Music is the Medium, not the Metaphor: 

Communication in Jazz and Psychoanalysis [1]

 Henry Markman, M.D.


A man highly attuned to me had immediate access to my emotional presence.  At the beginning of a session, as I was responding to something he said, he interrupted with, ‘Where are you?’ His words and urgent tone woke me up. I immediately noticed something a bit flat in my voice. I also had lost contact with my surroundings and my physical place in it. I was not there. As I worked through something that distracted me in the moment, feeling a bit on the spot and uncomfortable, and also having the impulse to deny it, I gradually was able to get myself back and settled down.  I began again with, ‘hmm, yes, my mind was elsewhere for a moment’. Not a lot of content. He remarked, ‘OK, I can tell you’re now here.’ He went on with what was on his mind after sensing my return.

This encounter concerns the fact that our emotional connection and my presence are communicated by the body, through tone, movement, and gesture.  I will call this felt connection embodied attunement. Attunement is understood here as a kinesthetic sensing of others, knowing their rhythm, affect and experience, as carried by the body. My presence in this register was necessary for him to go on. Any sort of disruption of the connection interrupted contact with himself and his ability to continue.

Two clinical questions with practical implications come up. One concerns the meaning and clinical importance of communication carried by the body in rhythm, tone, and gesture, and the other concerns how we handle moments when disruption occurs. I will explore the consequences of the experience of presence and absence in the analyst, and how that presence comes through, across a spectrum of patients.

In this clinical example, I could enquire into the patient’s fantasies about my state of mind. Or wonder what the impact was on him.  His confrontation was uncomfortable for me. Might he be trying to communicate through projective identification unease, or communicate what it’s like for his mind to be intruded upon and taken over? Perhaps my distracted state was primarily a consequence of projective identification. Or, did my distracted state represent my transference to something in him? These are all viable and potentially useful lines of approach.

I suggest though that one starts at the level of the embodied attunement, its breaks, and the need for restoration. This way of being together needs to be addressed first, in order for other aspects of communication to have fullness and a shared sense of reality. A shared sense of reality and meaning begins at this level. In a more general sense, the floor of shared experience, as communicated by the body, is what the subject stands on and develops from. The sort of disruption between the patient and me are inevitable and an important aspect of therapeutic process. The cycle of mis-attunement and its restoration gradually creates in the patient a sense of trust in the object world and their own capacity for reconnection.  Also, during periods of disruption, new, meaningful experience can emerge, e.g., W. Bion’s idea of ‘turbulence’, in states of dissonance. (See Markman, 2006, 2011). It is important to understand that attunement does not mean merger and lack of differentiation. Attunement does not erase difference, but rather allows for it.  In the active mutual responsiveness there is an alive recognition of the other and an enhancement of a felt sense of self--not a blurring of subjectivity.

The non-verbal, rhythmic and embodied aspect of the analytic relationship is very much in the current zeitgeist. . For example, see Peter Goldberg’s work on sensory symbiosis (2012), G. Civitarese’s (2010) concept of the embodied field and somatic reverie, D. Elise (2017) depiction of the ‘choreographic engagement’ by the analyst, Stephen Knoblauch’s (2004, 2011) use of musical metaphors to capture the rhythmic dimension of the analytic interaction. These writers, whose ideas are supported by infant research, take into account the way two subjects, including analyst and patient, share an embodied register of discourse. Civitaresse (2016) writes that the ‘symbiotic bond is the background of continuity that permits the acceptance of difference. This shared background is invisible’ (p.40). Goldberg’ considers, ‘Of particular interest is the way in which immediate sensory experience seems to lend itself naturally to a shared consciousness of the world and how this affects a kind of functional symbiosis between analyst and patient at the sensate level’ (p. 791).

The embodied way of being together is the foundation of human communication, necessary for emotional growth and vitality. This is the basis of human companionship as a shared lived experience. This allows for the emergence and expansion of subjectivity. I consider this sharing or unison experience an aspect of inter-subjective beauty, in which emotional truth and meaning emerge between patient and analyst (see Markman, 2017).

The idea of embodied attunement is simultaneous and occurs in the rhythmic nonverbal realm of tone and gesture. Colwyn Trevarthan and Steven Malloch (2002,2009) developed the concept of ‘communicative musicality’ in the their studies of the interaction between mothers and young children. Their concept is similar to embodied attunement. Communicative musicality is a rhythmic, bodily (meaning gesture and tone) mode of relating that is shared. The vitality inherent in communicating this way involves a ‘general capacity for polyrhythmic, stepping, swinging, dancing, and “melodic” ways human bodies move to celebrate and share’ (2002 p.12). The elements of communicative musicality are ‘pulse, tone, and narrative’ in ‘co-ordinated companionship’ (2002, p 11. Ital. mine.) Narrative here is meant as an emotional story without words. The impulse to communicate is, according to Trevarthen, a desire to belong to a world of other people with a common understanding-- i.e. a search for companionship.

Paul Byers, an anthropologist and musicologist, speaks of bodily attunement when he writes,

The information carried by interpersonal rhythms does not move directly from one person to another. Thus information cannot easily be conceptualized as messages since the information is always simultaneously shared and always about the state of the relationship’. (1976, p. 160) 

We cannot separate receiving from expressing/doing, receptivity from action. Simultaneity and resonance are central to communication at the ‘beneath’ level.  Here communication is not a passing of messages back and forth, but a shared experience. This draws our attention beyond—and underneath-- the verbal, sequential realm of time and language, to non-represented, embodied, rhythmic and patterned, attuned communication. And what is simultaneously passed is read, at the level of the body, about the nature of the relationship. This rhythm is a pulse in both senses: a steady ‘groove’ that is also, as in human physiology, a sign of the vitality of the relationship.

S. Leikert (2017) argues that emotional growth arises when rhythms overlap and are in synch, there is ‘the precise temporal coordination (that) is the first component of the immediacy of the experience of psychic growth’ (ital. mine p.666). Liekert also suggests that this ‘temporal coordination’ is crucial to a sense of vitality, and ‘leads to the emergence of the emancipatory impulse’(my ital.)

This knowing and sharing through the body thus has a mutual, powerful impact, which leads to growth of the mind. The experience can provide companionship that for some is crucial and reparative, bringing them into a world of others. Attunement can also foster integration of the psych-soma so often split in dissociated patients. Ultimately, embodied attunement is the springboard for the emergence of novel self-experience.

My goal here is to connect these theoretical ideas concerning the embodied ‘shared background’ to aspects of daily clinical practice. I will suggest ways the analyst can work at this register, and the necessary qualities the analyst brings to the task. What would it look like to work guided by this awareness? I will offer various clinical examples of finding embodied attunement in different clinical situations, and working with mis-attunements that are inevitable, constant, and in need of restoration. To do this means the analyst be aware of, accept, and work with the impact of his or her emotional-bodily states on the conversation and the field. The analyst who attends to this register requires two qualities in the attempt to find the patient’s rhythm and a shared sense of time:  ‘presence’ and improvisation.  As I will describe in more detail below, ‘presence’ and the allied concept  ‘availability’, as formulated by the French existentialist Gabriel Marcel, are active ways a person opens oneself up to another, makes space for and welcomes another.  Presence is the manifestation in the physical sphere of availability--which is an attitude of openness and welcoming. Improvisation is necessary to find ways of ‘being-with’ in rhythmic time that either supports the patient’s own improvisations and expands their sense of self, or opens up ways of improvising in mutual play.

To bring this ‘invisible’ register into better view and vitalize clinical theory, I will consider communication between jazz musicians in performance as illustration and model. Jazz is a rhythmic improvisational art form that allows for freedom of expression and spontaneity within a relationship that supports each member.Communication among jazz musicians foregrounds and bring into clearer view the embodied ‘shared background’ that has been considered ‘invisible’, and illustrates various modes of embodied communication. It makes vivid these modes that are difficult to observe in other settings. Jazz ensemble playing rests on communicative musicality. It is the musical genre that puts this ‘background’ out front, on top and not beneath. Because of that, it is easy to appreciate different ways of interacting and the effect these interactions have on the musicians. Jazz celebrates this interaction and effect.

We find analogous forms of interaction, attention, and action found in meaningful analytic dialogue. An emphasis on the type of connection through spontaneity and receptivity in real time is crucial to growth and vitality in both jazz and psychoanalysis. The links between these two activities will show in analytic work what tends to stay unattended, ‘invisible’, and in the background. As in jazz, it happens in analytic sessions that embodied attunement provides a place to grow, differentiate, ‘solo’, and play.

The link between jazz and psychoanalysis also involves the form of interaction. In more traditional jazz forms, a rhythm section supports the elaboration of self through an improvisational solo. The way the rhythm section and soloist relate is nuanced and evolving in moment-to-moment improvisational ways. This shared pulse, in which each musician listens to the other in the moment, allows for the freedom of self- expression. This over-simplification  still serves as a template for a type of analytic conversation in which the analyst provides support in shared time for the emergence of self-experience and expression.  One might envision the analyst as a drummer providing pulse and responsive support—an idea I will expand below. Another style of jazz, so called ‘free jazz’, involves group simultaneous improvisation, in which all instruments, including the rhythm section, are equally responsible for the musical pulse and narrative; this requires great focus and attunement on the part of the musicians. This mode serves another type of template for analytic conversation—the way mutual play, two-way improvisation deepens a sense of companionship and understanding, though entailing greater risk. There is a continuum between these two modes, and a dynamic move back and forth in analytic conversation.

Psychoanalysis, like jazz, is a temporal art: there can be a sharing of rhythm and mode in time. When this attunement experience occurs the effect can be transformative, and creates what W. Bion calls ‘at-one-ment’ and Citivaresse (2004) names the ‘symbiotic bond’.  When it falters or is absent, there is an intellectualized, barren atmosphere, and estrangement. The movement to and away from attunement experiences, and the nature of the analyst’s work to reach attunement, is crucial. There is no art form more devoted to ‘temporal coordination’ that leads to the ‘emancipatory impulse’, than jazz. And no therapy devoted to the same, as psychoanalysis.


Jazz Performance and Psychoanalytic Practice: Availability, presence, and improvisation in shared time

Jazz will illustrate aspects of analytic practice in two ways. First, to show the qualities of the jazz musician that make successful music possible, and compare that to similar qualities offered by the  analyst. Second, to explore forms of jazz ensemble interaction that model the analytic encounter at the rhythmic and attunement level.

What are the essential qualities that allow for the freedom and support found in successful jazz experience, and for the freedom of self-expression and creativity in analysis?  As indicated above, these are presence, availability, and improvisation. Marcel describes availability (disponsibility) as an attitude of openness; it is a welcoming, readiness to respond, and a yielding to what is encountered. “Disponsibility" literally translated means putting oneself at another’s disposal. Availability involves a welcoming that can disturb and confound the analyst. The capacity for availability is then contingent and requires the analyst’s internal work to remove emotional obstacles to receptivity and participation. This attitude is also felt in musical expression, when the rhythm section and soloist listen to each other, take in, and thus are in simultaneous conversation. ‘I hear you’ is a felt response, even if the soloist moves into new and turbulent waters.  This nonetheless creates a ‘groove’, a sense of being in synch.

Dennis Cali (2015), in writing about Marcel’s ideas, states that, “One acquires presence to another through an availability, a permeability, making space within oneself for the other” (p. 111). Presence manifests availability in tone, gesture, and movement. It is not passive but involves participation. It is common to distinguish receptivity from action. In both jazz and psychoanalysis, presence contains both meanings simultaneously. This way of being and open relating is more than what one says, but who one is at a particular moment.  

Marcel (1933/56) writes that presence is  ‘a kind of influx; it depends upon us to be permeable to this influx… Creative fidelity consists in maintaining ourselves actively in a permeable state (p.38)’.  ‘Creative fidelity’ refers to the commitment to do the internal emotional work of making oneself available; it is an investment in the continuing quality of the permeable that is attended to, acknowledging how fluid and in flux  (and threatened by anxiety) and difficult maintaining availability can be. This also gets at the inventive, renewing capacity for openness, to which he advocates ‘fidelity’—a wonderful word that focuses attention, awareness, and dedication Presence allows for embodied attunement. J. MaCown writes, ‘We know whether someone is present or not, because, when the other is present, he renews us in some way and makes us more fully ourselves than we would have been alone’. (1978, p. 41). The way the analyst manifests availability is in constant responsive movement in rhythmic time, and so is an improvisational effort of ‘creative fidelity’.

The analyst’s willingness to improvise is then necessary in their supportive and interactive rhythmic role. The analyst’s action might even evoke a pulse or ‘lay down a beat’. This active support is what makes it possible for the patient to improvise in a search to be ‘more fully [themselves]’. Presence is like the floor of support—musically and emotionally—that prompts the soloist and patient toward new ways of being and expression. When an analytic couple or ensemble creates a rhythmic bond, it is then possible for the soloist or patient to improvise novel aspects of self-experience. Traditionally, free association in the verbal register was considered the hallmark of the patient’s improvisation, and resistance to improvisation an internal affair. However, many clinical theorists have come to regard action as equally important--not just as repetition in place of remembering—but as a form of communication in its own right. Also, as I am emphasizing, this act of improvisation requires the support of embodied attunement from the analyst. Solo improvisation is the act of taking an existing form and transforming it in ways that are personal and self-expressive. In the analytic conversation, the patient improvises when he or she feels enough support to venture into spontaneous and new ways of being and expression. However, improvisation involves risk for both participants. It means to be true and personal, and in following a narrative, not to rest on knowing what will happen next. It is like saying to oneself, ‘I’m going to pursue that and I don’t know how or whether it will succeed’.

What holds the analytic couple and jazz ensemble is the ‘pulse’ or shared sense of time. The jazz ethnomusicologist I. Monson(1996) quotes Ralph Peterson: ‘The stronger the time feel, the easier it is for the soloist to take risks with solo phrasing (p.28) . P. Berliner (1994) writes that ‘within the groove, improvisers experience a great sense of relaxation, which increases their powers of expression and imagination’ (loc 8864). Translating this to analysis, the more solid and responsive the analyst’s presence, the easier for the patient to take risks. Is this not what we encounter in our daily practice, when we sense a shared embodied connection leads to a feeling of relaxation, goodness, and imaginative freedom?

Ralph Ellison the novelist defined jazz as ‘the soloist’s assertion within and against the group’, (1964, p. 234). ‘Assertion’ is self-definition. This suggests a simultaneous separation and unity—the ability to simultaneously express oneself while listening and responding to others, without losing either. The result may be, as  Ellison (2001) describes, ‘an ecstasy of rhythm and memory and brassy affirmation of the goodness of being alive and part of the community’ (p.9).  Ellison here captures individual self-expression and assertion (‘the of being alive’) while being ‘with the group’ (‘part of the community’). This has important implications for analysis in terms of the emotional experience of embodied attunement: one feels ‘the goodness of being alive and part of the community’ in a vital way, as a result of these unison experiences. The patient  gradually asserts him or herself through evolving self-definition, ‘against’ and ‘with’ the unity of the analytic couple.

To summarize: The supportive role of the rhythm section and analyst is to communicate availability through presence. This is an active and improvisational effort. This embodied attunement allows freedom for the patient and soloist to then improvise narratives of  self -experience that are novel and emancipatory, leading to emotional growth and integration.

The various forms of jazz illustrates modes of analytic communication. I will depict this with clinical illustrations below. These models in jazz are in a continuum from more to less structured interaction. The first form is the soloist with various degrees of strong rhythmic support. Here the drummer is usually the crucial ingredient supplying the pulse. This pulse can be clear and steady as in John Coltrane’s work with the drummer Elvin Jones on Impressions. In this piece, there is a strong sharing of the beat, each musician listening to the other in the moment, while Coltrane simultaneously develops his  solo.  Or, the pulse can be fluid and expansive in a more holding and quiet way, drawing less attention to the drummer, as in Paul Motian’s work on River’s Run. The drummer’s support here is palpably there, but less conspicuously.

Another variant is solo with accompaniment through rhythmic and melodic support, which is more intimately conversational.  The pulse is there with added conversation. Chet Baker and guitarist Philip Catherine on My Foolish Heart show this type of accompaniment through accenting rhythms with added color and melodic elaboration—that is, pulse and emotional narration.

With Billie Holiday and Lester Young on He’s Funny That Way, we hear a weaving of lyrical voices, a heart to heart dialogue, in which accompaniment merges and crisscrosses with solo in counterpoint. Miles Davis expands this intimate dialogue to ongoing interactive group conversation, on My Funny Valentine—Live at the Plugged Nickel.

At the other end of the spectrum is free jazz, where the ensemble can  create or find the pulse, or not. The pulse may drop out. This was first  heard in the drum performance of Sunny Murray with pianist Cecil Taylor, where the beat drops out and there are two simultaneous solos. An example of this is Lena. The drummer’s role here is as an independent interactive soloist rather than a keeper of the pulse. This is also heard in Miles Davis’ work on Pharaoh’s Dance. The less structure and pulse, the more the musicians must be attuned and responsive.  In the analytic conversion, this looks like mutual play. (e.g., W. Winnicott’s ‘squiggle game’)


Attunement experience: The clinical situation

What comes with presence is an ethic of acceptance of the embodied aspect of our being. This allows us to take in and accept its impact on our patients.  There is a contingent aspect to this: our embodied self shifts with each moment, and is dependent on what is going on in us, in our patient, and the interaction. It is from this place of awareness of our presence that the various forms of improvisation are possible. So pragmatically, presence is not some perfect zen state, but an openness to the embodied state we are in and the potential impact this has on the patient, and visa versa--the openness to the impact the patient is having on us. Being open to this dimension, in time, is quite contingent and is always evolving, and can be shaped through improvisation to reach attunement.

The analyst’s improvisation is meant to initiate, invoke, engage in, or enlarge the sphere of communicative musicality. This  implies that we are willing to take risks while improvising in the way we respond and attempt to meet the patient, by letting go of old forms and structures that are secure and protective, and accept we will make mistakes-- mistakes that are then incorporated into the stream of a solo. The analyst’s ethical obligation here is to be aware of risks that lead to miss-attunement and traumatic disruption.


1.  As a young man greets me, he communicates through gaze and gesture that I am less friendly than usual.  He seems to say, ‘You are not on my side’.  The embodied conversation has begun. I have to do something with this. My first reaction is disappointment and a let down feeling: ‘Oh no, we’re in this again’. I have to fight the urge to change his reaction, or somehow justify it by what I already know.  Availability is the openness to this dimension of mutual impact that can be uncomfortable—how I am at a certain moment, not what I say- and allowing for the influx of the patient’s experience (as he had of mine). Should I point out my patient’s suspicion, aiming to get at the unconscious phantasy guiding the patient? (and perhaps also to verify or deny the accuracy of his unconscious perception). Or, should we continue the conversation by making myself open to this register through observation of my state that is communicated through the body, and rhythm that the patient has responded to? I do not want to polarize this question but allow for other modes of understanding and working with communication at this level. What does that look like?

I must do something with my embodied state and find a way to accept what is going on, by making space for it. I do notice some tension in me, and a physical reserve. A more quiet ‘hi’. Yes, I’m guarded. As I filter through these sensations my body relaxes a bit. And I can sense that he gradually, simultaneously, seems more relaxed as well.  Something important was communicated without words, at the level of bodily resonance. This is attunement (as was his initial response to me, though in a different key). There is a simultaneous sense of the two of us settling in. I notice that the light in the office  is softer and the sounds from outside are less intrusive. “I like doing this’, I think to myself. I sink more deeply into my chair. What may follow is that the patient’s thoughts roam more freely and are less directed. In this instance I believe the patient sensed a shift in me without my putting it into words. The medium supplied by my embodied presence as a reliable pulse initially dropped out. With work it was reestablished, and the patient could go on elaborating aspects of himself.

It had gone differently at times. I was more agitated in sensing my negative impact on the him, which simultaneously led to a tense state in the patient. And it went on like this for a some time—a mutually shared tension.

But on this occasion we have momentarily reached a kind of resonant attunement. There are two modes that can ensue, as we noticed in the two different styles of jazz.

The first form takes shape in the analyst’s alive support of the patient’s ‘soloing’, ie, the patient finding in his or her voice an emergent self  that differentes from the ‘group’. The ‘group’ is the internal world of objects, as well as the external pressures for conformity (including conformity to the analyst’s expectations, technique, and language) , non-thought, and non-being. I am allowing for modes of expression that are novel, unprecedented. Yet my role is not a passive listener/receiver. To be present and available in the way Marcel describes, is an embodied, alive, resonant pulse or groove that meets the patient and gives the patient something to ‘riff’ off. This occurs primarily in the dimension of the body: the sensorial and rhythmical that is conveyed in many ways, including speech.

The hour continued in this way:

P-(after a passage of desultory thoughts). I’ve been thinking about our last session.

T-humm, yes?

P-I know. I think our sessions are important and I think you like to hear my thoughts about them.

T-it’s true (I’m aware of the punctuating or pulse of my response)

P-So yesterday when you spoke about… (this goes on for a bit, and then he stops suddenly) I sense I’ve lost you.

T-(I am startled out of a reverie and sense myself tensing and getting defensive and wanting to reassure  or deny it. Or cleverly make use of my reverie. I know how delicate this connection is. But facts are facts, and as I face this--that my mind was wandering--I relaxed a bit. How did he know this? When I spoke I heard a quality of calm and patience in me.) Yes my mind was wandering while listening to you.

P-oh, where to? (his voice arched at bit but there is curiosity too).

T-I was staying with an image of how you described X (I liked his description of some aspect of his reactions to the session and a particular image came to mind.  He often conveys attention to detail and I admire his way of expressing it. I am making a distinction here, that though my associations concerned the patient’s ideas, I was emotionally and physically removed from him at the embodied level. There was a disconnect,  and dissonance).

P—I wish I could know more what’s in your mind, or really, how I affect you. It’s strange that you can be distracted and with me at the same time. (I sense we are in an intimate moment,  a kind of excitement and energy in what he is saying that there can be freedom in separateness and intimacy). I want to go on with what I’m saying.  I can live without knowing what you’re thinking because I feel you’re with me.

This man took a long time to get to the point where he could have his own experience with me, and where he was not constantly looking to find himself in me. In the past, this experience had taken the form of a jagged staccato rhythm of self-interruption, in which I willingly supplied a steady stream of responses like a strong steady pulse. He could then feel supported enough to go on a bit on his own. He needed much less of me in this way at that moment. What eventually allowed for that movement of an emergent self in this conversation was a physical sense of my presence and involvement that was conveyed by my attention to that dimension. I think I managed to convey an authentic interest, not by what I said, but the way I related and responded to him in terms of presence. We were now in the mode of soloing with support.


2.  Here is another illustration where it took me a long time to understand what was going on, until my work and approach gradually shifted. B is an extremely successful doctor who came to therapy several years ago to discuss problems with her child, who was fussy and emotional.  From the initial contact she could not get confortable. I mean physically confortable. The couch, which she first tried, lacked proper support. She brought in her own blow up matrass to help, but that failed too. She lay on the floor, tried all the chairs in my office, paced, and so on. Nothing worked. In addition, she most often talked about somatic discomforts of one sort or another. I first interpreted the potential symbolic aspect of her experience, including her possible transference to me. I was flexible in thinking with her about the concrete aspects of my office that affected her, but nothing ‘worked’. As we went through failure after failure I became quite tense with her. I often thought about and at times interpreted the sort of transference-countertransference we were in. For example, the inadequate mother unable to soothe her baby. Again nothing moved.

Gradually I realized that I was not allowing myself to simply live on the same level she lived on, to welcome her and provide space for her, and share this uncomfortable repetitive experience. I had to do something different; actually be someone different. Now in retrospect I seemed to find a way to converse with her at her level--that is, have an embodied conversation that had little to do with the content of what we said to each other. This was not done as ‘technique’. I become emotionally interested in her physical states as physical states, not symbols or metaphors or unconscious phantasy (though of course there is that dimension perhaps). I found myself tending to her as someone in pain, perhaps pain that will never end. My tending, again in retrospect, was in the way I was present with her—which shifted from the anxious, tense, and edge-of-my-seat way a related to her before, to a calm and warm way of being. I think she had to sense in the physical dimension a shift in me for it to feel authentic to her, and she then experienced a sense of attunement. How did I know that?  From my side, I looked forward to our time together and felt a kind of physical fluidity in my movements. And as with the first patient, the sensory qualities in my office seemed nice. Now, it is not that the content of the sessions changed. The physical aspects did. She seemed more comfortable in the chair she settled in, and moved around less. She wanted more time with me. And things changed in her life. I would describe this kind of treatment as support at the most fundamental level of being: she did find a great deal more comfort in herself that opened up possibilities not there before. I would analogize my work here to the way Paul Motion creates a wide and flexible rhythmic container that creates space and does not push the pulse or announce a more differentiated state on my part, to the patient.


3.  Then there is ensemble playing, in which both patient and therapist are playing together, equally (the asymmetry has to do with the ethical responsibility of the therapist to care for and protect the freedom and vulnerability of the nascent self). This involves more anxiety for the analyst, demanding more spontaneity and improvisation.

A middle-aged male architect brought in endless obsessional accounts of his work in which he could not produce necessary drawings for his projects. I was restless, impatient. I found myself drawing on all that I already knew in relating to him in a way that unfortunately matched his deadening discourse. I was eventually able to recognize aspects of my transference to him: my need for repair, and a familiar sense of futility. I could recognize certain states in me that I sensed were a reflection of his internal world of paralysis. That is, what he did to his objects he also did to himself and I seemed to empathize with him.  However, these insights did not alter my agitated, contracted way of being with him. There was a strong sense in me of hopelessness and withdrawal; I often found myself doodling random images on a pad with no clear value or meaning. This was the kind of object I was to him. This deadness was not shared but resisted in me in an agitated impatient way.

As time went on as I struggled less, doodled less, and I found myself more alert to sensory aspects to our meetings: the light a particular time of day, the way the sound of our voices echoed in the room, smells of coffee, and so on. My attention had widened. It did not seem to matter what he talked about or even his affect, which usually lacked much variation. I felt content just as things were: a receptivity to what was, a hospitality even, which nevertheless felt paradoxically like a loss of my sense of purpose as an analyst. I had momentarily achieved an attitude of availability that was manifested by a physical relaxation in me. I noticed he also toiled less in an agitated way with insoluble problems. I sensed that this was in response to something between us in a new shared medium of beginning aliveness. This is nascent communicative musicality without speech--a distinct shared current nonetheless.

Two interactions grow out of this. First, when I noticed a nice sound the rain made one late afternoon, I commented on the sound the rain made. As if he anticipated my comment, he associated immediately to sailing in the most enlivened discourse I had yet heard from him. He emphasized the sensory qualities of the activity and sense of movement. Then, shortly after this, after a period of relaxed silence between us, he got up from the couch, sat next to me, and showed me pictures he had taken with his phone. The pictures were street scenes, glimpses of people in motion a la Cartier-Bresson. In contrast to many of his dreams early in the analysis, where were devoid of people and involved desert-like landscape, these pictures had life and richness. I had not known of his interest in photography. As he described the pictures and I responded with my associations, he noted how important this activity was to him, ‘It brings me into the world’. I thought but did not say, ‘with you’.

Over time we were able to build on these experiences with more of a similar kind. At times he would be the one to offer some important observation, to which I associated. I definitely felt the risk involved in playing with what he brought in. The risk of mis-attunement, or his sense I had taken over something of his, or used it for my own purposes, was quite real. At times I could sense I went too far and backed off. But most often he seemed energized by the interaction and continued to bring in new aspects of his life and interests. This seems to me analogous to free jazz, in which there is simultaneous give and take and we are both ‘soloing’: there is no obvious demarcation of soloist and rhythm section as in the previous examples. Of course the form shifted back and forth, yet I found with this man, in surprising ways, what he needed was more of a partner in improvisation rather than a participant supporting his emotional elaborations.


4.  It would be natural to turn to a situations now in which the disembodied is more relevant in the analytic conversation, where communicative musicality is lacking, to show the usefulness of some of the ideas presented thus far. J was a woman in her forties who sought treatment for marital difficulties. She was highly intelligent and had an elegant and erudite way of speaking that kept me interested. The stories she told however were vivid and disturbing, often involving scenes of sado-masochistic experiences with her husband. Their sexual life exhibited a current that infused her entire existence with others. The sado-masochistic sex involved the husband watching porn during sex, and without eye contact or any other emotional contact with her. My patient tolerated this without protest. Perhaps tolerate was not the right word, as I came to understand. She could not organize a thought that would have disapproved of her husband’s behavior because she did not experience it. She was not there.

The drama in her narratives and my outrage on her behalf, served as a protective barrier. I was so caught up in my own emotional reactions that I could not appreciate—resisted appreciating-- my patient’s empty state of mind. Gradually though, I had the uncanny feeling that we might as well be skyping. I sensed a glass wall or screen between us. Where we both watching another couple on TV? I started to have overt de-realization experiences: Her mouth was moving but no intelligible sound came from her. Or, I felt as if I was watching a movie without sound or in a foreign language. Her movements—gestures, tone, and narrative—were devoid of communicative musicality. There was no way to join her without entering a deadened pantomime. This was the current disembodied present reality. Earlier I noted that at the level of embodied communication, one can take the pulse of the relationship. Here, there was no pulse. I would have to try to provide it. This involved the risk of improvisation.

Here is a brief vignette from an early part of a session. An analogy to jazz is appropriate, when the rhythm section ‘sits out’ and the soloist plays alone. But here I had to be the soloist. My sense was to try to provide pulse, tone, and narrative, to see if she could join me. To do this, it is was crucial it not come from my anxiety and need to connect, which would initiate a subtle form of exploitation with which she was well familiar.  After she spoke for some time in that ‘silent movie way’, I started to narrate my sense of her coming in the room that day, how she moved and looked, her facial expression and tone of voice. But I tried not to do this as a distant observer but rather someone close up, as someone might narrate in their own heard what they are doing in an alive way. For example,

A-I heard your light footsteps coming up the stairs, and saw you smile when you came in to see me. Maybe you were happy and a little nervous.

P-You noticed that?

A-I felt it yes. And how your voice started strong but is quiet now. Now its sounds quiet but I can hear you. (I think at this point I’m injecting more feeling. I’m telling a story).

P--I’ll speak louder

A-Do you want to?

P--hmm. I don’t know. I didn’t notice my voice. Now I do. It sounds scared maybe…I remember going to a lake for summer with my family. My sister was fearless and would take a canoe way out. I would be on the shore looking at her and not being able to say anything, but I was scared.

(I can sense real feeling now as the story about her sister evolved.   I could make an interpretation of her frightened state now with me, or with her sister’s daring behavior, leaving her behind. But I felt how delicate the connection was at this moment and hoped to maintain it and not go beyond her. So I chose to emphasize that)

A--We don’t have to be that far apart.  I won’t drift away.

P--I want you to stay with me…tell me more what you see.

A--I hear a soft voice but with more feeling.

P---yes, I do too…hear my voice.

This exchange went from dissociation—a disembodied lack of presence-- to nascent, communicative musicality. This simple exchange concerns the way our rhythms start to match, including the length of our lines and our emotional tone. This is a matter of getting an ensemble going and finding a tempo that works, however slow. It was up to me to set the rhythm, like a slow ballad. I was also mindful of the way she could begin to narrate her own physical state, as a beginning move toward taking the lead in the conversation. Especially when she made the request that I stay close to her.


5.  A married woman D in her early thirties announced in our first meeting, ‘I don’t really know who I am’. She was a high-powered executive who ran at 78 rpm. She had many friends and an intimate male relationship. She spoke so rapidly I often asked her to repeat herself. One aspect of her history stood out: when she was eleven she underwent surgery following a traumatic injury. This history came out in passing despite the fact she had a frightening—from my point of view-- several months in hospital. She was facing the loss of important capacities for the rest of her life. She did fully recover physically.

My interrupting her with questions and clarifications altered her rhythm and at some point she was at a loss of what to say: ‘I realize I’m just filling space…what I’m saying has no real meaning to me’. My interruptions were an attempt to see if we could play together in time and also share some aspect of an emotional narrative. Lengthy silences ensued that I did not interrupt.  I felt this as progress but it was uncomfortable for both of us at first.  Her first response was concern for the impact she was having on me: “You must be so bored”, and like reactions. My discomfort was her discomfort: her anxiety about me, and how distraught she was at such a loss. I did have faith this could evolve productively if we both had the stamina. Gradually we both calmed down.

Then a unexpected event occurred. We had a flood in the office building. As a result, big dryers were placed in the common areas and the place was in shambles, with the rugs torn out, leaving unfinished flooring. I was pretty discombobulated, anxious, and distracted. Should I even be seeing people in this space? Plus the noise of the heaters was distracting. Aside from having no carpet and hardwood floors exposed, my office was pretty much the same--enough that I did not feel completely at sea. At least I was making that case for myself, that I had enough to attend to my patients.

When D arrived, I expected that like most of my patients, she would have some sort of reaction. The scene was dramatic and disturbing. But she moved to the couch and commenced her silent vigil as if nothing was altered in her/our environment. Then, in an unusual move she started to speak about my state. She would often worry about me—particularly her effect on me—but was not really tuned in to me in any realistic way. Today was different: ‘I can really sense something is wrong in you. You seem agitated, anxious, not yourself…Are you OK? This is starting to really distress me (She starts to cry). You are definitely not yourself.

This was a very important moment. I could interpret that she was projecting her own distress into me in a dissociated way, which has truth to it.  Perhaps even with some hostility because her safe environment had now been shattered. But I sensed at a more fundamental level that she was having an experience concerning me that was in fact accurate and connected to our environment—that was the main thing. I experienced her trying to find some place in which we both could reside that was real and attuned. The question was how to engage with her to allow this to unfold.

A--You’re right. I’m unsettled and distracted by my office as a result of the flood.

P--I noticed all that in the way you are, but assumed you had it all in hand and it was not a big deal…that sound is actually annoying but its so important I feel a connection with you—I don’t want that intrusion.

A--It’s pretty hard, at least for me, to completely ignore it.

P--It’s strange how I never had a sense of you in this way—not just this calm disembodied voice, but your whole anxious self. You’re moving a lot back there and your voice is strained.

A—Yes…and yours is different too. (I was worried that we would lose a sense of safety that I offered via her relationship to the office). Maybe that we’re both in it together can feel alright?

P—(After a very long silence). I don’t know. I think so. We are really together in a different way. You’re not just a talking head and I’m not either…this place is a drag.

In the following sessions we discussed the office scene and how we felt about the dryers, the floors, the smell, and future construction. As she took in more and more of the external reality, asking me detailed questions about the office and my reality as well, she  made contact with herself and me in a more physical way. Due to her experience in hospital, this aspect of her inner world had been severely attenuated. In the analysis she did slow down, which allowed for nascent experiences of her physical/emotional state. I attempted to stay with her in tempo and tone and let her take the lead, because I felt these silences were alive. The trigger for a leap forward was the office flood. She had direct access to my embodied state. The way to her body was through mine: she would first find in me (not exactly projective identification because it was a realistic sense of my embodied state) as a preliminary container for her states of mind. Over several months the experience in hospital entered our conversation, and she went over the physical aspect of her hospital room in great detail, and the terrified expression on her parent’s face, before touching on her fears of her own body and what was happening to it. In this phase I was in the position of support and witness; but there were moments when she sensed my anxious or disturbed reactions to her narrative that were correct and shared. This was a kind of booster that allowed her to continue in an emotionally present way. The establishment of communicate musicality eventually opened up the ‘residue’ of the dream of the flood: her traumatic stay in the hospital she had not experienced until then.



Embodied attunement is not symbiosis and merger but the dialectic of being ‘with and against the group’. As in jazz, the ultimate aim of these experiences is for the patient to simultaneously find companionship with others while feeling the support to differentiate, ‘emancipate’ from internal constraints, which leads to greater vitality and self-knowledge. Companionship in shared experience may be the first real contact some have with another, relieving a sense of alienation or dissociation. For others it involves a coming into being at a basic level of the body ego. Often the impact of this attunement, or attunement--mis-attunement-- repair, leads to an increasing sense of vitality and emancipation.

The active element of support is the analyst’s willingness to improvise, sometimes simply to take a bit of what the patient offers and find ways to enhance it or open up a new horizon for expression. Or, improvisation can alter the form in ways that make more demands on the patient, allowing for active mutually soloing and interaction at a more intense register.

The spontaneous and simultaneous  attunement that moves in and out of our conversation—communicative musicality alternating with moments of miss-attunement, where each partner’s rhythm, pulse and narrative is not shared and mutually experienced—marks an area of great importance for the analyst to attend to. It is easy to neglect or assume we know this through intuition, because it forms the natural background or ‘underneath’. Directed attention and internal perception does provide essential information about the ‘pulse of the relationship’ and suggests novel ways of improvising to initiate or restore embodied attunement, which is the basis of companionship and the foundation of emotional growth.

‘Medium’, following M. Balint and D.W. Winicott, is a surround that supports shared emotional experience and self-expression, as opposed to reaching and making contact. Communication depends on this medium. When the medium is music, qualities of simultaneity, loosening boundaries of self and other, and embodied living and being with others come to the fore. Music is not a metaphor here for what happens in analytic sessions, but rather, how foundational aspects of analysis are musical.



Further Explorations in Jazz and Psychoanalysis

These musical examples relate directly to our work as analysts. The examples will move from soloists with support, to a non-hierarchical conversation of simultaneous play and improvisation. These forms are analogous to structures of engagement, conversation, and transformation in psychoanalysis.


The soloist and their support:  John Coltrane: Impressions (with Eric Dolphy).

In Coltrane’s performance, in which there is a constant search and narration of novel self experience, he is always entwined and connected to the ensemble in ways that allow for his journey. Here is a musical example of improvisational soloing dependent on the improvisational support and presence of the rhythm section. Eric Dolphy, another soloist present on this track, reveals how Coltrane allows for influx into his own solo process by another.

Coltrane’s solo provides an example of how the self expands the boundaries of subjectivity.   This occurs in our consultation room as well, as the patient, through our support, ventures into new areas of experience.  The solo material in jazz and analysis is the movement of human feeling—its outline, forms, tensions, apprehensions, and perseverations. For Coltrane, it is the relentless pursuit for what is unknown. It becomes known in the act of articulation. This is the performative quality of jazz-- liberation in the midst of change, on a profoundly moving, bodily level.

Dissonance, meaning notes outside the normal harmonic order that creates tension,  marks much of Coltrane’s solo. Dissonance, according to Ellison, is the ‘capacity to create order out of chaos’. This is a paradox, yet dissonance, says Ellison,  ‘creates confusion out of no longer tenable forms of order’.  The undermining of untenable order offers the possibility of a new, more vibrant order. Ellison writes that, ‘It is a tactical interruption of our composure’. There is a corollary in analysis as well. The analyst is often confronted with dissonance in the patient’s material. This should not be assumed to indicate fragmentation, deliberate impenetrability, and so on. Dissonance can indicate that a search going on, an attempt to experience something novel and not yet formed and coherent, or the first experience of trauma that has been dissociated up to that point. This occurs, not due to a lack of support but rather the opposite:  the patient’s sense of the analyst’s presence and openness to new material.

Coltrane had an exceptional rhythm section. Yet Coltrane’s improvisational ability is so powerful, free, and coherent, that it takes several listenings to appreciate the power of the rhythm section and groove that ‘holds’—really allows for-- the solo. As a model of an analytic conversation, which I will expand below, there is here a lively interactive aspect of rhythmic support that allows for the elaboration of the self through soloing that upends the ‘untenable order’. This requires the analyst’s tolerance for dissonance and faith that the pair will sort it out.

As I noted above, there is also another other voice in the first part of the piece, in dialogue with Coltrane. This  voice is so different. Eric Dolphy’s voice is very close to speech in its odd jagged cadences, muffed sound, breathy quality, and passion to match Coltrane’s. At times he produces more sound than note.The soloist’s evolution is influenced by a dialogue with another soloist in real time. This requires presence on Coltrane’s part, to make room for another voice of equal power.


Two Solo Conversation: Coltrane and Dolphy: Mr. PC

The impact of Dolphy on Coltrane is primarily in the area of tone—its quality, range, and ‘voice’. Coltrane, who despite being the acknowledged master, was nonetheless open to influences around him. He manifests this openness through presence and availability. He does not quote or mimic Dolphy’s unique style, but blends it with his own. This offers the listener a sense of the shared presence of Coltrane and Dolphy (though sequentially, each within the other) that we feel and witness, and learn from. So Coltrane’s tone changes and enlarges in response to his active listening to Dolphy in ways we can hear on this piece.

The mutual influence fostering growth also occurs in the analytic conversation as the analyst finds ways to take in and transform the patient’s idiom in new ways. The analyst is also affected, and reflects his or her internal transformations in his style of speech and ways of being with the patient. That is to say, the analyst does not sound the same with each patient—or, with the same patient at different times and phases of the treatment. I do not mean in the register of content, but in the tone, pulse, and shared emotional narrative.


Attunement at the Edge:  Group Improvisation-- Miles Davis’ Nefertiti.

I want to move now to simultaneity in ensemble improvisation that occurs in ‘free jazz’. The meaning of this term its lack of an obvious organizing structure that the traditional jazz song offered, with chord progressions and choruses etc. This gives the musician the freedom to go where he or she wants to go, relying on the group to be there in time and response. Of course this occurs in traditional jazz as well, but not to this extent, here the rhythm section is not support but another soloist. Support and solo roles become blurred. In this piece the band is soloing at once, punctuated by a theme that Davis and Wayne Shorter play. The drummer has a new role in this form, as a solosist.

Free jazz puts a greater demand on the musician’s capacity for presence and attunement. Mitchell Kossak (    ), a musician and musical therapist, describes what is going on in his paper, Attunement and Free Jazz. He uses free jazz in group therapy to develop qualities of listening, trust  and risk taking. Attunement can be thought of musically—and beyond—as a sensorial felt embodied experience in the individual or group. Another definition is, as I noted above, is a kinesthetic and emotional sensing of others, knowing their rhythm, affect and experience….going beyond empathy to create a two person experience of unbroken feeling of connectedness by providing a reciprocal affect and/or resonating response. There is another word for this in the music theory literature: ”entrainment’, which means resonant fields rhythmically synchronizing together.

It is not always such smooth sailing: free jazz improvisation involves a process of relational connection and disconnection as well as discordant rhythmic flows (Nunn, 1988). The experimental is very important in breaking habitual ways of experiencing and relating. But it is also tumultuous.

The analogous experience in analysis is the way both patient and analyst allow for greater spontaneity and improvisation while the analyst lets go of more traditional forms of support. How far this can go will depend on both participants to tolerate tension and dissonance.


Attunement even farther out:  Miles Davis--Pharaoh’s Dance.

This is free jazz that creates greater tension, chaos, and power.  This music is even less structured than Nefertiti. There is no move toward a conclusion, no progression, and very little inherent structure. In Pharaoh’s Dance all are improvising together, moving into and out of more obvious solo roles.

Certain qualities are required of the musician to create cohesion within a matrix of spontaneity, improvisation, and freedom from most structural restraints. I would suggest that the aim is the frame. That each musician has the desire for free expression and support within the group. That is the frame as an internalized vision of cohesion arising from successful attunement and presence.

In the analytic conversation this involves a tolerance for turbulence and uncertainty. Out of this interaction a form, an intelligible voice will emerge. However, even in most free jazz—and analytic moments that are akin to it—the ‘beneath’ is there: a felt pulse and tone which may not be expressible in words for some time, if at all.


Group states of evolving mind: Coltrane--the Father, Son, and Holy Ghost.

This music, even freer jazz, is less structured and more chaotic, and stretches the limits of cohesion. I would still advocate that each musician has the same internal frame and aim, but allows for much more tension and dissonance. Perhaps Coltrane, by choosing tenor saxophones rather than contrasting bass clarinets, (as does Dolphy, for example), is symbolically extending his own solo, or perhaps blurring the individuality of the soloist. He wants to unfurl one long, symbiotic solo. J. Schott says,   “Coltrane no longer wants it to be about good music anymore, but about very, very long states of being. He is getting away from ‘John Coltrane’, ‘jazz’, and ‘music’’.  That is, a breakdown of boundaries and structure. This is certainly upending ‘untenable forms’ .The sound is manifesting the individual in the whole at the outer edge of differentiation—what Matte-Blanco called ‘pure being’.

The analytic conversation here would be ‘represented’ by emphasizing the ‘beneath’ as undifferentiated matrix, what P. Goldberg calls sensory symbiosis, or some aspects of field theory in the early writings of Bion on groups, his late writings on at-one-ment, and the idea of the dynamic field recently extended by de Leon de Bernardi, where the evolving flow is determined not by individuals but a shared state,  akin to certain analytic fields of high aesthetic and empathic intensity.



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Musical References

1.  John Coltrane, Impressions, The 1961 Complete Village Vanguard, Impulse, 1997

2.  Paul Motian,  River’s Run, Mark Copland New York Trio Recordings, Vol. 2: Voices, Pirouet, 2007

3.  Chet Baker and Philip Catherine, My Foolish Heart, Chet's Choice, Criss Cross Jazz, 1985

4.  Billie Holiday and Lester Young, He's Funny That Way, A Musical Romance, Legacy 1937

5.  Miles Davis, My Funny Valentine, Live at the Plugged Nickel, 1965

6. Cecil Taylor, Lena, Nefertiti, the Beautiful One Has Come, Revenant, 1962

7. John Coltrane, Mr. P.C., Live at Birdland, 1962

8. Miles Davis,  Nefertiti, Columbia 1968

9. Miles Davis, Pharaoh’s Dance,  Bitch’s Brew, Columbia 1970

10.  John Coltrane, The Father, the Son, and the Holy Ghost, Meditations, Impulse, 1966


[1] I am very grateful to Sam Klein-Markman and John Schott for their insights into jazz communication and improvisation.