Kelly Meashey: The Use of Voice in Music Therapy

Book Review

In early February 2017, I invited Kelly Meashey into my undergraduate Psychiatric Methods class to give a workshop on the use and impact of voice in mental health settings. This was shortly after an uneasy election in the USA, followed by demonstrations pro and against the then new President. My small class was made up of urban students from Philadelphia and students from Western Pennsylvania—each on opposing sides of the election. While administration, faculty, and students alike had been careful not to discuss our differences, there was an atmosphere of tension, fear, and mistrust rippling under the surface in every gathering, including the classroom. In retrospect, I believe that we were all in shock trying to grapple with the realization that the myth of America is One couldn’t be further from the truth of the nation. The ground had shifted under us and it is still trembling.

Into this classroom climate ventured Kelly Meashey. After a few vocal warm-ups, Kelly asked the class to sing “This Little Light of Mine” numerous times. At first, I wondered where this was going, but the wisdom of her method became clear. The students changed dynamics, tempo, and expression; they sang it to themselves and to others; they sang while imagining the light shining inside themselves and sang again as they shone the light outside into places in the world where there was darkness. In fifteen minutes, I watched a group of traumatized and withdrawn students breathe, become grounded in themselves, deepen into their experience, enter an altered state of consciousness, and finally, share their emotions with each other freely.

In fact, for some students, this was a watershed moment in which rigid defenses were abandoned for healthier coping mechanisms—the expression of feelings followed by a grounding and supportive discussion in a spirit of “we have music in common; we are still OK together.” I felt I had witnessed a little magic. I have thought about this experience since that time, trying to understand how Meashey had used such simple means to create a powerful experience of being in the music rather than doing something with music, while igniting the flames to create what Kenny (1989) would call a “field of play.” Thus, I was thrilled to read Meashey’s description of this process in her new book, along with many other insights into her practice.

Meashey has written a book that is the culmination of decades of deep reflection and practice as both a performing musician and as a therapist whose clinical work has spanned a range of clients from nonverbal children and adults to clients with trauma, wellness groups and music therapy students. With training in Vocal Psychotherapy (Austin, 2008) and the Bonny Method of Guided Imagery and Music (BMGIM; Bonny, 2002), she has a unique perspective of the potent intersection that is possible when imagery, body, and voice are unified in music. With this essential quality throughout her book, she provides pertinent theories and therapeutic rationale, exercises, variations for different levels of practice or developmental sequences, and steps in facilitating music experiences for different goals and outcomes. However, this is not a book that teaches us merely how to “do” vocal activities; rather, Meashey encourages us as therapists to use the voice to experience the beingness and centrality that the voice can bring to ourselves and to our practice.

Knowing that we can only take our clients to places we have been and are not afraid to inhabit ourselves, she begins the book with three experiential imagery exercises, each with a different goal; the first brings us to an awakening of music within oneself; the second brings an awareness of the impact of vocal production on clients; the third provides a perspective of the relationship of client, vocal music, and therapist. Following this introduction, Part One consists of five chapters focused on vocal self-training for the music therapist. Beginning with a reflective discussion of each of the musical elements reminiscent of Bruscia’s (1987) Improvisation Assessment Profiles, Meashey examines each element (rhythm, pulse, tempo, meter, melody, harmony, etc.) from a self and client perspective, providing clinical vignettes that illustrate the therapeutic use of each element. Detailed exercises for self-exploration, expression, and vocal identity formation as well as for the development of vocal technique and vocal improvisation are integrated with therapeutic applications and clinical perspectives. In doing so, she presents practical topics of concern such as self-care and burnout, clinical versus performative use of voice, working with verbal and nonverbal clients, and connecting authentically and expressively to clients’ music that we may find boring or distasteful.

Following self-experiences, Part Two presents 15 chapters on working with clients. These chapters present appropriate research as a therapeutic rationale to support a goal-driven domain perspective of vocal therapy. In these chapters, the book is a user-friendly clinical manual that provides ideas to facilitate a specific therapeutic outcome along with various interventions based on each of the four methods and case vignettes to demonstrate applications in a particular goal area. Goal areas include (but are not limited to) group cohesion, stress reduction, rational thinking and emotional regulation, self-expression and communication, emotional pain, physical pain, cognitive development, and social interaction and relationship building. Vocal methods of toning, chanting, singing songs, call-and-response, song writing, and vocal improvisation are presented in each chapter, yet each time, these forms or techniques reveal something wholly new.

Utmost in Meashey’s awareness is how we, as music therapists, are able to work at different levels of therapy. Thus, she presents a variety of vocal experiences with a focus on physiology, cognition, neuroscience, expression, support, social connection, or psychological insight, among other perspectives. Each time a method is presented, the focus changes, shining a light on how the entrainment process is fundamental to the client-vocal music-therapist relationship. For example, in discussing toning from the perspective of emotional processing and support, Meashey recognizes that too much aural stimulation can feel oppressive when in deep emotional pain, and also that words can be meaningless in this state. Here toning is used to sound the self—and to sound one’s pain without words or external impositions of musical elements executed in a particular way. In vocal improvisation, she provides ideas for chord sequences and seeds of vocal motives that are developed as the client delves more deeply into their internal experience, along with indications for interventions depending on particular client responses and therapeutic opportunities. One of the aspects I enjoyed most was how Meashey presented, then developed the interventions while including visually evocative vignettes that demonstrated the therapeutic process. In a similar manner, when singing songs, she describes different approaches for diverse client needs such as bereavement, NICU, hospice, anxiety, and depression, demonstrating how to shift the therapeutic perspective and exploit the musical elements to engage the client at the appropriate level and depth of practice. Personal experiences and short client examples demonstrate the significance of each musical concept she presents in both life and therapy.

In 250 pages, Meashey delivers both breadth and depth, including as well, an excellent chapter on ethics, a Toolbox that presents basic forms used in vocal therapy, and an Appendix with Sokolov’s (2020) duet games. The Toolbox has more ideas and exercises with notations and chords to sound the voice, improvise, chant, tone, create call-and-response activities, sing in various ways for various purposes, and compose new lyrics and/or music. All these activities and ideas throughout the chapters and in the Toolbox and Appendix will be excellent adventures for music therapists interested in expanding their use of voice in clinical practice. But there is also depth that underlies Meashey’s approach. The experienced clinician will be struck by her psychodynamic understanding of the power of “music activities”—when used with right intention—to help us to connect with our clients where they are, to journey with our clients through a process of entrainment, and to ultimately shift the field of consciousness that we create in synchrony and harmony with clients. In doing so, each client has an opportunity to find themselves in their unique sound, shine a light on it, make it grow, and bring that light to the world.

About the Author

Lillian Eyre is an accredited music therapist (MT-BC), a licensed professional counselor (LPC, Pennsylvania), and a Fellow of the Association for Music & Imagery (FAMI). She is a visiting associate professor at Temple University, USA. Prior to joining Temple, Eyre was Associate Professor and Director of Music Therapy at Immaculata University, USA. In 1995, she founded music therapy programs in psychiatry, dialysis and long-term care in the McGill University Heath System, Canada, where she worked until 2006. She co-founded Le groupe Musiart, a performing arts group and choir for persons with serious mental illness. She serves on the editorial review board of Music Therapy Perspectives and the Canadian Journal of Music Therapy. In addition to article and chapter publications, she edited Guidelines for Music Therapy Practice in Mental Health (2013, Barcelona Publishers).