The Autumn of Goodbyes

I love the Abbey Lincoln version of ‘The Windmills of Your Mind’. She approaches the song with a Coltrane-ish modal feel, creating a lot of space for the rhythm section, and Joe Lovano’s tenor. The lyrics are really interesting. It seems to be a song about memory, regret and dreams. There is an impressionistic quality to the array of images and a free associative way of linking these together. The killer couplet comes towards the end – “When you knew that it was over in the autumn of goodbyes/For a moment you could not recall the colour of his eyes”. The portentous quality that has been building all the way through reaches a catharsis at this moment. There is a big perfect cadence in the tonic minor, which follows a long sequence using a lot of fifth relationships, where for a while there is the possibility of a major key resolution. In this moment the true meaning of the song seems to be revealed. It’s about loss, perhaps even about death, and everything we have heard up to this point is revealed as fragmented memories, swirling around and seeming to appear at random. The cycle of fifths is also a clever musical allusion to this symbolic circularity, giving the impression of unending movement, along with eternal returns.

The other day I looked up the lyrics. Can’t remember why, maybe the song was just buzzing around my head (so to speak) – it’s very catchy. To my surprise, instead of the portentous couplet there were the lines ‘When we knew that it was over you were suddenly aware/that the autumn leaves were turning to the colour of her hair’. This was worrying. I looked up a number of different versions of the lyrics, all the same stuff about leaves and hair colour, except for the Dusty Springfield version, which had my treasured lines. Then I listened to some different versions on Youtube, including the Dusty Springfield one. She sings it beautifully, a cleaner more commercial sound than Abbey Lincoln’s jazz version, but still great. Then ‘the autumn leaves were turning to the colour of his hair’. I couldn’t find the Abbey Lincoln lines in any other version. They’re not just better lines, for me they had become the whole point of the song, the denouement. And it just doesn’t work. You wouldn’t notice wistfully that autumn leaves were turning to the colour of someone’s hair (leaving aside the racial implications of the line, which may have been important for Abbey). Autumn leaves are all different colours, even the leaves on one tree. The whole idea is bullshit. Now forgetting the colour of someone’s eyes – that I can imagine. I can imagine how devastating that could be, how the feeling that we knew someone could be dreadfully undermined by this sudden realisation, contained within it the suggestion that there may be many other things about that person that we didn’t know, or which had slipped away from our failing memory of them.

I finished working with a client, an 8-year-old boy with a history of trauma and ‘difficult’ home life, in a school with many similar children. This was several years ago now. For the final session I suggested that we record something as a memento of our time together. I promised to make a CD of the improvised piece and to give it to him when I was back in school later that week. This felt like a fitting way to end our final session, being creative together, and producing something meaningful, which he might perhaps refer back to, treasure even. Later that week I went to his class room to give him the CD. I handed it to him. He stood there and fixed my gaze. He continued staring right into my eyes, unmoving, holding the CD. I was filled with a sense that this ending had been abrupt, inadequate, that the ‘good’ ending had been for my benefit whilst in reality he was feeling abandoned. My lovely creative ending was an empty gesture. This moment transformed the final session which had happened two days before, decimated my convenient narrative. Since then I have found consolation in Adam Phillips assertion, paraphrasing Valéry, that therapy ‘is never finished, only abandoned’. This is, of course the reverse of my ‘Windmills of Your Mind’, experience. I started with the lame version, and this client gave me the killer couplet, the REAL version, the one with meaning. We lose people, and no two versions are the same, but the one that stares reality in the face, unblinking, that’s the best one, in art and in life, and in music therapy, which is somewhere in the overlap between the two.

On Playing Badly

I’ve said before that I think musical competence is a really important aspect of our work as music therapists. Clients often need to feel that we can support them, that we have the musical resources to do what’s needed. This might be to do with playing in the right key for the client’s voice, being able to lay down a solid groove on a drum, or just demonstrating general musical competence to reassure them that we know what we’re doing. It’s also an important part of our identity as music therapists, that we are also musicians. This can sometimes be a source of anxiety as we also all have our musical weaknesses, uncomfortable areas we’d rather not have exposed. For me it’s singing. This is awkward as there’s really no getting away from the need to use your singing voice at times, especially working with children. And don’t give me that stuff about how ‘everyone can sing’ and ‘it’s just about confidence’ and all that. In fact working with young children in music therapy has helped my confidence in singing, but I wouldn’t buy the album of me performing the ‘Great American Songbook’. I can use my voice in sessions to some effect, when needed, and sometimes I even sing in tune. However, it’s not my thing. Saxophone is my thing, and to a lesser extent piano, but I don’t spend all my time in music therapy sessions playing these two instruments. Sometimes I use guitar, sometimes bass, sometimes drums, hand percussion, and so on. Also, clients will ask me to do other things I can’t do very well, like beatbox, or play a particular song that I don’t know, by an artist I’ve only vaguely heard of (the generation gap isn’t getting any smaller). Then what?

Sarah Brand was quoted in Musician magazine recently as saying that “I wouldn’t say you have to be a great musician [to be a music therapist] but you have to be good”. This is an interesting statement because it begs several questions, among which, ‘What is a good, or great, musician?’ After all, you don’t have to be a ‘great musician’ to be a musician, so what’s contained in this assertion, because I think it means something interesting? Perhaps she was talking about technical capability, or versatility. Perhaps what she meant was that you don’t have to be able to play to a ‘professional standard’, which might mean that while you can play well enough, the phone’s not ringing with highly paid gigs and sessions. On the other hand, there are plenty of examples of musicians who have made a lot of money without being necessarily ‘great’, while there are also music therapists who undoubtedly are excellent musicians.

Being a musician, a good or great one, is such a multi-faceted thing. It’s not just about technical ability, as we all know. It’s also about tone, sensitivity, feel, timing, a sense of drama, so many things. Stan Getz reputedly said that ‘there are 4 qualities essential to a great jazz man [or woman]: taste, courage, individuality and irreverence’. Not a bad list, and nothing there about anything specifically technical. Those 4 things are also really good qualities for a music therapist to have, and perhaps to encourage in their clients.

And you don’t need to be able to ‘play well’ to be courageous, or irreverent, or to play with taste even. So Stan’s onto something interesting here that’s relevant to music therapists. When I play with other musicians, the things that can really annoy me, really grate, are not to do with musical ability, in a narrow sense. It’s when people don’t listen to what’s going on around them. It’s the piano player who fills all the gaps in the melody, the drummer who plays too loud and too much, the saxophone player who goes on for too long. It’s human, rather than musical, qualities which I really value, people who can play for the band, rather than just for themselves, players who you feel are really inside the here-and-now, rather than imagining themselves sounding like their favourite recordings, but not paying attention to the immediate musical events. ‘Hell is full of musical amateurs’ perhaps (said George Bernard Shaw), but it’s also full of lazy, bored professionals, just getting through the gig. If you can make a connection with another person by playing something simple which they get, which they can connect with right now, then you’re doing your job as a music therapist, and as a musician.

In music therapy, playing ‘well’ isn’t the only thing, it’s just one choice. In might even be an artistic choice. Martin Scorsese admires the Beatles film ‘Magical Mystery Tour’ partly for its amateurishness, which for him is refreshing in contrast to the slick professionalism of most Hollywood movies. When a client strums the open strings on a guitar, an appropriate and encouraging response might be for me to support on piano, creating a containing structure for their explorations, but it might be better on some occasions for me to play bass or drum kit at the basic level I have on these instruments. This forces me to play simply, and it puts me in touch with something about the client’s experience. We can ‘play badly’ together, which can sometimes be more liberating than playing ‘well’.

Accentuate the Negative

I went to see the movie Bridge of Spies recently. It’s really good by the way – see it if you haven’t already. One of the things I liked about it was the way it approached the problem of negative projections. A lawyer in the late fifties, played by Tom Hanks, is required to defend a Soviet spy, played by Mark Rylance. This is the height of the Cold War of course, so the spy is a hated figure in the USA, and by association the lawyer is too, for a while. In order to do his job with integrity, he has to be prepared to withstand this irrational hatred. He refuses to collude with it, and treats the spy as a fellow human being. This is the core of the drama, and is part of what makes the film really interesting and unusual. There are echoes of 12 Angry Men, The Shawshank Redemption or Erin Brockovich in this – one person’s resilience in the face of others’ hostility. One person who is able to think rather than act out. Some people have a talent for this. Others don’t. Jeremy Corbyn seems pretty good at it. ‘Dave’ Cameron – not so much, always seeking approval… JC seems a bit tetchy at times, but he does seem to be able to stick to his principles, to stay focused. I like the way he continues to ask questions from the public, despite the sneers of the Tory backbenchers.

I’ve written before about the role of the therapist, particularly in school, as an outsider, about how there can be something useful about this. Not for the first time, I’ve lost a couple of school contracts in the last few months. On both occasions this seemed to be linked to a key member of staff leaving (the head or deputy head) and being replaced by someone who wanted to make some changes (i.e. cuts). This is always difficult, because as the drama plays out, you have to stay focused on the sessions. The clients shouldn’t suffer because of my feelings of disappointment, resentment, hatred etc. Actually this is ok, because in my experience music therapy sessions are so much more intense than ‘normal life’ (whatever that is) that staying focused on the work while it is happening is perfectly manageable. What’s trickier is maintaining the professional relationships during this time of adversity, not acting out, but keeping an overview, seeing myself as one part of the system rather than the centre of the universe. If other people are able to develop fictions, for example that music therapy sessions are ‘just a bit of fun’ and so dispensable, then I am equally capable of inflating my own importance in my own mind. Understanding why people attach certain assumptions and fantasies to you, and why they project onto you, is essentially about adopting this broader perspective.

This was all brought into sharp focus by the BBC’s recent documentary about Camila Batmanghelidjh and Kids Company. I worked for the charity in 2008-9 and was aware at the time of certain flaws in the way it was being run. Camila was clearly being idealised by a lot of her staff and service users, and even more so by the media. Her big personality and flamboyant dress sense had certain advantages, enabling her to get the media exposure she needed in order to raise money from various high profile sources; the government, big time celebrities and so on. She also had a lot of very able people volunteering for the charity, giving their time for the cause, and it was a noble cause. There was a lot of great work being done and Kids Company had a strong therapeutic ethos. I was out on the edges of the schools’ programme, a newly qualified therapist grateful for the work and getting some valuable experience and support. But it appeared that Camila bought into the idealisation, both from the media and from the vulnerable people Kids Company was working with. The charity has been criticised for creating ‘dependence’, but this is inevitable when you are providing for the most needy in society. In a sense, they’re already dependent. What didn’t work out, and seemed to be part of her undoing, was the assumption of invulnerability, and that the idealisation could be sustained. Negative or positive, you need to take people’s projections with a pinch of salt, because they can quickly reverse their polarity. Jeremy Corbyn is being very careful to steer the narrative away from himself and to focus on more important topics. James Donovan (the lawyer portrayed in Bridge of Spies) takes the brick through his window philosophically.

A client told me ‘I like you’, then said ‘I want to have music therapy every day’. He’s struggling in school and is seen as a problem. This made me feel great. What a fantastic therapist I must be – the only person who really understands this child and gives him the space he needs to be creative and expressive. On the other hand, he only sees me once a week. If I accept the projection then I’m in danger of giving him the message: me=good, everyone else=bad, which is hardly helpful. Ultimately he needs to understand that the good things he sees in me are really coming from him. I’m just giving him the space to discover aspects of himself. I also need to try and share this with others, and to encourage them to see him in this way, that he can help them find the solution to the problems that they perceive in him, if only they give him the space to do this. Winnicott ends his chapter on adolescence, in Playing and Reality, with an address to the parents, saying “you won’t be thanked”. The satisfaction of a job well done won’t necessarily come from others, neither for parents, nor for therapists. We can’t wait for that pat on the back. But if we’re sceptical about idealisation, then we can also live with the negative projections and see them for what they really are, and understand the process.

Disruption

I attended an event recently for the Institute of Integrated Care, a collaboration between the Trust I work for and Greenwich University. The intention is to encourage new ways of thinking about how to deliver healthcare, with an emphasis on greater communication and collaboration between agencies that might not normally work together. It seems to be a positive step. One of the speakers talked about the importance of ‘disruption’. I like this word. It normally has negative connotations. Working with ’EBD’ children it’s a word one hears a lot, in the context of ‘disruptive behaviour’. In this context it was used with a positive connotation, the idea being that in order to change, we need to disrupt the old systems, the old ways of thinking. There is also a quality of randomness implied by the word, a suggestion that while we might not know what the consequences of our actions will be in any kind of detail, nevertheless it’s worth pressing ahead and shaking things up, because unless we have the courage to make a leap into the unknown, then we might stagnate. Change might never happen.

Think of the connections between professionals which can so often seem difficult, the crossed wires that can occur, the difficulties with ‘information sharing’. And when you work on the margins, as we often do, it’s easy to be forgotten by the mainstream. It’s still the case that sometimes I might hear about a CP conference for a child, or an annual review, after the event. If only we could establish stronger links, so that we feel we are working with other professionals to support an individual or a family, and so that music therapy can find a focus within a wider context, for each client. I know this would be good, because, sometimes it is possible. I have worked in collaboration with family therapists, working with the child while the systemic thinking is held by another professional. This is broadly beneficial, both for me and by extension for the client. It enables me to clarify the role of music therapy for this person in my mind. After all, music therapy isn’t a panacea. If things are going wrong elsewhere, if a family is in chaos, a child is suffering neglect or high stress at home then, frankly, there’s little I can do to help in a half hour weekly session. We need to know that there is some stability, otherwise we’re facing a Sisyphean task. We might be giving a child a brief positive experience which only serves to emphasise the deficits elsewhere, or the child might just be unable to access their creativity because other concerns are more immediate – Maslow’s triangle comes to mind. So we can’t work in isolation when dealing with complex situations, which we often are. And if we are working in isolation to some extent, then the system needs to be disrupted somehow.

And is therapy itself a disruptive process? We might think that therapy is about building up, or repairing. Are we trying, in the musical therapeutic relationship, to repair a broken attachment? We might be, but unless the client has other positive attachment relationships in their life, music therapy alone won’t be enough. More often it feels to me that I’m working with clients who have become entrenched in their coping mechanisms or defences. They express this musically, and I challenge it. I’ll search for ways of testing the client’s tolerance of newness. This might be quite a gentle process, such as when I make a suggestion about something else we might do, after allowing the client a long period of leading the session. But it might be more robust. One client who is adept at avoiding musical connections needed to be challenged more strongly. I tried setting a new pulse. He ignored it and ploughed on with his own music. I persisted for several minutes. Very slowly, he began to spend a few moments here in there inside the pulse I had set. After this, over time, I looked for opportunities to find pulse connections, and they became more frequent. He seemed to be developing trust, and expressing this through his musical responses. I couldn’t have predicted this, I could only give it a try, and see what happened.

One of the important characteristics of disruption, as I said, is that it is imprecise and unpredictable. But the imprecision of music therapy bothers me sometimes. I wonder whether it signifies a lack of effectiveness. If I can’t say what I’m trying to achieve with much precision then how can I claim to be ‘helping’ anyone. One answer is that where change is needed, disruption must happen first. The trick is how to respond to what happens next. When you try something, and the client reacts in a way you didn’t predict, you need to be ready, to be able to improvise. The pool will continue to stagnate, but disturb the surface of the water and you create movement, new clarity. The client repeating the same rhythm, always singing the same song, sitting in the same place, in the same mood, needs a new direction, but they don’t know how to find it themselves. Neither do we, but we know how to disrupt, and then how to improvise. There’s a whole row of doors to try: time to open one at random and see what’s on the other side.

In the zone

There is a place you can get to in music where you feel connected to what you are creating, where you feel one with it. This is not really a big mystery. It's actually quite easy to get to, but we put obstacles in the way. You're NOT there when you're trying to figure out dots on a page, or grappling with technique, but these things might (or might not) help you to get there. A child can sometimes get there straight away in a music therapy session, because knowledge of what they 'should' be doing is not getting in the way. A great composer, conducting their own symphony, has arrived there, but it took them a long time. Nevertheless this was a worthwhile struggle, because it expands the possibilities. Music connects us to something very important, more than early attachment. It points forward. It finds meaning. And I'm wasting my time trying to describe it in words, because, for one, I can't, and secondly, you don't need me to.

“So what’s music therapy then?”

“The people who know nothing about music are the ones always talking about it”
- Nat King Cole

“So what is music therapy? What do you do?” Questions at social gatherings which by all accounts strike terror into the heart of every music therapist. How can we possibly explain the subtleties of our work? They probably imagine that we’re music teachers, or perhaps that we play relaxing music to people to make them ‘feel better’. Perhaps they think that music therapy is like medicine, that it cures certain mental or psychological conditions. Sometimes these conversations can lead to damning put-downs of psychotherapy in general, along the lines of “A friend of mine had therapy once, but it didn’t help them at all. In fact I think it made them worse”. At which point one’s impulse might be to distance ‘music therapy’ from ‘psychotherapy’ and say that what we do is ‘different’ and that ‘everyone understands music and how beneficial it can be’. But the truth is, we’re caught between two stools. Are we on the one hand a sort of music facilitator, directing our clients through various ‘musical activities’ which might turn out to be ‘fun’, or, on the other, beard-stroking psychotherapists with a few instruments to hand should they be required at some point for the client to express something ‘unconscious’ using the ‘medium of music’ (apologies to beard-less therapists). How do we characterise ourselves?

One problem is that the various attempts to define music therapy in one simple, catchy sentence or two have not proved very satisfying. There’s quite a concise one on the ‘Music Therapy Charity’ website:

"Music Therapy uses sound and music as a therapeutic medium to bring about change."

Less concise is the APMT’s definition of the time quoted in Bunt’s An Art Beyond Words

"Music therapy provides a framework in which a mutual relationship is set up between client and therapist. The growing relationship enables changes to occur, both in the conditions of the client and in the form that the therapy takes…By using music creatively in a clinical setting, the therapist seeks to establish an interaction, a shared musical experience leading to the pursuit of therapeutic goals"

which more or less says the same thing, but without the relationship stuff, which it could be argued is accounted for in the first one by the use of ‘therapeutic’. Also one might point out that these definitions describe what it ideally does, not what it is. And if “change” doesn’t occur, what then? Still music therapy? Bunt himself is more concise.

"Music therapy is the use of organised sounds and music within an evolving relationship between client and therapist to support and encourage physical, mental, social and emotional well-being."

But again this suggests that therapy is “the use of…”, which I don’t think it is. The things that we “use” in therapy are not the therapy itself, but the tools or resources that we employ in order to “do” therapy, whatever “therapy” is.
The new BAMT website makes no attempt at the pithy one sentence definition, instead giving us a couple of paragraphs outlining the benefits of music and a proviso that “the therapist’s approach is informed by different theoretical frameworks, depending on their training and the health needs which are to be met”. This seems a pragmatic approach, but we may have lost our grip on the conversation by then in that imaginary social situation.

Perhaps the only quick definition would have to be vague, something like “Music therapy is therapy which uses music somehow or other”. That still doesn’t work, because other therapists, such as play therapists or integrative arts therapists, will happily incorporate music without describing themselves as ‘music therapists’. Also, it makes no attempt to define the therapy part, which is actually the tricky bit. A really honest one might be: “Music therapy is therapy performed by someone who has a qualification in music therapy”, but that gets us back where we started. How about this: “Music therapy is a process in which one person, called a therapist, provides another person, called a client or patient, with musical resources such as instruments, sees what happens, then responds in ways which feel appropriate, whether musically or otherwise, with the client’s, or patient’s, best interests at heart”. That’s more or less it isn’t it?

I fear there are many who would raise objections to this. “Music therapy is not purely responsive. It can also be directive, depending on the needs of the client”. “What about aims and objectives? This definition is too vague”.

Perhaps Wittgenstein has the answer. My layman’s understanding is that Wittgenstein developed an approach to the philosophy of language which provides an alternative to the concept of definitions. For example, when we use the word table, we are not referring to an idealised prototype, but rather to an object which fits easily into a large group of ‘table-ish’ objects. So a table with only 3 legs is ok, or one with a hole in the middle, but one on a 45 degree slant might not qualify. Is 30 degrees ok? It would still be impractical for eating your dinner off, but would it be a 'table'? If I see a client and we sing songs together, is that music therapy? If we listen to ‘relaxing CDs’? If the client asks how to play a certain tune on the piano and I show them? What about if the client asks me to prepare them for their grade 4 saxophone exam and accompany them? Music therapy is a broad category, with some activities being more music therapy-ish than others, with no single prototype, but with a general shared understanding amongst music therapists of the sort of things it might be.

So that dreadful question “what do you do in music therapy?” is difficult because we don’t have one simple answer. Perhaps being a fireman is easier. “What do you do?” “We put out fires and rescue people”. Or being a postman. “I put cards through people’s doors telling them that they were out”. A teacher? Not so straightforward perhaps, for although “teaching people about stuff” certainly comes into it, there is also a fuzzier pastoral side to the job, as well as the crowd control aspects with those classes that present ‘behavioural issues’.

A particular problem is the word “therapy”. “Music” most people get, it’s where the therapy part comes in that confuses people and leads to various preconceptions. Perhaps the dictionary can help:

Therapy: the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process

Or ‘psychotherapy’: the treatment of psychological disorders or maladjustments by a professional technique

Is this what we do? Do we ‘treat’ ‘disease or disorders’ using music? One of the things that we make clear on our referral form at my place of work is that we are not working with diagnosis, but with emotional needs; a ‘need’ is not the same thing as a ‘disorder’. I think that if someone who was perfectly ‘well’ wanted to have music therapy as an enriching experience, then they could have it. It could still be called ‘music therapy’.

The problem seems to be that every time we try to pin it down, it slips away from us. Are we still actually in the process of working out what music therapy is? Maybe the best answer is “I’ll get back to you on that one in 50 years time”. Or perhaps music therapy is not an activity, or a thing-in-itself, but rather a striving towards an intention. Perhaps figuring out what music therapy is, is what music therapy is. Try saying that next time you’re in that awkward conversation.

(Leading Note 2012)

Music therapy - who needs it?

I was struggling with a group. The problem was that there were only 3 clients in it. If one person didn’t show up, we had a pair. If two didn’t, then it was an individual session, with (in this case) two therapists. This could either feel a bit too intense for the client, or they might enjoy the undivided attention. Either way, it was difficult to maintain the feeling that what we had here was really a ‘group’. So the group needed more members. But did these new members need the group? I let other professionals know that there were spaces available – I could take 3 more people with ease. I had one new referral which I was following up. The group had been running (slow open) for nearly 7 years, with changing personnel, and we’d been here before. However this was the longest period (all of that academic year) during which there had been only 3 regular members, excluding the therapists. If one person left for good then we’d officially be down to a pair and this would begin to feel tenuous.

So who was ‘helping’ whom? If a new person joined the group I’d be grateful to them for helping keep the group, as an entity, alive. This subverts something about the therapeutic purpose of the group, which is that people were in it because they needed something. This symbiotic relationship shows how groups differ from individual therapy. The group needed its members, and the members (presumably) needed the group. Then the school cancelled the contract very abruptly, but that’s another story.

Individual therapy is different. The client has been referred because of specific needs, and the therapist is hoping to meet them. There is a ‘working alliance’, but the relationship is asymmetrical. However, I’m reminded of a time when I was training, back in 2007, and on a placement in adult mental health. The client was getting curious about me. He asked “Why are you here and not making money playing music? Are you on community service or something, like George Michael?” I mentioned this in supervision, expecting it to elicit a chuckle. Community service – how hilarious! My supervisor looked back at me stony-faced. “That’s a very perceptive question. What is your drugs bust?” My narrative of naïve client and knowing, professional therapist had been subverted. The client had noticed something, which was that I had a reason to be there just as much as he did. An important difference was that he had some idea why he was there, but I was less sure.

Now I’m an experienced professional it’s quite different of course. Through personal psychotherapy I have come to understand my unconscious motives for being a therapist and I can devote myself, unhindered by my own desires or needs, to the needs of the client. Yeah right… During the summer holidays the sessions become less frequent; people go away, the school clinics are not happening. It’s a nice change of pace but it can be a bit dull at times. I like the excitement and drama of sessions; it’s one of the reasons I’m doing this job. I like that, being a therapist, you get to relate to another person in a completely different way. There is the possibility of revelation, of new knowledge, of emotional connection. It’s a privilege, and it’s also, in some respects, a need. As music therapists we have access to fundamental human experiences and to the expression of profundities about the individual every day. It’s a responsibility of course, and it can feel overwhelming. The dangers of secondary trauma shouldn’t be underestimated, and some clients are very difficult to work with. As with being a parent there are lots of sensible reasons not to do it. For us, though, for the moment at least, the benefits must outweigh the drawbacks. I never forget that the client comes first, but I also have to be honest with myself; I’ve chosen to be here too.