One Size Does Not Fit All
A therapist's thoughts on therapy.
Posted Apr 25, 2012
Stage fright is a mystifying and unnerving experience for many performing musicians and often impedes professional and personal fulfillment. However, when some performers seek psychological treatment, it is not unusual for them to wish for a quick cure for a problem that is complex and long-standing.
Although performance anxiety touches many individuals besides musicians (e.g., test takers, public speakers, athletes as well as individuals who are not specifically in the public eye but must assert themselves in front of others), musicians are unique in two specific ways. (1) Musicians begin training on an instrument that becomes the focus of their life's work in childhood. While most career decisions typically are made in late adolescence or young adulthood, the musician spends critical formative years focusing on lessons and intense training while at the same time being interactive with important caregivers. This has monumental implications for personality development and social adjustment and often fosters fertile ground for the roots of performance anxiety to take hold. (2) The job market in the United States for performing musicians is much more problematic than it is for other highly skilled professionals. Unemployment in the arts is high, pay often inadequate, and many musicians work at jobs considerably below the level for which they were trained.
Certainly, individuals sensitive to issues of rejection, loss, and competition are internally primed for the external conditions of the performance profession.
An inevitable question arises: if beta-blocking drugs or behavior modification can eliminate or reduce symptoms and bring relatively quick relief, why should musicians consider a prolonged insight-oriented treatment? In fact, this is a question that dynamically oriented clinicians deal with daily as musicians' initial (as well as continuing) resistances and fantasies often are centered upon the wish for an omnipotent caretaker and quick cure — a virtuoso therapist with perfect technique. How ironic that performers who wish to become virtuosi and masters of the musical score, their instrument, and the audience are willing to give control to a therapist who would become master over them! These issues can be understood and interpreted in psychotherapy. One size treatment does not fit all.
Brief treatment and pharmacological approaches certainly do not provide the opportunity to develop an in depth, ongoing relationship with the therapist, thus many of the issues and affects associated with separation, rejection, and termination (so relevant to the underlying dynamics of performance anxiety) are avoided. And while not every patient will elect to enter in depth psychotherapy for stage fright (nor is every patient suitable for this type of treatment), the therapist's rationale for recommending psychodynamic treatment must be based on issues other than simply personal preference.
Clearly patients who experience stage fright often present with a variety of debilitating symptoms. But when is a symptom not only a symptom? How do symptoms become overdetermined, life long, and pose problems in living, loving, and working. Such issues are unconscious and outside awareness.
Often when musicians present for treatment, they have exhausted many behavioral, self-help techniques, and used alcohol or medication. Their performances still suffer and their self esteem plummets further because the "work harder" ethic has not produced desired results. Quick and painless remedies associated with beta-blockers and short term treatment perhaps provided a temporary respite but not long lasting relief. Furthermore, the source of the quick "cure" has been borrowed from external sources and not constructed from one’s internal resources and strengths. Thus, confronting anxiety has been avoided and circumvented. Some persons who have tried brief treatment or drugs possibly have been rewarded through collusion with wish-granting authority figures who prescribe and proscribe (perhaps at the expense of engendering uninterpreted masochistic guilt in the performer for commanding omnipotent powers). The symptoms that are so relentless are not understood as disguises of unresolved conflicts that continue to propel the anxiety. Thus, the recommendation for psychodynamic psychotherapy or psychoanalysis represents more than a theoretical bias on the part of the clinician who assesses performance anxiety to be more than a symptom.
Until performance anxiety can be viewed as a serious and complex problem, until patients can understand that there are no magic cures, and until the stigma of seeking psychotherapy is erased, many patients will hope for the omnipotent magic cure — the all knowing, all-giving therapist/parent. Inevitably it is disappointing to discover that such wishes are granted only in fantasy. Such fantasies are explored and worked through in treatment.
All of us live daily with our life histories. Our childhood experiences remain psychically influential lifelong; why should we not expect our unresolved conflicts to accompany us when we appear on stage? It is these conflicts that emerge as symptoms in the guise of stage fright. A psychodynamic perspective helps us understand the origins of those conflicts as well as the ways we continue to keep them alive…..and permits us to make a choice to let them go.
Julie Jaffee Nagel, Ph.D. is a psychologist-psychoanalyst in Ann Arbor, Michigan. She is a graduate of The Juilliard School with a major in piano performance and a minor in stage fright. She is also a graduate of the University of Michigan and the Michigan Psychoanalytic Institute. Dr. Nagel publishes and presents on the topics of performance anxiety and music and emotion. Visit her website at julienagel.net