Earlier this month I was interviewed by Hannah Nepilova, a counsellor who has her own private practice in South London. Although she uses talking as the primary mode of communication and connection in her work, Hannah is a musician herself and had a previous career as a music journalist. As such, she was really keen to hear a bit more about Music Therapy and the way I work.
You can watch the full video above and some of the themes we discussed have already been relayed in previous blogs. Other themes that came out of the interview and that I’d like to delve into a bit more right now are:
- What kind of person or circumstances might lend themselves to accessing Music Therapy
- Some details on the nature of musical interactions in Music Therapy
- Trauma and Music Therapy
Below you’ll see some transcribed extracts of my responses (minus all the umms, aahs, wells and you knows). I’ve also added some short additional notes to fill in some of the gaps and offer further information. This is under the heading of ‘Fact File,’ which I blame the Netflix kids’ show ‘Creature Cases’ entirely for. So here goes:
Hannah: Are there particular age groups or areas of mental health, or is there a particular kind of client who lends themselves well to Music Therapy? Does it help with certain issues more than others?
Hugh: It’s a really good question. And I think it’s a question that within the profession, we think about a lot. We are a very diverse profession in terms of the settings that we work in, the sorts of people we work with, but nonetheless, I think historically, there have been certain demographics that we’ve worked with more than others.
So, big areas that immediately come to mind would be:
- working with older adults who may have a neurodegenerative condition, so often dementia, or a form of dementia
- Children and young people who have additional learning needs, particularly where there might be challenges around verbal communication
- And similarly, adults with learning disabilities, where they might often feel quite disempowered or unable to access talking-based therapeutic work
They would often come to mind, but I could just keep adding areas where I know Music Therapists work. There are NHS Music Therapists working in acute adult mental health wards, for example. There are Music Therapists working in prisons. There are Music Therapists working with adolescents with eating disorders.
For me, a big untapped demographic would actually be neurotypical adults experiencing, I guess, quite common areas of mental health challenges; anxiety, depression, grief, that kind of thing, but who would typically gravitate towards either no therapy, or would gravitate towards talking therapy, even where they might not actually feel like talking therapy is what they want or is right for them.
So I feel like Joe Bloggs would not necessarily think about accessing Music Therapy aged 34 after a difficult breakup or something like that. But they might go and speak to a counsellor, which could be brilliant for them, it’s just what’s needed. But I would really like Music Therapy, eventually, to just be a bit more part of the mainstream conversation at that stage, as an option.
FACT FILE:
You don’t have to have any musical experience to access or benefit from Music Therapy. Sometimes people who are quite ambivalent or resistant to music, perhaps where there is a difficulty being playful, spontaneous or feeling creative, can actually be really good candidates for Music Therapy or other arts-based therapies.
Whilst Music Therapy can naturally attract referrals for people who have challenges around verbal communication, it can work very effectively with those who are extremely eloquent and articulate, but who want to explore alternative ways of expressing and processing emotions alongside talking. There’s more information on Music Therapy settings in the UK here.
Currently at Thame Music Therapy I work with a lot of people who experience high levels of anxiety. Engaging in creative, accessible musical activities can be a way to re-build trust and confidence, while giving space to consider their identity and potential. Ultimately this is with the aim of supporting their long term sense of self and mental health.
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Hannah: Are there particular techniques that you tend to come back to, or that you tend to favour? I imagine it varies from person to person, but perhaps there are certain things that you think, I know this is quite a powerful technique, and so you do come back to it?
Giving Space
Hugh: I mean it does vary a lot. Just to give a couple of examples, if a child came into a session and started moving around the room, perhaps pottering about a bit, testing out some instruments, seeing how they sounded, what they felt like, maybe touching some of the sensory resources in there as well…a simple technique would be to not do too much and just let them be, without getting in their personal space; showing them “that’s fine,” you’re very welcome here, take your time to have a look around, this space is for you. So offering them that kind of tacit permission, if you like, without it being specific to any technique per se.
Establishing contact and connection
But then I guess it’s often about trying to find a moment where you might be able to capture their attention to show that you have seen or witnessed something that they’re doing, and to see if they (in turn) might be able to register that you might clock that. So musically, it might be that you chime into their particular tone of voice, if they’re humming, they’re singing, and try and imitate that back some way, either through your own voice, or using an instrument to hit the right pitch that they’re at, or whether it’s a really striking sound, strong volume, or if it’s very sharp, it’s quite smooth. Or if they’ve done something more prolonged, you’re thinking about the length of the phrase and you imitate that as well. So I guess an early technique is seeing if they can register your presence, really, seeing if they can register you’re there and you’re listening to them.
Thinking about a parent-infant model
We would often think about making a comparison to early parent-infant communication; that’s a helpful model for us in Music Therapy. So thinking about when a very young baby is staring at their mum or dad or grandparent, with so much intensity between them. And often it’s about very simple mirroring, listening to the tone, the cooing or the babbling, feeding it back and just enjoying that moment in itself. There can be musical equivalents of that.
And there might be particular sorts of phrases that we might use, which are similar to a talking therapist, just to feed back, saying things like: “I really hear what you’re saying,” or “just to check I understand, it sounds like what you’re saying is X, Y and Z,” to try and check that you’ve understood and show that you’re listening, and you care about what that person is saying, without necessarily bringing in your own interpretations yet, just purely holding that line of, yes, I’m here and I hear you. There are definitely musical versions or equivalents of that too.
Developing synchronised play
Depending on who you’re working with, sometimes you can have really, really rich musical moments that go off in lots of different directions, and they don’t just have to be turn-taking. And of course, in music, you can do things simultaneously, which you wouldn’t necessarily do in talking, because it would feel invasive in some way.
As a Music Therapist, I might try and take the role of an accompanist. If you’re thinking about, let’s say, when you see someone perform a song, and they’re singing, and there’s someone else playing guitar, or someone playing piano, supporting them to communicate what they want musically. So if someone has found an instrument they’re really into, and they want to play, well how can I just support that gently? Support the rhythm of what they’re doing, show that I’m there, but I’m not taking over, you know. I’m not invading their space, I’m just trying to foster their musical space and what they want to express.
FACT FILE:
Within Music Therapy sessions, a lot of other forms of accessing music can come into sessions. Some people like to write songs, some like to re-create versions of their favourite songs, some like to listen to music and talk about it, some like to do art work or dance while listening to music. I could go on. A big part of my Music Therapy practice is to show acceptance and validation for who I’m working with. That’s why giving space to them is so important, as well as coming alongside their connection to music in a supportive, non-threatening way. We can all wear so many masks in different contexts and it can be hard to be authentic and spontaneous. Over time I want people accessing Music Therapy to feel like they can be themselves, whether in words, music or some other form of creative play. That way we can experience and explore real emotions in a helpful way.
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Hannah: As a talking therapist, I’m particularly interested in trauma and different approaches to it. I’m also, as somebody with a background in music, very interested in the way that music can be used as a therapeutic tool for those suffering from the after effects of trauma. Do you think that Music Therapy could be an effective tool for working with trauma?
Hugh: I mean, absolutely. And one thing I would say is that, sadly, trauma comes into so much of one’s work as a Music Therapist, because often the nature of the client groups we’re working with are that these people are incredibly vulnerable. And we know that people, for example, with physical or learning disabilities and neurodivergent people are more likely to have experienced trauma in their lives than the general populace.
There’s something about music being a non-verbal form of interaction and self-expression which is, I think, very, very important in trauma-based practice. Because we know that trauma is experienced in the body, and is held in the body, and is often triggered physiologically by certain experiences. And for lots of people, it’s not always possible to characterise that experience and emotion through words, or even when it is possible to express it and relay it in words, that might only be part of the story, if that makes sense; that might only be part of the way of processing it and getting to grips with it. So I think there are ways that music, and other art forms, art and drama and dancing, can really help give an avenue for someone to explore very profound, painful experiences in a different way.
Hannah: One thing you do experience with those who have suffered from traumatic events is that they can almost be a bit numb; it’s hard to access them emotionally. It’s part of the self-protective response to trauma. In which case, could something like music penetrate emotionally where words fail and listening to music specifically?
Hugh: I mean, in terms of that last part of your question, could it perhaps penetrate where words fail, I would say emphatically yes, but it’s a kind of “potentially” and it does really depend on the person and what form of music that is.
So in terms of the nature of the music itself, and whether it’s (the client) being part of active music-making or more listening to music that helps to access perhaps particular memories, particular experiences, particular emotions…it’s very hard to say broadly, but I think all of those things can come into Music Therapy. And I think often, as a Music Therapist, one has to be very, very sensitive actually about just how triggering in some way certain pieces of music or certain feelings of playing music could be for someone.
And actually, it might not be safe in some cases, to have a particular piece of music so readily available, or used in a session at certain points, especially if the therapeutic alliance or relationship isn’t so well established yet, because it might be really overwhelming. Or it might feel unfairly exposing in some way for certain emotions to be triggered in a way that they (the client) feel can’t be held at that stage of the relationship.
One might be very careful also about, within a session itself, when the music making takes place, or when to use a particular piece of music. I’m just thinking, if there’s five minutes to go in a session, it might be very unhelpful if one is aware that particular music is very evocative; it’s quite triggering to use that tool at that point when you haven’t got time within a session to process, to ground them before the session’s finished.
So there are lots of considerations, and I should also say that there are particular areas of Music Therapy such as GIM (Guided Imagery and Music) and also NMT (Neurologic Music Therapy) where there might be specific approaches to listening to music and how that relates to (trauma in) the body. And GIM and NMT, they’re not areas where I’m trained in, but they would use recorded music more than I do […] It’s definitely a tool to be used with thought and sensitivity and always thinking about the individual there and the working relationship.
FACT FILE:
In my previous career as a teacher, workshop leader and youth worker, as well as in my current practice as a Music Therapist, I have worked a lot with traumatised children who have significant attachment difficulties. And in my relational approach to Music Therapy, I am trying to offer a different blueprint for them to have a safe, trusting relationship where it is ok to be themselves. For a lot of young people I work with, it is important for them to know that they can get angry with me, reject me, dismiss me, maybe even try to humiliate me, which may well be related to their experience of trauma, but that I can hold that emotionally, that I will still be there for the next session and still be available to support them.
Some Music Therapists train in specialist areas that I alluded to, including GIM and NMT that I have linked to. Others train in EMDR, with this latter training particularly geared towards helping people to process traumatic events in a safe way.
You can see further information from Mencap and Autistica on the sobering links between learning disabilities, autism and trauma and mental health difficulties.
Thanks very much to Hannah for giving me this opportunity to reflect on my Music Therapy practice and on the profession in general. It always gives a lot of food for thought!