STAGE FRIGHT IN MUSICIANS: A PSYCHODYNAMIC PSYCHODYNAM IC PERSPECTIVE
Contents
1.
The paradox
2.
The conflict
3.
Case example
4.
Background
5.
Developmental history
6.
Discussion
7.
Acknowledgments
8.
References American American Accent
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Stage fright is a mystifying and unnerving experience for many performing musicians, and it often impedes professional and personal fulfillment in careers. However, when some performers seek psychological treatment, it is not unusual for them to wish for a quick cure for a problem that is complex and overdetermined. Using psychoanalytic theory and a case example, the author illustrates how stage fright is related to an individual's life history and how its symptoms are the manifestation of complex unconscious processes. Questions are raised about problems that arise in treating performers. 'Bulletin of the Menninger Clinic, 57[4], 492-503) The term stage fright is actually a misnomer. Musicians are not literally afraid of the stage--typically an elevated platform usually constructed of wood and nails. Rather, anxiety is aroused about what might happen while the musician is performing on stage in front of an audience. What we call stage fright i s a mystifying and unnerving experience for many performing musicians, often hindering their profession al and personal fulfillment. However, some performer s who seek psychological treatment want a quic k cure for a problem that is complex, long-standin g, and overdetermined. This article illustrates how stage fright is related to an individual's life history and how its symptoms are the conscious manifestation of complex unconscious processes. Because there are no "magic" cures or simple answers, performers who seek treatment may face difficulty forming a treatment alliance. Some performance-anxious patients may even terminate treatment prematurely. Although performance anxiety touches many individuals besides musicians (e.g., test takers, public speakers, and athletes, as well as individuals who are not specifically in the public eye but must assert themselves in front of others), musicians are unique in two specific ways: (1) The great majority begin training in childhood on an instrument that becomes the focus of their life's work. About 90% begin before age 12; nearly half (46%) begin before age 7 (Nagel, 1987). The average age at which musicians begin training is 10 years (Fishbein, Middlestadt, Ottati, Strauss, & Ellis, 1988). Although most career decisions typically are made in late adolescence or young adulthood, the musician spends critical formative years focusing on lessons and intense training while at the same time interacting with important caregivers. This upbringing has monumental implications for personality development and social adjustment and often fosters fertile ground for the roots of performance anxiety. (2) The job market in the United States for classical performing musicians is much more problematic than it is for other highly skilled professionals. Unemployment in the arts is high, pay is often inadequate, and many musicians work at jobs considerably below the level for which they were trained. The Juilliard School requests former students to describe their careers according to (1) principal occupation (the one that is most important to them), (2) second occupation, and (3) third occupation illustrating the uncertain nature of employment in the arts and the probability of multiple employers. Certainly individuals sensitive to issues of rejection, loss, and competition are internally primed for the external conditions of the performance profession. Thus one can conceptualize performance anxiety not only as a psychological problem but also as a broader issue of artist survival (economic as well as emotional), further illustrating the potentially devastating and career-threatening components of this psychological nemesis. Without doubt, today's musicians, particularly in the United States, live in a world where psychological, societal, and economic irritants add to the complexity of performance anxiety. The paradox We must confront a paradox concerning performance anxiety. Many classically trained musicians find themselves in a Catch-22. Nothing could be worse than not having the opportunity to perform, yet when considering the potentially
devastating effects of performance anxiety for those persons who are affected, nothing is more threatening than having that opportunity. Ironically, stage fright unfairly casts its spell on the performer at the very time the musician needs to be competent under the glare of the spotlight and the watchful eyes and ears of the audience. This conundrum raises a paradoxical question: If a musician desi res a career in the performing arts, if he or she is well trained, well practi ced, and of adequate talent, why would performance anxiety undermine the ability to show in public what the person can demonstrate in private? Public performance implies that musicians not only show competence, but also go beyond a mundane reading of the score to deliver an artistic and expressive interpretation with technical security and virtuosity. In other words, the paradoxical demands of public performance require musicians to maintain control (of memory and technique) and also to symbolically "lose" the very control that is so critical to performance proficiency in order to transcend the musical score. The loss of control has unique meaning for each individual and can foster anxiety in musicians whose personal history and childhood experience lend themselves to this complex dynamic. And although performance anxiety frequently is presented as a negative, debilitating problem, it must not be forgotten that it also can provide a positive source of energy for those performers who are not psychologically susceptible t o its unconscious determinants. However; because th e paradox of stage fright can have such devastating and far-reaching effects on musicians' sense of self and their careers, we must further explore its dark side. The conflict Conflict permeates the core of performance anxiety. This dilemma centers around an unconscious desire/fear dichotomy in which a need to show one's artistry in public is counterbalanced by a fear of appearing inadequate and of being rejected by that public. Overt, conscious symptoms of performance anxiety includ e subjective psychological dist ress, negative cognitions, and physical discomforts that range in severity. For example, stage fright assumes the guise of nausea, palpitations, sweaty palms, and muscle rigidit y or flaccidity, as well as threatenin g thoughts (e.g., Will the audience appreciate and endorse me? What if I have a memory slip or technical accident? Will I be exposed as the fake I fear I am?). These issues, to some degree, indiscriminately accompany both young and mature musicians, talented and less gifted performers when they cross the physical or symbolic threshold that separates backstage from center stage. Typically, individuals beset with performance anxiety are unable to demonstrate their competence when under pressure; in severe cases, careers must be abandoned or redirected. This possibility holds monumental implications for the performer who has begun training in childhood and has, by choice or by necessity, ruled out other career options and avenues of study. Cognitive-behavioral theory maintains that negative, irrational, and faulty cognitions predominate the thinking of individuals who experience stage fright (Ellis Harper, 1975; Kendrick, Craig, Lawson, O Davidson, 1982; Meichenbaum, 1977; Nagel, Himle, & Papsdorf, 1989). Performance anxiety is conceptualized as the problem rather than as a symptom of underlying issues. Biological and neurological explanations focus on the release of excessive amounts of adrenaline in the central nervous system (Brantigan, Brantigan, & Joseph, 1982; Gates & Montalbo, 1987; James, Pearson, Griffith, & Newbury, 1977). In fact, many anxious performers have resorted to the use of beta-b locking drugs to offset the somatic symptoms mentioned earlier. What is particularly disturbing about this flight to pharmacological intervention is that both data and clinical accounts demonstrate that many musicians use beta blockers without prescriptions (Fishbein et al., 1988). Whatever the meaning of a "magic pill" to stage fright sufferers, the rare but potential side effects of using these drugs without medical supervision can be quite serious. Looking beneath the neurological and cognitive manifestations of performers' discomfort, one can view performance anxiety as a symptom of unresolved unconscious conflicts. Furthermore, the artist-audience relationship forms the breeding ground for performance anxiety and reflects d ynamics underlying personality develop ment. The power and capacity of the audience to instill fantasies and fears of rewards and punishments are conceptualized and internalized as earlier meaningful relationships with parents and significant others. Unresolved conflicts about these relationships remain unconscious but are dynamically primed, given appropriate provocation. Childhood experiences and their intrapsychic significance affect not the presence or absence of stage fright, but the severity of an individual's reaction to appearing in public. For many performers, being on stage as the focus of attentio n provides the catalyst for these repressed psychic events and feelings to become activated. As are all psychic phenomena, performance anxiety is overdetermined and complex; I will make only brief reference to some of its dynamic origins. Stage fright is linked to conflicts about exhibitionism and castration anxiety. Some performers fantasize that they will be puni shed (castrated) for their wish to exhibit superiori ty (i.e., technical facility a nd brilliant musical insights) or- -even worse--that they will be exposed as inad equate in these attempts (Freundlich, 1968). In addition, Freundlich (1968) maintained that oedipal themes suggest that performers wish to be favored by audiences and chosen winners by committees who judge them. Performing successfully or winning an audition and thus eliminating rivals can arouse guilt feelings in the performer, because these accomplishments symbolically and unconsciously defeat the same-sex parental rival. If this dynamic emerges as stage fright, performance efforts are sabotaged because "victory" is forbidden. If there is a fear of the negative consequences of failure, is there also a fear regarding the positive outcome of success? Do some individuals have a need to avoid success? Does a musician who simultaneously experiences conflict over the desire to perform publicly and the fear of not being good enough actually fear being good enough? Are some people afraid of reaching thei r professional goals? The fear of failure voiced by performers is experienc ed on a conscious level, but the preoccupation with not being good enough may represent an unconscious fear of success (Gabbard, 1983). In the minds of some performers, occupying the limelight on stage takes opportunity away from others or may arouse
envy in a struggling performer toward other musicians who enjoy success. The sense of guilt that is experienced as a result of these feelings can sabotage the best-prepared performer. Narcissistic issues also are evident. According to Gabb ard (1983), the narcissistic individual... [lacks] a certain required internal structure, which results in an unending search, so that the individual is consigned to a life of dependency on certain external objects in an effort to satiate his intense object hunger.... the audience's applause and admiration is almost a matter of survival Some performers feel truly alive and complete only if they are receiving the confirmation and approval of an admiring audience. (pp. 428-429) This unending search for narcissistic gratification sustains performance efforts as it simultaneously coexists with the fear of rejection, thus maintaining the unconscious conflicts that fuel performance anxiety. Appearing as a soloist requires the musician to exert independence. However, the assertion of autonomy entailed in artistic performance can activate anxiety over unresolved childhood issues of separation from parents (Gabbard, 1979). To assert oneself as a competent, fully functioning adult on stage may represent the ultimate fear of abandonment by the mother/parents who are no longer needed (Mahler, 1972). Conflict between parents over their offspring's career in music is reflected in some performers' attitudes and anxiety. My research (Nagel, 1987) shows that positive parental support of the young child's musical activities often becomes negative as the growing adolescent professes a serious interest in music. Negative and mixed messages from parents undoubtedly arouse performers' feelings of insecurity and anxiety over displeasing them, even during the pursuit of a performance career. Case example This psychoanalytic theory can best be understood by discussing the case of a patient I treated. Details that would identify the patient will be altered, but the material illustrates the complex nature of performance anxiety and its underlying determinants. My intention is not to defend the efficacy of psychoanalytic treatment or to illustrate only its success. My goal is to explain the complexity of performance anxiety with a case that might have ended successfully if the patient had remained in treatment. As will be seen, the reason he left therapy was related to the reasons he sought treatment. Background When Mr. B came to see me, he was a 31-year-old student who had returned to graduate school to pursue piano studies. He had earned an undergraduate degree in music many years earlier. He had been referred to me by a friend because he constantly complained of his debilitating stage fright, which prevented him from playing with technical or mental security in public. Mr. B explained that his performance anxiety had increased since he had returned to school; his symptoms included lowered concentration, a subjective perception of playing less musically, missing notes, and sweating so profusely that his fingers slipped off the keys. He was concerned about loss of motor function in his technique. He noted, with some concern, that since he had arrived at school, performing had become more important to him and he had practiced harder-yet his playing had deteriorated. He observed that in the past, he could play in public with comfort and project "great musical ideas." His goals included playing Liszt and Tchaikovsky like Vladimir Horowitz. Although Mr. B earned his undergraduate degree in music and did some performing following his graduation, he left music to go into business with his stepfather. He claimed that he wanted to earn "big bucks"; his starting salary was around $50,000. He added, however, that his biological father was unhappy about his decision to leave music. While working in the business world, Mr. B found himself compelled to practice about 6 hours a day while also putting in 8 hours at the office. He felt worn out and said that his fatigue caused him to "screw up the business." He almost ruined his stepfather's company. He also became involved with drugs and alcohol. Consequently, he quit the family business. After depleting his savings within a year, he decided to return to music school, realizing that it had been difficult to give up the piano. He observed that his stage fright returned upon his first day b ack at school. Mr. B complained of "getting old," noting that the students around him were younger. He commented, "They play like monsters, which makes me feel inferior and incompetent." Because he was older than his fellow students, Mr. B felt that other people should look up to him. The competition now seemed much stiffer than when he was an undergraduate. It is of interest to note that although Mr. B began piano lessons at the age of 9, he felt that he was a late starter and said that other 9-year-olds were already playing concertos at that age. His pattern of feeling inferior was a long-standing one. Developmental history Mr. B's father left the family when the patient was about 2 years old, and his mother remarried the following year. Mr. B's biological father was indepen dently wealthy, with a large inheritance in rea l estate. Although Mr. B said he was on good terms with his father, he described a distance between them, attributing it to his less-than-stellar achievements as an undergraduate. Mr. B cynically described his father as a man who "played with toys" (i.e., cars, planes, houses). He also told of his father's several remarriages, adding that the relationships never lasted very long. Mr. B described his stepfather as a man who drank approximately half a gallon of Scotch a day. He was belligerent and fought with the patient's mother Mr. B recalled how his stepfather was particularly violent with him and his mother after returning home from a night of drinking. Mr. B's stepfather often belittled him and insisted that his stepson should be "perfect." It was notable that Mr. B did not talk about his mother in any detail. Mr. B told of his parents' "dragging" him to a psychiatrist when he was in the sixth grade because he was considered a "brat." He only went five or six times, claiming that the doctor "couldn't change me ... my parents were the ones with problems." He thought that his troubles would disappear when he cou ld leave the home of his mother and stepfather. When he was 16 years old, Mr. B made a suicide attempt. At that time, he was skipping school and his parents took away his car. He "ate tons of pills," describing them as aspirins that he "washed down with Scotch." His parents were out of
town, and Mr. B never told them what he did. Mr. B was furious when he awoke the morning after this attempt. He said that he still had suicidal thoughts on occasion. When I asked when these thoughts occurred, he replied, "After a bad performance, I feel unwell inside." When he was upset, he said he needed to be reassured that he was an OK person and pianist. He took aspirin before concerts to "pep me up." He drank a six -pack of beer or three fourths of a bottle of rum when he was lonely--once or twice a week and on weekends. Mr. B did not feel, however, that he was an alcoholic, and he claimed that he could control his drinking, despite evidence to the contrary. Mr. B said that he was lonely despite being well liked at school. One relationship with a woman had failed because Mr. B wanted to have "fun" while the woman wanted to get serious. He described past relationships without emotion. Mr. B came across to me as laconic, removed, and isolated affectively from the intense experiences he reported. He was often sarcastic and laughed selfconsciously after revealing difficult material. When I noted this detail, he commented that he was trying to keep himself from feeling disappointment and anger. At the end of the first session, he appeared surprised and relieved that a possible connection had been observed between his belittling himself if he was not "perfect" on the piano and his stepfather's demands and abuse when he did not live up to e xpectations. Mr. B exclaimed, "I knew my stepfather was an SOB, but I never realized it was connected to my performance anxiety before." Discussion Mr. B's performance anxiety clearly was embedded in issues that long preceded his return to graduate school. His psychological pain, which he dealt with t hrough denial, isolation of affect, and alc ohol abuse, was related to his anger and rage over feeling rejected as a child, his fear of future rejection, and his unconscious need to reject the very persons on whom he longed to depend (including his therapist). This rage and anger became internalized and were played out through his stage fright, where he punished himself by sabotaging his performances. It is not unusual for people to set themselves up,unconsciously, to do the very things they fear or complain about. Certainly, he "punished" his stepfather through his near sabotage of the family business. Mr. B punished himself further through his use of alcohol. His narcissistic image of himself as another Horowitz was incompatible with the "inferior student" (or little boy) situation he found himself in at school. Grandiose wishes for wealth and success and the emulation of the life-style of his biological father were not available to him through music and its accompanying gratification, nor through business, for that matter. He clearly felt rejected by those persons most important to him. He also felt competitive with his father, as he chased "toys" of his own. Mr. B was forced to cope as best a child could with the loss of his biological father at the age of 2, typically an age when toddlers narcissistically enjoy showing off and being the center of attention. It is reasonable to hypothesize that his performance anxiety reactivate d a primary fear of being abandoned by his audience when he "showed off" by playing Liszt and Tchaikovsky with virtuosity. His wish to "show off" induced shame, humiliation, and a sense of guilt, and he was left with two options: (1) to be successful and risk rejection and loss as he gained independence and adulthood, or (2) to fail and thereby remain dependent and a child. Mr. B's flight to and from the music and business professions (and back to music again) also suggests unresolved oedipal and preoedipal conflicts about competition with his biological father (a millionaire) and his stepfather (a successful businessman). To be successful and grow up held many psychic dangers for Mr. B. I expected at the outset that Mr. B would tend to avoid closeness in our treatment relationship at the same time that he sought it. His comments about his previous therapy in sixth grade and his lack of serious relationships with women foreshadowed his defensive tactics with me. His ambivalence was evident from his first appointment, which he missed without calling to cancel. He was 30 minutes late for the second session. In the third session, Mr. B revealed that he felt guilty about not phoning his mother on Mother's Day, and that he feared people would not like him if they got to know him. Clearly, these statements held significant transference implications for our work together. Although we explored Mr. B's ambivalence about keeping appointments, he did not continue in treatment beyond eight sessions, which were punctuated with absences. Although he seemed relieved that his performance anxiety was embedded in a broader context of interpersonal and intrapsychic issues, he also felt threatened at the possibility of exposure for not being good enough--or "perfect." His attitu de toward me was a recapitulation of what he feared would b e discovered by audiences when he played in public. What if I left him once I got to know him and found him less than the "perfect" patient? Moreover; it was not difficul t to trace Mr. B's deepest anxiety to his early interpe rsonal losses and interactions with his parents, their intrapsychic significance, and the affects he tried to fend off. In his mind, he had not been a "perfect" child. He terminated his treatment abruptly in a way that was reminiscent of leaving his stepfather's business--he walked away. He never called to reschedule, leave a forwarding address, or pay his bill, thereby continuing his pattern of impulsivity, flight, and retribution in situations where he felt anxious and could not cope. I chose to present this case because I wished to demonstrate the complex counterpoint that is embedded in what is popularly labeled stage fright. I also wished to ill ustrate the great difficulty some peopl e have dealing with this very personal and emotionally charged issue. Unli ke Mr. B, other people with complex issues remain in therapy and benefit from treatment. Certainly, Mr. B's defenses and impulsivity presented warning signals during his brief fling at analytic psychotherapy. This case clearly raises some difficult q uestions. Is the wish for a quick cure, which allows the patient to continue performing without confronting and working through anxiety-provoking regressive issues, more of a factor to contend with in the performing arts population than with other patients? Is a career choice in performance a way to seek instant gratification through audience applause? The model of music teacher/student is one that requires delay of gratification while long hours are spent in practice prior to public performance, but this model also embodies a relationship that is more overtly didactic than analytic psychotherapy. Can performers with strong narcissistic issues tolerate exploration (rather than explanation and illustration) and delay of gratification (i.e., "answers") as they inevitably
"perform" in the transference in treatment? It is clear in this case that the frustration of Mr. B's narcissism in his therapy was met with increased anxiety, resistance, and finally avoidance. This response poses challenges for the psychodynamic clinician who works with a patient like Mr. B, for whom such dynamics are long-standing and have presented problems in living, both on- and off-stage. The "quick cure" cannot be provided. Grandiose fantasies are interpreted, not rewarded. An inevitable question arises: If beta-blocking drugs or behavior modification can eliminate or reduce symptoms and bring relatively quick relie f, why should musicians consider a prolonged insight -oriented treatment? In fact, this question is one that dynamically oriented clinicians deal with daily, as musicians' initial (as well as continuing) resistances and fantasies often center on the wish for an omnipotent caretaker and a quick cure--a virtuoso therapist with perfect technique. How ironic that performers who wish to become virtuosi and masters of the musical score, their instrument, and the audience are willing to give control to a therapist who would become master over them! There issues can be interpreted, in part, from the beginning. The ambivalence and anxiety regarding commitment and prematurely leaving treatment often can lead the performer-patient to defensively reject the therapist before being rejected. Brief treatment and pharmacological approaches cert ainly do not provide the opportunity to develo p a deep, ongoing relationship with the therapist. Thus many of the issues and affects associated with separation, rejection, and termination (so relevant to the dynamics of performance anxiety) are avoided. An although not every patient will elect to enter analytic psychotherapy for stage fright (nor is every patient suitable for such treatment), the therapist's rationale for recommending analytic treatment must be based on issues other than simply personal preference. Clearly, patients who experience stage fright often come to treatment with a variety of debilitating symptoms. But when is a symptom not only a symptom? For example,, in Mr. B's case, his symptoms were overdetermined, lifelong, and posed problems in living, loving, and working. Despite previous attempts to "fix" his prob lems through alcohol and hard work but without professional help, Mr. B had been unable to resolve th e conflicts that raged b eneath his symptoms because they were unconscious and outside his awareness. Symptom removal through drugs and behavioral techniques would not have resolved these issues. Often when musicians come for treatment, they have exhausted many behavioral, self-help techniques, they have tried medication, and they have abused alcohol. Their performances still suffer, causing their selfesteem to plummet further because the "work harder" ethic has not produced desired results. Quick and painless remedies associated with beta blockers and short-term treatment perhaps provided a temporary respite, but not long-lasting relief. Furthermore, the source of this "cure" has been borrowed from external sources instead of being constructed from the musician's internal resources and strengths. Confronting anxiety has been avoided and circumvented. Those persons who have tried brief treatment or drugs possibly have been rewarded through collusion with wish-granting authority figures who prescribe and proscribe (perhaps at the expense of engendering uninterpreted masochistic guilt in the performer for commanding omnipotent powers). The symptoms that are so relentless are not understood as a disguise for unresolved conflicts that continue to propel the presenting problem. Thus the recommendation for analytic psychotherapy represents more than a theoretical bias on the part of the clinician who assesses performance anxiety as being more than a symptom. The theory and technique of psychoanalytic psychotherapy, like musical theory and technique, involve the analysis and mastery of these overdetermined or contrapuntal themes that result in an increasingly refined and detailed understanding of a larger fabric--be it the "self" or the "composition." This process takes time, patience, and perseverance. Unfortunately, when Mr. B. contacted me, he was unable to make the commitment necessary to resolve his conflict and work out his counterpoint. He found refuge in flight--the unanalyzed fugue. If psychotherapy is to be truly effective in treating musicians with debilitating stage fright, the therapist, like a teacher or performer, must probe beneath the obvious symptoms and look beyond the printed page. Therapists, teachers, and performers do more than just play notes! This task is enormous and--both for patient and therapist--is not undertaken lightly. Until performance anxiety can be viewed as a serious and complex problem, until patients can understand that there are na magic cures, and until the stigma of seeking psychotherapy is erased, many patients will h ope for the omnipotent magic cure--the all -knowing, all-giving therapist/parent. Inevitably and unquestionably, it is disappointing to discover that such wishes are granted only in fantasy. Typically, these fantasies are explored, worked through, and resolved in treatment. All of us live daily with our life history. Our childhood experiences remain psychically influential throughout adulthood; why should we not expect our unresolved conflicts to accompany as when we appear on stage? It is these conflicts that emerge as symptoms in the guise of stage fright. A psychoanalytic perspective helps us understand the dynamic origins of those conflicts, as well as the ways we continue to keep them alive. Acknowledgments The author wishes to acknowledge Howard Shevrin, PhD, for his creative and insightful comments on this case, and Glen O. Gabbard, MD, for his encouragement of my work, which has been informed and inspired by his explorations on stage fright. References Brantigan, C.O., Brantigan, T.A., & Joseph, N. (1982). Effect of beta blockade and beta stimulation on stage fright. American Journal of Medicine, 72, 88-94. Ellis, A. E., & Harper, R. A. (1975). A new guide to rational living. Englewood Cliffs, NJ: Prentice-Hall. Fishbein, M., Middlestadt, S.E., Ottati, V., Strauss, S., & Ellis, A. (1988). Medical problems among ICSOM musicians: Overview of a national survey. Medical Problems of Performing Artists, 3, 1-8. Freundlich, D. (1968). Narcissism and exhibitionism in the performance of classical music. Psychiatric Quarterly Supplement, 42, 1-13. Gabbard, G.O. (1979). Stage fright. International Journal of Psycho-Analysis, 60, 383-392.
Gabbard, G.O. (1983). Further contributions to the understanding of stage fright: Narcissistic issues. Journal of the American Psychoanalytic Association, 31, 423-441. Gates, G. A., & Montalbo, P.J. (1987). The effect of low-dose [BETA]-blockade on performance anxiety in singers. Journal of Voice, 1, 105-108. James, I.M., Pearson, R.M., Griffith, D.N.W., & Newbury, P. (1977). Effect of oxprenolol on stage fright in musicians. Lancer, 2, 952-954. Kendrick, M.J., Craig, K.D., Lawson, D. M., & Davidson, P.O. (1982). Cognitive and behavioral therapy for musical performance anxiety. Journal of Consulting and Cl inical Psychology, 50, 353-362. Mahler, M.s. (1972). Rapprochement subphase of the separation-individuation process. Psychoanalytic Quarterly, 41, 487-506. Meichenbaum, D. (1977). Cognitive-behavior modification: an integrative approach. New York: Plenum. Nagel, J.J. (1987). An examination of commitment to careers in music: Implications for al ienation from vocational choi ce (Doctoral dissertation, University of Michigan). Dissertation Abstracts International, 42, 5-A, 1154-1155. Nagel, J.J., Himle, D.., & Papsdorf, J.D. (1989). Cognitive-behaviour al treatment of musical performance anxiet y. Psychology of Music, 17, 12-21. ~~~~~~~~ By Julie J. Nagel, MSW, PhD An earlier version of this paper was presented at the Liszt in Russia Festival, St. Petersburg, Russia, September 23, 1992. Dr. Nagel, a graduate of The Julliard School, is in private practice and is the coordinator of the Arts Psychology Program at the McAuley Outpatient Mental Health Center, St. Joseph Mercy Hospital, Ann Arbor, Michigan. Reprint requests may be sent to Dr. Nagel at Ann Arbor Professional Building, 425 East Washington Str eet, Suite 200 South, Ann Arbor, MI 48104. (Copyright - 1993 The Menninger Foundation) This article is copyrighted. All rights reserved. Source: Bulletin of the Menninger Clinic
