Tuesday, January 26, 2010

1/26/10 Quote- Developing a relationship through music with someone who doesn't use speech

Close connection - VerbundenheitImage by alles-schlumpf via Flickr
I am slowly reading through a book called, "Music Therapy: Intimate Notes" by Mercedes Pavlicevic (1999, Jessica Kingsley Publishers). It describes, of all things, what it's like to be a music therapist in relationship with one's clients. 

Hmm. Where have I heard that before...

Anyway, I'm not sure why I haven't looked at this book until now. It's been around for ten years. I guess books come in to your life when you're ready for them. 

So I just finished the first chapter. Each chapter seems to be organized around a particular story shared by a music therapist. Mercedes Pavlicevic then adds her comments. 

Which is great, because her comments are beautifully put.

Here, for example, are some excerpts in which she very nicely describes the process of building a music therapy relationship, clarifying for readers (presumably not music therapists) what has just been shared in the story and why it's significant:
How do you respond to a child who does 'nothing'? The void that he presents, and his absence from the music therapy room, challenges a deeply natural aspect of human communication: that for communication to happen between people, we need the responsiveness of another person, we need them to show their responsiveness, whether in speech, movements or facial expressions, and we ourselves need to have a sense of their sensitivity to our influence- to mutual influence. We cannot communicate with someone who does not show any signs of being susceptible to us, influenced by us; who appears vacant.
She goes on to say:
     Communication between Oksana and Daniel is a two way process: Daniel begins to vocalize and at first he makes occasional short sounds. Oksana vocalizes too, but not just in any way: she listens to the quality of his voice, how short the sounds are, how high or low they are, whether she can hear any rhythm, any shape in what he does. And she adapts her own vocalizing in a way that is related to him, to his sounds. This is the beginning of interpersonal influence. She is influenced by what he does and by how he does it- no matter how tiny and apparently haphazard his sounds are at first- and her sensitivity to him sounds in her voice. He hears this, and feels her awareness of him in the song that she is singing, and in session four, this triggers something in him. Suddenly, he begins to vocalize much more intensely: he makes longer sounds, and immediately she responds, matching his longer, more intense sounds. In these moments, Oksana and Daniel connect with one another in a way that they have not been able to until now. What is interesting here, though, is that Oksana does more than just match, or mirror what he does. She begins to extend what he does.
     This is crucial: in order for Daniel to extend himself, to grow, to develop, he needs to be shown where he can go with his voice. Now that he and Oksana have 'met', now that each has a sense of the other, through their vocalizing together, Oksana keeps close to what Daniel is doing: she continues to match his singing closely. In this way, he knows- he has a sense- that her singing is related to his. And when she does a bit more- sings for longer, or louder, or quicker- he then hears where he needs to go in order to remain connected to her. (pp. 20-21)
Is that not gorgeously and articulately said?

She so nicely captures why it's so important to have a relationship with our clients. Without the relationship, there is no investment or interest in, heck, no meaning to what we present in a session. 

The very last sentence says it perfectly: "...he [Daniel, the client] then hears where he needs to go in order to remain connected to her [Oksana, the therapist]." 

In other words, the relationship now matters to Daniel, and he now has a reason to learn new things and a context within which he feels acknowledged and heard so he can feel safe enough to venture outside of himself. 

And, that, my friends, is music therapy. 

Sunday, January 24, 2010


Collared Inca hoveringImage via Wikipedia
On Wednesday this past week, O, was hovering nearby, poking and pushing at me as I tried to find E's jacket in the never-endingly-impossible-to-ever-find-anything-in-it closet. He actually followed me from room to room as I hunted through wardrobes and fished through various drawers for E's hat.

I told him I was glad he wanted to say "hello", but "right now it's E's time," and I promised I'd check in with him when we returned. If he still wanted me to sit with him then, I'd make some time for him.  

Well, E and I left and came back. And forty-five minutes later O was still reaching out and poking at me.

Guess he must mean business.

These days O's music therapy is on an "as needed" basis. When he wants some time with me he lets me know (as evidenced by the above mentioned interaction). He seems to like to just sit quietly, performing his usual series of rituals, while listening to me play the guitar and sing. 

It's probably helpful for you to know that O has terrible problems with his sensory system, and he often asks (and by "asks" I mean pokes and prods until we get the hint) people he knows and feels safe with to help him when he needs a back massage to alleviate his discomfort. 

On this particular day I figured he probably wanted me to provide some deep pressure to his back. 

He pushed me onward, out into the hallway, and we sat on a couch.

As I sat next to him, pressing my hand hard into his back, I grinned as I thought about our first music therapy session together, some seventeen or eighteen years ago. 

At the time we conducted our sessions in the dorms. Each of the dorms had four beds in it. In honor of the session (and in order to create a space that at least sort of implied "we do music therapy here") I pulled in two chairs and brought along my cart full of instruments, setting some of them out on a dresser.  

I picked up O from his day area (the cottages were all locked back then) and brought him to this makeshift music therapy space.

As soon as he got into the room he yanked all the covers and sheets off of the beds, hurled all the instruments onto the floor, kicked over both chairs and knocked over my music cart. 


The only thing I managed to save (barely) was my guitar, which I'd snatched up when I saw the rhythm instruments go flying.


I mean...really.


I sent him back to his day area (wondering why exactly I'd gone into this damned field anyway), went back, cleaned up the mess, and wondered what the heck I was supposed to do now.

I showed up at the next session with nothing but my voice (I learn fast, eh?).  I knew he liked "backrubs," although at the time I didn't realize it had to do with sensory problems. Just as I did this past Wednesday, after I let him know what I was planning to do, I pressed the palms of my hand to his back. And then, unaccompanied by any instrument, I sang to him. 

I sang about what I was doing, what (safe) ways he could use to let me know if he needed me to stop, and I sang about keeping the room a safe (is anyone else noticing a theme here?) place. 

Happily, although it took some time, O got used to me, and I began to understand what worked for him and what didn't. 

The fact that he now can let me know when he needs my assistance (or not) and that I can sit with him playing the guitar with no instruments being hurled about makes my day. 

And it reminds me that music therapy matters. It may not always look as I expect, but it matters. 

Tuesday, January 12, 2010

1/12/10 Quote(s)- Music therapy and power

Neon music signImage via Wikipedia
I think a lot about power in the music therapy relationship, to the point where I've even presented on the topic

So I was thrilled to find an article in the British Journal of Music Therapy by Randi Rolvsjord called "Whose Power of Music? A Discussion on Music and Power-Relations in Music Therapy" . 

She offers a thought-provoking perspective I hadn't even thought to consider. 

Well, I've probably considered it, but right now I can't recall when.

I've quoted her article rather liberally below, but the basic question I think she intended for me to ask myself when I finished reading the article was this: 

Are we taking away our clients' power when we attribute their progress to the "power of the music" or to the "power of our interventions"?

Just in case I'm not getting it right, I'll let Randi Rolvsjord say it in her own words:
In a contextual approach, the therapeutic outcome is primarily related to the client's ability to use the therapeutic context to make important changes in his or her life. With the therapist's help, the client uses the space provided in therapy to activate or mobilize resources for change (Bohart 2000: 130). In a contextual model, the specific "ingredients" (techniques and procedures) are not seen as the main source of change in the therapeutic process.  
She goes on to address music therapy more specifically:
A contextual approach impels us to shift our attention away from the therapist and the perceived inherent capacities of music, focusing instead on how clients make use  of music and music therapy in their efforts towards health and quality of life - and perhaps even towards music and musical experiences and activities. This does not require us to stop considering music as a powerful resource that can be used therapeutically: rather, it requires us to acknowledge the need for a client to make use of it, or relate to it. It also suggests that the client's own use of music is probably more important than the therapist's use of music, impelling us to consider how we can better nurture the client's own resources for health-related musicking
She notes:
When music therapy "works", it is primarily because clients are able to access music as a health resource. To support this process, it is necessary to hand back the "power of music" to our clients and enable them to use their musicality and musical competence, their musics, and their musicking to promote health and quality of life. 
And she repeats:
With a contextual approach to therapy, the focus of therapeutic effectiveness is shifted away from the expert-therapist implementation of effective interventions, and instead toward the client-therapist collaboration concerned with access to music, with enablement and empowerment. I have argued elsewhere (Rolvsjord 2004) that such a process of empowerment implies focus upon the nurturing and development of strengths in a mutual and collaborative relationship. 

I have to admit I don't know a blessed thing about the "contextual approach to therapy", but it sounds interesting, and I believe I'll have to go do some searching to find out more.

Anyone else out there have any opinions to register about this form of power within the music therapy relationship?