Abstract
In this text, I present examples of music therapy case material from my two professional perspectives as a practising music therapist and speech and language therapist. With a focus on communication, I highlight some of the similarities and differences in my thought processes from these two separate perspectives and reflect more generally on aspects of the work I found of interest as a dual practitioner.
In 1985, having finished studying the viola at the Guildhall School of Music and Drama, I went to Hamburg to continue with private tuition. My O-level German was dusted off and I slowly acquired more fluency, but there were many times when I became extremely frustrated, unable to communicate my message (and thereby myself) adequately. Yet my experience of communication, of being with people, of how I felt, was a very different one when playing music. These contrasting experiences became significant factors in my decision to train as a music therapist. After training at Nordoff Robbins, I chose to work with people who were non-verbal, and although over time I have worked with other client groups, most of the following illustrations will come from this work.
As we focus on communication and music, I will be sharing four pieces of music therapy work with you, speaking about them from my two different practitioner perspectives, as a music therapist and also as a speech and language therapist, in which discipline I trained more recently. As a practitioner within both disciplines, I regularly use the term “communication” in both professional settings, yet I have become increasingly aware that whilst there is some overlap in my meaning for the term, there is also significant difference. As a result, I periodically find myself in a state of internal dialogue, leading to larger philosophical and academic questions. As I share the experience of the work and some of my thought processes, I hope to convey some sense of this internal dialogue.
These particular pieces of work are important to me as I experienced a strong sense of communication and connection with the individuals and I learned something about music, communication and relationship from each of them. With the exception of my first excerpt, which contains the real name, I have used pseudonyms and I would like to express my gratitude to those who gave consent for me to play this work.
All the excerpts are available as Supplementary Material on the journal website.
Making contact (Excerpt 1)
Shortly after qualifying, I began working with a young child named Julianne at a playgroup. She was 2 years old, and had profound and multiple learning disabilities with visual impairment. Both within the playgroup setting and externally, Julianne became extremely distressed if separated from her mother, crying out loud continually, exhausting herself, unable to listen or focus on anything else. Yet her mother needed to go into hospital and everyone around Julianne was worried as to how she would cope. She was referred to see if music therapy could assist in any way. I worked with her for a couple of sessions, trying to calm her crying with soothing music, but this had little effect. This week, putting more faith in music’s ability to “meet” her distress rather than just sooth her, I tried something different.
Excerpt 1 (36 seconds, available as Excerpt 1 in the Supplementary Material):
Julianne was crying out loud as I brought her towards the room, a piercing high-pitched cry, distressing to hear. We walked along the corridor and I sang a few notes as I sat on the floor with her – falling intervals to reflect the downward phrases of her crying (Figure 11, in this and all following descriptions, the superscript numbers are used to refer to point numbers in the related figures). I began rocking her to offer comfort and reassurance and then, using her name, I started to “call” to her in the music2. Listen to what happens after I sing her name for the fifth time3 onwards.
Excerpt 1, key points.
Considerations from a Music Therapist’s perspective
My entire attention was focused on Julianne as I tried to feel the ebb and flow of energy and tension within her, aligning myself with the rhythm of her crying, with the pitch, volume and shape of her sounds. This is the process of attunement: watching movements, facial expression and breathing, hearing the musical details of her vocalizations and responding accordingly. Within her crying I suddenly heard two clear, pitched notes4 and responded5: she seemed to respond in turn6 and then what I identified as the tension in her voice went7 and we sang two longer phrases together8.
Julianne’s physical and sensory disabilities limited her knowledge of the world – she was unable to learn through exploring and experiencing her surroundings and other people in the way most of her peers could. Yet within only a few seconds I heard and saw that she seemed to have an understanding of musical communication. I heard adjustments in timing or pulse, I heard the quality of her voice change, and I heard the narrative within this music, how it evolved – the three parameters of communicative musicality proposed by Malloch and Trevarthen (2009). I heard her exploring and experiencing music at some level. Julianne was referred because she had been unable to listen or focus on anything other than her anxiety and distress over being separated from her mother: yet at this moment9 something in this music broke through and Julianne paused, the focus of her attention changed and she allowed me to direct her attention towards first a tambourine, then other instruments. I believe at this moment9 she had a sudden, vivid experience of relationship with another.
Paul Nordoff stated: When you play, or play and sing, to express the intensity or quality of a child’s crying or screaming, he hears something akin to what he is feeling, and his experience of himself in that state becomes related to his experience of the music. The music accepts and meets his state, while it matches, accompanies and enhances his expression. He cannot help but relate emotionally and expressively to it; this changes his experience of his crying or screaming – it becomes less isolated and tends towards a primary experience of intercommunication. (Nordoff & Robbins, 1977, p. 99)
Julianne’s cries presented me with sounds to work with: however, for the music therapist there is always something to attune ourselves to, whether it is breathing, blinking, small hand movements, crying or other vocalizations. We look and listen to these signs of life, signs of vitality. We use elements of music to reflect the characteristics of these movements and in doing so we “communicate” our presence, our listening, our togetherness with the other.
I remember the moment Julianne stopped crying/vocalizing9, her surprised facial expression: I don’t know which of us was more startled by that moment, Julianne or myself – I think we both experienced the sudden impact of musical contact.
Considerations from a Speech and Language Therapist’s perspective
As a Speech and Language Therapist (SLT) I now look back and relate this excerpt to language and communication acquisition. I think of Coupe O’Kane and Goldbart (1998), who have worked extensively with individuals with profound and multiple learning disabilities. Focusing on communication before speech, Coupe O’Kane and Goldbart examine the psycholinguistic and sociolinguistic theories of early communication in typically developing children to outline the development of early communicative functioning with a view to assessment and programmes of work, although they highlight the risks in assuming that the development of communication in typically developing children corresponds exactly to the development of communication in those with profound and multiple learning disabilities.
They describe pre-intentional communication, when automatic responses signal like, dislike and wanting, and are communicated through smiling, becoming still, crying or sounds such as lip smacking and gurgling. The next stage is that of intentional communication, when a child has learned the concept that he can affect other people’s behaviour by his own actions or vocalizations. A child moves from pre-intentional communication to intentional communication with the aid of an adult, who “shapes” communications, initially interpreting a wide range of actions and vocalizations as meaningful, then gradually becoming more selective, accepting only particular behaviours and sounds as meaningful and communicative. Once intentional communication is established, more formal communication is gradually built as a child communicates wants or draws an adult’s attention to things in the surrounding world.
Julianne seemed to be communicating at this pre-intentional level, responding to the absence of the familiar shape, smell and voice of her mother, rather than “intentionally” communicating a message of “I want my mother,” with the expectation that I would then act on that message.
As an SLT, I consider how Julianne could move on to the next stage of communication. She is trying to make sense of the world around, storing memories. She needs to be able to recognize routines and events, so that she can start anticipating: her mother needs to identify Julianne’s likes and dislikes, expressed through changes in body movement, vocalizing, smiling and making eye contact, and act on them so that Julianne experiences control. Gradually she would learn her actions have affected her mother’s behaviour.
Reflections
As I look back on this work with both professional hats on, I think how valuable music is, particularly with individuals for whom building a relationship with the world and with others is difficult. Not only can we “make contact,” giving someone the experience of relating within music, we can also contribute to the process of learning intentional communication, the process of an individual learning to understand that he can affect other people’s behaviour by his own actions or vocalizations. Within music therapy, we continually respond to an individual’s actions or vocalizations, no matter how small, seeking to give control over aspects of the music, even though they are initially unaware of that control. We offer musical routines and events, thereby providing opportunities for anticipation. We gradually respond more selectively, focusing on sounds that offer greater musical or communicative possibilities, and I find myself relating this process to Coupe O’Kane and Goldbart’s (1998) descriptions of shaping communication.
I note that the sociolinguistic approach to language acquisition highlights that a child will only acquire language if there is a reason to communicate: the child won’t communicate until he wants something, or he sees something is different, etc. Yet within music therapy, we treat individuals as constantly communicating, through sounds, gestures, breathing, stillness. No “reason” for communication is needed as each individual has vitality: each encounter within music can therefore be a satisfying, meaningful, “here-and-now” communicative encounter.
Developing communication (Excerpts 2a and 2b)
More recently, I worked with a group of five young women, Jane, Libby, Mary, Clare and Helen. Each had severe learning disabilities and used a wheelchair, although two were able to walk short distances with support. All were non-verbal, but three would vocalize when they wanted your attention: they all vocalized most, for longer periods of time, when they were excited or upset. Inevitably, within their classroom environment some of these vocalizations became intrusive, so voice use was sometimes encouraged and sometimes discouraged. Starting the group with a vocal improvisation offered the opportunity for vocal exploration without such restrictions.
As the young women seldom sustained notes or successions of notes for long, other than when they were upset, I had been both leaving gaps in the music to invite more frequent vocalizations, and using their sounds within longer phrases to encourage extension. I had to be careful with sudden high volumes as Jane had a strong startle reaction and tended to dislike loud sounds: she also had a high muscle tone and struggled to move voluntarily or vocalize unless she was relaxed. However, she liked the piano, so was positioned closest to me.
It is difficult to identify who is vocalizing from audio recordings of group work, so for each excerpt I have therefore provided a figure with a rough, pictorial representation of the content followed by a second figure listing the key points (Figures 2 and 3 refer to Excerpt 2a, whilst Figures 4 and 5 refer to Excerpt 2b) (Figures 2 and 3 refer to Excerpt 2a, and Figures 4 and 5 refer to Excerpt 2b. Excerpts 2a and 2b are available in Supplementary Material). In the pictorial representations each of the five participants’ vocalizations are indicated using different coloured blocks placed along a timeline, providing some orientation as to which participant is vocalizing at any one point. Other background noises, including a child vocalizing, are indicated at the bottom. The mp3 recorder was situated immediately to my left to pick up Jane’s quieter sounds and unfortunately my voice and the piano are in consequence louder than the other four participants and occasionally distort.
Excerpt 2a, pictorial representation of vocalizations by the five participants.
Excerpt 2a, key points.
Excerpt 2b, pictorial representation of vocalizations by the five participants.
Excerpt 2b, key points.
This day’s session seemed significant for all of us. Helen arrived at the session vocalizing repeatedly in distress. As she has got older, her support workers find it harder to interpret whether the distress is communicating pain, unhappiness or anger and sometimes she seems driven to vocalize, caught in a pattern of behaviour that she cannot break. I was told she had been vocalizing in this manner for 3 days and her support workers positioned her near the door, saying they would take her out if she disturbed the group. Yet the music made by Helen and myself, far from disturbing the group, became central to what happened next.
Excerpt 2a (2 minutes 16 seconds):
In this excerpt listen to how Helen began to respond to the high register of the piano (Figure 31,2): I heard her pitched notes4 and echoed them vocally5; I heard Helen sing a high tonic6 and repeat it twice7,8 as I sang the tonic myself and increased the intensity of the music with a vocal crescendo and slide to the octave below in a climax8. The others, who had been temporarily silent, began to vocalize after Helen stopped9.
The intensity of Helen’s sounds appeared to affect us all, myself included. We had all heard her distress and been in the music with her: she in turn perhaps felt journeyed with, accompanied rather than alone. As she stopped at the musical climax8, first Mary then Libby and Clare were drawn into vocalizing, whilst Jane made a sound on an outbreath that in context felt like a sigh to release tension. I experienced an enhanced sense of listening and of togetherness with them all. Mary, Libby and Clare began to offer new sounds and I used elements of a Spanish style of music to allow pauses and flourishes, trying to reflect something of the drama. As we continued there were moments when I found myself sitting on the edge of my seat, waiting excitedly to see what would happen next.
Excerpt 2b (1 minutes 9 seconds):
This next excerpt gives a flavour of some of these vocalizations from Clare, Mary and Libby, including a vocalization from Libby that was quicker than I’d ever heard her make (Figure 51), with her subsequent quiet laughter and the sound of her rubbing her hands together as I respond2.
Considerations from a Music Therapist’s perspective
There are similarities to the work with Julianne and yet there are also differences. The process of attunement to Helen’s sounds and movements still took place, but my musical response was more complex. Matching the volume and piercing quality of Helen’s voice would have upset Jane; I also couldn’t match Helen’s pitch with my voice: I therefore chose instead to accompany Helen’s voice and use the piano’s higher register to relate more directly. As with Julianne, I invited Helen to change. Her sounds had regularity and although I used her pulse, I also stretched phrases and left lingering chords, both to support her in changing the pattern of her vocalizations and to help her to hear more clearly how her own sounds fitted tonally with the piano.
In the excerpt with Julianne, there were just two voices: here, the inherent structure of music permitted different voices of different timbres in layers. This allowed me to “multi-task”. In the first excerpt, the bass and harmony within the piano provided a stable underpinning, a platform on which to rest, whilst the upper piano register interacted more directly with Helen’s voice. The use of my own voice allowed me to gradually increase intensity and volume and sweep downwards, contributing to the climax. In the second excerpt, the piano switched between harmonic and melodic features, accompanying, making statements, answering, repeating and offering changes. The voicing and layers can all be heard and each affected the overall music. The young women were free to combine their sounds into an integrated whole without a more specific turn-taking structure.
Considerations from a Speech and Language Therapist’s perspective
As an SLT, I relate aspects of this work to Nind and Hewett’s “Intensive Interaction” (1994), where gestural, vocal and other behaviours are carefully noted and purposefully interacted with in such a way as to specifically encourage basic communication skills. However, unlike the usual setting for intensive interaction, this music therapy work took place within a group, rather than individually.
I hear what I interpret as evidence of intentional communication, what I would describe as purposeful, first “messages” without words – vocalizations that perhaps comment on the disappearance of the music or indicate that they want it to start again. Bloom and Lahey (1978) suggested first communications include highlighting the presence, absence, disappearance and recurrence of something. McLachlan and Elks (2007) expand this, focusing on the need for a therapist to provide changes in the form of novel events, missing something out, making mistakes and adding choices (p. 48) in order to offer opportunities for communication. The potential for all of these types of changes clearly lies within music-making (pre-composed and/or improvised).
As an SLT, now that intentional communication is becoming established, I would be looking towards developing consistent and specific messages, such as one vocalization or a gesture to mean “more” and a different one to mean “no”.
Reflections
As I reflect with both professional hats on I find myself placing even greater value on the way music can be built in layers, different voices with different qualities, heard simultaneously. Music affords the possibility for individuals to contribute to a whole that is greater than the sum of its parts. Someone like Jane, for whom voluntary movement is so difficult, can contribute to the musical whole with significance, just as a cymbal may be used once to emphasize the pinnacle of a piece.
I find it difficult to describe what I felt and what I believe the young women also felt when we heard Helen: the word desolation came to my mind, yet this interpretative word seems inadequate, as the experience was more akin to seeing, hearing and feeling Helen herself – a period of meeting, of recognizing another individual, what the philosopher Martin Buber might call “I-Thou” (1937/1958). In contrast, as we continued and the others began to vocalize, there seemed to be a heightened sense of creating, rather than communicating: each individual seemed to offer carefully placed sounds to the whole, and the quality of listening within the room was almost tangible. This listening extended beyond the participants to the support workers present in the room: a role reversal occurred, with the usually chatty support workers now listening intently to the young women as they communicated.
Sustaining and re-establishing communication (Excerpt 3)
My third excerpt, of some work with a young man called David, involves music that is clearly dialogical in nature, an example of sustained vocal musical communication. The insights I gained into music and communication arose in this case when I analysed this work as part of some research. Within my SLT training, I’d looked at a number of assessments used by SLTs and had wondered whether these could be used to demonstrate the development of communication in music therapy sessions. My research project therefore focused on investigating the use of three such assessments and contrasting with the information acquired via music therapy assessments. I undertook a microanalysis (Wosch & Wigram, 2007) of several samples of music therapy work, comprising a graphic representation and thick description of each 2-minute excerpt. Figure 6 shows the graphic representation of one of these samples, my next excerpt. In conjunction with the key provided within Figure 6 itself, additional musical details were noted through the use of:
a stave with the treble and bass clefs placed closer together than normal, so that an equivalent middle C line could potentially be inserted between the two clefs, making the spacing of the pitches continuous to give a more accurate visual representation of the shaping of the pitch contours;
bar lines;
chord symbols indicating the harmonies within my steady, pulsed, improvised piano accompaniment.
It was difficult to hear defined, pitched notes within David’s vocalizations and the graphic representation is therefore just a representation rather than an accurate depiction. However, the more I listened to the recording during analysis, becoming familiar with the contours, the more I could hear pitches at moments.
Excerpt 3, graphic representation of excerpt.
Excerpt 3 (2 minutes, presented in Supplementary Material in audio format rather than the original video):
As my focus is on the analysis of this work, I will only introduce David briefly by saying he had global developmental delay, epilepsy and was non-verbal, but would sometimes vocalize, often gazing intently at you. He frequently rocked either back and forth or from side to side and I often used aspects of these movements within the music I made with him. The majority of our early work was instrumental, but as time continued we began increasingly to work vocally and this next excerpt is probably our most sustained, complex piece of vocal work.
The analysed excerpts were precisely 2 minutes long, and this excerpt therefore ends abruptly. Figure 6 contains its own key points so there is no separate figure identifying key moments.
Considerations from a Music Therapist’s perspective
As a music therapist, I found creating the graphic representation particularly interesting, as it gave me a chance to examine the musical interaction in depth and to literally see the overall shape and details of the dialogical relationship between the two voices. This visual examination helped to highlight aspects such as the absence of sustained notes in David’s vocalizing.
It was interesting to note overlaps at (1) and (5) in Figure 6: the first, as we started, could have happened as a result of the musical turn-taking structure not being quite established. However, at (4), David vocalized two shorter sounds: thinking he’d finished, I began to sing, overlapping with his third sound (5). We both immediately stopped and paused: in context it felt as though David, as well as I, recognized that the musical turn-taking structure had broken down and in consequence we both promptly stopped vocalizing, then waited briefly to see if the other wanted to take a turn.
The representation also highlighted David’s awareness of harmony, with David inserting an appropriate note that I hadn’t actually played into a chord at (3) and then starting a new phrase on an appropriate note having followed the baseline at (6).
Considerations from a Speech and Language Therapist’s perspective
As an SLT, I also found the creation of the graphic representation interesting. Here was visual evidence of David’s ability to recognize and participate within a turn-taking structure. Furthermore the overlap point at (5) suggested an example of conversational repair within turn-taking. However, when trying to analyse the same excerpt using Kiernan and Reid’s Pre-Verbal Communication Schedule (1987), I found myself unable to complete the assessment: the 2-minute data sample was too small and therefore severely limited the types and number of times specific communicative behaviours could occur.
Reviewing the excerpt again as a whole, trying to relate it to my SLT frameworks, I could clearly relate the music-making in dialogue format to conversation. Bloom and Lahey’s model of language components (1978) could be used in a simplistic comparison. I could liken individual notes, melodic contours, phrases and phrase structure to language “Form”. Similarly, the turn-taking/conversational repair could be located under “Use” (pragmatics). Yet I could not really locate meaning under the component “Content” – the music did not have a meaning in the sense I would use it within my SLT work.
Reflections
To summarize my thoughts: David was non-verbal, but his ability to listen, respond and sustain a period of vocal turn-taking resulted in a musical dialogue that shared aspects of a verbal conversation. Yet I found to my interest that my research methodology had highlighted the differences between musical dialogue and verbal dialogue rather than the similarities. I realized that in contrast to my music therapy analysis (comprising digging deep into the detail of the music), within my SLT analysis my focus is usually on collecting information from as many different communicative situations as possible, so that I can look for consistency. Verbal communication, or language, is a shared system of reference, where certain sounds consistently represent certain concepts. In contrast, within music such specificity and consistency are unnecessary for musical sharing. As a dual therapist I found my initial annoyance that the analysis hadn’t worked properly transformed, into celebrating the differences between the two mediums.
Yet I would highlight that within music therapy sessions I do at times refer to specific concepts, whether it be the named people in the room, the instruments, the time, etc. I greet people or celebrate and emphasize what an individual is doing for example: at these points I often use language through song in a way that supports language development.
Sustaining and re-establishing communication (Excerpt 4)
My final piece of work took place in a medium secure hospital, with a man called Brian. Diagnosed as having a personality disorder, he was informally described to me with many negatives including racist and derogatory towards women. Over six foot tall and heavily built, his physical presence was intimidating.
He expressed an interest in music therapy and I found he was a musician. Sessions lasted for 50 minutes at a time and contained minimal talking, because his focus was fully on the music-making. He would sit at the drum kit on the other side of the room and play complex music, usually loud, stopping only once or twice during the 50 minutes for a breather, after which we would resume playing. He poured so much energy into playing that the earlier sessions were characterized by him leaving dripping with sweat whilst I left with a severe headache. Very occasionally we talked briefly, but our relationship was almost entirely a musical one.
In this early music-making I frequently found myself feeling overwhelmed and I struggled to equal his strong, rhythmic playing with a somewhat cheap digital piano. I began by trying to matching the speed, volume and energy levels, providing melodies to his rhythms, many of which had a slightly military, march-like feel. Yet in doing this, my impression was that Brian often responded by becoming even louder and more complex, reinforcing my feeling of being overwhelmed. Whilst he was clearly physically able to play at many different speeds and he certainly had no difficulty in splitting the beat and getting faster, Brian rarely slowed the overall pulse and he rarely played with just one hand.
In my professional supervision we focused in detail on the music and observed that there were more fluctuations in his playing than I’d realized, more opportunities for slowing down, for quieter music etc. We identified that in attempting to match his musical strength, my music was at times almost competing against his and was so busy I could scarcely sustain it. I began to alter my playing, introducing stronger musical idioms and matching his intensity of volume and articulation whilst leaving more musical space through playing with fewer of his notes.
Excerpt 4 (1 minute 52 seconds, available as Excerpt 4 in the Supplementary Material.):
My final excerpt is taken from just after Brian and I have begun a session, with Brian on the drum kit as I play the piano. I am trying to incorporate his rhythmic patterns within the melodic line, playing in the Mixolydian mode. We are each at times slightly unsteady, coming in and out of complete synchronicity. However, there are two particular times of acute “togetherness” that I want to draw your attention to within this excerpt.
Leading to the first moment (Figure 74): Brian’s playing contains a tiny break1; I immediately add corresponding space in my playing with notes held for the equivalent of four of his quick beats2; he introduces a new pattern3 and I initially continue with my slower notes then add his triplet pattern4 and our music steadies, becomes more secure. Brian changes pattern again6, but from his playing7 I imagine a descending chromatic scale element, which I use8, resulting in a synchronized rest9 followed by very steady playing.
Excerpt 4, key points.
Considerations from a Music Therapist’s perspective
Brian was detained in hospital as a result of his difficulty in relating to others. However, in our music-making, I remember experiencing such moments as these as intensely exciting, a rapid give-and-take of ideas and changes, that led to a very strong sense of togetherness, of relating and equality, of a shared experience of communication. We focused fully on the music interaction and over time our experiences of “togetherness” increased in number and length. Brian began to play less complex, slower music, and subsequently to improvise songs expressing his feelings: on showing the words of one song to one of the psychotherapists within supervision, I was told that this was the first time to his knowledge that Brian had ever admitted wrong-doing and expressed remorse.
Music-making seemed to afford Brian experiences of togetherness, relating and equality. In consequence, as far as I could tell, he was beginning to show a degree of trust and willingness to express vulnerability.
Considerations from a Speech and Language Therapist’s perspective
Brian had no difficulty in the actual production of speech and language and since our relationship was almost exclusively music-based, there was relatively little verbal communication for me to reflect on. At a professional level, I therefore find it quite difficult to bring insight with my SLT hat on, other than to highlight pragmatic difficulties, although I acknowledge that I do not have experience of working as an SLT with this particular client group. At what feels like a more personal level, from the perspective of being a conversational partner, I can confirm that I found it difficult to talk to him, partly as a result of his intimidating physical presence and partly as a result of experiencing in our conversation some of the described racism and attitude of superiority towards women.
Reflections
As stated, music-making in music therapy seemed to afford Brian experiences of togetherness, relating and equality. As I try to apply a focus on communication, attempting to compare the music therapy work with Brian to verbal conversation has felt incongruous, for although we constantly adjusted our playing in response to the other’s playing, this did not feel like a verbal conversation with a turn-taking format. Instead, it felt like a joint creation and for me the word communication no longer characterizes the work appropriately, for as we learnt to communicate musically there was a development in the way we related to each other – the focus shifted from communication to relating. I now find myself in deep philosophical waters, as I am using these terms togetherness, relating and equality, from a personal perspective, rather than from something definable.
Conclusions
From my work as a music therapist, I was asked to draw out three main points about music and communication within this keynote presentation, taking into account perspectives from my role as a dual practitioner.
Firstly, as described in the work with Julianne, we can use music to make contact with those who find it hard to learn how to communicate. Communicative musicality (Malloch & Trevarthen, 2009) predisposes humans towards experiencing and responding to music. Within music therapy, through our musical responses to an individual’s sounds and movements, we offer someone what Nordoff called the primary experience of intercommunication (Nordoff & Robbins, 1977): within this we also offer them the opportunity to affect, or control, the music and ourselves in a way their physical limitations may preclude. With Julianne I also personally learnt that it sometimes requires considerable courage and faith in music to meet and match the intensity of emotion, of gesture and of sound.
Secondly, as described in the work with Helen and the group, music therapists use music to develop communication. Music can be either simple or complex, it can consist of one voice or many different voices, simultaneously heard; it can encompass repetition and change; its different elements – pitch, dynamics, pulse, etc. – can be combined to give an ebb and flow through time, to give direction towards a point and arrival thereat: within music therapy, through our use of these elements, we offer individuals music within which they hear themselves and each other as significant contributors within a musical whole, no matter how small any one offering may be; we offer music that energizes and supports at the same time as inviting and responding; we offer music that progresses, builds and arrives. With Helen and the group I had a vivid experience of offering music that, as it ebbed and flowed through time, carried the group members on a metaphorical journey together, a journey during which the developing communication enabled us to learn to know each other more deeply.
Thirdly, as described in the work with David and with Brian, music therapists use music to sustain or re-establish a form of communication. There are some ways in which communication in music can emulate verbal communication, such as in turn-taking, as seen in the dialogical format of the work with David. Music making can also of course include the use or creation of songs, a combination of musical and verbal communication that latterly became of great importance with Brian. However, as music does not require consistency and specificity, a significant alternative form of communication to verbal communication becomes available. For those whose ability to communicate verbally has become impaired, such as those who have had a stroke, this alternative can provide relief and fulfilment: communication can become less exhausting, impairment can be set aside. Music also allows communication and relating for those whose past experiences and previous ways of relating hinder current verbal interactions: it may be too difficult to put into words what has been experienced; it may be too difficult to relate to someone when words can be loaded with values and judgement, as with Brian. With David and with Brian I think I learnt the value of just “being together” in music, the value of moments of intense aliveness and communion.
I am reminded of the Russian philosopher Mikhail Bakhtin’s words: “The very meaning of man (both internal and external) is the deepest communion. To be means to communicate” (Bakhtin, 1984, p. 286). For those for whom, for whatever reason, verbal communication is, or has become, difficult, music allows us to have this deepest communion.
Footnotes
Author’s note
Because this article was constructed to engage the interest of an audience consisting predominantly of music therapists and music psychologists and act as a catalyst for discussions between these two disciplines, I have preserved the original spoken style of the keynote presentation. However, to help the reader I have added figures containing numbered key points referring to significant moments in the accompanying examples: these key points have been cross-referenced within the text through the use of superscript.
This paper was written on the basis of a keynote presentation at the inaugural Nordoff Robbins Plus Research Conference “Music and Communication: Music Therapy and Music Psychology.” Two responses to this keynote follow in this issue (see Fachner, 2014; Watson, 2014).
Supplementary Material
The Supplementary Material for this article can be found online on the journal’s website.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
Supplementary Material
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