The Peculiarities Of Music Therapy

The elements of music are all around us and within us as we move through our lives; from the changing rhythm of our beating hearts, the rise and fall of the breath in our lungs to the moving contours of pitch in the words we share with one another. But what if our understanding of these experiences in sound aren’t learned as we develop through our lives? What if there is an inane appreciation of music that children are born with and that this appreciation forms the building blocks of our first relationships?

For a carer and a pre verbal child to be communicating effectively the carer must tune into the sounds and movements the child makes and respond in a way that shows the child they understand what the child is feeling and that they both have an awareness of one another in a given moment. Instead of merely copying the child the carer may use a combination of movement and sounds to respond to one another, a concept that Daniel Stern calls ‘affect attunement' (Stern 2010). This communication is not just initiated by the carer, it is cooperative. The carer and infant distinguish the elements of timing, pitch, harmonic interval and vocal quality in their interactions, suggesting that infants are equipped with a way to communicate using musical factors form birth; Trevarthen and Malloch describe this as ‘Communicative Musicality’ (Malloch, S. N. 1999).

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This is significant when linking the first relationship in early childhood to music therapy practice as, if we model the therapeutic relationship on this first relationship, it can offer the therapist a way to relate to their client in a non verbal way that is supportive and communal. I believe it also demonstrates how our desire to make connections with others is something that we are born with and that our inane musicality is an example of this. At this point I also wish to state that in my opinion the concepts of communicative musicality and affect attunement are very closely linked and during my research I have found it difficult to find many discernible differences between them. This may well be due to my lack of in depth knowledge and perhaps this will change in time.

If we look at examples of where this ‘tuning in’ is ineffective and there is a lack of efficient communication between a mother and their child it becomes clear just how important this early relationship is for a child's development. Experiments where a mother shows no emotion on her face and is quiet in front of her child show that the baby responds negatively (Malloch, S. N. 1999).

Furthermore when mothers affected by post natal depression were compared to happy mother child dyads, the depressed mother demonstrated slower pulse, disruptions in rhythm and missed responses to an infants gesture or sound (Robb, L.1999). It is important to remember the evidence that supports the importance of these musical features of communication in building a healthy first relationship, as Louise Robb states, “a surge of data has emerged identifying rhythm and predictable temporal organisation as an essential and fundamental aspect of early communication, which, in essence, is built upon salient musical features” Robb, L. (1999)

Given the importance of this non verbal communication we can assume that in instances where it is inadequate or non existent, the childs development will suffer. Indeed the acute awareness of a carer to their 0-6 year old infant and their ability to provide appropriate responsiveness is a deciding factor of the kind of attachment the child may expect to form as they develop (Ainsworth, 1973).

If a therapist models their relationship with a client to that of a healthy primary carer and their child, the client may hope to overcome difficulties they may have faced in their own experiences in early childhood. In my observations of a healthy mother and child dyad I noticed a lot of mirroring, copying and turn taking of movements and sounds between them and I found it difficult at times to decipher who was initiating the conversation. Compare this to the story of Alex in Music therapy an art beyond words, (Bunt, L. 1994 pg 77) where a six month year old child with suspected ‘foetal alcohol abuse syndrome’ and with whom the foster carers were struggling to form a close bond with due to her muscles tensing and her becoming agitated upon handling. The Music therapist used a flute to establish a turn taking ‘conversation’ with the client whereby the client responded to his playing with a variety of sounds and movements (Bunt, L. 1994 pg 79). In the case of both the mother and child and the therapist and client, turn taking patterns are established which not only help facilitate learning and communication but also help to create a unique and close bond. This can also be seen as an example of where a therapist is able to repair difficulties in the early relationship by offering themselves as an alternative attachment figure for the client, as Bowlby states in his book ‘a secure base’

‘The therapist applying attachment theory sees his role as being one of providing the conditions in which his patient can explore his representational models of himself and his attachment figures with a view to reappraising and restructuring them in the light of the new understanding he acquires and the new experiences he has in the therapeutic relationship' (Bowlby, 1988 pg 156) Over the course of a few months of working with Leslie (the music therapist) Alex has the opportunity to reassess her relationship with those closest to her and slowly settle into a healthy life.

Music therapists employ techniques in their sessions that closely resemble affect attunement and communicative musicality in their form and they may be useful in establishing close non verbal bonds with their clients. A music therapist may use the clinical improvisation technique of ‘matching’ in their sessions whereby they make a musical offering that is similar in style and quality to that which their client is making (Wigram T 2004 pg 84). Using musical elements to ‘tune in’ with their clients they are able to transcend verbal exchanges and reach for a deeper shared connection. As Daniel Stern states,

As the therapist and patient enter the same dynamic flow created by the music , there will emerge moments of “mutual recognition” when they both realise, at the same time, that they are sharing a common experience. This is brought about by affect attunement, joint attention, and mutual confirmation”. (Stern 2010 pg 140) This rich and deep non verbal communication is comparable to the behaviour of a primary carer and their child as they search for connections using gesture and sound, finding shared moments of togetherness and harmony between them.

Rachel Darnley-Smith & Helen M. Patey give a clinical example of this in their book ‘Music Therapy’ and the case study of Tom, a 6 year old child with downs syndrome, severe learning difficulties and an autistic spectrum disorder diagnosis. In the initial stages of their first session Tom doesn’t appear to have any recognition of Helen’s (the music therapist) musical offerings, but as the session develops she is able to find the tempo in which Tom is playing on the cymbal and reflect this on the piano. She is also able to match his vocalisations on the piano and in doing so Tom briefly stops his playing and looks towards the piano appearing to have an understanding that someone is sharing this moment with him. Helen is ‘Using the techniques… similar to those used when a mother attending to her baby, matches and imitates the sounds that the baby makes’ (Darnley-smith, R. and Patey, H. 2003 pg 99). Clearly this shows that the notion of using the first relationship in early childhood as a model for music therapy practice can be very useful in establishing connections with clients, in this example maybe it was particularly helpful as the client was non verbal and music doesn’t need to rely on the use of words for an interplay to take place.

I recall a further example of the technique of ‘matching’ I encountered whilst working on a production of Alice in wonderland I was involved in at an SEN school in north London. During the production I became aware of a profoundly autistic girl in the audience rocking from side to side vigorously, I felt that she seemed distressed and unable to engage in what was happening in the story, so after we had finished I decided to pick up my mandolin and match the tempo of her movements to a simple chord structure and see what would happen in an attempt to build a connection. After a while I slowed down my playing and her movements also slowed down and she appeared to become aware of me for the first time. At the time I had no understanding of music therapy practice and so I focused on the non verbal communication aspect of the exchange which I found very moving and this sparked my interest in the field. However in hindsight it is interesting to reframe this exchange based on my current understanding; was I using a form of affect attunement here? I was certainly attempting to tune in to her movements but I expect I was relying on playfulness and intuition in the moment.

The use of Intuitive and spontaneous play are vital tools for both the primary carer in early childhood, and the music therapist, and in both cases, play may help the developmental growth of the infant or client. During my observations of a mother and her two year old child I noted a significant amount of non verbal communication and it was through the medium of play that these interactions were able to take place. The mother was attempting to understand the childs imaginary world by commenting and gesturing in connection to his actions as he built a tunnel and played with it. Moments of joy seemed to occur when the mothers playfulness interacted with the childs imaginary world, these moments were unpredictable and to me it seemed that it was the spontaneity that made them particularly arousing to the child. This seems comparable to a music therapy relationship as music therapists rely heavily on the use of playful improvisation to communicate with clients and there is a shared space between the musical ideas of the client and therapist. Winnicott introduces this concept in ‘Playing and Reality’

“Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist” Winnicott (2005 pg 51) In my experience of improvising music in a group I have found that it relies a great deal on listening and responding; all participants must make musical offerings sensitively and respond to other participants’ in order for the music to feel successful. During these improvisations there is a ‘to and fro’ between whoever may be leading, and this can shift over the course of the improvisation. To me this seems comparable to the shared space of play which Winnicott speaks of and I have noted above. (2005 pg 51)

I believe that it is important to acknowledge the significance of play and its role in developing growth and communication, in establishing close bonds and as a form of therapy in of itself. Winnicott (2005 pg 51). However i feel cautious when analysing play and intuition due to it being subjective and therefore very difficult to interpret conclusively, I also feel that we will never be able to capture the magic of spontaneity by documenting it, for me somehow the beauty is lost in the deconstruction of the playful moment.

When investigating affect attunement between primary carers and their children I was struck by the importance of cross modal matching, where pre-conversational exchanges rely on a mixture of sounds and movements which aren’t necessarily directly replicated, for example a raised arm could be matched with a vocal call rising in its pitch (Stern, 1985 pg 141). This cross modal exchange seems also to occur in music therapy practice, for example in Music Therapy intimate notes where Cathy (the music therapist) noticed that her client Shireen (a woman with a severe brain damage and multiple further complications) was using her foot to play a wind chime but only when Cathy was singing (Pavlicevic 1999 pg 101). In this example maybe the key thing was the therapists understanding that the communication could take place cross modally and to be on the look out for communicative gestures however they may appear. An important distinction here Is that in the case of the early childhood dyad the child’s ability to differentiate the modalities of sound movement, expression and gesture may be limited and so there is an emphasis on the multi sensory development of the relationship (Amanititi, 2013). Whereas in the case study of Shireen it seems to me there is a lot more uncertainty in relation to her cognitive awareness so it may be hard to know for sure her ability to differentiate cross modally.