Songwriting

Methods, Techniques and Clinical Applications for Music Therapy Clinicians, Educators and Students

Felicity Baker, Tony Wigram

• Publisher: Jessica Kingsley Publishers
• Year: 2005
• ISBN:
  9781846421440
• Topic: Media & Performing Arts
• Subtopic: Music

This comprehensive and groundbreaking book describes the effective use of songwriting in music therapy with a variety of client populations, from children with cancer and adolescents in secondary school to people with traumatic brain injury and mental health problems.

The authors explain the specific considerations to bear in mind when working with particular client groups to achieve the best clinical outcomes. All the contributors are experienced music therapy clinicians and researchers. They provide many case examples from clinical practice to illustrate the therapeutic methods being used, together with notated examples of songs produced in therapy. Particular emphasis is placed on how lyrics and music are created, including the theoretical approaches underpinning this process.

This practical book will prove indispensable to students, clinical therapists, music therapists, educators, teachers and musicians.

1

Improvised Songs and Stories in Music Therapy Diagnostic Assessments at a Unit for Child and Family Psychiatry

A Music Therapist’s and a Psychotherapist’s Perspective

Amelia Oldfield and Christine Franke

This chapter presents an opportunity to reflect on both the musical and the verbal content of the improvised songs and stories that are used as part of the music therapy diagnostic assessments at the Croft Unit for Child and Family Psychiatry. The verbal content of the songs and stories the children told in therapy are fascinating to the authors and presents challenges to the potential interpretation and use of this material. The music therapist also wanted to explore how the verbalizations related to and were influenced by the music-making.

As part of her doctoral research into how children on the Autistic Spectrum express, process and regulate emotions, the psychotherapist, Christine Franke, had observed a number of videos of Amelia Oldfield and Emma Davies’ music therapy sessions at the Croft Unit. The text of the children’s stories had been transcribed by the psychotherapist and she also documented her clinical observations. Through their discussions, the music therapist frequently gained new insights into the possible meanings of the verbal content from the psychotherapist’s more psychodynamic interpretations. The authors therefore decided to write this chapter together, drawing material from videos of music therapy sessions which the psychotherapist had observed and analysed. Songs and stories from five children Amelia Oldfield assessed and two children Emma Davies assessed are included in this account.

In this chapter, the procedures used by the music therapists to facilitate the creation of these improvised songs with individual children will be described in detail. The role of the music, the words and the non-verbal communication will be explored in depth. The ways in which the improvised songs enable both the music therapists and the psychotherapist to gain a better understanding of the child’s emotional world, ways of thinking and general strengths and difficulties will be explained. These new insights often influence the team diagnosis given to the child during admission to the unit.

Throughout the chapter, children’s improvised songs and stories are referred to and analysed. To preserve confidentiality, the names of the children and some of the verbal content of the stories have been changed.

This chapter will introduce readers to the use of improvised songs and stories as part of a diagnostic process. Although some children respond more to one aspect of these improvisations than others, each child’s creation is unique, and the stories are one-off events rather than on-going processes that evolve over time. For this reason it has not been possible to categorize the information in this chapter in table form. Instead we have used headings to try to show that various aspects of the improvised songs or stories will provide the most interesting diagnostic information for individual children.

The Croft Unit for Child and Family Psychiatry

The Croft Unit is a psychiatric assessment centre for children up to the age of 13 and their families. There are usually no more than eight children attending at the Croft at any one time, with a wide range of disorders such as autistic spectrum disorder, Tourette Syndrome or eating disorders. Some families are admitted residentially, or on a daily basis, ranging from four weeks to three to four months. During the day the children attend the unit school in the morning. In the afternoon they attend various groups, such as social skills, art and recreation groups which are run by the unit’s staff.

Staff on the unit include: psychiatrists, a family therapist, specialist nurses, a teacher, classroom assistants, health care assistants, clinical psychologists and music therapists. Social workers, health visitors and the teachers involved with the children outside the unit work closely with staff on the unit.

The strengths and difficulties of the children and the families admitted to the Croft are evaluated in different ways. The clinical psychologist carries out a number of psychological tests such as the Parenting Stress Index (Abidin 1995) as well as other cognitive or developmental tests on the children such as the Wechsler Intelligence Scale for Children (Wechsler 1992). Sometimes special questionnaires are devised by the clinical psychologist for different members of staff on the unit to complete, particularly when the team are trying to observe and understand children’s or families’ difficulties which occur in unpredictable and erratic ways. Specially trained staff carry out the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI) (Lord et al. 1989 and Dilavore, Rutter and Lord 1995).

The first author has been working as a music therapist at the Croft Unit for Child and Family Psychiatry for 17 years. Initially, the unit admitted children and families for up to 18 months but in the past ten years the work on the unit has focused more clearly on assessments and short-term treatment. Children and families are now routinely admitted for four-week assessments and may then be treated for up to three months with the occasional child or family staying on for six months. As a result of this shift in focus, the music therapist developed some specific Music Therapy Diagnostic Assessments (MTDAs) which assist the team in determining the children’s strengths and difficulties.

During the past five years Oldfield set up a PhD research investigation comparing the MTDAs with the ADOS (Oldfield 2004). The study indicated that the MTDAs were serving a useful and distinct purpose in helping the psychiatric team to diagnose children. The MTDAs are now routinely used by both music therapists working at the Croft, and have now become an established part of the diagnostic process at the Croft.

The Music Therapy Diagnostic Assessments

The MTDAs consist of two half-hour sessions, which usually occur at the same time and on the same day of the week over two consecutive weeks. A time will be arranged for two music therapy assessment sessions and the child will be informed about the sessions in a morning meeting when the child’s timetable for that day is explained. The music therapist will introduce herself to the child when she goes to collect him or her and they may ‘chat’ informally as they walk to the music therapy room.

The purpose of the music therapy diagnostic assessments

The overall purpose of these assessments is to use a different medium (music-making) to help the team in assessing children’s strengths and difficulties. The questions the Croft team is seeking to answer will vary tremendously depending on each child and it is therefore difficult to outline the general purpose of the assessments. However, experience and research (Oldfield 2004) have shown that music therapy diagnostic assessments are particularly effective at evaluating children’s non-verbal communication skills. Further, the music-making often produces heightened states of arousal in the children which enable the therapist to evaluate how they operate when they are very involved and engaged. Because of this heightened state of arousal children’s tics or repetitive ritualistic behaviours are often more frequent in music therapy diagnostic assessments. The music therapist can then observe and try to understand these behaviours in the children.

Music-making often allows the therapist to observe emotional responses or the lack of emotional responses in the children, in ways that may be different from the children’s reactions in other non-musical settings. The verbal content of the songs and stories can give insight into new aspects of the children’s inner world and also into how children regulate and deal with their emotions.

The music therapist feeds back her findings to the team in weekly management meetings. As there is not enough time to report back on all the strengths and difficulties she will have observed in a child arising from the MTDA, the music therapist will select those pieces of information which seem to shed a new or different light on the child’s abilities and difficulties. It is this new view of the child which is often of interest to the team. Occasionally, the music therapist’s observations will confirm what the rest of the team are saying, in which case the music therapist will give a few examples of events which support the opinion of her colleagues.

The room/equipment

The room is equipped with a piano, an electric organ, several guitars, and a wide range of simple percussion and wind instruments. There are also two small violins and the music therapist uses her own clarinet. All the instruments are laid out on shelves or stand near the wall and are accessible to the children.

Two small chairs (child size) stand facing one another a little distance from the instruments. Two bigger chairs are in front of the piano. The floor is carpeted and there are a few pictures on the wall: drawings and collages obviously done by children. There is no other furniture except some more stacked up children’s chairs. The room is friendly and spacious but has few distractions. The open shelves covered with instruments invite the child to take an interest in music-making. But there is also a sense of tidiness and organization conveyed by the carefully set out chairs.

Structure of the session

The following is a description of the format which is normally used. However, there will always be exceptions and the music therapist tries to be flexible to meet the needs of each child so that she can create the optimum situation and setting to evaluate a child’s strengths and weaknesses.

First, the child is invited to sit down on a chair facing the music therapist. The music therapist says something like ‘here’s a chair for you and I’ll sit here’, usually gesturing as she speaks. The session then begins with a ‘hello song’ that the music therapist sings to the child incorporating the child’s name and accompanying herself by playing chords on the guitar. The session ends with a percussion duet on the bongo drums where the music therapist sings ‘good bye’ and makes a clear ending. At some point, either at the beginning or at the end of the session (or as the music therapist and the child are walking to or from the music therapy room), the music therapist explains that they will be having two individual sessions together and reminds the child of the time of the session the following week.

In between the ‘hello’ and the ‘good bye’, the music therapist explains that they will take turns to choose what to do together. This structure gives the children the freedom to choose and make their own decisions but also allows the therapist to ensure she can implement the tasks she has prepared. If the process of choosing is too difficult or painful, the child can relax at the times when the music therapist provides him or her with her own choices and perhaps a reassuring structure. From the point of view of assessing the child’s strengths and weaknesses, the music therapist can find out a great deal from the ways in which the child chooses instruments and activities in music therapy sessions.

As one of ‘her’ choices the music therapist chooses improvised songs/stories. These will now be examined in more depth.

Improvised stories and songs

As with most aspects of Oldfield’s music therapy work, the method of facilitating the creation of improvised stories and songs evolved through her music therapy practice, where every child’s song or story in some way informed and influenced the way she implemented the method with subsequent children. Gradually, a system and some theoretical ideas have evolved, but these ideas will continue to change and grow as the work continues. This is why the authors have chosen to describe the work and case studies first and reflect on the evolving methodology later in this chapter.

Case example: Allan’s story

Allan is aged 12 and has a diagnosis of autistic spectrum disorder. He was admitted because he was having violent outbursts, had been excluded from school and was struggling at home, often being aggressive towards his mother. He had engaged freely in the musical dialogues with the music therapist (Amelia Oldfield) in the session before the story was suggested. As soon as the therapist sings ‘once upon a time there was a…’ he starts playing and singing freely. His singing style matches the diatonic notes he plays on the bass xylophone and fits in with the therapist’s melodic line. He sings about a troll called ‘Albert’ and a Mummy troll. Albert brought some goggles and they went swimming. At this point the therapist says: ‘…and suddenly they saw a crocodile…what happened?’ Allan continues playing but doesn’t sing or say anything… The therapist encourages a response by playing unresolved cadences and questioning phrases. Suddenly Allan starts chanting an unconnected ‘rap’: ‘Hey, baby, yea, I’m playing today, one two three, I’m playing today…’ The therapist now verbally says: ‘…but what happened to the trolls in the story when the crocodile came?’ …exasperated, Allan says: ‘The crocodile exploded…and that was the end of the story.’

The music therapist was impressed with Allan’s creativity and by his ability to listen to her musical ideas as well as initiate his own ideas. She found herself enjoying making music with Allan and felt that he was communicative through his playing. However, he was not willing to incorporate her verbal suggestions into the story. The psychotherapist pointed out that he might also have suddenly ended the story because he wanted to avoid thinking about conflicts and be unwilling to explore violence in a story. For the Croft team it was important to find out that Allan could be more communicative in a reciprocal way when he was using a non-verbal form of exchange than when he was talking. This observation contributed towards the Croft suggested diagnosis that he was on the milder end of the autistic spectrum. It was also useful to find out that he was purposefully shying away from talking about violence or aggression, indicating that he was in some way aware of these difficulties in his life, but unwilling to talk or think about them at the moment.

General description

During one of the music therapist’s choices she places a number of large instruments such as the drum, the metallophone and the wind chimes in front of the chil...