[Reflections on Practice]

Verbal Dialogue in Music Therapy: A Hermeneutical Analysis of Three Music Therapy Sessions

By Katarina Lindblad

Abstract

Verbal dialogue is often a main component of music therapy sessions, however, it is seldom discussed in the music therapy literature. This qualitative study examined three music therapy sessions arranged especially for research purposes. Video recordings of these sessions were analysed as well as interviews with the music therapists conducting the sessions. Specific verbal interventions used during the sessions included: questions, repetition and other types of commenting phrases, silence, paradoxes and rephrasings, symbolic language and interpretations. The functions of the verbal techniques are grouped under three thematic headings: to establish trust between client and therapist; to deepen the experience of the present moment; and to clarify some aspect of the client’s life story. Considering that verbal dialogue is so seldom discussed in the music therapy literature, this study aims to provide a contribution to the development of methodology by shedding light upon this topic.

Keywords: music therapy; music; verbal dialogue in therapy; methodology in professional dialogues; present moment; hermeneutics.

Introduction

There is an on-going debate among music therapists as to how verbal dialogue or verbal processing (both terms will be used interchangeably) is beneficial in music therapy, and whether the musical dialogue and the client’s experience should be interpreted. What is less often discussed is the actual content of the verbal dialogue and its functions. Why do we talk during a music therapy session? What do we say to each other?

We need words since they make things clearer to us, but the words that describe something are not the thing or phenomenon itself (Heidegger, 1996). Ricœur (1991) claims that every statement we make is an interpretation, namely of the thing itself. When the words do not capture the phenomenon they are trying to describe, the phenomenon itself should be the most valid, not the words (Gadamer, 1997). In a therapeutic context verbal dialogue can be regarded as an art rather than a technique. Different techniques may however be used, but must always serve the overall purpose of the dialogue and the context (Engqvist, 2003). Having empathy, being fully present and listening both to what is said and what is expressed through the tone of voice, body language, etc., are examples of general skills for creating a meaningful therapeutic dialogue. More specific guidelines to facilitate a therapeutic dialogue include asking open-ended questions, following up answers with deeper questions, repeating what the client has just said, rephrasing, interpreting, and also using humor, staying silent, etc. (Crafoord, 2005; Gordan, 2004). Active listening, reflecting, paraphrasing, open-ended questions, probes, and focused questions are skills used in verbal psychotherapy and counseling which are also applicable in music therapy (Grocke & Wigram, 2007). Additional verbal skills specifically applicable in music therapy include providing choices, being comfortable with silence, establishing, developing and maintaining a therapeutic presence, and closing a session.

Stern (2004) has explored non-verbal communication in psychotherapy and everyday life. He focused on what happens between the therapist and client, both verbally and non-verbally, thus implying that the process contains many interpersonal aspects in addition to the words. The client and the therapist are equally active in the communication process. Stern explained how the discovery of mirror neurons provides possibilities for understanding such phenomena as reading other people’s states of mind and experiencing what someone else is experiencing. He also stated that words have two sides; on the one hand they play an important role in the process of understanding the world but on the other hand they are not as good at capturing complex, multi-faceted experiences.

In music therapy, Nolan (2005) found that although verbal dialogue is in fact quite often used, hardly anything has been written about its purpose or about different techniques and guidelines. He noted that two different purposes have been observed: to enhance the awareness and understanding of the client and to give the music therapist information. Nolan claims that it is important for music therapists to use verbal dialogue in such a way that it is in tune with the musical experience during the session. Otherwise there is a risk that the verbal processing might counteract the process initiated by the music. Bruscia (2006) stated that although the core of a music therapy session is a musical experience of some sort, verbal discussions might occur:

Music therapy sessions may also include verbal discussions. The discussions may be part of or subsequent to the ongoing musical experience, or they may focus on specific issues, feelings, situations, or events that are pertinent to the client’s therapy. While verbal communication is essential in working with certain clients, it can be ineffective or undesirable in working with clients who are nonverbal or verbally defended, and who relate better to the nonverbal aspects of music. (p. 6)

Garred (2006) noted the difference between music in therapy and music as therapy, and stated that the dialogue differs according to the music therapist’s theoretical framework and view on the role of the music itself, either as mainly a symbol of something else or with its own inherent value as an aesthetic expression. Grocke and Wigram (2007) stated that music therapists need basic counselling skills in order to explore and process the musical experience that occurs during the session. According to the authors, music therapists rely on verbal processing a great deal during a music therapy session, to (pp. 25-26):

discuss with clients how they are feeling on the day, and what has happened since the last music therapy session

find a focus for the music therapy session

understand responses to a musical experience

gather more information about the client’s experience that enables us to ‘re-enter into the musical experience with new insight and more developed therapeutic alliance’ (Nolan, 2005, p. 18)

give feedback to the client about our own experience (where appropriate)

give interpretations of what the client is doing, or what is happening (when appropriate), and

close a session.

Finally, Paulander (2011) focused on the clients’ own experiences of music therapy. The clients in the study stated that they felt a need for verbal dialogue in order to process their musical experience, to understand it better, and give it meaning.

To summarize what has been found in the literature, verbal processing can be beneficial and necessary in clarifying a phenomenon and making it more understandable, but it can also diminish experiences that cannot fully be captured in words. While music therapists have anecdotally discussed verbal processing or verbal dialogues in music therapy, there is currently a gap in the literature that discusses how music therapists use verbal dialogue during music therapy.

Theoretical perspective

This qualitative study is rooted in hermeneutics, and influenced by phenomenology. Hermeneutics is an interpretation theory that is constantly developing through influences from other theoretical perspectives such as phenomenology and post-modernism (Alvesson & Sköldberg, 2008; Kenny et al, 2005; Kjørup, 2009; Ödman, 2004). In phenomenology a phenomenon is studied in all its multitude and complexity, from as many angles as possible, setting aside the researchers personal view through a process called “epoché” (Alvesson & Sköldberg, 2008). Some authors claim that there is no sharp line between hermeneutics and phenomenology (Bengtsson, 2005), but whereas hermeneutics can be described as the art of interpretation, phenomenology focuses on the things themselves (Alvesson & Sköldberg, 2008). Edmund Husserl, considered as the father of modern phenomenology, based his thinking on the idea that ”everything that we experience is directly related to our consciousness of the experience” (Wheeler, 2005, p. 322).

When a hermeneutic perspective is used in research, the dialogue between the researcher and the material is crucial. The parts influence the understanding of the whole, and the whole influences the understanding of the parts in an on-going process often referred to as the hermeneutic circle (Ödman, 2004). In order to ensure that the research is scientifically sound, it needs to be situated in its context and only reasonable interpretations can be made. It is also important to be able to make a critical evaluation of the source material.

Purpose Statement and Research Questions

The purpose of this study was to explore how music therapists use verbal dialogue during music therapy session.

What types of verbal interventions occur during the sessions?
Why do the music therapists say what they say and do what they do?
Which kind of functions do the verbal dialogues have during these sessions?

The Design of the Study

This is a qualitative exploratory study based in hermeneutics, inspired by phenomenology. It could be considered quasi-experimental, since the sessions were arranged specifically for the study; instrumental, since there was a specific question in focus; and multiple, since three sessions were studied to obtain a broader view of the subject of verbal dialogue in music therapy (Smeijsters & Aasgaard, 2005).

Participants

Three music therapists participated in the study. They were purposively sampled with the criteria that their training had a psychodynamic perspective and that they had long-term clinical experience. Their working experience as music therapists ranged from 15–30 years. Therapist A was also a psychotherapist and a GIM (Guided Imagery and Music) therapist. Two of the therapists were female and one was male. They all worked within a resource-oriented framework. For the study the music therapists were asked to work as authentic as possible, using the same methods and techniques as they normally would.

Recruitment

For ethical reasons authentic music therapy sessions with real clients were not used. Instead, an inquiry was sent out to colleagues and acquaintances of the researcher asking if they knew anyone who might be willing to participate. Close friends and relatives of the researcher were not accepted as clients. Those who volunteered were invited to participate in a single one-on-one music therapy session with one of the three participating music therapists. They were asked to be as genuine as possible during the session, bringing up issues that were real to them, but at the same time bearing in mind that there would only be one session and therefore very deep or painful topics should be avoided.

The music therapists and the volunteer clients gave written informed consent and their anonymity was guaranteed. The videos were only to be seen by the researcher and in part by the music therapist conducting the session. After the study both the videos and the recordings of the interviews were destroyed. The participants were given the opportunity of reading the article before publication.

Procedure

Each of the three music therapy sessions was video-recorded. The video camera was placed in the room and switched on in advance. The researcher transcribed summaries of the videos.

As a preparation for making interviews with the music therapist, the researcher watched the recordings from the sessions and read the summaries. Different turning points were identified, key moments where there was a certain turn in the content of the dialogue, or a change of action from words to music. Interview questions were prepared for each of these key moments:

What happens here?
What were you thinking about here?
What made you bring this up here?
What made you choose to change the subject here?
Why did you choose a musical/verbal intervention here?

Within a week after each session, the researcher conducted the interviews with the music therapists, during which time they could comment on their experiences of the sessions. In one of the interviews stimulated recall was used, i.e., an interview technique whereby an activity is videoed or recorded and afterwards played back to the person/s involved, who can then comment spontaneously (Haglund, 2003). The other two interviews were based on the written summaries from the sessions. Each interview started with the general question: “What is your overall impression of this session?” Subsequently the interview followed the written scripts, using the pre-determined questions.

All of the interviews ended with the closing question: “Is there anything from this session that we haven’t talked about and that you wish to add?” The interviews were transcribed verbatim and sent to the music therapists for comments and corrections. Key statements were identified and placed into themes (Forinash & Grocke, 2005; McFerran & Grocke, 2007).

Data Analysis

The video recordings and interviews (both the tapes and the written scripts) were processed according to the hermeneutic circle (Kenny et al, 2005; Ödman, 2004). The researcher watched the videos, listened to the interviews, read the interviews, asked questions of the material, re-read reference literature, and asked new questions. These steps were repeated according to the hermeneutic circle in order to be fully immersed in the data. The video recordings were analysed from as many different perspectives as possible; the client, the therapist, their tone of voice, tempo, and body language. The recordings were played with sound only and with images only. Type of questions generated by the material were: “what are they talking about?”, “what do the music therapists ask?”, “how do they talk about music?”, “what happens immediately after a musical intervention?” and “who talks first?” The reference literature on methodology in professional dialogues referred to previously (Crafoord, 2005; Engqvist, 2003; Gordan, 2004; Grocke & Wigram, 2007), generated new questions such as: “do they use silence?”, “do they interpret?” and “do they use metaphors?

Results

The following paragraphs contain a short summary of each music therapy session followed by a description of the types of verbal interventions that the therapists used during the sessions, and a summary and an analysis of the interviews with the music therapists.

All three sessions followed the same pattern, with a verbal introductory phase of about 15 minutes, a processing phase with some kind of musical experience and verbal dialogue, and a verbal closing phase. The music therapists informed the clients of the practical conditions, such as time frame, professional anonymity, and the fact that the session was being recorded. They also presented themselves and talked a little about how they work, and then they asked the clients to say something about themselves and what topic they wanted to explore during the session. In one of the sessions the client asked for the video camera to be switched off during the first 15 minutes. The recorded part of each session lasted from 45-75 minutes.

Session A.

In session A the client was a woman who was slightly older than 40. Music was a big part of her life. Her father was professionally involved in music and she herself sang in a semi-professional jazz group. She had earlier experiences of attending therapy as a client, and had taken a course in life-coaching. During the introductory dialogue she discussed the need to focus on a problematic love relationship during the session. The music therapist used a receptive method, starting with a verbal dialogue, followed by painting a picture, listening to a piece of film music (Stefan Nilsson: Aarons’s Dream), painting another picture, and finally discussing the paintings and the experience as a whole.

Session B.

The client was a woman in her 40s, who was in the middle of a life crisis since her partner wanted to leave her after 11 years, with no explanation. She was seeing another therapist because of the current crisis, but previously had no experience with therapy. She was interested in music but did not play or sing actively. The session was mainly based on verbal dialogue. The musical interventions were four short improvisations lasting from one to three minutes each. The client was asked to pick out an instrument and a sound to illustrate her overall feelings about her situation, and take part in a role-play dialogue together with the music therapist, representing herself and her boyfriend in the current situation. There were verbal dialogues before, during and after the musical improvisations.

Session C.

The client was a single woman, over 50, who had had therapy earlier in her life because of problems with anxiety and depression. She was on anti-depressive medication. Her relationship to music was strong and complex. She had been actively involved in music-making but had regarded music as being demanding and exacting rather than something pleasurable or fun. She did not have any special topic or problem that she wanted to work with, but was open to exploring with the music therapist. The music therapist and client improvised side by side at the piano, or with the therapist at the piano and the client on a xylophone. The music therapist suggested different ways of playing, such as only using one finger, only black notes, only white notes etc. The music therapist accompanied the client, tuning into her tempo and musical affect. Between the improvisations they talked about the music they had just played, how it sounded, and what it felt like for the client, looking for parallels between the experience of the music and the client’s everyday life.

Verbal interventions

Everything that was said during the music therapy sessions can be thematised as: questions, repetition and other types of commenting phrases, silence, educational comments, paradoxes and rephrasings, symbolic language, interpretations, and what was said about the music. Not all interventions were used by all three music therapists. The following is a list of the interventions with explanations and examples:

Questions

Factual questions – family, social life, work situation, and health care concerns.

Supportive questions – questions that focus on the client’s strengths and abilities; “what makes you happy in life?”, “what are you proud of about yourself?”

Clarifying questions – “how do you notice that?”, “what does that look like in your life?”

Here-and-now questions – such as “what happens to you right now when you talk about…?” And “what do you feel in your body when you think about…?”

Consequential questions – such as “what is the worst thing that could happen?” And “what could it lead to if you didn’t…?”

Verifying questions – “how does that work for you?”, “is it ok with you to…?”, “does this sound right to you?” And so on.

Closing questions – such as “what do you take with you from this session?”, “what feeling do you leave with?”, “what have we done?” And “how do you feel now?”

Repetition and other types of commenting phrases

In order to avoid the feeling of interrogation with a multitude of questions, the music therapists used other ways to keep the dialogue going. Examples included: “I need to know a little more about you”, or “… it would be nice if you could tell me something about yourself” or to say things like: “tell me more about that” or “say more about that”.

Silence

As an alternative to verbal interventions the music therapists sometimes simply remained silent, especially after a musical intervention.

Educational comments

All three music therapists used educational comments, such as explaining what anxiety is and how it works, in order to help the client understand their feelings and reactions cognitively. The music therapist in session A referred to giving the client “cognitive help”, while the music therapist in session B spoke about making things clear. The music therapist in session C referred to “psycho-education”.

Paradoxes and rephrasings

To make a paradox or to rephrase something that the client has said was another technique used by all three music therapists. In session B, for instance, when the client described her ability to adjust to the situation as being a weakness, the music therapist turned it round, suggesting that it could actually be a positive quality. In session C the entire introductory interview is full of paradoxes and rephrasings, where the music therapist turned what the client saw as weaknesses into potential strengths. For instance when she said that she tries to be a good person, but often messes everything up, he turned her statement around, seeing it as a sign of her ambitions and high ideals. He started by asking her what she was proud of about herself:

Client: I try to be a good person – but often it goes straight to hell...
Therapist: So you are ambitious. You have ideals. That’s something you can be proud of.
Client: Yes… and I’m a sensitive person – and that often puts me in difficult situations.
Therapist: So you’re sensitive for other peoples’ needs…?

Symbolic language

During session A the music therapist used a simile when she asked for a clarification: “so it (the music) is like life-giving air to you?” Apart from this the music therapists did not use symbolic language to a great extent. The clients, on the other hand, sometimes used descriptive terms. In session B the client said that the music sounded “sad”, the situation was “black and white”, there was “no space”, but later there was “hope” in the music.

Interpretations

Interpretations were made as open suggestions that allowed the client to comment or contradict. The music therapist in session A used the phrase “it sounds as if…” when she mirrored the client’s story back to her. The music therapist in session C interpreted his client’s story with the words “in your case I think it’s a matter of security, of feeling secure”, and “when you’re afraid of losing control, of ‘falling apart’, I interpret that as anxiety”.

Dialogue about the musical content

Music therapists in both sessions A and C asked about their client’s relationship to music. In sessions B and C, the music therapist suggested “play rules” for the improvisations, continually checking in to see that the client agreed to them. Both music therapists B and C invited their clients to choose an instrument and to explore different sounds. After the improvisations the music therapists asked about the clients’ experiences; what they heard, and what it was like to play. In session B the music therapist asked: “What do you think it sounded like?”. And music therapist C asked his client to give one of the improvisations a name, and also asked her: “if this would have been a soundtrack to a film, what would the film have been about?”

How the music therapists used tone of voice

In the beginning of session A the music therapist spoke quickly and at medium volume. After a while she slowed down her tempo and started speaking softly. At one point she whispered to match the content of what the client was talking about. In session B the music therapist spoke with a soft voice and sought for words tentatively, probably as a way to tune into the client’s way of speaking and show respect for her vulnerable state of mind. In the verbal dialogue that took place during a musical improvisation, the music therapist spoke in a musical, almost singing way, tuning into both the music and the client’s way of speaking.

In session C, the music therapist spoke with a gentle but matter-of-fact type of voice, similar to a normal everyday conversation. The contact between him and the client allowed him to make a few jokes, which added laughter to the dialogue.

Clinical Decision-making Process: Choice of Verbal and Musical Facilitation Techniques

The following paragraphs examine the interviews with the therapists. Each of the music therapists explained that, generally, they use verbal dialogue to create an atmosphere of security and trust, to support and strengthen the clients and to highlight their resources. They also stated that they use words to help the clients keep within their emotional boundaries and not bring up more than can be taken care of in an hour.

Session A

The music therapist in session A explained in the following interview how she had let herself be led by an inner dialogue that moved freely between theoretical knowledge, experience, and impressions of the moment; both from the client and from her own inner thoughts and reactions. She chose the topic for the session by listening to the client’s words and also listening to how she said things, sensing her tone of voice and body language. Overall, she described the impulses that led her towards the different choices as: “I sensed it in the room”, “I felt it strongly in me”, but also: “I saw it in her body language/her eyes”. The choices and decisions were made quickly and intuitively, based on experience. She stated:

Not everything that I sense in the moment should be put into words. But I need a cognitive system to understand it both theoretically and inter-subjectively: ‘What is it that happens between me and the person I’m working with? How can I understand what is happening in me?’ It’s a huge work.

Here she highlighted the immense work that is needed in order to use verbal dialogue consciously.

Session B

The music therapist in session B started her interview by addressing the ethical issue of the study. Since her client was in such an acute crisis and very vulnerable she questioned whether it was ethical to “open up to emotional doors” with such a powerful tool as music, and then leave her with only this one session, stating that if she wanted further sessions, it would cost her money. Because of the client’s fragile state the therapist tried to create as safe an environment as possible, which she did through words. She admitted that she had some degree of performance anxiety during the session. She pushed herself to start using music. If it had not been for the video recording and the study, she might have remained even longer in the verbal dialogue with the client.

While watching the recording from the session, the music therapist described how, during the session, she had kept wondering: “What is this really about? What is the main problem? Is it about the crisis in the relationship or is it more a matter of the client needing to start looking inward into herself in order to develop in life?” After a while it became obvious to her that the client would benefit from looking inward and start working with herself. Again and again during the session the music therapist tried to point out and suggest paths in that direction:

Client: I’m always adapting to other people, “when in Rome, do as the Romans”.
Therapist: Yes, and you’re good at that. It can be a great quality in life. But sometimes, when you back off all the time and never tend to your own needs and wants; it’s not doing you any good in the long run. At some point you need to stop, and start listening inward, to yourself and find out what you want from life, you yourself, not what everybody else wants, but you.

While watching the video recording the music therapist noticed that she was pushing the process too much. She perceived herself as slightly too quick in her remarks and interventions. Given an authentic music therapy situation, she would have allowed the client more time. The video shows that the client is crying on and off during the session. The music therapist did not make any verbal comment about this to the client. In the interview she explained why:

I don’t think I ignored it – my eyes and my presence were with her crying without me wanting to give any special focus to it. In a non-verbal way we both knew that she was crying and that it was ok, without any need this early in our relationship to verbalize or enhance it even more. It was confirmed on a non-verbal level. Maybe that is a special music therapy quality – a consciousness about the non-verbal communication, about that which is inherent in the words and at the same time beyond them. Maybe that’s a sort of musical attitude.

Session C

The music therapist in session C explained in his interview that he immediately had a sense of his client’s need to feel secure, from her very first comments and her body language. Throughout the session that sense was confirmed in different ways. He had planned before the session that if the client did not have any specific issue to work on, he would work on resource strengthening. Since the client did not have any specific issue, and showed signs of needing to feel secure, he decided to focus on supporting her. He did this by building a secure framework, reassuring her in words and actions that he took responsibility for the situation, and helping her to keep within her own boundaries so as not to feel exposed afterwards. He used silence often and deliberately, sometimes to let what had just been said or played sink in, sometimes because he needed to think about what to do next. ”Yes, you can sit in silence for a while, it’s not dangerous that there is a silence. And you feel it in the room, when it’s ok for the client and not disturbing”. The music therapist was guided by the client’s words, body language and the sound of her voice: “She was tense. Tense in her face, tense in the voice. And she even said that she was nervous”. He watched his own thoughts and reactions and was led by his overall knowledge of how powerful music is and therefore how easily it can violate the client’s boundaries:

She opens up here, but not too much. That’s my responsibility, to keep the balance and stop her if she opens up too much. Because otherwise she might leave with a sense of having been exposed, or even violated, and that evokes a feeling of shame. So it’s very important to help the client to keep her boundaries. To be in the playing field and then reflect about it, and go back and forth between those two, that’s really what we’re doing here.

The Function of Verbal Dialogue

The following section outlines the functions of the verbal dialogue that emerged from the interview transcripts. Three specific uses were found: to establish trust in order to bring about a genuine encounter, to deepen the experience of the present moment, and to clarify the client’s life story.

To establish trust in order to bring about a genuine encounter

Both music therapists in sessions A and C mentioned in their interviews that they felt that a real encounter had taken place with the client. A sense of trust was created. What might have caused this?

They both used words in the beginning to create a feeling of security. They were both very clear in explaining the therapeutic framework.
They were both explicit to their clients about their therapeutic thought models; therapist A described her thoughts on the subconscious, and therapist C described his view that making music in music therapy is about playing and not performing.

To deepen the experience of the present moment

The verbal dialogue, during and after the musical interventions, seemed to focus on the clients’ experiences in the present moment. By talking about what it felt like right now in the sessions, the clients became aware of emotions, associations and parallels between the musical experience and patterns in their everyday life.

In session A, the client drew two pictures, before and after the experience of listening to the music. The subsequent dialogue was centred on the pictures. The music therapist and client discussed details in the pictures and the client made her own interpretation as to what they meant to her. The emotions that arose in her when discussing the pictures were validated and deepened by comments from the music therapist. For instance:

Client: It’s like a huge grey stone, and the little girl is almost crouched under it. It’s very scary.
Therapist: Yes, it looks threatening for the little girl. She must be afraid.

In one of the improvisations in session B there was a verbal dialogue during the improvisation about what the music sounded like. The client used descriptive terms to illustrate how she experienced the music, such as “no space”, but also “hope” later on. Most of the time, the client was “in her head”, talking even as she improvised. The music therapist used the verbal interventions to help the client to become more aware of the here-and-now experience.

In session C the client was self-conscious and more focused on what it felt like for her to play than on how the music sounded. She became aware of how difficult she found it to relax and just enjoy the music, but also how tempted she was to let go. In the dialogue she described feelings of joy and playfulness on the one hand, and inhibiting thoughts of hesitation and doubt on the other.

To clarify the client’s life story

In each of the three sessions, the following life stories emerge. In session A, the client discovered common patterns in her relationship with her father and with her current partner. The story emerged in the images she drew, and were clarified verbally. The theme in session B was that the client put her own needs second to other people’s needs. Through the improvisations she experienced how stuck she was in her current relationship. The improvisations also gave her a feeling of hope and new possibilities. This understanding became audible in the music and was clarified in the verbal dialogue. Session C centred on the client’s insecurity and need for control. This theme became apparent in the musical improvisation and was then clarified in words. The client experienced an “Aha!” moment from seeing so clearly how this was a pattern in her life. The session was full of joy and laughter, with the client enjoying this kind of music-making. The process from challenge to relief seemed to happen in the music and was deepened and expanded through words.

Discussion

Considering that verbal dialogue is so seldom discussed in the music therapy literature, it is striking to note that it was such a dominant part of the sessions that were examined in this study. Session C seemed to contain the most music in terms of time, and yet the therapist and client only played 15 out of 63 minutes. Both Nolan (2005) and Grocke & Wigram (2007) found that music therapists in fact rely a good deal on verbal dialogue when working with clients who have access to language. Nolan stressed the fact that verbal dialogue should never overshadow the aesthetic, spiritual, or in other ways ineffable manifestations of the musical experience; but that in many cases it can build a bridge between the world of direct experience and cognitive processing.

There were both similarities and differences in how the music therapists in the study used verbal dialogue. One similarity was that all the therapists worked within a resource-oriented framework. Another was that both music therapists A and C mentioned in their interviews that they use silence as a conscious tool in their sessions. Grocke & Wigram (2007) identified comfort with silence as a verbal skill specifically recommended for music therapists. Nolan (2005) described how inexperienced music therapists are often uncomfortable with silence and start talking immediately after a musical experience. He noted that the ability to recognize different qualities in the silence comes with experience. Crafoord (2005) described seven different types of silence, where the contemplative and creative silence can be very beneficial for the therapeutic process.

The tone of voice and way of talking in all three sessions could be described as musical. The music therapists adjusted their tone of voice to match the clients’ ways of speaking, and the subject being discussed. Nolan (2005) stressed the fact that the music therapist’s tone of voice should also match the affective nature of the musical experience.

The differences between the three studied sessions lie in the methods the music therapists used, and what they focused on when addressing the clients’ problems. The music therapist in session A used her knowledge from psychotherapy and GIM in her verbal dialogue; repeating what the client had just said in a supportive way, using set phrases like “tell me more”, “say more about that,” etc. The aim was to help the client to stay with the experience and explore it further without intellectualizing and moving away from the experience itself.

In session B the verbal dialogue was cognitively supporting and therapeutic. To a certain extent the music was of secondary importance. In the interview, the music therapist even stated that if it had not been for the research she might not have used music at all during this session. The music therapist in session C was the one who used music the most, and he also had the most explicit thoughts about the role of music. He explained to the client that he saw music therapy as an opportunity to play music and explore, and that it was not about “music as performance”. He avoided verbally digging up the client’s past. Instead he ensured that the dialogue was about what actually happened in the music making, how she felt about playing music, what she heard, and what this did to her. He also used verbal dialogue to give her instructions such as: “play with one finger,” or “only use white keys or black keys.”

Specific dialoguing skills that are beneficial for music therapists were found to be necessary. One of which was the ability to be comfortable with silence. Another, as suggested by Grocke & Wigram (2007), was providing the client with choices; choice of which instrument to play, choice of which play rules to follow, etc. This contributes to a more equal relationship between the music therapist and the client. It also gives the client the opportunity to work on making choices and taking responsibility and of experiencing the positive self-esteem that follows.

All three music therapists in the study used verbal dialogue to help the client become aware of the present moment. Through this awareness they all discovered parallels between what they experienced in the session and patterns in their everyday lives. Stern (2004) claimed that true change in any therapy occurs through the direct experience in the present moment. Since such a large part of the sessions is verbal, it seems appropriate to encourage music therapists to acquire verbal skills, and for educators to provide students with the opportunity to develop verbalization techniques (Nolan, 2005).

Conclusion

While the results of this study cannot be generalizable, conclusions can still be drawn. The purpose of this study was to explore verbal dialogue in music therapy. In this context verbal dialogue was in fact quite a large part of the music therapy sessions, and it served both general purposes similar to any counselling dialogue, and specific purposes that are beneficial in music therapy. As has been noted by both Nolan (2005) and Grocke & Wigram (2007), music therapists should strive to attain some basic skills in professional verbal dialogue, and educators should provide students with opportunities to practice these skills.

The purpose of words is to make things clear and comprehensible and raise them to a conscious level. On the other hand, aesthetic and spiritual experiences that can be brought about through music are often rich and complex and difficult to capture in words. To deepen the understanding of how words can make things clearer or when they contradict the experience, and to develop a language suitable for describing musical, often non-verbal, experiences could be an important field for further research.

References

Alvesson, M., & Sköldberg, K. (2008). Tolkning och reflektion. Vetenskapsfilosofi och kvalitativ metod [Interpretation and reflection. Philosophy of science and qualitative method]. Lund: Studentlitteratur.

Bengtsson, J. (2005). Med livsvärlden som grund [With the lifeworld as base]. Lund: Studentlitteratur.

Bruscia, K. (2006). Case studies in music therapy. Gilsum, NH: Barcelona.

Crafoord, C. (2005). Människan är en berättelse. Tankar om samtalskonst [The human being is a story. Thoughts on the art of dialogue]. Stockholm: Natur & Kultur.

Engqvist, A. (2003). Om konsten att samtala [On the art of dialogue]. Stockholm: Prisma.

Forinash, M.,& Grocke, D. (2005). Phenomenological inquiry in music therapy research. In B. L. Wheeler (Ed.), Music therapy research (2nd ed.). (pp. 321–334). Gilsum: Barcelona.

Gadamer, H. (1997). Sanning och metod i urval [Truth and method in selection]. Gothenburg: Bokförlaget Daidalos.

Garred, R. (2006). Music as therapy: A dialogical perspective. London: Jessica Kingsley.

Gordan, K. (2004). Professionella möten. Om utredande, stödjande och psykoterapeutiska samtal [Professional encounters. On investigating, supporting and psychotherapeutic dialogues]. Stockholm: Natur & Kultur.

Grocke, D., & Wigram, T. (2007). Receptive methods in music therapy. Techniques and clinical applications for music therapy clinicians, educators and students. London: Jessica Kingsley.

Haglund, B. (2003). Stimulated Recall. Några anteckningar om en metod att generera data [Stimulated Recall. Notes on a method to generate data]. Pedagogisk Forskning i Sverige [Pedagogic Research in Sweden], 8(3), 145-157.

Heidegger, M. (1996). Being and time. Albany: State University of New York Press.

Kenny, C., Jahn-Langenberg, M., & Loewy, J. (2005). Hermeneutic inquiry. In B. L. Wheeler (Ed.), Music therapy research (2nd ed.) (pp. 335–351). Gilsum: Barcelona.

McFerran, K., & Grocke, D. (2007). Understanding music therapy experiences through interviewing. A phenomenological microanalysis. In T. Wosch & T. Wigram (Eds.), Microanalysis in music therapy. Methods, techniques and applications for clinicians, researchers, educators and students, (pp 273–284). London: Jessica Kingsley.

Nolan, P. (2005). Verbal processing within the music therapy relationship. Music Therapy Perspectives, 23, 18-28. doi: 10.1093/mtp/23.1.18

Paulander, A-S. (2011). Meningen med att gå i musikterapi. En fenomenologisk studie om deltagares upplevelser [The meaning of going in music therapy. A phenomenological study on the participants’ experiences]. Stockholm: KMH Förlaget.

Ricœur, P. (1991). From text to action. Essays in hermeneutics. Evanston, Illinois: Northwestern University Press.

Smeijsters, H., & Aasgaard, T. (2005). Qualitative case study research. In B. L. Wheeler (Ed.), Music therapy research (2nd ed.) (pp. 240–257). Gilsum: Barcelona.

Stern, D. (2004). The present moment in psychotherapy and everyday life. New York: Norton.

Ödman, P-J. (2004). Hermeneutik och forskningspraktik [Hermeneutics and Research Practice]. In B. Gustavsson (Ed.), Kunskapande metoder inom samhällsvetenskaperna [Methods to create knowledge in social science] (pp. 71–93). Lund: Studentlitteratur.