helping to heal the ills of humanity.