Author: Anne Moorhouse, Psychologist.
At times the rumble of drums or the soft tinkle of ivories floats into my counselling room at Little Window – Counselling, Psychology and Wellness. Then I know that our Music Therapist, Claire Stephensen, is working with a client, and I’m intrigued. Poking my head into the hallway, I try to see Claire using music in therapy, but her door is firmly closed and the mystery remains.
I would not describe myself as a musical person. I sing like a cat on heat, I’m an awkward dancer and my husband used to tell me off for singing Twinkle Twinkle Little Star out of tune to our children. Yet I also know music brings great joy. I hear the first beats of an old love song and memories flood back. My mood can be lifted or lowered through a few well-chosen songs. I know that there is magic in how we respond to music. To satisfy my curiosity about music therapy I had a chat with Claire and asked her a barrage of questions.
Thanks for having me Anne, I know your curiosity is shared with so many people. I look forward to sharing a glimpse into the ‘music therapy space’.
How do you start a music therapy session?
In music therapy training we learn a lot about the importance of overall structure of a session – the opening, middle and close are each considered to be very important for their own reasons (just like the open, middle and close of a song or piece of music!) – and it will look different for each person I work with. I always intend to meet the person where they’re at – and finish the session closer to where they want to be. For some, this might mean we start with talking before introducing music, and for others, we start with music before we do any talking. Some clients like to start their sessions by bringing a song or piece of music that resonated for them – to help bring language to their current challenges. At other times we talk through the key challenges or wins so we can decide together what the best modality will be for the ‘middle’ part of the session.
So you do talk during music therapy?
Yes – part of the music therapy course involves counselling skills, and I have personally done further training in talk-based therapies. While music can sometimes do the expressing and processing for us – I find talking to be helpful and sometimes quite important to bring language to the indescribable and to process sensory and emotional aspects of the music.
Who plays the music, you or the client?
It usually depends on the therapeutic intent of the session. For those who are new to music therapy, we often start with recorded music – but we also know how live music impacts engagement in therapy – so we often work towards live music. Live music can happen immediately for some clients – but for others, it can take many sessions. Sometimes a client might choose a song from my song list – which I then play live. I notice that when I play live, clients are more likely to tap their feet and sing along. I also notice a different level of emotional response with live music. We know how good music making is for our brains and bodies, so this can be a good way to introduce non-musicians to making music. Sometimes clients come in with existing music skills – so some might share a song they’ve written, or play a piece of music they’re familiar with. Other times, we use techniques called ‘therapeutic improvisation’ or ‘therapeutic songwriting’ and in these situations, we can both play.
Tell me more about therapeutic improvisation and songwriting!
We’ve come to know that communication is only 4% words, so I often talk about therapeutic improvisation as a way to take the words away and focus on the other 96% of communication. Improvisation is a musical activity where someone spontaneously creates music with no planned outcome. An improvisation becomes clinical or therapeutic when there are specific therapeutic intentions supporting it. We often use instruments that don’t require complex technique or skills to create sound, such as percussion or piano. We might use the musical interplay to explore how we relate to others, a tool to express emotions, to process our personal experiences or to gain insight into ourselves or other people. Music therapists are trained in tools to provide opportunities for creating safety, grounding and exploration within the music creation.
Therapeutic songwriting involves the participant and therapist co-creating lyrics and music to support self-expression. The therapist can provide as much or little structure to support the process. The supported songwriting process can support self-confidence, provide structure and metaphor for people to tell and process trauma experiences and help people to gain insight into themselves or their situation. We sometimes even record the songs, create an art album or film clips to strengthen core messages or themes in the music or lyrics.
Does the client need to know how to play an instrument?
No. No musical skills or experience is required to engage in music therapy – and I would say 90% of my clients have no prior experience in playing instruments! Some clients may choose to learn an instrument in sessions – and we call this ‘adapted music lessons’ as the focus is on the therapeutic outcomes of learning the instrument rather than the music skills. The music skills are an added benefit!
What instruments do you use?
The main instruments I use are electric piano, guitar, percussion instruments, and voice. Piano and percussion instruments are particularly great as they can be more accessible to those who don’t have any experience. The voice is also a great avenue – however, the voice is a lot more exposing for clients, so it may take longer before I formally introduce the voice.
Can you give me examples of three different types of sessions or clients?
Children are great at expressing themselves with their whole bodies. When children experience big emotions their movements might become chaotic and uncoordinated – so we use instruments or movement-based activities to meet the child in that place. We allow the child to be in that state and provide instruments to allow them to express these emotions physically. As the therapist, I might also provide some rhythmic structure to this to provide grounding within the chaos – and gradually reduce the speed so the child’s movements gradually regulate over time. Once this has happened, the child is more able to engage in expressing their challenges verbally. I will usually work alongside parents or carers so we can work together around understanding and supporting their child’s needs.
Music plays such an important role for teens and young people – and music is often the go-to for managing emotions, feeling heard, finding solace or understanding. Listening to music together in therapy then, is a great way to connect with the young person, for them to express their challenges, while also helping me understand what’s happening for them. Through the process, we may find that music is making them feel worse, so we might work together on creating playlists that help manage overwhelming emotions. This can be important – as we want the young person to feel confident in using music to support their own wellbeing. We then might use songwriting as a tool for them to tell their story, find the meaning of their story and integrate it into the bigger picture of their life. We often finish with recording the song and even creating a film clip which can provide something concrete for the young person to hold on to beyond therapy.
For adults who’ve experienced complex trauma, it’s important for me to be mindful of how I introduce music. Music can sometimes be associated with trauma, or certain sounds or songs could trigger dissociative responses without warning. So when working in complex trauma, our first priority is to develop rhythm, sensory, music or body based tools for grounding and safety. Once we have these tools in place, we will gradually introduce music and creative interventions, beginning with structure and reducing structure as it becomes more comfortable. Creative non-verbal therapies can help explore themes that are stopping the person to move forward or ‘pressing play’ on their lives. We then use words to process, make meaning and integrate these themes into working towards a more well life. We will usually weave between psychoeducation, grounding techniques, creative and talk-based therapies. The therapeutic approach depends on where the client is at.
Why would a client choose to see you, the music therapist, rather than me the unmusical psychologist?
Ha ha – I love this – though I could go on and on about what being ‘musical’ means 😉
The most common reason for clients to choose to see me – is that unfortunately, they’ve had negative experiences with talk-based therapies. So they are seeking something different to see if it is helpful. Another reason is that the client might have difficulty expressing themselves through words, so they want to see a therapist who is trained in non-verbal approaches to therapy. Thirdly, the client has experienced something powerful with music and they want to tap into that – and learn how they can use it to support their health and wellbeing. I have also seen clients who have had particular trauma responses to music and since music is everywhere, they want to understand what is happening so they can support themselves and work towards being able to manage these responses and work towards enjoying music.
I also work with teams of other health professionals. At times someone may see a psychologist as well as a music therapist. I’ve also had consultations with people who are seeing another primary therapist – but want to explore how they can use music for themselves or in sessions with their therapist.
How does music therapy work?
Most people have experienced how music impacts themselves – whether that is triggering an overwhelming emotion or memory – how it influences their heart rate and breathing – how it impacts the way they move or behave; or how it unites or divides groups of people. In music therapy, we draw from these personal experiences as well as the science-based research to support the individual. We know that music has such a strong impact on the brain – that when used systematically by a music therapist, it can support development and weight gain of pre-term babies in the neonatal unit; it can impact and influence vital signs of those in a coma or those in the end of life phase of palliative care. It can also support coordination and rehabilitation of walking, speech or attention for those who’ve experienced brain injuries.
Music engages the whole brain and whole body – so we are able to meet the person where they are at neurologically, physically, emotionally and cognitively to then strengthen neural pathways towards where they want to go. For example, when we are under high stress, or experiencing a trauma response, we can lose the ability to control our bodies, emotions, and thoughts. In music therapy we use music to work towards integrating all of these aspects, so we can better manage our response to stress or trauma.
What training did you do to qualify as a music therapist?
To become a Registered Music Therapist you have to complete an accredited university course. I completed a Masters of Music Therapy in 2008. I have also completed postgraduate study in Neurologic Music Therapy and have done formal and informal training in talking therapies. To maintain registration as a music therapist, I complete continuing education to make sure my knowledge and experience are up-to-date. I enrolled in a PhD this year, focusing on traumatic stress, however, I decided to put it on hold for a few years!
Wow, Claire, that’s all so fascinating, thank you. We are lucky to have you in Brisbane. I’m even more intrigued about music therapy now than I was before our chat. I understand the limits of talk-based therapy so its exciting for me to hear that clients can access such a creative and experiential healing process.