Tag Archives: nordoff-robbins music therapy

“Listen To The Bell”

“Mr B” is one of the clients who attends the community music group for adults with intellectual disabilities once a week. He is in a wheelchair and is accompanied by his carer, “Van” – a lovely lady with the sweetest personality.

Mr B usually sits and stares into the space in front of him. He doesn’t make eye contact with anyone, and his lips seem to always be in an inverted U shape. His eyebrows are also always knitted together, giving the impression that he is constantly unhappy about something. He doesn’t speak, and I can only imagine how difficult it must be to take care of someone who does not want to or know how to articulate their needs and/or emotions.

In recent weeks, Mr B. started making little breakthroughs. Slowly but surely, he started showing awareness of the activities we were doing in the sessions, making little gestures and movements to indicate his willingness to participate. Gestures like reaching for the guitar and making strumming motions instead of simply sitting still, making a choice regarding which bell he wants to play instead of letting Van choose for him, making brief but solid eye contact with people instead of staring at nothing in particular – small gestures and actions which are huge milestones in Mr B’s journey to communication.

In the recent week, we witnessed something so beautiful, I still get goosebumps when I think about it and watch the video recording.

After a session of upbeat music making, R wanted to end the session on a calmer energy level, and chose to do “Listen To The Bell” – a wonderful piece of work by Julie Sutton. The song invokes a sense of contemplation and calmness simply by use of open intervals and timbre of the hand chimes/bells.  R was playing the piano, and I was asked to “facilitate” each client’s interaction through the bell in their hand.

“Facilitate” – anyone who has taught anyone else before would know what a huge word that can be. I knew I did not want to simply stand in front of them and tell/prompt/encourage them to ring their bell – though that was what I did at first. Then, on a whim, I started to use the other readily available instrument I had with me – the voice. Improvising along to R’s playing, I used the voice to create melodic lines (though when I watch the video I realize I tend to stick to “safe” intervals – something I should work on) to form a musical relationship with the individual playing the bell – it certainly sounds texturally more interesting than simply telling/prompting/encouraging the person to play their bell. And since R didn’t stop me when I started doing that (as I know he would when he thinks things are not working out), I assumed it was ok to continue.

We moved from individual to individual in the circle in this manner, making music with voice, piano, and bell. Finally, I knelt in front of Mr B’s wheelchair. “It’s your turn,” Van prompted, using her hand to guide his hand in a rocking motion so that his bell made a soft ringing sound. As she continued doing that, and I continued singing, and R continued playing, it happened.

Mr B. SMILED.

He tilted his head back, turned sideways a little, and SMILED. His inverted U lips simply inverted back. The sides of his lips turned upwards. His eyes became smaller. The creases in his forehead looked a little less deep. He was SMILING.

It took us all about a second to realize what he was doing. Maybe we just couldn’t imagine that face of his ever looking like anything else!

“B’s smiling!” Van exclaimed softly, when she saw.

“Wow, that’s a beautiful smile, B.” R responded ever so calmly as he continued playing.

I was trying to keep the singing going and making sure that the intervals were in tune with R’s playing, so I think my reaction was the least reactionary at that moment, but wow, I was really blown away too. Who would have thought that Mr B was capable of demonstrating such a solid facial expression?

“He’s never done that before”, Van continued, awed.

Mr B. kept that smile for about 3 seconds, then it gradually faded, but somehow the inverted U lips and knitted eye brows didn’t make him look as unhappy anymore. It could have been my positive imagination, but I thought he looked a little more… at peace.

Someone once wrote (need to search for the source again) that the role of the music therapist is to create the musical experience which the client is unable to create for themselves, and then use that experience to bring them to their goals, be it in communication, emotional balance, or physical improvements, etc. I suppose, because of the role we play, it’s easy to get all self-important and think that we’re indispensable in our client’s lives, and I admit that for a moment or two after I saw Mr B’s smile, I was really pleased with myself. But then I also realise that it could have easily been anyone else doing what we were doing, and it could have easily been someone else standing in front of his wheelchair and seeing Mr B smile that day. His smile was not a miracle we pulled out of a bag through OUR efforts – it was the result of the music which was already in him, the musical experience being felt within him, and the fact that we happened to be there when he made the connection between the music and the people around him. And we were fortunate enough to have witnessed it.

Still many thoughts and feelings about this, but that’s the gist of what I think so far. And the journey continues.

The First Meeting

In Creative Music Therapy, the act of the therapist and client initially getting to know each other is known as a Meeting. This Meeting is not about physically saying Hello or HowDoYouDo – more often than not it may not even be verbal – it’s more about coming to a mutual understanding, acceptance and acknowledgment of each other’s presence and abilities. For the therapist, this means getting a sense of the client’s ability to communicate and their dominant emotions. For the client, it may mean feeling validated by how the therapist responds to them, getting used to the setting, feeling safe enough to express freely.

After weeks of observation, our supervisor (henceforth known as R) dropped a fine bomb on us on the recent Thursday, suggesting that we physically step into the session with M, a sweet 16-year old boy with autism. He doesn’t speak, with the exception of single words, usually popping up at the end of song phrases and sentences. He loves songs that have actions to go along with them, and recently started saying words AND doing the actions at the same time. He is also very routinized, and we were initially worried that the presence of strangers in the room might throw him off. Fortunately, M seemed relatively comfortable, and even shook our hands when told to. Five minutes into the session, R suggests that I start by Meeting M at the piano.

So I sit on the piano bench, hesitant but excited, and wait for M to make the first move. “Just use what he offers you musically and try to respond accordingly”, R tells me. In other words, clinical improvisation. Improvising, but in a clinical context, to Meet M and show him that his sounds are being validated and that he is being accepted as a person. From the observation room, watching R do it, it seemed like the most natural thing in the world. Just respond to what the client offers you. Take what he plays and return it. Call and respond. Basic musical concepts. Right? Except that from the moment my fingers hit the keys, my brain started screaming: “This doesn’t sound right! How do you know if you’re playing correctly?! What’s the correct way to do this?!” The extreme need to know whether I was right or wrong meant that my intellectual brain was working in overdrive, and that, was certainly no way for spontaneous improvisation to take place.

There is a phrase: “Creative Moments” – used to describe that moment when a true and pure connection has been made . When it happens, the therapist knows it, the client knows it (presumably). I felt such a moment for about 3 seconds, when I chose to play sustained, open chords in the base, to support M creating a rhythmically denser melody on the higher register. The intervals of 4th and 5th suggest openness and provides room for expression, inviting the music the develop and grow. We worked this way for the duration of about 5-6 chords, before my intellect kicked in and I thought: “Hey, this may be getting boring for him. What if I try to spice things up by adding some accidentals?” The moment my fingers hit those black keys, I cringed inwardly, for it was then I realised that M was only playing with the white keys, and there had been no need to add any accidentals at all! By trying to “spice things up”, instead of continuing to trust my feelings and obvious observation, I had ruined the Creative Moment for us. I tried to go back to whole-tone chords, but the moment felt lost, and M had proceeded to another mode/musical motive which I then had to catch up with.

That was just one example out of numerous in the session in which my intellect came in and got in the way. R was very encouraging after the session, saying that we did not too badly for the first time, pointing out the fact that clinical improvisation is something that can be learnt, and he would be more than happy to share some tips with us for the future. He just needed to throw us into the deep end for awhile to see how much we could do. And while I’m no olympic swimmer, I’m also happy I didn’t drown, and somehow managed to stay afloat long enough to experience the beauty of the ocean.

As one of our lecturers told us recently, it is possible to have a Meeting extend over a few sessions – she shared how she was still Meeting a client even after 3-4 sessions, and only felt that she had finally Met him in the 4th session, after which more focus could be given to the planned clinical goals. She added that we should not constrict our relationship with clients within sessions (not unlike how a teacher may think of a child’s development in terms of school terms and semesters), something bureaucracy tends to do to us. After all, a person’s development is never compartmentalized.

I’ve been thinking about M and this experience with him over the past few days. I don’t think I’ve ever reflected this deeply as a teacher.

I really want to do this.