Table of Contents
Table of Contents
List of Figures, Musical Examples and Tables ii
Chapter: 1 Introduction
Chapter: 2 Defining Music Therapy
2.1 Drawing a connection between music and the brain
Chapter: 3 Therapeutic Improvisation
Chapter: 4 Improvisation in Action
4.2 Creative Music Therapy with a Boy with Multiple Impairments
Chapter: 5 Conclusion
List of Figures, Musical Examples and Tables
Figure: 1 Music Therapy.www. crystalinks.com (2015).
Figure: 2 Synaesthesia.www. pinterest.com (2015).
Table: 1 Music Therapy Vs Music Performance. www. musablity.co.uk (2015).
Musical Example: 1 Simple Rhythmic Motif. Sinclair (2015).
Musical Example: 2 Simple Rhythmic Motifs with Altered Accents. Sinclair (2015).
Musical Example: 3 Simple I-V-I Chordal Dialogues. Sinclair (2015).
Musical Example: 4 Chordal Idea and Grounding Techniques. Sinclair (2015).
Musical Example: 5 Simultaneous Dialogue. Sinclair (2015).
Musical Example: 6 Tonal and Rhythmic Grounding. Sinclair (2015).
I would like to express my sincerest gratitude to my supervisor Dr. Rachel Talbot for all the support and encouragement given, without which, this dissertation would never have been completed. Dr. Talbot’s attention to detail, and insightful feedbackfacilitated a very enjoyable learning experience, and journey of discovery.
Thank you to, Dervilla Hynes, Eamon Nash and Paul Roe, for taking the time out of their busy schedules to meet and talk with, and for the valuable insights they provided
I would also like to thank all the lectures at DKIT that have taught classes over these last four years. They have made my time on the Applied Music course a most pleasant endeavour, and provided me with a solid platform with which to continue my lifelong musical studies.
I would like to thank my fellow students especially those of the class of 2015 who have made the interaction and joint learning a most memorable experience.
I would like to acknowledge and thank all the support staff at DKIT, Derek Farrell, Anne Coffey, and all the office staff, the library staff that work tirelessly behind the scenes.
I would like to thank my parents, and brothers for their words of encouragement.
And finally I would like to thank my wife Linda, daughter Amber and son Nathan, for putting up with me when I could not always acknowledge their love and support. They kept my feet firmly grounded when things seemed to get on top.
Investigation into the role of improvisation within the discipline of music therapy is achieved throughacademic research, interviews with performers and music therapy clinicians, and the examination of a case study of a seven year old boy with multiple impairments forms the basis of this study.
Musical examples based upon this research are offered as working models where the application of improvisation can be applied.
Contrasting the use of improvisation within performance, and the benefits of creative music within the health care environment, with the application of music therapy and its particular aims and goals is used in defining what music therapy is.
An investigation into the therapeutic application of music within the therapy environment, and psychodynamic principles, are used to clarify music therapy’s position within the health care system.
Examples of how improvisation can be applied are offered,detailing how improvisation can be used to develop an atmosphere of trust and exploration, leading to anddeveloping an interpersonal relationship between client and clinician. Investigating these clearly shows that the needs of the client are central to this relationship.
Music therapy is the analytically informed, and evidence based use of musicwithin the therapeutic environment to produce clinical goals, and clinical aims, that are centred on the needs of the client. This investigative research fully supports this premise.
Chapter: 1 Introduction
There are some misconceptions surrounding what is meant by improvisation, one of these being, that the improvised piece is a completely new and unlearned, unrehearsed, spontaneous response to what is happening at that given time. In his book, Thinking in jazz The infinite art of improvisation, Paul Berliner discusses the premise that improvisation is based upon what has previously been learnt and, quoting jazz musician Arthur Rhames, on the processes involved when he improvises in a live performance situation, states;
‘I’m calling upon all the resources of all the years of my playing at once: my academic understanding of the music, my historical understanding of the music, and my technical understanding of the instrument that I’m playing. All these things are going into one concentrated effort, to produce something that is indicative of what I’m feeling at the time I’m performing.’ (Berliner, 2009 p.86).
Rhames’s explanation makes clear that the popular conception of improvisation as performance without previous preparation is fundamentally misleading. Improvisation within music is not unique to jazz, but jazz and blues music are synonymous with improvisation, Tony Wigram, in his book, Improvisation Methods and Techniques for Music Therapy Clinicians, Educators and Students, articulates that the creation of music in all societies is centred on cultural styles of improvisation; Wigram also cites jazz as a complex expression of improvisational skill that fascinates and hypnotises audiences. He does however seek to dispel the myth that musical improvisation is just an ability of the gifted few, that it is not elitist but the property of us all. Wigram further states that, whether a highly elaborate multi-layered harmonic, melodic, and rhythmic structure is being created, or one is just tapping on a wine glass with a teaspoon, the ability to participate and join in with the musical experience through improvising is inborn and present in everyone. This element of improvisation Wigram calls the ‘ignored’ musical avenue for many children in schools where the teaching of music concentrates exclusively on learning to read music, listen and appreciate. It is however the preferred path for many music therapists as a primary method of work, reflecting the belief that the sounds we make can represent us, and that the improvised music can provide the framework for an interpersonal relationship between therapist and client (Wigram, 2004 p.19). LaDonna Smith an American avant-garde musician, composer and educator published an article entitled: ‘Improvisation in Childhood Music Training and Techniques for Creative Music Making’, in which she discusses the premise that improvisation is a necessary requirement in learning to play music. Agreeing with Wigram, she articulates the neglected aspect within musical education is the lack of focus upon improvisation. Although not primarily involved within music therapy, Smith draws the conclusion that improvisation is a connection to ones inner self (Smith 2015).
Drawing a comparison between improvisation within musical performance, and improvisation within music therapy, this study will seek to establish if there is indeed a difference between the two. This will be done by evaluating the role of improvisation within the music therapy session. Through academic research and interviews with performers, and music therapy clinicians findings will be compiled and research evaluated and conclusions drawn.
There are many people working within the health care system in Ireland that have not received accredited training or qualifications, that work in the role of music therapist, using music for its therapeutic benefits. In an article published in 2006 for and on behalf of the Houses of the Oireachtas Joint Committee on Arts, Tourism, Community, rural and Gealtacht Affairs, entitled ‘Defining Music Therapy’, it was noted in contrast to other countries, music therapy in Ireland does not have an ‘equal standing in the hospital team setting, with physio, speech and language, and occupational therapies’ (Keaveney, 2006). Furthermore this article highlighted there was ‘no distinction between the musical volunteer, the professional arts performer, and the qualified music therapist’ (Keaveney, 2006).
AingealaDeBúrca in her article, ‘Music In Common: probing the divergent mind-sets underpinning Music Therapy and Music in Healthcare’ has made the distinction that when she operates as a music therapist the musical outcome is not her main concern, whereas when using music in a healthcare environment, she combines performance with activities that enable the participants to engage, her primary concern is artistic and social.
As a music therapist on the other hand her primary concern is in creating a space where the client is free to respond and communicate, the client is central and the therapist does not direct the sessions, but uses informative ‘suggestions contained in the musical responses that occur’ (DeBúrca, 2014). In practice DeBúrca says she never combines the two disciplines.
Through academic research, and holding interviews with music performers and music therapy professionals, this study will seek to define music therapy. A clear distinction will be made between music in the therapeutic setting and music in the health care environment.
An investigation will be made into whether there are specific methods employed within the music therapy session and how these relate to other psychoanalytic therapies.
The role of music within music therapy will be investigated and how this is used to accomplish clinical aims.
Chapter: 2 Defining Music Therapy
There are many definitions given for music therapy, and on the official website of the American Music Therapy Association (AMTA) the following definition is given:
‘Music therapy is the clinical and evidence-based use of music interventions to accomplish individualised goals within a therapeutic relationship. 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. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings’ (AMTA 2014).
In an interview given by music therapist Eamon Nash of the COPE Foundation, Eamon similarly describes music therapy as the planned use of music by a qualified music therapist to support people in achieving identified goals. Music therapy is an established and researched profession and is used to support and encourage physical, mental, social and emotional well-being. Eamon goes further by stating
‘if you remove the term music from music therapy, you are left with therapy and that is what it is, music is only a tool applied in a therapeutic environment to achieve a clinical aim, many therapists would see themselves as therapist first, and musician second’ (Eamon Nash interview 2014).
Paul Roe, performer, and life skills coach reiterates this sentiment, when asked if the role of therapist and musician could be reversed. That is, therapy would take second place to music; Paul replied, ‘I think it’s appropriate in the context that a music therapist operates, is a medical one for the most part’ (Paul Roe interview 2014). Paul clarifies this further by stating that they are unlikely to be working in isolation, but as part of a team with other health care professionals. ‘So having a shared language with a shared focus on medical improvement, and development for the client is important’ (Paul Roe interview, 2014). Paul goes on to articulate that a musician may not have the complete training of a qualified therapist, which serves to protect both client and therapist. Agreeing with previous definitions Paul says’s ‘music therapy is a medical approach with clinical aims ’ (Paul Roe interview 2014).
Mary Butterton, in the introductory chapters of her publication Music and Meaning, puts forward the premise of music being a representation of ourselves, and equates life to an ‘emotional journey of musical associations with memories of significant relationships and experiences’ (Butterton, 2004 pp. 1-10). Butterton further Describes music as an ‘emotional holding for the listener and practitioner that can open up the door to an encounter with inner experience not usually brought to conscious articulation’ (Butterton, 2004 pp.1-10).
Many psychological disorders and malfunctions have at their core an inability to express or release pent-up emotions or feelings; those of hurt (physical or psychological) shame or guilt, remorse, and un-forgiveness, when not dealt with have a crippling effect upon human development. It is in this realm that the creative aspect of composition and improvisation are utilised as a means of expression where words fail or cannot even convey the deep inner workings of the client, in fact some may not even have the ability to speak.
In her article ‘The Role of Improvised Music in Psychodynamic Music Therapy with Adults’ Diane Austin, who is a psychodynamic music therapist currently in private practice, places the ways in which improvised music functions within music therapy into three categories,
Pure experience in the here and now
As a mediator between conscious and unconscious contents
As a symbolic language
In an explanation of the first category Austin calls this the ‘musical moment’ when the music resonates with the depths of one’s being and the client can experience a connection with his, or her, true self (Austin 1996). This mention of the musical moment would seem to agree with Butterton’s description of music being an ‘emotional holding for the listener and practitioner that can open up the door to an encounter with inner experience’ (Butterton, 2004 p.1). Austin goes on to say that it is here that spontaneity is evoked and it is possible for the client to be directly involved on a sensory and feeling level with the therapist. In this encounter the client’s need for mutuality is met, and has the experience of being companioned. In this realm the freedom to experiment and transcend limited self definitions occurs. The whole person, body, soul, mind, and spirit are engaged. On this point Austin writes; ‘this feeling of unity restores and revitalises, and a moment of healing takes place where change and growth can occur. The aesthetic properties of music—melody, harmony and rhythm—are an essential part of the therapy process’ (Austin 1996).
It is clear to see that an atmosphere of trust and exploration is developed here, and the element of risk and vulnerability, in which improvisation provides is a key ingredient, and a positive means of expression for both the client and clinician. In mentioning the vulnerability aspect of improvisation, Tony Wigram suggests the concept that anyone who is learning to improvise will undoubtedly feel vulnerable right from the very beginning. The reason for this is that,‘improvising is a process whereby one makes up music, and therefore opens oneself to the subjective and objective criticism of the quality of that music’ (Wigram, 2004 p.27).
Diane Austin’s second category, where improvised music within music therapy acts as a mediator between conscious and unconscious contents, refers to music as having the ability to‘mediate contents from the personal and collective unconscious to the conscious mind. Music can give access to the invisible world of image, memory and association’ (Austin 1996).This world where a client’s thoughts and emotions have only ever been accessed through frustration, anger or fear, as a coping mechanism the subconscious mind partitions. In the case of non-verbal clients these feelings have never been articulated and may never be, improvised music within music therapy provides the catalyst where expression may begin, and through expression release can be an experience.
‘Music can function as a bridge which aspects of the self normally not heard from can cross over into consciousness where they can be experienced, related to, and eventually integrated’ (Austin 1996).
Finally the third category examined by Austin, improvised music as a symbolic language; Diane Austin adds more weight to the linguistic aspects of music which within music therapy, as mentionedpreviously, is a means of communication between client and clinician. A mode of communication that can bridge the gap between articulations and the lack of ability to do so, yet she is quick to point out that music is only a symbolic means of communication that falls short of everything that can be imparted within the human interaction we call language, where words only make for a portion of the whole message communicated. ‘From a psychodynamic or psychoanalytic perspective, music is most often regarded as a language that gives symbolic expression to unconscious contents and internal psychological processes of the individual’ (Austin 1996).Tony Wigram agrees that music is often described as a language,
‘a language with syntactic and semantic aspects, but for it truly to be a language there would have to be a much clearer structure of symbols in it that are recognisable. Melody has many of the components of spoken language with its inflexions and its phrasing, however meaning within improvised music is usually specific to the person creating it, and the emphatic level of sharing that goes on is not precise but it is nevertheless truthful in reflecting moods, emotions and attitudes’ (Wigram, 2004 p.35).
The key to Diane Austin’s rationale in this instance is in the topic of the title; she does not say music is a language per se, but is used as a symbolic means of communication, which implies transference and counter transference, that music for its medial capacity allows feelings and emotions to be associated and integrated into the musical expression. Mary Priestly one of the founders of analytical music therapy defines her approach as ‘the analytically informed symbolic use of improvised music by the therapist and the client’ (Austin 1996). ‘Experiencing the emotion associated with past hurts symbolically in the music reduces the pain of that experience. This allows for a verbal processing of present and past issues’ (Austin 1996). Paul Roe maintains that, ‘music at a fundamental level can help you express gross emotion - be it joy, anger, sadness, or bliss- music has the ability to generate experiences, and project us forward and into a space where language can be applied’ (Paul Roe interview, 2014). In this statement, Roe would appear to be in agreement with Austin and Priestly.
2.1 Drawing a connection between music and the brain
Oliver Sacks, in his book Musicophilia asserts, ‘that we humans are a musical species no less than a linguistic one’ (Sacks 2008 p.3). In presenting information gathered from various case studies Oliver Sacks has sought to establish the connections music has in the brain, and the influence it has over mood and emotion. He remarks some individuals identify music not just with sounds, but tastes and colours, along with mood and emotion. This relationship to music details a much deeper level of cognisance and influence over the human psyche. Oxford Music Online defines this phenomenon as synaesthesia, and places it into two categories. The first is synaesthesia proper, where when one sense has been triggered this will also trigger sensations in one or more of the other senses. The second form is termed cognitive or category synaesthesia, and involves the cultural conditioning of smell, colour and flavour.
‘The most common forms of cognitive synaesthesia involve such things as coloured written letter characters (graphemes), numbers, time units, and musical notes. Synaesthesia has neurological components and is partly heritable. The percentage of the general human population which has synaesthesia varies with the roughly 60 types involved; estimates run from about 4% for basic types of cognitive synaesthesia (coloured letters or musical pitches) to about 0.03% for more common forms of synaesthesia proper (coloured musical sounds or coloured taste sensations) to less than 0.01% for people with rare or multiple forms of synaesthesia proper’ (Grove Music Online 2014).
This greater level of synaesthesia, for most of us is just an association, however for a small proportion of the population it is an immediate conjoining of the sensations and may involvesome or all of the senses.
In her book Music and Meaning, Mary Butterton discusses the very early developmental phases of our lives, before the ability to use or articulate language, ‘where feelings and sensations made sense of the world around us, calling this an ‘aural experience’ (Butterton, 2004 p.15). These experiences may not be immediately accessible to language. They are known and accessible, however by another route, that is, through sensations in the body.
‘Modern psychodynamic thought takes the view that certain aspects of an individual human being, her brain, her intelligence, feelings and bodily sensations, these aspects of each of us, which are the building materials of our human story, are an internal dynamic encounter with each other. Not only are these aspects in dynamic encounter with each other internally, they are also in dynamic encounter with the world around us and the persons with whom we engage’ (Butterton, 2004 p.16).
Aingeala De Búrca a trained music therapist, and professional performing musician, in an article published in the June edition of the Irish Association of Creative Arts Therapists (IACAT) E-bulletin discusses the premise that free improvisation is the primary language of music therapy. She refers to the conversation produced as ‘an organic conversation-like interactive process. This process is known as clinical improvisation, in which the focus is on the response to the internal world of the client’ (De Búrca 2014). The following excerpt from this article gives an insight into the main purpose of music therapy, and how a trusting relationship is developed between client and therapist.
‘These mutually reciprocal responses between therapist and client allow for great freedom in any given moment and an understanding that the music created is neither right nor wrong – it just is. This acceptance of what the client plays or says reflects an acceptance of who they are and what they can do. As the ‘language’ of music therapy is non-verbal, it has no ‘concrete’ cognitive meaning, but has great power to convey emotion, thus enabling a client to make deeper connections with others (an inability that is often at the root of psychiatric disorders). A client’s internal and unconscious world is revealed through the music they make. This provides emotional expression for the client and information for the therapist’ (DeBúrca 2014).
It is in this trusting environment, created using the medium of music, where the freedom to improvise opens the doors of exploration, through the analytically informed symbolic use of improvised music by the therapist and the client. Mary Butterton refers to this as ‘opening the door to an encounter with inner experience not usually brought to conscious articulation’ (Butterton 2004 p.1). In which the discipline of music therapy, utilising a medical approach, is able to extract unique information, and insights that might be contained in the individual’s inner thought process.
Chapter: 3 Therapeutic Improvisation
Having looked briefly at musical improvisation and the connection with oneself when giving expression to this, and investigating the premise that improvisation is the key that unlocks the doors to one’s inner self — that even when in a performance situation, musical improvisation is the art of calling upon ones complete academic, historical, and emotional resources; some fundamental issues are highlighted which require clarification. Is there a contrast between musical improvisation in the performance arena, and musical improvisation within music therapy and the clinical domain?
How musical improvisations are applied to achieve clinical goals, and are there some basic concepts to apply?
There is indeed a fundamental difference between musical improvisation and clinical improvisation. Although both are closely related by the dynamic of music, clinical improvisation is the ‘use of musical improvisation in an environment of trust and support established to meet the needs of the client’ (Wigram,2004 p.37). On the other hand musical improvisation outside of the clinical environment is more to do with the collective good, and is the spontaneous creation and interplay of music within a predetermined set of parameters, which Wigram defines as ‘any combination of sounds created within a framework of beginning and ending ’ (Wigram,2004 p.37). James Hillers in his publication entitled ‘Music Therapy Perspectives- Use of and Instruction in Clinical Improvisation’ contrasts musical improvisation and clinical improvisation in this way.
‘In clinical improvisation, client and therapist relate to one another through the music. Sometimes the improvisation results in a musical product of aesthetic value, however, this is neither a requirement nor is it often an essential aim.Music improvisation, on the other hand, is the process whereby musicians extemporaneously create a musical product that is most often intended to have aesthetic value. In music improvisation, the individuals do not relate to one another within a client-therapist relationship, and the purpose is not intended to be therapeutic in any way, although players may find the experience of improvising to be therapeutic in the general sense of the term’ (Hillers 2009).
Quoting Kenneth Bruscia, Hillers writes of clinical improvisation; that it is ‘the process whereby therapist and client improvise together for purposes of therapeutic assessment, treatment, and/or evaluation’ (Hillers 2009).
 ‘There is, in fact, a lifetime of preparation and knowledge behind every idea that an improviser performs. This preparation begins long before prospective performers seize upon music as the central focus of their lives’ (Berliner, 2009 p.87).
 ‘With children, I think it is important to include from the very start, a conceptual training, which will facilitate channeling the natural talent into usable musical forms.Improvisation is clearly a key to unlock the doors of music making in the future. With change being the constant element of our existence (as it always has been), musical training should begin with the concept of creativity placed first and foremost above "how-to" methodology, tradition, or technique. Those would become the "special" studies’ (Smith 2015).
 For further information see: http://www.oireachtas.ie/documents/committees29thdail/jcastrag/reports/Music_Therapy.pdf
 COPE Foundation is a not-for-profit organisation which supports over 2,000 children and adults with intellectual disabilities and/or autism based in Cork.
 AingealaDeBúrca published an article entitled Music in common: Probing the divergent mind-sets underpinning Music Therapy and Music in Healthcare which seeks to draw a clear distinction between music therapy and the health benefits of music.
 For further information see: http://0www.oxfordmusiconline.com.dkitlibs.dkit.ie/subscriber/article/grove/music/48564
 ‘Musical improvisation also called extemporisation, is the composition or free performance of a musical passage, usually in a manner conforming to certain stylistic norms but unfettered by the prescriptive features of a specific musical text’ (Britannica 2014)