Psychotherapeutic Treatment of Attachment Trauma in Musicians with Severe Music Performance Anxiety

The aim of this paper is to contribute to the further development of a coherent theory of music performance anxiety (MPA) and its treatment. Kenny (2011) proposed three forms of MPA – focal, MPA with social anxiety, and MPA with panic and depression. An attachment disorder was proposed as a possible underlying psychopathology for this third type of MPA. Accordingly, open-ended in-depth assessment interviews of professional musicians presenting with severe music performance anxiety that included panic attacks and depressed mood were analysed from an attachment theory perspective. It was hypothesized that the musical performance setting re-triggers unprocessed feelings related to early attachment trauma, and that performance anxiety can be a manifestation of the emergence into consciousness of these powerful early feelings. As hypothesised, severely anxious musicians suffered both early and current relational trauma that was expressed through symptomatology in their music performance anxiety manifestations. Three cases are presented in depth. The first is an assessment interview that demonstrates how music performance anxiety can arise in the midst of other challenging life circumstances that re-trigger feelings about early attachment failures and the importance of taking a full life history from a severely performance anxious musician. The following two cases present excerpts from their short term psychodynamic psychotherapy that resolves their severe MPA. Failure to identify and treat underlying attachment disorders in severely anxious musicians may render other forms of treatment ineffective or short-lived.