More Honest Than Words

Our correspondent gets a taste of music therapy.

barley-field_england

I’m asked to imagine a point of light. With my eyes closed, I wait for something to happen. There’s no light, only a sense of mounting anxiety. A panorama of darkness engulfs me. Then something in that space breaks off and moves toward me, a black sun, a negative light, fringed now with a faint orange glow. The light I want is obscured. I’m asked to throw the light up into the air and follow it. The darkness dissolves into a cloudy day, in the north of England. Now the music starts, something symphonic, lush and pastoral. I’m walking along the edge of a field of barley. I’m probably about eight-years-old, on my own. It’s a familiar scene from my childhood, a field at the top of “the lane” as we called it. I feel afraid as a car—a Citroen—drives slowly toward the old house to my left. That’s the old vicarage. When I’m prompted to go to a safe place, I crouch down and embrace a dog in front of me—my beloved dog, Spot—stroking his fur and smelling the top of his head. I’m safe for now, hidden from view by the tall barley.

I open my eyes and I’m back in the room. My therapist has stopped the music but its effect is powerful. It’s clear something has been stirred up. This is my first taste of music therapy—or more specifically a session of Guided Imagery and Music (GIM)—one aspect of a very broad field that uses music in a therapeutic context.

“Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals,” according to the American Music Therapy Association (AMTA), a national not-for-profit with 3,800 members in the United States, which maintains educational, professional, and ethical standards for the field, while trying to increase quality music therapy services for the public. A professional music therapist must hold a bachelor’s degree or higher from one of AMTA’s approved college or university programs. In addition, the Certification Board for Music Therapists (CBMT) accredits practitioners, who take a national board exam designed to measure and maintain competence. A growing number of states have formally recognized the profession of music therapy in various ways, and have begun to regulate it, via licensure, registration, or other mechanisms. In New York, music therapists with qualifying graduate training and post-graduate supervision are eligible for licensure as creative arts therapists under a larger mental health licensure law.

Although music therapy as a clinical practice has been around for at least a half century, public awareness of its healthcare benefits is growing, along with access to a broader range of music therapy services. Research into this field, according to the AMTA, supports its effectiveness amongst different groups, including children who have autism, older adults with dementia, hospitalized patients in pain, and people with brain injuries. Ten months after being shot in the head (in January 2011), Congresswoman Gabby Giffords relearned how to talk, in part, thanks to music therapy. The bullet damaged the left side of her brain, in a region that controls language. But neurologists were able to use music, as a kind of melodic and rhythmic speech therapy, to open up an alternate pathway back to language.

My experience of music therapy felt more akin to a psychotherapy session, a journey toward some kind of emotional catharsis. And certainly, music therapy can be used to treat everyday neurotics like me. I was fortunate to be in the experienced hands of Dr. Brian Abrams, a music therapist since 1995, currently based at Montclair University as Associate Professor of Music, and Coordinator of Music Therapy. I asked him later for an assessment of my session. What happened to me in that altered state when my imagination produced such vivid imagery? “When you enter into a deeply imaginative state, you’re finding ways of dealing with the energetic material of the unconscious in a very present and accessible way. You’re actually able to interact with it, operate upon it, deal with it,” Abrams said. “So, imagination —empowered by the artistic experience of the music—is the modus operandi of the therapy.”

It so happened that the piece that had provoked my imagination was a section from Ravel’s Daphnis et Chloé, a rich orchestral work complete with wordless choir. I learned this use of masterpieces from the Western canon is specific to Guided Imagery and Music, which was pioneered by Helen Bonny in the 1970s.  (It’s also known as the Bonny Method). The method uses a sequenced program of classical music “to stimulate and sustain a dynamic unfolding of inner experiences.” Bonny’s observations about the power of music were drawn from her own experiences of playing music; she was a graduate of Oberlin Conservatory of Music, and remained a violinist all her life.  According to Bonny, there is something about the music—its harmonic, melodic, rhythmic, and structural patterns—that helps push our imagination to the limit. That’s true. But what’s the difference between music therapy and simply listening to music without a therapist present?

I consulted Dr. Lisa Summer, a music therapist who studied with Bonny and is a first-generation practitioner of her ideas. She likened the process of GIM therapy to a scuba dive into deep water. A therapist can act like a diving instructor, taking a client out more gradually into the ocean. “When you feel safe, you feel safe enough to have strong images,” said Dr. Summer. When a client seeks her out, typically there’s a therapeutic intent that she recognizes, and directs the session accordingly, assisting the client as they go on this deep dive into their imagination. She recalled a case study where she worked with a man who was traumatized by sex-abuse, had turned to drugs and alcohol early in his life, and was diagnosed with depression. In his first session he described an existential feeling of dread. But he said there was one redeeming piece of music in his life—Albinoni’s Adagio, which he said he heard in his mind over and over. In fact, Summer observed, “he was holding onto this piece as if he were holding onto himself.” So when she chose to play the piece for him—after careful consideration—she helped guide his imagination. He described a flower inside of his stomach, all black and made of metal, whose petals were all closed up. “It was such a disturbing image that when I heard it, I directed him to stay open and see if the music affected the flower,” Dr. Summer said. The man described the petals opening up, and then a bright yellow light emanating from its center. And that was the end of the sequence. In Dr. Summer’s assessment, it was this humanistic approach that helped her client manage the horror his imagination signified. “It rejuvenated his relationship with that piece of music,” she said. “I felt like I had given him bullets for his gun to fight his depression.”

“This is what is so powerful about the aesthetics of music therapy,” she added. “I feel that classical music has special aesthetic power. When we feel our pain with this music, it brings us our pain in a different way. The music makes it digestible.”

New York-based music therapist Suzannah Scott-Moncrieff, and a former student of Dr. Summer, said that this intuitive approach to therapy is especially effective when dealing with clients who have suffered trauma. In recent years, Scott-Moncrieff said neurological research into the field of psychological trauma has validated the work of music therapists. “The field is more and more supporting relationship-based, right brain, creative, body-oriented approaches as opposed to cognitive-behavioral strategies. This is mostly because of what we’re discovering about trauma and the brain,” she said. “Integrative approaches like music therapy can address the trauma, beyond even explicit or retrievable memory, effectively working with lower brain processes where trauma becomes embedded. These kinds of approaches are the future of effective trauma treatment.”

Interest in the science behind music therapy is growing. In 2012, the National Endowment for the Arts teamed up with three units within the National Institutes of Health (NIH) — the National Institute on Aging, the Office of Behavioral and Social Science Research, and the National Center for Complementary and Alternative Medicine — to convene a public workshop to research the use of art, including music, to improve the health and well-being of older adults. The report summarizes some of its findings: “Participation in arts interventions has been linked with improving cognitive function and memory, general self-esteem and well-being, as well as reducing stress and other common symptoms of dementia, such as aggression, agitation and apathy.” In addition, the NIH is currently funds several clinical trials into the uses of music and its effects on the brain, including work on aphasia and to help children on the autism spectrum. One of the recommendations of the NEA workshop is to “develop better research models to inform the research agenda.” Dr. Abrams says he’d like to see music therapy “more comprehensively integrated throughout the healthcare continuum.”

It should be said that the benefits of music therapy are not restricted to people with musical ability. But often those who seek out this type of therapy—especially the psychotherapeutic model I experienced—tend to have some special relationship to music. “It’s a natural resource for them, perhaps the only place where they have felt understood,” said Scott-Moncrieff.  That was true for Vania, a 33-year-old writer based in Seattle, who recently turned to music therapy to deal with negative feelings she felt around her three-year-old son. As Vania described it, she detected an underlying anger that troubled her. She ascribed this to being raised by a “very abusive mother.” Her mother had been a pianist, and she too had played the piano. “The few good memories of my childhood are based around music,” she said. Her first session of music therapy—a one-on-one GIM session—made an immediate impact. “It felt like the music had curled around my hand and was dragging me along,” she said. “I was immediately taken to a place where I was five- or six-years old. I was broken already and I felt so unloved.” For Vania, the revelations of the therapy had a fairly quick impact. “I woke up one morning with this sudden realization that his last year and a half I’d been so anxious around my son. It was a moment of clarity as if a huge weight had been lifted. Now, looking at my son, I was able to see a contrast between then and now.” Vania said, although she didn’t understand the “mechanism” of the therapy, she trusted it.

During the second part of my own experience with GIM therapy, Dr. Abrams suggested I select an instrument from the room to express and deepen the feeling I had discovered in the barley field. Improvisation, active music making, is another key element in music therapy—the opposite of the “receptive” listening mode of GIM. There were many instruments from which to choose—an upright piano, an electric guitar, xylophones, glockenspiels, and many different drums from around the world. I approached the piano, which is an instrument I can play, but somehow it didn’t feel right. I needed something else, something more naïve and less percussive. That’s when I spied a small wooden flute, a Native American instrument it turned out, on top of the piano. Though I’ve never played this instrument, I picked it up and blew into it producing a soothing mid-register tone that I liked. Placing my fingers on the holes, I managed to move slowly up and down the scale, while Dr. Abrams accompanied me on a percussion instrument to enhance the vibe. “One thing that’s nice about music therapy is that those who tend to evade important, challenging issues in the verbal realm achieve greater access to these issues in and through music,” Dr. Abrams told me later. “It’s also important to understand that musical virtuosity, too, can be used to defend and evade; yet no matter how well trained one is as a musician, an astute music therapist is able to hear beyond that, into the ninety-nine percent of the music expressing the whole person, beneath any façade.” Even if it had been possible, virtuosity was beside the point. That was a relief. In that moment, playing the wooden flute felt right, peaceful, and more honest than words.

Originally published in Listen: Life with Music & Culture (Spring 2015).

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