It’s often difficult to put into words what our work involves – what it is we do as music therapists. I’m sure we all have versions of the same story – being asked: ‘Well – what exactly is music therapy?’ and floundering to explain the idiosyncratic, challenging and unique dialogues we enter into with our clients.

This is partly because we regularly connect to the wordless aspects of people – their expressions and communications, sometimes involving powerful outbursts, sometimes as fragile and subtle micro-moments; but also because when we as therapists enter into a relationship with our clients, what is often relayed is the dynamic, raw and perhaps unrevealed aspects of peoples’ lived experiences. Our ability to listen is key to being able to genuinely, reflectively acknowledge and accept these expressions, whilst our active involvement in musical dialogue endorses and contains the inner narrative of that person as it realises a more external form. Our task it seems is to hear, to allow and to respond – sometimes just simply enjoying the twists and turns of the musical worlds created and shared at that moment in time.

I’ve worked at Penwith Acorn Provision Academy (formerly the short stay school) for several years, with students who are given their therapy time and space to express their lived experiences during the school day. I would like to relay a quote written by the head teacher, Gary Owens, who, I think has said what music therapy in this context is with the clarity and understanding of someone else who sees what it can offer to these students:

“I believe that Music Therapy is a vital tool for students who are experiencing great difficulties with their emotional well-being. Many of the students that attend AP Academies have suffered traumatic and disruptive educational and personal lives and have often had an almost nomadic existence. It is vital for these students to experience some stability in their lives and to have an outlet for expressing their concerns and feelings. Music Therapy can be a calming influence amongst the often chaotic world in which they live giving them focus and a safe place to express their feelings and develop confidence through a medium that most students enjoy.”

Gary Owens - Headteacher, Penwith Alternative Provision Academy

Article by Ruth Boulton

 

I’d like to portray my recent work with a man at a Leonard Cheshire Home, for whom the Trust has provided 19 weeks of group therapy. ‘Dave’ (name changed) is middle aged, suffers from multiple sclerosis and is now living life in a wheelchair with deteriorating memory and minimal use of his hands. He was referred to music therapy due to his social isolation.

Initial sessions were difficult for Dave – he showed resistance to engage with the instruments and dismissed the idea of therapy. He did, however, come to the sessions. He had played guitar some years back, and was still a dedicated heavy rock fan. Being faced with my transportable range of instruments and piano may not have immediately appealed to him! It took some weeks, developing trust, for Dave to feel at ease enough to begin to share his thoughts and feelings. His first comment introduced what he called the ‘F word’, which he clarified as meaning ‘Frustration’. This was a constant, dominating part of Dave’s life. I wondered if one way of helping Dave understand that I was interested in his feelings was to play frustrated sounding music on the piano with jarring rhythms and clashes, which I did. The music did seem to give him direct feedback, and Dave reluctantly began to accept my attempts to acknowledge him. We explored other aspects of frustration over the weeks in the group, and what they might mean, and also if there might be another side to these powerful feelings. I wanted to help Dave engage with creative ways of dealing with these feelings. I also played slower, more open-sounding music during this time which Dave responded to as ‘P.O.M. – you need peace of mind’. It seemed that Dave was beginning to reference some important resources within himself which could help alleviate the frustration. Dave was becoming more open to playing some of the instruments, and we set up an African drum comfortably positioned so that he could play. His playing was unconfident at first, but he wasn’t going to be defeated even though he seemed nervous. We improvised music together, which now also enabled us to work together, giving a context for Dave to express himself and gain support through my playing.

 

The music we played developed over the weeks with Dave adding a new experimental rhythm every so often across the beat, becoming generally much more grounded in his playing. He enjoyed the continuity and structure of rhythmic Latino-style music. I was gaining a stronger sense of who Dave was through his commitment to playing the drum. This gave me real insight, as Dave wasn’t able to verbally communicate much of himself and his frustration often got in the way. Playing the drum with supporting music was expressing a more intact picture of Dave. At this point, I decided to work more specifically on encouraging his physical movement, hoping that this might further enhance his mood. It was a sort of game, where he played with a beater in one hand and a shaker in the other, which might encourage his hemispheric brain crossover.

After a few minutes of this, Dave would become noticeably freer and happier which made me wonder if parts of his brain had gone to sleep through under stimulation, and were now re-awakening. He spoke of ‘P.M.A. – positive mental attitude’, which I felt reflected this shift clearly. We were also still playing our previous music through which Dave had developed a more subtle quality and gained more flexibility to changes in my music. The endings of the pieces had now begun to take on significance and there were times when they were intuitively synchronised, but also times when they felt unconfident and anxious. Around this point in the therapy I needed to introduce the ending stage of the therapy to Dave, so that he could process his feelings about our relationship ending too. He needed these weeks to express some of his annoyance and feelings of rejection. Ambivalent feelings of loss and gain came into sharp focus over these sessions. I was uncomfortably reminded of the reasons for Dave’s initial referral, and that he would soon experience time without the now immediate interaction the therapy was able to provide. I struggled with this, but was partly reassured to discover that Dave’s interactions with other staff had noticeably been improving of late, and his annual review meeting had confirmed these changes as relating to his therapy.

 

In our penultimate piece, Dave clung on to the music, wanting it to carry on without ending. This seemed a powerful communication of his commitment to, and trust in the music, which he was wanting to hold on to. His therapy had had 19 weeks to develop, and had come a long way. It was therefore a lot to give up. Our final piece celebrated this journey in a guitar song with the words: ‘We’re here today to celebrate the things we really want to say’. This seemed a genuine acknowledgement of the process the therapy had enabled for Dave, and the sense of having arrived at this point together. The piece ended with a large, shared crescendo to its cadence. 

 

My hope is that the transforming musical relationship Dave engaged with in his therapy will remain in his internal, conscious or unconscious memory, and that these experiences will in some way be able to influence the quality of his life as he copes with the next stages of his progressive illness.

                                                                                          

Ruth Boulton, April 2012

The role of music therapy with a family involved in the child protection process.

I would like to introduce my work with a family within the context of the child protection process, where forming strong links with the core team (social care, health and education) benefitted a more holistic approach to the family’s presenting picture and needs, with music therapy providing an overarching role.

 

The family's social worker wrote the following: ‘Music Therapy has supported the family that I have been working with, to support a positive development of an attachment between the Mother and her children. This has significantly supported an improvement within the family dynamics, which has allowed the family to continue this within their home environment and the community. The family were [previously] unable to understand the music aspect of their relationships, understanding the differing sounds, to be able to work together effectively as a family and has benefitted alongside other partner agencies an effective change, evidencing the risk of emotional harm significantly reducing.’

 

  

In the therapy sessions – family dynamics; emotional trauma; the mother’s ability to form a healthier responsivity to her children; the children’s need for containment and trust leading to being able to play and be played with; mum and children’s fragile intimate interactions supported over time; mum discovering pleasurable experiences; a flexible approach involving groupings of family members, whole family of 6, individual or mother-child dyad sessions and occasional sessions in the home setting; long-term constancy (3.5 years)

 

Within the child protection team – long-term view evidencing the family’s developments over time; bonding issues and developments; redefining the team’s view of maternal ineffectiveness through communicating the mother’s current psychological needs, influential historical trauma and emergent parenting ability.

 

The 5 year old girl in a large family was referred to a project I set up with a children’s centre manager, funded by Cornwall Music Therapy Trust. The family had experienced domestic violence resulting in enduring emotional trauma. The girl had entirely stopped talking at home and discord between siblings was a daily battleground. The mother described the family as locked in a constant ‘war zone’– the potential dynamic flow within the family was arrested – impermeable – frozen relational ice. Contrary to her verbal freeze, in sessions the young girl persisted in driving ear-splitting power hits into the floor drum – a dynamic manifestation of her feelings’ force and pitch.  We built a relationship around these hits – exchanging them, altering them, exaggerating them, reducing them and observing the effect they had on other instruments in the room (they would set the xylophone ringing in sympathetic resonance). I was reminded of the ‘butterfly effect’ as depicted in the ‘chaos theory’ where a fluttering butterfly can generate airwaves which could significantly affect weather patterns on the other side of the globe.  She soon began to talk freely in sessions. Mum would occasionally attend these sessions along with her baby, providing her with instruments to explore.

 

At home, the relationship between the girl and older sister was reaching fever pitch. Mum asked if I could see them together. Interestingly, over the next 6 months the two sisters’ relationship within sessions consistently involved respectful dialogue, parallel, imaginative and cooperative play and was without any hint of conflict. Mum of course wished for this at home – she was constantly at loggerheads with the older daughter. Mum started coming to these sessions, witnessing her daughters’ evident closeness and friendship: she herself was drawn by them into playing – crowding small instruments onto the floor drum and displacing them with playfully fierce beater hits, making dens and various instrumental obstacle courses, playing hide and seek - rolling egg shakers across the xylophone. The family were just being together. Mum commented that this never happened and she hadn’t ever played with the girls at home. Their play was inventive, spontaneous, unique and well-guarded.

It was surprising to me when at this point mum advised me social care had informed the children were at risk of emotional harm and neglect. Much progress was being made within sessions and I hadn’t been approached.  However, a positive outcome was that now there was a forum for relaying the process of change within sessions to the child protection procedure and the family’s wider needs were being addressed with suitable provision and support. The bonding process in sessions between mum and daughters continued and strengthened over the year.  New, relaxed areas of their relationship were emerging – more intimate and fragile facets  manifested in mum and daughters sitting cuddled on a big floor cushion whilst mum read stories (in her maternally unique ‘musical’ voice) whilst I sat on the floor supporting the delicate healing process with soft, sustaining guitar chords – providing a ‘going-on-being’ presence.  Mum had in the past said she found it difficult to cuddle the children and recently the older daughter had spontaneously repeated ‘I love you mum’.

Some sessions took place at the family home and were always both lively and chaotic. There was a creative richness despite the simultaneous layering of personalities and needs – including retreat and protest. Mum, obviously worn out, nonetheless always recovered elements of playfulness with the children. On one visit I suggested we form a circle, choose an instrument and just listen to each other play something in turn. This was almost possible, but subject to the toddler’s need to be listened to through forceful random interjections which were re-directed constructively through our flexible musical play. I had encouraged mum to play the guitar in sessions and she now created her own ‘going-on-being’ sustaining quality, anchoring the family dynamic – a huge achievement.

As decided in core group meetings, the older daughter was now to have sessions with mum to sustain bonding and help transition to secondary school – she struggled with ADHD. The younger girl was now fully integrating her verbal capacity, was becoming more outgoing at school and had coped well with house and school moves.  It was around this time that the child protection conference decided that the children were no longer at risk of emotional neglect by their mother. The secondary school were proactively supporting the older girl and she was responding well although at home she was challenging and anxious – her combative expressions were morphing into hoarding behaviour. We worked together to connect with her powerful feelings of high anxiety and emptiness which helped maintain a responsive, 3-way trusting dialogue. Although fatigued by the behaviour’s effect, Mum suggested practical strategies to try at home. She was beginning to play music spontaneously for herself– she had often reminded me that she never experienced pleasure, but the relational ice-melting was thawing her sense of powerlessness. She had also begun to thank me at the end of sessions – significant, as her long-term experience of professionals had created hardened distrust.

Our last sessions were emotive – we had shared 3.5 years of process, the family had grown up and we had become bonded. We gave time to express, share and acknowledge our feelings of imminent loss. Mum often said that the music therapy sessions were the only constant in their lives - she described the sessions as ‘freedom’ and ‘supportive’. She also said she was now so much more bonded with her children.  In the last family session, the girl I initially saw asked that we could all sit in a circle and listen to each person in turn play something.  Symbolically, there was a wider circle – the effect of the therapeutic process was being integrated into the family and their relationships together were warming. The forecast was both more optimistic and settled.

Like the effect of the fluttering butterfly, the seemingly small musical waves had become amplified, resulting in a profound shift within the family’s relational climate.  

                                                                                          

Ruth Boulton