Voice Forum: The Voice as Primary Instrument in Music Therapy
Report from a Symposium at the XII World Congress of Music Therapy, Buenos Aires, Argentina, 22-26 July 2008
[Editorial note: This report is a revised and translated version of Uhlig, S.(2008) Die Stimme als Primaeres Instrumenta, a paper previously published in Musiktherapeutische Umschau, 29(4). The article is republished with kind version from Musiktherapeutische Umschau/Verlag Vandenhoeck & Ruprecht.]
Introduction
Voice Forum is an initiative to bring together music therapists from around the world who focus on the voice. This idea started through the collaboration of Kate Richards Geller and me in New York City, and culminated in the development of a voice-work approach. For many years, Kate and I invited music therapists to our experiential voice sessions. Our purpose was to explore the voice through partner work, in a dialogue form and in a group setting. Based on our client-therapist relationships, we focused on experiencing and interacting with any kind of vocal sound, beautiful or not. No words were necessary to use sound therapeutically. Our workshops were presented regularly in New York City and at music therapy conferences in USA and Europe. During the last European conference in the Netherlands in 2007, Sanne Storm joined us. We realized the similarity of our approaches and discussed the idea of a larger network of cooperation around the voice as primary instrument. Sanne invited Inge Nygaard Pedersen to our discussion and we planned a worldwide gathering for the conference in Argentina. Sadly, many colleagues we invited were unable to travel so far, even though they strongly desired more attention about the voice as primary instrument.
We wanted our colleagues to open their treasure boxes of voice experiences and share them publicly: collecting clinical experience and research, and working on future plans to speak about the importance of the voice. The four of us, Inge Nygaard Pedersen, Denmark, Sanne Storm, Faroe Island, Kate Richards Geller, USA and me from the Netherlands, all experienced music therapists, presented excerpts of our work methods, while more than hundred participants listened and participated. While we presented our individual work, the Voice Forum mirrored the collective connection between us around the following ideas:
The human voice is our earliest, most unique and most natural instrument for primary expression and communication in every culture. People all over the world express themselves primarily through their voice. The voice is our closest instrument and gives us the opportunity to make contact with our selves and our environment. In focusing our attention on the sound and expression of the human voice itself, away from the words, the human voice becomes a tool in itself for orientation and information to our selves and to others. The voice expresses who we are and how we feel. Primary sounds like a spontaneous outburst of laughter, cry, scream or shout will be an uncovered authentic sound of the human voice – a free voice where cultural limitation and personal restrictions are released – an expression of authentic "beauty."
In the following we will present some of the main ideas presented in Buenos Aires:
Inge Nygaard Pedersen
PhD, is Professor with specific tasks, Aalborg University and Aalborg Psychiatric Hospital, and Head of the Music Therapy Clinic – an integrated institution between the university and the hospital.
Inge presented principles and prototype exercises from her work with training music therapy students in therapy related body- and voice work. She is collaborating with Sanne Storm in developing this discipline and planning for a textbook in Danish for music therapy students. She has trained art therapists within the same discipline for the last 20 years.
Principles of Therapy-related Body and Voice Training
The principles of therapy-related body and voice training are to develop oneÂ’s self-identity and self-understanding through work with voice improvisations in specifically designed exercise frames. Each frame is to be understood as a nonverbal orientation tool for the student or client to obtain knowledge about oneÂ’s self. Overall principles for the direction of the exercises are: the principle of allowance and the principle of imagination connected to voice improvisation.
Examples of instructions of nonverbal orientation tools can be:
1)"Be present at home by yourself in listening to your own voice sounds, leave the sounds of the other participants out" as opposed to "Be present in being attentive towards someone else in listening openly to the voice sound of the other!"
Another nonverbal orientation tool instruction may sound:
2)"Be conscious about your private space, your social space and your soloist space and the transitions between them" (This exercise is specified below).
A third nonverbal orientation tool instruction is concerned about
3) "Be conscious about the different phases in the progression of A) free, chaotic, searching voice expressions, B) voice expression through one chosen sound, and C) voice expressions in forming a personal melody around one sound." Last but not least, a nonverbal orientation tool can be focussed on D) "Be conscious about relational patterns as understood from the perspective of a mother/infant relationship."
This last perspective contains three main steps in understanding relational patterns: One pattern is ‘the healing relationship’ where one can feel like being carried and nursed by somebody else through the voice improvisation. A second pattern is a ‘holding relationship’ where one can experience being met and confirmed by stable ‘centre point’ voice expressions from someone else no matter how dynamically extreme one’s own voice expressions are coming out. A third pattern is a ‘playing relationship’ where one can develop melodies or rhythms and play around in the music and create new forms and expressions with somebody else through voice improvisations. This last relational pattern can add new colours to one’s self-picture and self-understanding. Often the third creative step is not possible before step 1 and 2 are dynamically lived through together with the therapist and fully contained and accepted by the client. These first steps 1 and 2 are often challenging traumatic limitations for the free flowing creativity in voice expressions.
Examples of Prototype Exercise One
Inge explained two of the prototype exercises mentioned above:
- The space of chaos, rhythm and form, and
- The private space, the social space and the soloist space.
In instructing the first prototype exercise, the clients are told to explore their voice expression possibilities and to leave out the inner judge (also the super ego) and to really allow themselves to use the voice in all its qualities. The setting is that clients are working in pairs sitting back-to-back on a mat on the floor. They are told to actively leave out thoughts on what will be reactions of the others as the others are allowed to explore their own voices in the same way. This first space often creates both negative and positive reactions in the verbal feedback after the whole exercise, as somebody experiences terribly ugly noises and others find it a peak experience of being freely allowed to explore the voice possibilities in often very loud ugly, childish or beautiful ways without limitations. In the second space, the clients are asked to start again like before and to find a sound they like and to stay with it and repeat it over and over again. This normally creates a certain harmony in the room which most clients experience as healing and a form of meditative experience. In the third space, the clients are asked to find their sound again or a new sound and to create a little sound form or melody around their sound. A little form that is so simple that it can be remembered and repeated.
Clinical Application of Prototype Exercise One
Inge is using parts of this exercise or the whole exercise often in work with borderline or personality-disturbed patients. One example is a female patient who often expressed that she did not exist – she could not feel herself as existing in the physical world mostly when she periodically suffered from extreme diffused anxiety. She and Nygaard Pedersen repeatedly tried out the second and third part of the exercise, sitting back-to-back on the floor and she created a melody which she repeated over and over again. In the following weeks, she reported that she could now hold on to the melody she had created as something inside her representing her self during her overwhelming episodes of anxiety. She found the melody being a first step to identify something as ‘her self’ in her chaotic and frightening self-experience. Another example is a male client diagnosed as having a personality disturbance who realised that he needed a centre outside himself to be able to feel grounded. Inge Nygaard Pedersen kept the pulse for this client with her voice as a centre sound and gradually he dared to experiment with his voice in a way where he regained a feeling of his body and of being grounded. This process was illustrated by touching pictures created by this client showing his experiences of moving from feeling frozen as a fossilized sea urchin when starting this work to feeling alive and vibrating in his body and soul when finishing the therapy.
Examples of Prototype Exercise Two
Exercise two: "the private space, the social space and the soloist space." The exercise is structured by the group leader; moving into and out of each of the three spaces is marked by beating a drum. Concerning the private space, the clients are told to imagine being in their private space inside the body and just around the body – inside their inner mental space – the space where you can come home and regain your energy after being with many other people or the space where you can hide yourself from others. They are told to express the qualities of this space with the voice and to stay with their own voice qualities no matter what they can hear other voices doing around them. In moving into the social space, the clients are told to let themselves be inspired by and to inspire others’ voice expressions and to build music up together. Important here is that they are also told to be aware that they are not leaving the connection to their private space in moving out into the social space. If this happens, they are allowed to make a small break – to connect again and to come out into the social space again. In moving into the soloist space, the clients are told to allow themselves to imagine they are standing on a stage in a big concert hall and to try to find their way of being heard at the most distant parts of the hall. They are also told that they do not have to pay attention to the others as they are allowed to do the same. So the participants are allowed to be soloists simultaneously in a group. Again here it is important to inform that they should be aware if they lose the connection to their private space while being out expressing themselves as soloists on the stage. If so, they should allow themselves to take a small break, reconnect and to come out into the soloist space again.
Clinical Application of Prototype Two
Inge has often used parts of or the whole exercise both in counselling group work, where the aim has been self-development but also with patients within diagnosis of borderline and personality disturbances.
For borderline patients, the idea of being allowed to stay in your private space and vocalise without paying attention to being in tune or in harmony with the others and to improvise simultaneously with other patients being allowed to do the same is often amazing. It very often invites verbal dialogues on how they are normally afraid of being too much or too withdrawn in relation to others and how they are often afraid of being negatively evaluated or misunderstood when communicating with others. So they either keep back in relation to others and get stressed, or they express themselves in destructive ways where they lose contact with the private space. The principle of being ‘allowed to’ express yourself and to give space to others expressing themselves without paying attention to these others often creates a basis for constructive authentic dialogues later in which the clients can stay with their own experiences at the same time as they can differentiate themselves better from the experiences of the others. Being more secure in this private space gives gradually another basis for positive experiences in dialogues and in relationship patterns with others.
A Short Form Prototype Exercise at the Voice Symposium
In the symposium, Inge worked with the participants in the audience and asked each participant to improvise with the voice with closed eyes and open ears. She asked everyone to find a sound and to stay with it even if they could hear the sounds of the others. She asked the participants to allow themselves to listen carefully to their own sound in the big sound space of about a hundred voices improvising.
After a while, she asked the participants to change the awareness towards a united group sound, and to listen simultaneously to both oneÂ’s own sound and the sound of the others. This was carried out very impressively by this united group whose sound she conducted to a crescendo and a diminuendo which ended up in a whispering sound fading out.
Inge Nygaard Pedersen would be very interested in hearing about other music therapists using voice-work in self-experience or clinical work in music therapy and also to learn from, exchange and discuss experiences with other exercises at this voice edition forum.
Sylka Uhlig
MA, RMTh, LCAT, Hogeschool Arnhem/Nijmegen, HAN University Nijmegen, Netherlands: teaching methods of music therapy and vocal improvisation.
I did the second presentation and talked about excerpts of my book: Authentic Voices - Authentic Singing. I focused on the importance of the sound and the messages we are sending out through our voices. While I was talking, I assumed that the audience was judging me because of their perception of my voice – before they even listened to my content. Unconsciously, we all judge and interpret voices as pleasant or not before we know that we are doing this. From neurological research, we know that we first react emotionally to sounds – connecting to the older part of the brain. Later the cognitive part of the brain gets involved. Then we are able to perceive the content of words. In my book, this undiscovered potential of the voice in daily life and in the music therapy field is emphasized. This potential of the voice is not limited to singing songs but also includes sighing, crying, screaming, groaning, humming, laughing, and lamenting as effective forms of vocalization.
Today, many powerful vocal expressions are going unnoticed; they are unconscious or have lost their significance as crucial and functional for living creatures. Barking dogs calling for attention, singing birds communicating messages, yelling mothers protecting their children, weeping grow-ups mourning the loss of a loved one, groaning patients or dying solders moaning in pain-we hear and see these expressions but most likely with no special attention or involvement.
My book also focuses on natural forms of singing as human expression in different cultural traditions. Herein are cultural sound preferences included, like the various styles of vocalisations in Arabic, African or Western countries. Vocal sounds are often unusual for foreign ears but offer a tremendous spectrum of vocal skills. From these examples and my work as music therapist with clinical experiences, a vocal therapy method has emerged. This method I described in an attempt to structure my experiences and to categorize the therapeutic use of this vocal intervention on different levels.[1] Here is a selection of them:
Affective Level – human expression: Uttering primary sounds: sighing, babbling, laughing, crying, shouting, screaming, groaning, humming, silence. Information revealed in the quality in the voice:
- emotions: anger, grief, fear, pleasure;
- moods: love, shock, embarrassment, jealousy.
Relational Level – human contact: Communicating through the voice: calling, telling, talking, singing, silence. Information revealed about communication:
- intention to sooth, nurture, hold, comfort;
- intention to activate, stimulate, provoke, invoke, grieve, inspire, confront, protect.
Cognitive Level – symbolic representation: Giving meaning through words, melodies, imagery; focusing on content: humming; syllables, names, phrases, poetry, compositions. Information revealed about meaning:
- intention to sooth, nurture, hold, comfort, relax, calm;
- intention to stimulate and activate concentration and memories through sounds and words and to create neurological responses to vocal sounds and songs (brain development)
Aesthetic Level – authentic appreciation: Discovering beauty in any vocal sound; opening the senses and especially the ears to receive any human sound. Information revealed about acceptance, attraction and repulsion of human sounds, appreciating cultural origins in natural, authentic sounds.
These methods allow an analysis of the definite sounds clients and also therapists sending out. The vocal expressions are primary sounds with important information. I call these sounds acoustic symbols because of their valuable messages. Valuable information goes often unnoticed and unused, waiting in the therapy session to be acknowledged. A vocal dialogue for engagement with these primary sounds will finally transform the messages. A patient in pain does not need to tell the therapist about his condition. The sound of groaning is understandable for everyone who is aware of the message. This client needs a soothing voice. A crying child does not need to tell about these feelings. A comforting voice is needed. A screaming adult does not need to talk about despair. A voice that can invoke is necessary. An angry teenager does not need to talk about frustration. A powerful yeah, like in a rap is an answer. Many clients call out for acknowledgment of their situation or condition. The voice as primary instrument is a tool to interact with and to transform emotions and behavior. The therapist needs to develop awareness and training for this vocal engagement.
Sanne Storm
MA, PhD, student at the Graduate School in Music Therapy, at Aalborg University, Department of Communication and Psychology, working as a music therapist at Tórshavn Psychiatric Hospital, Landssjúkrahúsid Tórshavn, Faroe Islands and teaching music therapy students together with Inge Nygaard Pedersen in voice and body oriented music therapy at Aalborg University.
Sanne uses the voice as a primary instrument in almost all clinical settings with adult patients, and over the years an approach and method have developed and become more and more specific to her, which she calls Psychodynamic Voice Therapy. Listening to the human voice is a very essential part of SanneÂ’s approach and working method, in which the purpose of listening is to be informed about the client and their psychological state, and guided in the therapeutic approach. Because she presently is doing a PhD research study, she focuses on the client group suffering from depression. Over the years she has experienced that voice- and bodywork with depressive patients is very effective and stimulating. SanneÂ’s PhD study is about Research into the Development of a Voice Assessment Tool in Music Therapy. In her presentation she especially focused on two prototypes of her clinical exercises, which she also did with the audience.
Glissandi movement: Working with the glissandi movement in many variations from a very small circle in a sliding movement to very big circles starting with the very deepest possible tone to sing, and ending on the very highest possible tone to sing and back again. Sliding is a very important part of this exercise because it is both working with flexibility and tone-field of vocal expression without putting unnecessary effort into the vocalization. In any way it is supporting the self-experience of freedom in the vocalization.
Singing one note: This exercise is starting by the therapist supporting each client to find their individual Core Tone and allowing this tone to vibrate and sound. This exercise is very much connected to the Self in the understanding of allowing your Core Self to vibrate and sound – therefore the expression Core Tone. By the Core Self, Sanne refers to the theory of Daniel Stern. First task is to support the Core Tone to vibrate and resonate in the body and in the self-experience, and have this experience embodied. The next task is to allow this Core Tone to grow in both volume and power of resonance, and to stay with this experience and sensation, so it is possible to carry and keep this body sensation when widening your tone range – field of vocal expression (quotations of Sanne Storm). While the participants experienced their own voices, she explained more about the effect of these vocalizations on her clients. Sanne was able to move the audience into a very personal space of their own voices, and she helped them understanding the importance of these sounds in clinical settings.
Her simple examples and clear explanations about them were a wonderful experience to everybody.
Kate Richards Geller
MA, MT-BC, LCAT, singer/songwriter with MA in music therapy from New York University, USA.
Kate defined her music therapy approach of using the elements of music to create change based on the needs of the clients. The voice is the primary instrument, the way to make the most direct connection with another human being. Kate presented a part of her work which focuses on vocal improvisation as a vehicle for community building and for supporting and actualizing personal and social change. She offered the development of musical skills with vocal improvisation exercises – discipline and structure – to create freedom for artistic expression and potential of being in the here-and-now where healing can happen. This aspect of her work is currently influenced by "RhiannonMusic" and the Circle Song concepts of Bobby McFerrin.
To conclude our voice forum, Kate demonstrated a vocal improvisation exercise called "Voicestra" and she orchestrated a wonderful finale. She divided the large group of more than hundred people into 5 sections, offering each a distinct and interlocking melodic and rhythmic pattern. As each group sang their part, their bodies engaged in the groove and the whole audience transformed from a sitting and listening group into a swinging ensemble. A joyous finale to our voice forum, all of these primary instruments became one voice, a cohesive and collaborative vocal community (quotations of Kate Richards Geller).
Concluding Note
Through this exciting experience of the first Voice Forum in music therapy, people from the audience called for more collaboration around the voice. A Canadian participant announced that the next National Conference of Music Therapy in Canada, in spring 2009, will be focused on the voice. Other participants made arrangements for an international Voice Forum at the next world conference. Many music therapists connected after this forum to exchange their ideas about future voice projects. The awareness of the voice as an important primary instrument in music therapy is a fact. We received mails from Australia, USA, Brazil, Argentina, Germany and Great Brittan for more collaboration. We, the four initiators of this Voice Forum, were very satisfied about these enthusiastic responses. A great need was shown for focusing on the human voice as a primary instrument in music therapy. Many music therapists felt alone in their work and longed for the possibility of sharing and reflecting about voice-work within music therapy.
We as a group were also stimulated to further develop the focus on the voice within music therapy by writing a book together. We will jointly present at the Nordic conference in Denmark in April 2009 and engage separately in other projects like designing a PhD study around this subject.
More Information
Inge Nygaard Pedersen
More about IngeÂ’s work is written in two books from Jessica Kingsley Publishers:
Eschen, J.Th (Ed.) (2002). Analytical Music Therapy. London, Jessica Kingsley Publishers, pp. 168–215.
Wigram, T.; Pedersen, I.N. & Bonde, L.O. (2002). A Comprehensive Guide to Music Therapy. London, Jessica Kingsley Publishers.
Further sources by the author: www.musikterapi.aau.dk/forskerskolen_2006/i-n-pedersen.htm
Sylka Uhlig
Uhlig, Sylka (2006) Authentic Voices, Authentic Singing. Gilsum, NH: Barcelona Publishers (ISBN 978-1-891278-44-4).
Sanne Storm
Storm, S. (2007). Den menneskelige stemme – psykologi og psykodynamisk stemmeterapi. Psyke og Logos Nr. 1. Tema: Musik og psykologi. Dansk Psykologisk Forlag.
www.musikterapi.aau.dk/forskerskolen_2006/sanne-storm.htm
Kate Richards Geller
Note
[1]This method is after the publication of the book still undergoing changes.
