Friday 19 December 2014

I wish it could be Christmas every day

“Do you know that song, All About that Bass?” How to respond to a client who asks this? I knew it, but didn’t really know it. Also, the sound world of a highly produced pop song like this is hard to reproduce with the resources in a music therapy session. So we can explore the meaning of the fantasy (wanting to be a pop star, wishing for magical musical competence), we can try to find a way of recreating the song (getting hold of a recording, or the sheet music, or the chords and lyrics) or it could be interpreted as a test of the therapist’s limitations. Part of what is implied by the question is a desire to make music together by finding common ground. Is there a song we both know which we could do? Where is our shared culture? For young children we have a repertoire of songs and nursery rhymes which are widely used, at least within the UK. When you’re a parent you pick a lot of these up, or are reminded of them from your own childhood: The Wheels on the Bus, Wind the Bobbin Up, Old MacDonald Had a Farm and so on. Some of these date back many generations. They may even be the closest thing we have to a shared folk music. But once children get past 5 years old we start to run out of material. For people with a church background this can become the source for shared musical culture, but otherwise our musical experiences are becoming increasingly disparate. There’s no guarantee that two randomly chosen people will know the same songs as each other.

Except at Christmas! Literally everybody knows Jingle Bells. You’d also stand a good chance with Silent Night, Rudolph the Red-Nosed Reindeer, White Christmas, and Oh Come, All Ye Faithful. For a few short weeks most people in the country have a shared musical world (and in the town too). Some of these songs are religious in content, but many aren’t. Some are beautiful pieces of music, some are bits of kitsch. But they are probably the most widely known songs in the English speaking world. In a session last week a boy asked me to play Rudolph… while he played along on a drum. This moment of clear musical structure and predictability gave us one of our most musically connected moments. I occasionally wonder what music therapy is like in cultures with a strong living folk music tradition, where collective music-making is more a part of people’s day-to-day lives, and perhaps Christmas gives us a taste of this. That blast from the past, having a sing-song around a piano, does still happen at Christmas. In the Bleak Midwinter rubs shoulders with Winter Wonderland. Group musical cohesion, containment, structured play, even elements of improvisation when the alcohol kicks in – it’s all there. And it produces results, livening up the party at the very least, and maybe even changing the way people feel about being in each other’s company. Then in January the songs are lost for another year and singing together in that spontaneous way becomes less possible again.

Monday 8 December 2014

Music makes you feel better

Well obviously not. It’s clearly not as simple as that. But there is something about this idea that can sneak into music therapy. Certainly perceptions of MT from outside might go along with this – “It must be so rewarding”, or referrals which tell us how much a child enjoys music. And of course music can make you feel better. I had a gig not long ago which caused me to think about this. It was a jazz trio in a bar. Not much money, but some interested listeners, free beer, and a nice meal thrown in half way through. We played entirely music by Cole Porter, who is one of my favourite song writers. It was very enjoyable. The nice environment didn’t hurt. The opportunity to pay exactly the music I like, validating all the years of hard work learning how to play jazz, without too much pressure, but with some positive attention from a friendly audience, made a great combination. We had a lovely evening. After the gig I hung around and chatted to a few people, friends who had come along. I still felt good, which was related to the music. People told me they had enjoyed it, which boosted my ego. I didn’t feel as good as when I’d been actually playing though. There was some feeling of loss already. Then I had to get into my car and drive home. This was ok. The next day I felt sad. No jazz gigs in the diary for a while. I was already mourning the loss of the experience. So did the experience, overall, make me feel better? I don’t think so. What it did was reconnect me with something important and remind me that I need more of it. It made me feel more rather than better.

I did an assessment session recently with a boy who had a diagnosis of ASD and a history of trauma. He was an amazing drummer. And by that I don’t just mean he was a good drummer, I mean that I was actually amazed. After 10 minutes of playing the piano with him and becoming increasingly aware of his strong time feel I switched to saxophone. He stopped playing and shifted the groove into a slower tempo, with a very groovy shuffle feel, as if he’d played with saxophone players before, and he knew what sounded good with the instrument. This has never happened to me before in a session to quite such a marked degree. It raised a lot of questions. Was the music helping him in some way? His verbal communication was limited, making it difficult to get his non-musical perspective, but clearly his musical motivation was strong. But how did he feel when the music stopped? Did the positive effect so apparent during the session extend beyond the immediate experience? The natural assumption is that his high level of musicality is an indication that this is a good referral to music therapy, but it might also be possible that he doesn’t need it. He can already use music and it doesn’t require fostering or facilitating. Maybe he just needs a band to be in. Or – an even more pessimistic point of view – he can do music, but it doesn’t really help him. It’s just something he feels compelled to do.

I don’t think that last one is true by the way, but in the absence of certainty it remains a possibility. It’s certainly plausible that after playing he feels a bit like I did in the car on the way back from my gig – just ok. Our emotional response to music is unpredictable. Ever put your favourite piece of music on the stereo and it have no effect at all? Ever been surprisingly affected by a piece you’d heard a million times, but then experienced differently in a new context? Music can shake things up, alter perspective, reset your emotional responsiveness - sometimes. What it doesn’t always do is make you feel good. Therapy, of course, can actually trigger negative emotions, which can make it hard to want to go, even for people who are strongly motivated, but the temptation to evoke the music in music therapy as the positive bit, the ‘selling point’, leads to shaky ground. “Enjoy your session” is something I often hear from a parent or teacher when I collect a child for their session. “We’ll see”, I think to myself.

Monday 1 December 2014

To play or not to play?

Music is a medium for communication. We know this. In my experience, there is an emphasis amongst music therapists on the specific significance of musical interaction. Many of the audio or video examples played in lectures and presentations are of moments which take place between a therapist and the client, in which both are musically involved. Comparisons between music therapy and mother-infant communication, influenced in particular by Daniel Stern’s concept of ‘affect attunement’, have contributed to this.

But music is not always used in this way. In one session a 7 year-old (who is largely non-verbal) spent a good part of the session trying to work something out at the piano. She had a strong motivation to do this and would gesture to me to stop whenever I tried to play. I found myself thinking that this was a valid therapeutic way to use the session. She knew I was there, so I was supporting her with my presence, much as I might support my daughter by sitting with her while she does her homework. Interacting in such a situation might be unhelpful or even undermining. Some therapists might formulate this type of behaviour in terms of resistiveness or defensiveness, a need for control, or perhaps describe it as parallel play (extending the mother-infant analogy), and they might be right on the money. But there can be an adult feeling about it, a ‘don’t interrupt me while I’m doing the crossword’ quality. So this is about flexibility within a relationship which is about more than just music. The therapist is being asked to hold onto the possibility of music in the future while the client works something out. This is in fact a normal musical activity. It’s called ‘practice’. Why do we practice our instruments? One reason is in order to prepare for future musical engagement. In a therapy session the client might be intimating that they’re not content with the musical vocabulary they have available and would like us to wait while they work up some new stuff. Why not?

The hippest thing you can do is not play at all. Just listen.
Lennie Tristano

There’s another possibility too. I like playing the piano on my own, especially playing jazz standards. If another musician joined in halfway through Stardust, and didn’t know the chord changes, or couldn’t play in time, that would be a drag. Or as the trumpet player Ruby Braff reputedly said – “you have to be a really good drummer to be better than no drummer”. Maybe a client in a music therapy session can just be enjoying playing alone. Maybe (the stark truth) they don’t want us to play because we’re not cutting it according to their idea of what the music should sound like. This needn’t be defensive or controlling, it might be a musically motivated decision. It might be both of course, but the possibility remains that we are not playing in the right way according to the client. ‘Sometimes a cigar is just a cigar’, and sometimes the wrong music is just the wrong music. Perhaps it’s important to acknowledge our blind spots. We are more comfortable in some styles, and in some musical situations, than others. Might it sometimes be best to just ‘shut up and listen’? This would still communicate something; that the client’s music is worth listening to, and that we have something to learn from them.

I’d be interested to know of other therapists’ experiences of not playing. Do we have a tendency to feel – ‘Playing together good; not playing together bad’? While music therapy differs from talking therapies in that it encourages the possibility of therapist and client making sound at the same time, might there be more of a place for the model of listening therapist and (musically) active client?

Leading Note – October 2012


Music Therapy and evidence of efficacy – some open questions

Recently I watched an interview with the comedian Stewart Lee in which he discussed the economic difficulties faced by small theatres and music venues. The interviewer made the point that it was important to keep these venues open because they often provide a starting place for material that might go on to become successful in the West End. Without these small venues providing a space for new material, commercial opportunities would be lost. A similar argument has been made, for example, about the now defunct UK Film Council, which funded, for example, the highly commercially (and artistically) successful The King’s Speech. Stewart Lee, instead of agreeing, as perhaps the interviewer expected him to do, made what I think is a compelling counter-argument. If we argue for the funding of small venues on this basis, then we are implicitly conceding an argument about the true purpose behind art. We are saying that ultimately, it is only commercial worth that counts. In fact the real reason that small venues should be funded is because they provide a forum for material which has no further commercial potential whatsoever, but is nevertheless artistically worthwhile. He gave an amusing example of an avant-garde balloon act at Bush Hall which had no chance of ever “transferring to the West End”.

Music therapy, along with other therapies, faces a similar dilemma. It’s not a perfect analogy but it has similarities. Do we argue an outcomes-based case for our service that says that ‘evidence shows that clients coming to music therapy often make progress in these areas: behaviour, social communication, affect regulation etc. etc.’ or do we ‘come clean’. By this I mean that we admit that we cannot establish any clear causal link between music therapy and generalised outcomes. Music therapy is so individualised an activity that to suggest it might achieve this or that for a certain client group is at best speculation. If we try to base the case for music therapy on this type of medical-model evaluation of efficacy then are we on shaky ground? Are we, stretching the analogy, focusing too hard on the ‘West End transfer’ when we should be concentrating our efforts on the artistic content of the show?
Some time ago, in an instrumental teaching job I do, I was asked to produce a set of targets, including week-to-week planned activities for the term. To me, along with other members of the teaching team, this was patently absurd. How can you plan a set of activities when what you do is entirely dependent on what your pupil is capable of? Not only what they are capable of, but how much practise they are able, or feel motivated to do, which tunes it turns out they like, what other musical experiences inspire them in the meantime, and so on? Of course we did it. We all fudged it, producing sets of fictional planned outcomes which we secretly knew would have little bearing on or relation to real events as they were to unfold. I suppose we felt our jobs might be at stake.

How much less predictable is music therapy? With instrumental teaching there are in fact broadly definable and measurable aims. We can test students on their knowledge of scales or their developing sense of rhythm, for example (although how far you can really test musicality is also open to debate). Planning a term of lessons in advance might be pointless, but we can assess in retrospect whether a student has made good progress, and indeed, over time, whether a teacher is doing a good job. With music therapy, even when outcomes are excellent, there’s actually no way of demonstrating with certainty that this is a result of therapy. Fortunately, we are not yet being asked to ‘plan’ sessions, although we might outline aims.

However, let’s say a child starts behaving better in class after twenty music therapy sessions. Does this mean the therapy is helping? We all know that as therapists we can make no such claim. However what do we say to the SENCo? We accept credit when it is afforded us, perhaps, taking a “You win some, you lose some” approach. Or perhaps, being conscientious we say something like “That’s good to hear, and it may be that music therapy has contributed to this, but of course we can’t be certain”. The important question is, if we can’t confidently make direct causal links between music therapy and ‘good’ outcomes, what can we do to justify our interventions? What place does music therapy have in (to coin Lord Sugar’s phrase) ‘the current climate’? What ‘good’ does it do?

The answer to this question perhaps lies in that currently much ignored and discredited area – human experience. Everyone has a relationship to music. This is a fundamental tenet of music therapy, that we all innately musical. Ask any human being what they think life would be like if they had to do without music and they would nearly all say that it would be worse, and not just a bit worse. Intuitively we know that those that said otherwise would be (to coin another phrase) ‘in denial’. Listening to music makes you feel good, in a good way, in a way that feels healthy and nurturing. Playing music involves people in a beneficial creative process that connects them to their fellow human beings on a deep level of shared experience. It involves giving and receiving at the same time and is an expression of our humanity which, while we may not be able to put it into words very effectively, we all understand. There is no culture on earth that has no music. It’s a universal human activity.

Where people are in emotional distress of one kind or another music therapy can help them to reconnect with this shared experience of humanity. Music therapists are trained to facilitate this in various ways. We’re trained to attune to each person. We don’t respond to diagnosis, because we’re not doctors. We’re not even a bit like doctors, despite our use of the word ‘clinical’. But we are trained to understand the needs of the individual (and we don’t ignore diagnosis).

The auditors of our society are in the ascendant in the ‘current climate’, with its emphasis on ‘outcomes’ and numerical data. Unfortunately for us, you can’t measure the outcomes of musical interaction in any way that does justice to the actual experience. There may be some benefit from before-and-after studies, questionnaires, client feedback scores and so on, after all, if 50 clients attend music therapy and 45 of them show marked improvements in some aspect of their lives then this need not be ignored, but if we base our case for music therapy too strongly on data we may be missing the point. I don’t think many people would find this a controversial statement, but I think it’s worth reminding ourselves of this when we feel the pressure to come up with ‘good numbers’.

Because musical experience is so hard to put into words, even subjective accounts are unreliable. But is there more scope for appealing to the humanity of the decision makers, because a lot of them have an iPod, go to concerts, listen to the radio, play in a rock band, or sing in choirs? They know what music means to them. Human beings are all musicians, but some can forget sometimes.

(Leading Note - October 2011)

Singing in the shower

Here’s a true story that might ring bells for any other music therapists working in schools, and perhaps other settings too.
A while ago I wrote a report for a child and handed it to the class teacher. It had this paragraph in it:

"When his teacher suggested that he show me a song that he’d made up, he didn’t want to do this in his therapy session. I suspect that his relationship to the concept of musical performance is complex. While he enjoys the process of creation, he is not always amenable to this being witnessed by others and I have endeavoured to respect this." I later said, "it should also be noted that there are private aspects to his music, that music for him is not always associated with performance".

The first thing the teacher said when I saw him the following week was "Could you work on something in your session for a performance?"
There is a strong association in most people’s minds between music and performance. It is one of the ‘performing arts’. This is an issue that music therapists have to grapple with both in sessions and outside. It is being addressed directly by the Community Music Therapy movement through the assertion that music taking place in more public arenas can, in certain circumstances, still be described as ‘music therapy’. It can also come up in sessions as a fantasy, as the client, for example, imagines themselves as a ‘rock star’ playing to a huge admiring audience, or conversely, when the client is unable to play because they feel they are ‘not good enough’, or that they simply ‘can’t play’ an instrument. Music, even in the intimate context of an individual therapy session, can produce performance anxiety. This is often food for thought about what this might be representing. What is the client really afraid of?

This ambivalent relationship with the idea of musical performance is not confined to music therapy of course. In a way, the X-Factor phenomenon could be seen as a way of people distancing themselves from the possibility of musical exposure. We’d rather watch other people doing it, and be their judge, than participate ourselves. There is a hunger for the extremes, either those people who are so incompetent and deluded that we can ridicule them, or those who are far enough beyond the norm that they can become, temporarily, objects of adoration. We support them in the same way we support football teams or Andy Murray. This conveniently allows us to project the inadequate, hated parts of ourselves onto the deluded losers in the early rounds and to idealise the successes (but we can quickly switch allegiance).

But where does most music making really happen? The overwhelming majority of music is played in informal situations, where performance per se is secondary or absent. Most playing of instruments happens in the home. Ostensibly this might be in preparation for performance, perhaps a specific performance, perhaps a vague idea of performance at some point in the future. I had a conversation with another musician recently. We were rehearsing for a gig at a jazz club. I reflected that actually, practising at home is sometimes more fun than doing gigs. His reply – “It’s always a lot more fun”. This from a professional musician, supposedly someone who has realised the ambition of expressing himself to an admiring audience, but who has found the reality wanting. In performance, we are required to live up to expectations, to meet the audience’s needs, sometimes at the expense of our own. In fact jazz musicians have found their own solutions to this problem. A lot of jazz gets played in musicians’ houses away from the critical and demanding ears of an audience, and not always in the context of rehearsal, but often that of playing for its own sake. Even in a performance context, the audience is often seen to come second. Jazz jam sessions are conversations or sometimes competitions between musicians, on which the audience eavesdrops. So while we might perceive public performance as the most important goal of our musical striving, it might not be the most fun part, and there’s a big question mark about whether it’s why we choose to be, and remain, musicians. Here’s Bill Evans:
“Perhaps it’s a peculiarity of mine that despite the fact that I am a professional performer, it is true that I have always preferred playing without an audience”.
Perhaps it’s not so much a “peculiarity” as a very common phenomenon.

In The Adolescent Psyche (I am grateful to Steve Cobbett for drawing my attention to this book) Richard Frankel talks about adolescents’ need to “stay hidden”. Adolescence is a time of identity crisis, what Erikson refers to as ‘moratorium’, when the young person may not wish to share the disturbing twists and turns their psyche might be taking. Music can come in very useful here, because it allows the expression of unexplainable affects and wellings up without the need for verbal explanation. Attempts to make sense of the music, to decipher its meaning, may lead into therapeutic dead ends, but this is not necessarily a bad thing. In contrast, it is also when young people are encouraged to get out into the world, to develop their capacity for performance in a variety of guises. Musically it might be when people begin to gain competence on an instrument and to identify with a specific tradition or style. Others may witness the competence of their peers and decide to withdraw. “I can never play as well as that, so I’ll define myself as a non-musician”. In music therapy we can re-examine some of these assumptions. What is musical validity? What is good music? What is a musician? Does making music have to be linked to musical performance? Reminding people that it doesn’t might be an important part of our role. It’s ok just to play. From a Winnicottian perspective, this might be about the boundaries of the potential space. Some people aren’t ready for it to extend into a public arena. They may never be, and this is ok.

I was in a meeting in school attended by various members of staff along with a year 6 child who I am working with and his mother. It was my moment to speak about our work. I made some basic comments about the therapy and how long we might expect to continue. Then I said that it might be worth thinking about other circumstances in which he could participate musically, perhaps by looking for opportunities outside school, such as music centres. An LSA talked about his musical talent and backed me up. He said that people need to have good teaching to learn music. The boy’s response was “I can learn music on my own”. He was quite vehement about this, despite being surrounded by adults. He was right too. Many great musicians are self taught. But I think he was saying more than this. He was reminding me that his music therapy is a private thing for him, that by making this suggestion about extending musical opportunities I was poking my nose in where it wasn’t wanted. “My music is my own. Mind your own business”, he was saying, to all of us. I think we have to respect this. Music, like poetry and painting, is entitled at times to be a private art form.
I was once asked to speak to some new secondary school students about music therapy – “Just talk to them for 5 minutes”. I asked, on a show of hands, who among the group of about 15 young people considered themselves to be a musician. 3 or 4 put their hands up. Then I asked them who sings in the shower…