By Katherine Moore, MusicWorx Intern
“You’re way too young to know anything about the Eagles!”
While this sentiment may be true (the Eagles were just a few decades before my time), I hear statements like these all too often in the adult medical setting. Usually, a patient will make these kinds of comments not long after I begin a session with them. I cannot help but chuckle lightheartedly at the sarcastic declaration of my youth, because the patient may not realize that I’m planning to use their preferred music as a way to build therapeutic rapport.
The truth is, building therapeutic rapport (or “therapeutic alliance”) is the most essential part of what music therapists do on a day to day basis. This necessity is especially true in the medical setting. Many times, I only have about 30-40 minutes with a patient to build the relationship, assess their needs, implement a goal-oriented treatment plan, and terminate therapy. Without that rapport, none of the other steps go as smoothly.
Music therapy is a true process, beginning at a referral and ending with termination. The uniqueness of the therapeutic relationship in music therapy (when compared to traditional talk-therapy) is that we build rapport through two different mediums. First, we build it with verbal engagement, like most other therapies. Talking, active listening, asking questions, empathy, and being transparent are some of the ways we can build rapport verbally. But, we also build rapport through music. One way we can do this is by using a patient’s preferred music. Not only is playing songs or genres within a patient’s preferences scientifically proven to aid in the therapeutic process, but it also helps to build the relationship. A patient’s preferred music can evoke emotions, motivate the patient to participate, and potentially make them feel more important and understood. All of which leads to a successful therapeutic relationship. Hansen (1999) has a whole chapter dedicated to the concept of rapport, and sums up the concept perfectly by stating, “The music therapist attempts to establish certain conditions which maximize the opportunity to develop a close-working relationship with the person.” I personally really appreciate the wording of this statement, specifically when Hansen (1999) describes rapport as a “close-working relationship.” In any therapy, the facilitator cannot reach the goals alone, and the client must be willing and driven to reach their goals as well.
The first session with the client is when the relationship building begins. Typically, the music therapist aims to do these five things:
- Begin to develop the therapeutic relationship
- Gather any and all information
- Observe the patient(s)
- Develop areas of need and goals
- Establish responsibilities of patient(s) and client (Hansen 1999).
In long-term therapy, we have the opportunity to continually build a relationship with our patient(s). We learn more about them every session; we learn their preferred music, what instruments they favor, and how their personalities work with ours and/or with other group members. Therapy like this has the luxury of being able to take the time to build a strong, meaningful therapeutic alliance. on the other hand, in medical settings, we often do not see the patient again. If we do see them again, the patient could be in a different state based on the fluctuation of their condition. For example, I may see a patient that was minimally responsive, only to come back a few days later, to find them awake and alert. In this situation, I almost have to start over when building rapport, now that the patients communication abilities have changed.
How Does Rapport-Building Differ Based on Age?
As I continue my journey through internship, I have had to consider that building a relationship with a patient in these short-term settings requires different approaches, especially when comparing adult and pediatric work. It is truly all about perspective. When getting to know a patient, Norfolk e. al., (2009) suggests to also learn how they are experiencing their illness. Better yet, how are they experiencing the illness’ implications, and the overall hospitalization. Do they not understand the implications (often the case in pediatric work)? Do they talk about it with a sense of determination and strength? Are they scared? Are they putting on a façade that they are handling things fine? The list goes on. Once I begin to pick up on their overall experience, I can not only provide more beneficial therapy, but I know how to improve the therapeutic relationship. Taking this time to really listen and asses also makes the relationship between me and a client more genuine because I am able to better empathize with a client once I know more about their experience.
I have found that adults often have an intimate relationship with their music preferences. Allowing them to discuss their love of an artist or genre and then experiencing that music together is helpful in the rapport building process.
You’re right, I don’t know a lot about the Eagles. Tell me more about their music!
The special musical relationship is also true in older adults, and their music preferences often spark memories of a specific time in their life.
That was a beautiful song you had me play. Does it take you back to a certain time in your life?
Children, however, are often too young to understand that I am not a nurse or doctor, and may have fear responses that make building a genuine relationship difficult. Independence is a huge factor in building rapport with kids. Letting them call the shots helps them feel in control, allows for creativity, exploration, and expression.
Look at all of the awesome instruments I brought for us to play! Which one would you like to play?Which one should I play?
Okay, you tell me when to start playing, and when to stop playing!
And of course, adolescents. The term adolescents describes the period in time (roughly ages 10-21) where one transitions from child to adult. Basically, it is the in-between period where one doesn’t feel like a kid anymore, but does not have the same privileges of adulthood. There is a sense of new independence and an often misunderstood “you don’t get me, mom, leave me alone,” attitude. Because of the anticipation of change, adolescents bring a unique set of factors to the therapeutic table. Because they are seeking independence, their actions are often seen as uncooperative. Also, in the quest for autonomy, they are less likely to openly seek help. Much of the research of therapeutic engagement with adolescents centers around being a support to them. As Oetzel & Scherer (2003) put it, they just want to feel understood! Instead of taking the usual, “neutral stance” therapists are trained to adopt, we as therapists must respect their perspective and their rationale.
Yeah being in the hospital really sucks. What kind of music do you listen to when you feel like no one here understands you?
Of course, we do not want to support destructive behavior in the rapport building process. We can be supportive and empathetic, but must always recognize and redirect a patient’s behavior that can be perceived as destructive.
The above scenarios are just a few examples of the millions of avenues one can go when building rapport in the hospital setting. The key word being millions. Everyone experiences their illness in their own unique way and reacts to hospitalization in their own unique way. The exciting part of my job (aside from literally getting to play music all day) is the challenge of fitting the puzzle pieces together when meeting someone new. Sometimes, rapport building is the easiest part of the therapeutic process, other times, it is the hardest. Patients may want to sing and reflect on the lyrics, or they may just want to play. Getting to know the patient through their experience musically is what makes music therapists in the hospital so distinctive. That, and the guitars strapped to our backs.
Allen, Brittany., & Waterman, Helen. (2019). Stages of adolescence. Retrieved January 19, 2020 from https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx
Bolton Oetzel, K., & Scherer, D. G. (2003). Therapeutic Engagement With Adolescents in Psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40(3), 215.
Hansen, Suzanne B. (1999). A first session: Building rapport. The new music therapist handbook (pgs 55-72). Boston MA: Berklee Press.
Norfolk, T., Birdi, K., & Patterson, F. (2009). Developing therapeutic rapport: a training validation study. Quality in primary care, 17(2), 99-106.