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  • Rachel Swanick

Keeping the music metaphor alive in therapy


When I first started working as a music therapist way back in 2008, I worked with learning difficulties – both functional and profound and multiple. In these sessions I would solely improvise; reflecting the subtle mood and movements that I detected in my client. Any verbal interactions were mainly sung and were based on names or sounds. Move forward a few years and I started to work with children under 5. There was so much more verbal interaction in the sessions but still with a high quantity of music. One difference in these sessions was that instead of improvised music, there was a formal structure based on cultural and educational songs. Our verbal interactions were limited to instructions or compliments and affirmations, and the usual ‘motherese’ type language we use when working with little ones.

In the most recent episode of my career, the last four years, alongside my work with younger children, I also work with attachment and trauma in adoptive families. In the adoption work, music is sporadic and infrequent. The children often don’t feel safe enough to play or create -perhaps having very little experience of such things in early life. These children have developed finely tuned defences which are often expressed through behaviours and verbal interactions. Now, the sessions are rarely structured; they are creative in a controlled way and often contain little music. And this is the case for many of the music therapists that I work with. During supervision, one question often rings in the air, “Am I a music therapist if I am not playing music?”.

There are many reasons why the music may not be happening and to understand them we have to look for the metaphor behind the music. In music therapy, the music represents the interpersonal dynamics, or the relationship, between the client and the therapist- and subsequently, it can mirror other relationships the client has outside of the therapy space. In a successfully functioning relationship between two people conversation will flow freely. Perhaps each will take a turn at listening and speaking, there may be mirroring of body language and there will be agreements, disagreements and comfortable silences. Imagine you are talking to a beloved friend or family member and the effortlessness that you feel when talking to them. You will feel safe in their company and because of this, you will have the ability to be creative and playful in your conversation. Now, imagine your favourite song or piece of music. Can you hear the way the melody and harmonies blend and move together? The way the beat and rhythms are perfectly synchronised or how each instrument and voice has its moment? Perhaps if you stay in your imagination, you can see how your favourite music and a chat with your closet friend feels, well, the same. This is where the metaphor for music in music therapy belongs: the perfect pop song is a quick feel good catch up, the symphony is a deep discussion in to the night, full of exploration and recapitulations.

Of course, not all conversations are reflective of how you feel and there are songs that don’t connect with you (have you ever wished you could turn off someone else’s music selection at a party!?). This is the same in the therapy space. Some clients really connect with music and are free to explore and create with the therapist. However, sometimes, it is difficult for both the client and therapist. They may not be able to understand each other’s musical language and the rapport between the dyad might not be working. Thinking of the metaphor of music, there could be several reasons for this. Perhaps the client is blocked by fear and anxiety, therefore does not feel able to play with someone. Conversely, the therapist may be anxious about being with the client, about a personal problem, and may not be fully present in the room. There may be overwhelming counter-transference (ie the feelings brought to the session by the client and therapist) and this could be stopping the pair from thinking together. Here is a case study to help illustrate the ideas:

Keiran was 14 and was referred to music therapy by his parents. Kieran was an average teenage boy; he was not interested in school instead wanting to be with his friends and play on computer games. He was rude to his parents and teachers and experienced angry outbursts in both home and school settings. Keiran’s parents were a same-sex female couple and initially the family had asked for a male music therapist. As this was not possible, I was given the case. Kieran was reluctant to meet with me but he did come. We met at school weekly for seven weeks. The atmosphere in the room was excruciating for us both. Keiran couldn’t look at me in the eyes and slouched in his chair. I quickly realised that my bag of instruments and djembes was not at all helpful so resorted to an ipad with Garageband and Youtube. My questions and interest were greeted with grunts and silence. Sometimes, we sat in silence with me occasionally offering an analysis of the situation, “It feels hard to be in the room right now……”. Even writing this down is difficult, the level of feelings in the silence were that powerful. At the end of each session, I asked Keiran to bring a song that we could talk about. In session seven, he brought an angry grime song with swearing and brutal language. He said he didn’t want to come anymore and this was song was a clear way of him expressing that.

Keiran did not feel safe with the therapist and she certainly wasn’t feeling creative and comfortable either. The silence in the session described here is so full, you can almost hear it. The metaphor of music is still alive. There are some hidden melodies around Keiran’s feelings of needing a male rather than a female therapist and the expectations of the family for the therapeutic outcome. The initial referral stated that Keiran was angry and rude towards his parents and this was being acted out in the deafening silence during the session. Also, there is the rhythm of the body language: we know that Keiran slouches and does not make eye contact but what of the therapist – what rhythm is she bringing to the room and what does/would this tell us about her feelings? And what about the timbre of the atmosphere in the room – what quality of sound would that have when we try to translate the experience of the client and therapist being together? Would it be a huge bass drum sound as Keiran tries to push the therapist away, or a vibrating and high sound that reflects the fear and anxiety they are both feeling? Even though there is not any actual music in the therapy space, we can use the language of music to make sense of what is happening to try and provide something tangible for our clients. As therapists, we hold the psychic space for our clients, providing somewhere where they – and their behaviours and feelings – can be thought about. As music therapists, we bring the metaphor of music on to the relationship, helping clients to think about who they are and how they present in a supportive and helpful way. With Keiran, music therapy may not have been the right choice at that time. With another client, using the language that music therapists are so used to – that of music – can be a meaningful way to bring awareness and insight to relationships in a non judgemental way. To end on a much used (and very apt) quote, “Where words fail, music speaks” and when the music disappears, we have to listen a bit harder. In silence, we are still music therapists.

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