The Use of Music and Sound
to Enhance the Therapeutic Setting
By Mary Anna LaTorre
Much of what goes on in a therapy session is determined by language and verbal communication. Language is the system we use to send and receive messages. It is the vehicle for assessment and intervention, and forms the basis for much of the supportive change that occurs in the therapeutic relationship (Fine, 2001). Underlying this system of words is the sound itself-the vibration of tones, the quality it evokes, the resonance it has to both mind and body. In sessions, sound is often used only through words, but there is a whole array of other ways to incorporate sound into the therapeutic relationship to enhance the resonance between client and therapist and to promote healing.
To appreciate the power of sound itself, it is important to understand its effect on mind and body. Sound is a vibration, and as Gaynor (2002) points out, "We are all systems of vibratory matter" moving in rhythm and resonance to each other (p. 71). This vibration touches every part of our body, so that sound is heard not only with the ears but also through our skin and bones and every cell (Brewer, 1998). Sound is a form of energy, and research is showing how different types of energy can directly effect the cells' receptivity to information (Pert, Dreher, & Ruff, 1998). Sound is also a manifestation of breathing, as well as a way to reenergize the breath so that working with sound can revitalize and heal on many levels. Sound creates the vibration allowing us to synchronize to one another, to breathe and blend together. When sound is properly mobilized, it can synchronize the human body toward greater harmony and balance (Gaynor).
Looked at in this way, it is surprising that sound is one of the most underused of the mind and body tools. A therapeutic session often works only with the tone and timbre of words to convey meaning and emotion rather than with the wide range of sound approaches that can be considered such as vocal toning, singing, and music. Such approaches fall into two categories: those that involve the client directly in music making, and those that involve listening to vibrational sounds rather than making them (Brewer, 1998). Both approaches seem to be successful with a whole gamut of problems from high stress to schizophrenia. The choice of one approach over the other has less to do with a specific diagnosis and more to do with the therapist and client's own level of comfort (Gaynor, 2002). A decision to incorporate different sound approaches into the therapeutic session involves an understanding of how to go about doing this effectively, and a willingness to follow wherever the sound takes a client.
Direct Music Making: The Use of the Voice to Tone and Sing
Involving a client directly in making tones and sounds adds another dimension to the therapeutic interaction and can help resolve tension and emotions by providing a new avenue of expression. Using vocal sounds and toning is a very old art that dates back to ancient civilizations when singers would chant one note for hours at a time to see the effect this note had on their minds and body (Khan, 1988). In recent years, research has found that using the voice to make tones and sounds helps to release tension and give expression to something that may not yet have a precise conscious meaning for the client (Beaulieu, 1987).
Finding a tone that gives sound to a feeling allows the client to experience this emotion from another place, while increasing the flow of breath and resonating specific body areas to which the sound is directed (McClellan, 1991). This tone can be a sigh or a moan or a hum; often, in the beginning, before the client feels comfortable enough with making sounds, it may be almost inaudible (Goldman, 1992). In fact, as Gardner-Gordon (1993) shows in her book on the healing voice, it is often possible to begin with the sound of the breath by asking a client to make a sound as he/she exhales. As this activity is repeated several times, the sound becomes longer and more sustained, with the client feeling comfortable enough to play with the sound and find those sounds that are pleasing or cleansing or soothing in some way. Allowing a client to express sound in this free, unstructured manner encourages spontaneity and gives permission to express whatever is within. Using sound and toning in a therapy session enhances the opportunity to express what may be difficult to verbalize through language.
A similar effect can be produced by stringing a few tones together and singing them, for singing allows us to "exercise our breath and simultaneously become our own instrument of self expression" (Gaynor, 2002, p. 101). This activity may be more difficult than toning a single note, since singing often carries with it a value judgment of performance; but with support and encouragement, clients can discover their own voice and explore the wide range of emotions that are reflected in the sounds that they combine.
Listening to Sounds and Music
Allowing a client to listen to music while in a session, whether for relaxation or to expand awareness, is another approach. This can be equally as effective as clients making the sounds themselves, for music has a powerful effect on mind and body. Studies have shown that it decreases the stress response and induces relaxation (Watkins, 1997), and enhances higher cognitive functioning (Rauscher, 1995). Once again, the rhythmic pattern of sounds vibrate the body and activate stored memories (Steckler, 1998). Since listening is a nonverbal event, the client does not need to think about it but can just experience the free flow of thoughts and images that arise. These images then can be expanded on in discussion or with other relaxation techniques. Depending on the client's needs or the therapeutic focus, the therapist may choose to select a piece of music that matches the mood of the client (Howard, 2001), or may use a nonrecognizable melody with no harmonic progression as a vehicle for relaxation and contemplation (Brewer, 1998). The music may be used to begin the session or at the end as a way of promoting integration. Obviously there are many possibilities once the concept of music has been introduced into the therapeutic setting.
Combining music with other supportive therapies such as guided imagery is another consideration. Studies have shown that music seems to enhance the imagining experience, particularly if both music and script support the client's own memories (Snyder & Chlan, 1999). Selecting the type of music that would be most conducive to this supportive work seems to depend on the personal choice of the client, since music likes and dislikes vary widely (Snyder & Chlan). Also, it seems that clients who have enjoyed listening to music and include it as part of their life experience respond better to this musical approach (Gerdner & Swanson, 1993).
A Case Study
Jane was a 38-year-old nursing student with a husband and two children. Early in the second year of her studies she began to experience extreme exhaustion and depression, feeling overwhelmed and frightened that she would not be able to continue with her studies or take care of her family. Jane evidently had always been able to take care of everything, and this sudden change and debilitation made her afraid that she was "going crazy and might have to be hospitalized."
At the same time it was clear that when she was functioning, she spent all her time responding to her family's needs while sacrificing her own, feeling that she was not truly worthy to receive until everyone else had been taken care of. She seemed aware that this pace contributed to her exhaustion and depression but felt powerless to do it any other way. In sessions, she would sigh frequently when describing the pressures of her day and how overwhelmed and tired she was.
When asked to take a deep breath and make that sigh as loud as she could, Jane initially seemed surprised at the request, but complied. She wasn't comfortable with making a loud sound, but after repeating this activity a few times, the sigh began to get louder. As the sigh got louder it began to take on a different characteristic and sound more and more like a moan. The moan got louder, and it was as if Jane was using the sound to hear her feeling of sadness.
When we spoke later about the sounds, Jane seemed puzzled about where they came from but she felt that making them seemed to help somehow. When she started sighning, her chest felt tight and it was hard to take a deep breath, but as she continued, her chest began to loosen and she felt all kinds of feelings, including sadness and tiredness. As she continued to moan, it became almost a soothing activity that seemed to quiet her and ease her distress.
Working with the sound created less resistance than talking about her life and the guilt she felt trying to be a wife and mother while having student responsibilities. Working with the sound also provided entry into feelings of which she was unaware and ashamed. Throughout our sessions, we used the concept of making sounds frequently as a release for her feelings and as a way to relax and refocus into a balanced place. Making sounds and tones seemed to soothe Jane and help her find her own voice.
In this instance, tones and sounds were used to enhance the therapeutic relationship since they provided another entry into the client's emotional state. In other cases, music might be the effective approach, particularly if both client and therapist have a comfort and familiarity with it. The choice is an individual one. The key concept, however, is the importance of using sound to its fullest capacity rather than only limiting it to language and words.
As Gaynor (2002) so aptly puts it, "Music, whether produced by voice, instrument or the two in concert, restores our connection with our essence" (p. 78). It is this power, this resource that we add to the therapeutic experience whenever we touch upon the variety of sounds that can be made.
Listening to Sounds and Music
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Brewer, J. (1998). Healing sounds. Complementary Therapies in Nursing and Midwifery, 4(1), 7-12.
Fine, J. (2001). Using language in psychiatry. Canadian Journal of Psychiatry, 46, 916-922.
Gardner-Gordon, J. (1993). The healing voice. Freedom, CA: Crossing Press.
Gaynor, M. (2002). The healing power of sound. Boston: Shambhala.
Gerdner, L., & Swanson, E. (1993). Effects of individualized music on confused and agitated elderly patients. Archives of Psychiatric Nursing, 7, 284-291.
Goldman, J. (1992). Healing sounds. Rockport, MA: Element Books.
Howard, B. (2001). Sweet the sound: Music in medicine. North Carolina Medical Journal, 62, 166-170.
Khan, H. (1988). The music of life. New Lebanon, NY: Omega.
McClellan, R. (1991). The healing forces of music. Rockport, MA: Element Books.
Pert, C., Dreher, H., & Ruff, H. (1998). The psychosomatic network: Foundations of mind-body medicine. Alternative Therapies in Health and Medicine, 4, 28-33.
Rauscher, F. (1995). Listening to Mozart enhances spatial-temporal reasoning: Toward a neurophysiological basis. Neuroscience Letters, 185, 44-47.
Snyder, M., & Chlan, L. (1999). Music therapy. Annual Review of Nursing Research, 77, 3-25.
Steckler, M. (1998). The effects of music on healing. Journal of Long-Term Home Health Care, 27(1), 42-48.
Watkins, G. (1997). Music therapy: Proposed physiological mechanisms and clinical implications. Clinical Nurse Specialist, 11, 43-50.
MORE INFORMATION
This article first appeared in the July-Sept, 2003 issue of Perspectives in Psychiatric Care Journal. Click here to visit their website.
Music without words means leaving behind the mind. And leaving behind the mind is meditation.
Meditation returns you to the source. And the source of all is sound. — Kabir
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