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By Katherine Moore, MusicWorx Intern

“What lyrics in the song stood out to you?”

I ask this question frequently in my music therapy sessions, especially if the patient requested the song. This icebreaker can provide a patient with the opportunity to open up about something that’s on their mind. If the patient is willing to share, the process of song discussion may begin; a technique common in music therapy practice because it’s an efficient tool for emotional processing. In the hospital setting, patients are often subjected to painful, traumatic procedures, or receive diagnoses that change their lives forever. By using a technique like lyric discussion, which offers verbal reflection, I can encourage a patient to express what is on their mind and help them to process their emotions, while making important assessments.

A patient’s personal connections with music are often related to the experiences they have had with a song or songs. One song may spark a special memory such as a wedding, another’s lyrics may remind a person of a late family member.  As the facilitating music therapist, I must quickly learn the connection a patient has with a song, as this guides the types of questions I ask, or the direction I may go with a discussion. However, the often unexamined portion of the therapeutic relationship pertains to the verbal discussions themselves; the value they hold to a therapeutic goal, the line between music therapist and verbal counselor they can potentially cross, and their necessity within music therapy as a profession.  As a music therapist in training, I strive every day to advocate for our profession and the unique use of music as a modality. But the necessity of the use of verbal interventions within music therapy sessions is present, and discussing song lyrics is one of many instances when I find opportunity for their use.

What do these interventions look like?

In my undergraduate education, I was able to take a counseling psychology class, which taught me the basics of verbal interventions and how to guide a client through processing verbally. I learned that in their most simple terms, verbal interventions can just involve me listening, being present with the patient, and offering validation. Yet I was astounded to learn that even the way I ask a question can affect the direction I can take within a therapeutic relationship, both musically and non-musically. A close-ended question, for example, only requires a “yes” or “no,” answer.

But if I were to use an open-ended question, I am encouraging a client to elaborate (much like the first sentence of this blog). I could also use a swing question, which gives the client the option to choose whether or not to elaborate (i.e. “Could you talk about how it felt to write that song with me?”).  But verbal questioning isn’t always a, “And how do you feel about that?” situation. When a patient is eager to process,  I may need to be sure I am gathering the correct information. If necessary, I can easily employ the other verbal counseling techniques in my toolbelt, such as paraphrasing or summarizing to double-check that the patient and I are on the same page. If a patient is having trouble coming to their own conclusions, these simple techniques of reiteration can also help them sort through their feelings.

As a budding music therapy intern, I have strayed away from deeper emotional talks with patients. Mainly because I feel I do not yet have the skills to help with processing, or I feel guilty: after all, I am training to be a music therapist, and talking is not in my job description. But as I have gained more experience with hospital patients, I am realizing that sometimes it’s necessary to talk. First and foremost, I must acknowledge that both verbal and musical interventions give a therapist insight in their own respective ways. That being said, there are instances that one should always be aware of when using verbal interventions within a music therapy context.

First and foremost, verbal interventions with clients should not overshadow the music. Instead, they must seek to give the musical experience meaning. As Amir (1999) states, “the relationship is bigger than the picture.” In the medical setting, the success I have with a patient relies on two things:

1. How well I am able to build a relationship with a patient, and
2. Their willingness to participate (note that my abilities to build a relationship with them affects their participation).

The scholarly research I have found on this topic provides little clarity on the difference between a verbal intervention in music therapy and just talking. In my humble opinion, verbal interventions are used with the intention of guiding the process closer to the end goal (which is different depending on the patient). They can help the music therapist gain a clearer assessment, validate a patient’s experience, or help a patient process their feelings. Verbal interventions can guide a patient through relaxation or songwriting, or initiate a discussion of song lyrics. They guide us back to the music.  However, the other verbal conversations in a session do not just become meaningless. All of it is tied back to the relationship I am cultivating between me and the client.

Music is within all parts of the human experience, and is experienced both consciously and unconsciously.  The beauty of music therapy as a profession is that the music acts as the catalyst. Patients may find it challenging to open up sometimes, but a wonderful thing about music therapy is that the music often does the opening naturally. As I mentioned earlier, everyone has their own experience with music. We as music therapists often use the connections our patients have with music to elicit emotions that may need to be processed.  And what is in my job description? Making the unsung, sung.

How can we use verbal interventions in music therapy?

Verbal interventions within music therapy can:

• identify the direction a session should go
• make a client aware of their thoughts and feelings
• provide clarification
• interpret musical experiences
• guide clients back to their consciousness after intense music experiences

More often than not, I’ll begin a song with a patient that ends with puffy red eyes and a somber face. I may then employ simple verbal interventions to allow the patient to express themselves.

Here’s an example:

Me: I noticed you became a little emotional during the song. Could you tell me what you’re experiencing?

Patient: It’s just been really hard being in the hospital away from my family. I really miss being with them.

Me: Yes, I’m sure being here makes you feel pretty lonely.

Patient: Very lonely. I just want to be with them, but I know I need to get better first.

Me: That’s true, it’s important for you to get better first. That way you can fully enjoy being with. What are some things you’d like to do with your family once you’re home?

In this case, verbal interventions can provide the clarity I need to be able to go on with the session. By acknowledging the patient’s emotions, I am recognizing the shift in energy, and inviting the patient to tell me what is on their mind. As the patient elaborates, I gain more insight to their thinking process. Then, I am able to validate their sentiments. In this example, I could even move into potential songwriting based on my final question. A simple conversation like this gives more meaning to the musical experience (the initial song I sang that made the patient tearful), and allows me and the patient to enter another music experience with more insight.

Another important instance where verbal interventions come in handy is after an improvisatory experience. If a patient has just experienced playing spontaneously, discussing what was felt during the improvisation is important. This is especially true if I noticed a shift in the energy of the room, or if the patient’s playing was especially intense. Of course, if the improvisation spoke for itself, a verbal intervention may not be needed (the patient may also talk before I even get to asking a question). But if it is, I can increase the patient’s awareness of their musical behavior by asking something like, “What did it feel like to play the drum?” A question in this vain also encourages their awareness of the internal experiences they may have had within the improvisatory playing.

The topic of a patient’s conversation can also be validated musically. I may notice a theme developing in their words and think, “Hey! I know a song that talks about that!” Or, better yet, I can just take their words and put them to a tune. Using songwriting in its many forms is a wonderful way to bring completion to the music therapy process. By taking the words of the patient and putting them to a song, I acknowledge them and bring us back to the musical experiences. Not only that, but I could suggest that the patient continue to use songwriting as a coping mechanism for healthy expression. That way, the patient has a healthy leisure activity to take part in that allows them to process their emotions.

Verbal interventions are not always about the patient expressing their feelings or describing a musical experience. Sometimes in the hospital setting, I may offer music-assisted relaxation or guided imagery. These particular techniques are very helpful when a patient is anxious or in a lot of pain, and actually require verbal intervention. While I am containing the space musically by playing guitar or piano, I am also verbally directing the patient through mindfulness techniques, and/or imagery scripts. These promote relaxation and anxiety reduction.

When the session is heading to a close, I may then facilitate a shorter music-assisted relaxation or play a less emotionally provoking song. I do this because it is always necessary to bring the patient back to as regulated of a state as possible. Regulation is  another reason why verbally checking-in with the patient after a musical experience is useful. By doing this, I will know if they feel validated, if they feel closure, and if it is time to move on or end the session.

Actions speak louder than words.

As the therapist, you must also check yourself, making sure that you aren’t just talking because it feels more natural (I know, I know, growth can be scary). Always remember, music therapy is unique in that it uses music as the medium for expression. Once one has built that necessary rapport with the patients, the shift from talking to music can feel interwoven, but the emphasis should be on the music. When in doubt: assess, check-in, and play on!

References

Amir, D. (1999). Musical and Verbal Interventions in Music Therapy: A Qualitative Study. Journal of Music Therapy, 36(2), 144-175. https://doi.org/10.1093/jmt/36.2.144

Nolan, P. (2005). Verbal processing within the music therapy relationship. Music Therapy Perspectives, 23(1), 18-28. https://doi.org/10.1093/mtp/23.1.18

Sommers-Flanagan & Sommers-Flanagan (2015). Clinical Interviewing. 5 Ed., Wiley & Sons, Inc., Hoboken: NJ.