Psychoanalytic music therapy (Pellizzari)

1. Introduction

Version followed: Pellizzari, P. (1993), Musicoterapia psicoanalítica: el malestar en la voz (Buenos Aires: Ricardo R. Resio), as summarised with page references by Ulkowski, Cunha & Pinheiro (2019). The book itself is not drawn on. Gaps are filled from current psychoanalytically (Lacanian) oriented music therapy at the Universidad de Buenos Aires (UBA) and from procedures published by ICMus, the institute Pellizzari founded. Each of these is labelled, and the writer's own guidance is marked [synthesis]. The author's first name (Patricia), her later books, ICMus, the Argentine practice law (Ley 27.153) and the national association (ASAM) are taken from sources. Her own 1993 voice techniques remain [uncertain]. [source: Ulkowski et al. 2019; Arndt 2019; Basutto, Pellizzari & Smith 2021; Barbaresco et al. 2017]

What it is. This is a theoretical orientation, not a manualised method. Pellizzari's 1993 book reads music-therapy practice through Lacanian psychoanalysis. Its subtitle, "the malaise in the voice", points to voice and sound as the place where the subject's suffering shows itself. The author is Patricia Pellizzari, the city is Buenos Aires and the year is 1993. Three sources confirm her first name: she co-authored a 2021 ECOS article, an ICMus paper names "Dra. Patricia Pellizzari" as its supervisor, and a former student names her in an interview. In 1998 she founded ICMus (Instituto de Investigación en Musicoterapia) and directed its first research project, Música y Psiquismo. ICMus became a civil association in 2008 and works in collective health, promotion and prevention. Her later books are Música y Psiquismo: Lo Psicosonoro (with others, ICMus, 2006) and Crear salud. Aportes de la musicoterapia preventiva-comunitaria (2011). Bibliographies differ on the publisher of Crear salud (ICMus or PP Editora) and on whether it has co-authors. The sources date Crear salud to 2011 and do not list Ricardo Rodríguez as a co-author. The titles from the first pass, Salud, escucha y creatividad (with Rodríguez, 2005) and Arte, escucha y creatividad (2006), each appear in only one bibliography and remain [uncertain]. A former student places her in a generation of community music therapists working in prevention and cites her concept of modos vinculares (relational modes). A 2021 ICMus article cites the 1993 book for "una poética de la resonancia". So the psychoanalytic book of 1993 is one phase of her work. Her later work, carried on through ICMus, is preventive, community-based and psychosocial rather than strictly psychoanalytic. These books are not drawn on [uncertain]. [source: Arndt 2019; Basutto, Pellizzari & Smith 2021; Barbaresco et al. 2017; Pérez Molero et al. 2025; Ruiz & Onorio 2020; Chavez & Bibbó 2013]

How change happens (as reported). Pellizzari asks whether psychoanalysis and music therapy are two opposed discourses. She concludes that they differ in important ways, above all in how transference is handled (book p. 47, per Ulkowski et al.). In music therapy the musical act is central to technique and the therapist's body takes part in playing. In psychoanalysis, acting is limited by the rule of abstinence. Pellizzari holds that abstinence must still be kept within the musical act, because otherwise analysis cannot take place. On this account, change comes from the subject's relation to their own sound, voice and speech, worked through in transference. It does not come from music acting as a remedy. That last formulation of the mechanism is my reading of the reported claims [synthesis]. [source: Ulkowski et al. 2019]

2. Framework

None of the sources describes phases, session counts or criteria for moving between phases for Pellizzari's approach [uncertain]. The frame below is a [synthesis] based on psychoanalytic convention and on the UBA case material. It is not taken from Pellizzari.

Preliminary phase (assessment and the start of transference) [synthesis]. Aim: hear the reason for consultation, observe how the person uses voice, sound and silence, form a structural diagnostic hypothesis, and find out whether a transference can form. The UBA authors treat transference as something that shapes diagnosis itself, not as something that comes after it. Format: individual, about weekly. Time: often 3–6 meetings [synthesis]. Move on when the person keeps returning, brings their own material (a song, a sound, a complaint about the voice), and the therapist can say how the transference is positioned. [source for the transference-diagnosis link: Marchesotti & Vizzolini 2024]
Working phase [synthesis]. Aim: musical and spoken production inside the transference. The therapist chooses at each moment between a stance of comprensión (understanding) and one of análisis, a distinction reported from Pellizzari pp. 51–52. In severe cases (psychosis, autism) the work may consist of building a stable relationship to a musical object, such as a repertoire, a recording or a workshop, rather than interpreting. Length: open-ended. No session count was published in the sources. [source: Ulkowski et al. 2019; Marchesotti & Vizzolini 2024]
Ending [synthesis]. Plan the ending when the complaint has shifted, when the person can sustain their own musical or social link outside sessions (for example, performing at institutional events in the UBA case), or when the frame cannot continue. Prepare the ending over several sessions and work through it in the transference. [source for the outside-link outcome: Marchesotti & Vizzolini 2024]

Format. Individual sessions are the default in the psychoanalytic material opened. The UBA case moved into a workshop and public performance. Pellizzari's later ICMus work uses individual, dyadic and group improvisation in psychiatric rehabilitation and open monthly community groups (see D17–D18). [source: Marchesotti & Vizzolini 2024; Barbaresco et al. 2017; Basutto, Pellizzari & Smith 2021] Setting: a room with voice, percussion and harmonic instruments (guitar, keyboard) and recording equipment if recording will be used.

Professional frame. Use this approach only if you are a qualified music therapist with psychoanalytic training, or a psychoanalytic clinician working jointly with one. In Argentina, music therapy is a regulated health profession under the national Ley 27.153 de Ejercicio Profesional de la Musicoterapia (sanctioned 10 June 2015, published in the Boletín Oficial on 3 July 2015). The law reserves practice to: holders of a university licenciatura en musicoterapia; holders of an earlier musicoterapeuta university title from a plan in force when the law passed; and holders of revalidated foreign titles. The title must be registered (matrícula) with the authority of the jurisdiction. Practice may be autonomous or within multi- or interdisciplinary teams, and covers promotion, prevention, care, recovery and rehabilitation. It includes reports for teams, interconsultation and referral. The law forbids acting outside one's scope, promising cures and advertising false successes, and unlicensed practice is a criminal offence. Provinces and the City of Buenos Aires apply the law by adhesion, and Buenos Aires Province has its own Ley 13.635. The official Boletín Oficial text is not drawn on, so these details come from a legal-information summary and an ECOS article. [source: Derecho en zapatillas 2019; Basutto, Pellizzari & Smith 2021] Degrees exist at UBA (Licenciatura en Musicoterapia, which hosts annual Encuentros de Musicoterapia) and at the Universidad del Salvador (Facultad de Medicina) [source: Bárcena & Castello 2026]. The national association is ASAM (Asociación Argentina de Musicoterapia), founded in 1966. It helped create the country's first university music-therapy degree and runs seminars and a library [source: Gómez Carrillo, WFMT]. Whether ASAM keeps a register or an ethics code was not found [uncertain]. Elsewhere: HCPC registration (UK, BAMT), MT-BC via CBMT (US, AMTA), or your national body. Personal analysis and clinical supervision are expected in this tradition [synthesis]. One UBA-area author mentions the therapist's own analysis in passing (Fernández 2020). A psychotherapist without music-therapy training should not use the musical-act components clinically [synthesis].

3. Guiding principles

Two discourses, not one (Pellizzari, reported). Do not treat music therapy as psychoanalysis with instruments, or psychoanalysis as music therapy with words. Practical meaning: before you act, know which logic you are working in at that moment. [source: Ulkowski et al. 2019, book p. 47]
Transference is the axis (Pellizzari, reported). Transference is where music therapy and psychoanalysis differ most. Practical meaning: read every musical exchange as an address to someone, and ask what place the patient is giving you. [source: Ulkowski et al. 2019]
Abstinence inside the act (Pellizzari, reported). You play, sing and use your body, but you do not use the music to meet your own or the patient's demand for love, reassurance or fusion. Practical meaning: play in a way that leaves room for the patient's production, not your own performance. [source: Ulkowski et al. 2019]
Understanding or analysis (Pellizzari, reported). The therapist can take a position of comprensión or of análisis (book pp. 51–52). Practical meaning: decide case by case, and moment by moment, whether to hold and accompany or to punctuate and question. [source: Ulkowski et al. 2019]
Reciprocal transferences (Pellizzari, reported). Pellizzari asks whether what the music therapist feels while playing is really countertransference, or rather "transferências recíprocas" (book p. 50, quoted in Portuguese). Practical meaning: what you experience while making music together is clinical material, and it should go to supervision rather than straight into interpretation. [source: Ulkowski et al. 2019]
Lacanian orientation (reported). The book is described as clearly Lacanian. Ulkowski et al. warn that Lacan admits many readings. Practical meaning: think in terms of subject, speech, voice-as-object and the singular case, not normative goals. [source: Ulkowski et al. 2019]
A position docile to transference (UBA, not Pellizzari). Let the transference set the direction rather than imposing a plan. [source: Marchesotti & Vizzolini 2024]
Offer an empty space (UBA). Leave the session open so that a subject can emerge, and respect the distance the patient sets. Do not impose knowledge. [source: Marchesotti & Vizzolini 2024]
The therapist as artisan (UBA). Make each offer for this case, not from a protocol. [source: Marchesotti & Vizzolini 2024]
Flexible tactics (UBA). Choosing between music and silence, speech and pause, movement and stillness is itself a tactic. [source: Marchesotti & Vizzolini 2024]
No clinic without ethics (UBA, citing Miller). The direction of treatment answers to the singularity of the subject. [source: Marchesotti & Vizzolini 2024]
Attend to the word's effect on sound (UBA, Gentili). Speech changes what happens in the sonorous-musical field, and this matters especially in severe cases. Be careful about treating music simply as a language. [source: Gentili 2022; Gentili 2021]

4. Intervention inventory

Read this first. None of the sources attributes a named technique list to Pellizzari's 1993 book. Items A1–A4 come from the stance positions reported from that book, and their step-by-step operationalisation is mine [synthesis]. Items B5–B14 are procedures published by present-day UBA psychoanalytically oriented music therapists. They belong to the same Buenos Aires Lacanian current, but they are not Pellizzari's. Items C15–C16 are borrowed or general. Items D17–D18 are procedures published by ICMus, the institute Pellizzari founded and supervises. They belong to her later preventive-community work, not to the 1993 psychoanalytic book. All example language is illustrative.

A1. Choosing the position: understanding or analysis (Pellizzari, reported)

Purpose / when: Pellizzari describes two positions the music therapist can take, comprensión and análisis (book pp. 51–52) [source: Ulkowski et al. 2019]. Use the choice at every decision point. Decide it explicitly in assessment and review it in supervision.
Steps [synthesis]: (1) After the first sessions, note whether the person can tolerate equivocation and questioning of what they say or play (pointing to analysis), or needs a stable, accompanying presence first (pointing to understanding, which is common in psychosis, autism and acute crisis). (2) In a given moment, if understanding: mirror, sustain, accompany, and do not interpret. (3) If analysis: punctuate a slip, a repetition or a sound, and ask about it. (4) Write down which position you took and what followed.
Example language (illustrative): Understanding: "I'll keep the rhythm with you." Analysis: "You stopped singing right on that word. What was that word?"
Watch for: Moving into analysis too early with fragile patients, which can show up as disorganisation or a persecutory reaction. Staying in understanding for good, so that the work becomes pleasant music-making with no movement in the complaint. It is working when the person starts to say something about their own production.

A2. Abstinent participation in the musical act (Pellizzari, reported)

Purpose / when: Pellizzari places the act at the centre of music-therapy technique and keeps the rule of abstinence even though the therapist's body is involved [source: Ulkowski et al. 2019]. Apply it whenever you play or sing with the patient.
Steps [synthesis]: (1) Play only what supports or frames the patient's production: a pulse, a harmonic ground, a reply. (2) Do not show your skill, take over the lead, or fill silences because you are anxious. (3) Do not use music to grant demands ("play me something nice so I feel better") as a routine way of soothing; note the demand and work with it. (4) Avoid physical closeness and touch during playing unless clinically agreed. (5) After the improvisation or song, leave a pause before you speak.
Example language (illustrative): "You'd like me to play for you. What do you imagine that would do?"
Watch for: Sessions turning into concerts, the patient becoming an audience, and therapist enjoyment taking over. It is working when the patient's sound takes up more of the space and their own phrasing appears.

A3. Registering reciprocal transferences (Pellizzari, reported)

Purpose / when: Pellizzari asks whether what the music therapist experiences while playing is countertransference or "reciprocal transferences" (book p. 50) [source: Ulkowski et al. 2019]. Use this after any session with intense shared music-making.
Steps [synthesis]: (1) Straight after the session, note your own bodily, emotional and musical impulses: what you wanted to play, what you held back, what you found yourself repeating. (2) Separate them from what the patient produced. (3) Bring the pattern to supervision or to your own analysis before you act on it. (4) Use it to locate the place the patient gives you, not as a basis for telling the patient how you feel.
Example language: None with the patient; this is a therapist-side procedure.
Watch for: Disclosing or acting out (for example, changing the music to rescue). It is working when the place the patient assigns to you becomes clearer over sessions.

A4. Listening to the voice as the site of malaise (title-derived) [uncertain]

Purpose / when: The subtitle el malestar en la voz makes the voice a privileged object. Neither research pass found a description of how Pellizzari works with the voice [uncertain]. A 2021 ICMus article cites the 1993 book for "una poética de la resonancia" when discussing aesthetics and listening, but it does not explain the idea [source: Basutto, Pellizzari & Smith 2021]. Use with complaints about voice, speech or singing, and when the voice itself carries the symptom (inhibition, breaking, stammering, a monotone, screaming).
Steps [synthesis]: (1) Listen to the voice as much as to what is said: timbre, breath, breaks, volume, where it stops. (2) Invite non-verbal vocal sound (humming, vowels, calls) without asking for beauty or correctness. (3) Punctuate moments where the voice changes. (4) Do not coach or correct technique; you are not a voice teacher.
Example language (illustrative): "Your voice dropped when you mentioned your father." "Would you try just the sound, without words?"
Watch for: Shame and exposure, since voice is intimate. Never insist on singing. It is working when the person can produce and talk about their voice with less inhibition.

B5. The open offer / empty space (UBA)

Purpose / when: Leave room for a subject to emerge, especially at the start and in severe cases [source: Marchesotti & Vizzolini 2024].
Steps: (1) Begin sessions without a set activity. (2) Ask what the person wants to do, and leave instruments available. (3) Wait, and accept silence or refusal as material. [source: Marchesotti & Vizzolini 2024; the wording of the steps is mine]
Example language (illustrative): "This time is yours. What would you like to do today?"
Watch for: Anxiety in people who cannot organise themselves in an unstructured space. If that happens, offer two or three concrete options [synthesis]. It is working when choices start coming from the patient.

B6. Respecting the distance the patient sets (UBA)

Purpose / when: Severe cases and persecutory transferences [source: Marchesotti & Vizzolini 2024].
Steps [synthesis of reported principle]: Let the patient choose where to sit, how close to be, whether to play together or alone, and whether to look at you. Adjust your volume and proximity to match.
Example language (illustrative): "You can play from there; I'll stay over here."
Watch for: Intrusion felt by the patient: covering ears, leaving, rising agitation. Step back.

B7. Tactical alternation: music or silence, speech or pause, movement or stillness (UBA)

Purpose / when: These are the moment-to-moment tactical choices in directing the treatment [source: Marchesotti & Vizzolini 2024].
Steps [synthesis]: (1) Notice what dominates the session: noise, talk or motion. (2) Bring in the opposite pole on purpose, for example stopping the music to allow a word, or answering speech with a sound. (3) See what the change produces.
Example language (illustrative): "Let's stop here for a moment." (silence) ... "What came to mind when the music stopped?"
Watch for: Doing it mechanically. It is working when the shift brings out new material.

B8. Accompanied singing of the patient's songs (UBA)

Purpose / when: To build a link through repertoire the person brings; useful in psychosis and with people who will not improvise [source: Marchesotti & Vizzolini 2024].
Steps: (1) Ask which songs matter to the person. (2) Accompany on guitar or keyboard in a key that suits their voice. (3) Let them lead tempo and choice. (4) Listen to what the lyrics and the choices bring out, and to where the voice falters, without forcing interpretation. [steps partly synthesis]
Example language (illustrative): "Which song shall we do? You set the speed."
Watch for: Lyrics or melodies tied to trauma or loss (see Section 5). It is working when the person keeps choosing, extends the repertoire, and talks around the songs.

B9. Song list and music notebook (UBA)

Purpose / when: Gives the person a stable object that ties sessions together and organises their own production. Useful in severe cases [source: Marchesotti & Vizzolini 2024].
Steps: (1) Write down the songs the person wants to learn. (2) Keep a music notebook with lyrics, chords and notes, and let the patient decide what goes in it. (3) Come back to it at the start of sessions. [steps partly synthesis]
Example language (illustrative): "Shall we add that one to your notebook?"
Watch for: The notebook turning into homework or a performance target. It belongs to the patient.

B10. Recording, editing and patient-selected recordings (UBA)

Purpose / when: Turns what was played in the session into a lasting product that the patient owns. This supports a sense of authorship and a link to others [source: Marchesotti & Vizzolini 2024].
Steps: (1) Get explicit consent before recording, and agree where files are stored, who keeps them and how long they are kept. (2) Record songs or improvisations. (3) Edit them together with the patient. (4) Let the patient choose which recordings to keep or share. (5) Treat recordings as clinical records under your data-protection rules [synthesis].
Example language (illustrative): "Do you want to keep this take, or record it again?"
Watch for: Distress at hearing one's own recorded voice, and sharing without consent. It is working when the patient can listen back and comment.

B11. From session to workshop and institutional performance (UBA)

Purpose / when: In the UBA case, individual work led to a workshop and to playing at institutional events, which built a social link [source: Marchesotti & Vizzolini 2024]. Use it when individual work is stable and the patient asks for more.
Steps [synthesis]: (1) Only when the patient raises it or accepts it, talk through the step from private to public. (2) Prepare the repertoire. (3) Agree on the patient's role and how they can opt out. (4) Debrief afterwards in session.
Watch for: Exposure, shame and decompensation after a performance. Institutional pressure to show off patients. The patient's wish takes priority over the institution's.

B12. Diagnostic orientation through the transference (UBA)

Purpose / when: The UBA authors frame transference as a strategy that affects diagnosis, drawing on psychoanalytic psychopathology (Sotelo) [source: Marchesotti & Vizzolini 2024]. Use it in assessment and whenever a case is reviewed.
Steps [synthesis]: (1) Note how the person relates to you and to sound: demand, defiance, indifference, intrusion, invasion by sound. (2) Form a structural hypothesis (neurosis, psychosis, perversion, in Lacanian terms) and adjust your position to it (see A1). (3) Revise the hypothesis as the transference develops.
Watch for: Fixing a diagnosis too early. Using musical behaviour alone as proof of a diagnosis.

B13. Attending to the effect of the word on sound (Gentili, UBA)

Purpose / when: Gentili examines how speech changes the sonorous-musical field in severe cases [source: Gentili 2022].
Steps [synthesis]: (1) After a sound sequence, try a short spoken intervention (naming, a question, or a single word). (2) Observe whether the playing changes: it may stop, organise itself or become disorganised. (3) In severe cases, keep words few and light if speech invades the patient.
Example language (illustrative): "That." (pointing to a repeated motif) ... wait.
Watch for: Speech felt as intrusive or persecutory.

B14. Starting from the sounds of lalengua (Mistrangelo via Gentili) [uncertain]

Purpose / when: Mistrangelo (2016) proposes that music therapy can start from the sounds of lalengua, the sound-substance of a person's language that comes before meaning. Gentili partly agrees but disputes that communication is lalengua's primary function [source: Gentili 2021]. Mistrangelo's text is not drawn on. Use this with patients for whom meaning-based exchange fails.
Steps [synthesis]: (1) Pick up the patient's own sound fragments: babble, idiosyncratic syllables, words used for their sound. (2) Return them inside a musical frame with rhythm or pitch, without translating them into meaning. (3) Let the patient play with them.
Watch for: Pushing for communication. It is working when there is playful repetition and variation.

C15. Vocal and clinical improvisation methods from other schools (not Pellizzari)

Purpose / when: Argentine music-therapy training uses vocal work drawn from Pavlicevic (clinical improvisation), Sokolov (vocal improvisation) and Loewy ("vocal holding") [source: Moreau et al. 2008]. Those authors' manuals are not drawn on [uncertain]. If you use them, credit them and run them under the psychoanalytic stance (A1–A3).
Steps [synthesis]: (1) Give a simple harmonic ground (for example two alternating chords). (2) Invite the patient's voice over it. (3) Follow rather than lead. (4) Talk about it afterwards only if the position (A1) allows.
Watch for: Technique replacing listening.

C16. Opening, closing and session notes [synthesis]

Purpose / when: Every session.
Steps: (1) Keep the time, the place and the instrument set constant. (2) End on time even in the middle of the music: fade out rather than cutting abruptly. (3) Write notes on what was played and said, and on your own position (A1) and reactions (A3).
Example language (illustrative): "We'll stop here; we'll take this up next time."

D17. Toma Sonora and ISI-V sound assessment (ICMus, not the 1993 book)

Purpose / when: This is ICMus's assessment device, reported from a psychiatric-rehabilitation group programme. It combines an individual and a dyadic improvisation with the therapist, using voice and instruments, followed by a semi-structured verbal interview and a one-question written questionnaire. It draws on Música y Psiquismo: Lo Psicosonoro (Pellizzari et al. 2006) and on Wigram (2004). The material is read through two ICMus concepts. The first is Modalidad de Enlace, the way the person connects with sound objects, shown in action, posture, gaze, time and investment. The second is the Perfil Sonoro Individual / Vincular: the person's own sound profile, and their mode of intersubjective sonic connection, including how far they differentiate from the other. Use it at intake and to review progress. [source: Barbaresco et al. 2017]
Steps: (1) Offer voice and a range of instruments. (2) Invite a free improvisation alone, vocal and instrumental, and then a shared one with the therapist. The ISI-V (improvisación sonora vocal e instrumental individual y vincular) has referential versions, played on a theme, and non-referential ones. (3) Follow with a semi-structured interview about the experience, then ask the single open written question about the sonic experience. (4) Note the Modalidad de Enlace and the features of each profile. In groups, log notable sonic scenes across sessions in a grid (the ICMus group data matrix). [source: Barbaresco et al. 2017] The 2006 interview guide and questionnaire wording are not drawn on. Do not reconstruct them [uncertain].
Example language (illustrative): "Pick whatever you like and play, or use your voice, however it comes." Then: "Now let's play together. You start when you want."
Watch for: These are frames for clinical observation, not validated diagnostic instruments. The source opened gave no reliability or validity data [uncertain]. Never use a sound profile as evidence of a diagnosis. Watch for patients who cannot tolerate the exposure of the shared improvisation (see B6).

D18. Monthly social music-therapy encounter (ICMus, "Escucha y Arte entre mujeres")

Purpose / when: This is a preventive community group, not psychotherapy. ICMus has run it on Zoom since May 2020: it is open and free, meets monthly for about two hours, and has around twenty women in a meeting. Coordination is shared and rotates among ICMus music therapists, neighbourhood leaders and participants. The authors frame it as social music therapy within critical collective health, with gender and human-rights perspectives, built on situated listening (escucha situada). Psychotherapists can refer into such a group or work alongside it. [source: Basutto, Pellizzari & Smith 2021]
Steps: (1) Welcome: eye contact and sharing of how each person feels. (2) Main theme, which comes from the group, explored through a performance or a playful, expressive, receptive or participatory activity. Reported activities include group vocal improvisation, group singing, reinventing songs, composition, sound-dramatisation, edited music, drawing to music, masks, puppets, phrases on a shared whiteboard folded into improvisation, and reading participants' own poems. (3) Conversation. (4) Poetic or aesthetic synthesis: condense the meeting into a shared product, such as a group poem. (5) Close with spontaneous movement or dance. Participants choose how much to take part and may turn camera and microphone off. Meetings are not recorded or posted. Coordinators adjust timing, rhythm, density and energy, and balance who takes the lead. [source: Basutto, Pellizzari & Smith 2021]
Example language (illustrative): "Join in with sound, with words, or just by listening, whichever suits you today."
Watch for: The article gives no protocol for acute distress [uncertain]. Agree in advance how a participant in crisis will be contacted and referred, and keep the boundary between community group and therapy explicit [synthesis]. Lack of connectivity excludes some people, and the authors propose building neighbourhood networks to address it [source]. Topics such as violence and sexuality came up in the meetings, so have referral routes ready [synthesis].

5. Handling problems

The sources do not address problem handling for this approach. Everything below is my own [synthesis], apart from the principles it rests on, which are cited in Section 3.

Stuck client (pleasant music-making, no movement). Check whether you have settled into comprensión by default (A1). Bring in a contrast (B7): stop the music, or point to a repetition. Ask what the person comes for now. Take the case to supervision with a note on your reciprocal transference (A3).
Resistance or refusal to play or sing. Do not push. Refusal is material and fits the empty-space offer (B5). Offer listening to recordings the patient brings, speech alone, or a low-exposure instrument such as a shaker or a single drum. Say the refusal out loud without interpreting it too early: "(illustrative) Today the instruments stay quiet. That's fine."
Overwhelm or disorganisation (sound invasion, agitation, dissociation). Lower the volume and density at once, or stop. Move to the understanding position (A1). Give a simple predictable pulse, or silence, depending on what calms this person. Increase the physical distance (B6). Ground with orientation: the room, the time, your name. If psychotic decompensation or risk appears, assess risk in the usual way and involve the treating psychiatric team.
Musical trauma triggers. Particular songs, genres, instruments, volumes or kinds of voice (for example a shouting voice, or anthems and religious music tied to abuse, war or political violence, which matters in the Argentine context) can bring back trauma. At intake, ask about music the person must avoid. Do not introduce repertoire yourself without asking. If a trigger happens: stop, orient, name what happened, and let the patient decide whether to go back to that music.
Hearing safety. Keep drums, cymbals, amplified instruments and recordings at moderate levels. Avoid long loud playing in small rooms. Offer earplugs or ear defenders for people who are hypersensitive to sound (common in autism) and use them yourself when needed. Watch for covering ears, flinching or tinnitus complaints. Let the patient control volume. Check that headphones used during recording playback are set low.
Non-adherence (missed sessions, lateness). Treat it as transference material within a consistent frame. Keep the session time and fee policy steady, and explore what the absence says. With institutional or severe cases, contact the referring team rather than reading it only analytically.
Rupture. For example, the patient feels used, exposed (after recording or performance) or pressured to perform. Acknowledge it, go back to their own choice (B10–B11), and remove the activity that caused the rupture. Look at your own part in it, for example your enjoyment or wish to show off the work (A2, A3).
Demand for a concert or for soothing. The patient asks you to "just play". Note the demand and occasionally meet it if understanding is the chosen position. Do not let it become the routine. Ask what they expect from it (A2).
Erotised or idealising transference made stronger by shared music. Keep abstinence (A2). Keep physical distance and avoid duets that feel intimate. Take it to supervision.
Therapist acting out musically. Signs are over-playing, changing the music to rescue, or self-disclosure. Keep the post-session notes (A3) and use supervision or personal analysis.
Recording and data. Get written consent, store recordings securely, and never share or perform material without fresh consent. For minors, also get parental or carer consent and the young person's assent.
Children and young people. Follow local safeguarding and mandatory-reporting rules (in Argentina, the provincial child-protection systems; elsewhere, national law). Get assent alongside parental consent. Hold regular parent interviews in a way that protects the child's space. Do not treat a child's sound, song lyrics or play as evidence of abuse; report on disclosures and observed indicators according to protocol.
Psychosis and autism (the severe cases in the UBA literature). Prefer understanding and object-building work (B8–B10) over interpretation. Keep words few (B13). Coordinate with psychiatry. Never present music therapy as a replacement for medical treatment.
Scope. If you are a psychotherapist without music-therapy training, use the stance (Section 3) in talk-based work and refer to a licensed music therapist for musical-act interventions. Do not run improvisation or recording interventions on your own.

Sources

Sources:

Further sources:

Arndt (2019). Entrevista: Araceli Onorio. Revista InCantare 10(1):142–166. Confirms the first name Patricia and the concept of modos vinculares.
Basutto, Pellizzari & Smith (2021). Pertinencia de un dispositivo de Musicoterapia Social Online. Escucha y Arte entre mujeres. ECOS 6(Esp.3):e008. Covers the history of ICMus, Crear Salud, Ley 27.153 and D18.
Barbaresco, Galli, Castagnero & Saviotti (2017). Orquestrando sonoridades na vinculação: dispositivo ICMus para adultos em reabilitação psiquiátrica. Revista InCantare 8(1). Covers the 2006 and 2011 books and D17.
Pérez Molero, Echezuri, Fernandez & Macía (2025). Procesos participativos en los abordajes vinculares en musicoterapia entre infancias y sus figuras de cuidado. ECOS. Gives the full title of Crear Salud.
Derecho en zapatillas (2019). Regulación de la musicoterapia. Summarises Ley 27.153. The Boletín Oficial text is not drawn on.
Gómez Carrillo, P. ASAM Anniversary: 50 years. WFMT
Bárcena & Castello (2026). La implementación de la Musicoterapia Preventiva Social para el abordaje de la ley de Educación Sexual Integral en el Nivel Inicial. TIF, Licenciatura en Musicoterapia, USAL

Further reading (not drawn on) [uncertain]:

Pellizzari, P. (1993). Musicoterapia psicoanalítica: el malestar en la voz. Buenos Aires: Ricardo R. Resio.
Pellizzari, P. & Rodríguez, R. (2005). Salud, escucha y creatividad. Musicoterapia preventiva psicosocial. Buenos Aires: Ediciones Universidad del Salvador.
Pellizzari, P. (2006). Arte, escucha y creatividad. Buenos Aires: Ediciones Universidad del Salvador. This is as listed by Chavez & Bibbó; it may be a different title or year for the 2005 book.
Pellizzari, P. et al. (2006). Música y Psiquismo: Lo Psicosonoro. Buenos Aires: ICMus. Cited in Barbaresco et al. 2017.
Pellizzari, P. (2011). Crear salud. Aportes de la musicoterapia preventiva-comunitaria. Buenos Aires: ICMus. Basutto et al. 2021 list it as published by PP Editora, with co-authors Kinigsberg, Tuñón, Brusco, Patles, Menéndez, Villegas and Barrenechea.
Mistrangelo (2016), chapter "El lenguaje sonoro", as cited in Gentili 2021. Full details were not verified.

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