Key Change: Music Therapy
Music therapy in action — the art of using music, in all its forms, to facilitate meaningful interactions and communication in order to improve quality of life.
In a locked acute psychiatric ward in London, a 40-year-old female patient shuffles into Cerrita Smith’s music therapy room. It’s the first time they’ve met, but Smith knows her background. This patient is restless. She chooses not to sleep in her bed and is constantly distressed by disturbing hallucinations. She dresses very expressively, often covering herself in dark layers — even black veils — to try to conceal herself. She is impossible to organise and is disturbing others on the ward. So, now it’s Smith’s job to see if she can engage her.
“During the first few sessions she would only stay in the therapy room for a few minutes, playing very loudly on the piano, shaking the maracas, hitting the drums, producing a real cacophony of sound,” Smith remembers. “Her playing was expulsive. She played so forcefully until she couldn’t sustain it any more, then left without a word. Slowly she started staying longer, noticing that I was responding to her music. She began to sing. Gradually this became the way she accessed and communicated her distress verbally. Now she has gone back to living in the community.”
This is music therapy in action, the art of using music, in all its forms, to facilitate meaningful interactions and communication in order to improve quality of life. “The therapist is always seeking to respond to the client’s musical expression, or to create a frame around it,” says Smith (Guildhall Alumna, Music Therapy 2012), a flautist and singer who manages Guildhall’s music therapy outreach programme. “It’s important to let them explore the instrument on their own, but also to be able to step in and move things along. And while some are happy to improvise, others can’t access music at all, so it can help if you choose a familiar song so you can then talk about the piece of music’s relevance to them.”
“Taking an instrument and spontaneously expressing yourself is not as unusual as you might think, especially with children,” explains Donald Wetherick, one of the teachers for the Master’s in Music Therapy at Guildhall. “But if someone is angrily beating the drum, and then someone else adds harmony over the noise they are making, that changes the creative expression and creates a connection. And you can slowly draw people into expressing themselves in a different way.”
It was this unique power of music as therapy that first attracted Head of Department Ann Sloboda to the field. “I had become disenchanted during my undergraduate degree in Musicology — it seemed to me we were only studying the structure of music without the emotional content.” Having decided she wanted to work more directly with people than a performing career as a pianist would allow, Sloboda considered training as a social worker, but couldn’t bear to give up music. “Then I discovered music therapy, which ticked both my boxes — playing music and working with people.”
Sloboda went on to qualify as a psychoanalyst at the Institute of Psychoanalysis in London, and today’s Guildhall music therapy students, in line with the usual training for anyone to be a therapist, all undergo personal therapy, as well as group experiences during their training programme. Here they can explore interpersonal dynamics and consider the impact people have on each other, personally and through their musical interactions. “It’s very important for them to have the experience of dealing with their own reactions in such circumstances, in a safe place, before encountering them in real-life clinical situations.”
Those situations vary widely, as Wetherick explains: “I have been a music therapist for 25 years and over that time the diversity of work has grown. Whereas I started off working in SEN schools or with excluded pupils, now you see a lot more music therapy in mainstream schools. Work with the elderly, and dementia care in particular, is a huge field of growth. Work in prisons is increasing. Music therapists also work very well with homeless people and those with HIV/AIDs.”
Another field is working with adopted children and their families, an area Smith specialises in. “Music can provide a way for the children to explore earlier trauma as well as help them build better relationships with their new parents and siblings.”
Music Therapy and Outreach Tutor, Marianne Rizkallah (Guildhall alumna, Music Therapy 2013) stresses that through the outreach programme, “music therapy is now available in places which wouldn’t have access to it in the past, such as community centres and schools in deprived areas. Music therapy can work at any age — I’ve had clients ranging from age 2 to 100.”
“Age can be a cultural factor.” adds Wetherick. “The music children and teens engage with is different. I have become very familiar with the theme tunes from children’s television. But sometimes clients playing music they know can be a way of avoiding improvising — which might be more helpful for them.”
The audition process for a place on the Music Therapy Master’s programme at Guildhall is in two stages. At the first stage, applicants play pieces they have prepared and then undertake an improvisation task with one of the interview panel. It doesn’t always go according to plan, as Rizkallah remembers: “I auditioned with singing and flute, and I completely messed up the flute. I simply forgot where I was in the piece and my accompanist looked absolutely horrified. But somehow that got me through because what they were looking for was someone who can improvise — which I certainly needed to then!”
She survived the experience, and Sloboda agrees that the ability to be flexible musically is crucial. “Improvising is simply playing around with the skills you already have. Personally, I was classically trained, but I have always enjoyed ‘fiddling around’ on the piano.” What matters just as much are inter-personal skills, she says. “When I am interviewing, I want to know what part music has played in a candidate’s life and why they want to become a music therapist. They have to want to work with people.”
Wetherick acknowledges that it’s a vigorous audition process, but says they are looking for particular attributes. “We are interested in that individual’s personality and how they use their music in interaction.” As well as teaching and his clinical work, Wetherick is halfway through a part-time PhD on musicianship as it relates to music therapy training — in other words, what kind of musician makes a good music therapist. “It is not always true that the best musical performers make the best therapists; but if you are musically limited, you will struggle.”
Sloboda cites the example of a group playing with adults with learning disabilities. “Someone wants to play the drum and that’s fine. But what if they want to play it so loudly that no-one else’s part can be heard? Or what if everybody wants to play the drums? It’s the music therapist’s job to help people negotiate so that everyone gets something out of the session. The end product could be anything in musical terms, but seeing a group of people come together is very invigorating.”
The students hone their interactive skills during a series of placements on the Master’s course. In their first year, they will be sent one day a week on different placements, in contrasting settings, be that a hospital, school or adult residential care. Initially they observe before participating. In their second year, students spend two days a week working on clinical placement. “It can be very revealing,” says Sloboda. “You might come to Guildhall convinced that you want to work with children with special needs, but end up concluding that you enjoy working with adults in a psychiatric unit.”
Whatever route the students choose after graduation, they will need to be resilient. “It’s hard work,” Sloboda says, “and funding pressures mean each organisation wants to gain maximum benefit from their music therapist, who is generally working on their own within the unit.” It can be stressful too, as Smith, who has experience of working with addicts as well as those in acute stages of psychosis, knows only too well. “Managing risk is always part of the work. You need to be mature, and resilient as a person, to be able to cope.”
The personal rewards, however, are great. As Rizkallah puts it: “It can be very liberating for the therapist as well. You can be free with the music — you don’t have to stay within traditional music idioms, it can be entirely improvised. And as you listen to the tapestry of sound your clients create, you wonder why someone should make that particular sound on that instrument right now. That can lead you to a greater understanding of the way they are feeling, so you and others can better help them understand themselves — which is what we all want to do.”
This article first featured in the Spring/Summer 2019 edition of the Guildhall magazine, PLAY, and was written by YBM for the Guildhall School of Music & Drama.
