Music Therapy and Emotional Expression: A

0 downloads 0 Views 742KB Size Report
Oct 4, 2013 - (2005). Psychoterapia . Teoria . Podręcznik akademicki . Warsaw: Eneteia. Grzesiuk, L. (1998). ...... documents/100004FBStandards_of_Proficency_Arts_Therapists.pdf ..... w muzyce. Warsaw: Polskie Wydawnictwo Muzyczne.
The Karol Szymanowski Academy of Music in Katowice

Music Therapy and Emotional Expression: A Kaleidoscope of Perspectives

Edited by Ludwika Konieczna-Nowak

Katowice 2016

Editor: Ludwika Konieczna-Nowak Reviewer: Dr. Barbara Wheeler

Akademia Muzyczna im. Karola Szymanowskiego w Katowicach The Karol Szymanowski Academy of Music in Katowice ul. Zacisze 3 40-025 Katowice

ISBN: 978-83-942090-3-2 Katowice, 2016

Acknowledgement

I would like to thank Dr Barbara Wheeler for her help in making this book happen and also for support and inspiration she offered in my music therapy journey from the very beginning! Ludwika Konieczna-Nowak

Contents Foreword Ludwika Konieczna-Nowak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Music, Emotions, Expressivity, and Expression Ludwika Konieczna-Nowak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Expression of Emotions in Psychotherapy: Selected Aspects Alicja Michalak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Emotional Expression in Neurologic Music Therapy Sarah Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Playing My Feeling or Feeling My Playing? A Music-Centred Perspective on “Emotional Expression” in Music Therapy Simon Procter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Letting the World In: Psychodynamic Perspective of Emotional Expression in Music Therapy Helen Short . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Emotional Expression in Music Therapy Using Guided Imagery and Music Krzysztof Stachyra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Songwriting: A Vehicle for Expressing Emotions Felicity Baker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Emotional Expression in Family Music Therapy Amelia Oldfield . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Emotional Expression Through Music with Older Adults Anna Bukowska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Foreword Ludwika Konieczna-Nowak

Emotional expression is considered an important therapeutic factor in many kinds of treatment (Iwakabe, Rogan, & Stalikas, 2000). In both popular and scientific literature, it is linked to psychological wellbeing, while inhibition of emotion seems to play a role in the development of various diseases, including physical illnesses such as cardiovascular diseases, asthma, or cancer (Maus & Gross, 2004). At the same time, some theories of the arts see creative activity as a specific form of expression of affective processes and artistic products as objects that possess emotional meaning and messages. Given this information, it is logical to suppose that involvement in artistic action could be beneficial for health on many levels. It follows that emotional expression is one of the most popular goals for different arts therapies, including music therapy. In clinical practice, “increasing emotional expression” often appears in treatment plans for different clients, placed there by therapists working in a variety of models and methods. However, the meaning of this phrase is quite blurred. What do clinicians consider “emotions”? How do they assess the expression? How do they link it with music? When reflecting on it analytically, it becomes clear that the understanding of all these elements might differ strongly, depending on the theoretical and practical perspective and experience of the music therapist. On the one hand, using the same words for different phenomena might lead to confusion and miscommunication. On the other, it is completely natural that language, which is a live and constantly changing construct, will be used flexibly to describe all aspects of reality and never will achieve total precision. In this context, searching for a single way of understanding “emotional expression” does

7

L u dwika K onie c zna - N owak

not make much sense. It also might simply be impossible to convey complicated, fluent, and subtle processes within strict frames. It seems, however, that explaining thoughts hidden behind therapeutic actions concerned with emotions could help make the exchange of ideas clearer. The aim of this book is to present different perspectives on emotional expression in music therapy. It is not an attempt to define or structure different points of view. Our hope is to share a variety of reflections that will build a picture of the position that emotional expression holds, as seen by practitioners with different backgrounds and experiences and utilizing different models and methods in the music therapy world. The chapters of the book provide a palette of ways in which emotional expression is present in therapeutic work, how it is understood, and how it impacts clinical practice. The book opens with two introductory chapters that are not strictly oriented to music therapy but touch upon subjects that are the core of this discipline: music and therapy. The first chapter, “Music, Emotions, Expressivity, and Expression” by Ludwika Konieczna-Nowak, gives an overview of current psychology of music concepts and research regarding music and emotion. It is focused on process of musical communication and music features that correlate with emotional responses in audiences. It also presents chosen concepts regarding how emotional contents are carried and transferred by composer, performer, and improviser. In the second chapter, “Expression of Emotions in Psychotherapy: Selected Aspects,” Alicja Michalak considers the role of emotional expression in the psychotherapeutic process and regards it as one of the main factors leading to change in clients. However, the author indicates that expressing and discharging emotions, or any kind of cathartic experience, may be a good starting point but that further, deeper exploration during the following phases of therapy is also required. Michalak also elaborates on different roles played by emotional expression in chosen psychotherapeutic approaches, including those based on verbal processing and using different modalities of experiences (such as Gestalt, emotion-focused therapy, emotional schema therapy, body-mind therapies and primal therapy, integrative body psychotherapy, dance movement therapy, and mindfulness practice). The concepts that she explains may be inspiring for music therapy theorists and practitioners, providing frameworks on which to base music therapy work. The second, main part of the book includes chapters outlining aspects of emotional expression from the position of a few leading music therapy perspectives. The first one, “Emotional Expression in Neurologic Music Therapy,” written by Sarah Johnson, presents point of view of NMT, which is based in a medical context, where standardization of techniques and measurement of effectiveness are 8

Foreword

central concepts. Emotional expression seems not to fit in here easily, and in fact it is not a primary focus of NMT work. However, as Johnson points out, its elements are present in clinical experiences in all of the domains included in this approach. It is sometimes suggested that the model is “not creative enough” and “reserved” rather than “emotional” but, perhaps surprisingly for some, the author here sees the importance of the potential of music to elicit and facilitate expression and underlines its value in a clinical context. She states strongly: “Emotional expression is not the exclusive domain of any particular ‘style’ of music therapy. Inherent in all forms of music therapy, whether it is based on a neurological/ functional model, or an improvisational/emotional model is the MUSIC itself!”, implying that whenever music is present emotional expression has to take place. Quite a different opinion is stated by Simon Procter, who says: “Music is not a vent, nor does it convey specific emotional information.” This is probably an unexpected statement from a Nordoff-Robbins music therapist, considered an “improvisational/emotional” model (using Johnson’s words) and marking his position as music-centered. In his chapter, “Playing My Feeling or Feeling My Playing? A Music-Centred Perspective on ‘Emotional Expression’ in Music Therapy,” Procter makes his point by suggesting shifting the focus from what he calls “well-meaning emotional fantasy” to what is happening during the sessions musically. He draws upon the phenomenon of expressivity, regarded as one of the dimensions of musicality, and a state of “being able to be expressive in the moment” as crucial to music therapy process, but different from “emotional expression.” Another “improvisational/emotional” model that has a prominent place in current music therapy is Psychodynamic Music Therapy. Another shift of perspective is present here. Both Johnson and Procter seem to delineate emotional expression from other forms of activity noticeable within the therapeutic process. Helen Short, the author of the chapter “Letting the World In: A Psychodynamic Perspective of Emotional Expression in Music Therapy,” takes a more inclusive position and considers emotional expression broadly, saying that “every expression of the client can be considered related to their internal, or emotional world and as such is useful in interpreting feeling states or patterns of relating.” She not only suggests that most of the actions of the client could be interpreted as linked to emotional experiences (and therefore might constitute different forms of emotional expression), she also believes that exploration of feelings leading to corrective emotional experience is a general aim of psychodynamic therapy. In this framework, the focus on emotional processes, including expression, is a fundamental feature of therapy.

9

L u dwika K onie c zna - N owak

The next chapter in this section is Krzysztof Stachyra’s reflection on emotional expression in Guided Imagery and Music (GIM), titled “Emotional Expression in Music Therapy Using Guided Imagery and Music.” This is different again, because GIM is a receptive method in which recorded, precomposed musical pieces are used, so emotional expression through musical production is unavailable. Nevertheless, Stachyra opens his paper saying that “emotional expression in both its active and receptive forms is an intrinsic part of each music therapy session” and then, providing a description of the method, he presents imagery as a possible manifestation of emotional expression. Stachyra also emphasizes the role of other artistic mediums, such as visual arts or poetry, as means of emotional expression that are utilized in GIM. The chapter by Felicity Baker is not constructed around any particular established model of music therapy but around the process of songwriting, which can be used in different orientations. Baker provides with a review across songwriting practices, categorizing different kinds of work within outcome-oriented, experience-oriented, and context-oriented songwriting models. In songwriting, the combination of using verbal and musical information is unique. Both levels might facilitate emotional expression. Baker presents methods that focus on lyric creation, those where the roles of lyric and music are balanced, and those where musical structure dominates. The numerous possibilities and different experiences involved in songwriting process support the title of this chapter: “Songwriting: A Vehicle for Expressing Emotions.” For Baker, one of the methods/techniques used in practice makes an excellent structure for exploring emotional expression in music therapy. For Amelia Oldfield, this role was played by the specific setting and populations that she works with clinically. The center of her chapter is family music therapy and the chapter is titled accordingly “Emotional Expression in Family Music Therapy.” What Oldfield presents is related in part to the stance offered by Short. Although describing her theoretical foundations not as psychodynamic, but rather rooted in the music therapy work of Alvin and Nordoff and Robbins and inspired by achievements of psychologists such as Stern, Bowlby, and Winnicott, Oldfield says that “nearly all my interactions and musical improvisations could be described as forms of emotional expression,” which resonates well with the psychodynamic perspective from Helen Short’s chapter However, the source of the emotions and their expression during the sessions according to Oldfield is linked not only to the element of music but also to the presence of Oldfield leads the reader through her work by presenting different practical interventions in relation to their emotional potential and content. 10

Foreword

The crucial part of Oldfield’s chapter and also a valuable component of the papers by Procter, Short, and Baker are case vignettes that illustrate the authors’ perspectives, showing specific therapeutic situations and drawing conclusions about emotional expression in music therapy. This grounds the book in clinical work and also engages the reader by referring to everyday music therapists’ lives and work. The book ends with Anna Bukowska’s text, “Emotional Expression Through Music with Older Adults.” Bukowska concentrates her reflections on emotional expression in music therapy around one chosen population: older adults. She provides information on how emotional functioning, including recognition, regulation, and expression, changes with age, and how these processes can inform music therapy practice. Bukowska sees affective processes as a base for working on other domains, including cognitive, motor, and social functioning. Clearly, all of the authors have different understandings of the relationship between emotional expression and music therapy. Sometimes the differences are only nuances, sometimes the same words cover different aspects of broadly understood behavior or phenomena. Nevertheless, all the perspectives are well argued and can be justified. As mentioned in the beginning, the aim of the book is not to structure current music therapy achievements or call for universal terminology. The book is intended to present a “kaleidoscope of perspectives.” A kaleidoscope is an instrument that contains different colorful objects that create various patterns, depending on how you look at them. All of the authors are competent therapists with deep knowledge of therapeutic processes. The therapeutic situations they all take part in are those colorful objects. Their perspectives are the patterns that they see. But for the reader, a bigger picture also reveals that, if the optics are altered and individual perspectives become colorful pieces inside the tube, the reader can observe both: the patterns of authors’ individual “looks” and the full picture emerging from the entire book.

References

Iwakabe, S., Rogan, K., & Stalikas, A. (2000). The relationship between client emotional expressions, therapist interventions, and the working alliance: An exploration of eight emotional expression events, Journal of Psychotherapy Integration, 10(4), 375-401. Maus, I. B., & Gross, J. (2004). Emotion suppression and cardiovascular disease. Is hiding feelings bad for your heart? In I. Nyklicek, L. Temoshok, & A. Vibgerhoets (Eds.), Emotional expression and health. Advances in theory, assessment and clinical applications (pp. 61-81). East Sussex, UK: Brunner-Routledge.

11

Music, Emotions, Expressivity, and Expression Ludwika Konieczna-Nowak

Introduction

While reflecting on emotional expression in relation to music, one can take many different stances. This subject can be explored from the perspective of biology and neuroscience, psychology, sociology, anthropology, musicology, philosophy, and so forth. The field of emotions and music is broad, as is also the vast and immensely complicated area of affective sciences. This makes it difficult to keep terminological order and stay on the same, common ground of reflection while studying relationships between affective processes and music. The researchers who focus on this area point out various problems with terminology and methodology of the field. According to Juslin and Sloboda (2012), “A major problem that has plagued the field of music and emotion is terminological confusion” (p. 9). They indicate that in the available research studies the same words were used to describe different phenomena, or the same phenomena could have been labeled differently. Moreover, the literature of the field of emotions and music “presents a confusing picture with conflicting views on almost every topic in the field (Juslin & Västfjäll, 2008, p. 559). Additionally, as Scherer (2004) states: “The study of emotional effects of music is handicapped by a lack of appropriate research paradigms and methods” (p. 239). Nevertheless, affective sciences and the interdisciplinary area of music and emotions are growing very fast and often bring fascinating discoveries.

13

L u dwika K onie c zna - N owak

Approaches to Emotions Before moving on to considerations of emotions and music, a few introductory paragraphs on emotions in general will be presented. Emotions may have many definitions, and their nature can be understood in many ways. Four main approaches might be identified within the current perspectives: (a) dimensional; (b) categorical approaches, including the concept of basic emotions; (c) appraisal or componential theories; and (d) prototype approaches (see Fontaine, 2013; Juslin & Sloboda, 2012; Scherer, 2013). According to dimensional theories, emotions can be described on several different continuums (such as positive/negative, low/high arousal, calm/tense, or tired/energized spectra), representing different dimensions (valence, arousal, power). A basic emotions approach suggests that affective reactions can be put in categories and labeled separately. These categories include basic emotions such as happiness, sadness, fear, disgust, and anger. Basic emotions are considered to be found in all cultures and have distinct correlations to expression (facial and vocal). Componential approaches suggest that every emotional episode consists of correlating changes in components such as physiological arousal, motor expression, subjective feeling, behavior preparation (action readiness, action tendencies), and cognitive processes that allow for eliciting and noticing differences among emotional patterns (Scherer, 2004). According to the prototype approach, categories of emotions, just like categories of natural objects or events, result from repeated experiences, which become organized around prototypes (Shaver, Schwartz, Kirson, & O’Connor, 1987). These approaches all have an impact on the area of music and emotion (Sloboda & Juslin, 2012), and some of them will be referred to later in this chapter.

Definitions Affective Processes Attempting to organize and allow for better understanding in the field of music and affective processes, in the most complete source of knowledge on this area to date, Handbook of Music and Emotion: Theory, Research, Applications, Juslin and Sloboda (2012) suggest definitions of key terms, which are consistent with most of current psychological considerations and can improve the communication among those interested in this area. According to them: – Emotions refer to affective reactions that are focused on the object; they are rather short and intense and also synchronized with subjective feeling, physiological arousal, expression in behavior, action tendency, and regulation; – Moods are not clearly focused on any object, they last longer but are less intense, there is no synchronization with physiological response and expression; 14

Music, Emotions, Expressivity, and Expression

– Affect covers all states, such as emotions and moods, that are evaluative and “valanced” in nature; – Feelings are descriptive of subjective experiences of both moods and emotions. Considering the fact that all of the above terms are used frequently in the common language, this delineation is important in order to achieve real understanding and true communication among researchers. These definitions help in keeping the discussion clear, but, bearing in mind that theories mentioned above do affect the ways the studies of emotions and music are being conducted, universal terminological agreement is difficult to achieve. As mentioned before, the complexity of this multifaceted field is also a problem when trying to determine research methods or measurements. Depending on the approaches adopted, researchers use different test instruments. The studies on music and emotions conducted within psychology of music usually correspond with one or another approach to emotions and therefore are directed to specific data. Most of the available studies focus on basic emotions (Juslin & Lindstrom, 2010). The measurement tools that are used in the research in this field include selfreports, expressive behaviors, and bodily responses (including psychophysiological measures and neuroimaging) (Juslin & Sloboda, 2012). All of them have problems and limitations.1 Self-report instruments are based on differing approaches: basic emotion, dimensional, or componential (Zentner & Eerola, 2012). Expressive behaviors can be measured through “perceptual, cognitive, and behavioral tasks that tap into processes that are correlated with affect” (Västfjäll, 2012, p. 260). Bodily responses that are associated with emotional responses and therefore can be measured to gather information on affective reactions to music are heart rate, biochemical responses, skin conductance, respiration, blood pressure, muscular tension, body temperature, gastric motility, blood-oxygen saturation, and chills (Hodges, 2012). Methods that are used to visualize neural activity to investigate relationships between music and emotions include functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) (Koelsch, Siebiel, & Fritz, 2012). Expression and Expressivity To conclude the discussion of definitions and meaning, it seems important to mention one more delineation, namely the one between expression and expressivity. These terms are sometimes used interchangeably in colloquial language, but, 1

These will not be discussed here, as they are not central to the focus of the chapter. For those who are interested, see Juslin and Sloboda (2012), Handbook of Music and Emotion: Theory, Research, Applications, Chapter 12.

15

L u dwika K onie c zna - N owak

when it comes to the reflection on emotions and music, a distinction must be introduced. However, researchers in this field cannot agree. “Expression is something persons do, namely, the outward manifestation of their emotional states. Expressivity is something artworks, and possibly other things, possess. It is presumably related in some way to expression, and yet cannot simply be expression for the reason just given,” writes Kania (2014, n.p.). Following his thought, one could see the “doing of the person” in the composer’s and performers’ actions. But this might not necessarily be the only possibility. “Expression’s domain is the mind of the listener,” say Kendall and Carterette (1990, p. 131), placing all expressive aspects within perceptive abilities of the receiver of musical messages. Juslin (2005) negotiates the roles and proposes that “expression refers to a set of perceptual qualities that reflect psycho-physical relationships between objective properties of music and subjective … properties of the listener” (p. 88), not excluding composer and performer but seeing their role in building an acoustic “product.” Taking into consideration Kania’s (2014) words, it seems that objective properties of music should be labeled as “expressivity.” Nonetheless, for purpose of this chapter, all people involved in the communicative music process – composer, performer, improviser, and listener – will be those who might express something through or with music. Keeping Kania’s (2014) perspective, the music itself will be considered to have a certain expressivity, but one that is not necessarily easily transferrable from the artists’ expression. Communication of Emotions Communication can be described as a process of transferring a certain message between objects or persons. Communication of emotions is an important aspect of humans’ functioning on many levels, from building social relationships to psychotherapeutic factors (Iwakabe, Rogan, & Stalikas, 2000). In short, it requires expression on one side and the content/message/meaning and perception on the other side. Music is considered to be an effective medium of emotional communication. This specific kind of communication consists of a few elements, with the composer’s expressive intention being the starting point, followed by the performers’ expressive intention, then music as an acoustic phenomenon, the listeners’ perception of musical features, and, finally, as a result of this perception, the induction of certain states at a mental level (Juslin, 2005). However, when observed in greater detail, this sequence is not clear at all. The characteristics of music associated with certain emotions are defined. There is a good body of knowledge on the perception side and the listeners’ experiences. Fewer studies consider intentional expressive conditions in the 16

Music, Emotions, Expressivity, and Expression

composer and performer that give the first impulse for musical communication. Nevertheless, existing materials allow for saying that composer and performers can convey designated emotions through music (Juslin, 2005). These factors will be now explored, starting with considerations on the expressivity of music itself and its impact on the audience and then followed by reflections on the expression of artists involved in the process – the composer, improviser, and performer.

Music Features Correlating with Emotional Experiences Music Expressivity Most people agree that music is expressive and that its expressivity relates to emotions. However, not all emotions are easily identified in musical structures. Only some of them – happiness, sadness, anger, fear, and tenderness, according to research findings – are usually associated with specific features of music with high agreement among listeners. Major mode with fast tempo and simple, consonant harmony and a medium to high sound level with smooth rhythm and bright timbre is decoded as happiness. Sadness has opposite characteristics: minor mode and slow tempo, with dissonance and dull timbre. Anger and fear are both linked to fast tempo, minor mode, and dissonance, but anger goes with high sound level and sharp timbre, while fear is associated with low sound level and soft timbre with high variability in timing, articulation, tempo, and dynamics. The last one, tenderness, has slow tempo, major mode, consonance, soft timbre, and medium to low sound level (Juslin & Lindstrom, 2010). Although the combination of different features of music seems to be important for evaluating its emotional tone, specific aspects of music might be enough for emotional expressivity. For example, the results of one of the newest studies (Lahdelma & Eerola, 2016) suggest that even chords alone, taken away from the larger musical context, might convey different emotional messages. Affective Responses to Music When it comes to relationship between music and affect, it becomes clear that there are relationships between music and emotions, music and mood, and music and feelings. Although different, these states do influence each other. For example mood is a background state for the emotions, but emotions might change the mood. These relationships are interrelated and sometimes difficult to specify, which is also mirrored in affective responses to music. While trying to figure out the answer for the question: Why do people listen to music?, arguments from the affective area appear. Results of a study by Schäfer et al. (2013) suggest that one 17

L u dwika K onie c zna - N owak

of the main reasons can be summarized and labeled as: “to regulate arousal and mood” (p. 1). To be more specific, a few points should be mentioned here. – Evidence shows that music not only can express emotions or moods that could be decoded by the audience, but it might also induce them in the listeners, as happens occasionally. The distinction between perception and induction of emotions is important and needs to be clear: Listeners might both perceive and feel the emotions conveyed by music. The perception of emotion does not mean the actual experience of emotion (Juslin & Sloboda, 2012). Regarding mood, the relationship between its character and music is mutual: People listen to music to change their moods, but the mood they experience also impacts their musical choices (Konecni, 2012). – Most of the emotions evoked by music are positive. Negative reactions occur only occasionally, and if music leads to a change in the emotional state of the listener, it usually is in a positive direction (Juslin & Sloboda, 2012). But when it comes to mood, some results suggest that listening to “sad” music might be related to maladaptive mood regulation strategies in some listeners; being exposed to music considered sad might lead to increase in depression, even if the listener’s goal was to improve their mood (Garrido & Schubert, 2015). – Intentions, motivation, and goals of the listener influence the emotional responses to music. Besides musical structure, personal previous experiences and general contextual information contribute to emotions that are not only perceived in music but also induced by it (Vuoskoskil & Eerola, 2015). – Even if we agree that music does express and induce emotions, the question could be raised about what kind of emotions these are. As mentioned above, emotions involve subjective feeling, expressive behavior, and physiological reaction. When it comes to musical emotions, subjective feeling is involved, but behavioral and physiological components are indistinct. Therefore, some researchers argue that musical emotions differ from typical, everyday, utilitarian emotions and propose a separate category: aesthetic emotions (Hunter & Schellenberg, 2010). Emotional Expression in Composing There is no one answer to the question: Why do some people compose music? Composers have reasons to take this interesting professional path, but most of the motivations are very individual. Some composers like to justify their music intellectually, some rely purely on intuition. Some value emotions in the music and see affective processes as a source of inspiration while others do not; this is 18

Music, Emotions, Expressivity, and Expression

dependent on historical context, musical genre, and individual properties. From the perspective of aesthetics, the theory that music does express emotions somehow connected to the composer has some advocates, including Tolstoy, Dewey, Collingwood, and Langer. For neuroscience, the process of creation of music is still not clearly explained. Nevertheless, some research on this topic is available. Results of a study by Lu et al. (2015) indicate that a specific brain state of musical creation is formed when professional composers are creating music. In this brain state, the neurons of visual and motor areas are used to enhance the functional connectivity between the anterior cingulate cortex and the default mode network “in order to integrate musical notes with emotion” (n.p.). They concluded that composing is an “emotional task.” But there is no answer as to what kind of emotions it engages and how exactly the process works. On the psychological level, Simonton’s (2012) studies suggest that composer’s personal experience of stress or physical illness may increase melodic originality of the music being written. Melodic originality should then impact music’s expressivity. Technical aspects matter here. Professional composers can use their tools effectively and convey the emotions they planned (Thompson & Robitaille, 1992), but these are not necessarily the genuine emotions experienced while writing. Composing music is and difficult work and a complex process that involves a lot of intellectual effort and patience, and it seems reasonable to say that short and strong affective reactions do not correspond with it easily. While reflecting on film composers, Douek (2013) says that music “can transport us to a human emotion, on a journey from sadness to joy” (n.p.). Keeping the transportation metaphor, one might say that, rather than a driver who goes with the audience to the destination, the composer is an engineer who constructs the autopilot. Emotional Expression in Music Performance It seems to be a common assumption that the performer of the musical piece truly expresses their emotions during the concert production, and that honesty in this expression makes a great performance. In fact, this does not occur very often. The state that is required for successful performance is contradictory to intense emotional experience and can be characterized by relaxation and concentration. Additionally, performance anxiety often accompanies a musician’s performance, leaving little space for other affective reactions. Still, many musicians work hard to aim at expressive play by focusing on the emotions they actually feel, or even inducing certain moods by recalling personal memories for the sake of inspired performance (Woody & McPherson, 2012). According to Juslin and Timmers (2012), emotional expression is present in musical performances, and it can be both spontaneous (when the emotions are 19

L u dwika K onie c zna - N owak

genuinely felt by the performer) or symbolic (when the emotions are portrayed by the performer). Concert musicians usually do aim to express emotions and feelings and consider this to be important. Trying to achieve the communication of emotions, they use specific cues (including tempo, dynamics, timing, intonation, articulation, and timbre) to enhance music’s expressivity; research indicates that tempo, sound level, and timbre are features that impact listeners’ judgments of the emotional expression most (Juslin & Timmers). These features interact with aspects of music that come from the composition (melody, harmony, rhythmic structure) and together influence the perception or induction of emotions in music. Aspects of music coming from both the composer and the performer play a role in the construction of music’s emotional expressivity; however, “fear” and “tenderness” seem to rely more on characteristics of performance (Juslin & Lindstrom, 2010). Emotional Expression in Improvisation Just recently, musical improvisation has received quite a lot of attention from neuroscientists. This specific activity was studied to reveal neural correlates of human creativity. As a complex cognitive task, improvisation involves dynamic communication between regions across the entire cortex. Available studies were focused on jazz pianists, free-style rappers, classical musicians, and non-musicians (Beaty, 2015), but the results are not always consistent between trials. In general, “results may reflect cooperation between large-scale brain networks associated with cognitive control and spontaneous thought” (Beaty, 2015, p. 108). The correlation between emotional responses and improvisation is not clear. Liu et al. (2012) concluded that improvisation activates “a network linking motivation, language, affect and movement” (abstract, n.p.), noting the affective element of spontaneous music making but interacting broadly with other functions. Clearly, more research is needed to discover the mechanisms that might be involved here.

Sources of Emotions in Listening to Music

As a summary, possible mechanisms underlying relationships between music and human emotions will be considered. It is agreed that music and emotions are linked. But how does this work? Many perspectives are available in the literature. According to Sloboda (1999), emotions in music might be evoked in three different ways. First are episodic associations, which link certain musical pieces with specific life circumstances and situations coming from the autobiographies of listeners. Second, iconic associations come from the musical resemblance to nonmusical phenomena. The final option, structural expectancies, suggests that emotions are derived from structural features of the composition (Sloboda, 1999).

20

Music, Emotions, Expressivity, and Expression

Scherer (2004) provides a different perspective, suggesting that music may evoke emotions through central routes, such as appraisal, memory, or empathy, or peripheral routes, such as proprioceptive feedback or facilitation of expression of pre-existing emotions. Juslin and Västfjäll (2008) suggested more complete set of psychological mechanisms underlying musical induction of emotions; some of them are similar to Sloboda’s ideas, others are extensions or additions to them. These are: – Brain stem reflexes: acoustical characteristics of the music that are taken by the brain stem to signal an event lead to experiencing emotions; – Evaluative conditioning: through multiple repetitions certain music becomes linked with positive or negative stimulus and leads to induction of the emotion; – Emotional contagion: perception of the emotional content of music is mimicked by the listener, which leads to induction of the same emotion; – Visual imagery: content of the imagery that is elicited by music and the interaction between music and vision leads to experiencing emotions; – Episodic memory: a specific life situation from the listener’s life is recalled because it was linked with the music and leads to experiencing emotions; – Musical expectancy: violation, delay, or confirmation of the listener’s expectations lead to emotional experiences.

Implications for Music Therapy

All of the information provided above should impact music therapy practice. “Music therapists are indeed uniquely positioned to apply concepts from theories of music and emotion to more deeply understand and bring benefit to humans in their change process” (Hiller, 2015, p. 38). “Emotional expression,” “induction of emotions,” “identification of emotions” are phrases frequently used in music therapy, sometimes as goals that can be achieved in the process, sometimes as descriptions of what is taking place within the course of therapy. It seems, however, that they are sometimes used without full awareness of their meaning. The fact that listeners hear the emotions in music does not mean they are actually experiencing them. Even if they are, are these emotions same as everyday emotional experiences or specific to the aesthetic experience only? The fact that someone plays in a certain way does not mean that the expressivity of this music is identical to the emotional state of the musician. While performing a song, the performer might be experiencing emotions that are very far from emotions that are identified by the audience. Without musical education and technical resources, the client might be unable to portray musically the feelings they have. 21

L u dwika K onie c zna - N owak

Does this mean that music therapy has nothing to do with expression of emotions? Obviously, no. But what it does mean is that music therapists should be aware of the complicated processes that are present in any contact with music and consider all layers of this interaction in order to be as competent and effective as possible.

References

Beaty, R. (2015). The neuroscience of musical improvisation. Neuroscience and Biobehavioral Reviews, 51, 108–117. Douek, J. (2013). Music and emotion – a composer’s perspective. Frontiers in Systems Neuroscience, 7(82). doi:10.3389/fnsys.2013.00082 Fontaine, J. (2013). Componential, categorical and dimensional perspectives to meaning in psychological emotion research. In J. Fontaine, K. Scherer, & C. Soriano (Eds.), Components of emotional meaning: A sourcebook (pp. 31-45). Oxford: Oxford University Press. doi:10.1093/ac prof:oso/9780199592746.001.0001 Garrido, S., & Schubert, E. (2015). Moody melodies: Do they cheer us up? A study of the effect of sad music on mood. Psychology of Music, 43(2), 244-261. doi:10.1177/0305735613501938 Hiller, J. (2015). Aesthetic foundations of music therapy: Music and emotion. In B. L. Wheeler (Ed.), Music therapy handbook (pp. 29-39). New York: The Guilford Press. Hodges, D. A. (2012). Psychophysiological measures. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 279-312). Oxford: Oxford University Press. Hunter, P., & Schellenberg, E. G. (2010). Music and emotion. In M. R. Jones, R. Fay, & A. Popper (Eds.), Music perception (pp. 129-164). Columbus, OH: Springer. Iwakabe, S., Rogan, K., & Stalikas, A. (2000). The relationship between client emotional expressions, therapist interventions, and the working alliance: An exploration of eight emotional expression events. Journal of Psychotherapy Integration, 10(4), 375-401. Juslin, P. (2005). From mimesis to catharsis: Expression, perception and induction of emotion in music. In D. Miell, R. MacDonald, & D. Hargreaves (Eds.), Musical communication (pp. 85115). Oxford: Oxford University Press. doi:10.1093/acprof:oso/9780198529361.003.0005 Juslin, P.& Västfjäll, D. (2008). Emotional responses to music: The need to consider underlying mechanisms. The Behavioral and Brain Sciences, 31(5), 559-575. doi:10.1017/S0140525X08005293 Juslin, P., & Lindström, E. (2010). Musical expression of emotions: Modelling listeners’ judgements of composed and performed features. Music Analysis, 29, 334-364. doi:10.1111/j.14682249.2011.00323.x Juslin, P., & Sloboda, J. (2012). Introduction: Aims, organization and terminology. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 3-13). Oxford: Oxford University Press. Juslin, P., & Timmers, R. (2012). Expression and communication in music performance. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 453492). Oxford: Oxford University Press.

22

Music, Emotions, Expressivity, and Expression Kania, A. (2014). The philosophy of music. In E. Zalta (Ed.), The Stanford encyclopedia of philosophy. Retrieved from: http://plato.stanford.edu/archives/spr2014/entries/music/> Kendall, R., & Carterette, E. (1990). The communication of musical expression. Music Perception: An Interdisciplinary Journal, 8(2), 129-163. doi:10.2307/40285493 Koelsch, S., Siebel, W., & Fritz, T. (2012). Functional neuroimaging. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 313-345). Oxford: Oxford University Press. Konecni, V. (2012). The influence of affect on music choice. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 697-724). Oxford: Oxford University Press. Lahdelma, I., & Eerola, T. (2016). Single chords convey distinct emotional qualities to both naïve and expert listeners. Psychology of Music, 44(1), 37-54. doi:10.1177/0305735614552006 Lu, J., Yang, H., Zhang, X., He, H., Luo, C., & Yao, D. (2015). The brain functional state of music creation: An fMRI study of composers. Scientific Reports, 5, n.p. doi: 10.1038/srep12277 Liu, S., Chow, H.M., Xu, Y., Erkkinen, M., Swett, K., Eagle, M., Rizik-Baer, D., & Braun, A. (2012). Neural correlates of lyrical improvisation: An fMRI study of freestyle rap. Scientific Reports, 2, n.p. doi:10.1038/srep00834 Schäfer, T. Sedlmeier, P., Städtler, C., & Huron, D. (2013). The psychological functions of music listening. Frontiers in Psychology, 4(511), 1-34. doi:10.3389/fpsyg.2013.00511 Scherer, K. (2004). Which emotions can be induced by music? What are the underlying: mechanisms? And how can we measure them? Journal of New Music Research, 33(3), 239-251. doi:10.1080/0929821042000317822 Scherer, K. (2013). Measuring the meaning of emotion words: A domain-specific componential approach. In J. Fontaine, K. Scherer, & C. Soriano (Eds.), Components of emotional meaning: A sourcebook (pp. 7-30). Oxford: Oxford University Press. doi:10.1093/acprof:oso/9780199592 746.001.0001 Shaver, P., Schwartz, J., Kirson, D., & O’Connor, C. (1987). Emotion knowledge: Further exploration of a prototype approach. Journal of Personality and Social Psychology, 52(6), 1061-1086. Simonton, D. K. (2012). Emotion and composition in classical music: Historiometric perspective. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 347-366). Oxford: Oxford University Press. Sloboda, J. (1999). Music – where cognition and emotion meet. Psychologist, 12(9), 450-455. Sloboda, J., & Juslin, P. (2012). At the interface between the inner and outer world. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 73-98). Oxford: Oxford University Press. Västfjäll, D. (2012). Indirect perceptual, cognitive and behavioral measures. In P. Juslin, & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 225-278). Oxford: Oxford University Press. Thompson, W., & Robitaille, B. (1992). Can composers express emotions through music? Empirical Studies of the Arts, 10(1), 79-89. Vuoskoski, J., & Eerola, T. (2015). Extramusical information contributes to emotions induced by music. Psychology of Music, 43(2), 262-274. doi:10.1177/0305735613502373

23

L u dwika K onie c zna - N owak

Woody, R.H., & McPherson, G.E. (2012). Emotion and motivation in the lives of performers. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 401-424). Oxford: Oxford University Press. Zentner, M., & Eerola, T. (2012). Self-report measures and models. In P. Juslin & J. Sloboda (Eds.), Handbook of music and emotion: Theory, research, applications (pp. 187-222). Oxford: Oxford University Press.

24

Expression of Emotions in Psychotherapy: Selected Aspects Alicja Michalak

Introduction: The Purpose of Psychotherapy

Psychotherapy is a healing process which allows the patient to gain new emotional experiences and new knowledge, and to learn new behavioural patterns (Aleksandrowicz & Czabała, 2003). The main objective of psychotherapy is the change that consists in removing the disorders of experiencing and behaviour, as well as eliminating the causes and the symptoms of psychogenic disorders in the functioning of the patient’s organs. All psychotherapy models emphasize that an effective therapy process also involves development, and the patient may learn new ways to respond, experience, and behave, which is helpful in day-to-day life. It is facilitated by the unique therapeutic relationship in which the psychotherapist is entrusted with the task to stimulate the patient – verbally and nonverbally – to analyse themselves, to try to understand their own reasons for acting, and to gain new experiences. This process allows the patient to learn about themselves and to develop new skills and habits consciously in a safe way, in the atmosphere of acceptance, respect, and understanding granted by the therapist (Aleksandrowicz, 2000). The psychodynamic, behavioural, cognitive, systemic, and humanistic schools of psychotherapy are commonly known. These are the main theories of psychotherapy. The history of their development is the longest, and they are the most extensively described and the most popular among psychotherapists. They differ in their theoretical assumptions as to the causes of mental disorders and the changes that the process of psychotherapy should result in, as well as the methods of achieving such changes. Briefly, (a) psychodynamic therapy focuses mainly on changing the suppressed or hidden feelings; (b) behavioural therapy on chang-

25

A li c ja M i c halak

ing the dysfunctional behaviours that had been learnt in the past; (c) cognitive therapy on changing inadequate schemes of thinking and interpreting the reality; (d) systemic therapy on changing the ways of functioning in social relations, in particular in family relations; and (e) humanistic therapy on adjusting emotional states that distort self-esteem and self-development. Despite all the differences, all above schools assume that a change that is achieved during psychotherapy will practically automatically cause a series of other desired changes in all areas in which the patient is functioning. A desired result of each psychotherapy is healthier functioning of the given person in the emotional, cognitive, and behavioural zones, making that person able to follow their own needs and objectives. This will result in being in good mental health (Czabała, 2010). Thanks to this specific feedback loop, it is possible to achieve a relatively stable mental health, development, and self-realization.

Treating Factors in Psychotherapy

The results of research on the effectiveness of different psychotherapy schools (Lambert, 1991; Lambert, Shapiro, & Bergin, 1994) show that most psychotherapeutic methods bring similar results in terms of reducing symptoms. Summarizing the review of the effectiveness of psychotherapy, Lambert (1991) indicates that the elements of the process that are common to different psychotherapeutic schools have a significant impact on the changes in patients. Conclusions of authors working in this field (Lambert, Shapiro, & Bergin, 1994) indicate the most frequently listed elements of the psychotherapeutic process: the therapeutic relation, new emotional experiences of the patient, new knowledge gained during psychotherapy, and new behaviours learned during therapy. They all affect each other, enabling the patient to harmoniously and fully develop their emotions, cognitive skills, and behaviour, in terms of their sense of identity as individuals as well as in terms of their social relations. The relationship between the patient and the therapist is appreciated by all schools of psychotherapy. The therapeutic relation is an experience that is different than any human relations that the patient has ever known. The therapist may serve as the “object” of projecting the experiences of the patient from important relations from the past (transference). It makes it easier to reveal and release the difficult feelings experienced towards persons that are important to the patient’s life. The therapeutic element in this relation consists in the fact that expressing even difficult and strong feelings in the relationship with the psychotherapist does not involve responses that the patient expects (e.g., rejection or punishment), which allows the patient to reveal them and lower apprehension. This in turn of-

26

Expression of Emotions in Psychotherapy: Selected Aspects

fers the patient the possibility of experiencing corrective emotions, that is, of reliving moments of psychological injuries from the past within a safe relationship and fully expressing their needs and emotions. Another result of therapy lies in gaining awareness of the experienced feelings, gaining understanding of their causes and functions within a relationship. Moreover, a real relationship between the patient and the therapist (based on trust, respect, authenticity, empathy, acceptance, and understanding) allows the patient to safely observe the patient’s emotional response and to recognize cognitive schemes and habits, as well as to learn new skills that are more functional in their lives. The results of the research that describe the views of patients on the factors that helped them get better mention: (a) the feeling of being understood; (b) the support of the therapist; (d) the incentive to achieve understanding; (d) the honesty of the therapist, their care and interest. These elements enable true emotional, cognitive, and behavioural expression and the development within the psychotherapeutic process, leading to strengthening and expanding their mental resources (Lambert, 1991). All schools of psychotherapy emphasize that effective therapy is also based on new experiences related to emotions and feelings that take place during the therapeutic process. Expressing emotions leads to the feeling of relief and relaxation. Such relief leads to reorganizing the way the patient perceives the world. It improves the ability of the patient to distinguish their own emotions and to change the perception of their past and current experiences. Eliciting new feelings is incredibly important for undertaking new behaviours; for example, eliciting anger facilitates assertive behaviours or reduces the sense of helplessness. At the same time, psychotherapy creates the opportunity for patient to take responsibility for their own emotional experiences. Becoming aware of the impact of your own feelings on the distortion of perception of yourself and of the world, as well as recognizing their impact on the relations with others, leads to realizing that you are the source of your own experiences. This changes the perception and the behaviours of patients. The earlier sense of helplessness towards the patient’s own feelings is replaced during psychotherapy by understanding their reasons and by consciously shaping and “using” the patient’s own feelings to change the course of life events. The patient is offered the opportunity to directly influence their own emotional states and learns specific ways of exerting such influence in everyday situations. This is of particular help in the case of dysfunctional emotions (e.g., anxiety in the case of phobias). Eliciting and discovering emotional experiences is present in all models of psychotherapy. They differ in techniques used only. A psychoanalytical or psychodynamic therapist uses the technique of free association to reveal the suppressed feelings and goes on to analyse them and interpret them, which 27

A li c ja M i c halak

allows the patient to find a release. In turn, behavioural-cognitive psychotherapy mostly offers the patient the opportunity of corrective experiences, for example, during systematic desensitization, immersion technique, or overcoming emotions related to introducing alternative behaviours. Humanistic psychotherapy techniques serve mostly to create the conditions in which the patient is able to experience unconditional acceptance and being understood, eliciting hope and trust. It allows the patient not only to confront their own difficult, often suppressed and painful experiences, but also helps them to learn to depend on their emotions and their positive strength. As regards systemic psychotherapy, therapeutic techniques are factors that elicit multiple new emotional experiences within the family system of the patient (Czabała, 2010).

Expressing Emotions in the Process of Psychotherapy

Releasing emotions is a therapeutic phenomenon in psychotherapy. Certain psychotherapeutic approaches treat it as one of the fundamental treating factors. For the purposes of psychotherapy, it is important for suppressed feelings to be released. By revealing the feelings, the patient learns about themselves and about their true feelings. This helps them to understand their responses, habits, intentions, difficulties, and resources. Releasing the mental stress facilitates insight, gives the opportunity to resolve the problem, leads to personality changes, and offers the patient a chance to develop (Grzesiuk, 2005) The terms “expressing emotions,” “discharging emotional stress,” “release,” “emotional venting,” “catharsis” are not clearly defined in psychotherapy. Discharging emotional stress is usually understood as expressing emotions (revealing them by acting or verbally) and as expressing traumatic emotional experiences that might be the primary source of emotional disorders. Moreover, discharging emotional stress is defined as reducing drive-related tension. In turn, catharsis is frequently understood as revealing strong emotions that had been suppressed in the past, mainly anxiety, anger, and sadness, caused by traumatic events (Chaplin, 1971). Palmer (1980) defines expression of emotions as discharge, release, and venting, while catharsis is treated as a result of releasing the emotions. Releasing the stress is helpful in patients that experience the fear of expressing emotions. When such fear prevents revealing feelings, a somatic stress is stimulated, leading to a permanent loss of the natural ability to experience emotions. The scope of suppressed responses is getting wider, meaning that even if originally the fear of expression related only to anger, for example, ultimately that person loses their ability to experience any emotions. As we refrain from revealing emotions, we lose energy. This is why expressing emotions allows the patient to take 28

Expression of Emotions in Psychotherapy: Selected Aspects

advantage of the mental energy in a positive, constructive manner. Moreover, after discharging the emotional stress, the patient feels relieved, calm, relaxed. The sense of relief is a desired outcome in psychotherapy, though relatively shortlasting (Palmer, 1980). Therefore, it is recommended to apply techniques that promote discharging emotional stress at the beginning of psychotherapy, as the positive results motivate the patient to continue the therapeutic work (frequently expanded to include cognitive and behavioural aspects) that leads to resolution of the problem. Some psychotherapists believe that discharging stress is also therapeutic in the event of crisis interventions in mentally healthy persons who experienced a strong, traumatic stress such as rape, violence, or a highway accident. Hayder (1983) notes that after the emotional stress is discharged, patients experience an incredible, close to ecstatic feeling – the feeling of being “cleansed,” “newly born.” Thanks to reduction or elimination of psychosomatic symptoms, patients focus their attention on other areas of their lives and they gain insight into their own behaviour. This is where the conditions promoting recovery and development start. Fear of expressing feelings causes emotional and somatic tensions. The longlasting control exerted over experiencing and expressing emotions weakens the patient; it might even make the patient unable to feel. Following an emotional discharge, for example, during catharsis, the patient experiences clear changes in their well-being. Such a person seems to be radiant, beaming with delight. Their eyes become clear, muscles are relaxed, ready to work, the moves and the speech are full of grace. They experience the energy, the comfort, the freedom in their bodies. This is when change easily happens. The conditioning, the programming is here removed. A new system of values and beliefs might be conditioned or programmed. (Grzesiuk, 1998, p. 177)

Psychotherapists representing all schools emphasize that this ecstatic state is relatively short. It might be followed by a worsening of well-being and by symptoms of depressive moods. All the previous ailments might return and sometimes deepen. This is why the stage of expressing emotions and discharging them, or catharsis, is not full psychotherapy and may not be its only element. In order to attain a permanent change in the functioning of a patient, their full recovery and proper development, it is necessary to include other elements of the psychotherapeutic process that relate to the cognitive, behavioural, and interpersonal zones of the patient. The awareness of the therapeutic function of experiencing and expressing emotions had a say in developing many psychotherapeutic techniques including psy29

A li c ja M i c halak

chodrama, the empty chair technique (Gestalt therapy), and many others. Psychodrama, according to Jacob Moreno, enables the patient to relive the pathogenic situation in “meta-reality” created by spontaneous drama, consisting in reenacting past events. Playing roles with full expression of emotions and behaviour allows the patient to observe the situation through the eyes of another person and to feel and experience it. Playing roles allows the patient to behave in a way that they would not normally behave in a real situation. During the role play, memories come out that facilitate recreating the traumatic situations and to discharge the emotions related to them. The empty chair technique, which also takes advantage of the therapeutic role of expressing feelings, allows the patient to gain insight and “closure” of unfinished business that continues to instigate strong emotional tensions (Stankiewicz & Tomczak, 2012) Individual approaches in psychotherapy ascribe different therapeutic value to discharging stress. Introducing a relation between these phenomena and the treatment effect in psychotherapy is present mostly in the humanistic-existential approach (in particular in Gestalt therapy) and in the group of therapies based on experiencing. Using the therapeutic role of expressing emotions is also visible in other areas of modern psychotherapy. This paper continues to discuss the main objectives, assumptions, and work methods in selected psychotherapy approaches, related to the psychotherapeutic function of expressing emotions. Expressing Emotions in Gestalt Therapy Gestalt psychotherapists focus on emotional experiences; they encourage patients to live through emotions, and, according to them expressing emotions is one of the most important treating factors. Gestalt therapy techniques, created by Frederick Perls, are based on existential dialogue that a therapist carries out with a patient, which promotes better understanding of emotions that the patient is driven by (insightful character of the therapy). However, Gestalt therapy places strong emphasis on experiencing your own emotions and signals from your body “here and now” (Perls 1973, 1969, 1981). The experience aspect of Gestalt psychotherapy assigns more value to actions than to words; it pays more attention to experiencing and living than to thinking, and the process of therapeutic interaction is treated as more healing than beliefs or conversations on this topic. It releases patients from avoiding or suppressing emotions that they had learned in the past. Psychotherapy puts emphasis on living through and expressing the currently experienced emotions within the therapeutic relation, as the therapeutic process focuses on what is going on “here and now.” Diverging from the present means avoiding living through true experiences and prevents the patient from gaining full awareness of themselves and of reality. Usually, the 30

Expression of Emotions in Psychotherapy: Selected Aspects

breakthrough stage of Gestalt therapy process is the implosive stage, when the patient begins to experience their emotions and needs, but their emotions are not expressed and their needs are not met. The patient experiences their mental energy, but a lot of it is still blocked at the time. In another stage of therapy, the so-called explosive stage, its cumulated energy is released and explodes. Emotions start to be clearly expressed and the needs met. At the end of the therapy, the patient gains contact with their authentic “I,” which results in the sense of internal security and peace. The patient is able to experience all emotions at any time, express them in a mature manner, communicate with others using emotions, and use the mental energy constructively in undertaking actions adequate to the given situation, needs, objectives, and intentions (Fagan & Shepherd, 1970; Latner, 1974; Perls et al., 1979). Expressing Emotions in Emotion-Focused Therapy According to emotion-focused therapy (EFT), an emotional change is necessary in order to attain a permanent change in the psychological functioning of a human being. Behaviour might change thanks to the change in emotions that motivate them. This therapy is rooted in humanistic approaches in psychotherapy. It takes advantage of the significance of expressing emotions and their adaptive function, also considering the biological character of the types of emotions and emotional processes, their origins, duration, and release. “The idea of EFT lies in the belief that while emotions are adaptive in nature, they might turn problematic for many reasons. These reasons are, for example: past traumas, recognition deficits ... or avoiding emotions (for fear of their impact on themselves or on others)” (Greenberg, 2013, p. 18). Emotions make it possible to access needs and objectives, and they elicit acting to attain them. Both “pleasant” and “difficult” emotions are of equal significance in terms of self-development of human beings. This therapy emphasizes the role of becoming aware of yourself, of experiencing, accepting, and understanding emotions, without diminishing the significance of cognitive and behavioural change. The fundamental principle of EFT says that in order to change a feeling, you must first experience it. EFT focuses on actual emotional experiencing of the patient, accepts it unconditionally, and works with it in order to elicit emotional change. The patient must experience emotions so that the change might reach them. EFT is based more on the “I feel, therefore I am” principle than on the “I think, therefore I am” principle. The impact of emotions on thinking is emphasized more than the reverse. Therefore, by changing how emotions are experienced, the contents of thoughts and beliefs is changed. In the course of the therapeutic process, the patient is encouraged to “face” difficult emotions, because it is only then that they may be transformed and used in a con31

A li c ja M i c halak

structive manner. The emotional pain must first be experienced and accepted, so that it can be fully felt and heard. It is only then that it might be changed. According to EFT, the main source of disorders is the lack of awareness of emotions, that is the deficit in the ability to be self-aware. Moreover, denying or avoiding expressing emotions deprives people of valuable adaptive information. Alexithymia, the inability to identify and describe emotions, is the most extreme form of lack of the ability to use the information derived from emotional experience. EFT strategies enable patients to recognize, understand, express, accept, and use emotions and to manage them in a flexible manner within an emphatically-adjusted therapeutic relation, which facilitates these processes. As a result, these emotions allow the patient to access important information about themselves and to use it more efficiently to attain full and adaptive functioning. The emotional schemes learnt in the past might be dysfunctional (e.g., a child severely punished for any manifestation of anger in the past might experience secondary fear of experiencing and expressing anger in the future). EFT work strategies allow the patient to experience corrective emotional experience in therapeutic context, within which the patient may accept the feeling of anger in themselves and learn to express that anger in a manner that is safe to themselves and to others. General EFT strategies concerning working with emotions are based on two main tasks that facilitate: (a) patients that experience too little emotion themselves in reaching their own emotions, and (b) patients that experience too many emotions in managing them. Paradoxically, one of the most effective ways of helping clients to manage emotions might be to support them in becoming aware of emotions, expressing them, and deciding what to do about them, when they appear. It is due to the fact that suppressing emotions and failing to undertake any actions in connection with them generates even more uninvited feelings, which makes everything seem more overwhelming and scary. (Greenberg, 2013, p. 78).

In the course of EFT therapy, the patient learns to recognize when the experienced emotions are adaptive and might be treated as “guidelines” and when the emotions are not adaptive and must be changed. The client therefore learns the following: (a) using certain emotions; (b) calming themselves internally, for example, regulating feelings automatically and effortlessly. The fundamental objective of EFT is to improve awareness of emotions, thanks to which the patient also becomes aware of their needs and gains motivation to meet their needs. The emotional awareness goes beyond intellectual knowledge; it is the conscious ex32

Expression of Emotions in Psychotherapy: Selected Aspects

perience of feelings. Expressing emotions in therapy does not consist in venting emotions but in overcoming the tendency to avoid experiencing and expressing them consciously. During therapy, stimulation and expression are valuable, but they are not always enough to spark therapeutic progress. Acceptance and careful observation of the experienced emotions and reflecting on them also deliver data that are significant for the process of therapeutic change (Greenberg, 2013). Over the past 20 years, a type of emotion-focused therapy that has been intensively developed is process-experimental psychotherapy (Greenberg, Rice, & Elliot, 1993). Over that period of time, the underlying theory was expanded to include additional elements; the six basic therapeutic tasks were supplemented by new ones, and a series of studies was conducted to analyse the effectiveness of this approach in psychotherapy (in particular as regards treating depression and traumas, even though this approach became more and more extensively applied in the case of other mental disorders) (Elliott, Davis, & Slatick, 1998; Elliott & Greenberg, 2002). Despite its development, the central task of psychotherapists following this approach is to recognize, learn, and effectively use the emotional process of patients in experiencing emotions directly, expressing them, and observing them within a therapeutic relation. Examples of such psychotherapeutic work include: reprocessing problematic experiences, two-chair technique in the case of splits, or empty chair dialogue in the case of working on unresolved interpersonal problems. We can see the inspiration by techniques of, for example, Gestalt therapy or psychodrama as developed by J. Moreno. Expressing Emotions in Emotional Schema Therapy Emotional schema therapy (EST) makes it easier for the patient to recognize different emotions and to consciously include them in their personal experience. EST is a form of cognitive-behavioural therapy based on the following principles: (a) painful and difficult emotions are universal; (b) emotions were evolved to warn us of danger and tell us about our needs; (c) underlying beliefs and strategies (schemas) about emotions determine an emotion’s impact on the escalation or maintenance of itself or other emotions; (d) problematic schemas include catastrophizing an emotion; thinking that one’s emotions do not make sense; and viewing an emotion as permanent and out of control, shameful, unique to the self, and needing to be kept to the self; (e) emotional control strategies such as attempts to suppress, ignore, neutralize, or eliminate emotions help confirm negative beliefs of emotions as intolerable experiences; (f ) expression leads to normalization, better understanding, differentiation, and strengthening emotions and helps increase beliefs in the tolerability of emotional experience without guilt, fear, or shame (Leahy, Tirch, & Napolitano, 2011). Normalization teaches patients that even the 33

A li c ja M i c halak

most difficult emotions are temporary, common, and universal – and that they are a natural part of the human experience. Therefore, they need not be the source of shame, guilt, or fear. Negative interpretations of emotions facilitate fear of them and inability to tolerate or regulate them. It leads to problematic strategies, such as worrying, ruminations, binge eating, acting out, or substance abuse in an attempt to suppress or eliminate the experienced emotions. EST helps the patient accept emotions and use them in a constructive way instead of suppressing or eliminating emotions, in particular difficult and painful ones. Accepting your emotions does not mean believing that an emotion is good or bad, but it means recognizing that it is an experience that we have at a given time. Accepting an emotion might help the patient resign from strenuous and futile attempts to eradicate the given emotion. Expressing and observing experienced emotions allows the patient to notice that emotions are not only changeable and naturally spontaneously passing, but also diverse and sometimes seemingly conflicting. The technique of accepting mixed feelings allows the patient to notice that dialectic perception of emotions (as harmonious despite the fact that they are conflicted) reflects a higher and higher awareness of the true and complex nature of the human psyche and the reality in which it exists. Therefore, the patient is able to feel a “better living space,” to expand and integrate all their emotional experiences. EST places emphasis not only on expressing the emotions that are incurred and on passive acceptance, but also on making a conscious choice of emotions, which the person will strive to achieve on a given day, by purposefully provoking them. EST appreciates the significance of positive psychology, in particular, the role played by positive emotions in protecting against stress (Leahy, 2002). EST techniques include: (a) recognizing emotional schemas, (b) naming and differentiating emotions, (c) normalizing emotions, (d) noticing the passing nature of emotions, (e) acceptance of emotions, (f ) tolerating mixed feelings, (g) specific choice of individual emotions. Modification of emotional schemas during the EST process allows the patient to learn, experience, normalize, and accept emotions, understand their passing nature, and to resign from dysfunctional avoidance or suppressing strategy to undertake using emotional experience in a constructive way (Leahy, Tirch, & Napolitano, 2011). Expressing Emotions in Bioenergetics Analysis The fundamental principle of this approach to psychotherapy is the unity of mind and body. The approach of its creators has its roots in psychoanalysis, but the practical influence is here first focused on movement and flexibility of the 34

Expression of Emotions in Psychotherapy: Selected Aspects

body. Both Reich and Lowen described characteristic muscle blocks, which are the consequence of suppressing emotions and needs. They are in-built into our body, creating so-called muscle armour. The body is in an inseparable relationship with the psyche, influences it, and the psyche in return influences the body. According to the creators of bioenergetics, releasing emotions may be attained by systematic work on the body (remembering other intrapsychic processes). Wilhelm Reich (1976) stated that emotional disorders have their source in a physical obstacle in energy flows, which takes the form of chronic muscle stress that limits emotional expression of a person. This stress is in turn caused by a conflict, related to the prohibition to release basic emotions and drives (mainly sexual energy) learned in early childhood. According to Reich, it is possible to reach these prohibitions – learnt and blocking the natural energy flow – only by way of expression. Therapy is intended to activate expressing emotions by deep breathing. Holding your breath might be a subconscious way of controlling your feelings. Lowered oxygen intake as a result of shallow breathing leads to losing corporal sensations, which in turn lowers emotional responsiveness and makes muscle mobility more difficult. Chronic muscle stress reduces or blocks movements related to expressing emotions, for example, stress in the throat might limit the ability to cry or shout. Therefore, Reich proposed therapy techniques that directly influence the somatic zone of a patient and serve to discharge muscle stress – and so also, emotional stress. Deep breathing weakens the fear and allows the patient to release suppressed emotions blocked in the body, which accompanied traumatic experiences in the past. Alexander Lowen (1976, 1990, 1991), referring to Reich’s concept, stated that being in contact with your own body and reducing muscle stress are just as important as being in direct contact with your emotions. Therefore, patients are encouraged to systematically do individual or group bioenergetic exercises proposed by Lowen and developed by his successors. However, it is the heart that lies at the centre of the therapeutic work, as the heart is the most vulnerable body organ according to Lowen. Experiencing a situation in childhood, when the heart rhythm was disrupted by a strong mental stress, causes that person to subconsciously create multiple defence mechanisms to protect their heart against the risk of any disruptions to its functioning. In psychotherapeutic work, these defence mechanisms are recognized, their relation to the life experience of the patient is analysed and worked on, to reach the “open” heart. In the bioenergetics discussed here, the therapy pertains to the following defence layers:

35

A li c ja M i c halak

1) Ego, which contains the mental defence mechanisms: denial, mistrust, blaming, projection, rationalisation, intellectualisation; 2) Muscles, where the muscle stress is located, supporting the defences of the ego and protecting the individual against suppressed feelings that are not expressed; 3) Emotions, where the suppressed feelings are located, in particular anger, anxiety, dread, despair, sadness, and suffering; 4) Heart, the deepest layer, from which the feeling of love and desire to be loved originates. Psychotherapeutic work on all those layers allows them to fully eliminate the unnecessary defence mechanisms. Working on the ego enables the patient to become aware of their tendency to use defence mechanisms in their behaviour (that usually make it harder for them to function in everyday situations), but it does not release the muscle stress or suppressed feelings. If needed, it is possible to reach the suppressed feelings and unblock them by loosening the tense muscles, which hinder and block emotional expression. Working on the muscle stress might help the patient understand how the rigidity of their body causes mental stress. Another technique from the area of Lowen’s bioenergetics, which leads to releasing and discharging suppressed emotions, is initiating shouting, which is a catharsis to the personality. Shouting, crying, weeping – these are all explosions of personality, which loosen the rigidity caused by chronic muscle stress. Releasing fury in therapeutic situation is also beneficial. Revealing fear, though difficult to do, is even more important. If the panic or horror that had been suppressed in the past are not brought up and worked through, the cathartic effects of releasing the sadness, anger, and shouting will be short-lived. The suppressing process will be replaced by cathartic process, but no major developmental changes will occur. Without understanding the causes and nature of emotional stress, living through that temporary cathartic release might lead to an even stronger fear and disorientation. “Working through” your emotions means living the emotions and understanding their causes, which promotes therapeutic and permanent change in personality. In bioenergetics, the goal is to release and vent suppressed feelings, so that the energy needed for the changing process is released. However, working with the emotional layer exclusively also fails to produce the desired results from the viewpoint of therapy. Working on muscle stress has benefits, but without analysing the defence mechanisms lacks the nature of a full psychotherapeutic process. In psychotherapy according to Lowen, you need to work almost simultaneously on the first three layers that supplement each other – the first one concerns intellectual defences; the second one, muscle stress; and the third one, emotional stress. 36

Expression of Emotions in Psychotherapy: Selected Aspects

A similar approach is expressed by Kepner (1991), who draws the attention to the dangers of psychotherapy that is carried out by therapists that focus exclusively on processes in the patient’s body. He notes that the influence of methods of a physical nature only might lead to short-term relief but not to permanent change. Physical methods themselves will not transform the neurotic beliefs. If a conflict, associated by the therapist with corporal processes, is not worked through and clarified, the old habit might return. Expressing Emotions in Primal Therapy The therapy proposed by Janov (1975) is focused on treating traumatic experiences, but its main purpose is to help patients become fully authentic. The intended aim of this approach is to eliminate or reduce negative consequences of a childhood trauma on adults. The influences applied are intended to focus the attention of the patient on their childhood memories, because the majority of emotional disorders are a signal of the needs that had not been satisfied in the past (primal pain), which hampers the natural development. Instead of acknowledging their own suppressed needs, the patient experiences non-specific stress that the patient does not understand and is not able to identify properly and, as a result, experiences chronic anxiety. In the course of the therapy, the suppressed emotions of the patient are discharged. The pain and mental suffering experienced by the patient are acknowledged and connected to the traumatic events from the past. The traumatic pain might be released thanks to fully living through and expressing the pain. Then, it is possible for the patient to acknowledge their true, deeplyhidden needs, followed by eliciting the courage to satisfy them. In order to attain this state of emotional discharge, the therapist instructs the patient to lie down, which causes the feeling of helplessness, to breath deeply, to keep their mouth open (so that the patient is not able to “swallow” their feelings) and to dig into the events from childhood. When the therapist notices that the patient is experiencing certain feelings, they encourage the patient to express them to the fullest extent possible, to say things that the patient failed to say in the past in their relations with important people. The scream of pain from the patient opens up the defence system and promotes insight. The more the patient focuses on painful experiences, the deeper primal feelings are experienced, and the stronger the patient’s real “I” becomes. The patient’s scream is of therapeutic significance. ...The patient’s scream, originating from deep feelings, releases the stress.” (Grzesiuk, 1998, p. 176)

Janov calls it the “primal scream.” This stage of therapy only acts as a stage intended to reach the traumatic experiences, after which further psychotherapeutic work is needed, focused on integrating these experiences with the personality of the patient (Janov, 1970). 37

A li c ja M i c halak

Expressing Emotions in Integrative Body Psychotherapy Rosenberg (Rosenberg, Rand, & Asay, 1987) believes that a weak spot of certain forms of therapy is the fact that the patient is led to release emotions through catharsis without full psychotherapeutic relation. Such contact is a factor that promotes treatment and makes the change permanent. The role of the therapist is to provide the patient with the support of a perfect parent by behaviours such as smiling, hugging, approving looks, expressing acceptance and unconditional love. Lack of such experiences was the cause of the patient’s wounds. In psychotherapy, such experiences might treat the patient. This support is temporary – until the patient feels their corporal “I” and internalizes the positive parent (Grzesiuk, 1998, p. 177).

Without this contact, the cathartic release is short-term, and therefore has no psychotherapeutic value. It might even be dangerous, because it could cause the patient to learn to repeat the emotional discharge in an impulsive, or abusive manner. The objective of the integrative body psychotherapy is not the discharge of the stress in itself, but releasing the full “I” and identification derived from the understanding of the sources of chronic muscle stress. Their presence in the patient’s body (originally as a defence mechanism) means that the patient’s experiences from the past are not closed, finished. The patient is an emotional hostage of their past. Rosenberg is against the frequent use of the invasive technique of emotional discharge that is very strongly expressive. Leading to a cathartic release is justified when the muscle blocks in the patient’s body are strong, chronic, and specialist help from outside is needed. The purpose of such an approach in psychotherapy is therefore not to eliminate the defence mechanisms in full. In case of a threat, defence mechanisms are adaptive. If no danger is present, a person with a healthy body and mind is able to find a release. The aim of the therapy is for the patient to gain flexibility in terms of the patient’s conscious ability to take advantage of the mental and physical stress and release. Expressing Emotions in Dance Movement Therapy Dance movement therapy (DMT) or dance movement psychotherapy (DMP) uses movement as a tool to build a relation with the patient, as a language of expressing yourself, your emotions and thoughts, and as a way of experiencing the physical, emotional, cognitive, and social integration of human beings (Meekums, 2002). Movement makes the internal psychical change easier, and it may also improve the ability to begin and maintain relations with others. Dance movement therapy was defined as: 38

Expression of Emotions in Psychotherapy: Selected Aspects

Using expressive movement and dance for psychotherapeutic purposes, by way of which the human being may engage in the process that leads to personal integration and development. It is based on the principle that there is a relation between emotions and movement, and by exploring more diverse movement, the clients have the opportunity to experience a better balance, at the simultaneous improvement in spontaneity and adaptive skills. Through movement and dance, the internal world of a person becomes easier to understand, and in the joint dance – a relation becomes visible. The therapist creates the conditions, in which emotions may be safely expressed and shared, and accepted. (Payne, 1996, p. 4)

DMT may be carried out as individual or group therapy. The purpose of joint movement is not to make it uniform, but to express it and accept its individual nature. Spontaneous movement allows the patient to express the experiences from the preverbal period or experiences that are difficult or impossible to be expressed in words, which are the sources of certain problems or mental disorders. Moreover, DMT makes it possible for persons that find it difficult to communicate verbally due to symptoms of disease to attend psychotherapy. Initially, Marian Chace (1896-1970), the pioneer of dance therapy, used it mainly while working with patients with schizophrenia, if it was difficult to enter into verbal contact with them. Movement therapy might also be beneficial for persons with disrupted impulse control. Through movement with changing rhythm and intensity, it is possible to strengthen the neurological connections between the limbic system and the frontal lobes, which leads to improved control over the body and over the emotions (Meekums, 2002). DMT originated in modern dance, even though the current form of this therapy uses widely-understood movement. The purpose of modern dance is the spontaneous, authentic, and individual expression of a wide range of emotions expressed individually and in interpersonal relations. DMT belongs to the action-oriented psychotherapy approach. It enables exploring emotions and other mental experiences by combining psychomotoric and verbal interventions. Psychotherapists working in this approach use artistic techniques (e.g., dance, painting, drawing, music) or drama techniques to elicit catharsis of the emotional stress and to gain insight into subconscious contents, which is followed by corrective therapeutic influence. This approach is based on the belief that engaging the body in movement in the course of the therapeutic process promotes acknowledging and expressing suppressed emotions and other subconscious contents. Key significance is assigned to metaphors, symbols, associations of the patient with spontaneous movement – they are helpful in gaining access to the feelings that had been subconscious and in integrating them with the consciousness (Levy, 1992).

39

A li c ja M i c halak

DMT is also based on the principle that dancing by way of improvised movement is also therapeutic, because it allows the patient to experiment with new ways of moving, which lead to new ways of functioning and expressing themselves to the world (Stanton-Jones, 1992). Claire Schmais (1985) distinguishes and defines the following treating factors that are specific for dance psychotherapy: (a) synchrony – identification with the social group by the movement of the group participants at the same time and in the same space; (b) expression – movement promotes expressing a wide range of emotions and experiences – both conscious and subconscious, and also from the preverbal stage; (c) rhythm – using the rhythm in music strengthens the structure in the course of the DMT process and improves the safety level for patients; (d) vitalisation – chronic anxiety and chronic suppression of emotional impulses might block mental and physical energy, which leads to the feeling of helplessness and low vitality; DMT promotes release of rigid muscles and restoration of the natural flow of life energy; (e) integration – a DMT therapist strives to integrate the activity of the body, mimic expression, and verbalisation; thoughts, feelings and words; the past with the present; (f ) group consistency – social isolation barriers are gradually reduced by way of group acceptance of individual history of the patient, which is frequently marred by strong and usually difficult emotions, such as anxiety, anger, sadness; (g) insight – during movement tasks, patients gain insight into themselves and their relationships; (h) learning new behaviours – patients may experience and learn new responses and behaviours, mostly related to emotional and verbal expression; (i) symbolism – the movement metaphor is used as a language of expression of your self. It is important to mention that DMT is not equal to choreotherapy (in which the main treating factor is the verbal and nonverbal psychotherapeutic relationship between the patient and therapist and the therapeutic process), even though these therapeutic methods are related. Dance movement psychotherapy is still a growing discipline and requires further research on its effectiveness. Qualitative research and meta-analyses of qualitative research show that DMT’s effectiveness is similar to the effectiveness of other forms of psychotherapy in terms of lowering the level of anxiety and depressive behaviours and of improving bodily awareness and improving selfimage (Cruz & Sabers, 1998; Jeong et al., 2005; Ritter & Low, 1996). DMT might be particularly beneficial while working with children. It might also be beneficial to apply DMT in psychotherapy of persons whose verbal expression is limited, for example, in the case of people with schizophrenia, patients suffering from diagnosed autistic syndromes, or persons with mental disabilities. 40

Expression of Emotions in Psychotherapy: Selected Aspects

This form of psychotherapy is particularly justified in the case of persons whose trauma affects their bodies, in the case of lack of or limited bodily awareness, chronic tension, rigidity, and also in persons who experience distorted impulse control. Expressing Emotions According to the Mindfulness Approach A wide range of modern psychotherapeutic approaches refers to the mindfulness approach. It is the most clearly visible in the so-called “third wave of cognitive-behavioural therapy.” Examples are Mindfulness Based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Dialectical-Behaviour Therapy (DBT). These approaches derive the knowledge and techniques primarily on Mindfulness Based Stress Reduction (MBSR) by Jon Kabat-Zinn. Mindfulness means being mindful, aware, or fully mindful. The most frequently quoted definition of mindfulness says that mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. It consists in bringing one’s complete attention to the present experience (meaning your own thoughts, emotions, feelings, sensations, responses to external stimuli) on a moment-to-moment basis (Kabat-Zinn, 1990). Mindfulness is also understood as self-regulation of attention so that it is maintained on immediate experience (Bishop, 2002), or as a process of observing, describing, and participating in reality nonjudgmentally (Dimidjian & Dime, 2001). In turn, Epstein (2007) describes mindfulness as allowing one to experience each moment in full. The mindfulness technique does not mean avoiding difficult emotions or fighting with them, with thoughts or somatic sensations. It means opening up to their variety, changeability, and the passing nature, where noticing the undesired emotional and cognitive conditions leads to a positive change. Expressing emotions under mindful observation is also of great value, including from the therapeutic point of view. Mindfulness training focuses on the body, emotions, and thoughts. Persons who have mental disorders frequently have deficits in their awareness of the experienced emotions. They also exhibit high emotional vulnerability, intense emotional responses, high vulnerability to emotional stimulation, and are slow to recover the emotional homoeostasis. Mindfulness includes approaches and techniques that develop the ability to being aware of your body and all the contents that appear in the consciousness. The purpose of the training is not to achieve relaxation or relief. Mindfulness is a skill and allows you to diverge from the habitual way of responding to internal stimuli (emotions, thoughts) and external stimuli (influences exerted by other people). It allows you to recognize emotions and thoughts automatically and to avoid succumbing to them subconsciously. Walsh (2005) compares this skill to observing the stream of consciousness. Mind41

A li c ja M i c halak

fulness techniques help us to change the dysfunctional emotional, cognitive, and behavioural schemas. Mindfulness is recognized as a technique that reduces the cognitive vulnerability and the tendency of the mind to respond in a given way (e.g., by ruminations) to stimuli and events, which causes or strengthens emotional stress, and in some cases, feeds the symptoms of mental disorders. The objective is to learn constructive ways of dealing with emotions, such as: mindfulness, the ability of responding to and expressing emotions, tolerance to frustration, that is the skill to tolerate difficult emotional conditions. The mindfulness-based approach might supplement the psychotherapeutic process with techniques that focus on improving the ability to name, understand, accept, modify, and express your emotional states. The mindfulness process is affected by five interrelated mechanisms (Baer, 2006): (a) observe – the ability to experience all and any sensations related to the functioning of the muscles, body organs, and body parts; (b) actaware (activation with awareness) – acting with awareness of what you are doing (contrary to “autopiloting,” where you do not know, for example, why and how you found yourself in a given place); (c) nonjudge – nonjudging and nonassessing observation of spontaneous thoughts, emotions, and sensations (contrary to blocking thoughts and emotions); (d) nonreact – tolerance to difficult emotional stress without the need to discharge them immediately; (e) describe – the ability to name the thoughts, emotions, and somatic sensations experienced.

Not a Conclusion

While appreciating the input of the representatives of many approaches in psychotherapy, psychology, psychiatry, neurobiology, and many other specialisations into the theory and practice of the role of emotional expression in psychotherapy, I must emphasize that this chapter in no way reflects the sheer richness of literature, and in particular the experience of psychotherapists, in this area. I hope that readers will find enough information here to provide good insight into this issue, and the contents of this chapter will inspire curiosity and willingness to seek additional sources from the theory and practice of psychotherapy.

References

Aleksandrowicz, J. (2000). Psychoterapia. Warsaw: PZWL. Aleksandrowicz, J., & Czabała J. (2003) Psychoterapia. In A. Bilikiewicz, S. Pużyński, J. Rybakowski, & J. Wciórka (Eds.) Psychiatria. Tom 3. Terapia, zagadnienia etyczne, prawne, organizacyjne i społeczne (pp. 203-243). Wrocław: Elsevier Urban & Partner.

42

Expression of Emotions in Psychotherapy: Selected Aspects Baer, R. A. (2006). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Burlington, MA: Elsevier. Bishop, S. R. (2002). What do we really know about mindfulness-based stress reduction? Psychosomatic Medicine, 64, 71-84. Chaplin, J. C. (1971). Dictionary of psychology. New York: Dell Publishing Co. Cruz, R. F., & Sabers, D. (1998). Dance movement therapy is more effective than previously reported. The Arts in Psychotherapy, 25(2) 101-104. Czabała, J.C. (2010). Wspólne, uniwersalne czynniki leczące w psychoterapii. In L. Grzesiuk & H. Suszek (Eds.), Psychoterapia, integracja. Podręcznik akademicki (pp. 249-259). Warsaw: Eneteia Wydawnictwo Psychologii i Kultury. Dimidjian, S., & Dime, L. (2001). The clinical application of mindfulness practice. Panel discussion conducted at the Association for the Advancement of Behavior Therapy 35th Annual Convention, Philadelphia, PA. Elliott, R., Davis, K., & Slatick, E. (1998). Process-experiential processing for posttraumatic stress difficulties. In L. Greenberg, G. Lietaer, & J. Watson (Eds.), Handbook of experiental psychotherapy (pp. 249-271). New York: Guilford Press. Elliott, R., & Greenberg, L.S. (2002) Process-experiental psychotherapy. In D. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research and practice. Washington, DC: American Psychological Association. Epstein, M. (2007). Psychotherapy without the self: A Buddhist perspective. New Haven, CT: Yale University Press. Fagan, J., & Shepherd, I. L (1970). Gestalt therapy now. London: Penguin Books. Greenberg, L. S. (2013). Terapia skoncentrowana na emocjach. Gdańsk: Harmonia Universalis Greenberg, L. S., Rice, L. N., & Elliot, R. (1993). Facilitating emotional change: The moment-bymoment process. New York: Guilford Press. Grzesiuk, L. (Ed.). (2005). Psychoterapia. Teoria. Podręcznik akademicki. Warsaw: Eneteia. Grzesiuk, L. (1998). Zjawiska w psychoterapii. In L. Grzesiuk (Ed.), Psychoterapia. Szkoły, zjawiska, techniki i specyficzne problemy (pp. 137-193). Warsaw: PWN Hayder, L. (1983). Katharsis – poszukiwanie jednej drogi. Przez psychoterapię ku duchowej edukacji. Warsaw: Stowarzyszenie Buddyjskie Zen Czogje. Janov, A. (1970). The primal scream. Primal therapy. The cure for neurosis. New York: Dell Publishing Co. Janov, A. (1975). The primal revolution. London: Abacus. Jeong, Y. J., Hong, S. C., Lee, M. S., Park, M. C., Kim, Y. K., & Suh C. M. (2005). Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. International Journal of Neuroscience, 115, 1711-1720. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacorte. Kepner, J. L. (1991). Ciało w procesie psychoterapii Gestalt. Warsaw: Wydawnictwo Pusty Obłok. Lambert M. J. (1991) Introduction to psychotherapy research. In L. E. Beutler & M. Cargo (Eds.), Psychotherapy research. An international review of programmatic studies (pp. 1-11). Washington: American Psychological Association

43

A li c ja M i c halak

Lambert, M. J., Shapiro, D. A., & Bergin, A. E. (1994). The effectiveness of psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (pp. 157-211). New York: John Wiley & Sons. Latner, J. (1974). The Gestalt therapy book. New York: Bantam Books. Leahy, R.L. (2002). A model of emotional schemas. Cognitive and Behavioral Practice, 9(3), 177190. Leahy, R.L., Tirch, D., & Napolitano L. A. (2011) Emotion regulation in psychotherapy. A practitioner’s guide. New York: Guilford Press. Levy, F. (1992). Dance movement therapy: A healing art. Reston, VA: American Alliance for Health. Lowen, A. (1976). Bioenergetics. London: Penguin Books. Lowen, A. (1990). Miłość, seks i serce. Warsaw: WydawnictwoPustyObłok. Lowen, A. (1991). Duchowość ciała. Warsaw: Agencja Wydawnicza Jacek Santorski. Meekums, B. (2002). Dance movement therapy. London: Sage Publications. Palmer, J.A. (1980). Primer of eclectic psychotherapy. Monterey, CA: Brooks/Cole Publishing Company. Payne, H. (Ed.) (1996). Dance movement therapy: Theory and practice. London: Routledge. Perls, F. (1969). Gestalt therapy verbatim. Lafayette: Real People Press. Perls, F. (1973). The Gestalt approach to therapy. Palo Alto, CA: Science and Behavior Books. Perls, F., Hefferlin, R., & Goodman, P. (1979). Excitement and growth in the human personality. New York: Bantam Books. Perls, F. (1981). Cztery wykłady. In K. Jankowski (Ed.), Psychologia w działaniu (pp. 156-194). Warsaw: Czytelnik. Reich, W. (1976). Character analysis. New York: Pocket Books. Ritter, M., & Low, K. (1996). Effects of dance/movement therapy: A meta-analysis. The Arts in Psychotherapy, 23(3) 249-260 Rosenberg, J. L., Rand, M. L., & Asay, D. (1987). Ciało, jaźń i dusza: Odkrywanie integracji. Warsaw: Laboratorium Psychoedukacji. Schmais C. (1985). Healing processes in group dance therapy. American Journal of Dance Therapy, 8, 1-36. Stankiewicz, S., & Tomczak, K. (2012). Psychodrama w psychoterapii. Gdańsk: GWP Stanton-Jones, K. (1992). An introduction to dance movement therapy in psychiatry. London: Routledge. Walsh, R. D. (2005). Beyond therapy. Levinas and ethical therapeutics. European Journal of Psychotherapy. Counselling and Health. 7(1-2), 29-35.

44

Emotional Expression in Neurologic Music Therapy Sarah Johnson

Introduction

In the field of music therapy, the belief that engagement with music invokes and facilitates the expression of emotions is a universally accepted construct. According to Sena Moore and Hanson-Abromeit (2015), the idea that music can induce emotions began to emerge in the scientific literature in the late 1800s and continued to be mentioned and explored in subsequent psychological and anthropological fields. More recent neuroscience research indicates there are shared neural networks implicated in both emotion and music processing (Sena Moore & Hanson-Abromeit, 2015). The act of creating music, whether through an improvisational experience or through participation in structured, live music interventions, can provide unlimited opportunity for individuals to express themselves through music making. Although the ability of music to express and induce emotions seems so essential as to be obvious, it is only research from the last decades that allows us to state with scientific confidence that music can communicate and induce specific emotions to listeners (Carlson et al., 2015).

Music and Neurosciences: Neurologic Music Therapy

Neuroscientists, therapists, and researchers, have been developing a growing body of knowledge that explores the ways in which music is processed in the brain and how to utilize this “sensory language” for retraining brain functions. Neuroscience research in music has created new insights into the therapeutic benefits of music, shifting the models of music in therapy from social science and interpretative models to neuroscience and perceptual models (Thaut & McIntosh, 2014).

45

S arah J ohnson

In the early 1990s, a research partnership was formed in Fort Collins, Colorado, between Poudre Valley Hospital and the Music Therapy Department of Colorado State University. The team conducted ground-breaking research examining the importance of rhythm in motor tasks, specifically gait rehabilitation. This research, in combination with the collaborative clinical work that was being developed at the hospital between the music therapist and co-workers of the rehabilitation department, led to the creation of Neurologic Music Therapy (NMT). NMT is defined as “the therapeutic application of music to cognitive, affective, sensory, language, and motor dysfunctions due to disease or injury to the human nervous system” (Thaut & Hoemberg, 2014, p. 2). Twenty standardized NMT techniques are organized within three domains: sensorimotor, communication, and cognition. For some individuals in the music therapy profession, the identification of techniques and defining protocols has sometimes been viewed as a confinement of creative expression within the therapeutic process. However, it is this structure that assists in clarifying the role music plays in bringing about therapeutic change for the client and also provides a bridge for communication with other therapists, health professionals, patients, and families. The definitions do not define the creativity, the possibilities are only limited by the imagination of the therapist. An abridged version of the Neurologic Music Therapy techniques is listed below to give the reader a cursory introduction to the “language of NMT” (abridged from Thaut, 2005, and Thaut & Hoemberg, 2014).

I. Sensorimotor Techniques

Rhythmic Auditory Stimulation (RAS): Utilizing auditory rhythmic cueing to facilitate intrinsically biologically rhythmical movements (i.e., walking). Patterned Sensory Enhancement (PSE): Providing the musical temporal, spatial and force cues to facilitate and structure functional movement patterns. Therapeutic Instrumental Music Performance (TIMP): Using instruments to engage patients in motor tasks, optimize functional movement patterns, and challenge patients’ balance and coordination.

II. Speech and Language Techniques

Modified Melodic Intonation Therapy (MMIT): A modification of a speech therapy technique used to facilitate spontaneous and voluntary speech through sung and chanted melodies which resemble natural speech intonation patterns. Musical Speech Stimulation (MUSTIM): Using overlearned musical material to elicit automatic speech. 46

Emotional Expression in Neurologic Music Therapy

Rhythmic Speech Cuing (RSC): Controlling the initiation and rate of vocal output through rhythmic cuing and pacing. Oral Motor and Respiratory Exercises (OMREX): Vocal and breathing exercises and/or wind instrument playing to strengthen articulatory control and respiratory strength. Vocal Intonation Therapy (VIT): The use of vocal exercises to develop and/or rehabilitate voice control (e.g., inflection, breath control, and dynamics). Therapeutic Singing (TS): Using songs (with individuals or groups) to synthesize speech, language, respiratory control and vital capacity into an integrated therapeutic experience. Developmental Speech and Language Training Through Music (DSLM): Developmentally appropriate musical experiences (singing, chanting, playing instruments, movement to music with speech) to enhance and facilitate speech and language development. Symbolic Communication Training Through Music (SYSCOM): Structured instrumental or vocal improvisation to train communication behavior.

III. Cognitive Techniques

Musical Sensory Orientation Training (MSOT): Using musical stimulation for arousal and recovery of wake states, progressing to active engagement with musical stimuli to increase attention. Auditory Perception Training (APT): Discriminating and identifying varied components of sound and/or integrating different sensory modalities during active musical exercises. Musical Attention Control Training (MACT): Active or receptive musical interventions in which the music provides structure and cues the patient’s practice of sustained, focused, selective, divided and alternating attention skills. Musical Neglect Training (MNT): Using instruments or musical stimuli to focus attention and actively engage patients with their neglected or unattended side. Musical Executive Function Training (MEFT): Improvisational and compositional exercises for groups or individuals that create opportunities to practice skills such as organization, problem solving, decision making, reasoning and comprehension. Musical Mnemonics Training (MMT): Musical exercises to sequence and organize information to improve a person’s ability to learn and recall. Musical Echoic Memory Training (MEM): Using the immediate recall of musical stimuli to retrain echoic memory. 47

S arah J ohnson

Associative Mood and Memory Training (AMMT): Utilizing music to access mood and memory networks to facilitate memory recall, access long-term memories, and enhance learning through positive emotion states. Musical Psychosocial Training and Counseling (MPC): Musically based interactions to address mood control, affective expression, cognitive coherence, reality orientation, and appropriate social interaction.

Emotional Expression in NMT

When learning about NMT, using music to facilitate emotional expression is not emphasized. The primary focus of the majority of NMT based interventions would tend to be tied to more quantitative, functional goals. According to Thaut and McIntosh (2014), NMT is “based on how the structures and patterns in music engage the brain in ways that can be meaningfully translated and generalized to nonmusical therapeutic learning and training” (p. 1). NMT-based therapeutic music experiences are formulated through the use of the Transformational Design Model (TDM) (Thaut, 2005). Within this process the emphasis is on the non-musical functional goal of the client and how to transform and engage the client in a musical experience to achieve that goal. When utilizing the TDM, the music therapist is encouraged to know and understand theoretical and scientific knowledge regarding the neurophysiological processing of music, as well as creating an aesthetically meaningful music based experience. Therefore, though it is infrequently the primary goal of an NMT-based intervention, awareness and skill in using music to facilitate emotional expression is still important. A music therapist that works within the NMT model should be completely aware of the inherent power of music to elicit emotional expression. Whether the client is engaged in creating the music or actively listening to music, it is important the therapist comprehends and maximizes the role such expression plays in facilitating achievement of functional goals and improving the client’s quality of life. Emotional engagement and/or expression with NMT interventions is mentioned in several of the chapters in the Handbook of Neurologic Music Therapy (Thaut & Hoemberg, 2014). In their chapter, “Rhythmic Auditory Stimulation (RAS) in Gait Rehabilitation for Patients with Parkinson’s Disease: A Research Perspective,” de Dreu, Kwakkel, and Van Wegen (2014) briefly discuss the cross cultural ability of emotion to be expressed through music, as well as music’s ability to alter mood and enhance compliance in long term therapy situations for motor rehabilitation with Parkinson’s disease.

48

Emotional Expression in Neurologic Music Therapy

Sensorimotor Domain In the chapter, “Therapeutic Instrumental Music Performance (TIMP),” Mertel (2014) refers to the positive emotional states that engaging in music interventions facilitates, as well as increasing motivation for participation. Though specific emotional expression through music may not seem at the forefront of using the NMT techniques, particularly within the sensorimotor domain (RAS, PSE, TIMP), the importance of using music to emotionally engage the client in the process of working towards the functional goal is imperative. Physical rehabilitation can be very painful and fatiguing. On a neurophysiological level, the music organizes and maximizes the physical responses of the body and drives the client to move more efficiently and naturally. Not only is it visible to the therapist, but the clients feel this “realignment” process as well. Once, as he began to regain purposeful movement in his arm and hand following a stroke, a patient participating in TIMP interventions told this therapist that “the music is the audio driver of my body!” The dynamic use of music can maximize clients’ participation through active engagement with the rhythmic music, thus completing more repetitions of an exercise, for example, or participating for a longer duration in an intervention leading to improved recovery. Engaging with music in motor tasks also can help the patient redirect his or her perceptions of pain and fatigue towards the music stimulus, also leading to more emotional engagement and increased participation in their therapy. For example, Lim et al. (2011) found that perceived exertion and perceived fatigue levels were significantly less when participants were participating in therapeutic instrumental music performance (TIMP) in comparison with traditional occupational therapy interventions. The researchers identified TIMP as an effective sensory-motor rehabilitation technique for physical rehabilitation because of these findings. Tamplin (2015) also notes that “music has an analgesic effect in reducing anxiety and diverting attention from negative experiences, which can assist patients who have neurological difficulties to cope better with emotional stress. Emotional adjustment following severe trauma or debilitating illness can have a significant impact on rehabilitation outcomes” (p. 464). Regardless of actual diagnosis, music therapists’ clinical experiences, as well as an emerging research base, point toward the importance and the effectiveness of emotional engagement with music for increased participation and observable improvements, particularly within the sensorimotor domain. When a client is improving physically there is an increased probability that their emotional wellbeing will also improve. 49

S arah J ohnson

Speech and Language Domain The ability to communicate and verbally express ourselves is intrinsic to a person’s daily life. When we are unable to make our needs known and articulate our thoughts and feelings to others, feelings of isolation, frustration, and despair will most likely follow. There is no doubt that creating music and engaging in musical processes is an excellent way to create opportunities for non-verbal emotional expression. However, our ability to emotionally express ourselves through music can also be inevitably linked to communication and socialization. Participating in musical improvisational interactions with others creates opportunities for development of non-verbal interaction patterns and the pragmatics of communication. The areas of emotional expression and a more quantitative assessment of communication do not need to be mutually exclusive, but rather complement and build upon each other through music. By using music in structured techniques to regain and/or develop abilities for verbal expression, we are able to enhance and make possible emotional expression. C. Thaut (2014) references “emotional expression through a non-verbal ‘language’ system” (p. 217) when explaining the technique symbolic communication training through music (SYCOM). However, within the chapter, the focus of the technique is more directly linked to communication patterns and social interaction than specific emotional expression. The chapter addressing therapeutic singing (TS) (Johnson, 2014) also refers to the use of vocalizing to facilitate not only speech/language goals, but emotional well-being and expression. “Therapeutic singing can reach out to patients on social and emotional levels to increase their engagement in therapy as well as improving their quality of life” (p. 188). Through active participation in singing we increase oxygen in our systems and improve our vital capacity. Clients relate and respond to the content of the song lyrics as well as the musical structure of the song. Therapeutic singing is something that often involves more than the client singing, and thus increases social interaction opportunities. Whether working with aphasic patients to regain their ability to communicate, or helping a child develop their language abilities, or addressing articulation impairments for increased intelligibility with someone with Parkinson’s disease (to name only a few clinical scenarios), the use of music can be an incredibly powerful way to bring communication, interaction and expression to clients’ lives. Cognitive Domain Within the chapters on techniques of the cognitive domain, the clearest and most direct references to emotional expression occur, although still within a neurologically based framework. De l’Etoile (2014), in her chapter “Associative Mood 50

Emotional Expression in Neurologic Music Therapy

and Memory Training (AMMT)” and Wheeler (2014) in her chapter “Music in Psychosocial Training and Counseling (MPC)” both provide excellent summaries and references of the therapeutic mechanisms involved in cognitive and affective processing of music. This information increases our understanding of what actually occurs on a neurophysiological level when we engage with music, and explains why music is such a superior tool for facilitating emotional expression and other therapeutic goals. According to De l’Etoile (2014), when a music therapist is using the AMMT technique, we engage our brains with music and are activating several of the same areas that are employed for affective and cognitive activities, which in turn assists in the facilitation of memory. Because of this, music can provide an emotional framework for reinforcing, encouraging, and assisting in accessing memory. Wheeler (2014) provides the most extensive examination of the use of music to facilitate emotional expression within the NMT framework. She addresses the therapeutic mechanisms involved and research references for the goal areas of affect identification and expression, mood control, and social competence and self-awareness. She outlines specific clinical protocols for these areas and provides guidelines to assist the NMT to “work at a level at which they are competent and that is appropriate for their clients” (p. 340).

Conclusions

From its beginnings in acute neurologic rehabilitation, the structure of NMT has expanded and evolved over the decades to include a broader group of client populations. According to Thaut, McIntosh, and Hoemberg (2014), “since NMT was built on existing research data, the future shape of NMT will be dynamically driven by continued research. One of the largest areas of therapeutic need is in psychiatric rehabilitation. Emerging views on the nature of mental illness, driven by new insights from neuropsychiatric research, may allow a more focused extension of NMT techniques in the areas of executive and psychosocial function, attention, and memory to contribute to psychiatric treatment” (p. 4). Hiller (2015) poses the question, “What does it mean to the client, the therapist and/or the therapeutic process when we say that a client expresses emotion while making music?” (p. 30). Answering such a question seems to only create more questions! Should we confine emotional expression in music therapy to the use of music listening with clients, or engagement with creating music for facilitation of a psychoanalytical process? Or are the emotions expressed within a musical improvisational experience between a client and music therapist what is most important when we discuss emotional expression? Hiller feels that “emo51

S arah J ohnson

tions may be found in a variety of locations during music engagement, including but not limited to, musical products and processes, in bodily actions or in sound produced through them, in or outside of a client’s consciousness, in recordings, and or in the moment of feeling an emotion or after a client’s emotional experience has passed” (p. 32). Emotional expression is not the exclusive domain of any particular “style” of music therapy. Inherent in all forms of music therapy, whether it is based on a neurological/functional model, or an improvisational/emotional model is the MUSIC itself! Within the music therapy sessions the music therapist must remain focused on the client and what aspect of emotional expression is meaningful for them. This is where following the process of the Transformational Design Model (TDM) truly guides the therapeutic process; through assessing, defining functionally what the client needs and wants, understanding how that would be addressed nonmusically, and then creating a musical intervention to facilitate that goal. For example, when a person has lost their ability to express themselves verbally due to a stroke and we use modified melodic intonation therapy (MMIT) to assist them to say “I love you” to their family members again, a huge amount of emotional expression occurs within a very structured use of music. Is the emotional component less valuable because it came from a protocol-defined use of music versus an improvisational design? When a patient is able to entrain to a strong rhythmic musical stimulus and therefore begins to walk after neurologic injury, there is also a component of emotional expression that is intrinsically produced with the engagement of the client with music and intensifies the therapeutic experience. The interface of the neurologic system of the patient with the creative, flexible, yet defined use of music is where therapeutic change is synthesized. Whether it is focused on cognitive, physical, communicative, or emotional healing is steered by the goals of the patient. The musical context in which the trained music therapist utilizes the properties of the music to elicit change and response with a patient is what differentiates music therapy from other forms of therapy. This may sounds simplistic, but unfortunately, not all music therapists have the skills and awareness of how to effectively use the music. Because of this, the musical engagement of the client in a music therapy session gets “lost in translation,” and thus there is less effective opportunity for therapeutic change. An effective and competent music therapist will actively engage a client with the music. An appropriate choice of the musical source is vital, whether it be instrumental, vocal, or in some form of electronic media. The musical structure that is chosen also influences the success of facilitating the goals of the client. It is imperative that the end musical product and/or experience 52

Emotional Expression in Neurologic Music Therapy

be aesthetically pleasing. It goes without saying that a skilled music therapist is an excellent musician. The real key is the therapist’s ability to effectively coalesce all the musical elements together to create a musical experience that engages the clients and helps them work towards their goal.

References

Carlson, E., Saarikallio, S., Toiviainen, P., Bogert, B., Kliuchko, M., & Brattico, E. (n.d.). Maladaptive and adaptive emotion regulation through music: a behavioral and neuroimaging study of males and females. Frontiers in Human Neuroscience, 9. doi:org/10.3389/fnhum.2015.00466 de Dreu, M., Kwakkel, G., & Van Wegen, E. (2014). Rhythmic auditory stimulation (RAS) in gait tehabilitation for patients with Parkinson’s disease: A  research perspective. In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 69-93). Oxford: Oxford University Press. De l’Etoile, S. (2014). Associative mood and memory training (AMMT). In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 314-330). Oxford: Oxford University Press. Hiller, J. (2015). Aesthetic foundations of music therapy: Music and emotion. In B. L. Wheeler (Ed.), Music therapy handbook (pp. 29-39). New York: Guilford Press. Johnson, S. (2014). Therapeutic singing (TS). In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 185-195). Oxford: Oxford University Press. Lim, H., Miller, K., & Fabian, C. (2011). The effects of therapeutic instrumental music performance on endurance level, self-perceived fatigue level, and self-perceived exertion of inpatients in physical rehabilitation. Journal of Music Therapy, 48(2), 124–148. doi:org/10.1093/jmt/48.2.124 Mertel, K. (2014). Therapeutic instrumental music performance (TIMP). In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 116-139). Oxford: Oxford University Press. Sena Moore, K., & Hanson-Abromeit, D. (2015). Theory-guided therapeutic function of music to facilitate emotion regulation development in preschool-aged children. Frontiers in Human Neuroscience. doi:org/10.3389/fnhum.2015.00572 Tamplin, J. (2015). Music therapy for adults with traumatic brain injury and other neurological disorders. In B. L. Wheeler (Ed.), Music therapy handbook (pp. 454-467). New York: Guilford Press. Thaut, C. (2014). Symbolic communication training through music (SYCOM). In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 217-220). Oxford: Oxford University Press. Thaut, M. (2005). Rhythm, music, and the brain: Scientific foundations and clinical applications. New York: Routledge. Thaut, M. H., McIntosh, G. C., & Hoemberg, V. (2014). Neurobiological foundations of neurologic music therapy: rhythmic entrainment and the motor system. Frontiers in Psychology, 5, 1185. doi:org/10.3389/fpsyg.2014.01185 Thaut, M., & Hoemberg, V. (Eds.). (2014). Handbook of Neurologic Music Therapy. Oxford: Oxford University Press.

53

S arah J ohnson

Thaut, M., & McIntosh, G. (2014). Neurologic Music Therapy in stroke rehabilitation. Current Physical Medicine and Rehabilitation Reports. doi:org/10.1007/s40141-014-0049-y Wheeler, B. L. (2014). Music in psychosocial training and counseling (MPC). In M. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 331-359). Oxford: Oxford University Press.

54

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective on “Emotional Expression” in Music Therapy Simon Procter

He becomes emotionally involved, not only in the particular music itself or in his activity in it, but also in his own self-realization and self-integration within all the therapy situation holds for him. (Nordoff & Robbins 1977, p. 2)

Preamble A few years into working as a music therapist, I took a particular problem to supervision. I had got to know a patient on a psychiatric ward who was happy to have conversations with me (often about music) but refused every invitation to come to music therapy sessions, insisting that music just wasn’t her way of expressing her emotions. I wanted to know how I could help her to feel that she could express her emotions in music therapy. My supervisor’s response was brusque: “Tell her music therapy has nothing to do with expressing her emotions!” I was shocked. Wasn’t there something fundamental to therapy about emotional self-expression? My supervisor took me back to first principles. What was important for this woman? How might experiences I could offer her in musicmaking help in that direction? These coupled questions have provoked much thinking for me since. But I have come to agree with my supervisor: Emotional expression is rarely a desirable end in its own right and it certainly isn’t the most important thing I have to offer. This is not to deny the significance of emotion—or of expression—in living well. Indeed, it is clear that for some people a pronounced lack or excess of espressivity (a term I shall grapple with later) is an impediment to living well, and something music therapy is well-placed to assist with, but I am not sure that this is what is generally meant by “emotional expression”. 55

S imon P ro c ter

Introduction

Ask a layperson what music therapy is and they are likely to come up with a number of familiar scenarios. One is the idea of playing recorded music to relax people or calm them down. Another is the idea of a medical-style treatment where Bach might be prescribed for headaches or G major for autism. Both of these are far from my own practice, but music therapy does take these forms in some places. A third popular notion of music therapy is the idea that it is an opportunity for people to “let off steam”, perhaps “saying things that can’t be said in words”. Particularly in Europe, this is a pervasive image of music therapy, and one that is perhaps based on an apparently logical three-step set of assumptions which runs something like this: Emotional expression is important for good health, therefore therapy should enable people to express their emotions. Music is essentially emotion made audible, so an excellent way of expressing emotions, and some emotions might be expressed more readily in music than with words. Therefore doing therapy musically makes sense because music facilitates the very emotional expression which is at the heart of the therapeutic project.

Whilst there is certainly some logic in the stringing together of these three assumptions, it is not one I am comfortable with, primarily because the outcome does not accord with my own experience, either as a musician, or as a “musician therapist” (Nordoff & Robbins, 1971, p. 141). My motivation for offering music therapeutically stems not from a desire to do musically what psychotherapists do verbally, but from recognition of the experiences and opportunities that involvement in music making can bring to the lives and interactions of people, including my own. I don’t mean this in a “miraculous” way: I don’t believe in Bach for headaches or G major for autism, because I haven’t experienced music having these impacts on me. But I do have all sorts of experiences of music not only making things possible for me, but also of it actually being a means by which I reconstitute and re-experience myself—and part of this is certainly finding a means of expression, whether or not this is necessarily “emotional expression”. Before going further, I therefore need to declare my own position. I am a musician trained in the so-called “music-centred” Nordoff Robbins approach to music therapy. This is the work of a person-focused musician: It demands all of my musicality and musical experience as well as commitment to the people I am working with. It regards slavish adherence to non-musical precepts imported from other disciplines (e.g., behaviourism or psychoanalysis) with suspicion as they are likely to distract from acute awareness of what it is to be musically with another person. 56

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective…

I will address each of the three assumptions outlined above, and then turn to consideration of the role of expression in music therapy, illustrating these with examples from practice. I will argue that emotional expression might be less of a goal in music therapy than is often assumed, and that what music therapy really has to offer is espressivity, which is an important part of emotional experience, as identified by Nordoff and Robbins in the opening quote, with a recognition than this is not simply a cognitive or psychological phenomenon. Finally I will try to draw out some lessons for music therapy practice, training, and research.

Assumptions Assumption One - Emotional Expression As the Heart of the Therapeutic Project Ours is a confessional age. No longer confined to the privacy of the church, in the twentieth century confession became a matter of spectacle. To aid the public consumption of confession, it has to be accompanied by a display of emotion, demonstrating the speaker to be suitably affected. Failure to exhibit the requisite manifestations of emotion is certainly suspect and could even lead to a psychiatric diagnosis. Emotional expression is a trapping of a particularly modern conception of well-being: As Evans (2003, p. 57) puts it, “we look back at the stiff-necked Victorian with a smug sense of superiority”. This is largely thanks to Freud, and in particular his pneumatic conception of the emotions, which suggests that when emotional pressure builds, unless it is released in some regulated way, it will eventually but unavoidably “blow” the system, which will give way at its weakest point. Thus if we don’t “let off steam”, our entire capacity for self-regulation is at risk. This has led (in a most un-Freudian way) to the development of a street-level therapy industry (as opposed to the rarefied elegance of psychoanalysis itself ) based on addressing the “problem” of emotion in one of two principal ways: either pursuing the release of emotion via catharsis, or else casting what are seen as “negative” emotions as being in need of excision or redirection (neglecting the fact that there may be good reasons why, for example, someone might be angry at their treatment at the hands of others, or at the hands of society itself ). For me, the first option seems uselessly indulgent, the second a pitiless means of maintaining the status quo. Another outcome has been the notion of “venting”, much promoted by pop psychology, but widely regarded as lacking credibility (e.g., Bushman 2002), but which is exactly what music therapists do when they tell someone to “take out their anger on the drum”. Furedi (2003) observes that when people experience social or communal challenges, “therapy culture” recasts these as fundamentally emotional and therefore 57

S imon P ro c ter

personal. It is therapists (rather than their clients) who need every situation to be couched in terms of emotion—because this is the field they have claimed as problematic and thus in need of their self-declared expertise. Whilst this may seem provocative, it is unarguable that “feelings” play a key role in many approaches to psychotherapy. The psychodynamic movement places great emphasis on the quasi-mechanics of counter-transference. These are posited on feelings experienced by the therapist in relation to the client (or not) For a therapist to make effective use of the countertransference it is essential that she should be able to distinguish between her own feelings and those she is experiencing countertransferentially. Gray (1994, pp. 25-28) outlines clearly how failure to distinguish between these can impact on therapy. Without these feelings it would be hard to make the case for an interaction between two people being psychodynamically psychotherapeutic at all: Perhaps this is why it seems to matter so much to some music therapists that their work should be cast in this way despite the clear differences in practice (and training) between music therapy and psychotherapy. Andrade (2015) demonstrates how the realm of emotion, relatively recently articulated but much privileged in European culture, has been systematically adopted as a means of economic management. Therapeutic intervention forms an integral part of this approach, whether on an individual level (workers being counselled, for example) or more collectively (via marketing, etc). The management of emotion is a significant tool in the armoury of neo-liberalism, which aims to “emancipate” potential troublemakers into pliable consumers who adopt an economic view of their own life trajectories. Illouz (2007) argues that the therapy industry is complicit in the intertwining of emotional and economic spheres, with far-reaching and arguably debilitating consequences for people’s own capacities to cope and to thrive. A partial response to this within music therapy comes from the incorporation of Antonovsky’s salutogenic thinking, for example within the ‘Resource-Oriented’ (e.g., Rolvsjord, 2010) and ‘Community Music Therapy’ (e.g., Stige & Aarø, 2012) traditions. Assumption Two – Music as Fundamentally Expressive of Emotion Susanna is preparing for her boyfriend’s arrival. Dinner is nearly ready and she wants this to be a really special evening. The recipe is Moroccan, there is a new tablecloth on her kitchen table and the scented candles are ready to be lit. She’s thought about the music too, and has invested in a new CD - “Classical hits for lovers”, as the cover describes it. As soon as she hears Peter nearing the door, she lights the candles and presses play. The familiar opening of the first movement of Beethoven’s “Moonlight” sonata fills the room. The scene is set …. 58

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective…

But Peter seems oddly inattentive: He seems preoccupied, not fully present. After a while, Susanna is feeling irritated. What is wrong, she demands to know? Peter is embarrassed: He hadn’t realised that he was being ungallant. “It’s the music,” he explains. He knows that Susanna will have chosen this track for its romantic connotations – after all, “everyone knows” that this piece of music is a romantic one, perhaps because of the imagery of the name, perhaps because of its role in popular culture, perhaps because of the music itself. But Peter’s attention is drawn away from Susanna to the music itself: For Susanna it is background sound which non-verbally conveys by cultural association her intentions for the evening ahead. Peter knows this cultural code too and absolutely shares Susanna’s intentions. But he keeps getting pulled back into physically attending to the music. In particular he finds himself waiting for it – actively holding his breath in anticipation of the bass line falling, and noticeably relaxing when there is resolution of harmonic tension. Peter has learned to play this piece – he knows it very well – and (although his fingers aren’t moving – Peter knows that would look ridiculous) somehow his body is reliving something of the experience of actively making this music. He has a sense of being bodily drawn forward by the harmonic line, of resolution and well-being at cadences. Rather than “putting them in the mood” as Susanna intended, the music has temporarily separated them.

Much of the literature about the relationship between music and emotion comes from psychology: This has skewed the range of insight on offer because psychologists tend to be interested in the effect of something (in this case, of music) on human behaviour or thinking (in this case, on expressions or other manifestations of emotion). Psychology likes to test, and to do experiments, but the experimental situation is ill-equipped to cope with a phenomenon as socially, culturally and aesthetically multifaceted as music. Thus music gets stripped down to some “thing” that is conveniently measurable but often unrecognisable in experiential terms as music—hence the burgeoning literature investigating sensorimotor synchronisation as an aspect of music and dance performance by means of laboratory “tapping” experiments (see, for example, Repp, 2005). Music’s action is also necessarily assumed to be linear and unidirectional. Whatever else music is, it is certainly complex and the idea that it can simply map onto, convey, “express” or induce emotion is therefore challenging. DeNora (2001) maps out a useful historical trajectory of thinking: Adorno’s mid-twentieth-century theoretical conceptualisation of music (1973, 1976) not simply as “affecting” people emotionally but as formative of their consciousness was collided with empirical observations in the 1970s by researchers such as Paul Willis. Researching biker culture, Willis showed that music did not simply lend values or dress sense to the biker’s lives—rather, it actively shaped possibilities for action and made particular ways of being, feeling, perceiving and relating possible in real time. This is echoed in the work of Frith (1978), who provides many

59

S imon P ro c ter

examples of how music can actively configure its users, including in the realm of what are generally called emotions. This leads to descriptions of music as a technology of emotion construction, as evidenced by Gomart and Hennion (1999), who, working in the Actor Network tradition, compare the ways in which drug users and music amateurs can be observed to go through rituals of preparation (requiring work) in order to make it possible for the drug or the music to have a certain kind of effect on them. In other words, the music amateurs are not simply “affected” by the music, but rather this effect is facilitated by the social processes surrounding it. Interaction between person and music is not simplistic or linear, but complex and intersubjective. Gouk (2002), introducing a volume considering music’s use for healing across cultural contexts, emphasises how music’s association with emotion is culturally negotiated as well as interdependent, and goes on to point out that music “not only provides a context in which a language of the emotion can come into being, but also gives actual shape and meaning to the emotions themselves, to what it means to be human” (p. 13). Ruud cites this (2010, p. 9) in calling for music therapists likewise to adopt a more complex constructivist stance towards trying to understand what is happening in particular situations in music therapy, instead of what he calls “fuzzy talk” about emotions and musicality. Here we must add an awareness of the corporeality of musical engagement – it is decidedly not simply a “mindful” engagement but a necessarily physical one too. Assumption Three – The Value of Music Therapy Conceived as Its Ability to Promote and Facilitate emotional Expression For many music therapists, emotional expression is key to what they do. Bates (2006, p. 12) describes his career change from teacher to music therapist working in schools thus; “What I wasn’t doing as a teacher—and which, as a music therapist I am now totally focused on—was helping people deal with their emotions”. De Backer and Van Camp (1999), writing about music therapy in psychiatric services, emphasise the need for emotions to be contained not only by the therapist but also by the instruments, which “need to be sufficiently strong in order to bear outbursts of repressed emotions” (p. 15). This is the cue for the claim to music therapy’s value – “Words can slow down the affective experiences or even make them impossible. Before an experience can reach the verbal level it has to be fully ausgefühlt (feel it fully) and shaped though music” (ibid., p. 16). Here we see a familiar trope emerge, namely, the notion that music makes emotion expressible, and that this is a necessary intermediate step on the road towards making it ver60

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective…

balisable (and therefore workable with in a more conventional psychotherapeutic manner). Mahns (2003) likewise (in a chapter tellingly entitled “Speaking without Talking”) describes a course of Analytical Music Therapy sessions with a boy with selective mutism, making clear that music therapy is offered as a means of emotional expression which can subsequently lead to verbal expression. Dvorkin and Erlund (2003) even suggest that “the addition of music as a facilitator” (p. 183) to usual psychoanalytic procedures makes emotional expression more achievable and therefore analytic treatment more successful. Smeijsters and van den Hurk (1993, pp. 255-256) provide instructions for music therapists on how to “encourage or check the expression of anger”. This is one of the sources about music therapy reviewed by Boyce-Tillman, which understandably lead her to the conclusion that “self-expression is central to music therapy” (2000, p. 220). Yet these are not the only perspectives in the literature: Ansdell (1995, pp. 124125) carefully picks apart “expressionism” (or catharsis) from useful shared musical experience. Catharsis is fundamentally an individual experience and does not allow for listening or experience of others, nor does it allow for the intersubjective creation of something new. A degree of inhibition of the purely “self-expressive” is required in order that new experiences can be had. So what does constitute emotional expression in music? Much has been written as to how “emotions” can be conveyed by performers of pre-composed music: What is evident from this literature is the lack of consensus as to how this can be achieved, or indeed whether it can or should be an intention. Trained instrumentalists draw on technique and skill to conjure this illusion of emotional expression: Is it therefore realistic to expect that non-trained users of music therapy services do not need this degree of technique to convey their emotion because it is somehow authentic? Or is the claim that the therapist has some special skill of decoding the emotion from its supposed expression?

So What Is the Role of Emotional Expression Within Music-Centred Music Therapy?

Clearly, emotions are part of everyone’s experience of being themselves: Clearly also, therefore, emotions come into music therapy. The relationship between emotion and music is problematic and contested: Rather than taking philosophical sides on this here, I wish simply to highlight the notion of “espressivity” (using the Italianate version to emphasise its essentially musical nature). By “espressivity” I mean not a specific conveyance or depiction of emotional state from one person to another, but rather a state of “being able to be expressive in the moment” - of 61

S imon P ro c ter

regulating and adjusting one’s self-presentation in relation to that of others, hence intersubjectively re-shaping one’s experience of one’s way of being. This is very much in line with DeNora’s (2003) “music-in-action” sociological perspective. “Espressivity” is a dimension of musicality—something innate to all of us, but something that can become occluded or inhibited by life experiences. So how do emotion and espressivity relate within music therapy? To try to answer this question, I will present three accounts from practice, and then draw together some of their shared themes.

Accounts from Practice Account One – James – Who Is Determined to Express Emotions Attending his first music therapy session, James makes a beeline for the congas. There he starts drumming frenetically and vocalises in a wailing tone which gets louder and louder until he is almost screaming. At first I attempt to join in with him, but it is evident that I am redundant: James’ music simply doesn’t need me. Instead, I try to play alongside him in an attempt to discover what this must feel like for him. It feels relentless and unyielding. The playing continues until James seems to have had enough. “Ah,” he says. “That’s better”. “Really?”, I think.

Many people are drawn to music therapy precisely as a means of self-expression. Afterwards they will mention the “release” it affords them. But I was unconvinced by James’ claims: My attempt to attain the same experience was not at all the way he described it. As a music therapist, I am always thinking about the nature of people’s musical ways of being, the implications of this for their musical experiences of themselves and of themselves in relation to others, and hence the experiences I may need to work to help people have for themselves in making music with me. With James, I was already thinking about the kinds of musical experience that this relentless pursuit of catharsis was precluding and therefore what I might need to do in order to make other areas of experience possible for him. Over several months of weekly sessions I increasingly challenged him not to fill all the space, thus allowing me to offer him experiences that were not about being continuously loud but rather about being drawn into relating and being expressive. I made some verbal suggestions as to how we could start playing differently and for the most part James was responsive to these (perhaps because always playing the same way was both exhausting and boring). Most of it, however, was done musically: I worked to draw James (or tempt him, or lead him) into coming into new musical territories with me because they were in and of themselves engaging and appealing. But what I offered was 62

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective…

not random: I was working to let James hear himself melodically, and with a variety of tempi. That first unshared music making gave way to genuinely shared experiences of different ways of being – even of lyricism and a degree of playfulness. James’ original preoccupation with emotional expression gave way to relational experience. It was still expressive—indeed, I would argue that it was far more expressive—but it was not self-consciously trying to be expressive of an emotion. Instead, it was inevitably expressive of James himself and, as time went on, of us ourselves: Simultaneously, of course, it was also the means by which we worked together and hence became us. As we progressed in our work together, James would be “taken from behind”, as he put it—and this was usually because he was “caught” by something in the music—a lilt, a swagger, a swing, an “oomph”. He then found himself “carried along” by this and would later try to recapture something of this for himself. His comments made clear that this wasn’t just a musical experience – it was a personal experience. Time and again we hear clients tell us that what they find themselves doing in music with us is something new, not just a novelty but an experience that, uncomfortable or thrilling, adds richness to what it is to be oneself, and hence possibilities to life. Account Two – The Ward Band, Who Find Expression Leading to Emotional Experience in Structure I’m at a “band rehearsal” on a psychiatric ward. The band members represent quite a range of musical expertise. Marvin on the drums has played for many years in local bands, repeatedly interrupted by his psychotic episodes. Lucy on bass guitar has only taken up the instrument since being admitted and is working hard to get the right notes at the right moment. Chris on guitar is a Pink Floyd fan who is extending his repertoire of styles now that we are doing “Angels” by Robbie Williams. I’m on keyboard, and we have four singers – two of whom are new today and somewhat diffident. One of our returning singers is in quite a manic state and I’m having to work hard to keep things on track. One of the reasons we keep coming back to “Angels” is the combination of the hopefulness of the words, which people readily identify with, and the way its chorus starts – “And through it all …” – the leap through a major triad, not to the octave above but to the ninth. It feels physically thrilling, especially with the chords underneath, and seems to summon a new level of espressivity out of people. That’s most obvious in the singers because of the ways in which they get loud and raucous, but also in the instrumentalists – Marvin waits for the first beat and I can see him catch Lucy’s eye to ensure togetherness. There’s also a great instrumental section – the singers sing along as Chris goes for it. It’s raucous and even the quieter members of the group are drawn into “letting go”. But this isn’t abandonment of self: It is involvement of self in something beyond oneself. At the end, there are whoops and echoes of the big melodic moments, and a sense of having done something special, having been somewhere musical together. This 63

S imon P ro c ter

is group process achieved extraordinarily quickly – at the end people walk out still singing the song, still with their band member identity intact. They are changed by their experience of being expressive.

It is a potent paradox of music that freedom of expression can be found in structure, and furthermore that structure can offer opportunities for the experience of espressivity. Each person is not “unleashing” some emotional state which they have brought with them to the session, rather, the group as a whole is finding a way of being expressive together which is contained, managed and enabled by the music itself—by the structure of the melodic phrase which launches the chorus, and by the structure of the song as a whole. The structure works beyond the song too, because the structure of the session (focused not on the production and examination of intra-group dynamics but on collaborative musical work) similarly contains, manages and enables the happening of group, enabling individuals to be true to themselves in ways that are contributory rather than detractive. Account Three – Yvonne Finding Range (and Espressivity) Challenging life events triggered depression for Yvonne: After a brief period of hospitalisation she returned home but not to work, and found herself progressively withdrawing from social contact. In her early sessions with me Yvonne felt polite – there was a real contained-ness and monotony to her static, quiet xylophone-playing, where her melodic range would be just a few tones either way. Our music making made me feel physically restricted and constrained. She always played beat-by-beat – in accompanying her, I found myself longing for a sense of flow and a sense of lyricism, and tried to suggest this musically, with little sustained effect. After several weeks of working together, Yvonne picked up a recorder and blew into it, softly at first, without using her fingers. The way in which it responded so readily to the differences in her breathing seemed to catch her attention and suddenly she was playing loudly and softly—and, because of the way the recorder works, inevitably also high and low. I accompanied correspondingly – ranging from dissonant and frenzied to consonant and spacious. After a couple of minutes of this, she caught my eye and I knew that already something was different. “That was really expressing my emotions”, she said. In future sessions she often used the recorder in this way, after which I would seek to continue this readiness for more diverse expression on other instruments and in other musical situations. Over time her melodic and dynamic ranges widened tremendously and she was able to “be expressive” in much more lyrical, subtle and interactive ways. This in turn

64

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective…

drew greater physical commitment from her, and this was reflected in her comments about “feeling different”. What started for her as “expressing her emotions” became a route for new experiences which were not simply about externalising emotion, but more complexly about discovering new ways of being, as a person, and as a person with another person.

Reflections on the Accounts – Experience of Espressivity Rather than Emotional Expression?

Each of these accounts moves from what seems to be “emotional expression” (whether highly intended, as in James’ case; completely unintended, as in Yvonne’s case; or facilitated by the structural opportunities of a song, as in the group) towards emotional experience made possible by espressivity. Part of what music therapists have to offer is the skillful, strategic, supportive and celebratory drawing out of people’s espressivity. This isn’t just a technical matter, it is also about our experience of being ourselves – surely the very stuff of therapy. It is social: Espressivity is both an aspect of musical companionship (Ansdell & Pavlicevic, 2005) and what helps to make it possible. It is corporeal—as Colombetti notes, musical engagement can “enhance patients’ emotion experience, and … entrain and thereby structure their expression and physiology” (2009, p. 13). Epp (2007) reinforces this view: “Musical autonomy is only possible through music’s embodiment. In each act of musicing, the ‘purely musical’ is newly defined.” The responsiveness of the recorder to Yvonne’s physicality is the gateway to espressivity and hence to growing integration of the physical. It is a means of taking risks with another person (Procter, 2011) and hence growing emotional experience. All of this clearly has implications for the ways we work. We must be cautious about imposing “commonplace” assumptions about emotional expression on the practice of music therapy. Rather, what we do in music therapy needs to be rooted in our own awareness of our own musical experience of espressivity. We need to be able to connect what is happening musically with people’s likely experiences and opportunities in the contexts of their life situations and experiences. As well as the technical skills to support others’ expression musically, music therapists need to have experience of recognising and responding to espressivity in their own music-making and that of others. A musical education centred on taking exams, emphasising accuracy above all else, is not necessarily the best preparation for this. We also need a rigorous focus on what actually happens in music therapy sessions, rather than being seduced into well-meaning emotional fantasy. Likewise, we need research methodologies which don’t attempt to simplify music to one or two measurable parameters, in the process abandoning music itself, but which attend 65

S imon P ro c ter

to real-life empirical detail, including the social, cultural and aesthetic dimensions of music—ethnography offers a rich seam of possibilities here, and one that is now being drawn upon by leading figures in the field. We need to abandon the linear “venting” conception of expression. Music is not a vent, nor does it convey specific emotional information. But at the same time, neither is it ineffable (Kramer, 2012, p. 1). Music is a complex means of doing the work of constructing ourselves, not simply discharging our emotions. Above all we need to value experience and view espressivity as a means of growing emotional experience. As usual, this is not an observation unique to music therapy: So the last word here goes to Lawrence Kramer, as he attempts to reconcile expression and truth in relation to the music of knowledge: “Experience is the key: the locale where both concepts and feelings are lived out, lived by, lived through” (Kramer, 2012, p. 5).

References

Adorno, T.W. (1973). Philosophy of modern music (trans. W. Blomster). New York: Seabury. Adorno, T. W. (1976). Introduction to the sociology of music (trans. E. B. Ashby). New York: Seabury. Andrade, D. P. (2015). Emotional economic man: Power and emotion in the corporate world. Critical Sociology, 41(4-5), 785-805. Ansdell, G. (1995). Music for life. London: Jessica Kingsley Publishers. Ansdell, G., & Pavlicevic, M. (2005). Musical companionship, musical community: Music therapy and the process and value of musical communication’. In D. Miell, R. MacDonaldm, & D. Hargreaves (Eds.), Musical communication (pp. 193–213). Oxford: Oxford University Press. Bates, R. (2006). Providing emotional space: music therapy in an educational framework. In A. Paterson & S. Zimmermann (Eds.), No need for words: Special needs in music education (pp. 1213). Matlock: National Association of Music Educators. Boyce-Tillman, J. (2000). Constructing musical healing: The wounds that sing. London: Jessica Kingsley Publishers. Bushman, B.J. (2002). Does venting anger feed or extinguish the flame? Catharsis, rumination, distraction, anger, and aggressive responding. Personality and Social Psychology Bulletin, 28(6), 724-731. De Backer, J., & Van Camp, J. (1999). Specific aspects of the music therapy relationship to psychiatry. In T. Wigram & J. De Backer (Eds.), Clinical applications of music therapy in psychiatry (pp. 11-23). London: Jessica Kingsley Publishers. Colombetti, G. (2009). What language does to feeling. Journal of Consciousness Studies 16(9), 4-26. DeNora, T. (2001). Aesthetic agency and musical practice: new directions in the sociology of music and emotion. In P. N. Juslin & J. A. Sloboda (Eds.), Music and emotion: Theory and research (pp. 161-180). Oxford: Oxford University Press. DeNora, T. (2003). Music sociology: Getting the music into the action. British Journal of Music Education 20(2), 165-177

66

Playing My Feeling or Feeling My Playing? A Music-Centred Perspective… Dvorkin, J.M., & Erlund, M.D. (2003). The girl who barked: Object relations music psychotherapy with an eleven-year-old autistic female. In S. Hadley (Ed.), Psychodynamic music therapy: Case studies (pp. 183-203). Gilsum, NH: Barcelona Publishers. Epp, E. (2007). Locating the autonomous voice: Self-expression in music-centered music therapy. Voices: A World Forum for Music Therapy, 7(1). Evans, D. (2003). Emotion: A very short introduction. Oxford: Oxford University Press. Frith, S. (1978). The sociology of rock. London: Constable. Furedi, F. (2003). Therapy culture: Cultivating vulnerability in an uncertain age. London: Routledge. Gomart, E., & Hennion, A. (1999). A sociology of attachment: Music amateurs, drug users. In J. Law & J. Hassard (Eds.), Actor Network Theory and after (pp. 220-247). Oxford: Blackwell. Gouk, P. (Ed.). (2002). Musical healing in cultural contexts. Aldershot: Ashgate. Gray, A. (1994). An introduction to the therapeutic frame. London: Routledge. Illouz, E. (2007). Cold intimacies: The making of emotional capitalism. London: Polity Press. Kramer, L. (2012). Expression and truth: On the music of knowledge. Berkeley, CA: University of California Press. Mahns, W. (2003). Speaking without talking: Fifty analytical music therapy sessions with a boy with selective mutism. In S. Hadley (Ed.), Psychodynamic music therapy: Case studies (pp. 53-72). Gilsum, NH: Barcelona Publishers. Nordoff, P., & Robbins, C. (1971). Therapy in music for handicapped children. London: Gollancz. Nordoff, P., & Robbins, C. (1977). Creative Music Therapy: Individualized treatment for the handicapped child. New York: John Day. Procter, S. (2011). Reparative musicing: Thinking on the usefulness of social capital theory within music therapy. Nordic Journal of Music Therapy, 20(3), 242-262. Repp, B. (2005) Sensorimotor synchronization: a review of the tapping literature. Psychonomic Bulletin and Review, 12(6), 969-992. Rolvsjord, R. (2010). Resource-Oriented Music Therapy in mental health care. Gilsum, NH: Barcelona Publishers. Ruud, E. (2010). Music therapy: A perspective from the humanities. Gilsum, NH: Barcelona Publishers. Smeijsters, H., & van den Hurk, J. (1993). Research in practice in the music therapeutic treatment of a client with symptoms of anorexia nervosa. In M. Heal & T. Wigram (Eds.), Music therapy in health and education (pp. 255-263). London: Jessica Kingsley Publishers. Stige, B., & Aarø, L. (2012). Invitation to Community Music Therapy. New York: Routledge. Willis, P. (1978). Profane culture. London: Routledge.

67

Letting the World In: Psychodynamic Perspective of Emotional Expression in Music Therapy Helen Short

What happens when a sense of security becomes established in the child? … The mother, after an initial period of protection, gradually lets the world in, and the individual small child now pounces on every new opportunity for free expression and for impulsive action. (Winnicott, 2001, p. 45)

Introduction

In this chapter we will explore emotional expression in music therapy from a psychodynamic perspective. I open with this quote from psychoanalyst Donald Winnicott, as I feel this captures something of what we are aiming to achieve in psychodynamic practice. The term ‘Psychodynamic’ is broad and refers to the therapeutic practices that make connections between conscious and unconscious processes (Bunt & Stige, 2014). It will be used to encompass those ideas originating in the clinical theory of Analytical Music Therapy developed by Mary Priestley and will include ideas from those analysts I consider most influential within my clinical work including Bion (1962), Klein (1946), and Winnicott (1967). Whilst rooted in psychoanalysis, I consider my therapeutic approach as flexible, in order to address the clients’ needs. I intend to illustrate the way in which psychodynamic theory can be utilised to understand the emotional expression of our clients in a similarly flexible manner and within contemporary models of working. In line with psychodynamic thinking, I believe that every expression of the client can be considered related to their internal, or emotional, world and as such is useful in interpreting feeling states or patterns of relating. It is my intention to avoid detailed analysis of the material presented, however, as I believe adhering too rigidly within the traditional psychoanalytic constructs can hinder our understanding of 69

H elen S hort

the unique material our clients present. The clinical work presented in this chapter will be presented in a plain language that can be understood and used clinically with more ease. Excerpts from my clinical work shall be amalgamated in order to best illustrate theoretical concepts and music therapy techniques and to protect anonymity. Within the scope of this chapter it will not be possible to illustrate this rich and varied field extensively therefore I will limit my exploration to a small number of concepts that I have found useful in informing my clinical work with children and adults.

Psychodynamic Music Therapy

Psychodynamic music therapy originates in the Analytical Music Therapy model developed by Mary Priestley (1975) and is based upon the psychoanalytic concepts of Freud, Jung, and Klein (Hadley, 2002). Characteristic of the approach is the symbolic use of improvised music played together by client and therapist. Priestley’s unique approach has since been developed and expanded upon within the broader field of psychodynamic music therapy to include the work of other prominent and pioneering psychoanalysts, many of whom lived in the UK and as such influenced British practice.1 Bruscia’s (1987) definition provides a useful basis from which to further explore the concepts addressed in this chapter. He outlines psychodynamic therapy as being characterised by several fundamental elements which include ideas that: – The psyche operates at several levels of consciousness ranging from the unconscious, the layer containing material that is out of awareness to the conscious, the layer in which material is in awareness; – The past influences the present and individuals utilise experience from past situations within present ones; – Defence mechanisms are developed as a way of coping when there is a risk that certain experiences may stimulate potentially disturbing material held within the unconscious to enter into awareness (p. 12). The construct of the defence mechanism originated in the work of Freud who viewed defences as necessary in managing the everyday complexities of mental life. Difficulties arise when defences are maintained in a rigid manner, which hinders and restricts interpersonal relating and authentic emotional expression. This can occur as a result of painful past interactions and relationships, often experienced in childhood, which are recreated and stimulate difficulties in current 1

It is currently a requirement of all UK practising music therapists to have a knowledge of “the principle psychotherapeutic interventions and their theoretical bases” (HCPC, 2013, p. 13).

70

Letting the World In: Psychodynamic Perspective of Emotional Expression…

relationships, subsequently leading to the further reinforcing of an individual’s defence mechanisms. A broad aim of psychodynamic therapy, therefore, is to create a safe space for exploration feelings and in which psychic defences can be loosened so that a corrective emotional experience can take place (Hadley, 2002). There are a number of elements fundamental to the psychodynamic framework that can allow this to happen: the therapeutic relationship, the therapeutic space and interpretation. The Therapeutic Relationship The psychodynamic approach to music therapy emphasises the importance of the relationship between the client and therapist and the feelings that are exchanged within it via transference and counter transference responses. These concepts, originating in psychoanalysis and the work of Freud, will be explored further shortly. In describing her work from a psychoanalytic perspective, Odell-Miller (2001) describes the relationship with the therapist as equal value to that of the music, whilst at the other end of the spectrum, clinicians practising within other therapeutic frameworks may understand the clinical work as being ‘purely musical’ (Pavlicevic, 1997). In my practise I would distinguish two types of relationship: the therapeutic relationship between client and therapist, the development of which has been encouraged via shared music-making, and the musical-therapeutic relationship in which the therapist employs musical techniques, providing a psychodynamic function, that supports the client’s emotional expression within the music. I would also say that both types of relationship form a continuum upon which the relationship is placed according to the needs of the client. The Therapeutic Space Within a psychodynamic framework, emotional expression is held within boundaries created as part of the therapeutic work, aside from those comprising the practical framework (for example the length and location of therapy). Music therapist Pavlicevic (1997) describes the importance of post-Kleinian psychoanalyst Winnicott’s concept of the ‘space between’, referring to the work taking place between client and therapist. She then links this to Casement’s work (1985, 1988) emphasising the importance of the protection of this space from the outside world and intrusions from others in enabling a way of relating to emerge between client and therapist. This may encompass the musical and verbal relating2. Most importantly the therapeutic space must “. . . enable the client to feel safe enough within it to risk feeling unsafe…” (Pavlicevic, 1997, p. 143). 2

For further discussion please refer to Pavlicevic (1997).

71

H elen S hort

Interpretation Interpretation is a technique in which the therapist offers an understanding or insight that may go towards naming or clarifying a perceived emotional expression or undeveloped meaning detected within the work undertaken. This may be derived from and take the form of both musical and verbal expression and allows mutual exploration between therapist and client (Pavlicevic, 1997). Interpretations may be made in response to feelings evoked by the client within the therapist and inform the musical interventions that are employed3. They may be fed back to the client as a way of assisting with the development of insight and the therapeutic process, on both a musical or verbal level. Alternatively, they may be used solely by the therapist to develop therapeutic technique, depending upon client need and the aims of the work. A number of key psychodynamic concepts I consider fundamental to my work will now be defined and later addressed in within the context of my clinical work in three case studies. Projection and Projective Identification (Klein) Klein’s concept of projection is useful in understanding the therapeutic process here. Projection is a primitive defence mechanism that involves attributing an aspect of oneself or a feeling to another. Klein proposed that from birth our emotional experiences have a mental representation in the form of phantasies, which shape our internal world and affect our experience of the external world. The experience of phantasy consists of concrete objects, which are felt to have either good or bad intentions towards the self. One example is the baby’s feeling of hunger, experienced as a bad object devouring the core. Klein developed the notion that young children take in parts of the external world to create an internal world, naming this introjection. The opposite of this is an unconscious process of expulsion or “getting rid of ”, named Projection. Klein suggested that during play, the child is provided with an opportunity to project an element of their internal world into the external world (Lemma, 2003). In the process of projective identification, feelings that become overwhelming for the baby are split off and projected into the mother who then contains and is identified with the bad, unwanted parts of the self and may now be felt as threatening. Within the clinical context, Lemma (2003) describes projective identification as: “attributing states of mind to another person and relating to them as if they embodied the projection. The interactional force of this dynamic can result in the recipient acting in a manner congruent with the projection” (p. 211). 3

Concepts of transference and counter transference will be explored in more detail later in the chapter.

72

Letting the World In: Psychodynamic Perspective of Emotional Expression…

Transference and Countertransference Transference and countertransference are constructs originally developed by Freud that are related to the dynamic of the therapeutic relationship and can function to assist the therapist in understanding the client’s emotional expression as related to the therapeutic relationship and its complex interaction with the client’s internal world. Transference can be described as the client’s feelings towards therapy and the therapist that are introduced by the client and that arise as a result of the therapeutic work. The Freudian concept of transference was originally based on the idea that the client unconsciously recreates the dynamics of unresolved dialogues from past relationships within current relationships (Temple, 1996). Within psychodynamic music therapy this can also include the client’s projections onto the therapist and on to, or into the music (Hadley, 2002). Countertransference can be described as the therapist’s emotional response to the client (Hadley, 2002). Through conscious and unconscious modes of relating, the patient may stimulate emotional responses in the therapist that are representative of facets of their internal world (Kernberg, 1980, as cited in Stortz, 2014). Originally, Freud considered the countertransference response a manifestation of unresolved issues within the therapist which is potentially harmful to the therapeutic work, advising that therapist should put aside her own feelings when conducting therapeutic work. Heimann (1950), reshaped the construct in a way that favoured the therapist’s emotional response and that viewed the countertransference response, as an instrument of research into the patient’s unconscious, as one of the most important tools for her work. Many current definitions encompass all of the therapist’s reactions to the patient, allowing a greater tolerance of the therapist’s subjective response (Lemma, 2003). Kernberg (1965, as cited in Lemma, 2003) highlighted the importance of remaining aware that the therapist’s conscious and unconscious responses to the client should be considered responses to the client’s reality as well as to his transference, and also to the therapist’s reality and neurotic needs. Clinical supervision is essential in making sense of countertransference responses to our clients. As with transference, countertransference responses can manifest within the musical relationship, with an initial awareness of the client’s traumatic or relationship history often becoming apparent from countertransference responses arising in the music. This can enable the therapist to both employ musical interventions that meet the needs of the client and to consider the quality of the musical relationship within the context of the here-and-now in order to gather further information relating to the client’s history and to further the therapeutic process. 73

H elen S hort

Priestley distinguished three main types of musical countertransference (classical, complementary and emotional)4, Scheiby’s (1998) general definition of musical countertransference is useful to consider: Musical countertransference consists of the sound patterns that reflect or evoke feelings, thoughts, images, attitudes, opinions and physical reactions originating in and generated by the music therapist, as unconscious or preconscious reactions to the client and his or her transference. The medium through which these countertransferences are conveyed is the music played in the session. (p. 214)

Scheiby (1998) also points to a number of cues that can be used to determine whether a countertransference relationship is present within the music which include: – Music that seems out of context with the client’s expression at that moment, – Music that does not seem to be appropriate from the therapist’s perspective, – Musical expressions the therapist makes that take her by surprise, – Musical expressions that the therapist feels pushed into using. (pp. 216-217) Containment Within psychodynamic music therapy, containment is an “essential aspect in the therapeutic relationship” (De Backer, 1999, p. 18). In his concept of ‘the container and the contained’, psychoanalyst Bion (1962) extended the idea of projective identification and suggested that the mother acts as a ‘psychic’ container for the infant’s projected feelings throughout the child’s development. The container(s) absorbs the feelings projected from the baby, hangs on to them, makes sense of them and reacts accordingly. This enables the child to experience the feeling that the good object, or mother, is not overwhelmed by the feelings but can give shape to the frightening and confusing experiences so that the child then can deal with these feelings. Bion (1962) suggested that a mother who failed to absorb their infant’s projections was perceived by the child as hostile to the infant’s attempts to get to know them. The child then has an idea of a world that doesn’t want to know it and doesn’t want to be known. The containment process is translated within the therapeutic relationship as follows: It is the creation of a psychic space in which each and every communication, however confused and painful, is received by the therapist, retained and mentally digested with the aim of removing any unbearable qualities from the patient’s feelings. These feelings can then be given an acceptable form and place in the patient’s experience. The final aim

4

For definitions please consult Hadley (2003).

74

Letting the World In: Psychodynamic Perspective of Emotional Expression…

is for this experience to enable the patient to accept his anxieties and learn to live with them: in other words, to understand and accept the containment function. (p. 306)

Within the music therapy context, the music of the therapist and the therapeutic methods used in improvisation can provide a multi-layered container that allows the client a space and context within which he or she can express and process a wide range of feelings and needs (Wigram, 2004).

Case Studies

Please note names have been changed to protect anonymity and written consent has been obtained. Oliver

Oliver was a 12-year-old boy who experienced social, emotional and behavioural difficulties which had led to his exclusion from mainstream primary school and admission to a therapeutic learning community. Oliver’s mother had a diagnosis of personality disorder and substance misuse and Oliver had been removed from her care when it became clear she could no longer meet his needs. Oliver was referred to music therapy by the social worker in the institution who stated that although his emotional needs were severe, his bright presentation and behaviour was deemed less challenging than others in the school. This meant he was often overlooked when the school team were considering referrals for the limited amount of psychological therapies on offer. Oliver experienced difficulties with emotional expression and regulation which often impacted upon his relationships with staff and peers and he often became distressed in the classroom which he perceived as hostile. Given his background and history it is likely that he had experienced attachment difficulties. It was thought that a course of individual music therapy could assist Oliver in providing a space to assist thinking about relationship difficulties, a place to ‘play’ and an opportunity for emotional expression within the safety of a therapeutic relationship. From the outset, Oliver was eager to see me and enthusiastic to attend. Initially he was keen to take up my suggestions of shared music-making, suggesting playful ideas of how to play the instruments together. He had a strong musicality demonstrated in the melodic and rhythmic aspects of his playing and engaging in the music seemed pleasurable for him. As the work progressed, Oliver began to reject musical improvisation in favour of playing games or acting out stories, both of which involved using the instruments as props, or symbolically. The therapy space became the setting for high drama in which we became medieval knights, animals or torturer and victim. Whilst Oliver seemed to be having fun, the nature of the play began to take on a sinister, gruesome and even sadistic quality with Oliver suggesting at times I was tied-up and gagged and at others chopping my arms, legs and head off before bringing me back to life. It was necessary for me to maintain boundaries when Oliver wanted to play in a way that might hurt me or felt inappropriate, narrowly missing striking me during a sword fights or attempting to jump on my back so that he could ride me like a horse. During our play I responded both in character, describing how frightening it felt to

75

H elen S hort

be in such situations and in my role as therapist, I interpreted that Oliver was showing me how frightening it can feel inside sometimes. A consistent feature of the play was that Oliver was in a position of power whilst I was expected to submit.

Oliver’s use of the instruments in nonmusical ways should be considered an important communication here. Whilst it is not unusual for children to act out fantasies of aggression and destruction, my interpretation was that Oliver was expressing something of his internal world via imaginative play, providing a picture of a terrifying emotional experience resulting from the potentially neglectful and turbulent relationship with his mother, followed by their subsequent separation. Engaging in shared musical interaction most likely felt too intimate for him at this stage of the therapy. The concept of projection is useful to consider here. Oliver was defending against both acknowledging these difficult feelings and engaging in the therapeutic relationship by “getting rid of ” or projecting the internalised bad object(s) into his external world, or more specifically, onto me via symbolic play. Bruscia (1987) emphasises the importance of the therapist’s role in holding and protecting the client as she expresses something of her emotional world, whilst also connecting or grounding the client to external reality. The therapist can empathise by reflecting back the client’s feelings through either the verbal or musical relationship, through words or music. In being alongside him in his symbolic play and taking on the roles represented in his internal phantasies I was empathising with Oliver in a way that felt safe, whilst my interpretations of the material he presented as related to the here and now allowed me to ground our play in reality. It was necessary for me to be strong and stable enough to maintain my own identity but remain vulnerable to the message of Oliver’s projections (Priestley, 1994). It was important that I demonstrated that I could both withstand and understand Oliver’s frightening projections in order to demonstrate “an understanding of and tolerance for the client’s inmost feelings that were not experienced during childhood” (Bruscia, 1987, p. 149)5. The psychodynamic framework allowed the therapeutic process to begin. Oliver was able to recognise the therapy space as safe and the therapeutic relationship as intimate and one in which he could allow his terrifying feelings to surface. The therapeutic relationship, developed also via the shared music-making process in the early stages of the work, was a crucial therapeutic tool despite the symbolic play being ostensibly the main vehicle of the therapy during the stages described6. 5 6

For a case example of the projective identification process, please see Robarts (2003), p. 165. Developmental concepts such as regulation are often integrated with psychodynamic music therapy practice, but are not discussed in detail here.

76

Letting the World In: Psychodynamic Perspective of Emotional Expression…

Philip

Philip was a young man diagnosed with paranoid schizophrenia and detained within a secure psychiatric hospital. As a child, Philip’s father was often physically violent towards him. He experienced a loving but neglectful relationship with his mother who felt unable to protect Philip from his Father. As a teenager Philip became involved in criminal and violent activity which led to his detention in prison. Philip’s mental health deteriorated in prison and subsequently he was admitted to secure psychiatric care. At the time of his referral for music therapy, Philip had engaged successfully in structured psychology work and was considered settled in his mental health awaiting discharge into the community. His psychiatrist felt that further work was required for Philip to connect more authentically with his emotional world, of which he revealed little. Philip was enthusiastic about learning to play an instrument and it was thought a course of music therapy could provide a way of supporting him in his transition from hospital and a space to engage in creative expression. He was a warm and likeable character and was motivated to engage in the relationship and therapeutic work. Work with Philip felt difficult at times. He had a clear musicality and motivation to play but often found it difficult to sustain interaction when we improvised freely together, cutting short the interaction and citing feeling “bored” as the reason. Despite his warmth, I detected an underlying anxiety in his presentation which was amplified within his musical contributions which felt rigid and inhibited. Although I was fond of Philip I too often felt anxious in his presence and this seemed to impact upon my creativity within the music. During free improvisation I struggled to provide something that allowed us to connect and my music moved between something that felt too rigid or too elaborate. I was often left feeling as if I wasn’t “good enough”7 as a therapist. Philip often expressed his reluctance to improvise without any clear guidelines, stating a preference for musical interaction that was more structured or was contained within a framework, for example requesting to practise the chords he had been taught during the guitar tuition he had also been receiving. I often felt unable to meet Philip’s needs and rejected in favour of the guitar tutor, who had apparently been able to engage Philip in a way that had been useful for him. As I recognised Philip’s difficulties with spontaneity and flexibility which would be beneficial to address prior to his discharge into the community where the structure of the hospital routine would be removed, I encouraged him to continue to engage in free musical interaction. Incorporating loose structures such as tempering the instruments to create the jazz or pentatonic scale seemed to allow his ability and motivation to sustain interaction to increase and allowed his music to music to become more expressive, melodic and responsive to mine. Following several sessions in which we had been able to play together in a way that felt congruous and compatible and less anxiety-ridden, I interpreted that Philip’s music now felt more authentic and that it was both a lack of confidence and anxiety as relates to the therapeutic relationship that had influenced his previous style of playing. Philip was able to disclose that previously he had experienced lack a fear that his music was not “good enough” rather than a feeling or boredom. There was a sense that fostering a more equal and com-

7

This refers to Winnicott’s concept of the “Good Enough Mother” (1990).

77

H elen S hort

patible relationship within the music had both allowed Philip’s anxiety to subside and had allowed him to experience pleasure from shared interaction.

During the work with Philip, the anxiety I experienced can be understood as transference resulting from Philip’s anxiety related to the therapeutic work and relationship which he had projected into me as part of the projective identification process. This manifested in my anxious demeanour in Philips presence and apparent inability to provide an intervention that he was able to engage positively with that was not congruent with his warm presentation and motivation to engage but rather the content of the projections. The countertransference response I experienced was powerful. In feeling neglected, I had introjected Philip’s feelings of neglect that were representative of the unresolved dynamic with his mother. Within the musical relationship I felt pushed into matching and attuning to Philip’s rigid expression or providing something that was inappropriate and out of context with the emotional content of his music, suggesting countertransference phenomena within the music. Priestley’s (1994) definition of complementary countertransference is useful in considering the countertransference relationship here: “Complementary identifications, or c-countertransferences, occur when the therapist identifies with one of the patient’s introjects; or … when he introjects his patient’s introject and is taken over by it” (Priestley, p. 85). In the musical countertransference I was left with a feeling of not being ‘good enough’ which was representative of Philip’s internal representation of his mother who as a result of the abusive family dynamic, may have been unable to attune to Philip’s emotional needs. In the music I felt hindered and unable to provide an empathic musical response that resonated with Philip’s emotional expression. My countertransference response informed my decision to temper the instruments as to enable a more comfortable or successful interaction (Hakvoort, 2014) that allowed Philip to gain pleasure from the music-making. This fostered a way of relating that was more appropriate for Philip at this stage in the therapeutic work and that served to strengthen the therapeutic relationship. The verbal and musical relationship had served to allow Philip to unlock past patterns and shed defence mechanisms in place so that therapeutic growth could be stimulated (Bruscia, 1987). Marcus8

Marcus was a young man in his thirties who participated in a community music therapy group incorporating rap lyric-writing as a therapeutic intervention. Marcus had recently

8

Marcus’ story is a condensed version of the case study featured in my paper “One Man’s Journey Within a Community Rap/Music Therapy Group” as part of the UK’s National Health Service (in press).

78

Letting the World In: Psychodynamic Perspective of Emotional Expression…

experienced an episode of psychosis, symptoms of which were hearing voices and paranoia which resulted in his referral to music therapy. Marcus had little insight into his mental health difficulties. He was referred by a mental health professional who felt he could benefit from the opportunity for emotional expression, to develop insight and to come to terms with past experience. Marcus demonstrated a strong passion for rap music and this was demonstrated in his creative and powerful lyrics which were delivered with both skill and enthusiasm. It was unclear whether Marcus had any history of engaging in violent activity however at the start of the work some of his lyrics contained themes of violence and criminality: I’m a trouble maker Ain’t scared of no man I believe anything that bleeds u can kill it You can’t take the blast from me bullets I can smell flesh burning I’m from a war zone Now you are in the wrong zone Oiling my gun thinking “how I’m gonna kill him tonight?” In the early stages of the work, owing to the word-play, double entendre and storytelling inherent in rap9, it was often difficult to determine whether he was sharing his own or somebody else’s experience. I often communicated that I understood something of the emotional experience conveyed in Marcus’s contributions by remarking upon the nature of the lyrical content or feeling that was conveyed within them however any further exploration seemed uncomfortable for him. Much of the shared interaction occurred whilst co-creating a musical accompaniment for his lyrics. Using a drum machine and synthesizer we would collaborate to create a one-bar percussive beat which would repeat continuously during a song and a melody, also consisting of simple one-bar motifs that were repeated with small variations. As the work progressed, the nature of Marcus’ lyric writing shifted from material that was violent and potentially offensive in content to material that was more reflective and emotionally resonant and that revealed something of his inner world with one such song describing his experience related to a serious physical illness: Sinful crucifix I got a cross to carry Carry by myself No one to help me. . . Embracing the pain like it’s my friend Struggling to open my eyes Having nightmare dreams Feel like my bones been chopped to pieces. Later in the work Marcus became able to engage in shared interaction as part of the lyric writing-process, allowing me to help shape his ideas and provide suggestions of ideas for words that could best capture an idea or feeling. Towards the end of the course of therapy, Marcus became able to share with me difficult personal experiences that were related to 9

For further description of characteristics of the rap genre, please see Lightstone (2011).

79

H elen S hort

his lyrics and described using the songs as a “place to put all the [feelings of] anger, the violence”.

The work with Marcus can be understood within the context of containment. The therapeutic process occurred within two ‘containers’: the rap form and the musical-therapeutic relationship (Robarts, 2004). During the initial composition process, Marcus communicated something of his distress or internal conflict in the form of lyrics, which was received and contained within form of the music. The stability and structure of the percussive and harmonic accompaniments served as a holding ‘tool’ where the use of repeated sounds without attempts at interactive or dynamic music making provided the musical containing frame (Wigram, 2004). This musical container demonstrated to Marcus that I was not overwhelmed by his projections but could receive and retain them. This allowed Marcus to trust that I could receive his emotional expression, no matter how powerful. Subsequently this enabled the musical-therapeutic relationship to strengthen and the work to progress to the next level which involved my assisting Marcus in the verbal processing of his lyrics. Here I was serving the function of the mother within the psychic containment process, absorbing the feelings that were projected from Marcus, making sense of the violent and unbearable experiences conveyed within them and responding accordingly (Bion, 1962). This allowed me to communicate to Marcus empathy and an appreciation of his emotional expression which in turn allowed him to begin to internalise the containing process. This was demonstrated in his lyrics, which were now delivered in a more authentic and considered form.

New Developments and Closing Comments

In summary, this chapter has served to outline a select few of the psychodynamic concepts that I feel are fundamental in informing my clinical work and assisting the client in expressing and making sense of their emotional world. At this point I would like to direct the reader towards the work of Ann Alvarez (1992) for further consideration, whose influence has a significant presence within psychodynamic practice. It is also worth considering some more recent developments in psychodynamic thinking that I have found useful, namely the concept of mentalisation (MBT ) and its incorporation within music therapy is an exciting development (see Fonagy et al., 1995; Hannibal, 2014; Strehlow, 2009) . Nevertheless this is beyond the scope of this chapter. To close, I would like to further emphasise the importance of approaching the psychodynamic framework with a critical yet open attitude that allows us to

80

Letting the World In: Psychodynamic Perspective of Emotional Expression…

continue to make use of these wonderful concepts to enrich our work as the music therapy landscape evolves.

References

Alvarez, A. (1992). Live company: Psychoanalytic psychotherapy with autistic, borderline, deprived, and abused children. London: Tavistock/Routledge. Bion, W. R. (1962). The psycho-analytic study of thinking. International Journal of Psychoanalysis, 43, 306-311. Bruscia, K. (1987). Improvisational models of music therapy. Springfield, IL: Charles C Thomas. Bunt, L., & Stige, B., (2014). Music therapy – An art beyond words. Hove: Routledge. Casement, P. (1985). On learning from the patient. London: Tavistock/Routledge. Casement, P. (1988). Further learning from the patient. London: Routledge. De Backer, L. (1999). Specific aspects of the music therapy relationship to psychiatry. In J. De Backer & T. Wigram (Eds.), Clinical applications of music therapy in psychiatry (pp. 11-23). London: Jessica Kingsley. Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press. Hadley, S. (2002). Theoretical bases of Analytical Music Therapy. In J. Th. Eschen (Ed.), Analytical Music Therapy (pp. 34-30). London: Jessica Kingsley. Hakvoort, L. (2014). Multifaceted music therapy in forensic psychiatry. In J. DeBacker & J. Sutton (Eds.), The music in music therapy (pp. 138-151). London: Jessica Kingsley. Hannibal, N. (2014). Implicit and explicit mentalisation in music therapy in the psychiatric treatment of people with borderline personality disorder. In J. DeBacker & J. Sutton (Eds.), The music in music therapy (pp. 211-223). London: Jessica Kingsley. Heimann, P. (1950). On counter-transference. International Journal of Psycho-Analysis, 31, 81-85. Klein, M. (1946). Notes on schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99110. Lemma, A. (2003). Introduction to the practice of psychoanalytic psychotherapy. Chichester: John Wiley and Sons. Lightstone, A. (2011). The importance of hip hop for music therapists. In G. Yancy & S. Hadley (Eds.), Therapeutic uses of rap and hip hop (pp. 321-336). New York: Routledge. Pavlicevic, M. (1997). Psychodynamic meaning in music therapy. London: Jessica Kingsley. Priestley, M. (1975). Music therapy in action. New York: St. Martin’s Press. Priestley, M. (1994). Analytical Music Therapy. Phoenixville, PA: Barcelona. Robarts, J. (2003). The healing power of improvised songs In S. Hadley (Ed.) Psychodynamic music therapy: Case studies (pp. 152-177). Gilsum, NH: Barcelona. Scheiby, B. (1998). The role of musical countertransference in Analytical Music Therapy. In K. Bruscia (Ed.) The dynamics of music psychotherapy (pp.213-247). Gilsum, NH: Barcelona. Storz, D. (2014). From paranoid experience to incipient Trust – Focal music therapy with an adult paranoid psychotic patient. In J. DeBacker & J. Sutton (Eds.), The music in music therapy (pp. 138-151). London: Jessica Kingsley. Strehlow, G. (2009). The use of music therapy in treating sexually abused children. Nordic Journal of Music Therapy, 18(2), 167–183.

81

H elen S hort

Temple, N. (1996). Transference and countertransference: General and forensic aspects. In C. Cordess & M. Cox (Eds.) Forensic psychotherapy. Crime, psychodynamics and the offender patient. Vol. I. Mainly theory (pp. 23-47). London: Jessica Kingsley. Wigram, T. (2004). Improvisation. London: Jessica Kingsley. Winnicott, D.W. (1990). The maturational processes and the facilitating environment. London: Hogarth Press. Winnicott, D. W. (1967). Mirror-role of the mother and family in child development. In P. Lomas (Ed.), The predicament of the family: A psycho-analytical symposium (pp. 26-33). London: Hogarth Winnicott, D.W. (2001). The family and individual development. Oxon: Routledge. Standards of proficiency: Arts therapists (2013). Retrieved from www.hcpc-uk.org/assets/ documents/100004FBStandards_of_Proficency_Arts_Therapists.pdf

82

Emotional Expression in Music Therapy Using Guided Imagery and Music Krzysztof Stachyra

Introduction

Emotional expression in both its active and receptive forms is an intrinsic part of each music therapy session. This applies primarily to direct participants of the meeting—the client and the therapist—but you can also find it in the music, which incorporates the emotions of the composer. Looking at the origins of the Guided Imagery and Music (GIM) method, one might dare to say that its roots came to be as a result of experiences related to emotional expression. When Helen Lindquist Bonny, a violinist, performed the piece titled “The Swan”, a part of The Carnival of the Animals by C. Saint-Saëns, something happened that she could not explain at the time. When she repeated the first theme, her perception of her surroundings and of herself changed, “as if the violin was not mine”, a beautiful sound resonated, more beautiful than ever before, the notes flew and danced with unrivalled grace. According to her, when she finished the piece, she was not able to suppress her emotions, she was shivering all over. She was asked to play one more piece. She decided to play “Ave Maria” by Bach/Gounod, and that incredible “orgasmic” experience came upon her again (Bonny, 2002, pp. 5-6). Guided Imagery and Music, also known as the Bonny Method of Guided Imagery and Music (BMGIM), is defined as a process in which the images inspired while listening to music serve as the exploration of (sub)consciousness that leads to unification and internal integration. It is an in-depth approach to music therapy, where programmed classical music is used to generate a dynamic development of internal experience (Stachyra, 2012). GIM combines the strength of carefully selected classical music with human imagination (Ventre & McKinney, 2015).

83

K rzysztof S ta c hyra

The beginnings of this method date back to the 1970s, when Helen Bonny, an established music therapist at the time, was working to introduce music to experimental therapy based on psychoactive substances while working at the Maryland Psychiatric Research Centre in the USA. The objective of using drugs was to facilitate the ability of the person to reach deeper levels of consciousness. That was a popular approach at the time, as it was in the 1960s and in the 1970s when the interest in using psychoactive substances in psychotherapy was the highest. It was believed that their careful, clinically controlled use might improve self-awareness and lead to specifying the system of values of the individual, allow them to release the emotional energy, and allow them to experience the spiritual transformation or the so-called peak experience (Bonny, 2002). Music associated with that experience was to help patients rid themselves of typical control and allow them to enter more deeply into their internal world, to facilitate venting intense emotions, to contribute to achieving the peak experience, to grant continuity in experiencing timelessness, and to manage and give structure to experiencing (Bonny & Pahnke 1972, pp. 65-66). As time passed, Bonny noticed that combining relaxation with properly selected music sometimes brought surprising results. More importantly, from the therapeutic point of view, such a combination turned out to be more effective than sessions with psychoactive substances (Bonny, 2002). Helen Bonny’s method is based on several theoretical concepts. Humanistic and transpersonal psychology were of particular significance to her. Being under the influence of the work of Abraham Maslow, she emphasized the role of self-actualization and accepted the “peak experience” concept. The theoretical background of GIM also includes references to Rogers’ client-centred therapy. Influences of the concepts by Carl Jung, Roberto Assagioli, Stanislav Grof, and Ken Wilber (Bonny, 2002; Stachyra, 2012) are also visible. GIM therapy is most frequently used in the case of persons with post-traumatic disorders or who are dependent on psychoactive substances or suffering from depression, eating disorders, personality disorders, or various psychosomatic disorders. It is also slightly less frequently used in working with children and pregnant women. It is important to emphasize that this method is also commonly used to support personal development, expand self-awareness, and improve self-esteem and motivation in people considered mentally healthy (Stachyra, 2012).

Stages of the GIM Session

Ultimately, after many years of practice and testing different variants and modifications, the classical Guided Imagery and Music method emerged. A session consists of four stages:

84

Emotional Expression in Music Therapy Using Guided Imagery and Music

1. 2. 3. 4.

Prelude Induction Music journey Postlude

I. Prelude. Prelude is usually based on a conversation that is typical for a verbal psychotherapy session. During the first meeting, the therapist gathers information about the client; in subsequent sessions, observations from the previous sessions and the events that occurred since the previous session are discussed. At the prelude stage, the therapist pays attention to observing the emotional expression of the client, which might be, for example, visible in the way they move or the tone and timbre of voi­ce. Based on these observations, the therapist selects the proper music programme, a set of pre-selected pieces of music that will be used during the session. In the course of the conversation, the therapist gradually directs the client’s attention to their internal experiences. The prelude ends by establishing, together with the client, the focus, that is the image that will be the st­art of the music journey. II. Induction. The induction stage consists in maki­ng the client relaxed and focused on their interior. Relaxation and focus – these are the states that are needed to conduct the th­erapy, to immerse in the imagery. Sometimes induction is referred to as “opening the doors to new layers of consciousness”, which symbolizes the change in the state of awareness in order to facilitate reaching its deeper layers. In the classic GIM method, this part of the session is held without the accompaniment of music. It must be noted that induction might take multiple forms. Application of a given form depends on many factors – con­sideration is given to the mental and physical condition of the patient, the purpose of the session, and also the music programme (music journey) that the induction prepares for. One induction might be more relaxing while another could be more energizing­. III. Music journey. Music journey is the central stage of a GIM session, and also the only time when music is played. As was mentioned, the music is se­lected by the therapist, considering the current mental condition of the client and the course of their imagery. Usually, one of the BMGIM music programmes is selected. In terms of emotions, music within GIM serves a few purposes: It offers support in reaching and releasing emotions; it also strengthens them and facilitates expression.

85

K rzysztof S ta c hyra

In the course of the music journey, the client is encouraged to describe their imaginations and experiences. The therapist takes on a non-directing role, and the fundamental role of the therapist is to observe, listen, and perceive, as well as to encourage and support the client. The therapist must be a kind of a companion who assists the client in following their selected path. All the details that come to the client’s mind are considered – starting fr­om visual, hearing, kinaesthetic, olfactory, and gustatory images through recalling memories and emotions. The purpose of this part of a GIM sessions is to mobilise the client to explore the imagery that appears. IV. Postlude. The session concludes with a postlude, which serves as a “waking up” time for the client, or restoring the normal state of mind. The last stage is the time to process, express, and integrate the experiences of the music journey. Importantly, the therapist helps the client to express their emotions by encouraging them to artistic activities, such as drawing mandalas or makinga sculpture, but also other creative activities, which most frequently include music improvisation, discussion, writing a diary, writing a poem, or a combination of those techniques (Rugenstein, 2000, p. 25). There is also the place for the di­alogue that is intended as an attempt to interpret relations between everyday experiences and the prob­lems, which in turn offers new insights into the client’s problems. The therapist attempts to help the client find the relationships and interpret imagery, but not provide “ready-made” solutions. Expressing in words or in a creative work the events from the sess­ion helps the client integrate the experience and gain awareness of different aspects of self, relations, and connections. Omitting the postlude stage might lead to a situation where the experience gained by the client is not strengthened. Another form of expression that the client is encouraged to do is keeping a diary of the therapeutic process or continuing to do creative work at home.

Music and Emotional Expression

Emotional expression refers to external, visible signs of internal experiences (Oatley & Jenkins, 2003, p. 161). More information about emotional expression and its role in therapy is provided by Kennedy-Moore and Watson (1999), who define it as observable verbal or nonverbal behaviours that communicate and symbolise an emotional experience. It may be expressed consciously or subconsciously, is at least partly controllable, and may result in purposeful action to a lesser or higher extent. Emotional expression offers a connection between the internal world of experiences and the external world; therefore, its significance is

86

Emotional Expression in Music Therapy Using Guided Imagery and Music

great, not only during the therapeutic process but also in everyday situations. It also plays an important role in gathering information about the client by observing the client’s condition, the degree of their awareness of their own emotions, the degree of maturity of their emotional competence, and so forth (Kennedy-Moore & Watson, 1999, p. 4). It takes place through transforming or symbolising emotions, whose source lies in different forms of emotional expression. In GIM therapy, emotions and emotional expression have at least a few sources. They are governed by complex mechanisms. It is important to start by looking at the relationship between the music and the listener, and the relationship among emotions, imagination, and music in particular. The role of music and imagination, which might serve both as a trigger and means of expression of emotions, is of particular interest in the context of this publication. How does this occur? Frances Goldberg (2002), in her description of how music exerts its influence, states that music generates conscious or subconscious emotions by direct psychological stimulation of the autonomic nervous system (ANS), which translates into images. Based on these principles, subsequent images flow from the first image, so long as the emotions related to the given sequence of images are sustained. Next, the affective impact of music returns, giving rise to a new series of images. As regards the physiological aspect, emotions are strictly related to autonomic nervous system, being a response to the stimulation of the ANS. Jeanne Achterberg (1985, as cited in Goldberg, 1992, p. 9) perceives emotions as a translator between the language of the ANS and the language of the brain. Therefore, the view is expressed that if an emotional reaction begins in the ANS, while an image is the form of communication between the ANS and the brain, it may be assumed that the image is a representation of the emotion. Thus, during a GIM session two main sources of emotions are present: music and imagery (and this is why the music journey stage was initially referred to as “synergy of music and imagery”). In both cases, these entities act as triggers to the emotions “sleeping” within the client and that they bring to the session. The above statement might be supported by situations when music of a specific character elicits emotional responses that are contrary to the expression of the music, which occurs quite often. It might be understood that emotions do not need to be a direct response to music or imagery, but to the issue that hides behind the given music phrase, timbre of the instrument, or imagery. In such situations, the music or the imagery acts as a trigger to the emotions hidden in the client. You cannot ignore the importance of associations, which are the result of combining the stimulus with a relevant memory 87

K rzysztof S ta c hyra

trace. Associations, like emotions, might be created as a result of all the experiences the client has during a session. Another confirmation of the theory presented by Goldberg (1992) comes from therapeutic practice. Sometimes one piece of music is played multiple times during a single GIM session. It turns out that this does not prevent the traveller (the client) from continuing the imaginary narration that might follow through different, sometimes quite disparate emotional states, without disrupting or interrupting the continuity of experience, which would surely occur if emotional responses were related solely and directly to music. This is confirmed by Sloboda (2005), who writes about the complications related to studying the emotional response to music due to the fact that the same piece of music might generate different emotional experiences in different persons; moreover, one piece of music might bring a person to tears on one occasion, while in a different situation that same person will remain indifferent to it (Sloboda, 2005). The above is also argued by Goldberg (1992, p. 7), who says that her long-term experience shows that only a part of the imagery affects or relates directly to associations to the music the client listens to. The majority of the imagery seems to come from other sources. Taylor (1973, p. 93) noted that classifying a given piece of music as physically stimulating or calming may not be based on the features of the music itself; such classification should consider both the characteristics of the music and the response of the listener when they hear the music. All of these statements provide grounds to treat the response to music as a form of expression of emotions, expression of internal experiences at the given moment. On the other hand, a specific choice of pieces of music used in GIM programmes is focused on the emotional component of music. Classical music, which is used to create practically all GIM music programmes, thanks to its richness, changeability, and emotional flavour, allows us to expect the same in the listener’s response and offers hope for the highest emotional stimulation for eliciting a higher emotional expression. In GIM, music is different and has other purposes than the music used for relaxation or music imagery, whose task is to lead to relief. The pace of music in GIM is more changeable, and it is richer in terms of its sound, harmony, and dynamics. It is a much better stimulant of the nervous system, and as such elicits emotions that are managed by it. Moreover, during a GIM session, music not only elicits imagery, but it also strengthens experiences and stimulates them to develop and evolve (Goldberg, 2002). As such, music - like imagery - might play a double role in therapy. Surely, it is an emotional stimulus that elicits emotions, and on the other hand it is related to expressing emotions, it allows us to communicate these emotions. Langer de88

Emotional Expression in Music Therapy Using Guided Imagery and Music

fines it as a sort of “language without words”, noting that, in a sense, it overlooks the language. Because its expression might take forms that are not accessible to ­language, it might also serve as a symbol of emotional experience (Langer, 1976, pp. 232-233). Goldberg (2007) made an accurate observation, stating that the most important function of music is the fact that it might be authentic with respect to emotions in a way that language cannot be. It is a consequence of its specific nature, which allows music to capture the ambivalence of the contents that the words cannot express, where you are lost for words.

Expressing Emotions Through Imagery

Imagery might be a manifestation of emotional expression. It might be noted that expression by means of creative forms frequently exceeds the awareness of emotions itself. In other words, we can frequently express more through a medium like the arts than we are consciously aware of (Lusebrink, 1990). There was a reason for what Claude Debussy wrote that music begins where words end. Imagery, as a means of expression and representation, has a sequence of cognitive levels and a depth of emotional experience. A visual image has multiple layers and has its own formal elements and its own syntax. Internal images emphasize space, while their layout and course might represent the internal, subjective experience. In the latter case, the flow of images changes along with the emotions associated with these images, as in daydreams and dreams (Klinger, 1971). In the case of imagination-based therapeutic techniques, it must be emphasized that the notion of “imagery” is more than an “image”. The elicited imagery might be visual, kinaesthetic, olfactory, and as such, might refer to each of the senses. Quite often they are deprived of images—they are sensations. The sensation/feeling of floating in the air or being crushed down to the ground might be experienced by the client in a much more emotional manner than an analogous image. It must be remembered that emotions may be expressed by images in the GIM session. The contents, the representation of the images, is a carrier of conscious (or more frequently subconscious) emotions. It is difficult to clearly state whether the given emotion is triggered directly by music, image, or any other factor. Similarly, all these factors affect each other, leading to the shaping of the direction and dynamics of the emotions experienced. According to Meyer (1974), the first imagery is triggered by music, but subsequent images are more related to that first image than the music. On the other hand, it must be noted that the ambivalence and nonspecific character of music offer the ability to experience different emotions, create different images. 89

K rzysztof S ta c hyra

While stimulating the ANS, music might trigger conscious or subconscious emotions that elicit images or sequence of images. In field theory according to Goldberg (2002, p. 363), emotions are a result of stimulation of the autonomic nervous system by music. The conscious or subconscious emotions elicit images, which in turn might serve as the basis for creating subsequent images. Another piece of music might elicit different emotions that might affect the modification of the given imagery or the creation of a completely new internal image. This process is repeated multiple times during one session. Therefore, you might say that in music therapy according to the Guided Imagery and Music method the emotional expression basis takes the form of internal experiences of the client elicited by the music. In the music journey stage, emotions are expressed by the client both verbally and nonverbally. They are visible in the facial expressions, positions, and movements of the body and in the strength and timbre of the voice. Each person has their own manner of experiencing—some people express what they feel verbally practically all the time, others speak little and show little, too. The fact that a session participant is experiencing intense emotions at a given moment might be noticed by observing the tension in the body, skin colour, eye movement, or pulse (usually clearly visible on the carotid artery). Sometimes certain clients experience the so-called “peak experience”, a sort of catharsis, euphoric, mystical experience, defined by Maslow as the sensation of awe, elation, rapture, or ecstasy. It is the moment of the peak happiness and satisfaction, an overcoming experience of your own identity and the full scope of their being, or a therapeutic or intellectual insight (Maslow, 1968). This experience, though holistic, is internally focused – at the time the session participant usually does not speak, as the experience is so intense that they experience it with all they have and are not able to express it verbally. Tears are frequently visible in their eyes. The strength of this experience is huge enough that even talking about it in a postlude stage is very emotional for the client. Usually, clients say that they are at a loss for words when they try to describe the experience. Then, creative activities might serve as a “back door” for expression. Despite the fact that the central stage of the session is the music journey, when the highest number of images and emotions appear thanks to the stimulation with music, it would be a mistake to state that emotional expression is limited to that stage only. In the course of therapy, the idea is for the emotional expression to lead to the patient’s understanding of their own emotions, which is facilitated by the last stage of the session—the postlude.

90

Emotional Expression in Music Therapy Using Guided Imagery and Music

Expression and Integration

The final stage of a GIM session offers the participant a wide range of emotional expression channels. It is intended to facilitate the “transfer” and strengthening of the internal experiences from the music journey in the consciousness. This stage might be defined as a bridge between internal experiences and everyday functioning. Talking, writing, improvising, vocal or moving expression, or doing an artistic piece helps to integrate the right and left hemispheres, and to gain insight. The above happens with the help of the accepting approach of the therapist, who tries not to offer any interpretations. Undoubtedly, one of the forms of emotional expression most frequently used in the postlude and also to integrate the experiences from the music journey is drawing/painting. This activity is usually based on a mandala. For the majority of session participants, this form is a natural continuation of the experiences from the music journey, it also sometimes serves as closure and a way to the stand-by mode. The client receives a piece of paper with a circle drawn in the middle. The client is tasked to draw, paint what they are feeling, or to colour the paper as they see fit. The client does not need to fit the drawing/painting within the circle; they may use it as the base for their creative expression. Examples of mandalas drawn by clients as a part of GIM sessions/experiences are shown in Figure 1.

91

K rzysztof S ta c hyra

Figure 1. Examples of mandalas created during the session or under GIM experience1

For many ages, the Tibetan mandala has been used as a visual aid in meditation and in spiritual discovery. It is important to note that mandalas are drawn in a circle, as a circle is a reflection of your self as a framework space, while formal elements such as shapes and colours “are individual in nature, and colouring the circle or going beyond it are both an expression and a projection” (Popek, 2001, p. 177). It is natural and it happens irrespective of the cultural origins – children from all cultures all over the world begin to draw circles, and they used them to create their surroundings, which is not a learnt skill and is spontaneous (Popek, 2001). S. Fincher, the author of a book that is frequently consulted by GIM therapists, Creating Mandalas for Insight, Healing, and Expression (1991), says that a mandala drawn by an individual represents a monad, being that person and their world. In this way, a mandala becomes not only an emotional expression, but it might be treated more comprehensively as a representation of a part of the patient’s psyche. Based on a similar principle, S. G. Jung made an attempt to systematize the symbolism behind the mandala. Four basic categories of symbolism of the mandala based on the research and drawings by Jung may be distinguished: – Basic symbolism, – Other structural motifs, – Symbolism of colours, – Other motifs. (Sikora, 2006, p. 77) From a therapeutic point of view, drawing a mandala has two primary purposes: to enable the client to find (create) a specific representation / interpretation of non-verbal elements of the music experience, and to give the client the ability to 1

Mandalas (originally in colour) come from real-life GIM sessions conducted by the author. Only the last one comes from the article by Cindybet Perez-Martinez titled “The Bonny Method of Guided Music Imagery – Osobista Podróż” published at www.arteterapia.pl

92

Emotional Expression in Music Therapy Using Guided Imagery and Music

go through an easy and pleasant return back to the normal state of mind (Bonny & Kellogg, 2002, p. 208). The therapist is tasked with observing the colours, shapes, and ways of filling the space selected by the client. Colours serve as an expression of emotions, a form of expressing the current condition of the session participant (Fincher, 1991). In more difficult cases, a therapist might ask for painting specific sensations that appeared during the sessions, both positive and negative. Negative sensations might be used to open the blocked, suppressed contents. Positive sensations might serve as the basis for strengthening the client, for giving him or her support, the feeling of safety, the distance that is needed to deal with difficult matters. Moreover, expressing emotions, describing experiences and images, frequently using metaphors, allows us to reach and touch upon the issues that could have been left untouched in a direct discussion, for example due to a weak ego of the client. The metaphors included in words, images, or music allow us to take the necessary steps back. Looking at the individual forms of expression used in GIM, it seems that each of them is also a test paper for the current condition of the client. This is the case for dance and movement (Pickett, 1994) or poetry, which are each a reflection, a transfer of emotions on paper. Interestingly, expression in GIM therapy might also be deferred. It means that certain experiences might be reflected upon after some time has passed since the session. Time may mean a few hours, a few days, even a few months. It usually takes the form of dreams, which serve as a continuation or the key to interpreting, understanding the experiences and images from the session. Sometimes, even after a long while, a person sees the need to draw a mandala or to undertake another creative activity (see Perez-Martinez, 2014).

Conclusion

The descriptions of the forms of emotional expression taking place during a music therapy session according to the Guided Imagery and Music method are limited and do not discuss this issue fully. The source of emotions lies first and foremost in the expressions of the client, stimulated by music and images, allowing or facilitating the patient to “dig them up”, that is bring them to the conscious level. It is important to note that a certain problem emerges in the case of methods categorized as receptive music therapy. Expressing emotions means communicating emotions to your surroundings through means that are observable. They are easily accessible in the case of activities where the participant is physically “active,” engages in improvisation or action, not in those where the participant is 93

K rzysztof S ta c hyra

primarily physically passive, lies down, or is in a reclining position, and the processes accompanying the emotions are better hidden. It is difficult to achieve rich expression then, which should not be recognized as the right to treat these forms of music therapy as less emotionally stimulating. This might exactly be the reason why Guided Imagery and Music in its last stage offers the session participants a wide range of non-music creative activities, incorporating different forms of widely-understood arts therapy, which is hardly ever present in other music therapy methods. All these measures have one common goal next to expressing feelings and emotions – that is processing them, expanding consciousness, and shaping the feeling of identity. As Helen Bonny wrote, “healing comes from within, from the expression and exploration of all areas of the self ” (Bonny, 1978, p. 54).

References

Achterberg, J. (1985). Imagery in healing. Boston, MA: Shambala. Bonny, H., & Pahnke, W. (1972). The use of music in psychedelic (LSD) psychotherapy, Journal of Music Therapy, 9(2), 64-87. Bonny, H. L. (1978). The role of taped music programs in the GIM process. GIM monograph #2. Baltimore, MD: ICM Books. Bonny, H. L. (2002). Music consciousness: The evolution of Guided Imagery and Music, Gilsum, NH: Barcelona Publishers. Bonny, H. L., & Kellogg, J. (2002). Guided Imagery and Music (GIM) and the mandala: A case study illustrating an integration of music and art therapies. In H. L. Bonny (Ed.), Music consciousness: The evolution of Guided Imagery and Music (pp. 205-230). Gilsum, NH: Barcelona Publishers. Fincher, S. F. (1991). Creating mandalas for insight, healing, and expression. Boston, MA: Shambhala. Goldberg, F. S. (1992). Images of emotion: The role of emotion in Guided Imagery and Music. Journal of the Association for Music and Imagery, 1, 5-17. Goldberg, F. S. (2002). A holographic field theory model of the Bonny Method of Guided Imagery and Music (BMGIM). In K. E. Bruscia, & D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny Method and beyond (pp. 359-377). Gilsum, NH: Barcelona Publishers. Goldberg, F. (2007). Training materials from first level of training in Guided and Imagery and Music method. Chicago, IL. Kennedy-Moore, E., & Watson, J. C. (1999). Expressing emotion: Myths, realities, and therapeutic strategies. New York – London: The Guilford Press. Klinger, E. (1971). Structure and functions of fantasy. New York: University of Rochester Irving B. Weiner Rochester. Langer, S. K. (1976). Nowy sens filozofii. Warsaw: Państwowy Instytut Wydawniczy. Lusebrink, V. (1990). Imagery and visual expression in therapy. New York: Plenum Press. Maslow, A. H. (1968). Toward a psychology of being. New York: Van Nostrand Reinhold. Meyer, L. B. (1974). Emocja i znaczenie w muzyce. Warsaw: Polskie Wydawnictwo Muzyczne.

94

Emotional Expression in Music Therapy Using Guided Imagery and Music Oatley, K., & Jenkins, J. M. (2003). Zrozumieć emocje. (J. Suchecki, Trans.). Warsaw: Wydawnictwo Naukowe PWN. Perez-Martinez, C. (2014). The Bonny Method of guided music imagery – Osobista Podróż. Retrieved from http://arteterapia.pl/the-bonny-method-of-guided-music-imagery-osobista-podroz-cindybet-perez-martinez/ Pickett, E. (1994). Awareness of body sensations and physical movement as part of the Guided Imagery and Music (GIM) experience. Journal of the Association for Music and Imagery, 3, 95-103. Popek, S. (2001). Barwy i psychika. Lublin: Wydawnictwo Uniwersytetu Marii CurieSkłodowskiej. Rugenstein, L. (2000). Music as a vehicle for inner exploration: The Bonny Method of Guided Imagery and Music (GIM). Guidance & Counseling, 3, 23–28. Sikora, K. (2006). Mandala według Carla Gustawa Junga. Kraków: Wydawnictwo Uniwersytetu Jagiellońskiego. Sloboda, J. A. (2005). Empirical studies of emotional response to music. In Exploring the musical mind: Cognition, emotion, ability, function (pp. 203-214). Oxford: Oxford University Press. Stachyra, K. (2012). Guided Imagery and Music. In K. Stachyra (Ed.), Modele, metody i podejścia w muzykoterapii (pp. 33-50). Lublin: Wydawnictwo Uniwersytetu Marii Curie-Skłodowskiej. Taylor, D. B. (1973). Subject responses to precategorized stimulative and sedative music. Journal of Music Therapy, 10(2), 86-94. Ventre, M., & McKinney, C. H. (2015). The Bonny Method of Guided Imagery and Music. In B. L. Wheeler (Ed.), Music therapy handbook (pp. 196-205). New York – London: The Guilford Press.

95

Songwriting: A Vehicle for Expressing Emotions Felicity Baker

Introduction

Throughout the ages, songs have been used as a vehicle to express emotion. The lyrics tell stories and the melody and musical accompaniment express the emotions associated with these stories. Readers will be most familiar with popular songs focusing on relationships whether these are about relationship loss or passionate longing. Songs are also known to communicate personal or collective struggles associated with oppression, displacement, abuse, sexual or racial discrimination, homelessness, domestic violence, or overcoming drug addiction. For example, many Hip-Hop songs are authentic reports of the difficult lives many African American communities experience (Tyson, Konstantin, Detchkov, Eastwood, Carver, & Sehr, 2012). Therapeutic songwriting has been defined as “the process of creating, notating and/or recording lyrics and music by the client or clients and therapist within a therapeutic relationship to address psychosocial, emotional, cognitive and communication needs of the client” (Baker & Wigram, 2005, p. 16). This use of songwriting as a tool to tell stories and express emotions in a therapy context is a much newer phenomenon and has only recently emerged as a powerful music therapy method. For example, pre 1990, there were only two publications describing its use in the clinical field (Ficken, 1976; Freed, 1987). By the mid-2000s, clinicians and researchers reported a much larger uptake of the method (Baker, Wigram, Stott, & McFerran, 2008, 2009) and now there is a growing interest in researching its utility as a therapy method by several researchers including myself (e.g., Baker, Rickard, Tamplin, & Roddy, 2015), Krout (e.g., 2011), Krüger (e.g., Krüger & Stige, 2014), Viega (e.g., 2015b), and Silverman (e.g., 2012). Its utility

97

F eli c ity B aker

can be attributed to its many strengths, particularly in relation to its capacity to express subtle differences in emotion, which can be revisited (and re-processed) through repeated listening and refining (Baker, 2015a). In this chapter, I will share some of my research findings and clinical cases to illustrate how songwriting can be used as a vehicle for emotional expression during music therapy programs.

Songwriting Models

How a clinician facilitates emotional expression in songwriting is largely dependent upon the model of songwriting the therapist draws on, and the method of songwriting. In my recent research, I constructed a number of models of songwriting that influence the types of emotional expression that emerge during therapy (Baker, 2015a). Built from Bruscia’s (2014) ideas of outcome-oriented, experience-oriented, and ecological-oriented thinking, I constructed models of songwriting that utilised the characteristics of each of these and drilled down to construct ways of thinking about songwriting according to the clinician’s orientation. Outcome-Oriented Songwriting Models Outcome-oriented therapy approaches that are influenced by behavioural, cognitive-behavioural, and neuroscience and learning theories, are present in many clinicians’ therapeutic songwriting programs. In particular, the cognitivebehavioural models of songwriting (songwriting for cognitive restructuring, psychoeducational songwriting, and transtheoretical songwriting), allow for emotional expression to emerge in the songs that are created (Baker, 2015a). Silverman (2011, 2112) is inarguably the best known for using these models, especially the psychoeducational songwriting model, whereby he uses the songwriting process to “educate” people with mental illness about how to manage their symptoms, cope, and live independently. A structured three-verse blues song begins with a verse that expresses their emotional state. The following verses identify negative behaviours that exacerbate their issues and positive behaviours that enable them to cope. The Blues is an appropriate musical genre for this style of work because its form allows for expressing a problem and then resolving it. Within the outcomeoriented approaches, the therapist is considered the “expert” who will use carefully planned songwriting experiences to facilitate the emotional expression and cognitive reframing. Experience-Oriented Songwriting Models Experience oriented approaches to songwriting draw on psychodynamic, humanistic, and positive psychology thinking. Psychodynamic forms of songwriting include free associative songwriting, reality contemplation songwriting, and

98

Songwriting: A Vehicle for Expressing Emotions

songwriting as a transitional object. Embedded in these models are concepts of transference, free-associative thinking, object-relations, self-integration, and the unconscious (Baker, 2015a). For example, in free-associative songwriting, the clinicians recognise that as lyrics (especially metaphors; Thompson, 2009) and music are created, they represent the unconscious, inner-self surfacing and being made conscious through music and lyrics. Unconscious material expressed via metaphors occurs frequently in my current research with young people who have received acquired brain injuries or spinal cord injuries consequential to road traffic accidents. A sample of lyrics include: “But once we step on water, and stand afloat the sea,” “So the Phoenix of Mountain Creek flew from the nest,” and “A fog has descended over my mind.” Davies (2005) described her songwriting models and methods with children and adolescents attending a psychiatric unit and illustrated through case studies how the songwriting process facilitated unconscious inner material to become conscious. The role of music in psychodynamic models of songwriting is particularly important. It serves to weaken censors to allow unconscious fantasies to emerge. My research findings (Baker, 2015b) indicate that clinicians believe music has the capacity to bypass censors and connect to our inner core, in ways that are sometimes beyond our control. Similarly, the music created to accompany the lyrics can symbolically express latent material increasing the potential for the emotions to become conscious. The music also has the capacity to express juxtapositions of order and chaos in ways that the lyrics alone cannot achieve. For example, sometimes the lyrics communicate one emotion but the music can express a conflicting emotion. This is particularly useful if the songwriter is feeling ambivalent about what the lyrics are actually communicating. Finally, the music of the songs created provides structure, holding, containment, grounding, and opportunities for play as needed to achieve the therapeutic aims. For those clinicians who subscribe to object-relations theory, the song created during therapy may be considered a transitional object (Baker, 2013). In the same way a blanket or soft toy is used by children as a transitional object during key developmental periods, songs created in therapy can also function as a transitional object between therapy sessions. Because the song is crafted over time, the songwriter becomes increasingly familiar with it, and the song transforms into a tool that can assist the songwriter to manage his or her anxiety outside of the therapy program. One clinician asserts that when the song is played outside of her therapy sessions, it functions as “a voice in his treatment from day to day rather than once or twice a week for 30 minutes” (Baker, 2013, p. 44).

99

F eli c ity B aker

Humanistic models of songwriting are currently the most commonly used in clinical practice. Essentially the songwriting process facilitates the expression of “here and now” feelings, allows for self-actualisation and expression of the authentic self to be translated into a song, to enable people to process and re-process their responses to painful experiences, and to build self-esteem, resilience, and have self-acceptance (Baker, 2015a). The therapist facilitates a lyric and music creation process that enables the songwriters to create meaning from the songwriting process. In insight-oriented songwriting, by crafting lyrics and music, the songwriters think, rethink, re-know, re-feel, and gain insight into their feelings (Baker, 2015a). As they refine their songs, they will look critically at their lyrics with the therapist probing them to consider if this is the most accurate expression of their inner self (both lyrically and musically). In addition, the song product offers further opportunities to revisit the song, re-experience its power, and re-evaluate whether it still holds meaning or whether it is now redundant. In songwriting, it is important to acknowledge that the song expressed emotions that were a synthesis of a therapeutic process that was important at that time, and may no longer be relevant or hold meaning at a later time (Baker, 2013). Narrative songwriting (Tamplin, Baker, Rickard, Roddy, & MacDonald, 2016) focuses on the use of the songwriting process to narrate a person’s story. The verses function to communicate the narrative while the chorus functions to highlight the most salient feeling or emotional expression associated with the narrative (Baker, 2013). There are many examples of the use of narrative songwriting in the literature although never labelled as such. For example Roberts (2006) used various songwriting methods with children and adolescents who were bereaved, to tell their stories. In the strengths-based songwriting model, strengths-based theory is called upon to inform the songwriting practice. The songwriting process aims to have the songwriters recognise and develop their strengths and resources, to develop appropriate coping mechanisms, and to feel empowered. Day, Baker, and Darlington (2009) reported on the use of strengths-based songwriting in a study examining the long-term impact of group songwriting with women who had experienced childhood abuse. The album of songs created by three separate groups of women who participated in original songwriting once per week for 12-weeks, described the individual and collective experiences of these women’s previous abuse and their journey towards healing. The therapist’s role was to facilitate a safe and trusting environment where stories of abuse and of conquering the effects of the abuse were shared and transformed into lyrical ideas. The sense of group support and

100

Songwriting: A Vehicle for Expressing Emotions

shared understandings of the impact of their abuse were the binding elements of the strengths-based approach. Another model of experience-oriented songwriting is that developed by Iliya (2015) called sung imaginal dialogue. This model of songwriting reflects the Gestalt therapy approach known as the empty chair technique. In Iliya’s model, the songwriter sits in a chair opposite a second but empty chair (which represents the person the songwriter wants to personally address), and sings his or her communication to the empty chair. After processing this experience, the songwriter then moves to sit in the other chair, and then sings back to the now other vacant chair as if he or she is the person not currently present. Iliya (2015) used this model of songwriting with people who were recently bereaved. The songwriter was first singing to the deceased person, communicating whatever he or she wished. Following this, the songwriter sat in the other chair, and then sang to the empty chair, this time as if speaking from the point of view of the deceased person. The music created during humanistic models of songwriting plays a distinctly different role to that of psychodynamic models of songwriting. In humanistic songwriting models, the music serves to enable the songwriter to express his or her authentic self. More specifically it provides a means to express individual or collective identity which boosts and sense of empowerment. Creating a song that is aesthetically acceptable to the songwriter and well produced offers opportunities for experiencing pride and receiving recognition from a broader audience. Songwriting is a “skill” that attracts public recognition. In contexts where songwriters may be failing at many other daily tasks, such accomplishment and pride in the creation of a good song is a source of importance in their therapeutic journey. Context-Oriented Models of Songwriting Context-oriented models of songwriting have emerged from those practicing within Community Music Therapy, Feminist Music Therapy, and Resource-Oriented Music Therapy frameworks. Beginning with feminist songwriting models, the main emphasis is to enable the songwriters to feel empowered and to voice their experiences of feeling silenced, abused, discriminated, disempowered, and marginalised. Equally important, the therapist’s role is to facilitate the creation of lyrics and music that assist the songwriters to identify, understand, and later reflect and replace faulty internalised messages. The role of songwriting is to give voice to the internalised messages and give voice to that which was previously silenced (Baker, 2015a). Much the same way as narrative songwriting models propose, feminist models of songwriting promote the songwriters telling their stories, authentically express their emotions, or share experiences of oppression, as well as providing an opportunity to present actions that may enable them to be freed 101

F eli c ity B aker

from the oppression. There is a certain sense of feeling empowered when you put words and music to the feelings of oppression you are experiencing. The songs created during the feminist models of songwriting process have the potential to function as political activism. One example was relayed to me by an Australian music therapy colleague who told me how some of her adolescent and young male clients on the autism spectrum had created songs that communicated messages to others managing their care. The messages could be summed up as a statement that tells the autism specialists to “stop making assumptions about what people with autism feel and need, and that it would be more beneficial to ask them directly” (Baker, 2015a, p. 247). This is somewhat akin to the disability activism slogan “nothing about us without us.” To effectively facilitate self-expression in songwriting, the therapist fosters an egalitarian relationship and creates a therapeutic presence that “supports, validates, and respects” (Baker, 2015a, p. 279) the songwriters’ contributions. Although being authentic in their expression and needing to express pain in the song content, where possible (and appropriate), the therapist will challenge the songwriters about faulty internal messages and guide them to embed positive statements into the songs lyrics and advocate for equality. The music in these songs serves to heighten the emotional content of the lyrics or to convey the tension and struggles between the songwriter’s views and that of society. Songwriting models within the Community Music Therapy frameworks are based on overarching principles. Within the model, songwriting methods are framed as influencing perspectives, participatory, collaborative (rather than expert driven), resource-oriented, ecological, performative, culture-centred, and have socio-political and empowerment aims (Baker, 2015a). Songwriting becomes a focus for achieving several aims including gaining mastery of songwriting as a craft, provides a context for musicking, enables the development of musical, individual, and social skills, it directly offers a relevant activity for collaboration, and it can address social action and societal attitudes and assumptions. O’Grady (2009) illustrates how she combined feminist songwriting models within Community Music Therapy frameworks while creating songs with women who were incarcerated. While from a feminist perspective, the songs enabled the women a vehicle to express their oppression, share their emotions about their context, and embed positive actions for change, it also provided opportunities for the women to bond with each other and bridge with the outside world (Putnam, 2000). For example they performed their songs to family and to relevant stakeholders including government representatives and health professionals. This “bridging” enabled the outside world to have a small window into these young 102

Songwriting: A Vehicle for Expressing Emotions

women’s lives, promoting a better understanding of their experiences but also to witness their positive and creative contributions. The last context-oriented songwriting model is that of resource-oriented music therapy (ROMT), an approach developed by Rolvsjord (2010). This songwriting model shares many tenets with experience-oriented models of songwriting (namely narrative songwriting, strengths-based songwriting, but in addition, takes into consideration the context of the songwriter. Further, there is more of an emphasis on collaboration, and equal and mutual relationships. Another defining feature of songwriting within ROMT is the notion that the song can have aesthetic social value. In other words, it’s not just about the process of creating the song, but the product should have inherent meaning and social value (Baker, 2015). The role of the therapist in this approach is varied and may take on the form as a guide (to enable the songwriter to identify his/her own strengths and resources), a fan, a supportive listener, a collaborator, and a music producer (Viega, 2015a). In more music-oriented approaches used by Viega, the therapist helps the songwriter to “shape” his or her individual sound, with the music production process being an integral part of assisting the songwriter to express his or her identity, express emotion, and produce a music product that they can connect with and value.

Songwriting Methods

Methods of songwriting have also been developed into distinctly different methods (Baker, 2015a). Some methods focus on lyric creation as the means to express emotions. These include fill-in-the-blank, song parody, and strategic songwriting, and rapping over pre-composed music where the musical structure including the melody line are fixed prior to the songwriting experience, and its only lyrics that are created by the client. These methods are valuable when a preexisting song expresses the emotion that already resonates with the songwriter’s emotion. So for example, many people (females in particular) identify with the song “I Will Survive,” as an expression of inner strength and a will to overcome adverse situations. As a consequence, it has been used extensively in song parody whereby the phrase “I will survive” is the focus of a songwriter’s story. In a case study by Glassman (1991), a young woman rewrote the lyrics of the song “I Will Survive” as a way to process her response to her trauma and find her place in the world. Similarly, Ledger (2001) presented a case study of an adolescent girl being treated for cancer. In her case, the adolescent used the song to give her the inner strength to fight and “survive” the disease. Another category of songwriting includes methods where emotional expression is conveyed through the original creation of both lyrics and music. One 103

F eli c ity B aker

method in this category is the rapping or singing of lyrics over original music. Within this method, essentially the songwriter will create a set of lyrics and “rap” these over rap music that he or she has created. This can happen in two ways. First, and perhaps most common in the therapeutic setting, is the “asynchronous” approach whereby the therapist will assist the songwriter to craft lyrics and music. Several iterations of lyrics and music may occur as the songwriter “tries out” his or her ideas, and shapes the rap lyrics and music until it expresses the story and emotion he or she intended. Here, the therapist’s role is to provide supportive feedback, prompt, question, assist (particularly musically), be present, and ensure the songwriter is able to translate his or her inner world or externalised feelings into lyrics and music that appropriately express what the songwriter intends. The synchronous approach to rapping over original music draws on psychodynamic principles of “free association.” Sometimes known as “freestyling,” the lyrics of the rap song are rapped in real-time. That means there is no crafting of the lyrics. Instead, the songwriter “raps” in the here-and-now moment. The notion of free association is relevant as this approach attempts to have the songwriter get in touch with his or her inner self. But this does not happen without some preparation. The first step in this method is to create a rap backing-track. The therapist engages the songwriter in discussion and uses this discussion to facilitate the creation of the music. The therapist’s role here is to guide the songwriter and assist him or her to find a (therapeutic) focus for the music. This process serves to “prime” the songwriter, the music assisting him or her to get in contact with the inner self, bring issues to the pre-conscious and potentially conscious mind so that when the rapping in real-time begins, the songwriter can move into flow. It is important to note here, that such free association or freestyling, can be very threatening to those not used to engaging in this type of creative experience. Being able to construct lyrics in such a free-flowing way is by no means a simple task. But when a suitable therapy client presents him or herself to you, it is an extremely effective approach to getting to the heart of the issues and feelings that are negatively impacting his or her life. Song collage is an approach to creating songs that allows a person with cognitive difficulties, to create a song that has personal significance. In this technique, lyrics from pre-existing songs are reviewed by the songwriter, and, as certain lyrics “stand out” to him or her, they are written down (Tamplin, 2006). Later, the therapist assists the songwriter to order the lyrics so that a story or key emotion is expressed. So, as the term collage suggests, there is a collection of lyrics pasted together (sometimes with adaptations and sometimes originally composed lyrics may be added to the set of lyrics) to form a song. Following this, the therapist 104

Songwriting: A Vehicle for Expressing Emotions

assists the songwriter to create music that fits with the lyrics and expresses the songwriter’s emotions and/or identity. This approach to songwriting is particularly effective for people with cognitive issues who for whatever medical reason are unable to generate ideas or their emotional state or story remains in the preconscious and is not yet conscious. As the therapist and songwriter review various lyric sheets (sometimes with the music included to prime emotions and thoughts), the songwriter is able to begin to articulate his or her own experiences. The final categories of songwriting approaches are the ones where the music creation dominates the songwriting process. Here, the music becomes the focus of the emotional expression and the means to express identity. Examples of methods include mash-ups where pre-existing music is layered over other pre-existing music, so called mashed together to create something new. This is akin to the song collage except this involves pasting music together layering it, musically editing it, and creating a sound that resonates and has meaning for the songwriter. Perhaps the most well-known songwriting approach that emphasises music creation as an integral component of the process, is the creation of original songs using known song structures. The most common of these structures is the verse chorus verse chorus structure (sometimes with a bridge or middle 8 placed towards the end of the alternating verse chorus structure). The verse communicates the storyline, while the chorus expresses the key emotion attached to the story. The bridge serves to introduce some tension, which is eventually resolved. This moment of tension can be likened to a moment of ambivalence that may be part of any personal journey. Case Vignette The case study of John will be used to illustrate how songwriting enables people to express themselves emotionally, re-invent themselves, express their identity, and tell their stories. John was a participant in a federally funded randomised control trial that was designed to test the effectiveness of a songwriting program on enhancing the self-concept and wellbeing post brain injury. At the time John was a part of the study, he was a 29-year-old participant who had a hypoxic brain injury following a drug overdose. Although not confirmed, there is good reason to believe that the overdose was a suicide attempt. The songwriting protocol that John received, has been published in detail elsewhere (Tamplin et al., 2016) and is useful if the reader wants to know more specifically how to address songwriting in this context. Over the 12 sessions, the therapist facilitates the songwriting session asking the person with a brain injury to create three songs. The first song was an original song that focused on exploring John’s past self, the second song focused 105

F eli c ity B aker

on exploring John’s present self, and the third song focuses on John creating a song about his imagined future self. Each song takes approximately 4 sessions each to create including making a recording of the song. In the first song titled “Requiem for Innocence,” John describes his past life. The lyrics communicate the story of a difficult childhood, his mother dying when he was young. His father remarried but he found it difficult to connect with his stepmother. He rebelled and described finding solace in his school friends. He later settles into what seems like an unsatisfying career, and then finds his wife. The aesthetics of the music tell us a similar story. Loud distorted guitar is used in the recording, which gives the sense of rebellion he describes. The rough distorted sound matches the childhood he presents. It also expresses his musical identity. The melodic lines of the verses are very monotonal and fall, and almost create a depressive feel. The music does not give the listener the impression he had a happy pre-injury life.

Requiem For Innocence B5                                

Intro





 

B5

     

     

     

                           





     

simile

     

      

Verse

B5

   



  

  

     

          

   



     



Interlude

106





    



    

     

  

   

     

         B5

 

D5



    

E5

 



     

      

  

   





   

F maj(b5)

 

        

     



  

   

                                                     

B5







   



  

B5

    

Interlude





    



     

         

     

   

  

E5

 

  

  





F maj(b5)

 

        

     

  



   

                                                       

    

Chorus

B5





     

       



 

     



        



 







    

 

 

 



        

   

C5



   

B5

 



    

 

      for Expressing   Songwriting:  A Vehicle    Emotions     

     

           

 

    

  

   





    







simile

  

  

 

     





 

D5



  





B5











   





    

Verse 2: Child grows, into a boy Responsibility, tries to avoid Got stability, from his babcia Little did he know, it was all gonna rupture Verse 3: Started to rebel, never gonna end well Found himself when, he got to high school Learning was still, such a hard sell But found that friends, eased the iron rule Verse 4: Started going out, on the weekends Biggest part of life, always was his friends Opened up the gates, to designer consciousness The only way he knew, to deal with feelings he’d repressed Verse 5: Dreams to fly away, to a different place Hard reality, he needed to face Found the means to, pay the way The job he got, he never meant to stay

107

Little did he know, it was all gonna rupture

F eli c ity B aker

Verse 3: Started to rebel, never gonna end well Found himself when, he got to high school Learning was still, such a hard sell But found that friends, eased the iron rule Verse 4: Started going out, on the weekends Biggest part of life, always was his friends Opened up the gates, to designer consciousness The only way he knew, to deal with feelings he’d repressed Verse 5: Dreams to fly away, to a different place Hard reality, he needed to face Found the means to, pay the way The job he got, he never meant to stay Verse 6: Six years later, found his soul mate Happiest he’s been, convinced that it was fate They live together, he wants to settle down Feels contentment, in her arms no need to frown

Figure 1. Requiem For Innocence.

The second song is titled “Contemplations” and is the song about the present self. The lyrics focus on being disappointed in himself, reflecting on how his drug overdose has hurt the people he loves. Later in the song there is a focus on needing to be physically independent, and staying positive. He focuses on his wife Elly and how much he loves her. The lyrics of the chorus are particularly powerful and offer insight into how he sees himself. He feels like a stranger in his own body, he describes it like being in a fog. The recording of the song matches this sense of being in a fog. There is a prominent use of reverb, which muffles the sound, creating a sense of distance and a lack of direction – much like his life. There is also the use of the accompanying feature that has bopping sounds bouncing around (not depicted in this figure), also signifying a lack of direction.

108

Songwriting: A Vehicle for Expressing Emotions

Contemplations                                    

Intro

Verse

C

   

C



  



Em

Em

    



 



F



     

Em               

C

  C





       







           Em

C

         



Am





   

Am











F

   F





F

   

F



  

    

  



   





Am

   



     

        C

       



Am



   

Em

 

   



F



  



        

Am

   

 

Em

C







     

    Chorus

     

Em

F

           

Am

C

      

Am



       

Em

   

  





Am

  

F



109

F eli c ity B aker

C

 C



 

       

Em

  

    

      

Em

        



















 





Am

  



F





F





Am





Verse 1: Sitting here, in my room And thinking about what I have done All the people I’ve hurt, everyone I’ve let down And what I have become Wondering if I will ever feed myself again Creativity’s shot, and humour is gone Chorus: Looking at myself through stranger’s eyes The person looking back at me I barely recognise A fog has descended over my mind Personality dull, words hard to find Verse 2: And I’m dreaming of the day That I’m back in my own bed Years spent in the gym have disappeared Only memories remain Body is weak, but intentions are strong Verse 3: No need to remind myself what I’m doing this for The reason’s so obvious it’s the person I adore She makes all this, a lot less scary She’s the love of my life, my world, my Elly

Figure 2. Contemplations.

His third song about the future, “Back to Life,” is distinctly different in lyrical structure and music. Many of the lyrics express hope and positivity while others express his concern about how difficult life will be. The lyrics convey mixed emotions and inner conflict. This internal struggle is portrayed in the juxtaposition of major keys when lyrically expressing sadness and pain, and minor keys when he lyrically expresses hope and positive emotions. It is like he does not truly believe everything that is being said in his words. The musical accompaniment itself is acoustic with a single picked guitar and voice. It is raw, solemn, and leaves the listener feeling like he has no hope even though the lyrics would imply otherwise.

110

Songwriting: A Vehicle for Expressing Emotions

Back To Life Intro

Am

Dm

&C ’ ’ ’ ’

Verse

Am

&Œ œ œ œ œ œ

When I think a - bout

Am

&ΠChorus



E - ven though

œ œ ˙

has

I

j œ œ œ œ

Look - ing

the

for - ward

made

fu

œ

E

re - main

things don't seem so bleak

to

Œ

me see

œ

œ

-

ture

œ œ œ looks

‰ Jœ œ C

that things

G

œ œ œ

get - ting back

œ œ œ œ J

all the pe - ople

E

Œ

hope - ful

œ J

E

œ œ œ ˙

œ œ œ

Dm

Am

Dm

œ J

’ ’ ’ ’

Œ œ œ œ œ œ œ œœ œ œ ˙

star - ting my new life

œ œ œ

’ ’ ’ ’

Am

E

œ œ œ œ ˙

What I've ben through



F

Dm

j œ œ œ œ

Dm



’ ’ ’ ’

E

œ œ. J

my own

with

my fu - ture wife

Am

œ œ œ œ ˙ J

that

tru - ly love

w

A

me

∑

hard

œ

G/B

will

work

œ.

Am

w

œ J

Am

˙

Ó

out

∑

life

Verse 2: When I think about starting back at work It feels daunting staying focused and alert It will surely put my mind to the test Have to make sure that I get proper rest Verse 3: Gotta join a gym and get back in shape Work on my physique by lifting heavy weights I am determined to run like before Cardio, I just can’t ignore

Figure 3. Back to Life.

This case vignette of John illustrates how lyrics and music can represent his journey towards building a new sense of self post-injury. By guiding John to explore different aspects of his self-concept – his family self, physical self, moral self, etc. – the songwriting experience became the vehicle for him to tell his story and for the music to convey the emotions associated with his story. The songs were

111

F eli c ity B aker

created using three different genres of music which enabled him to capture his experiences of transition to a world where he has acquired a permanent disability.

References

Baker, F. A. (2013). The ongoing life of participant-composed songs within and beyond the clinical setting. Musicae Scientiae, 17(1), 40–56. doi:10.1177/1029864912471674 Baker, F. A. (2015a). Therapeutic songwriting: Developments in theory, methods, and practice. London: Palgrave Macmillan. Baker, F. A. (2015b). What about the music? Music therapists’ perspectives of the role of music in the therapeutic songwriting process. Psychology of Music, 43(1), 122-139. First published online 4 October 2013. doi:10.1177/0305735613498919 Baker, F. A., Rickard, N., Tamplin, J., & Roddy, C. (2015). Flow and meaningfulness as mechanisms of change in self-concept and wellbeing following a songwriting intervention for people in the early phase of neurorehabilitation. Frontiers in Human Neuroscience, 9, 299. doi:10.3389/ fnhum.2015.00299. Baker, F., & Wigram, T. (Eds.). (2005). Song writing methods, techniques and clinical applications for music therapy clinicians, educators and students. London: Jessica Kingsley. Baker, F., Wigram, T., Stott, D., & McFerran, K. (2008). Therapeutic songwriting in music therapy: Part 1. Who are the therapists, who are the clients, and why is songwriting used? Nordic Journal of Music Therapy, 17(2), 105-123. Baker, F., Wigram, T., Stott, D., & McFerran, K. (2009). Therapeutic songwriting in music therapy: Comparing the literature with practice across diverse populations. Nordic Journal of Music Therapy, 18(1), 32-56. Bruscia, K. (2014). Defining music therapy. Gilsum, NH: Barcelona Publishers. Davies, E. (2005). You ask me why I’m singing: Song-creating with children and parents in child and family psychiatry. In F. A. Baker & T. Wigram (Eds), Song writing methods, techniques and clinical applications for music therapy clinicians, educators and students (pp. 47-70). London: Jessica Kingsley. Day, T., Baker, F., & Darlington, Y. (2009). Beyond the therapy room: Women’s experiences of “going public” with song creations. British Journal of Music Therapy, 23(1), 19-26. Ficken, T. (1976). The use of songwriting in a psychiatric setting. Journal of Music Therapy, 13(4), 163–172. Freed, B. S. (1987). Songwriting with the chemically dependent. Music Therapy Perspectives, 4, 13–18. Glassman, L. (1991). Music therapy and bibliotherapy in the rehabilitation of traumatic brain injury: case study. Arts in Psychotherapy, 19(2), 149-156. Iliya, Y. A. (2015). Music therapy as grief therapy for adults with mental illness and complicated grief. Death Studies, 39(3), 173–184. doi:10.1080/07481187.2014.946623 Krüger, V., & Stige, B. (2014). Between rights and realities – Music as a structuring resource in child welfare everyday life: A qualitative study. Nordic Journal of Music Therapy. First published online 5 March 2014. doi:10.1080/08098131. 2014.890242 Ledger, A. (2001) Song parody for adolescents with cancer. The Australian Journal of Music Therapy, 12, 21-28.

112

Songwriting: A Vehicle for Expressing Emotions O’Grady, L. (2009). Therapeutic potentials of creating and performing music with women in prison: A qualitative case study (Unpublished doctoral dissertation). The University of Melbourne. Melbourne, Australia. Putnam, R. D. (2000). Bowling alone. New York: Simon and Schuster. Roberts, M. (2006). I want to play and sing my story: Home-based songwriting for bereaved children and adolescents. Australian Journal of Music Therapy, 17, 18–34. Rolvsjord, R. (2010). Resource-Oriented Music Therapy in mental health care. Gilsum, NH: Barcelona Publishers. Silverman, M. J. (2011). The effect of songwriting on knowledge of coping skills and working alliance in psychiatric patients: A randomized clinical effectiveness study. Journal of Music Therapy, 48(1), 103–122. Silverman, M. J. (2012). Effects of group songwriting on depression and quality of life in acute psychiatric inpatients: A randomized three group effectiveness study. Nordic Journal of Music Therapy, 22(2), 131–148. doi:10.1080/08098131.2012.709268 Tamplin, J. (2006). Song collage technique: A new approach to songwriting. Nordic Journal of Music Therapy, 15(2), 177–190. Tamplin, J., Baker, F. A., Rickard, N., Roddy, C,, & MacDonald, R. (2016). A theoretical framework and therapeutic songwriting protocol to promote integration of self-concept in people with acquired neurological injuries. Nordic Journal of Music Therapy, 25(2), 111-133. doi.10.10 80/08098131.2015.1011208 Thompson, S. (2009). Themes and metaphors in songwriting with clients participating in a psychiatric rehabilitation program. Music Therapy Perspectives, 27(1), 4–10. Tyson, E. H., Detchkov, K., Eastwood, E., Carver, A., & Sehr, A. (2012). Therapeutically and socially relevant themes in Hip-Hop music: A comprehensive analysis of a selected sample of songs. In S. Hadley & G. Yancy (Eds.). Therapeutic uses of rap and hip-hop (pp. 99-114). New York: Routledge. Viega, M. (2015). Working with the negatives to make a better picture: Exploring hip-hop songs in pediatric rehabilitation. In C. Dileo (Ed.), Advanced practice in medical music therapy: Case reports (pp. 46-61). Cherry Hill, NJ: Jeffrey Books. Viega, M. (2015). Performing “Rising from the Ashes:” Arts-based research results from the study “Loving me and my butterfly wings: An analysis of Hip Hop songs written by adolescents in music therapy.” Music Therapy Perspectives. Advance online publication. doi:10.1093/mtp/ miv044

113

Emotional Expression in Family Music Therapy Amelia Oldfield

Introduction

I have worked as a music therapist with children and their families for almost 30 years. I first presented some initial reflections on this subject in 1992 and a chapter based on the presentation was published soon afterwards (Oldfield, 1993). In the beginning, many colleagues were dubious about working with both the child and the parent in the room, and I am still asked the question about how I manage to meet the needs of both the parent and the child, when I present this work at conferences today. Nevertheless, in the last 10 years the interest in this work has ‘exploded’ as many music therapists across the world have researched and written about this topic. By 2008 in a first textbook on this subject ten different music therapists in the UK described a variety of approaches to music therapy with children and their families (Oldfield & Flower, 2008). A few years later another book by Edwards (2011) similarly gathered together accounts by different music therapists working with families, but focused more specifically on younger children and parent-infant bonding and included music therapists from Ireland, Australia, and the USA as well as the UK. A new, more theoretical book outlining different models of music therapy work with families is planned by Jacobsen and Thomson (in press) which will include music therapy authors from all over the world. I have also attempted to give a shorter overview of different types of family approaches in music therapy with young children in a recently published generic music therapy book (Oldfield, 2016).

115

A melia O ldfield

The Settings I Work In I am currently involved in two different types of clinical family music therapy: long-term (1 to 2 years of weekly sessions) work with young pre-school children with developmental difficulties and their parents referred from an out-patient child development centre; and short-term (two to eight sessions) work in a child and family residential psychiatric unit. In this chapter I will give examples from sessions in both these areas of work. Most of the children referred from the child development centre are of preschool age (between 3 and 5 years old) and come especially for weekly outpatient music therapy sessions usually with their mother but sometimes with their father, a grandparent or a nanny, or any combination of these. Younger siblings sometimes join in the sessions as do brothers and sisters during the school holidays. Many of the children referred will have autism, and / or learning disabilities or may have physical disabilities or emotional problems. Parents take part in the sessions, and I take time at the end of each session to talk to the accompanying adults while I provide toys for the child to play with during this review. I also liaise with other members of the multi-disciplinary team that might be working with the family, and will often invite physiotherapists (for example) to attend sessions and give me advice when working with physically disabled children. The music therapy work in child and family psychiatry occurs in the same building as the residential unit attended by the families. Six to eight families are admitted residentially between Monday and Friday, usually for a period of 8 weeks but sometimes for a little longer. The children referred are between the ages of 6 and 13, will mostly have attended mainstream school, and may have diagnoses such as high functioning autism, hyperactivity, obsessive compulsive disorders, depression and eating disorders. However, the majority of the children have complex difficulties and some symptoms from many different psychiatric disorders. The parents, siblings, and relatives frequently also have their own psychiatric difficulties and may have suffered from abuse or trauma as children or adults. There are often attachment difficulties between parents and children, and some families may be very deprived and might be struggling with financial and housing issues. The team consists of psychiatric nurses, psychiatrists, a clinical psychologist, a psychotherapist, family therapists, a music therapist, a social worker, a housekeeper and administrative staff. We all work very closely together, attending daily hand-over meetings and discussing each of the families at a three-hour management meeting every week. 116

Emotional Expression in Family Music Therapy

My Music Therapy Approach In my work as a music therapist I use live, and mainly improvised music to achieve non-musical aims. I play the clarinet, the piano, percussion and the guitar, and sing and move with the children. The children and the families also sing and move, as well as playing percussion, guitar, piano and simple blowing instruments. My music therapy approach was initially influenced by Alvin (1975) and Nordoff and Robbins (1977) and later I became aware of the parallels between interactions in my music therapy interactive improvisations and the mother and baby early babbling exchanges described by Stern (1987). Bowlby’s (1988) attachment theories also often appear important and relevant to processes occurring in my music therapy sessions, and the links between Winnicott’s thinking and music therapy practice have been described in detail by Levinge (2015) and equally inform my work. In addition, I have a deliberately positive stance, consciously focusing and highlighting the strengths of the children and the parents I work with. Through building on these strengths and celebrating these, difficulties can then be addressed. I have outlined my music therapy approach both in a child development centre and in a unit for child and family psychiatry in more detail in two books (Oldfield 2006a, 2006b).

Emotional Expression

When trying to think about ‘emotional expression’ in my music therapy work with families, one challenge is that nearly all my interactions and musical improvisations could be described as forms of emotional expression. Indeed the general topic of music therapy, the very idea of helping people overcome difficulties through live improvised musical interactions will often bring tears to the eyes of non-music therapy specialists. Perhaps this is because music itself is often associated with the expression of emotion. We expect a sad song to bring tears to our eyes, we will feel part of a united crowd by singing football songs, and we are not surprised by ecstatic expression in pop-concert audiences. In my clinical musical therapy improvisations I think of two extremes: music as a way of holding and calming, and music as a means to energise and motivate. In most sessions the emotional effects of the music made will fall between these two poles, or move from one to the other, usually gradually but sometimes quite suddenly. Similarly the concept of working jointly with parents and children is an emotive subject, and audiences are often moved when I show DVD excerpts of parents and children working together in music therapy sessions. This could be because we have all been children with mothers ourselves and many of us will also be parents, and so we easily identify with the relationship between a parent and a child. 117

A melia O ldfield

So I have decided to tackle this subject through focusing on specific techniques I use in my music therapy work with children and their families and reflect on the emotional content of the work in relation to these techniques. I will use short case study vignettes to illustrate my points. Hello Song Hello songs, greeting music or warm-up activities are used by many music therapists particularly those working with children. Nordoff and Robbins (1977) describe a ‘Good morning’ song alternating with improvisation which they use to greet and reassure a disabled young girl who is entering the music therapy room. Elefant (2011) explains that when working with a little girl with Rett syndrome she uses the same greeting song at every session but changes the words according to her client’s responses. LaGasse (2011) describes a case where she is developing speech through music and how she uses a welcome song to emphasise the use of common greeting phrases. In Darnley-Smith and Patey (2003), a music therapist sings a ‘Hello’ song which is improvised to match the mood of a very distressed little girl. She echoes the rhythms, energy and pitch of the child’s movements and distressed vocal sounds. She writes: “Her screams subside…. and she recognises the intensity of her emotions reflected in the music” (p. 90). When working with 4-year-old Miles who has autism and learning disabilities and his mother, I invite him to sit down on a small chair next to his mother, placed in the same part of the room. I then sit down on the floor with my guitar opposite them both. Both Miles and his mother have been attending weekly sessions with me for 3 months, so they are both used to this routine. As soon as I start playing my familiar ‘Hello’ song he looks at me and smiles, recognising and reassured by the tune and perhaps associating it with a weekly activity he generally enjoys. I can also feel his mother relaxing from the effort of getting Miles up, into the car, and to the music therapy session. For her it is important to share a positive moment with her son where she can enjoy his pleasure in the music rather than worry about aspects of development which are not matching up to his peers. Like Elefant (2011) I then modify the words of the song to describe Miles’ excited rocking and vocal sounds, keeping the original chord structure. I also sing about how Miles and his mother have come to music together to emphasise the shared nature of the session. I then incorporate a turn-taking structure into the song where he and his mother are alternately offered the guitar to strum. After a few exchanges I pause expectantly as I’m about to offer the guitar to one of them and Miles says “Mummy” telling me she should play next. Miles’ mother is delighted as he has only just started using a few words. Here I am using the song in a similar way to LaGasse (2011), to encourage Miles to use speech. Perhaps the 118

Emotional Expression in Family Music Therapy

predictable and nurturing nature of the ‘Hello’ song enabled both Miles and his mother to relax and feel cared for. This then allowed Miles to engage with us and say “Mummy.” Nine-year-old Charlie and his mother, Sharon, came to just four joint music therapy sessions with a view to giving them both a chance to have some positive time together. Charlie, his older brother Richard and their single mother, Sharon, had been admitted to the child and family residential psychiatric unit for 6 weeks mainly because of Richard’s aggressive and difficult behaviours but also because Charlie was presenting with symptoms of depression. Richard’s violent behaviours not only frightened Charlie but also meant that he very rarely had time on his own with his mother, and when he did she was usually too exhausted and drained to play him much attention. A few bars after I started singing the ‘Hello’ song to Charlie and Sharon, Charlie leant towards his mother and put his head on her shoulder. She then put her arm around him, and the song soon became a ‘hugging’ song and an opportunity for mother and son to physically express their feelings for one another. For other families the ‘Hello’ song may feel a bit strange and embarrassing. I will often introduce the song by saying that this is an unusual thing I do, many people think it is funny and it is OK to laugh. I sometimes exaggerate phrases and sing in a light hearted way, making a joke of it and laughing myself. This enables children and their parents to giggle, releases tension, and helps the children and the parents to relax and become playful. It also shows that although I am the musician and I have a caring stance, I am playful and can laugh at myself, all of which, hopefully, makes it easier to establish a trusting relationship between the families and myself. Expressing Feelings Through Spontaneous Musical Improvisation The image of a child letting off steam by energetically playing the drum while the music therapist supports the playing at the keyboard, is perhaps one of the most familiar improvisational music therapy scenarios. Juliette Alvin (1975) writes about the importance of working off strong emotions through music, and there is a picture of a young boy playing the drum while Paul Nordoff accompanies him on the piano on the cover of one of Nordoff and Robbins books (1985). More recently many music therapists have written case studies where feelings are expressed through clients and music therapists improvising together (e.g., Brackley, 2012; Derrington, 2012). Other music therapists have described work where the child may not be playing themselves but where the music therapist attempts to match the child’s feelings and movements through playing. For example, Carpente (2011) tried to musically meet the intensity of a little boy’s crying and Old119

A melia O ldfield

field (2006a) matches a child’s movements and energetic mood, through moving herself, singing and playing the clarinet. Ten-year-old Anna, her 4-year-old younger brother and her mother, Olivia, were admitted to the unit because of Anna’s difficult behaviours and symptoms of depression. Olivia wondered whether her daughter had attention deficit disorder and/or autism. After a couple of weeks the psychiatric team felt that the problems stemmed more from an attachment disorder than from a neurological problem and were possibly related to the fact that Olivia had had a very difficult childhood herself. In my first two individual music therapy assessment sessions it was immediately clear that Anna loved music making, was naturally musical and particularly liked singing. She had dreams of taking part in a singing competition on television. We decided to offer Anna and Olivia four joint weekly music therapy sessions with a view to boosting Anna’s self-esteem (but not building up unrealistic musical aims), giving them both a chance to express feelings of anger and frustration through free improvisations, and helping them to feel relaxed and at ease together through nonverbal musical exchanges. They both seemed to enjoy their first music therapy session together. Anna’s musical confidence and ability to improvise freely impressed and inspired her mother and enabled her to take part in a similar way. Anna was pleased to ‘show off’ in a healthy way and Olivia relished the opportunity to enjoy her daughter’s creativity rather than be completely caught up with anxiety about Anna’s difficult behaviours. When I went to get Olivia for their second session she was in floods of tears. She had just had a long family therapy session where she had talked about the sexual abuse she had suffered from her stepfather. She remembered feeling angry and powerless that her mother had not believed her or protected her. I asked her whether she would prefer to put the music therapy session off until later and she became animated saying with humour and determination, “no… just bring on that drum-kit – I can’t wait…” Anna, who had not been present in the family therapy session but could see that her mum was upset, looked worried. I reassured her saying that grown-ups could also let off steam on the instruments. I offered them both large drums and cymbals and went to the piano myself so I could match, contain and hold the energetic playing. The playing was very loud for about three or four minutes, but did not feel chaotic, mainly because of Anna’s strong regular pulse, which I supported on the keyboard. Gradually some turn-taking exchanges immerged with Olivia playing a short phrase which Anna and I both mirrored. Olivia needed a safe place to express her anger and Anna was pleased to be able to support her mother rather than always being the one who needed help herself. When reviewing the session later with Olivia, she said that she felt better after she had played 120

Emotional Expression in Family Music Therapy

the drums so loudly and freely. She also said she was pleased that she had managed to ‘pull herself together’ and come to the session with Anna as she knew that Anna loved the music sessions. I pointed out that Anna was worried about her mother and pleased to be able to support her through music making. Olivia was moved by this and agreed that Anna probably did worry about her, but that she didn’t often think about this as so much time was spent sorting out Anna’s difficult behaviours. For this family music making provided both mother and daughter with an emotional outlet. Anna could lose herself in her playing and singing, and also feel good about herself in a way she struggled to do elsewhere. For Olivia, music making was a way to express anger and frustration in an immediate and acceptable way. In addition, for both of them, the sessions highlighted aspects of feelings they had for one another which they had not thought about very much before. Maria, mother of 4-year-old Tom who was nonverbal, had learning disabilities, and a diagnosis of attention deficit disorder, watched him happily while he danced around the room and I accompanied his movements through singing, moving with him and playing the clarinet. I stopped when he stopped, accelerated when he started running and moved more slowly when he slowed down. She told me that she loved to see how I matched her son’s mood in this way and that the music therapy sessions were the only times when he was so engaged and communicative with another person. He had a huge amount of energy and was always on the move, so these sessions were a rare moment when she could relax and enjoy watching her son, rather than constantly worrying about whether he was safe. The music therapy sessions were a way of validating Tom’s constant need to be active and moving. These movements became a means of communication and emotional expression for Tom, which his mother, Maria, could then enjoy rather than be worried by. Conducting and Leading Versus Following and Listening / Regulating Emotion Through Structure Expressive, improvised and shared music making described between Anna and Olivia in the previous section often leads to exchanges where one person leads and the others follow. This balance between following and initiating is something the music therapist is very aware of and may consciously seek to influence or change (Oldfield, 1995; 2006a). Being in control in a positive way in improvised musical exchanges can give children a sense of achievement and confidence, and can enable parents to feel proud of their child’s ability to lead. Parents and children can be ‘equal’ partners during the music making without the usual need for parents to control their children’s behaviours sand without the children responding by automatically rebelling against authority. The predictable structure of musical 121

A melia O ldfield

exchanges can help regulate chaotic and uncontained emotions, and the music therapist can continue to support both the parent and the child by altering the shapes of the improvised musical phrases to match the ways in which they are improvising. Amy was an 11-year-old girl with high functioning autism who attended the psychiatric unit with her single mother, Molly. Over the past year, as she was becoming an adolescent, Amy had become more and more verbally and sometimes physically aggressive towards her mother. Molly worked hard to be warm and kind to her daughter, but was very anxious and unsure what to do, lacking selfconfidence and struggling to set any boundaries. During the six music therapy sessions we had together, music making allowed Amy and Molly to be together in a room without having to talk, which meant that Amy didn’t insult or swear at Molly. They would both play separate drum-kits very loudly while I matched and ‘held’ their energy on the piano. This allowed Amy to be cross with her mother in an appropriate way, without verbal or physical aggression. Molly took time to get going, but then played even louder and more aggressively than her daughter, releasing her own frustration and anger with energy and enthusiasm. I then suggested that we take it in turns to lead. When it was Amy’s turn to direct, she immediately tried to catch both her mother and me out, by playing in a way that was difficult to follow. I made a joke about how difficult I was finding it to match Amy’s playing, which alleviated Molly’s anxiety. I then took the lead, starting with very simple short rhythmic phrases. Amy and Molly responded together and I gradually made my phrases slightly harder to follow but returned to very straightforward suggestions occasionally to allow the rhythm of the music to continue to flow. After a while I realised that Amy and Molly were working together musically, jointly making sure I didn’t catch them out. On a couple of occasions they even looked at each other and smiled when it was clear that they had managed a slightly harder rhythmic imitation. Molly and I discussed our work together on a separate occasion and she told me that playing loudly and freely as well as musically following and giving instructions had made her feel less powerless and stuck in the relationship with her daughter. In these sessions, Amy and Molly were able to use music making to express non-verbally the difficult emotions that they felt for one another. This then enabled them to briefly experience moments of joint enjoyment during the playing, sharing feelings of positivity which they usually found so difficult to do together. Four-year-old Leni, who also had a diagnosis of high functioning autism attended weekly music therapy sessions with both his mother and his father for 9 months. Leni would always be delighted to see me and smile happily whatever I 122

Emotional Expression in Family Music Therapy

played. He would play any instrument I offered him enthusiastically, but when we improvised together he tended to follow my rhythms and musical structures rather than making any musical suggestions of his own. Similarly, he struggled to make choices or to direct us in any way. In spite of his sunny disposition he greatly lacked confidence and on a couple of occasions when he felt he had got something wrong, he became very upset, crying and saying he wanted to go home immediately. I instigated a game where after I had finished singing the ‘Hello’ song while accompanying myself on the guitar I passed the guitar to his Mum to strum once (saying “Mummy play”), and then in the same way to his Dad, to Leni and then to myself. I continued in random order, sometimes making a game of going between two people in a repetitive way. I encouraged Leni to tell me who should go next, and he gradually became able to do this, but it took a long time and he tended to go around in the same order every time so the game quickly became a bit repetitive and boring. Gradually the game varied and we would ask each person to play not just once, but two or three times each, and also specify whether the person should play loudly or softly. One day, Leni’s mum made a mistake and played three times instead of two times. I pretended to be outraged and shocked, saying that mummy had been a ‘sausage’ and not listened properly. Leni collapsed with laughter thinking this was very funny. From then on he became much more spontaneous, always wanting to purposely get the instruction wrong so he could be the ‘sausage’. He became quicker at directing and less rigid in the way he gave us instructions. Leni’s parents both started to use humour more with Leni and continued to encourage him to give them directions in everyday life. In this case structured musical games and humour enabled Leni and his parents to relax. Leni stopped feeling so anxious about getting things right, and his parents, in response, were freed up to be more playful themselves. Performing, Composing, Learning Musical Skills Many music therapists have written in detail about the emotional benefits to clients of song writing or composing (Baker, 2015; Wigram & Baker, 2005). This aspect of music therapy is not so prominent in my mainly non-verbal improvisational work with parents and children. However, there are a couple of aspects that I feel are important to mention here. For most of the families with pre-school children with developmental difficulties, I may be the first clinician they have seen who is focusing on the musical strengths of their child, rather than on the child’s difficulties and on what the child can’t do. For many parents this can be a moving experience. As I wrote in a previous article (Oldfield, 2011) two parents reported on feeling touched and proud of their children’s singing and musical performances, in a way they had never done 123

A melia O ldfield

before. If parents appear slightly ‘envious’ of the positive relationship I develop with their child through music making, I can often alleviate their anxiety through explaining that it is because of their child’s healthy interest in music that this is occurring. As parents gain confidence in making music themselves they can also enjoy these playful musical interactions together. The majority of primary-aged children I see on the psychiatric unit have low self-esteem and are desperate to feel a sense of achievement. When we improvise together, I will often identify a short phrase they have played, check with them that they feel they like it, feel it is ‘their own’ and I have heard it correctly, and then point out that they have just composed a small piece of music. I will note the composition down on scored paper, writing the names of the notes under the musical notation. At the top of the page I write the name of the child, what instrument the piece is composed for and the date. A series of short compositions can be added to each week. I will hand the child the piece of paper at the end of the session as evidence of their achievement (keeping a photocopy myself, in case the original gets lost). Most of the children show their composition to their parents with great pride and in a couple of cases the families have framed the composition to put on the wall at home. In a similar way, as soon as children feel they have mastered part of a song through singing or playing the melody on the keyboard or the xylophone for example, many of them express a wish to perform this piece to their families. This performance can then form the start of a short-term piece of family work where we support parents to help their children to increase in confidence. Sometimes children will enjoy teaching their parents how to play, at other times parents with previous musical skills can be helped to find way of accompanying their children’s performances. Kazoos Kazoo exchanges, where the players vocalise into a small plastic tube with a vibrating piece of paper or plastic, are one of the quickest ways for me to identify whether a child can non-verbally identify and match different emotions. Kazoo playing can also easily lead to playful and humorous exchanges, which many children and adults will enjoy. Although some children and parents need a little time to get used to producing vocal sounds into the kazoos I have found that using kazoos in family music therapy work can be useful in a number of ways. Five-year-old Bruce and his Dad, Ken, were admitted to the psychiatric unit because of Bruce’s difficult behaviours which had meant that he had been excluded both from nursery and primary school. He had attention deficit disorder, was very loud and noisy and tended to lash out at peers and adults when he could not do get his own way. Bruce had always liked music and music making and it 124

Emotional Expression in Family Music Therapy

was decided to offer him and his Dad six sessions together to help them both to enjoy some positive and constructive moments together. Bruce particularly liked the kazoos, giggling in a delightful way at the funny noises the three of us were making at one another. At one point he tried saying swear words down the kazoos, laughing and watching to see our reaction. His Dad got cross saying he should stop, this was inappropriate, and took Bruce’s kazoo away. Bruce reacted by looking very sad and downcast and saying he hated music he wanted to leave straight away. I suggested we try to sing the Star Wars theme (one of Bruce’s favourite tunes) together on the kazoos. This diverted them both from the conflict and reengaged Bruce. I then explained to Bruce that you could imagine a bad word or a cross feeling, but express it through shouting or growling on the kazoos; it was fine as long as the adults couldn’t recognise the word. I demonstrated through making very noisy growling noises myself on the kazoos. Both Bruce and Ken laughed, and from then on they were both able to express themselves freely and (mostly!) acceptably on the kazoos. Eleven-year-old Amy and her mum, Molly, who I mentioned earlier, under the heading: ”Conducting and leading versus following and listening / regulating emotion through structure,” were able to ‘speak’ to each other on the kazoos without Amy being verbally insulting or disparaging towards her mother. The three of us played kazoos together and I was able to model different emotions which they both copied. Eventually Molly was able to express anger and frustration freely towards her daughter on the kazoos, which she could not do at all verbally. Amy reacted with similar anger, but this felt contained, healthy and equal to her mother, rather than the one-sided verbal abuse she previously used towards her passive and over-anxious mother. As in the earlier example, where Amy and Molly angrily and noisily played percussion, here they used the kazoos as a way of expressing the difficult emotions they felt for one another Goodbye on Bongos or Conga / Review of Session Many of the same music therapists who I quoted earlier as having written about the previously mentioned ‘Hello’ songs, have also written about the importance of closing activities. This afore-mentioned literature echoes my opinion that an expected, planned and familiar ending is reassuring and comforting for both children and adults. This is of particular importance for children and families who lack internal, and in some cases external, boundaries and structures. I have often experienced an increase in engagement in very withdrawn preschool children with autistic spectrum disorder when I get out the bongo drums which they know is going to be my way of saying goodbye. I can also feel the

125

A melia O ldfield

parent next to the child relaxing at that point, perhaps getting ready for the discussion they know we will have together after the session. In the child and family psychiatry setting we often review what we have done in the session with the parent and the child as we play the conga drum together at the end. This is a relaxed ritual which helps us to remember what we did and reflect on what we enjoyed, and what we might want to include in the next session.

Conclusion

In this chapter I have explored emotion in my family music therapy work through looking at some key techniques or activities in my sessions. I hope this has given the reader some insights into the emotional material children and families present me with. There are, however, many aspects that I have not mentioned. For example, I have not written about ‘song-stories’ that I often use with children in the psychiatric unit to get an insight into their internal world. I have not explored this aspect of my work, partly because I only rarely use song stories with children and families together, and partly because I have quite recently described this work in another publication (Oldfield, in press). Another aspect that I have not looked at is the role that my own emotions play in my work. If I am very tired or overworked myself, I sometimes struggle to find the energy to play with enough vigour to match the loud playing I am presented with. At other times it is hard to be calm internally and to listen intensely or acutely enough. It is also difficult not to empathise too strongly with some families. When working with Amy and Molly, for example, I had to work hard not to feel angry with Amy for being so unkind to her mother, and frustrated with Molly for not reacting and telling Amy off. I was also aware of parallels I was experiencing at home with my own teen-age children, and trying not to compare the two situations. This is a huge subject which I regularly explore in clinical supervision, but which would probably need a further chapter to be explored in any depth. Perhaps it is interesting to reflect briefly at this point on why music therapy can so effectively address the emotional needs of children and families. In my approach, which is mainly focused on musical rather than verbal interactions, I would suggest that in the first instance I can engage people who are difficult to reach because they will often be motivated to be involved in musical activities. Primarily, however, the important factor is that emotions can easily be expressed non-verbally through live, improvised music making.

126

Emotional Expression in Family Music Therapy

References

Alvin, J. (1975). Music therapy. New York: Basic Books. Baker, F. (2015). Therapeutic song writing: Developments in theory, methods and practice. London: Palgrave Macmillan. Brackley, J. (2012). Music therapy and the expression of anger and aggression: Working with aggressive behaviour in children aged five to nine who risk mainstream school exclusion. In J. Tomlinson, P. Derrington, & A. Oldfield (Eds.), Music therapy in schools: Working with children of all ages in mainstream and special education (pp. 89-102). London: Jessica Kingsley Publishers. Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge. Carpente, J. (2011). Addressing core features of autism: Integrating Nordoff-Robbins Music Therapy within Developmental, Individual-Difference, Relationship-Based (DIR)/ Floortime Model. In T. Meadows (Ed.), Developments in music therapy practice: Case examples (pp. 86-103). Gilsum, NH: Barcelona Publishers. Darnley-Smith, R., & Patey, H. (2003) Music therapy. London: Sage. Derrington, P. (2012). “Yeah I’ll do music!” Working with secondary aged students who have complex emotional and behavioural difficulties. In J. Tomlinson, P. Derrington, & A. Oldfield (Eds.), Music therapy in schools: Working with children of all ages in mainstream and special education (pp. 195-211). London: Jessica Kingsley Publishers. Edwards, J. (2011). Music therapy and parent-infant bonding. Oxford: Oxford University Press. Elefant, C. (2011). Unraveling hidden resources of a girl with Rett syndrome. In T. Meadows (Ed.), Developments in music therapy practice: Case examples (pp. 86-103). Gilsum, NH: Barcelona Publishers. LaGasse, A. B. (2011). Developing speech with music: a neurodevelopmental approach. In T. Meadows (Ed.), Developments in music therapy practice: Case examples (pp. 166-181). Gilsum, NH: Barcelona Publishers. Levinge, A. (2015). The music of being; Music therapy, Winnicott and the School of Object Relations. London: Jessica Kingsley Publishers. Jacobsen, S. L., & Thompson, G. (Eds.) (in press). Models of music therapy with families. London: Jessica Kingsley Publishers. Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day Co. Nordoff, P., & Robbins, C. (1985). Therapy in music for handicapped children. London: Victor Gollancz LTD. Oldfield, A. (1993). Music therapy with families. In M. Heal & T. Wigram (Eds.), Music therapy in health and education (pp. 46-54). London: Jessica Kingsley Publishers. Oldfield, A. (1995). Communicating through music - The balance between following and initiating. In T. Wigram, R. West, & B. Saperston (Eds.), The art and science of music therapy: A handbook (pp. 226-237). London: Harwood Academic Publishers. Oldfield, A. (2006a). Interactive music therapy, A positive approach – Music therapy at a child development centre. London: Jessica Kingsley Publishers. Oldfield, A. (2006b). Interactive music therapy in child and family psychiatry – Clinical practice, research and teaching. London: Jessica Kingsley Publishers. Oldfield, A., & Flower, C. (Eds.). (2008). Music therapy with children and their families. London: Jessica Kingsley Publishers.

127

A melia O ldfield

Oldfield, A. (2011). Parents’ perceptions of being in music therapy with their children. In J. Edwards (Ed.), Music in parent-infant programmes (pp. 58-72). London: Oxford University Press. Oldfield, A. (2016). Family approaches in music therapy practice with young children. In J. Edwards (Ed.), The Oxford handbook of music therapy (pp. 158-175). Oxford: Oxford University Press. Oldfield, A. (in press). Music therapy with families in a psychiatric children’s unit. In S. L. Jacobsen & G. Thompson (Eds.), Models of music therapy with families. London: Jessica Kingsley Publishers. Stern, D. (1987). The interpersonal world of the infant. New York: Basic Books. Tomlinson, J., Derrington, P., & Oldfield, A. (Eds.). (2012). Music therapy in schools: Working with children of all ages in mainstream and special education. London: Jessica Kingsley Publishers. Wigram, T., & Baker, F. (Eds.). (2005). Songwriting, methods, techniques and clinical applications for music therapy clinicians, educators and students. London: Jessica Kingsley Publishers.

128

Emotional Expression Through Music with Older Adults Anna Bukowska

Introduction

Emotional expression is defined as a human expression of internal feelings and emotions through physical behavior. An expanded definition depicts emotional expression as the behavioral reaction to the emotions presented to us by others (Rime, Herbette & Corsini, 2004). The definitions, through their theoretical background, offer great opportunities for observation and research on emotional expression in different groups of people. The outcomes might be translated into clinical practice for professionals dealing with client’s emotions in their treatment. The purpose of this chapter is to present the topic of emotional expression through music, which has a great potential in emotion enhancement in an older population. The first part will describe emotional recognition and regulation related to age; the second part will focus on emotional expression entailed by music in a group of older adults; and the last part will touch upon emotional expression in music therapy for older adults and groups of clients, considering age-related conditions.

Changes in Recognition, Regulation, and Expression of Emotions with Age

In the process of aging, some alterations in emotion recognition, control, and expression are observed. Emotional recognition allows a person to distinguish between the ability to experience emotions and the actual level of emotions experienced in everyday life situations. The ability to recall the events associated with the strongest emotions decreases only slightly 129

A nna B u kowska

with age. Nevertheless, older individuals describe their current emotions as less intense and also less frequent. This means that elders experience their past emotions more strongly than they experience emotions in the present. Emotional regulation and control usually improve with age. Seniors are able to control their emotions more efficiently, which is observed as a capability of enhancing positive emotions (joy, happiness, and beauty) and suppressing negative ones (fear, anger, and sadness). It is the result of anticipatory emotion regulation strategies that have developed through life experience (Gross, Carstensen, Pasupathi, Tsai, Skorpen, & Hsu, 1997). The emotions that appear during social interactions with newly-met people are less positive, and those situations are more stressful for the elderly (Charles & Piazza, 2007). On the other hand, the secure environment, which consists of closest family and friends, provides a satisfying level of positive emotions and supports the regulation of emotions (Carstensen, & Turk-Charles, 1994). Like the control of emotions, emotional expression in everyday life circumstances manifests in considerable expression of positive feelings. Expression of negative emotions decreases significantly with age (Charles, Mather, & Carstensen, 2003). This phenomenon is explained by organic alterations of the amygdala with age. This brain region, which plays a primary role in the processing of emotional reactions, demonstrates less emotional reactivity to negative information but is able to maintain or even increase the level of reactivity to positive ones. This knowledge is important in order to better understand the emotional behavior of seniors (Barrick, Hutchinson, & Deckers, 1989; Izdebski & Polak, 2008; Lawton, Kleban, Rajagopal, & Dean, 1992; Levenson, Carstensen, Friesen, & Ekman, 1991).

Musical Emotional Experience and Expression in Older Age

Emotional experience seems to be one of the most common reasons for musical engagement in human life. Music, as a strong emotional stimulus, can influence our moods, memories, and spirituality, offering a large space for emotional expressions (Juslin, 2001; Sloboda, 1999). The first paragraph of this chapter introduced the notion that emotional expression is altered with age. Music seems to be a powerful medium that enables the older generations to express their own emotions in many different ways and with better ease. Expressing emotions is possible by listening to, singing along, or even performing songs while playing an instrument. Music gives seniors the opportunity to recall the same emotions they had experienced many years ago, and

130

Emotional Expression Through Music with Older Adults

also to share them with others. Music improves the emotional awareness and helps older people to understand the emotions and feelings they experience. Furthermore, what is important at that stage of life, emotions evoked by wellknown music allows seniors to feel connected with their personal story and with their loved ones. Music takes part in emotional well-being experienced by the elderly as a consequence of engaging in music activities with positive emotions. In the moments seniors are engaged into music, the capacity to sense beauty, joy, and spirituality is substantial, and the level of life energy and health increases (Hays & Minichiello, 2005).

Additionally, emotions appearing in music activities such as listening, singing, or playing instruments facilitate cognitive functions such as memory or attention. However, the perception of music is always individual, providing unique ways of emotional expression stimulated by music in seniors’ everyday life (Bunt & Stige, 2014). The emotional response in music occurs in many different ways. Usually, music emotional expression takes the form of physical and behavioral reactions, mostly through movement, gestures, and mimics. To understand how music influences emotions, it is necessary to recall the theoretical perspectives of emotional expression. The mechanism of the emotional expression in music is described by the term “emotional contagion.” This term concerns the process when emotions are induced by a piece of music. That means, for example, music with fast tempo and high sound level and pitch might have a cheerful and happy expression, inducing happiness through the listener’s auditory system (Juslin, 2001; Wild, Erb, & Bartels, 2001). Moreover, the meaning of those emotions in music is perceived internally in the human mind, and next the identical emotions are vividly expressed in human body (Lundqvist et al., 2009; Rime et al., 2004). Emotional expression by listening or playing music makes older people smile, laugh, sometimes cry, furrow their eyebrows, move their body parts, or even dance. Those physical and behavioral aspects of emotional expression can help seniors experience their feelings much more strongly.

Emotional Expression in Music Therapy for Older Adults with Age-Related Conditions

Emotional expression induced by music has a great potential to be used for therapeutic purposes. Music therapy is utilized to achieve many different goals in a group of older individuals who may have a wide range of age-related health problems and conditions, including areas such as movement, focus or mood. 131

A nna B u kowska

In the theory of motor learning, emotions are described as a one of the most important factors that affect the motivation and the ability to learn. It means people are able to achieve their learning goals only when emotions are involved in the process (Kitago & Krakauer, 2012). Therefore, music seems to be the most appropriate way of evoking emotions for the seniors, which by positive associations influences movement, motivation, communication, cognitive skills, and offers relaxation options. What seems to be very important for the older generations is the fact that emotions in music enhance the social contacts and they allow all people, even people with disabilities, to experience their life in a more positive manner (Hays & Minichiello, 2005). Music Emotional Expression in Music Therapy of Depression in Older Adults According to the statistics, depression is observed in approximately 15% of individuals that are above 65 years of age. The reasons are very often connected to psychosocial factors, such as loneliness, grief, or lack of social and family support. However, poverty, malnutrition or a newly-diagnosed terminal illness might also cause the depression in seniors. In seniors suffering from depression, as a consequence of symptoms that include apathy, negative mood, and lack of physical activity, emotional expression is largely limited (Dudek, Zięba, Siwek, & Wróbel, 2007). Music therapy for seniors who have depression concentrates on different aspects, allowing them to enhance their emotional expression. The most important objective is to achieve mood regulation by listening or singing. Emotions connected with familiar music and lyrics are used in reminiscence-focused music therapy (Aldridge, 2005; Ashida, 2000). Music therapy can also attract attention to some positive aspects of elderly life. Active way of music emotional expression is employed in order to activate and motivate seniors (Chan, Wong, Onishi, & Thayala, 2012). Thereby, music has the potential to evoke an emotional response in the depression of seniors. The brain structure (the limbic system) responsible for emotional experience and expression is stimulated and engaged by musical pitch and rhythm. The emotions influence positive mood alteration and they lead to improvement of health condition (Guetin, Portet, Picot, Pommi, Messaoudi, & Djabelkir, 2009; Murrock & Higgins, 2009; Sacks, 2007). Music Emotional Expression in Music Therapy for Older Adults Who Have Dementia and Alzheimer’s Disease Dementia, including Alzheimer’s disease (AD), is one of the most difficult health problems in older age. This progressive condition is diagnosed in 10% of population above 65 years of age. Cognitive functions such as memory, thinking, 132

Emotional Expression Through Music with Older Adults

attention, orientation, understanding, calculating, learning, language skills, and executive functions are profoundly disrupted. Furthermore, the motivation, the behavior, the control of social reactions, and the control of emotional reactions are decreased (Barcikowska, 2007). The music therapy goals with AD and dementia patients include facilitation of cognitive function. All of them are connected to emotions, and they can be stimulated by emotional expression. Singing of familiar songs is commonly used to regain the verbal language, memory, and orientation (Aldridge, 2005). Listening to pleasant, relaxing music is employed to decrease the level of anxiety. Active music therapy in group settings supports executive functions and social interactions (Koger, Chapin, & Brotons, 1999). Music therapy seems to be an effective intervention for improving and maintaining cognitive skills, decreasing behavioral problems, and supporting emotional control of older individuals with dementia (Ridder, 2005). Moreover, active music therapy for a group with dementia or AD is able to facilitate social interaction and also reinforce functional and physical state (Ashida, 2000; Clair & Bernstein, 1990; Pollock & Namazi, 1992). Music Emotional Expression in Music Therapy for Older Adults Who Have Parkinson’s Disease Parkinson’s disease (PD) is a common degenerative and progressive condition of the central nervous system, mostly diagnosed in the elderly population. It leads to impairments in cognitive functions, problems with emotion control, and causes major physical disabilities. PD affects 1% of people over the age of 60 in well-developed countries (De Rijk et al., 1995; Friedman, 2005). Even though music therapy for PD patients is not focused directly on emotional problems, but rather on the other symptoms of the disease, emotions seems to be the strongest trigger in active music therapy process. In the music therapy treatment for improving the movement, everyday life activities, and balance that are significantly distorted in PD the emotional expression through music plays an important role. It enables patients to make a move, because music has the power to drive the movement (Paccetti et al., 2000). However, music therapy for people with PD is strongly associated with a high level of sensory stimulation, which directly influences emotional expression. The motor response to music is based on emotional reaction trough the limbic system, which activates the cortical-basal ganglia motor loop, primarily affected in this disease. That explains the connection between emotions and movement facilitation in PD (Menza, Golbe, Cody, & Formann, 1993). Music therapy by inducing positive emotions is also utilized to relax, reduce anxiety, and alter the physiological functions, mostly cardiac and respiratory systems, in the PD patients (Haas, Distenfeld, & Kenneth, 1986). 133

A nna B u kowska

Moreover, the changes induced by music and emotions are observed in PD patients in the form of improved in socialization, better involvement with the environment, easier expression of feelings, and higher awareness and responsiveness. It leads to significant changes in the quality of life in PD patients (Hays & Minichiello, 2005; Le Doux, 1992).

Conclusions

Even though emotional expression is changing with age, music can still prominently enhance emotions in seniors. Music has a greatly positive effect on how the feelings can be expressed. Music therapy dedicated to older individuals employs and utilizes emotional expression in many different ways. The therapists need to realize the important role that emotions play in the lives of seniors. Moreover, the necessity of evoking of emotions needs to be considered in music therapy planning. Otherwise, it will be not possible to improve either cognitive function nor movement or mood without emotions and emotional expression.

References

Aldridge, D. (2005). Dialogic-degenerative diseases and health as a performed aesthetic. In D. Aldridge (Ed.), Music therapy and neurological rehabilitation: Performing health (pp. 39-60). London: Jessica Kingsley Publishers. Ashida, S. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. Journal of Music Therapy, 37(3), 170-182. Barcikowska, M. (2007). Otępienie w podeszłym wieku. In T. Grodzicki, J. Kocemba, & A. Skalska (Eds.), Geriatria z elementami gerontologii dla lekarzy i studentów (pp. 98-107). Gdańsk: Via Medica. Barrick, A. L., Hutchinson, R. L., & Deckers, L. H. (1989). Age effects on positive and negative emotions. Journal of Social Behavior and Personality, 4, 421-429. Bunt, L, & Stige, B. (2014). Music therapy – An art beyond words. New York: Routledge. Carstensen, L. L., & Turk-Charles, S. (1994). The salience of emotion across the adult life course. Psychology and Aging, 9, 259-264. Chan, M. F., Wong, Z. Y., Onishi, H., & Thayala, N. V. (2012). Effects of music on depression in older people: A randomised controlled trial. Journal of Clinical Nursing, 21, 776-783. doi: 10.1111/j.1365-2702.2011.03954.x Charles, S. T., Mather, M., & Carstensen, L. L. (2003) Aging and emotional memory: The forgettable nature of negative images for older adults. Journal of Experimental Psychology: General, 132(2), 310–324. doi: 10.1037/0096-3445.132.2.310 Charles, S. T., & Piazza J. R. (2007). Memories of social interactions: Age differences in emotional intensity. Psychology and Aging, 22, 300–309. Clair, A., & Bernstein, B. (1990). A preliminary study of music therapy programming for severely regressed persons with Alzheimer’s-type dementia. Journal of Applied Gerontology, 9, 299-311.

134

Emotional Expression Through Music with Older Adults De Rijk, M., Breteler, M., Graveland, G., Ott, A., Grobbee, D., & Van der Meche, F. (1995). Prevalence of Parkinson’s disease in the elderly. Neurology, 45, 2143-2146. doi:10.1212/ WNL.45.12.2143 Dudek, D., Zięba, A., Siwek, M., & Wróbel, A. (2007). Depresja. In T. Grodzicki, J. Kocemba, & A. Skalska (Eds.), Geriatria z elementami gerontologii dla lekarzy i studentów (pp. 108-112). Gdańsk: Via Medica. Friedman, A. (2005). Choroba Parkinsona: Rozpoznanie. In A. Friedman (Ed.), Choroba Parkinsona. Mechanizmy, rozpoznawanie, leczenie (pp. 139-145). Lublin: Wydawnictwo Czelej Sp. z o.o. Friedman, A. (2005). Epidemiologia. In A. Friedman (Ed.), Choroba Parkinsona. Mechanizmy, rozpoznawanie, leczenie (pp. 1-5). Lublin: Wydawnictwo Czelej Sp. z o.o. Gross, J. J., Carstensen, L. L., Pasupathi, M., Tsai, J., Skorpen, C. G., & Hsu, A. Y. (1997). Emotion and aging: Experience, expression, and control. Psychology of Aging, 12(4), 590-599. Guetin, S., Portet F., Picot, M. C., Pommi, A. C., Messaoudi, M., & Djabelkir, L. (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: Randomised, controlled study. Dementia and Geriatric Cognitive Disorders, 28, 36–46. Haas, F., Distenfeld, S., & Kenneth, A. (1986). Effects of perceived musical rhythm on respiratory pattern. European Journal of Applied Physiology, 61, 1185–1191. Hays, T. & Minichiello, V. (2005). The meaning of music in the lives of older people: A qualitative study. Psychology of Music, 33, 437. doi:10.1177/0305735605056160 Izdebski, P., & Polak, A. (2008). Regresja czy progresja? Emocje w okresie starzenia się. Gerontologia Polska, 16(1), 1-5. Juslin, P.N. (2001). Communicating emotion in music performance: A review and a theoretical framework. In P. N. Juslin & J. A. Sloboda (Eds.), Music and emotion: Theory and research (pp. 309-337). New York: Oxford University Press. Kitago, T., & Krakauer, J.W. (2012). Motor learning principles for neurorehabilitation. In M. P. Barnes & D. C. Good (Eds.), Handbook of clinical neurology (pp. 93-103). Amsterdam, The Netherlands: Elsevier. Koger, S., Chapin, K., & Brotons, M. (1999). Is music therapy an effective intervention for dementia? A meta-analytic review of literature. Journal of Music Therapy, 36(1), 2-15. Lawton, M. P., Kleban, M. H., Rajagopal, D., & Dean J. (1992). Dimensions of affective experience in three age groups. Psychology and Aging, 7, 171-184. Le Doux, J.E. (1992). Brain mechanisms of emotion and emotional learning. Current Opinion in Neurobiology, 2, 191–197. Levenson, R. W., Carstensen, L. L., Friesen, W. V., & Ekman, P. (1991). Emotion, physiology, and expression in old age. Psychology and Aging, 6, 28-35. Lundqvist, L. O., Carlsson, F., Hilmersson, P., & Juslin, P. N. (2009). Emotional responses to music: experience, expression, and physiology. Psychology of Music, 37(1), 61-90. Menza, M. A., Golbe, L. I., Cody, R. A., & Formann, N. E. (1993). Dopamine-related personality traits in Parkinson’s disease. Neurology, 43, 505-508. Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes: Discussion paper. Journal of Advanced Nursing, 65, 2249-2257.

135

A nna B u kowska

Paccetti, C., Mancini, F., Aglieri, R., Fundar’o, C., Martingnoni, E., & Nappi, G. (2000). Active music therapy in Parkinson’s disease: An integrative method for motor and emotional rehabilitation. Psychosomatic Medicine, 62, 386-393. Pollock, N., & Namazi, K. (1992). The effect of music participation on the social behaviours of Alzheimer’s disease patients. Journal of Music Therapy, 29(1), 54-67. Ridder, H. M. (2005). An overview of therapeutic initiatives when working with people suffering from dementia. In D. Aldridge (Ed.), Music therapy and neurological rehabilitation: Performing health (pp. 61-82). London, UK: Jessica Kingsley Publishers. Rime, B., Herbette, G., Corsini S. (2004). The social sharing od emotion: illusory and beal benefits of talking about emotional experiences. In I. Nyklícek, L. Temoshok, & A. Vingerhoets, (Ed.), Emotional expression and health: Advances in theory, assessment and clinical applications (pp. 2740). Hove, East Sussex, UK: Brunner-Routledge. Sacks, O. (2007). Lamentataion: Music and Depression. In O.Sacks, Musicophilia. Tales of music and the brain. (pp. 295-304). London, Picador. Sloboda, J. (1999). Everyday uses of music listening: A preliminary study. In S. W. Yi (Ed.), Music, mind and science (pp. 354-369). Seoul, S. Korea: Western Music Institute. Wild, B., Erb, M., & Bartels, M. (2001). Are emotions contagious? Evoked emotions while viewing emotionally expressive faces: Quality, quantity, time course and gender differences. Psychiatry Research, 102(2), 109-124.

136