Sung-Yong Shim offers the compelling opinion about the use of clinical improvisation. Shim stresses, "The role of improvisation in the clinical setting is containing meaningful components of musical, clinical and therapeutic relationships through interactive music making." I am interested in the clinical improvisation because the musical improvisation can create dynamic activities with a simple structure. One such activity using simplistic structure is telling the client using one sentence, "Let’s play softly, and get extremely loud, and then go back very soft." The client can express their unconscious and oppressed feelings using such activities, and also the music can be improvised by anyone, on any instrument or perhaps even just on a chair, a table, glass, or one’s own knee (Wigram, 2003).
I am also interested in Shim’s examples of improvisation that he collected from elements of music in a multicultural music context: using the Tango idiom in a group improvisation, making music with a tone chime by using the Arirang, Korean folk music, and so on. Using traditional folk rhythm and beat in the clinical improvisation is a great idea because the traditional folk rhythm is usually very simple, repeatable and stable. It means that the clients in the group sessions can understand the structure of rhythm and beat easily and play along with the therapist readily.
Shim also suggests, "using variations of the marches is likely to make musical and clinical interaction not only very effective, but also an exciting experience for clients while they are playing percussion instruments." I thought that the marches can be more effectively applied if the client has a problem with motor skill because the cheerful tone and repeatable beat can be helpful to stimulate the motor skills. However, he reported, "the march and its variations seem to be inappropriate for clients who have difficulties with gross and fine motor skills because the atmosphere of the march’s rhythm seems to overwhelm those who have these difficulties." I look forward to continue learning about the relationship between the motor skills and the clinical improvisation.
Shim mentions a therapeutic relationship by using the clinical improvisation. The improvisation can help the client and the therapist establish a relationship because when the music therapist and client share the musical space between them in the improvisation, both of them can express themselves and create an intimate and dynamic relationship, which I agree. A therapeutic relationship in music which is unbounded by words can have more possibilities than a verbal relationship. At this point, I wonder what a difference of the therapeutic relationship between by improvisation and by non-improvisation is.
This article evoked many inquiry of the clinical improvisation from me as a person who has a different cultural background than the clients. I hope I can continue researching on cultural issues and the relationship between a client and a therapist in clinical improvisation.
Wigram, T. (2003). Improvisation: Methods and Techniques for Music Therapy Clinicians, Educators, and Students. Philadelphia, PA: Jessica Kingsley Publishers.
I am interested in Shim’s article since I have a language barrier during my internship. I like the sentence he quoted regarding music therapy by referring to Heinrich Heine, “When words leave off, music begins.” It is a meaningful quote, and lets people know how important music is.
As a therapist, communicating with patients is very important. It is like a psychology therapist getting to know the patients through communication. If verbal communication does not work, I want to know how we can work with patients. Some patients speak other languages, so we can not talk much. We not only play music with them for fun, we use music as a tool in order to go into the patients’ inner world. When patients play the instruments, or improvise the music, it is a way to let them express their feelings. Shim emphasized using clinical improvisations and his motivation to explore it when he works with non-verbal patients. Therefore, I think musical communication through clinical improvisation is not only good for non-verbal patients, but also good for us—English as second language people. In general wherever I work people will have different cultures, and I can not understand all of these cultures well enough to work with some patients. But music as a world’s language, we can understand the patients’ feelings through their music.
Shim also mentioned Aesthetic Music Therapy and it was developed by C.A. Lee. He considers “music therapy from a musicological and compositional point of view. Looking at theories of music to inform theories of therapy, it proposes a new way of exploring clinical practice.” (p.1) To consider musical structure and find the relationship looks important in this process. Through his point I am interested in what is Aesthetic Music Therapy. Lee explained, “Aesthetic Music Therapy is a music-centered approach that takes its fundamental belief from the fact that in order to understand music therapy.” (p. 1)
I agree with Shim about the “Bridge” between client and therapist. During the music therapy session the relationship is not about “offer and accept.” We need to find an effective approach suitable to the patients. I really enjoy the part he mentioned about how to expand the music resources in improvisation. Shim used Korean traditional song to work with patients. It is a new music style for patients because people are willing to try new music instead of try a new thinking idea. He used Tango idiom work with non-Latin American background patients, especially for drumming group. Tango rhythm can match the beat well, and patients can expand their beat. The adolescents are familiar with Hip-hop rhythm, even though they are developmentally delayed. This kind of music can reflect this generation. According to different patients, he would choose a different style rhythm to work with them. As a therapist, I need to try to use new music or familiar music to work with patients because nobody knows what kind of music will work for them.
This article encouraged me to never give up to work with people who use another language because I have a useful tool—music. It will help me express my feelings to patients, and let me understand the patients’ feelings. Clinical improvisation not only works for non-verbal, or difficult verbal patients. Also I may work with Schizophrenic people, to reduce their delusions, and face their reality.
Reference
Lee, C. A. (2003). The architecture of aesthetic music therapy. NH: Barcelona Publishers.
The article, Personal Experiences of Non-verbal Communication through Musical dialogue, written by Sung-Yong Shim explains how music can be a tool to communicate with clients. In his practices in Music Therapy, the use of improvisation is the main methods used to communicate with his clients without verbalization. Music can serve as a universal language to bring people together regardless of what language they speak and their background cultures. Myself as an Asian-American who also went through experiences of learning English as a second language and not able to communicate with other verbally was challenging. Everyone in the universe listen to the some type of music at one point of another in daily living. There are different types of instruments, genres, styles, forms vary by country to country, but all of music can be used to communicate with others.
Musical dialogue is a basic tool for music therapy setting. Clients and therapist must have the great bond with the music to bring out the best and to achieve his or her music therapy goals. The way Shim started doing his music therapy session with his language barrier is by using improvisation. It can be just effective as verbal conversation to bring interpersonal relationship with the clients. When the relationship of musical dialogue is built, then clients can freely express themselves musically while therapist can examine self-expression, fine motor skills, focus, creativity and many more. Improvisation is a great method to use in the music therapy, because any population of clients can use this method. It can focus on so many goals such as rhythm, melody, emotion, musical, cultures and others. I agree with Shim’s idea of how improvisation can be used to communicate with clients. When everything is musically and clinically supported then clients and therapist can work together without verbalization.
In addition, the expansion of using improvisation universally in his practice caught my attention. He used different songs from other countries in his therapy session. One of the examples of using Korean traditional song where he used the major pentatonic scale of the song “Arirang” helped clients with their increase in confident, anxiety, depression, fine gross motor and communications. Also, tango, hip-hop, and other international music are used in his music therapy session. I would never image to use Korean traditional music in my session with clients, but variety of music and exposure to different music can help music therapy session to become more interesting and effective. In musical dialogue, therapist must know the music well enough to present to the clients and use as the tool to communicate with each other. Heinrich Heine, German poet and writer once said “When words leave off, music begins.” This quote really sates how music is more than vocalization.
Reference
Shim, Sung-Yong (2007). Personal Experiences of Non-verbal Communication Through Musical Dialogue (Clinical Improvisation). Voices: A World Forum for Music Therapy. Retrieved September 18, 2009, from http://www.voices.no/mainissues/mi40007000244.php