What happens in music therapy: An ecological approach and ......By analysing the ‘context’ of a music therapy session, I hope to under-stand the different expectations and preconceptions

Music Therapy TodayVol. V (3) May 2004

What happens in music therapy: An ecological approach and a theoretical model

Hughes, Philip

SRAsT(M), PhD

ABSTRACT

This paper will first examine the perception of music in a music therapysession with reference to ecological psychology and music psychology. Asummary is given of the complicating factors such as clients’ past experi-ence of music, but also associations with musical idioms and the soundsof the instruments. This serves as a reminder that the theoretical posi-tions (for instance music psychotherapy and ‘music as therapy’) whichtherapists use to inform their work, could lead to idealisations of a‘messy’ reality. Notwithstanding this, a theoretical model is presented ofwhat music therapists might be doing when they work in the two media ofwords and music, drawn from the author’s experience of mathematicalmodelling. The concept of bi-level optimisation is put forward as ananalogy for the way the therapist has to think in two media at once, or atleast in the same session, and ‘optimise’ the distance between therapistand client in both media, at the current point in the process of the ther-apy. A separate but related model is given of insight and resistance inmusic therapy, using ‘catastrophe theory’. The ideas may be of particu-lar relevance to music therapists working in psychiatry and/or with psy-chosis; a clinical vignette is used to illustrate this.

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Hughes, P. (2004) What happens in music therapy: An ecological approach and a theoretical model. Music Therapy

Today (online) Vol. V (3) May 2004, available at http://musictherapyworld.net

INTRODUCTION

This paper has two strands, both motivated by the big question “What is

music therapy?” As a relatively recently qualified therapist, I have found

myself inevitably trying to work out my own response to this question, in

the process of finding and consolidating my way of working in clinical

practice. Thus as models of what happens in a music therapy session

they are personal to me, and there is always a danger they will seem

obvious, or “so what?” The ideas will serve their purpose if they provoke

some thought, and perhaps clarify some of the assumptions we

sometimes make.

As a UK-trained music therapist I use improvised music as a means of

non-verbal communication. In the search for a theoretical framework for

this tradition of music therapy, (at least) two contrasting positions have

emerged. In one the importance of verbalising where appropriate or

possible is stressed, so that a model of a talking therapy, often but not

always based on psychoanalysis, is vital. The other stresses the

therapeutic value of music itself, so that it may be impossible or

undesirable to try to verbalise what has happened in the music.

In this first section I want to point out the ways in which music therapy

doesn’t quite fit into any particular theoretical framework, while in the

second section I fail to resist the temptation to provide my own

theoretical framework. Music therapy has always been a ‘practice’, and

the value of a framework will be in stimulating ideas in practitioners,

whilst the limitations of such frameworks should always be

acknowledged.

INTRODUCTION 2



THE IMPORTANCE OF CONTEXT

By analysing the ‘context’ of a music therapy session, I hope to under-

stand the different expectations and preconceptions which therapist and

client bring to the experience. Clearly, there is a therapeutic context

which we as therapists hope to set. Defining this will in effect be yet

another definition of music therapy: my attempt at this would be the con-

text of a developing relationship between therapist and client, expressed

through music and (where appropriate) words, in which the therapist’s

interventions are aimed at helping the client to achieve greater under-

standing of his or herself. This definition of the different roles of thera-

pist and client will vary slightly according to therapists’ theoretical

orientations.

However, there will be other contexts, expectations and preconceptions

that intrude, that need to be overcome and/or acknowledged. At a basic

level, we have associations that are brought to mind by any sound or

instrument. The field of ecological psychology deals with how we

perceive our daily environment, including sound. Gaver (1988 and 1993)

has written about sound in this way, giving a framework for ‘everyday

listening’: sound provides information about the environment, in terms

(for instance) of the speed, size, direction of an approaching car.

Categories of sound were suggested as produced by vibrating solids,

gases and liquids, also the source attributes (interaction type, material,

configuration e.g. shape/size). Gaver asked subjects to identify a range

of everyday sounds, which they did very accurately. He also included

some ‘implausible’ sounds, such as someone walking across a floor

covered in newspaper; this was identified as walking on snow or gravel,

or rhythmically crumpling paper – one person correctly identified the

sound, and then rejected it as impossible.

THE IMPORTANCE OF CONTEXT 3



The conclusion is that we use sounds to make sense of our world at quite

a basic level, and it certainly seems likely that those associations will stay

with us even when we know that they are produced by musical

instruments. In my experience, clients can compare the sounds of the

instruments directly to everyday noises such as a door shutting, and this

is perhaps trying to make sense of the somewhat strange experience of a

music therapy session in terms of things they know well. Again, because

the focus in the session is on sound, there may be a heightened awareness

of outside noises which can be used consciously or unconsciously to

distract from the process of therapy. Gaver’s categories of sound

production and source attributes have their parallels in the categories of

musical instrument, although the correspondence is not always exact –

obvious examples are the rain-stick and ocean drum, producing quite

convincing watery noises using non-watery substances.

Ecological psychology also has something to say about our perceptions

of musical instruments as objects. Palmer et al. (1989) carried out four

experiments where adults and children tried to identify the picture of an

instrument which was played on a recording. Results were better for

Western than the unfamiliar Chinese instruments, but identification of

the family of each instrument was quite good (chordaphones,

aerophones, idiophones and membranophones). The authors suggest an

interpretation based on ‘affordances’, being in this case the combination

of substance and surface layout specifying how the instrument should be

played. Gibson (1977) defined ‘affordances’ as “specific combination of

the properties of its substance and its surfaces taken with reference to an

animal”.

One conclusion from the Palmer et al. experiments seems to be that

people are quite good at identifying how a sound was produced. This

may be somehow related to the observation that clients in music therapy




often display an affinity or preference for one instrument or class of

instrument, although part of the process of therapy may be in beginning

to explore more varied musical expression. Another client of mine had a

fascination with the cymbals to the exclusion of any other instrument,

and in the early phase of therapy would quite happily have played them

on his own for the full session. My challenge was to find a way to move

this fascination with a particular sound towards more interactive music-

making.

The other finding of the Palmer et al. experiments was that there were, as

expected, cultural factors: the instruments from the subjects’ own culture

were easier to identify. Clearly, a client will find some instruments in a

music therapy room familiar, and some less so. Leading on from this, the

client’s previous experience of those instruments will influence their

perceptions. Some percussion instruments may seem childish if they

were last seen in school music; the piano or the therapist’s other

instrument may bring associations of unsuccessful music lessons, and

hence feelings of failure. The issue of skills and the perception of the

therapist as a teacher is one of the commonest hurdles for client and

therapist to overcome.

The cultural perception of instruments also leads, of course, to the issue

of the musical cultures of the music therapist and client. Music therapy

trainings help therapists to improvise in as flexible a way as possible, but

it is inevitable that they will be most comfortable in idioms which they

are familiar with. There are various examples in the music therapy

literature (for example Henderson 1991, Loveszy 1991, Mereni 1996,

Pavlicevic 1994) where the importance of being able to adapt to an idiom

from another culture is discussed. Whilst a therapist cannot necessarily

become an instant expert in another idiom, for instance to the extent of

learning unfamiliar instruments, he or she will probably be able to use the




skills they have to respond sensitively to the client’s particular form of

musical expression.

The musical backgrounds of the two parties are only one facet of course

of the cultural issues involved in a therapeutic encounter. Other issues,

which of course overlap with the talking therapies, are verbal cultural

issues – whether therapist and client share the same first language, and

whether there are different cultural assumptions about verbal

interactions. Within British culture, there are many subtle differences in

the way people interact verbally and many clues that we give away about

our social class, ethnic background and regional allegiances – for

instance, people from the North of England often say that they have a

more direct, friendly style of verbal interaction than those from the

South. As music therapists we are interested in musical communication

but there are other non-verbal communications to be aware of, such as

our body-language, and the way we dress.

These are all contexts which might be seen as ‘obstacles’ to the ‘pure’

communication in words or music which we might be aspiring to. Seen

positively, they may provide fruitful work for therapy, in that the

exploration of obstacles to a relationship is the beginning of the

exploration of that relationship. At the least, I suggest they need to be

acknowledged. I defined a context at the beginning of this section which

might be the one which the therapist is ‘aiming’ for: a developing

relationship between therapist and client, expressed through music and

(where appropriate) words, in which the therapist’s interventions are

aimed at helping the client to achieve greater understanding of his or

herself. To arrive at this context, music has to be understood as

communicative, and that what the client plays may have emotional

significance and meaning. Clearly this achieved principally by ‘doing’,

by responding musically to the actions of the client. However, given that




there is no universal agreement within music therapy on how to interpret

the ‘meaning’ of a musical interaction, different therapists will approach

this problem in different ways. If the musical communication is seen as

having sufficient meaning in itself, and indeed is ‘untranslatable’ into

words, the client may be encouraged to play without much recourse to

words. Other therapists may encourage the client to try to put into words

what ‘happened’ in the music, the feelings which may have been aroused.

FIGURE 1. Contexts in Music Therapy




A THEORETICAL MODEL

TRAFFIC AND MUSIC THERAPY

I spent some years in my first career, developing computerised models of

traffic, predicting in particular the way people choose routes, and the

impact on delays on roads. The model of music therapy which follows is

based very loosely on mathematical ideas from that field, but I feel it is

important to stress at the outset what should be obvious, that it is not a

mathematical model in the same way, but an analogy which I have found

helpful and interesting. For myself, of course, there is also a pleasing

symmetry in bringing together ideas from the two diverse parts of my

working life.

There are at least two problems in traffic which involve ‘bi-level

optimisation’, in other words trying to find the ‘best’ set of variables in

two problems at once. For instance, the set of traffic flows on different

roads through a town is assumed to obey the rule that drivers are trying to

minimise their journey time. The set of demand variables, on the other

hand, represents the number of people who want to travel between each

possible start and end point in the network. This (we assume, again) will

depend on the cost/time of the journey, so people choose their shopping

trips for instance based on length of journey, as well as factors such as

the choice and cost of purchases. The most accurate prediction will be

found by satisfying both the demand and the flow assumptions at the

same time, yet this is mathematically very difficult. We can find a

solution by solving first the demands and then the flows, and repeating

until there is no change, and this will usually yield a ‘good’ solution, but

not necessarily the ‘best’.

Since I began my second career in music therapy, I have been fascinated

by the relationship between words and music. I now wonder whether the

communication in these two media has something in common with ‘bi-

A THEORETICAL MODEL 8



level optimisation’. The optimisation represents the therapeutic aims of

the therapist, who is trying to find the best place in the musical

relationship and (at the same time) the best place in the verbal

relationship, for the current phase of the therapeutic process. The best

places in music and words may be quite different – for instance the

closeness which is achieved in a musical encounter may be difficult to

transfer immediately into words. Because we operate in one medium at a

time, it may be difficult to see the best overall place to be, just as in the

traffic problem.

DISTANCE IN A RELATIONSHIP

The quality of a relationship clearly has many facets, positive and

negative, which we might be able to call ‘variables’; I would like to

project these many dimensions onto one, and call it ‘closeness’. A client

is often referred because they find it difficult to achieve closeness in

words, so the scenario where the musical relationship is closer than the

verbal one may be common and appropriate, especially in the early

stages of therapy; however, I suggest that this imbalance becomes

uncomfortable if it is sustained. On the other hand, if the verbal

relationship is much closer than the musical one, it is possible there is a

temporary resistance to the client expressing themselves musically.

Again though, there are implications if this position is sustained:

presumably the sessions are then operating more as a talking therapy, and

should be acknowledged as such. In figures 34-36, these possibilities are

shown by the lengths of the arrows joining the client and the therapist




FIGURE 2. Communication in words and music




FIGURE 3. Closer in music than words




FIGURE 4. Closer in words than music

If the ‘distances’ in words and music were plotted, we could show the

three positions mentioned above in graphs:




FIGURE 5. Graph – As close in words and music

FIGURE 6. Graph – Closer in music




FIGURE 7. Graph – Closer in words

A CLINICAL ANECDOTE

I found the concept of distance and closeness in a therapeutic relationship

very helpful while I was training, when I saw a man with schizophrenia

for nine months. He would often attend for part of the session, and

would also periodically miss sessions; I felt there was a game between us

as I tried to guess which sessions he would miss, and that I was gaining

greater understanding as I was more able to predict this. Often we would

achieve a closeness in one session, but I would be able to predict that he

was likely to miss the next one. This feeling that he could only tolerate

closeness on his terms, and for a certain amount of time, extended to

individual pieces of music; there were many times when we had just

found a common music, when he would suddenly put down his

instrument, leaving me ‘stranded’.

The comparison between the verbal and musical relationships is

illuminating here as well; often he would object violently to an




interpretation, or even storm out, and I had to work out whether my

verbal abilities were indeed wanting, a real possibility especially as I was

still training, or whether he found the insight too threatening, in the same

way that the musical closeness seemed to be threatening. Verbal

communication became easier as the musical relationship developed, but

was probably led by progress in the musical communication.

INSIGHT AS A VARIABLE

To extend these graphs, we now include the ‘optimisation function’,

which in simple terms is ‘the thing we are aiming to maximise’. In music

therapy, again this could be represented by many variables, which I will

ruthlessly project onto one, called ‘insight’. We can imagine a graph of

the level of insight possible for different positions in the musical and

verbal relationships; when this is plotted above the 2-dimensional surface

of the graphs in Figures 37-39, we have a contoured landscape. As

therapists we are trying to find the highest point of this landscape at the

current moment - to help the client to the maximum level of insight

possible at that stage of therapy. So the graph of insight is not static –

one possible scenario may be for the maximum to be for some time

where the two people are close in music but not in words, to then move to

closeness in both, and then to a healthy separation as the client works

towards an ending.




FIGURE 8. The best place is closer in music




FIGURE 9. The best place is closer in words




FIGURE 10. The best place is equally close in words/music

HIERARCHICAL CONSTRAINTS

Without stretching the traffic analogy too far, there is one more

comparison which may be interesting, or indeed we may decide that the

analogy breaks down here. In bi-level optimisation problems, the two

problems are often not completely ‘equal’; in the traffic example, once

the demands are fixed, the flows can only take a certain range of values,

so they are ‘constrained’ by the demands. In music therapy, an

analogous statement might be that what is possible in the verbal

relationship is determined by what has happened in the musical

relationship. Some therapists will agree with this statement more than

others; I am not sure I agree with it, if it were to be taken as operating in

every moment of every session. There must surely be times when the

musical relationship is not progressing, and a verbal intervention moves




things forward. On the other hand, as a summary of what is possible over

the progress of therapy, perhaps the hierarchical view is a statement that

as music therapists we are (generally) trained in musical more than in

verbal communication.

CATASTROPHE THEORY, INSIGHT AND RESISTANCE

Catastrophe theory was developed in the 1970’s first by Rene Thom

(1975), and then by others including Christopher Zeeman (1977), my

supervisor for an M.Sc. in mathematics. The arresting title refers to

sudden (rather than particularly negative) change; in nature many step-

changes occur as a result of continuous changes in other variables, which

were difficult to model mathematically before catastrophe theory. As

catastrophe theory was popularised, it was used to model phenomena in

the social sciences, where the variables are less quantifiable; a layman’s

summary of such applications is given in Woodcock and Davis (1978).

In this tradition, I will use a ‘cusp’ catastrophe model to extend the

previous model of music therapy to include resistance. In Figure 10

below, the surface is akin to a piece of paper, folded in an S-bend at one

side, but not the other; it represents the possible states open to the client

(at the current stage of therapy). As ‘communication’ increases, the

client moves along the sheet of paper from the right-hand end. If

resistance is low, then the client can move smoothly up the piece of paper

and to increased insight. If resistance is high, however, there is a point

where the client needs to ‘jump’ to the upper part of the paper, and where

of course the therapist’s help is particularly needed. Perhaps the

therapist’s intervention at this point is to let the client know that they are

not in fact bound by the two-dimensional surface of the paper!




FIGURE 11. Catastrophe theory graph illustrating resistance

This graph could be viewed as embodying the overall resistance in music

therapy, or else we could think of a pair of graphs of musical and verbal

resistance. For instance a client could encounter greater resistance in

words than in music (or vice versa at different parts of the process).

NON-VERBAL CLIENTS

Clearly the ideas described above apply most naturally to clients who are

physically able to communicate verbally. So therapists working in

psychiatry may find the ideas more interesting, compared for instance

those working with clients with severe learning disabilities, or advanced

dementias. However, often clients’ receptive language is much better

than their spoken language; the communication may be ‘one-way’ and as

therapists we make judgments as to what kind or level of verbal

relationship may be possible. One valid position is that the musical

relationship is the one which empowers the client and puts them on an

equal footing with the therapist - to use many words oneself emphasises




the client’s disability. This position does not of course preclude the fact

that we are thinking in words about the relationship when we reflect

afterwards, and in supervision.

FIGURE 12. Model of communication with a learning disabled client

CONCLUSIONS

This paper has attempted to point out the ways in which clients’ and

therapists’ perceptions impinge on the process of music therapy. The

pure ‘transference’ model of psychoanalysis and the purity of the

experience of musical communication may be ideals which we try to

facilitate, but do not achieve, even though we may come close. The

second half of the paper used some mathematical ideas to give pictorial

views of how music therapists may be working within music and words

at the same time. The writing of this paper been enjoyable, in bringing

together ideas from my previous career with my present one, and helpful,

CONCLUSIONS 21



in clarifying and developing my thinking on the process of music

therapy.

ACKNOWLEDGMENT

The author is indebted to Dr Philip Barnard of the Cognitive Brain

Sciences Unit, Medical Research Council, Cambridge, for some

illuminating conversations in the early stages of writing this paper, in

particular, in pointing out relevant parts of the psychology literature and

helping to clarify my thoughts as to how they might apply to music

therapy.

Philip Hughes is a music therapist, currently working for Rampton

Special Hospital, in forensic psychiatry, and in private practice with

children and adults with learning disabilities.

Correspondence may be addressed to the author by email

([email protected]) or at the following address: Arts Therapies

Department, Rampton Hospital, Woodbeck, Notts. DN22 0PD.

REFERENCES

Gaver W.W. (1988) Everyday listening and auditory icons. Unpublisheddoctoral dissertation, University of California, San Diego.

Gaver W.W. (1993) What in the world do we hear?: An ecologicalapproach to auditory event perception. Ecological Psychology5(1), 1-29, Lawrence Erlbaum Associates.

Gibson J.J. (1977) The theory of affordances. In R. Shaw and J.Bransford (eds.), Perceiving, acting and knowing: Toward anecological psychology, (pp. 67-82), Hillsdale, NJ, Erlbaum.

Henderson H. (1991) Improvised song stories in the treatment of athirteen-year-old sexually abused girl from the Xhosa tribe inSouth Africa. In K. Bruscia (ed.), Case Studies in Music Therapy,(pp. 207-217), Pennsylvania: Barcelona Pubs.

ACKNOWLEDGMENT 22

mailto:[email protected]



Loveszy R. (1991) The use of Latin music, puppetry, and visualizationin reducing the physical and emotional pain of a child with severeburns. In K. Bruscia (ed.), Case Studies in Music Therapy, (pp.153-161), Pennsylvania: Barcelona Pubs.

Mereni A.-E. (1996) ‘Kinesis and Katharsis’: The African traditionalconcept of sound/motion or music: its application in, andimplications for, music therapy. British Journal of Music Therapy10(1), 17-23.

Palmer C.F., Jones R.K., Hennessy B.L., Unze M.G. and Pick A.D.(1989). How is a trumpet known? The “basic object level”concept and perception and perception of musical instruments.American Journal of Psychology 102(1), 17-37.

Pavlicevic M. (1994) Between chaos and creativity: music therapy with‘traumatised’ children in South Africa. Journal of British MusicTherapy, 8(2), 4-9.

Thom R. (1975) Structural Stability and Morphogenesis: An Outline of aGeneral Theory of Models. Reading: Benjamin.

Woodcock A. and Davis M. (1978) Catastrophe Theory. Penguin Books.

Zeeman E.C. (1977) Catastrophe Theory, Selected Papers 1972-1977.Reading: Benjamin.

This article can be cited as: Hughes, P. (2004) What happens in musictherapy: An ecological approach and a theoretical model. Music TherapyToday (online) Vol. V, Issue 3, available at http://musictherapyworld.net

REFERENCES 23

Documents

What happens in music therapy: An ecological approach and ......By analysing the ‘context’ of a music therapy session, I hope to under-stand the different expectations and preconceptions