Friday, December 11, 2009

Vocal Psychotherapy: A fine balance of objectivity and subjectivity

A Summary and Review of a Vocal Psychotherapy presentation at the 2009 CAMT (Canadian Association for Music Therapy) 35th Annual Conference, May 6-9, 2009.

Summary: Earlier this year, I attended the CAMT Annual Conference, a gathering of many of Canada’s music therapy practitioners, researchers, teachers, interns and students. The conference consisted of many different events including workshops, lectures, poster presentations, ceremonies, video screenings and motivational speakers. The various facets of the conference offered opportunities for everyone (including people like me with little to no experience in formal music therapy) an opportunity for learning and growth. The presentations covered an incredibly broad range of subjects including stories from the palliative care patient’s beside to bringing the practice of music and cognition together to medical music therapy and the development of a clinical approach for people receiving hemodialysis. Several were particularly moving, including one of Dr. Diane Austin's talks.

Dr. Diane Austin, a music psychotherapist, founder of The Music Psychotherapy Center in New York and teacher at New York University gave a beautiful and brilliant presentation on vocal psychotherapy titled “When words sing and music speaks”. Her talk consisted of several anecdotes of patients she has worked with, and their journeys towards recovery. Using psychotherapeutic principles in combination with music and songwriting, such as free association to access the subconscious through writing lyrics and singing them, Dr. Austin was successfully able to help many clients open up about repressed feelings, and helped them solve unresolved issues. Dr. Austin discussed the principles of vocal psychotherapy including “free associative singing”, a technique that can be implemented when words enter the vocal holding process. It is closely linked to Freud’s technique of free association, however it differs in that the client is singing and not speaking. Furthermore, the therapist is also singing and adding to the client’s musical stream of consciousness. There is frequently a repetitive riff-like accompaniment which the therapist provides that serves as a backdrop to both the client’s and therapist’s voices. The music provides a sense of forward momentum as the client sings words, phrases, etc. Often, the therapist begins by repeating a word or phrase which the client sings, and often adds layers such as harmony, alternative rhythms, and other forms of variation. The repetition is meant to create and facilitate a safe environment in which the client feels comfortable expanding their vocal ideas. This practice is deeply rooted in psychotherapy practices involving the unconscious and is often used for clients who have suffered from trauma. Many music therapy practices are often employed when working with trauma sufferers, and has been shown to have astounding healing effects. I know of many case studies along these lines, but nothing was quite as powerful as when Dr. Austin played a tape of a session with one of her clients who was struggling with overcoming sexual abuse in her childhood. This client was a woman of about 45, and the session we heard was one of many that Dr. Austin had done with her. The dynamic between the client and Dr. Austin began very simply and steadily, and gradually increased to an intense, loud, emotional and rich musical expression of a childhood destroyed. Both client and therapist were singing with such power and expression that it almost sounded pre-scripted, although there was a sense of spontaneity and improvisation, since that is exactly what was happening. It was a beautiful expression of the power of music to unlock facets of the mind that may have otherwise been unaccessible.

Reflection: Although I have been witnessing and hearing about the incredible effects of music for a while now, I never cease to be astounded at the impact that music therapy can have. Almost every person sitting and listening to Dr. Austin’s client express herself through song wound up in tears. Something I have perpetually struggled with as an aspiring music therapist is the ability to engage clients in such intensely emotional work, but remain a somewhat objective participant. How can music therapists not become emotionally engaged and moved by the process? It seems to me that music therapists, as well as many other healthcare professionals have the responsibility of balancing their objectivity with a sensitive subjectivity necessary for the client feel a sense of mutual trust. I assume that in order for a client to be able to open up and share a part of themselves, they need to feel as though what they are offering their therapist does not fall on unfeeling ears. To me, empathy is such a huge part of the client/therapist relationship, however too much can be unproductive and even harmful. This is where objectivity comes in. In order for the therapist to be able to offer perspective and guide the healing process, they need to be somewhat cognitively stable, and they need to anticipate further action that would benefit the client. How can this role be fulfilled if the therapist is too emotionally engaged? Furthermore, the therapist has the responsibility to reign in a client, particularly with free associative singing if the client feels out of control (which is sometimes the case). Naturally, these questions and concerns are dealt with by therapists on a daily basis, and the training they undergo allows for, anticipates and provides coping mechanisms for these situations. Still, it seems to me to be a fine balance.

Another particularly interesting and common occurrence is countertransference, a Freudian concept which involves the therapist’s emotional entanglement with the client’s emotions. It can have several different meanings and facets, and can be hugely problematic if not dealt with. Although I do not know the extent to which counter-transference can go, I do know that it needs to be recognized and dealt with, or else it can have intensely difficult consequences. Closely related is the notion of the “wounded healer”, a Jungian term which refers to a therapist (or psychoanalyst) finding that a patient’s wounds activates their own. It is closely connected to countertransference and can also be potentially dangerous, as it can adversely affect the patient’s healing process and the therapist’s well-being. Dr. Austin discusses being a “wounded healer’ herself, yet she approaches it in a positive light in that she is very open about the various affects of her own childhood trauma and how she deals with it in light of the work she does with her clients.

On the whole, vocal psychotherapy has proven to be beneficial in many ways. It raises many issues regarding the therapist/client relationship and can be intensely emotional, however I do believe that the fine balance of therapist objectivity/subjectivity can be achieved.


Myrtle D. Millares said...

This form of therapy is really interesting. I hadn't ever heard of it before. I'm curious to know more about what it is about singing that makes clients feel safer. What is it about music? In a way, it seems that the potential for the unleashing of so much emotion can be scary for someone who has the tendency to repress. But something in this combination of music and words obviously works and it's intriguing.

I've been in many difficult conversations, as a student counsellor, in which I've definitely been challenged by the need to balance professional distance with personal empathy in the face of stories that are so compelling. What I did conclude is that so many confused emotions and memories need an outlet, and not having the means through words, for whatever reason, contributes immensely to further anxiety, sadness, etc. I have often wondered whether music, as a seemingly less intimidating avenue for expression, would help.

Leonid said...

This is a really interesting and thought provoking question. Although, personally, I have no aspirations for music therapy it seems that the therapists’ struggle to balance their objectivity/subjectivity (or degree of their emotional involvement in the process) is akin to that of the practitioners of many other professions. For instance, as a teacher I realize that impartiality is important if I want to evaluate critically my students` progress and recommend the means for further improvement. However, I always find it difficult to distance myself from my students while ‘objectively’ assessing their performances and tests. I do not think objectivity is an option in that case. After all, there is (not a small) part of my pedagogical soul in what they do. At times, it seems to me that a ‘fine balance’ between objectivity and subjectivity is unachievable, especially when a certain degree of emotional attachment is developed. It becomes increasingly clear when I evaluate other teachers` students. Here, it appears that I can be completely objective, precisely because I am emotionally detached.
That is not to say that I do not see the technical or interpretational deficiencies of my students` performances, however, it seems that the students would benefit much more from my highly emotionally charged advice rather than from a cold, calm, unemotional, ‘neutral’, dispassionate recommendation. In short, I am totally against objectivity. To me, the attempt to achieve a balance between my subjectivity and objectivity would mean to develop a certain degree of neutrality. As a human being, I would rather keep my subjectivity and “biases”. And with regards to the music therapy I think that knowing SarahRose it would be hard to deny that it is precisely her personal qualities and especially her emotional involvement that attest to her great potential to contribute to the field.

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