I recently read a wonderfully provocative essay by San Francisco Chronicle staff writer Jon Carroll entitled “Is Something Missing?” Reacting to pop psychology televangelists who insist that we have to work harder to fill the void in all of our lives, Carroll wrote, “Yes, there is something missing in all of our lives. That is the nature of life, that there is something missing from it. It is not a problem.”

I heartily agree. As a music therapist who works primarily with stressed and injured musicians, I am convinced that perfectionism – which can be interpreted as a deep-rooted belief that one is not xxxxx enough – is a force to be reckoned with in the musical community.

Current research findings indicate that stress in the performing arts is reaching almost epidemic proportions. Seventy-five percent of orchestra musicians surveyed internationally reported having one or more performance-related injuries. One quarter of the musicians experienced performance anxiety as a debilitating medical problem. Although there are many underlying causes of performance-related stress and anxiety, after 15 years of working clinically with professional musicians, and being a performing musician myself, I have found that the most insidious one is the stance of uncompromising perfectionism.

This extreme form of perfectionism seems to be rooted in the vulnerable musician’s need for outside approval and validation of his or her innate worth. When these musicians receive unfavorable feedback associated with a musical activity, they often experience it as a reflection of their inherent “badness” and judge themselves as being deficient. Because many musicians’ self esteem is dependent on how others perceive them, they often lose touch with their own inner reality – the essential self – which holds the individual’s unique life purpose, innate gifts, feelings, beliefs and somatic states. Instead of trying to connect with their own essential selves, these musicians try to imitate the process of others whom they deem to be “successful.” Vulnerable musicians often are unable to accept their own humanity – which is, of course, prone to error, fatigue, fear and other less than ideal self-states.

Certainly, perfectionism isn’t all bad. It sustains the creative fire that fuels our desire to give the very best that we can. But problems arise when perfectionism becomes polarized and we reject the vulnerable, intensely human aspects of the self. “Polarized perfectionists” are those individuals who seem to be wedded to left hemispheric brain activity. They are product, rather than process oriented in their approach to learning and performing music. They rely primarily on external, as opposed to self-generated, feedback. They focus a lot on detail, as opposed to seeing the “big” picture, when preparing performance pieces. And they tend to forget about their bodies when they practice and play, ignoring its subtle cues for rest or emotional expression.

Other characteristics of polarized perfectionists include: extreme drive and competitiveness, tendency to isolate, obsessive/compulsive inclinations, inflexibility, and extremes of emotion. Often these musicians are unable to connect mind and heart in the process of playing music and spend hours in mindless musical activity. I have come to believe that this kind of mindlessness during practice sessions may be the root cause of many performance-related injuries and anxiety, essentially because the musician is not present while he or she is engaged in the musical activity. It is when we are unable to be present in our lives that we harbor the gnawing feeling that something is missing.

What are the causes of polarized perfectionism? One of my clients, a professional opera singer, brought in a deeply moving song with lyrics by Langston Hughes to one of her music therapy sessions. The opening refrain subtly points to the root cause of this joy-sapping syndrome:

 Pierrot took his heart and hung it on a wayside wall.
 He said, look passersby, here is my heart.
 But no one cared at all.
 No one cared at all that there hung Pierrot’s heart upon the wall.
 So Pierrot took his heart and hid it far away.
 Now people wonder where his heart is today.

Most musicians with the perfectionist syndrome have experienced some kind of narcissistic injury (as did Pierrot above) or performance-related abuse early in life, usually at the hands of unaware parents and teachers. Depth-oriented music therapy – in which you explore images and feelings that emerge from musical improvisations and spontaneous song-writing – can be an effective treatment for this syndrome. It is also quite possible to change overly perfectionist attitudes and habits on your own by regularly practicing the following simple, playful exercises that can gently take you to a place of serenity and fullness:

1. Waste time. This is probably one of the most difficult things for a perfectionist to do consciously. Book stores, record stores, playgrounds, beautiful places in nature… find places where you can refrain from doing, let yourself unwind, and enter the imaginal realm.

2. Meditate. Spend about 10 to 20 minutes each day focusing inward. Allow yourself to be completely alone and undisturbed, sitting comfortably with your spine straight and focusing on the rhythm of your breath. In a short while, your body-mind will begin to relax and a warm glow will emanate out from the center of your being. Meditation helps you shut out the external world and connect deeply with the source of your being – your essential self.

3. Improvise. Yes, you can improvise! In all my years working with classical musicians, I have never found one who couldn’t. If you feel uncomfortable improvising with your primary instrument, center yourself and breathe deeply, connecting with the “energy garden” in your belly. Listen for your first note. Sound that note and then wait for the next one. Play the next note and continue to listen for the succeeding notes – then just let go and let the music take you where you need to go. Improvisation also connects you to your creative source and strengthens the body-mind connection. Additionally, it’s a lot of fun. Do it regularly.

4. Improvise with others. Get together with a group of your most creative musician friends and jam. You do not have to set a theme for the improvisation. Just allow yourselves a few seconds to ground and center and then begin to play, being aware of your own contribution and that of your friends, letting the music take the group where it needs to go. Consider recording the improvisation. You will be surprised at how wonderful free improvisations can sound. Spend some time processing the experience afterwards. This will help you all to understand your musical roles within the group and how the force of the music affected each of you individually and the group as a whole.

5. Get to know your “inner critic.” If you truly listen to the inner dialogue that goes on in your head around difficult performance issues, you can begin to discriminate between helpful criticism (like “You need to take more time to ground and center yourself before playing the first note of the Italian Concerto at your upcoming recital”) coming from the self, and destructive criticism (like, “You are not good enough to play the Italian Concerto. Who do you think you are? You’d better start thinking about selling shoes instead of playing music”) which comes from voices of negative teachers and/or family members. These voices are usually internalized when we are quite young and become part of our self-concept. You can change this negative self-talk by examining the truthfulness of the statements. If the self-talk can truly serve you in some way, then you can continue to allow it to inform you. But if you sense that it is untrue, cruel or exaggerated, choose to let it go and replace it with an affirmation that will serve you, such as, “I am well-prepared and will joyfully give my very best in my upcoming performance of the Italian Concerto.” As you let go of the negative energy of the inner critic, perfectionism can return to its normal function in your musical life, and playing music can once again become an awesome adventure.

6. Nurture yourself. A very old, yet spry participant in one of my music and healing workshops told the class that if they all didn’t feel like God’s perfect children, then there indeed was something wrong. So take some time each day to acknowledge your innate perfection and take good care of yourself – treat yourself to healthy food, good music, relaxing baths and massage, and quality time with yourself and loved ones.

I encourage all of you to explore one or more of the above techniques for de-polarizing perfectionism and achieving harmony and balance in your lives. But even with devoted practice, it may take quite a while to unravel the paradox of the creative void. In the meantime, let us agree that, yes, there is something missing – but for those who have let go of the compulsive need to be perfect and uncovered the essential self, there is only an ongoing celebration in anticipation of what is to come!

Dr. Louise Montello is a psychoanalyst, certified music therapist and research scientist in the Department of Psychology at NYU, specializing in the treatment and prevention of stress in the performing arts. She is an associate editor of the International Journal of Arts Medicine and Coordinator of the Creative Arts Therapy Certificate Program at The New School for Social Research. Dr. Montello is also a professional jazz pianist and composer and maintains a private practice in expressive therapy and supervision in New York City.