Panel II From Turkey:
An Adolescent Journey: Filling the Void with Sound

Gover's creative and touching account of her work with Ayda demonstrated the role of sound and music as a communication tool in reaching the central issue of her patient. Gover's initial descriptive remarks tells us that despite her chronological age, 14, Ayda is developmentally very young. Early on in the treatment, sound became a real medium of encounter through play with the rattling of crayons and murmuring sounds as if the crayons were an instrument and Ayda was the vocal. Gover's attuned response, which consisted in murmuring back, was the beginning of communication and, according to Gover, "sound became an invaluable asset in helping Ayda and me verbalize pre-linguistic fantasies."

Ayda's response to this intervention was a dream, her first one since the first grade: "Me, my grandmother, and my twin cousins are eating at home. There is two of me. I feel full as I eat. The cousins escape on foot, a robot comes and pretends I am not there." Talking about her six-month-old cousins, Ayda expresses her wish to stay a baby because growing up is painful. This pain is expressed in physical terms and affected Gover. "It was as if her body carried the pain and I carried the intensity of the feelings that were jammed into a body." An association made by Ayda informs us that she feels as if she is inside a corpse and we are told that Ayda went to sleep immediately after this association, establishing a pattern of falling asleep in the sessions which made Gover feel very alone.

Another intensly lived episode occured after the first vacation break. When Gover responded to Ayda's request for water with a verbal interpretation, Ayda became angry, threatening to throw playdough and singing, "You do not give me water, you make me sick, weary of this life." Ayda then starts playing the "looney tunes" music on her mobile phone which was to be repeated for the next eight months whenever an intense emotion came up. This episode proved to be a turning point in therapy insofar as Ayda began pushing the frame and calling Gover bad and evil-hearted. As if to prove a point, Ayda brings in a new song called " There is a Difference." The song speaks of differences between people, good and bad, as well as giving voice to loneliness and a myriad frustrations. But despite her threats to tear the place down and strewing the floor with play dough, Ayda, tells Gover that she knows Gover would always accept her no matter what.

Nine months into therapy Ayda brings a new song, "Take Me," a love song from a soap opera. Therapy during this period revolves around writing scenarios in sessions, Ayda's messing up the therapy room to prevent others from coming in, and her strongly asserting her choice of an art school to her family. During a once-a-month family meetings, Ayda's father talks about his sister who died at age five. Gover's impression was that father was afraid of hurting Ayda in the belief that closeness would be deadly. In fact, Gover discovered that since the whole household lived in their own rooms, Ayda was deprived of the meanings of things and behaviors. The next song Ayda brings in is the ringer tone of her father's mobile phone, which is the theme song of a soccer team of which father is a fanatic fan. In the song, Ayda hears the name of father's dead sister, to which Gover responds: "Maybe to be on your father's mind you have to be asleep, frozen or even a corpse." Ayda responds with yet another song, " Who am I?". The song speaks to a search for identity.

The next family meeting brings new information. Ayda's mother went away to take care of her own seriously ill mother for nearly eight months when Ayda was two. The possible consequences of this separation was openly discussed and mother's concern for Ayda became evident. Gover states that: "Ayda's mother, like her father, was also surrounded by death. Perhaps the only way to be in this family was to be a corpse". After this meeting we see Ayda making an association without the aid of a song: " I am like Michaelangelo who lost all his family as a child and hid his pain under his skin." When Ayda brings in another new song, " Life Speaks," she interprets the song herself, saying, "it speaks to emptiness, wondering if there is love." Gover's narrative tells us of Ayda's concerns with real life issues such as love relationships, and real people who are not afraid to express themselves. During a weekend session, Gover takes the opportunity to tell Ayda that to have feelings and desires mean she is a living, lively girl which is probably very frightening to her. This comment, along with mother's expressed concern for Ayda in the family meeting, had a transforming effect to the extent that Ayda comes to the next session full of news, the most important of which is the structural change she is feeling. The last dream she brings entails first the theme of betrayal but then resolves into a happy ending, with themes of love, and recognition.

Gover ends her presentation with an association of her own: "While preparing this paper, I read about sound and music, and in contrast to that experience, I thought about the silence I inevitably faced when I finished this paper. At that point, my mind became like Ayda's and an association in the form of a song returned from my youth - 'The Sound of Silence' by Simon and Garfunkel and that is how I would like to end."

Filling an Emotional Developmental Void with the Aid of Attuned Selfobject Responsiveness

By Eldad Iddan, MA: A critical response to Gover's Paper

EIdad discussed Gover's paper in a thoughtful and thorough manner from a self psychological perspective. He agrees with Gover on the decisive influence of the external environment with its sounds and emotional atmosphere on the fetus and on the newborn. Extrapolating from Gover's introductory remarks and her moving description of humming back to Ayda, he points out that Ayda presented as developmentally very young. Gover's accepting and sensitive presence, he says, evoked in Ayda a renewed hope that here her thwarted selfobject needs stood the chance of being met, thus reactivating her growth process. He views Ayda's first dream as "a self-state dream," highly suggestive of her family environment, that is, being taken care of by an emotionally detached mechanical entity that pretends she is not there. Iddan sees Ayda's reluctance to grow up as a manifestation of a self's healthy insistence on obtaining an appropriate selfobject responsiveness. In the same way, he views the corpse metaphor as not only carrying the theme of death, but also depicting Ayda's experience of herself as if she were in a cacoon awaiting the conditions necessary for its emergence.

Iddan takes issue with the interaction that occurred after the first break in therapy. After lauding Gover for her ability to empathically immerse herself in Ayda's experience and preserve aliveness and "going-on-being" for both of them, he sees the verbal interpretation to Ayda's request for water as an empathic failure. He regards Ayda's going to sleep, with one exception, as responses to empathic failures, as if Ayda retreated to her cacoon on such occasions. Although he agrees with Gover's treatment of songs as free associations, Iddan objects to Gover's attempts to look for hidden elements behind the songs by asking Ayda for their meanings. He sees this approach as more traditional then self psychological. For Iddan, the songs Ayda chose were what she felt and experienced. He appreciates the developmental trajectory of the songs and their lyrics and Gover's permission to let Ayda take her into the music and let herself live via the music. He believes that, in this way, Gover provided Ayda with a badly needed, strong, idealizable presence. Iddan approaches Ayda's aggressive behaviors from the standpoint of transference. Instead of viewing these behaviors as the resurgence of a repressed aggressive drive, he reviews the points at which these reactions occured and concludes that they can be traced to Ayda's possible experience of Gover's responses as unempathic. On the other hand, Iddan gives examples of later interventions by Gover as beautiful mirroring responses. In conclusion, he applauds Gover's sensitivity, creativity and patience as profoundly helping to fill Ayda's developmental void by affording her an attuned selfobject responsiveness which she needed so deperately and demanded so insistently.

Music as a Tool to Mentalization

By Yavuz Erten. MA

Yavuz Erten approached the case material from a "mutual regulation/intersubjective" perspective. He likens the intraction in the mother-child relationship to a dance. He asserts that in a dance each partner has a series of figures to perform in keeping with the music in a relationship of mutuality and/or complementarity. After drawing our attention to a mulititude of problematic situations in which partners may step on each other's feet, not hear the same music, and so on, he asserts that: " In this case study we see clearly that from the beginning there is a therapist whose ears are very open to hear and listen to the music brought to the therapy room and who is ready to begin to a mutual play/dance with this music."

Erten also appreciates Gover's sensitivity to the sound that exists in silence itself, as evidenced by the song "Sound of Silence." He points to similarities in the analytic medium where we try to see what does not appear immediately and try to hear the unexpressed words that are hidden by those that are expressed. Thus Erten carries Gover's argument that "sound became a real tool of interaction, enabling them to express their pre-linguistic phantasies" one step further, adding "voiceless" to the pre-linguistic. He states there may be many emotions, fantasies, and experiences belonging to earlier periods in life that may have been left voiceless, such as those evoked by death and suffering that get expressed through music. Touching upon the vitalizing effects of music, Erten sees Ayda as trying to enliven her father with love songs and distinguishing herself from her dead aunt through the song "There is a Difference" as if to say, "She died. Look I am here alive." Erten adds, "It again seems that there is a similar message in her anger she expressed to her father when he forgot her birthday." He believes that the song, "There is a Difference" is a good example of how Gover became an inclusive container for Ayda. The words of this song accept the differences between people just as Gover accepts Ayda's complete being including both the good and bad aspects of her. Erten then gave a few clinical examples of Gover's capacity to hold and contain Ayda.

Erten concluded with a five-step summary of how the therapy went so far. He then added a possible sixth step in which Ayda would be able to communicate without using songs. He suggests the possible danger of Ayda's presenting a façade, a "false self," whereby her songs and dances are intended to please the therapist, but hide the deep sense of loneliness she feels. If this occurred, music would become an end, rather then a tool for development. But if all goes well, according to Erten, the void created by the lack of songs will provide the necessary space for the formation of a substitute for the lost thing. This space will be transformed into a new mentalization field which, in turn, will embody a developed subjectivity such that Ayda can express her feelings, complaints, and wishes directly, assume responsibility for them, and show initiative to act according to them.

A Musical Response to Gover's Paper

By Gianni Nebiosi, Ph.D.

The panel was concluded with the review of a segment from the video first presented in 1973 by Leonard Bernstein when he was "The Charles Eliot Norton" lecturer at Harvard. It was titled, "The Unanswered Question: Six Talks at Harvard." In it, Bernstein talks about humanity's common language - music, and presents his material very warmly, sincerely and skilfully. The second segment was from" Isaac Stern in China: From Mao to Mozart." In it we see Stern working with a Chinese girl during a master class in a very moving way. Gianni Nebiosi's enthusiasm while showing these segments to the audience at the conference matched perfectly with Bernstein's and Stern's and provided a very apt and moving end to the panel.