Dynamic Interplay in Clinical Improvisation
[Editors note: The article presented here is republished from Journal of British Music Therapy Vol. 4, no. 2 1990 with the kind permission from the publisher and the author.]
Abstract
When a therapist and patient/client are actively engaged in improvising music together, the potential exists for the development of an intimate and dynamic emotional relationship. The improvisation reveals both players' capacity for forming, expressing and communicating dynamic forms of feeling, within the context of this music relationship.
This paper examines the concept of dynamic forms, with recourse to the literature on mother-infant interaction, and applies this concept to clarify' the use of clinical improvisation in music therapy.
I would like to begin by examining the title, since this will clarify the theoretical framework within which this paper will develop. Chambers Dictionary (1988) defines "dynamic" as relating to force; activity or things in motion; forms or patterns of growth or change; any driving force instrumental in growth or change. The word "interplay" refers to the reciprocal, mutual musical interaction between therapist and patient. Both players' contributions help to clarify the quality of the emotional interaction in the musical relationship. The concept of "clinical improvisation" in music therapy is best illustrated by a detour via the literature of mother-infant interaction.
Mother-infant interaction
Studies which have micro-analysed the nonverbal interactions between infants and their mothers reveal the subtle and highly complex processes whereby infants perceive, apprehend and respond to their mothers' emotional signals. These studies suggest that these processes are innate, as is the motivation to engage in an intimate emotional relationship (Stern, 1985; Trevarthen, 1980, 1987).
A newborn infant has the capacity to read the mother's internal state by decoding, so to speak, the emotional signals in her voice, gestures, movements and facial expressions. A crucial aspect of these signals is that they are not restricted to a particular mode of expression, i.e. they are cross-modal. The infant perceives these signals and coordinates them into forms or patterns. He knows these forms separately from the modalities through which they are expressed, i.e. that they exist in abstract form, and he has the capacity to represent them expressively through other modalities. I would like to call these abstract forms "dynamic forms".
In a hypothetical example, an infant moves his arm in such a way as to cause an object to flop about. This movement has a certain quality: it is irregular, quick, and comes to an abrupt stop before suddenly jerking in another direction. (These qualities reveal something about the infant's internal state.) The mother apprehends the dynamic form of the movement i.e. its tempo, irregular rhythm and unexpected lengths of phrases, and expresses these qualities in her vocalization which accompanies the infant's arm movement. (Through apprehending the infant's forms, she has a sense of his internal state.) The infant recognises the form of her vocalisation as being related to his arm movement. (He knows that she has a sense of how he feels.) He then changes the movement, e.g. he decreases the speed of his arm movement, expressing a variation in tempo, and awaits the corresponding change in his mother's voice. In this way, the infant learns how his own alternation of the form is perceived and reflected by another through vocal sounds. However, for this to happen, he is dependent upon his mother being sensitive to the forms of his movement and expressing them appropriately on her behalf.
Lynne Murray has shown that when the mothers' expected corresponding behaviours are not forthcoming, babies' attention towards their mothers decreases and they become withdrawn and show signs of distress. (See Murray and Trevarthen, 1985; Murray, 1988.) Stern makes the point that when the correspondence is well matched, the infant frequently reacts by not reacting. Thus, an infant expecting a response to the dynamic form of his own movement or vocalization may appear to ignore it when he receives it. However, when there is a mis-matching where, for example, the mother over-attunes or under-attunes to the infant's action, the infant's reaction communicates to his mother an alertness to this. Thus, for example, if her vocalization is far too slow or erratic, he may stop what he is doing and look at her quizzically. Tronick et al (1979) comment on the quality of mis-matching, proposing that a sensitive mother's mis-matching will not be beyond her baby's capabilities, and will offer him a more complex and expanded environment to grow into. A consistently perfectly matched environment, although enhancing communication at that moment, would not provide for growth. Winnicott makes a similar point when he talks about the inherent frustration of growing older: the mother-as-object does not always act or react as though she were an extension of the infant (Winnicott, 1971).
This knowing and interacting with another's internal state has been termed affect attunement (Stern, 1985) and inter-subjectivity (Trevarthen, 1980). When the relationship is inter-subjective, both infant and mother initiate, complement and respond to one another in a highly fluid and intimate dance, within which their internal states resonate with one another through their apprehending one another's dynamic forms. This "dance" has all the complexities and subtleties of a musical improvisation duet, and includes expressive features of tempo (e.g. accelerando, rubato, ritardando, allargando, ritenuto); of dynamics (e.g. sforzando, crescendo); of timbre (e.g. changes in voice quality) and of pitch (melodic contours and harmonic colour).
These expressive features, described above in musical terms, correspond with the dynamic forms of emotions. These dynamic forms are expressed through the qualities of our acts. Stern uses the term "Vitality Affects" to describe the dynamic shifts of feelings within us, e.g. "surging", "fading away", "fleeting" and "drawn out" (Stern op.cit. p.47 & p.54); and proposes that the qualities which are common to all modes are: intensity, shape, time, contour, motion and number. These, says Stern, exist in the mind as abstract forms which are not inextricably bound to a particular mode, or even to the world of feelings at all - and it is these which permit us to experience a perceptually unified world. These amodal properties can be recognised in any of the senses: thus we understand the meaning of a child bursting with energy, a burst of temper, a burst watermelon, thoughts bursting out of my head, bursting into tears, a burst of speed, and so on. The "bursting" is the dynamic form of the action or feeling, irrespective of whether it is a positive or negative emotion, or of whether there is any feeling component at all. In music we speak of a sforzando to describe a burst of sound.
Thus, it is the dynamic forms of actions, rather than merely the actions themselves, which enable the mother and infant to know one another intimately. I would now like to turn to music therapy and suggest that it is the dynamic forms, revealed through musical sounds, which set the musical agenda of the improvisation.
Dynamic Forms in Clinical Improvisation
In clinical improvisation, therapists use highly specific musical techniques to realise or embody these abstracted dynamic forms through music. Therapists are trained to create improvisations with a wide range of intensity (harmonic, dynamic, rhythmic), contour (melodic shape, harmonic contours), time (tempo changes), motion (the illusion of different tempi through rhythmic subdivisions); and to exercise disciplined and subtle control over these within a highly aesthetic medium - that of music. These techniques were pioneered by Paul Nordoff and Clive Robbins in their exploration and extention of improvisation within clinical directions.
Therapists create clinical improvisations with patients by "reading" the dynamic forms of their patients' musical utterances, and by responding to these musically, with the specific goal of moving towards an inter-subjective musical/emotional relationship with them. This is what I understand by the application of clinical improvisation techniques in music therapy. It is important to state here that the clinical improvisation does not, in my opinion, symbolise an emotional state per se. Nordoff and Robbins illustrate this with a description of both the healthy and pathological features of musical behaviour. For example, a fast tempo may indicate tenseness, over-excitement or obsessiveness, or it may indicate an alertness, playfulness and buoyancy (1977: pp.158 & 159). The clinical improvisation is simply presenting the patient's capacity for organising dynamic forms, for trying them out in different ways, for re-creating their boundaries, for trying out new forms - within the context of a shared relationship.
Here we are entering the world of play, and I would like to use Winnicott's description of play, since I find it a useful analogy for understanding clinical improvisation. For Winnicott, playing takes place neither in the inner world nor in the outer world, but in the potential space between mother and infant. Play offers the possibility of testing the fluidity of boundaries between the self and other, and the infant develops the capacity for playing with ideas introduced by an other. The infant's use of the potential space is related to his confidence and trust in the adaptability and dependability of the environment. Where there is mistrust and fear of the environment, the creative potential of this space is threatening and frightening. It may disappear or disintegrate. Where this space can be filled with the products of the infant's imagination, it offers the opportunity to shape and reshape images (Winnicott, 1965; 1971).
Similarly, where the music therapist and patient are able to create a shared musical space between them, within which both players can express themselves, then a highly intimate and dynamic inter-subjective relationship is possible. For this to happen, the therapist needs to enable the patient to express himself through the music; she needs to apprehend the dynamic forms of his or her expression and give meaning to these by responding dynamically in a way which the patient himself apprehends, i.e. the two players need to share a reciprocity of intention. This relationship is central to the music therapy session and has no need for words: the therapist does not need to know what the forms refer to; or what their context is in the patient's life.
Dynamic interplay in clinical improvisation
When using clinical music improvisation techniques with adults, the therapist usually asks the patient to begin playing. She listens carefully to the patient's musical utterances: tempo, rhythmic structure (or lack of it); melodic shape, phrasing, the quality of pulse or beat (is it regular, irregular, intermittently regular and irregular?). In these first solo moments, the patient's capacity for organizing dynamic form is revealed. We have seen above that this capacity for perceiving, abstracting and reproducing dynamic forms is innate.
The therapist then joins in, improvising in a manner which reflects or confirms aspects of his playing. Thus she will match the tempo and dynamic level, play in the same meter and pulse, if this is regular, or attempt to match or meet the pulse if it is irregular. The therapist's first goal is to meet the patient's music, thereby providing a shared musical environment within which both players' improvisation can make sense to one another. Now, it may be that the patient's inner disorganization is such that his playing is utterly chaotic and unpredictable. Here, the therapist cannot detect a pulse, cannot infer a rhythmic pattern, and despite attempts to do so, is unable to meet the patient's playing with her own improvisation. The joint musical impulse is unsynchronised and there is no mutual musical contact between the two players.
If and when the therapist is able to meet the patient's music, by matching or meeting aspects of the patient's tempo, meter, rhythm and pulse, she is creating a musical context with the musical features which are common to the two players. She is providing a potential space for sharing.
However, as we shall see, she does not only support the partner's musical utterances, since merely supporting them does not offer a therapeutic experience in the long term. It may also deny the patient the potential of extending his expression to areas of himself which are unexplored.
Once a potentially shared context has been created, she may offer a variation of existing musical material by, for example, extending the rhythm or offering a variation of tempo. This offers a potential musical direction for the joint interaction. This extending or altering of the music by the therapist is called clinical intervention, and is a feature of clinical improvisation technique. A crucial aspect of clinical intervention is that it must be appropriate to the preceding musical context, in the same way that a mother who offers alterations in actions to her infant must be sensitive to the level of over- or underattunement which her infant can absorb.
The therapist's clinical interventions help her to check the patient's capacity to be flexible with the dynamic form expressed through sound. Can he allow this form to ebb and flow? To accumulate tension? To slow down quickly or slowly? To speed up? And so on. By checking this, through improvisation, she is gaining insights into the patient's emotional profile. She is also, at this early stage, attempting to establish whether the patient acknowledges her playing as being related to his in any way; she is testing the interactive potential of the improvisation.
When the patient fails to respond to the therapist's clinical intervention, but continues to play in his own narrowly defined motif, he is preventing the improvisation from extending into new musical territory (Steele, 1984). This, however, assumes that the therapist's intervention was appropriate in the first place. Here I want to stress that an open attitude in the therapist is essential. One of the questions we must never stop asking is: was a particular intervention or response appropriate within this musical context? It is all too easy to suppose that a patient is being resistive when in fact it is the therapist's lack of attunement which limits the development of the mutual relationship.
Let us assume, for now, that the therapist's interventions are congruent with preceding musical material, and that the patient, by not responding, is limiting the shared use of the potential space. The therapist needs to be alert and sensitive to the patient's non-responsiveness (which is in itself, of course, a response), and initially at least, respect this. By not responding the patient is defining his or her limits: he or she is saying, "This is what I can do now.
Let us continue on the theme of resistiveness for a while. At a later stage in the shared work, the patient may show a more sophisticated and deeper way of expressing resistiveness. In this case it is within the shared musical space. For example, the patient may constantly take the musical initiative in a way which does not acknowledge the preceding shared musical material, i.e. by initiating out of context. This is incongruent with the shared material, and it effectively keeps the therapist on the periphery. This is again preventing or limiting the shared use of the musical space.
Where the patient responds, no matter how tentatively, in a manner which is directed towards the therapist's music, he is beginning to acknowledge the interactive features of the improvisation. Thus he begins to explore and expand, with the support of the therapist's improvisation and within the context of the shared musical medium, his range of musical expression. The therapist notes the quality and range of the patient's responses, usually listening to an audio recording of the session and notating any relevant musical material. This material can be used in future sessions, so that the musical product of their joint efforts becomes familiar to both players over the (usually) weekly sessions. This offers the patient a musical structure which becomes sufficiently familiar to enable him to participate in the shaping of it by taking the musical initiative.
For example, the patient may come to know that at a certain period in a march, which has been developed over several sessions, there is a cadential moment followed by a change of meter, e.g. from 2/4 to 3/8. When he has gained sufficient confidence in his ability to be fully part of the march, he may spontaneously give a loud cymbal crash to punctuate the cadential moment, and then use the bongos to participate in the compound duple musical material. Here he is taking the initiative in his use of instruments, and offering
The therapist a potential direction: she will note the cymbal crash at the cadential moment, and may develop music which expands this, offering more cadential moments, inviting more cymbal crashes, and this may, in turn, lead to a quieter waltz, using the cymbal.
The therapist needs to be acutely sensitive to the quality of the patient's responses, and to acknowledge the complex nature of these. For example, a patient who is highly responsive to the therapist's music may be being just that and nothing else. He may be following the therapist very closely, but making no attempt to maintain any independent features in his contribution. He may be over-dependent on the therapist, allowing her to dictate the dynamic forms and their shapes. Here again, the relationship is not a mutual one: its direction is being dictated by one of the players, in this case the therapist.
The patient is motivated, with the support of the therapist's clinical intervention, to extend his or her musical performance. Later he begins to take the musical initiative by contributing new, congruent musical material which the therapist responds to. The joint improvisation provides an opportunity to make dynamic forms, to try out new bits of them, to recombine them and to make new patterns. This is the therapeutic process in clinical improvisation.
When the therapist and patient come to a point of sharing the shape of the improvisation, they jointly define the structure and fluctuation of the music and jointly explore its musical possibilities. It is now that the relationship is at its most intimate and its most dynamic. Neither player controls or is threatened by the potential musical direction, and both players, because of their trust in one another's responsiveness, share a reciprocity of intention, using one another's musical ideas to play.
It is the strength of clinical improvisation that within the musical relationship, the dynamic forms of emotion emerge instantly and in sharp focus. This bypasses the need for assigning referential meaning to these forms - indeed by speaking about the improvisation, the profound and complex emotional experience may be reduced to satisfy the semantic limitation of words. However, I do not wish to ignore or dismiss the value of the spoken interchange, nor to advocate a rigid orthodoxy ("No words please, this is music therapy"), since patients frequently make spontaneous comments after improvisations. Furthermore, in early sessions, the depth and immediacy of contact as well as the sharp focus of emotional experience may be frightening. Here the therapist may need to check, verbally, the patient's experiences and feelings. I see this verbal interchange as an adjunct to the musical relationship, rather than a secondary, verbal, relationship.
Where the musical context is the therapist's vehicle for working towards an inter-subjective sharing of selves, the use of verbal interpretation or the development of an extensive verbal relationship with the patient may confuse the musical relationship. A verbal relationship reveals its own dynamic forms, and these may not correspond to those elicited through the improvisations. This results in two concurrent relationships between therapist and patient and can be so complicating as to hinder both relationships. Where clinical musical techniques are not used, music can be seen as being an adjunct to verbal (or art, or movement) therapy rather than as central to the relationship. The improvisation is then a vehicle for verbal psychotherapy.
Where an authentic inter-subjective musical relationship can develop between therapist and patient in music therapy, we must not be afraid to allow dynamic forms to speak and to resonate through sound, with a little inspiration, of course, from the muses.
References
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