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Part I
Theoretical Foundations of Vocal Psychotherapy
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CHAPTER 1
The Voice
‘Hi Diane,’ Cindy greets me with a smile as she enters the room. She puts her bags on the floor, comes over to the piano and sits on the bench next to my chair. She makes eye contact with me while asking if she can have a glass of water. I say ‘sure’ and get one from the kitchen for her.
She seems to have thought about what she needs from today’s session. She says, ‘I have a sense that there is a huge scream stuck in my throat.’ She had a dream about this stifled scream and believes the way to access it is through vocal improvisation therapy.
She tells me the scream feels related to her history of early sexual abuse by her uncle. She also talks about feeling angry toward her mother and disappointed with her father. She feels her parents emotionally abandoned her and tells me she feels ready to ‘get the scream out and deal with the pain’.
As she talks, I notice that she speaks slowly and sighs occasionally. Her voice lacks energy and the melody of her sentences often descends at the end. She sounds slightly depressed to me.
We have spent several sessions taking her history. I feel it is important for her to tell her story slowly with time for us to interact and relate to the material and each other. I have learned through experience that very wounded people can become traumatized when they have to condense a lifetime of painful and intense memories into an hour-long therapy session. Going slowly helps them to digest the feelings that emerge.
I ask Cindy if she feels like singing. I want to get a sense of her music and her singing voice. I also sense that her words are disconnected from her feelings. I think singing can offer her a way to access and express some of the emotions contained in the memories and incidents she has been describing.
Cindy has many strengths and both inner and outer resources, but I am wary of her enthusiasm to ‘get the scream out’. It seems too soon in the process to work deeply. I offer her choices: ‘We could tone, sing a song or improvise over chords.’ She says, ‘I’m a little afraid of improvising…but…yeah, let’s try it.’
I ask her what she is afraid of and she says she’s not sure, ‘probably just the unknown of it…maybe the closeness’. She repeats, ‘let’s try it’. I ask her what chords she would like. She says, ‘I like the key of D flat.’ I begin playing D flat to G flat/B flat, medium tempo and dynamics. Cindy likes this combination. I suggest that we begin by breathing together several times and that whenever she feels ready she can begin singing sounds or words.
I feel curious. What will it be like to sing together? She sighs; we sing ‘ah’ in unison on an F then we move to a B flat. I sing in unison to support her vocally and emotionally. I am also ‘feeling out’ her response to the unison to get a sense of what she needs and what she feels comfortable with. (Is unison comforting, supportive or too merged? Does she need more tension, more distance, more differentiation?)
She begins to sing softly, ‘m-m-m’, then starts growling, increasing the dynamics, range and intensity of her sounds. I sing in unison with her then mirror (repeat) her sounds and at times hold the tonic to ground her vocalization. My intention is to accompany her on this journey so that she feels supported and met in the music.
She begins to sing long, legato phrases on ‘ah’. She goes rapidly up the scale like a siren and then switches to intricate rhythmic patterns, syncopated ‘da da, ba da’ repetitive, drum-like sounds on E flat.
She seems to be exploring her range, different rhythms, vocal qualities and emotional states. I notice that she has a well-trained voice with a deep rich quality and a wide vocal range. At times it is difficult to follow her. I feel challenged yet determined to stay with her. I am living in the unknown of the moment with her and I don’t know where we are going. I notice that she is changing dynamics, phrasing, pitch and vocal qualities rapidly. I am trying to stay with her and meet her laughter, screams, and gentle melodies. Now I change the chords slightly, adding some dissonant notes, and play the piano louder to support her screams and growls.
Cindy begins singing louder, then laughs and returns to the ‘m-m-m’ sound in the lower part of her range. She builds on a simple melodic line of repeated thirds and fourths and works her way up the scale ending with a loud scream on ‘ah’. She then slides down the scale and is quiet for a moment. She breathes deeply and returns to ‘m-m-m’, now singing softly and rocking herself back and forth. I notice she is crying.
I rock back and forth with her and attune myself to her breathing, phrasing, dynamics and vocal quality. I notice how similar our voices sound. She stops singing but continues rocking back and forth and breathing deeply. I continue to sing and rock back and forth with her. I would usually stop singing when the client stops but Cindy is still crying and rocking herself and I feel like continuing to sing, probably because I sense that she needs this holding and containment. I feel I am soothing her. I sing ‘ooo’ to a melodic refrain built around A flat, B flat, D flat, A flat for a few minutes, then slow down the tempo and gradually bring the music to a close. Cindy has stopped crying.
I breathe deeply. I do not speak. My intention is to leave space for us to be in the silence together and to allow her to speak in her own time. After a few moments Cindy says, ‘That was good… I feel more present now…more grounded… I really needed to get that out.’
The voice is a primary instrument in music therapy. It is the instrument we are born with, the body’s own voice. Yet there is an obvious lack of literature addressing the physical, emotional, psychological and spiritual benefits of using the voice and singing in therapy and the effectiveness of vocal interventions in music psychotherapy. This is surprising since sounding and singing have been a way to communicate, express ourselves and create ritual and community since ancient times.
Throughout the years I have noticed that whenever I attend a music therapy conference, supervise a student or listen to a colleague’s work, the most compelling clinical examples involve the client and therapist singing. In my own practice, I have also noticed that the most climactic moments occur when clients begin singing. They have powerful feelings, insights and memories, and make deep connections to themselves and to me. When I sing to or with clients, it is usually experienced as extremely moving and often melts away their defences so that blocked feelings can be released.
No matter what population a therapist works with – infants in neo-natal care, children with special needs, adolescents at risk, psychiatric adults, geriatrics or hospice patients – and no matter what the therapist’s primary instrument may be, the most healing connections seem to occur through the voice.
Why is singing such a powerful therapeutic experience? When we sing, our voices and our bodies are the instruments. We are intimately connected to the source of the sound and the vibrations. We make the music, we are immersed in the music and we are the music. We breathe deeply to sustain the tones we create and our heart rate slows down and our nervous system is calmed. Our voices resonate inward to help us connect to our bodies and express our emotions and they resonate outward to help us connect to others.
The human voice is the most versatile of all instruments in that its resonances can be continuously changed by movements of the larynx, jaw, tongue and lips (Jourdain 1997). Singing is also a neuromuscular activity and muscular patterns are closely linked to psychological patterns and emotional response (Newham 1998). According to Levine (1997), the residue of unresolved, un-discharged energy gets trapped in the nervous system and creates the debilitating symptoms associated with trauma.
Children raised in families where the emphasis is on looking good and performing well learn early in life that their instinctual responses are not valued or acceptable. These feelings are chronically locked into the musculature of the body. Authentic feelings are cut off from the instincts and are not expressed or lived but remain in the unconscious where they wreak havoc by showing up as somatic symptoms or self-defeating behaviour. According to Woodman (1985), her female patients who have body issues and have never fully lived out their sexuality have energy blocks in their pelvis and thighs. When these blocks are released, sexual energy is able to flow through the entire body and women who had looked for cuddling and holding from men no longer try to turn their lovers into mothers.
When we sing we produce vibrations that nurture the body and massage our insides (Keyes 1973). Internally resonating vibrations break up and release blockages of energy, releasing feelings and allowing a natural flow of vitality and a state of equilibrium to return to the body. These benefits are particularly relevant to clients who have frozen, numbed-off areas in the body that hold traumatic experience.
Singing can provide clients with an opportunity to express the inexpressible, to give voice to the whole range of their feelings. Singing meaningful songs often produces a catharsis, an emotional release, due to the effect of the music, the lyrics and the memories and associations connected with the song.
The self is revealed through the sound and characteristics of the voice. The process of finding one’s voice, one’s own sound, is a metaphor for finding one’s self.
From a scientific perspective, research has shown that singing improves our health. Researchers in the US, England, Canada and Germany have found that singing can improve one’s mood by stimulating endorphin release. Singing is also able to relieve stress and boost the immune system. In a research study at the University of Frankfurt scientists found that after singing Mozart’s Requiem for an hour, choir members’ blood tests showed significantly increased concentrations of immunoglobin A (proteins in the immune system which function as antibodies) and hydrocortisone (an anti-stress hormone). A week later, when researchers asked members of the choir to listen to a recording of the Requiem without singing, the composition of choir members’ blood did not change significantly (Clift and Hancox 2001). Other research conducted with choirs has also shown the positive health benefits of singing (Hunter 1982; Krutz et al. 2004; Weinberger 1996). Singing and making music have also been linked to lower heart rate and decreased blood pressure (Gaynor 1999).
Researchers at the University of Manchester have discovered a tiny organ in the ear, the sacculus, which forms part of the balance-regulating vestibular system in the inner ear and responds to musical frequencies. It is stimulated by low frequency, high intensity sounds like singing (sound levels in the larynx have been estimated to be as high as 130 decibels) and relays these sounds to parts of the brain that register pleasure. Your ear and your brain tend to find your singing pleasurable, even if others do not agree (Weinberger 1996).
On a similar note, in an experiment conducted by scientists at McGill University in Canada, listening to or singing a favourite piece of music stimulated the areas of the participant’s brain that release dopamine and other euphoria-inducing opioids. The sounds produced chills of pleasure in the participants (Harkins 2005).
The vocal connection between mother and child
We enter the world and, with our first sound, announce our arrival. Our first cry proclaims our birth and the life force flowing through us. We begin as vital, spontaneous beings, curious and open, and the sounds we make express this. We laugh, we cry, we scream. We make sounds instinctively and receive pleasure from playing with our lips, tongue and vocal cords. There is a flow, a freedom to the sounds and movements we make that characterizes spontaneity and health.
We are also born listeners. The ear is the first sensory organ to develop and is functional four and a half months before we are born (Minson 1992). The voice is a primary source of connection between mother and child. ‘During gestation, the human fetus receives musical and other sound stimuli from vibrations transmitted through amniotic fluid’ (Taylor 1997, p.24). The sounds we hear in the womb, the rhythm of our mother’s heartbeat, the flow of her breathing, and the nuances of her voice ‘stimulate our brain and fire electrical charges into our cortex’ (Minson 1992, p.92). These electrical charges provide nourishment that is critical to the development of the brain and the central nervous system (Minson 1992; Storr 1992; Tomatis 1991).
After birth, the bonding between mother and child occurs through touch, eye contact and sound (Miller 1981). Babies naturally tune in to the music of their mother’s voice and, optimally, the mother is attuned to her child’s sounds and learns to distinguish the nuances of the different sounds and the needs they convey. In a mutual, co-created dance of sounds and movements, mother and baby feel a sense of oneness. The infant feels safe and begins to trust the mother and ‘the mother receives the instinctive reassurance that will help her understand and answer her child’s messages’ (Miller 1987, p.33).
Somewhere between the third and fourth month, infants produce sounds that resemble singing. The infant’s babbling or singing as he or she settles down to sleep provides feelings of self-sufficiency and preserves the illusion of a comforting, soothi...
