The Heart of the Matter

Music and Art in Family Therapy

Hilary Palmer

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429792083
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The Heart of the Matter invites therapists from all disciplines to consider the use of music and art in their work with families. It introduces systemic music and art ideas, giving clinical examples from practice, and a rationale for using each technique. Conversations with therapists who have explored and incorporated the techniques into their work are shared, and include both personal and professional responses to incorporating new methods in practice. Through a back drop of exploration into what creativity is, the history of the arts in therapy, and consideration of what happens when we use words, the case for music and art to be part of practice with families is presented. This book is more than a handbook of techniques; it explores who we are as therapists, our challenges and our resourcefulness, as we operate in multiple systems to bring about positive change.

CHAPTER ONE

Beginnings: a musical journey with Alice Brown

During the early years of my family and systemic psychotherapy training, I had an honorary contract on an adolescent unit where I first began thinking about transferable skills and ideas between the arts therapy professions and systemic practice. Let me introduce you to Alice and our journey together as a way of illustrating how this book began. The chapter concludes with an exploration of how being dual trained has affected my position and identity as a therapist.

Meeting up with Alice again

I had worked at the adolescent inpatient unit before, as a music therapist, mainly doing group work. When this work ceased after two years, I had already begun my family therapy training and requested to remain on the unit in an honorary capacity, as part of their family therapy team. It was in this role that I met Alice again. Alice was fifteen years old and from a white, middle-class background. She had experienced several inpatient admissions over a three-year period due to depression and deliberate self-harm. Alice had received individual psychology and art therapy in the past; the latter she had particularly and found useful.

Alice had attended my music therapy group over a three-term period a year previously; she was pleased to see me and bemoaned the fact that I had stopped working as a music therapist on the unit. The family had been working in family therapy for some time and, throughout this period, had requested for Alice to meet with each parent separately, rather than as a whole family group, as they felt this would be too overwhelming for all concerned. Mr Brown felt that Alice had exhausted talking about things and so the family were offered the opportunity for me to join the two therapists working directly with the family in the room, to offer some music into the sessions. Alice was excited about this prospect and felt she might be able to work with both her mother and father together if music was used.

Alice and her family attended four sessions where music was used over a six-month period. These sessions were alternated with talking only sessions. The team consisted of two family therapists, two specialist registrar doctors who were on rotation, and who acted as a reflecting team, and me. Below is a brief description of the content of each session, followed by reflections from the team about the work. These were gathered from retrospective interviews held three months after the last session.

Session one

The family was asked to choose instruments for each other which represented each of them. Mr Brown was given the ocean drum as he was constantly on the move and liked things to be harmonious. Alice also felt he should have the cymbal because sometimes he would flare up in anger. Alice was given the djembe drum by her mother because Alice had quickly stated that it was her favourite. Her mother explained that it looked as if it had great scope to make a variety of sounds, and had a depth and darkness. Alice responded that it was good because you could “communicate whatever the feeling”. Mrs Brown was given the xylophone to symbolise someone quiet but complex. Alice then chose instruments for the two therapists and me.

With the instruments chosen, I introduced the idea of improvisation. After a period of silence, Alice began to play her drum, it wastentative to begin with but careful and steady. Gradually, family members and the team joined in. At the end of the music, Alice asked why I had not played the handbell which was beside me and had instead played a small drum only. I explained that I was concerned about making too much impact and the music being all about me. Mrs Brown shared this view and said she wanted to play the high notes on her xylophone but was worried about speaking out and being “out of sync”. Alice responded to her mother, saying that she should have played what she felt because Alice would have made it “in sync”. It was noted that Mr Brown had not used the cymbal—he had not become angry.

The family was then asked whether they would like to continue to improvise or would like to create a sculpt using the instruments they had chosen for one another (see the chapter on music techniques for ideas on how to do this). They opted for a sculpt and chose further instruments for absent family members. Mr Brown was chosen by the family to lead the sculpt. During the sculpt, Alice was able to express that she needed “something emotionally”. Alice left the session saying that she felt “confident and experimental”. Mr Brown felt the session had helped to represent things that were hard to put into words and, at the end of the session, he spoke of feeling that they were nearly at the crux of the matter when it was time to stop.

Session two

On arrival at the unit, I realised that I had forgotten to bring my instruments. I felt quite silly and suggested the session be a talking one instead. However, the two therapists were keen not to disappoint the family and for it to be a music session. We scavenged around the unit for instruments and came up with a motley collection of half broken, homemade, and toy instruments. I felt rather foolish and disappointed with myself. I also felt quite vulnerable without the beautiful professional percussion instruments I usually had with me. However, I was encouraged by the therapists’ enthusiasm and resourcefulness.

Alice arrived at the session with her father only and, although somewhat disappointed, she also appeared amused that I had forgotten my instruments and laughed at the strange collection we had pooled together. We tried to improvise, but we all felt rather held back by the limited tonal quality of the instruments. However, Alice was keen to keep trying. Mr Brown spoke about how it was typical for Alice to make positive things happen from nothing; he felt Alice to be a “go getter”, but also cut off, and thought the music sessions revealed this. In return, Alice expressed that the music revealed this because the music sessions were more than the ones.

The session ended with Alice suggesting that we play an improvisation about a person. She chose Maria, the art therapist on the unit, whom she had worked with previously. Alice chose instruments and led the music with a plastic Fisher Price apple, which had a lovely, Tibetan-sounding bell inside. The sound of the bell was quite resonant in comparison to the other instruments and Alice thought it symbolised Maria well. The improvisation felt like a coming together and Alice satisfied with the result.

Session three

The family came to the session in good spirits. “Things” had been going well since we last met. Continuing the theme of the last session, Alice suggested that she would like everyone to improvise about each member of the family while the person chosen sat and listened. This took up the whole session and resulted in intermittent and avid discussions around issues of trying and not getting it quite right, levels of understanding, and knowing and not knowing each other.

Session four

Alice had mixed feelings about attending this last session, she had a headache and she and her mum had just had a “blow out”. Alice explained that she felt frustrated when she could not make people understand and went from being angry to being scared. I asked Alice if we could help her put some of these feelings into music to help us understand better, and if she could choose instruments for us and lead an improvisation about being scared. Before we commenced, we set out some clear boundaries for the music to keep it safe. These included a clear decision that the music would rise up and then die away slowly, thereby making sure that the music was contained in a framework which would allow Alice’s experience to be both supported and held by her family and the therapists, and not become out of control and overwhelming.

The improvisation was powerful and Alice felt that it went some way to being able to express her feelings; she also felt that these feelings had been heard by her parents. Where the music had not expressed her feelings adequately, Alice was able to begin to put into words what it felt like to be scared. After the music finished, Alice was able to move on from her angry/scared feelings and share that she felt, in general, her relationship with her mother was improving. She spoke of casual moments they had shared which made her feel more connected. We reviewed how the family had felt using music over the last six months and whether it had been helpful. Mr and Mrs Brown felt that everyone had been there “trying to understand and make sense of things” and the music had helped this to happen. Alice stated, “I wanted it to help us talk about things and it certainly did that.”

Responses from the team and wider setting

I interviewed the two family therapists working with the family separately, three months after the last session. Unfortunately, the two doctors who acted as a reflecting team had left the unit and were, therefore, unavailable to be interviewed.

The team’s hopes and expectations of the work were that the family would find a way to express different emotions, and that the music might help them find the words they needed to express these emotions verbally. They felt that the family had struggled in family therapy but that the talking had become easier since the music sessions commenced. Both therapists had talked about the work with colleagues on the unit. These conversations were mainly to nursing staff and other therapists who felt that the use of music might help the family think in a more abstract way. Nursing colleagues were interested and thought the approach was new and unusual. The manager— clinical nurse specialist also supported the work. It is interesting that one of the therapists specifically avoided conversing with the consultant psychiatrist about the work, as he felt that the psychiatrist might not understand what the team was trying to achieve. The therapist was concerned that the approach might not be valued and not be taken seriously. The work was also mentioned in a positive way to the community team in the locality to which Alice was being discharged.

The team felt that the music became a metaphor in their work with Alice and brought out the emotional styles of family members. In this way, they felt the family discovered a unique way to be together and think about feelings in a safe space. One therapist said he experienced honesty in the work and felt it was very empowering for Alice, especially as she had experienced music therapy before and could bring her knowledge and experiences into the work with her parents. The therapists commented that they witnessed the family “free up”. In previous “talking only” sessions, Alice and her mother had worried that anything they said might exacerbate their problems, whereas the team perceived that music allowed them to relax and communicate in a non-threatening way.

When asked whether the talking only sessions with the family had changed at all since the music sessions began, the male therapist commented that the atmosphere was “palpably less tense” and that the therapist found himself being less annoyed and challenging to the family and had instead adopted a more narrative approach. He felt the music sessions had helped Alice co-construct a new image for herself from the one usually seen by Alice’s parents. The female therapist spoke of overcoming a boundary because “somehow we had all been through the experience [of playing music] together” and this helped engagement.

It was felt that the use of music had created a space for doing something differently and for the team it had felt liberating, although one of the therapists expressed that she had worried that the music element might constrain her from doing her best because she was not musical. While welcoming the opening up of boundaries, there was also some concern that because the music did not fit in with the traditional view of family therapy, there was a danger that it would not be taken seriously.

The therapists felt that the work had reinforced the idea for them that action ways of working can be good to use, especially with young people who found it hard to engage in talking therapies. Neither therapist felt confident to use the methods of working I had engaged the family in on their own, but felt that the work had generally affected how they engage with families and gain trust.

The team’s lasting impressions of the work were that it made tense and uncomfortable work more bearable. It was felt that Mrs Brown had been at her most committed in the music sessions and able/willing to change her position and construct new meanings. The therapists felt the work had challenged the whole team and heightened the idea of multiple perspectives. It was suggested that, just as Anderson and Goolishan (1988) stress the importance of meaning through words, meaning could also be created and expressed through music, and that it was a different, but equally important, way for voices to be heard.

Reflections

In music therapy, the therapist is an integral part of the music making. This was quite new for the team and appeared to help us meet the family on an equal footing and share new experiences. One of the family therapists described themselves as musical and one as not musical. Of particular help to the family was having a non-musical member of the team participating, as this added an element of moral support and mutual discovery. Through looking at strengths within musical interactions and exploring differences, new discourses arose for the team, as well as for the family, which allowed a move away from the dominant discourse of fragility and stuckness that surrounded the work. Within the improvised music, musical conversations developed that allowed the family and team to interact in a fun and non-confrontational way. This helped to explore how the beliefs, actions, and feelings of the family were interconnected and meanings created.

In keeping with the view that a different way of seeing things is essential for change, I was conscious that the experiences gained through the music process helped the family to begin to reframe themselves and interrupt the problem-saturated cycle. Choosing instruments for each other allowed for insight to individual lenses and an exploration of the family members’ perception of each other. This technique also explored how we want to be seen and how we think we are seen by others. The improvisations themselves took on a narrative flavour and each musical improvisation could be described as a “mutually validating conversation” (Dallos & Draper, 2000). In manyways, the sculpt did not differ from any other sculpt in a family therapy setting; it just used musical instruments instead of people or objects. However, there was always the opportunity available that, when the instruments were in place, each person could be given a voice by the playing of various instruments in various combinations, allowing for themes to be explored further and absent family members to be actively included.

I was very encouraged by the work, but disappointed that the team felt they would not attempt anything similar in my absence. My experience as a music therapist put me in an expert position and I was left to consider how I could have made the experience more collaborative and enhanced the accessibility of music as a medium for the talking therapists to use. Alice was also very much a customer for the use of music; she had a positive experience in music therapy previously and a good therapeutic relationship with me.

Thinking about Alice and ideas about change

As I progressed through my family therapy training and into the role of family therapist, my professional identity and working practice developed through a coming together of different theoretical stances. As a result, I have a theoretical identity that is systemic, but inclusive of psychodynamic theory, and it is in this context that I practise.

In systemic terms, the individual is seen in the context of the intimate connections of which she or he is currently a part (Gorell Barnes, 1998), the social constructions, and dominant and subjugated narratives within that person’s family and culture. I believe that there is “continual change through exchange” (Hoffman, 1995) and that some of these realities are discovered through social discourse (Real, 1990). However, in the context of my work with Alice, I was also interested to discover through what other “exchanges” involving art and music, new realities can emerge.

My theory of change is influenced by psychodynamic thinking, in which resistance to change can be seen as the product of unresolved conflict on an individual’s developmental pathway. However, as a relationally thinking family therapist, I have married this with Stern’s (1985) concept of “self” in which the development of self and relationships are two sides of the same issue, with a belief that development isa process in which self and relationships are co-dependent. For Alice, it was in the repairing of fractures in her relationship with her parents that allowed her to develop a deeper sense of herself.

I am also influenced by attachment theory in thinking about the connections between past and present relational experiences, and how this influences both the ability to change and what that change will look like. I wonder if the music in some sense allowed Alice to revisit an earlier developmental stage when relating to her parents was fun and easy, and the use of music allowed for a relived experience which acted as a bridge to the here and now.

I believe the process of change is a complex web of interaction often broken and remade until it fits with each family. Therefore, in thinking about creating difference we must honour a client’s theory of ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• About The Author
• Series Editors’ Foreword
• Foreword
• Preface
• Dedication
• Introduction:
• Chapter One Beginnings: a musical journey with Alice Brown
• Chapter Two Foundations: culture and creativity
• Chapter Three Professional contexts: music and art therapy
• Chapter Four A shared humanity: music, words, and the mind
• Chapter Five Trying something new: thoughts from the starting line
• Chapter Six Introduction to systemic music and art techniques
• Chapter Seven Systemic music techniques
• Chapter Eight Systemic art techniques
• Chapter Nine Testing the waters: applying new methods
• Chapter Ten New horizons: implications for practice
• Conclusion
• References
• Index