The Musical Edge of Therapeutic Dialogue

Steven H. Knoblauch

• Éditeur: Routledge
• Année: 2013
• ISBN:
  9781134900695
• Édition: 1
• Sujet: Psychology
• Sous-sujet: Applied Psychology

Such nuances and shifts in the music of a patient's voice have long been familiar to clinicians. Indeed, as Steven Knoblauch observes, the music of psychotherapy has been acknowledged across a variety of theoretical orientations, from Freudian to self-psychological to interpersonal and relational perspectives. In The Musical Edge of Therapeutic Dialogue, Knoblauch provides a model of "resonant minding" in which the musical elements of speech become a major source of information about unconscious communication and action. More specifically, resonant minding, by distinguishing between discrete and continuous levels of communication, between the verbal and the musical, offers a way of accessing and affecting levels of unconscious interactive process by attending to the musical edge of dialogue -- provided only that we can hear it.Drawing on detailed clinical vignettes, he explores shifts in embodied dimensions of musical expression including rhythm, tone, pauses and accents across a sequence of patient-therapist interactions in order to show how the dyadic logic of mutual improvisation operates at the periphery to guide the continuous flow of unconscious communication and mutual regulation. In so doing, Knoblauch provides a vivid sense of how the shifting movement of the patient's "solo performance" can be facilitated and enriched by the creative "accompaniment" of the therapist.Ultimately, Knoblauch argues, the music of therapy is not only another road to the unconscious, but one uniquely able to convey emergent meanings in a variety of domains, from conflicting cultural identifications to the experience of the body to the emergence of desire. His vision of mutual immersion in a shared "performance" aimed at fostering growth coalesces into a major contribution - at once evocative and clinically consequential - to the current movement to grasp nonverbal behavior and processes of mutual regulation as they enter into all effective psychotherapy.

Listening to the Rhythm

1

“The word in itself is frequently insufficient to express … meaning clearly. The student of language by keen study can discover this. Even modern languages are but a simplification of music. No words of any language can be spoken in one and the same way without the distinction of tone, pitch, rhythm, accent, pause and rest. A language however simple cannot exist without music in it; music gives it a concrete expression.” (Khan, 1923, p 51.)

“I … I … I’m … not sure … what… to … th … s …”

Lenny’s voice started and stopped. Staggered beats marked the end of his breath and thought with unfinished words. He grasped and gasped to speak the conglomerate of half-formulated feelings all stuck together, unresponsive to his desperate effort to sort them out. My voice had been strong and direct. My formulation of his disorganization and its etiology had been framed in terms of his agonized, idealized paternal introject, a father of demanding proportions, an olympic-sized athlete with a drinking pattern to match and a samurai business style.

His response tripped off a rush of red flags, stop signs, and shift signals in me. My shame carried me through a fast rewind of the last moment. I could hear my firm and evenly paced words of authority—clearly and unquestioningly judging my patient’s inner state and emotional history so accurately and with such sincere confidence and certainty that I was able to squash totally any remnant of I-ness or space for breath that might be left for him in the affective field we inhabited.

I slowed my pace. Then I hesitated as I began to flood with confusion. I did not want to dominate and obliterate, but, I also did not want to collapse. I was in between, grasping for a foothold or a handhold. I felt as though I would be washed downstream before I could assess, evaluate, and formulate what to do next. So I stopped short. I closed my eyes. I downshifted my breathing. Time slowed. I half-thought and half-felt an emergent sense that my disorganization might be what my patient had experienced with his father and was experiencing with his family, his coworkers, and me. He did not want to be too harsh, as his father had been, and he also did not want to let his father or others down in their need for a strong, supportive son, leader, guide, partner, friend, father, husband. And in trying to be perfectly strong and perfectly consistent for everyone, he melted down and flooded, as I had.

The experience of action time between two people feeling, thinking, speaking together is different from that of listening time, especially in psychoanalysis. Psychoanalysis is the creation of an imaginative place, a way of attending and affecting, where time and space absorb, stretch, and contract in an interwash. In listening time, action can be slowed down for reflection and the opening of possibility for choices, shifts in state, and subsequent action. In action time, emotional experience generally has a half-life infinitely shorter than that of the kinds of metaphors I am using in my listening time to try to create a sense of the continuous process in which Lenny and I were absorbed. In action time, emotions are continuously evaporating, condensing, or absorbing into each other. In listening time, they are congealed into a discrete, frozen moment for examination, discrimination, delineation, definition, and, ultimately, articulation. Throughout this book I will be shifting between action time and listening time to illustrate ways to attend to and affect patients within the therapeutic interaction.

As I slowed down and regained my emotional footing, I was able to speak not with perfect cadence and unmodulating tone, but with some melody and rhythm, which shifted, rising and falling as I made my thoughts into words that formed speech in polyrhythmic sounds moving as in a dance, permitting space for breathing, taking in and letting go, a percussive dialogue, mutually coregulating. This time, I did not speak of Lenny’s past relational experience. Rather, I spoke of my confusing experience with him. Feeling overwhelmed had loosened in me a wonder about his being overwhelmed. I noted the professional and family projects that he had recently launched, which were now taking off and requiring of him the responses of six people. I spoke slowly but with a bounce in my voice through which I tried to communicate a recognition of his alarm that he would not be able to live up to his high expectations of himself and a hope that he might find a way to trust that he could be satisfied with his efforts.

But, most significantly, my breath accented my speech. My pauses were sometimes slower, sometimes faster, but with as much awareness as I was able to build on, linking breath and feeling, so that ideas could flow. Although I was not perfectly matched to my intent, only partially painting the patterns I reached for with my body, his breathing, which had been short and quick, eased, and his rhythms slowly began to resemble mine. He seemed to be calming down. The feeling of flood had receded, and there now emerged the possibility for a flowing interplay of our rhythms. I needed this shift in time to find space for reflection about how I had contributed to this moment. He needed this shift so that he could begin to free himself from the unconscious repetition of choking pressure and deadening confusion he had learned as part of his father’s world, a form of suffering that he had carried in his body and attention and that had blocked the flow of his breath to take in both life-giving air and life-giving relatedness.

My patient’s father had been a successful competitive swimmer. The discipline of breathing that he learned in order to win at his sport had to be regular and evenly paced. It had to be automatic, for attention to one’s breathing while engaged in the immediacy of a race can only distract one from the drive to the finish line. Winning is everything, and, in the face of such totality, all else falls away. (For some, and I think for my patient, all life is like this.) Lenny’s father took pride in his son as a “chip off the old block.” Unfortunately, his father seemed not to feel the need to recognize or speak to his pride in the physical and intellectual attributes that characterized the similarity between him and his son. He spoke out only to correct and guide, only to coach his son in the areas in which my patient seemed to need help. The not so subtle impact of this pattern of dysregulation was to leave my patient with a deep, unconscious sense of uncertainty about whether he was ever living up to father’s expectation and many moments of experience that evoked the certainty that, in fact, he was not.

My father, though not as harsh, was not unlike Lenny’s father in his selection of moments for verbal engagement. He too seemed to feel he had to attend to me only when I was in “trouble,” when I needed his guidance. I have become increasingly aware as an analyst and a parent that when and how to speak can be a difficult choice point for affecting openness or unwanted closure in a particular interaction. I have found myself often, unconsciously deciding, as our fathers had, not to speak to a particular aspect of my patient (or my child), of which I am feeling proud. Sometimes I fear that, were I to speak my feelings, I might be narcissistically robbing the other of a particular moment that is his or hers to be cherished and fully experienced. The focus should be on how she or he feels. While this strategy is sensible, I have also found on reflection, both as a parent and an analyst, that my silence leaves me open to being experienced as not recognizing or not valuing the feelings, thoughts, and actions of the other. To speak or not to speak? Are not my feelings and thoughts of significant impact? Of what value to how the other feels is what I feel? Such choice points can be extremely difficult, and the process of attending that I am addressing here can be very helpful in such pregnant and ambiguous moments. To do this, we need to think more about breath and rhythm.

Breathing that is automatic can be a wonderful, stable backdrop to a sense of one’s own, embodied self and for a vital sense of relatedness to others. It is an accompanying rhythm to our activity that is mostly in the unconscious background, especially for adults. At the same time, it is always integral to the regulation of our activity such that we continuously shift our breath either in support of or in reaction to our intent. Automatic, background breathing is often fairly regular but changes slowly over time, reflecting and shaping the unfolding of the relatively pleasurable feelings that midrange arousal can bring to the vitalization of any shared activity. Early in development it constitutes a powerful medium for caregiver and infant to communicate and for the caregiver to regulate a child’s distress. For example, James McKenna (1997) has described how a mother’s output of carbon dioxide is used by an infant to dampen down arousal and enter sleep. But there are many types of breathing. Breathing can also be a constricting vise, squeezing the fullness of emotional expression out of experience. This kind of breathing is anxious and presses for release and relief. It is often short, shallow, and quick, rising and falling unevenly with the uncertainty of the feelings that it simultaneously expresses and tries to overcome with the accelerating activity of intake and expulsion. While this kind of breathing can be momentarily pleasurable when contextualized by the animating impact of the erotic tactile exchange that occurs during lovemaking, more often, in a perseverating pattern, it accompanies and contributes to suffering arising out of a dysregulated relationship.

Working with Lenny was often frustrating. Over time, I came to understand my frustration countertransferentially as similar to the frustration he felt about not being able to know for sure how he felt about himself or others and how they felt about themselves or him. Although this insight was helpful to my work with Lenny, the feelings of frustration continued. This dilemma precipitated the following reflections about three theorists whose work has helped me to think about similar clinical challenges.

The kind of adhesiveness characterizing the repetitive relational patterning of affective experience just described is no stranger to the psychoanalyst. Brandchaft (in Stolorow, Brandchaft, and Atwood, 1987, pp. 47-65) points clinicians to “structures of accommodation,” subtle and obscure unconscious organizing principles that shape collusions between analyst and analysand that can undermine treatment progress and often lead to lengthy impasses. Fairbairn (1958) first characterized this kind of relational pattern by noting that

psychoanalytic treatment resolves itself into a struggle on the part of the patient to press-gang his relationship with the analyst into the closed system of the inner world through the agency of transference, and a discrimination on the part of the analyst to effect a breach in this closed system and to provide conditions under which, in the setting of a therapeutic relationship, the patient may be induced to accept the open system of outer reality [p. 385].

Fairbairn’s characterization of therapeutic process is consistent with the observation made earlier by Marcus Aurelius (1964) that, “the art of living is more like wrestling than dancing” (p. 115). Brandchaft elucidates the ways in which patient and analyst can perpetuate their system as closed. Brandchaft and also Bromberg (1998) focus on subtle affective state shifts in the therapeutic dialogue that can signal breaches in the system and open spaces for choice points. For example, Brandchaft, a self psychologically oriented analyst, describes a moment when he asked a patient to consider the impact of the patient’s behavior on the analyst (a query not usually expected as part of the kind of empathic inquiry used by many self psychologists). This query shifted the patient into an interaction facilitating a transformation of the patient’s former lack of a sense of agency in articulating his yearnings to another (1987, p. 55). Bromberg (1998, p. 276) describes how attention to the shifts in both his and his patient’s tone of voice precipitated the patient’s ability to speak of childlike needs that were hitherto not accessible to treatment dialogue. The clinical examples offered by these authors can help guide analysts to a careful listening stance for clues to the kinds of powerful unconscious assumptions about self and other and dissociated affective states that contribute to a patient’s attachment to affectively dysregulating relational patterns maintaining a closed system. (See Seligman, 1999, p. 141 for an articulation of the concept of identification within a dyadic relationship.) These openings offer opportunities for imaginative responsiveness.

As I have tried to adopt the recommendations of these writers and others who are guiding our analytic focus toward these subtle state shifts, I have become acutely aware of how I organize my awareness of my patients and myself. Whereas Freud (1897, pp. 257–271) used self-analysis to form a universal theory of mind, of how his mind and another’s mind works, contemporary psychoanalysts are now using self-analysis (awareness of their own subjectivity) to form particular, but often provisional theories of how they and their analysands are minding each other. Theorists of intersubjectivity (Atwood and Stolorow, 1984; Beebe, 1986; Benjamin, 1988, 1995, 1998; Beebe and Lachmann, 1992, Beebe, Jaffe and Lachmann, 1992; Stolorow and Atwood, 1992; Beebe, Knoblauch, et al., 1997; Ogden, 1994, 1997; Aron, 1996; Lachmann and Beebe, 1996) have sought to provide a conceptual representation to this process. This contemporary theoretical context forms the backdrop for each of us to wonder about how our own organizing principles, our own associations and dissociations, construct our insight, our empathy, our authenticity with our patients. Framed in this way, these categories of treatment—insight, empathy, authenticity—while personally constructed out of culturally contextualized unfolding experience and, therefore, having some consensual validity, are also unique to each treatment dyad, forming from the idiosyncratic variations that emerge out of the complexity of one’s subjectivity interacting with that of another.

With this sense of psychoanalytic work in mind, I have wondered about my own subjectivity and the uniqueness with which I contribute to the shaping of interactions with my patients. Over the last 10 years or so, I have begun to recognize in music as well as in psychoanalysis, the metaphors for self and relationship that I have come to through experience and training. As these reflections began to coalesce, it became clear that these metaphors or organizing principles continuously permeate my preconscious activity and consequently my analytic performance. Victoria Hamilton’s (1996) fascinating book on the analyst’s preconscious reminded me that we all have and are shaped by such mental activity. I have felt my experience echoed in Stephen Mitchell’s (1998) recent re-presenting of Loewald’s (1977) theory of language formation, which shifts the emphasis from Freud’s word-thing model, privileging translation into semantic symbolization, to the significance of an acoustic field in which words always have somatic impact both pre- and postverbally. Loewald’s view points to the affective impact of the acoustic experience of words both before and after symbolic meaning is recognized. Here mental and affective activity are interpenetrating dimensions of the same experience. In fact, they cannot be sorted out except through the abstract activity of verbal categorization. In particular, Mitchell (1998) provides a clinical example in which the somatic feel of the word, the making of the sounds with his tongue and lips and the place and rhythm of the word in the context of a relational experience, become central to meaning and relatedness.

The significance of rhythm in human relationship and its value in “healing” is not an original idea. That significance has been elegantly recognized in other fields of thought and in other cultural contexts. For example, the Sufi teacher, Hazrat Inayat Khan (1923) wrote:

Sufis, in order to awaken in man that part of his emotional nature which is generally asleep, have a rhythmic practice which sets the whole mechanism of body and mind in rhythm. There exists in all people, either consciously or unconsciously, a tendency toward rhythm. Among European nations the expression of pleasure is shown by the clapping of the hands; a farewell sign is made by the waving of the hand which makes rhythm. …

Rhythm in every guise, be it called a game, play, amusement, poetry, music or dance, is the very nature of man’s whole constitution. When the entire mechanism of his body is working in a rhythm, the beat of the pulse, of the heart, of the head, the circulation of the blood, hunger and thirst, all show rhythm, and it is the breaking of rhythm that is called disease. When the child is crying and the mother does not know what ails it, she holds it in her arms and pats it on the back. This sets the circulation of the blood, the pulsations and the whole mechanism of the body in rhythm; in other words sets the body in order, and sooths the child. The nursery rhyme ‘Pat-a-cake’ which is known all the world over in some form or other, cures a child of fretfulness by setting its whole being in rhythm. …

There is a psychological conception of rhythm used in poetry or music which may be explained thus: every rhythm has a certain effect, not only upon the physical and mental bodies of the poet, on him for whom the poetry is written, on the musician, or on him to who the song is sung, but even upon their life’s affairs. The belief is that it can bring good or bad luck to the poet and musician or to the one who listens. The idea is that rhythm is hidden under the root of every activity, constructive or destructive, so that on the rhythm of every activity the fate of the affair depends. Expressions used in everyday speech such as “he was too late,” or “it was done too soon” or “that was done in time” all show the influence of rhythm upon the affair. [pp. 48-49].

Rupert Sheldrake (1988) the author of morphic resonance theory in the field of biology has written:

All organisms are structures of activity, and at every level of organization they undergo rhythmic oscillations, vibrations, periodic movements, or cycles. In atoms and molecules, the electrons are in ceaseless vibratory movement within their orbitals; large molecules such as proteins wobble and undulate with characteristic frequencies. Cells contain innumerable vibrating molecular structures, their biochemical and physiological activities exhibit patterns of oscillation, and the cells themselves go through cycles of division. Plants show daily and seasonal cycles of activity; animals wake and sleep, and within them hearts beat, lungs breathe, and intestines contract in rhythmic waves. The nervous system is rhythmic in its functioning, and the brain is swept by recurrent waves of electrical activity. When animals move, they do so by means of repetitive cycles of activity, as in the wriggling of a worm, the walking of a centipede, the swimming of a shark, the flying of a pigeon, the galloping of a horse. We ourselves go through many such cycles of activity, for example, in our chewing, walking, cycling, swimming and copulating [pp. 108-109].

Jon Pareles (1998), describing a musical event in Salvador, Brazil, wrote:

In the broadest sense, music is all rhythm: we perceive faster rhythms, like a string playing an A and vibrating 440 times per second, as pitch, making harmony a form of polyrhythm, while we experience very slow cycles of repetition as structures. More practically, rhythm is music’s connection to the body: to pulse and respiration, to locomotion and dancing, to sex. “Rhythm is the installation of life itself,” said Gilberto Gil in Salvador. “Life is periodicity and repetition, the cycles of nature, and rhythm is fundamental.”

When music becomes functional, rhythm often defines the function: pacing manual labor, galvanizing dancers, rallying marchers or summoning spirits. Rhythm can directly affect physiology; in a room filled with a loud, steady beat, listeners’ heartbeats shift into sync with the rhythm they hear. And it can affect psychology, providing soothing regularity or jolting tempo shifts and breaks: jungle and related disk-jockey styles do both at once, making a game of psychic whiplash [p. 20].

In his description of affective attunement between infant and caregiver, the infant development theorist Daniel N. Stern (1985) recognizes that

a rhythm, such as “long short” (_____ ___), can be delivered in or abstracted from sight, audition, smell, touch, or taste. F...