Voices ResourcesA website for the worldwide community around the journal Voices: A World Forum for Music Therapy

failure of therapy--the therapist's approach is not proper and the client is not showing any changes,

client's physical condition-- the therapy is working well but because of their physical conditions (handicap, exhaustion, etc,) the clients cannot outwardly display his/her expression

client's choices--the client does not want to outwardly display his/her expression. With the Japanese elderly population I have been encountering many of these situations.

However, it seems to me that most of the researchers' discussions on the effect of music therapy rarely talk about this issue. They simply look for the responses as an evidence of effect of therapy, and getting responses means a victory for the research. Why is this so? Because music therapy is a form of "expressive therapies?" But there are so many ways of expressing according to cultures/personalities ... including not expressing. Let me talk about one of my clients - an old Japanese man.

From September 1999 to March 2001 I had the opportunity to provide music therapy sessions at the bedside of this 90 year old man. He was a dignified, hale and hearty man, but a few years earlier he sufferd a stroke and since then, he gradually lost his physical/mental abilities. When I first met him, he was already bedridden with no speech. The challenge was that nobody could clearly define how much cognitive/emotional functions remained because he was not necessarily an expressive man even when he was healthy. In music, for the first several months, he sometimes waved his hands to greet us, nodded to say yes, and reached his hands for the instruments. However these communicative gestures soon diminished, his overall functioning obviously declining. However there was also many occasions where we could not define whether he couldn't understand our communication, or he was unable to physically activate response, or he simply did not want to express his feelings. The caretaker who was very close to him often said that he showed completely different facial expressions according to who visited him, or what people was talking about.

In the music therapy sessions his facial expression slowly changed when different songs were played, even though he was half a sleep most of the time. He seemed to have an especially strong feeling for the song called Kojo no Tsuki (The moon and the deserted castle). This song describes the scenery of a deserted castle. It symbolizes the human beings' rise and fall, in contrast to the everlasting moon. It is an old song with which all the Japanese share the cultural sympathy - an unspoken deep feeling to life and death. When we sang this song, his face expressed mixed feelings of excitement, bitterness, happiness and sadness but all in a uniquely reserved way. At times we saw tears in his eyes.

As you see, unspoken, reserved, and unexpressed are the keywords here. It might sound strange, but Japanese shares a common sympathy that the most essential thing should be understood through silence. It means that once it is expressed, it is not there any more, or something essential changes. (I am sure some other cultures have a similar wisdom too.) So, this old man's subtle, covert and almost secret reaction to the song, had a deep meaning to us. It was not just the sign of his dysfunction in cognitive/communicational skills. In a way, the less responses he showed, the more invisible sympathy we shared with each other. The musical expression of my own singing and playing avoided the too much expression, and it became a very restraint expression. Needless to say, still keeping a relationship between a therapist and a client, it was more like living in the same feeling rather than observing the reactions.

In the last half year, his doctor announced that he could pass away at any time and that his family should be prepared for that. Of course this was a sad situation, but he and his wife were already exhausted with the repeated crisis. There was an atmosphere in his room that everybody, including himself, was waiting for the comfort of the ending of his life. During this period his physical condition worsened everyday, but he lived on because his heart function was extraordinarily strong. To us, it seemed like his soul was already so transparent that he was ready to be in the next world. With this feeling, the song Kojo no Tsuki had an even deeper meaning every time we sang it.

One Wednesday in March, I was informed by phone that he wouldn't make it through that night. It was not my working day for that facility, and I decided not to change my schedule just for this information. (It was a hard decision, but I felt that his physical being of alive or dead was not of ultimate significance...everybody dies at one point, and if I could be there or not at that moment was not the most important... how I had had been with him until then was more important.) Despite all the relatives gathered for his crisis, he did not depart on that night. I heard from the staff that his wife whispered to him, "Oh dear, you're being naughty again!"

Two days later, on Friday (my working day), I went to his room to give the usual session including Kojo no Tsuki. He was quiet but seemed very relaxed. As a good-by greeting I said to him, "So, this is the end of today's music time. I wish to see you next week too, but if you are too tired, you could go too." Two hours later, he passed away.

I have no intention of creating to much mystery in unexpressed communication in modern music therapy. However I think it is very dangerous to hasten the result of music therapy just through the reactions under the name of rationalism. The backside of rationalism is that the researcher tends to narrow the channel to the phenomenon irrationally, because it is simpler. This man had his own way and time frame of expressing himself that was not necessarily the same as our ordinary communication channels. Especially in the case of such a low functioning client with a rich inner world (at least he had lived more than twice as long as I had!), if we had had not really listened to his unique way of being, we would have easily fell into the mannerism of looking for expected reactions, and had to write the everyday session report no reactions today. Of course we could not understand him fully anyway, but our attitude of trying to understand him made it possible for us to be with him, I suppose. I think he appreciated not WHAT we understood about him, but HOW we tried to understand him.

If you don't mind, I want to add one more episode from my relationship with this old man. On the critical Wednesday when I could not visit him, I had an appointment with my own doctor and there I found out about my first pregnancy, which I hoped for many years. I secretly think that this was a gift from him, and that he waited for me until Friday to end his life and to hand the new life to me. It was another unique way of his communication.