Music Therapist’s Perspective2019-10-14T09:35:14+00:00

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Music Therapist’s Perspective

Maria made her first appointment with Dr. Alan Turry, a Nordoff-Robbins music therapist, in 1994. During their first meeting, Dr. Turry defined music therapy as a creative process of musical exploration and expression. He and Maria established that they would make music by improvising together. Maria was encouraged to explore the musical instruments placed around the room. She giggled as she explored making sounds, slightly embarrassed yet engaged in the process. This playful exploration intrigued her, and she later explained that it was the first time she had laughed since her diagnosis 5 weeks earlier. This collaborative exploration between them would continue for another 24 years and would inspire Dr. Turry’s own doctoral research, culminating in his dissertation, The Interconnections Between Words and Music in Clinical Improvisation.

A Truly Collaborative Process

The Epoch Times published an article and three comprehensive videos on Maria and Alan’s working relationship. One video tells Maria’s story as she went from music therapy client to singer and performer. The other two are focused on Alan’s therapeutic techniques and philosophy.

see the full article

Alan Turry’s Dissertation

The Interconnections Between Words and Music in Clinical Improvisation crystalizes Alan Turry’s doctoral research: examining the relationship between lyrics and music in improvised songs that were created in the context of music therapy with Maria Logis. View the Table of Contents below or download the entire PDF file. (Please note that the pseudonym Gloria is utilized in the dissertation.)

Table of Contents

ACKNOWLEDGEMENTSiii

LIST OF TABLESxi

LIST OF IMPROVISED SONGSxii

CHAPTER

  1. OVERVIEW OF THE STUDY

    1
    • Words and Music: Introduction

      1
    • Nordoff-Robbins Music Therapy

      5
    • Outline of the Presentational Format

      8
  2. THE CONTEXT OF THE RESEARCH MILEU: THERAPY SYNOPSIS

    10
  3. PROFESSIONAL CONTEXT: THE FIELD OF MUSIC THERAPY AS IT RELATES TO THIS STUDY

    • Introduction

      30
    • The Relationship Between Physical and Psychological Well-being

      30
    • The Relationship Between Musical and Psychological Understanding: Nordoff-Robbins Music Therapy and Music Psychotherapy

      33
    • Community Music Therapy

      39
    • Research in Music Therapy Related to Words and Music

      41
    • Musicological Context

      44
    • Perspectives on Nordoff-Robbins Music Therapy and the Integration of Psychological Constructs

      45
  4. THE SOURCES THAT INFORMED THE RESEARCH METHOD AS IT DEVELOPED

    55
    • Introduction

      55
    • The Central Issues of This Study

      55
    • The Sources Used to Explore These Issues

      56
    • Deryck Cooke: Musical Elements as Components of an Emotional Language

      57
    • Music and Emotion

      57
    • Diatonic Music as the Context

      59
    • Tonal Directions

      60
    • Emotional Meaning of Music: Relative Not Absolute

      61
    • Limitations of Cooke's Approach at it Relates to This Study

      61
    • Cooke's Ideas as They Pertain to This Study

      62
    • Jenefer Robinson: Listening Emotionally to the Psychological Drama in Music

      63
    • The Combination of Music and Words

      65
    • Musical Commentary

      66
    • The Building Blocks of Musical Structure and how They Work in Evoking Emotions

      66
    • Constructing the Meaning of Music

      67
    • The Benefit of Musical Ambiguity

      67
    • Experiencing a Feeling and Reflecting on the Feeling

      68
    • Robinson's Ideas as They Pertain to This Study

      68
    • Nordoff-Robbins Musicological Theory and Clinical Practice as it Relates to This Study

      69
    • Non-Diatonic Music: Utilizing Tones with Clinical Intention

      69
    • Music Used to Support and Challenge

      71
    • Tones are Events

      71
    • Tempo and Dynamics: What They Reveal

      73
    • The Fusion of Words and Music: How the Meaning of Words and Music Combine for Maximum Therapeutic Benefit

      74
    • Preparation for Reading the Method and Findings

      76
  5. DEVELOPMENT OF A RESEARCH METHOD

    77
    • Naturalistic Inquiry

      78
    • Purposive Sampling

      81
    • Trustworthiness

      84
    • Researcher's Stance

      87
    • Researcher's Stance: Personal Source of the Study

      87
    • Personal Philosophy and Assumptions

      90
    • The Researcher's Work

      91
    • Indexing as It Relates to the Research Process

      94
    • Selection of Excerpts

      96
    • Defining the Use of the Term Song

      98
    • Analysis

      100
      • Winnowing Excerpts

        103
      • Recursive Listening

        103
    • Trustworthiness Mechanisms

      110
      • Narrowing the Focus of the Listening

        110
      • Meta-categories

        112
    • Presentation of the Findings

      113
      • Theme Statements

        114
      • Pastiche

        114
      • Metaphor

        115
  6. FINDINGS OF MUSICAL ANALYSIS

    116
    • Tell the Truth

      117
      • Detailed Description and Analysis

        122
      • Concluding Thoughts on Tell the Truth

        159
    • There, There

      160
      • Detailed Description and Analysis

        167
      • Concluding Thoughts on There, There

        198
    • Do I Dare Imagine?

      199
      • Detailed Description and Analysis

        203
      • Concluding Thoughts on Do I Dare Imagine?

        233
    • Woman Why Are You Weeping?

      233
      • Detailed Description and Analysis

        238
      • Concluding Thoughts on Woman Why Are You Weeping?

        287
  7. THE THERAPIST'S PROCESS OF CLINICAL-MUSICAL CREATION

    289
    • How Did the Therapist Listen?

      290
      • Listening with the Whole Body

        292
      • A Balanced Listening Approach

        293
    • What Did the Therapist Listen For?

      294
      • Listening for the Client's Needs

        294
      • Listening for the Message in Words and Tone

        296
      • Listening for Psychological Discovery

        297
      • Perceiving Gloria's Vocal Quality Perceived Emotional Quality

        297
      • Perceived Musical Quality

        298
      • Perceived Intention in Creating Lyric and Melody

        299
      • Perceived Underlying Stance of the Client: Personae

        299
      • Musical Forms

        301
      • Who was Gloria Singing To?

        302
      • How Did the Therapist Respond?

        304
      • Musical Elements as They Relate to Therapist Intervention

        305
      • Embracing Tensions: Creating Blends of Qualities

        335
      • The Use of Contrasts to Evoke Awareness

        337
      • Music-Word Fusion

        338
      • Unexpected Discoveries

        342
  8. PSYCHIC INTEGRATION THROUGH IMPROVISED SONG

    346
    • Improvising Songs as a Therapeutic Process

      347
      • Creativity

        347
      • Relationships

        349
      • Processing

        353
    • Bringing Together of Polarities

      354
  9. CLOSING

    363
    • Summary of the Excerpt Tell the Truth

      363
    • Summary of the Excerpt There, There

      365
    • Summary of the Excerpt Do I Dare Imagine?

      367
    • Summary of the Excerpt Woman Why are you Weeping?

      369
    • Reflections as a Researcher

      372
    • Suggestions for Further Study

      374
    • Implications of the Study

      376
    • Final Thoughts

      377

REFERENCES379

APPENDICES390

  • A EXEMPTION FROM HUMAN SUBJECTS

    390
  • B EXAMPLE OF RESEARCH PROCESS WITH MUSICAL NOTATION

    392
  • C EXAMPLES FROM RESEARCHERS LOG

    397
  • D COOKE'S DESCRIPTION OF MUSICAL TENSIONS

    400
  • E COOKE'S DESCRIPTION OF INTERVALS

    406

“[Maria] explained that the music from the piano encouraged her   
   to continue her exploration and expression even when the   
   feeling she was experiencing in the moment was intensely   
   painful. She felt contained by the music …”  

-Alan Turry, DA, MT-BC, LCAT, Nordoff-Robbins Music Therapist

In-depth Analysis of Improvised Songs

In order to provide the opportunity for the reader to gain as direct access as possible to the material under study in the context of the therapy process, the following descriptions of improvised songs are presented in chronological order. Including the actual words that Maria sang and offering access for the reader to listen to the material under study is also a way for Maria to speak directly to the reader. (Please note that the pseudonym Gloria is utilized in the dissertation.)

Tell the Truth (They Tell Me I'm Sick)

December 19, 1994

The following archived material comes from a session very early during the course of therapy. Gloria was struggling to come to grips with the reality of her physical condition regarding her recent cancer diagnosis.

  • No I don't want to go to the next phase
  • I don't want to suffer
  • I don't want to be sick
  • So that's It. I think treatment is making me sick

Gloria never did begin chemotherapy or radiation treatment. She went to many oncologists and found one who was willing to wait before starting treatment. She later shared that she meant to sing that she believed that treatment would make her sick. But her words could also relate to her attitude towards the helping professionals and the emotional reaction she had to the care she was receiving at the time as well. She reported having strong negative reactions to the bedside manner of some of the health care professionals treating her and a general mistrust of doctors who in her view acted in an omnipotent fashion.

  • Because I don't really believe that I am sick now

When I heard these words as therapist I was concerned that Gloria might avoid treatment and silently noted that an important issue would be to help her deal with the reality of her condition. This informed my own creative process as I improvised music with Gloria. I responded to the lyric content describing her not believing the diagnosis by trying to make the music more emotional, more intense. The figure of speech “shaking things up” comes to mind. If she could start to feel emotion while singing about being sick, perhaps she could allow herself to feel the feelings related to being sick, and this would help her in believing she was sick.

Musically this increase in intensity was attempted by creating alternating contrasts of texture, playing in a louder dynamic, and using dissonant tones to create tension. Though Gloria was describing a situation that she understandably had trouble coming to grips with, the here and now process of improvising was something that Gloria could experience and invest in. This potential to experience and express emotion in music was a contrast to her admitted resistance to feeling the emotions associated with truly accepting the reality of her situation. It was my hope that musical experience would provide her with another opportunity to revisit the feelings triggered by the diagnosis, while tapping into her creative strengths.

  • Tell the truth, tell the truth, tell the truth

I interpreted these words as revealing the part of Gloria that wanted to accept her situation and deal with her repressed feelings. Implicitly believing that this was an important idea, before I even knew why I was doing it, I repeated the melodic rhythm of Gloria's lyric. This seemed to spur her on.

  • Tell the truth, tell the truth, tell the truth
  • Tell the truth, tell the truth, tell the truth...yes
  • What is it?
  • Tell the truth.
  • Stop this stuff.
  • What is it? What's the truth?
  • Tell the truth
  • Awgh

Primal sounds that resembled vocal responses to physical blows and seemed to express the internal battle going on inside Gloria poured out of her at this point.

  • Ugh! Ugh!

At the end of this primal sounds section there was a change in Gloria's vocal quality. I sensed a quality of surrender in Gloria's voice. She paused while the music from the piano continued. Then she sang a melody while creating the following words.

  • Oh I love to sing
  • And tell my story to you in a song.
  • Oh I love to sing
  • And tell you my story.

This final section of the excerpt has a clear song form as harmonic and melodic direction unfold with the words that are sung. Gloria sings clearly formed melodic ideas from this point, and I create a pulse and harmonic progression that combines with her melody and words.

  • They tell me I'm sick.
  • They tell me I'm sick.
  • They tell me I'm sick.
  •  
  • And so I proceed
  • To learn all I can.
  • I organize everything.
  •  
  • They tell me I'm sick.
  • They tell me I'm sick.
  • They tell me I'm sick.
  •  
  • I move ahead.
  • I make appointments.
  • I take notes.
  • I analyze everything.
  •  
  • They tell me I'm sick.
  • They tell me I'm sick.
  • They tell me I'm sick
  •  
  • And I have to learn to believe it.
  •  
  • They tell me I'm sick.

As we ended this improvisation I was less concerned that Gloria would avoid treatment, though I recognized the need to help her deal with the emotional reality of her situation. The song ends with Gloria expressing her struggle to accept her diagnosis. The quest to accept the diagnosis will be ongoing, but the expression regarding the quest in this moment seemed to be quite satisfying for Gloria, as this was an excerpt she often shared with close friends and family when they asked how she was handling her cancer diagnosis.

Detailed Description and Analysis

Gloria is struggling to come to grips with the fact that she has recently been diagnosed with a serious form of cancer. She sings:

“No, I don't want to go to the next phase. I don't want to suffer. I don't want to be sick. So that's it, I think treatment is making me sick. Because I don't really believe that I am sick now.”

She has been improvising out loud having a kind of dialogue with herself, but her dialogue is also with me. There is no verbal conversation between us as I am improvising at the piano, responding to her words by attempting to create music to assist her in her self-exploration and expression. Her statement was sung, with the words “want” and “suffer” emphasized with the highest tones of her melodic phrase:

The melody is step wise, with one exception — the ascending major third formed by Ab going to C - when Gloria sings the word “want”. Upon analysis, a relationship can be seen between the word “want”, describing a striving, and the ascending interval used to arrive at the word and sing it. As Cooke (1959) describes, the larger intervallic motion of the third reveals more effort in moving away from the tone. The striving quality in considering the word “want” and the larger ascending interval have qualities that work together and as Beardsley (1981) describes, fuse coherently.

As Gloria sings I harmonize her tones at the piano, moving chords from Ab major to a C minor in second inversion and then to an F minor ninth chord after she has ended her phrase. My notes relate to the tones she is singing and create a harmonic direction, but do not result in a cadence. I hold the harmony tones without motion as she sings her melodic phrase, and then as she pauses at the end of her sentence, I create tonal motion.

The final tone of the melody with the F minor harmony lends the music an unresolved quality. The lack of a strict pulse or definitive meter lends the music a quality of deliberation, and I play the harmony slowly in part with the intention of allowing Gloria to create words and melodies at her own pace. The tones from the piano also reflect the unresolved emotional drama of Gloria's lyric content, as she describes resisting what may be a painful future. Gloria sings with a dramatic ascending minor melody:

She holds the word “suffer” on the last tone. I respond by picking up on her tonal direction, improvising an ascending C minor scale that moves rapidly to the highest register on the piano. Both of my hands play notes of the scale at the same time creating an intervallic tension of a ninth -minor and major ninths - as it moves up through the scale. The music slows slightly at the end, and these scale passages do not reach the C tonic, which creates a suspended quality in the music:

My musical response is an intuitive one based on many factors including: my developing understanding of Gloria and what her needs may be; my immediate reaction to her lyric content; the quality of her singing and the fact that her tonal direction has shifted from a descending direction to an ascending one; and my own relationship to the musical qualities we are both creating, tapping into past associations to music of a similar style and quality. My response is also a reflection of my underlying belief that entering into the flow of the emerging musical form will be of benefit to Gloria, so I want to both create forward momentum in the music and leave space for Gloria to participate in building the musical path we are taking.

The ascending piano tones after Gloria finishes singing “I don't want to suffer” serve to intensify the overall quality of the music that is being created by therapist and client. They create a tonal context for Gloria respond to. They expand the tonal range of the music to sounds that go beyond where Gloria can sing. Listening in retrospect, there is a sense that the music serves to sweep up both participants, creating a musical pathway that is more than the sum of its individual parts.

As Robinson (2005) describes, these tones from the piano are also my commentary to Gloria's melodic tones, emotional intensity, and lyric content. The piano tones create a sense of rising, and in combination with the rapid motion create a quality in the music of running or even escaping. It is my way of offering an experience to Gloria of hearing and actually feeling what it may be like to escape from the suffering. The rising melodic direction of Gloria's vocalization has triggered an intuitive response on my part, as I sense that Gloria would like to escape from the suffering, and my music manifests this escape. It is a musical way to attempt to convey empathy as a therapist. Though I want to help her face the challenge her predicament poses, I can understand her desire to avoid suffering, and by playing the ascending tones I am saying “I join you in your quest to escape”.

It could be argued that playing these ascending tones was my musical countertransference, my own emotional response manifested in music to Gloria's struggle. From this perspective, my need to avoid feeling the emotional turmoil that Gloria was working to avoid, drove me to play tones that manifest running away. My musical countertransference was based in part on sensing Gloria's state and partly based on my own instinctual reaction of not wanting to suffer. This is another perspective brought to bear upon the examination. In an earlier analysis (Turry 1998) I have written about how my musical countertransference reactions did not necessarily impede the therapy process; in fact at times they fueled the therapeutic process. In this case, it appeared to have the same effect. Gloria later commented that the music from the piano helped her to stay engaged and continue, rather than give up.

Upon further analysis, because the ascending piano tones have an intervallic relationship that creates tension, it brings awareness to the fact that there are two ascending melodic lines moving in parallel. These two melodic lines rising together can be heard as a metaphor, each line representing one of us. They suggest that Gloria and I will take a journey that may be painful. The journey may induce suffering, but we will do it together; she will not go on this journey alone. The fact that neither of the melodic lines reaches the tonic creates a quality in the music that the journey has not been completed.

There is yet another perspective to this rising series of tones. The scale is minor, which brings a quality of sadness. As the tones of the minor scale rise they become thinner (each note played in the upper register of the piano strikes two strings rather than three in the lower registers). The piano music becomes softer as the tones rise. There is a quality in the music of moving, of fading away. This is a reminder of the grave nature of Gloria's illness, and that she is in danger of fading away. The fact that the tones ascend into the highest register of the piano relates to the idea of leaving this corporeal life and ascending to heaven, an ethereal quality as Cooke (1959) describes. There is an allusion to Gloria's grave situation even as the music offers an escape from it.

Bonny (2002) points out the religious or transcendent quality of rising pitches. Since Gloria is a religious person who seeks out God when looking for support and comfort, the ascending direction of tones bears further analysis. Gloria's “I don't want to suffer” melody makes a leap of an ascending perfect fifth and in response I play an ascending series of notes that go to the highest possible register of the piano. So this ascending run may not be an avoidance as much as a search for help from a higher power.

The fact that the same portion of music can be experienced as both comforting and challenging is an example of one of the most profound qualities of music. It can contain opposing polarities in a single moment, blends of emotion as Robinson (2005) describes. Music conveyed both a sense of support and challenge for Gloria to experience. Returning to the unfolding musical description, after “I don't want to suffer” Gloria continues singing after the ascending piano notes reach their apex:

In response to her vocal statement, “I don't want to be sick”, which she sings using the tones of a C minor triad, I play a melody that uses many of the same notes that she sang, changing only the last note G, which actually is present in the bass tone I play at the end of the phrase. I harmonize the last tone of Gloria's melody (“sick”) with tones that create parallel motion of perfect fifths. There is no major or minor third in this harmony and the sound is consistent with Organum music. This ancient style predates diatonic harmony as we know it, developing within the institution of the Church. This gives the overall music a kind of religious gravity with a grounded flavor.

In contrast to the previous ascending run, when this piano music comes to rest, it is in a much lower register, another factor that adds to the grounded quality of the music. While ascending music was a metaphor which included running away, this lower register music is about being present. The final G minor chord does include a minor third. The bass tone of this chord is not the tonic of the implied key of C minor created by Gloria's melody, and thus creates a sense that the music, though solid with a harmony in a root position, is not finished. The fact that the music has slowed down before reaching this chord lessens the rhythmic momentum and adds to the overall gravity of the music.

The tones of the chord are held, and Gloria continues singing:

The lyric that Gloria sings at this point, “so that's it!” leads me to believe that she has come to a realization. She sings it as a statement with more of a conversational tone than an actual melody. In this music psychotherapy creative process there is a potential for Gloria to discover unconscious beliefs and attitudes as she reflects on what she is singing, feeling and hearing around her. This can happen within the music making process itself, as both Brown (1999) and Austin (2004) have reported.

Looking at the lyrics more literally, “I think treatment is making me sick” yields data for further analysis. Gloria has not begun medical treatment, so saying she thought treatment would be making her sick is not accurate. This error may reveal her difficulty in facing her fears about having cancer. At this point it may have been easier for her to assign her worry to the treatment, which she could decide to follow or not, rather than the cancer, which could begin to get worse at any time without her having any sense of control. Also, it might have been easier for her to focus her fear on the chemotherapy or radiation, something outside of herself, rather than the cancer, which was inside her.

In retrospect, I've discovered I often employ the following combination of musical elements to give Gloria time to reflect on what she has just sung: play a melody at the piano that repeats what Gloria has just sung; create a harmony that holds tension and does not resolve; and slow down the overall tempo of the music.

As Gloria makes this statement, “so that's it! I think treatment is making me sick”, she is singing one tone but there is no melodic motion. This bears further analysis, because Gloria often sings on a single pitch. This can indicate that she is placing additional focus on her words and considering what she is saying. It can also indicate a feeling of being stuck emotionally in relation to the content. Repeating a single tone can often bring to the music a quality of relentlessness which is what Gloria often describes when she feels stuck in a particular emotion or with a particular issue. At other times singing one tone can be an indication of sadness or resignation. It may be an indication of being cut off from emotion, depicting a lack of energy. This is an example of what Cooke (1959) describes as monotonous deadness. Gloria may be gaining intellectual insight but at the same time be unable to emotionally internalize this understanding. She may need the safety of staying on the single tone rather than venturing outward by moving her melody tones. Or it could be that the singing of one tone allowed her to focus on feeling emotion rather than on the formation of a melodic idea. She may be getting more deeply into her process by locking in on one tone rather than trying to sing a melody that has tonal motion.

As her therapist, at the time of the creation I am not sure what the specific significance of singing one tone means for Gloria at this point in the session. But I do have an intuitive response based on the content of her lyric and the fact that she is singing a single tone. There is incongruence between the turmoil described in the lyric and the lack of motion and vocal energy in the melody. This triggers a musical countertransference reaction here. If I put myself in her place (finding out that something that was supposed to be helping me was making me sick) I would have a strong visceral reaction. The way that Gloria has sung this lyric triggers a musical response in me. I start to play a melodic fragment in the upper register with a sharper articulation, infusing the music with energy:

These tones come as a surprise, reflecting the “aha” emotional quality of Gloria's discovery in her lyric statement. This is another example of how my emotional response to Gloria feeds into the improvisational process as I shape the music in a moment to moment fashion. My emotional reaction is processed through my musical response, translated to my hands which shape tones in the context of the ongoing musical form. This musical form then becomes part of what I hear and respond to in addition to the words and music that Gloria sings.

Gloria continues singing:

The pattern that I play in response continues after she stops, ascending and descending, creating a swirling quality:

Upon analysis it sounds as if I am trying to create a spell, or break Gloria out of her spell. I interpret her last two lines to be communicating 'I am not really sick so there is no need for treatment'. Gloria's actual lyric, “I don't really believe that I am sick now”, seems to be revealing what the single tone she sang hinted at, a state of denial, a clue that Gloria's expression is lacking the emotional content that her situation would seem to warrant. It is an indication that her single tone may be a manifestation of her lack of acceptance, at least on an emotional level, that she is sick. Looking at the course of therapy in retrospect and Gloria's own description of how the music helped her to feel repressed feelings, gives this hypothesis added credibility.

The music in this section had a suspended quality. The bass melody begins with a Bb. This is the same single tone that Gloria just finished as she sang “because I don't really believe I am sick now.” This melody at the piano has the same rhythmic cadence (including a triplet pattern), played in the same register that Gloria sang, at the same tempo and lasts almost exactly as long as her vocal line. But at the end of the phrase, instead of continuing on the one tone, I create descending melodic motion. In retrospect, this is a way of literally matching and then attempting to enhance Gloria's musical contribution, modeling melodic direction and furnishing an experience of what it would be like to move off the single tone. It is an attempt to change momentum both in the musical process and in Gloria's intra-psychic process. By playing the melody that Gloria just sang, Gloria can hear it and reflect on what she just sang and how it felt to sing it. The combination of the piano melody repeating in the lower register, and the continuing tonal pattern in the upper register which does not resolve, creates the sense that change is inevitable and imminent. The bass note G also lends the music a sense of stability, since the music in the treble also contains a G at its highest point. The two G's, one low and one high, create a containing quality. The space between the bass and the treble gives the music a balanced texture between the low and high register. So there is a blend of qualities in the music: unresolved questioning within the confines of a stable balanced relationship. The music enhancing Gloria's single note melody is a commentary, as Robinson (2005) would describe it. It says to Gloria, “I hear you. I know we are facing a crisis. I will hold you and face this with you. Would you like to try this? What is next?” Gloria responds to my G by beginning her phrase with the same tone:

Gloria appears to respond directly to the quality of the musical/emotional experience by spontaneously expressing her desire to be honest about how this crisis is affecting her emotionally. When she first sings this statement, she slides her voice and holds the sound so that she is singing on a G, goes slightly flat and then rises up to the G. This G pitch is significantly higher than her previous Bb tone and holds more tension because of this. The pitch she is now singing is, in fact, the same note that seconds before I had begun to play on the piano and repeat. The fact that Gloria slides up to the repeated piano tone seems to indicate that Gloria is taking in the piano music even as she continues to generate tones herself.

While Gloria slides into, wavers below pitch and then comes back to the G as she sings “Tell the Truth” I add an accented Ab note and then F# note, and repeat these notes at a short duration while continuing to play the G. The Ab and F# surround the G creating half steps. Upon analysis these notes can be seen as accentuating the unstable quality that was created by the sliding pitch Gloria sang.

Gloria holds each tone as sings. Her longer tones sliding into and out of G and then back in, combined with the minor seconds from the piano that are being held with the sustain pedal, lend the music a haunting, almost ghostly quality. Her wavering melodic motion as she sings “Tell the Truth” - moving down slightly in the middle of the statement and then rising back up in pitch - may reflect her tentativeness and reluctance in trying to do what she is commanding herself to do: express herself fully and truly about her situation and its implications.


To continue reading, please download the full dissertation.

Woman Why Are You Weeping

June 30, 1995

The next excerpt revealed some of the life-long psychological conflicts that Gloria began to grapple with in music therapy. “Woman Why Are You Weeping?” contained issues of loneliness, sadness, and the sense of having a weak sense of self, which Gloria attributed to her mother's smothering parental style.

  • Choking, choking on her tears
Gloria sings about a “her”, a woman who is crying, and is also identifying with the woman. Singing 'her' instead of 'my' was a way to gain some distance over the potentially overwhelming feelings and to create imagery and a dramatic story.
  • Choking on her tears
  • Suffocating
  • Silent tears
  • Choking on her tears
  • The song of the tears
  • The song of the tears
  • Oh..oh.. oo
  • Woman why are you weeping?
  • Woman why are you weeping?
  • Woman why are you weeping?
  • Why are you weeping?

Gloria often sang questions to herself, developing a way to reflect on the content of what she was singing. A religious person, she was familiar with the Bible and often used words and images from it. The woman she is singing about in this example has to do with herself, while also relating to the image described in the Bible of Mary Magdalene crying after the death of Christ. Religious imagery not only gave her a source of inspiration in creating lyrics, it also lent a spiritual tone to the music making process. She often sang in a prayer like style or chant. At times she consciously referred to Biblical text, at other times only afterwards realized the connection. She often made conscious efforts to find solace in singing to God or singing from God's perspective. So there is a dual perspective, as Gloria asks a question to the woman, and also seems to relate the experience to her own feelings in the moment.

  • They've taken away my song
  • They've taken away my voice
  •  
  • I have no voice!!!!!!!!!!!!!!

Gloria shared that the sense of being stifled, of being rendered powerless by having cancer, was related to life long feelings of being stifled, of having “no voice.” Though the feeling was familiar to her, she had never framed the issue in quite that way.

One of the powerful effects of the infusion of words and music was that it allowed for Gloria to make statements related to her inner life of thoughts and feelings that were at once contradictory, yet true to her experience. She sang the lyric 'I have no voice' with a very strongly supported tone that lasted for a significant amount of time. So even as she sings she has no voice, she experiences having a voice. The frustration in trying to express herself fueled her expression. These paradoxical moments came up often in therapy and seemed to hold special significance for Gloria. It seemed to be a way that Gloria integrated previously disparate parts of herself. She was experiencing her voice, discovering her voice, even as she sings about having no voice. Austin (2004) writes that “the process of finding one's voice, one's own sound, is a metaphor for finding one's self” (p.215).

  • What do you want to sing about?
  • I don't know anymore
  • It's all gone
  • I don't know anymore
  • Whatever was there, I don't know anymore
  • And I can't find it anymore (the music cadences to the tonic)

Though the content of the words convey a sense of hopelessness, the experience of the music making — both creating it and listening to it while creating it — evoked a powerful sense of satisfaction for Gloria. She described the process as going deeply into her own pain, the “underworld of darkness”, and coming up feeling changed, feeling more accepting of herself.

After a powerful improvised song like the one above, she often reflected on the experience by taking a different perspective within the same session. Later in the session in which we improvised “Woman Why Are You Weeping?” she continues to refer to its content. She begins to sing once again about the woman who cannot find her voice, but as the music continues and Gloria renders the characters in greater detail, a connection to her childhood appears to develop. The weeping woman becomes a child, a “kid” and her interrogator becomes — partially in response to music from the piano that Gloria later characterized as nurturing — more involved and concerned. Here are the lyrics that exemplify this development:

  • Now this is a sad sad story indeed. I'm so sorry to hear it.
  • Let's go down to the cellar and bring that kid some cold water
  • Put my arms around her
  • Just prop her up, hold her, give her a little hug
  • Drink the water
  • Don't be afraid to drink the water
  • It's safe
  • It's safe to drink the water and tell your story
  • Sing your song
  • I was lonely and afraid
  • I was lonely, no one to talk to
  • I was lonely and afraid.

Like a dream, the characters she created in these song improvisations represented distinct parts of herself. There is a part of herself that feels lonely and damaged. And there is a part of herself that is capable of nurturing and accepting feelings towards herself. Like a dream, the characters give her some distance from the material so she can explore the emotional conflicts of her psychological condition that the characters represent. She sings of a kid in a cellar, representing the isolation she felt as a child and that has affected her as an adult. She also creates the point of view of a character that can nurture the child. The musical experience seemed to provide an environment of nurturance that contributed to the emergence of this nurturing character. After being nurtured the isolated kid character can answer the question to which the woman who was weeping could not voice a response. Why was she (the child) weeping? She wept because she was “lonely and afraid”. Gloria explained that the answer to the question “Woman, Why are you Weeping?” was found during this experience. Though the answer was intensely sad, the experience of finding the answer was powerfully satisfying for her.

I, too, experienced an intensity of emotion and a powerful sense of completion as the experience of creating the music with her words and melodies came to a close. The mutual music making experience allowed us to journey together. This was integral in order for me to resonate with and understand Gloria, and for Gloria to experience my presence and support as she continued to tap deeply into her creative expressive process.

Detailed Description and Analysis

Gloria is half singing, half sighing in a breathy voice, a series of gentle moans. She sounds tentative, fragile and tenderly sad. I play a D minor arpeggio and then hold a D minor chord. I add an E on top of the chord:

This E is also repeating but at a faster rate than the sound of the moans. Because it is being played in a higher register, repeated and played more quickly, the E note brings a quality of urgency to the music.

Gloria's vocal sounds are moans of short duration. Upon reflection her moans are related to the music in that they have pitches - E and then D. I add a D in the bass D, and this D minor chord adds a sense of finality. When this happens there is no tempo from the piano, but the tones are still heard as they are held and begin to fade. This is a decisive moment in the music: it can come to an end by simply fading, or continue.

But Gloria continues to moan, creating a pulse as each moan has the same duration and the same length of time between them, and I take up that pulse and begin to play D minor chords in a very low register and in marcato articulation, playing a chord for each moan:

The low register and close spatial relationship of the chord tones, in addition to the rhythmic articulation of the piano creates a more primal rhythmic quality in the music. The combination of Gloria's moans, the repetition of both the voice and the piano on the same pitches, and the piano accompaniment lends the music a more ominous quality. The entire section described occurred in eight seconds. The next three paragraphs will review these eight seconds.

My intention is to help Gloria involve herself in musical expression even while supporting her non-musical sounds. The D minor ninth harmony, which upon reflection is one I often use to create a blend of sadness and warmth, creates a tonal context for Gloria to sing. My faster E note in the higher range of the piano is a provoking, stimulating factor for Gloria to respond to. By matching the tempo of Gloria's moans in the left hand while playing at a faster tempo in the right hand, I am attempting to follow and lead at the same time. Yet upon analysis this is a limited understanding of the interaction. Gloria is also leading me, and the sounds are going on at the same time, so that there is no clear cause and effect. There is rather a simultaneous and mutual shaping of the music.

The ominous quality of the music created by my repeated marcato D minor chord in the low register is a musical commentary; “I hear that something painful is present and there is more that has yet to be expressed. Go ahead.” The fact that the chord at the piano does not change tones and does not sustain tones brings the thick texture and rhythm to the forefront. This is done in an attempt to match the primal quality of the vocal sounds. Yet it also provides tonal possibilities that might lie ahead for Gloria if she chooses to sustain her vocal sounds. She has a harmonic context within which to make melodies. The fact that the primal moans she makes are in the tonality of the music is an indication that the harmony is being perceived and responded to on some level, and that melodies are possible in the future.

It is not apparent that Gloria is making a conscious choice to match the music she hears from the piano. Her sounds are breathy, revealing of her physical state and her respiration. Upon analysis, the shifting of my music at the piano from a higher to a lower register was an invitation to Gloria to sing, as the higher register sonority of her vocal range was now available for her. It was an invitation for Gloria to take up where I left off in that register of the music. The bass notes create the ground, the platform for the vocal melody.

Returning to the description, the D minor ninth chord continues in a marcato articulation at a slow, steady tempo. Gloria stops her moans, and then comes in at a higher pitch. She sustains her higher pitched moan, and then does two shorter moans. Her pitch on the last moan is an Ab. I add this note into the harmony, adding an additional tension as this note has a tritone relationship with D, the bass tone of the chord:

I now begin to roll the chords of the harmony so that we hear the bass note first with the other notes following rapidly, almost but not quite simultaneously. The chord ends with the Ab, in effect emphasizing that note. The Ab, a tritone away from D and a dissonant tone in D minor, adds a more painful quality to the already painful sounding music.

Gloria reenters with a sound close in pitch to Ab for each beat of the music. In tempo and matching the length of the harmony, the vocalizing sounds like the beginning of weeping that is being restrained. More breath is heard after the tone of each short vocal sound. The music has more of a rhythmic emphasis now, as the marcato articulation and the voice entering together accent each beat. I bring back the E natural we heard earlier in the higher register. This E alternates with the Ab below it, and then tones G and A above the E are added in pointillistic fashion, slightly anticipating the pulse:

Upon analysis, these tones are suggestions for Gloria and from Gloria. They start with the Ab which she barely moans, and then move with each moan that she makes. Gloria stops vocalizing. After five beats of piano alone in marcato, I change the articulation to legato, and the dynamic becomes louder, emphasizing the highest note E:

Upon analysis I did this in response to Gloria's stopping. No longer responding to her sounds, my music now has a slightly dreamy quality, and there is more forward momentum in the music as notes are heard on every eighth note of the pulse. During recursive listening the metaphor that came to mind is that the legato has created a pool for Gloria to enter into.

More time passes without the voice. The D minor chord with the E on top continues until a high C that rings out at a louder dynamic enters strongly and is held:

Upon analysis, I hear the playing of the C as a way of calling out, searching, for a direct response from Gloria. It is an invitation and a stimulation to try and encourage her to come back actively into the musical creation.

More tones- both tonal (A) and nontonal (Ab), are added to the D minor accompaniment figure, so that it takes on a rocking quality. This combined with the legato articulation creates a more soothing effect than the earlier marcato music.

I am adapting the music to make the accompaniment pattern more soothing, but at the same time acknowledging the dissonant quality of her feelings. It is my attempt to convey my acknowledgement that Gloria is in turmoil, and yet continue to present possibilities for movement and development. The combination of elements creates a blend of emotional qualities: soothing, comforting, painfulness and foreboding. This is an example of how music can blend a variety of emotions in the way that Robinson (2005) describes. Gloria begins to sing now in a low register. The vowel “oh” is used as she enters and ends on pitches that are predominant in the harmony. The melody begins with E and quickly rises up to F and then leaps up to Bb before settling on A to end. It takes up 2 beats and ends right in tempo:

This is the first truly musical vocalization of the improvisation, and as such it bears analysis. There is an unsettled quality to this phrase as it slides from pitch to pitch before it ends on the A and sustains this pitch. E and F are half steps and Bb and A are half steps, and so the melody has qualities of tension. The Bb is a minor sixth away from the minor tonic and creates painful tension as described by Cooke (1959) that resolves sadly downward to the fifth of the D minor chord.

Gloria makes more soft primal vocal sounds in tempo and then moves to the higher melody note D and sings:

She holds the note for a sustained period before fading it out gradually over the steady pulse of the emerging ostinato-like bass line with the D being held. The vocal phrase ending on the tonic D combined with the bass line pattern has now contributed to the establishment of a definitive pulse and tonal center. This creates a quality in the music of finally arriving at a starting point. D is clearly heard as the starting point for both the voice and the bass line. It is both the highest note and the lowest note heard. The combination of the clearly established D in both the highest and lowest register, with the repeated bass line creates structural stability yet an ominous quality. There is more animation in the music as Cooke (1959) describes since the bass line is establishing the steady eighth note subdivision.

The harmony that has been heard from the beginning of the improvisation and established up to this point includes the extended tones - E, Ab, C - over the primary D minor harmony. These tones create potential alternatives for Gloria to sing that can add tension, ambiguity, and emotional color by creating dissonance. They are potential melody tones that will sound congruent with the overall harmonic landscape that has emerged. However, they are not tones of relaxation, of resolution, but of tension. This creates the possibility of musical and emotional exploration.

The piano bass line continues as we hear the first words sung:

Gloria has moved from moans, to tones, to sung words, to creating melodic phrases. Upon analysis, the first words sung - “choking on her tears”- reflect her experience a few seconds earlier. She is describing her physical state as she made the sounds described earlier in this analysis as “weeping that is being restrained.” Considering what she is experiencing, reflecting on her previous inability to make more sustained sounds and sing words, Gloria then creates words and melody. Singing specifically about her struggle, about her inability to express, is a successful approach for her in finding her creative voice.

The first melodic phrase starts on the tonic and goes down to the fifth step of the key. The downward direction of the tones of the natural minor scale combined with the words give the music an expressive quality of anguish. This is reinforced by the repetition of the word “choking” and the repeated tonic note D. Yet the words “she” followed by “her” rather than 'I' and 'my' add an ambiguity to this inward quality. At this point it is difficult to know: is Gloria singing about herself, or is she telling a story about someone else? The ambiguity is amplified by the actual tone on 'her' going upward rather than down. By emphasizing “her” through this tonal movement, Gloria appears to be distancing herself from the character of being observed.

The phrase “she's choking on her tears” starts on the melody tone A and repeats with some pitch variation before sliding up on the last note of the phrase to D. There is a metric implication to the timing and length of her lyric, and the content of the words sets the stage for a story to be told. The words “choking” and “tears” begin to explain Gloria's previous expressions of anguish, adding to what is now emerging as the basis for the creation of a lyric song form, with the theme of a protagonist who is in turmoil. After the first singing of the words “choking on her tears” I respond harmonically by echoing the rhythmic pattern of the lyric phrase, then rising to a higher register, with the notes moving in parallel motion in fifths to create a counter melody, as Gloria repeats the phrase:

The parallel motion and the use of the B natural to establish tones of the Dorian mode on D give the music a slight suggestion of Organum.

The fluctuation in her vocal pitches seems to be a reflection of Gloria's tentativeness. Yet her entrance and exit reveal her sense of phrasing and that she is feeling the pulse and meter of the improvisation, and that she is in the flow of the music. The musical process allows her to experience and express her vulnerability even as she takes a developmental step forward by creating a melody with words. The fact that Gloria is now creating words that reveal her being reflective of her experience conforms to Robinson's (2005) description of the process of how feelings emerge. There is cognitive monitoring here, evidenced by the addition of words, and this music and word combination adds to and alters the experience that Gloria is having.

Gloria continues to sing using words:

The limited tonal range of the melody, the repetition of tones and words, and the content of the words create an overall quality of being constricted that is relentless in its persistence. The accompanying harmony reassumes an ostinato-like repetitive form reflective of the relentless constriction of the experience. The accompaniment continues the clearly D minor harmonic base, while creating motion with the descending half step motion of F to E.

The fusion of the word “suffocating” with the repeating tone A, harmonized in minor with a repeated ostinato harmony, gives the sense that there is no escape from Gloria's predicament. Yet the basic pulse of the harmony, and the more sustained melodic rhythm are creating and building forward momentum at the same time. The word “tears” is held for the longest amount of time of any melody note sung to this point, then fades out gradually.

By beginning to use words and melodies, Gloria has accepted the invitation to enter into the song form and in doing so there is hope that at the very least she can discover and express herself in music. The words imply any feelings present are repressed. Perhaps there are tears that need to flow outward in order for the sense of choking to diminish. Singing is a way of breathing with support and not suffocating.

The vocal melody comes in at a louder dynamic and on the tonic D:


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Do I Dare Imagine

November 27, 1995

This excerpt comes from a session right after Gloria's first public sharing of music from the music therapy sessions to an audience of close friends and family. During preparation for the concert she acquired a piano and was beginning to try to play it, improvising while she was alone at her apartment. In the music therapy session this excerpt is taken from when she is reflecting on one of the first experiences in her apartment trying out the piano, and more broadly reflecting on her new found relationship to music. She is singing while I am at the piano:

  • Playing the piano wondering what my mother is thinking.
  • Playing the piano wondering what she is thinking.

Gloria's mother has been dead for many years. Gloria reports that the two had a tumultuous relationship and fought often. One point of contention was practicing the piano. Gloria refused to do so as a child, but now as a result of her new relationship to music she bought a piano. As the therapist, I recognized from her singing that Gloria is simultaneously taking a risk and creating an opportunity to work on her relationship to her mother. As her therapist I wonder if there is a way of lessening the intensity of the conflicted feelings about her mother in the present, despite all their conflict in the past? Perhaps she can shift her internalized representation of her mother to one that is more nurturing and supportive. This could be a key in helping Gloria to feel less critical of herself.

  • Is she angry with me, angry because I didn't try?
  • Is she angry with me, angry because I didn't try?
  • Playing the piano, fooling around.
  • Hanging out with the piano.
  • I'm not disciplined, but I do hang out with the piano amazing
  • What is my mother thinking?
  • Is it possible to think that she
  • Might be rejoicing for me?
  • Might she be rejoicing for me?
  • Might she be rejoicing for me?
  • Might she rejoice?
  • That the depression has lifted that music is in my life.
  • Is it possible she might be rejoicing for me?
  •  
  • Or do I always have to see her....criticizing
  •  
  • Angry...criticizing... angry...
  •  
  • Never satisfied..criticizing.. angry
  •  
  • Never satisfied never satisfied
  •  
  • Would she be rejoicing for me?
  •  
  • Dino was rejoicing for me, impressed and amazed
  • What is my mother thinking?
  • Could she be possibly be rejoicing for me
  • Relieved to see me coming out of the depression.
  • What could she be thinking?
  •  
  • Do I dare imagine that she would rejoice for me?
  •  
  • Do I dare imagine that she would rejoice for me?
  •  
  • Do I dare? Do I dare?

Upon analysis, the repetitions in the lyric facilitate both the creative and the therapeutic process. They make it easier to create the song form by establishing a predictable metrical structure. They also allow Gloria to consider the content of the lyric and the feelings it brings up. When the lyric is a question, the repetition allows time for Gloria to consider the answer.

  • Do I dare imagine..oh....oh..oh...oh
  •  
  • Do I dare imagine?
  •  
  • That she would be
  • Full of joy to see
  • To see
  • Me smile and sing and play the piano
  • Would she just be angry and say she didn't listen to me
  • She didn't listen to me so now she has to do it on her own she didn't listen to me
  • Would she be resentful?
  • Resentful of my success
  •  
  • Keep pointing out my failures
  •  
  • Pointing out how long it's taken
  •  
  • How much darkness I went through
  •  
  • Would she ridicule me?
  •  
  • All that darkness
  • Would she say you didn't have to do all that.
  • You chose that, you were a fool. You were a fool.
  • Would she ridicule me?
  • Put me down?
  • Or would she rejoice?
  • That I've found my life at last.
  • I've found my life at last.
  • I've found my life at last.
  • I've found my life at last.
  • Oh oh oh oh oh.
  • I've found my life at last.
  • Leaving the darkness behind.
  • Sailing south to calm waters.

In considering the significance of Gloria's lyrics, I note the imagery of the final phrase. Imagery involving water is a literary device Gloria uses in several improvisations. In other excerpts she has sung about swimming with the dolphins, driving in a car, and a train traveling on tracks. It could relate to Gloria's desire to move to a better place emotionally, to feel more hopeful about her future. The sense of forward motion that is created by the music seems to be a strong impetus behind imagery that has to do with travel.

  • Navigating through the icebergs
  • Sailing south.
  • Blue skies turquoise waters
  • Songs, music
  • Would she rejoice
  • Would she rejoice for me? Oh
  • Who knows?

Gloria sang this improvised song “Do I Dare Imagine?” several times during the early years of treatment. In her public performances she would choose an additional lyric to end with depending on what would feel true to her in the moment regarding her attitude toward her mother and her general emotional state. The addendum would either be a confirmation that Mom would rejoice, or a conditional statement wondering whether she would.

Detailed Description and Analysis

This example is rich in material for analysis related to the tentative hypothesis that musical choices by the therapist at the piano influence the unfolding psychological process of the singer. The uses of major and minor harmonies are a vital component of this idea. Smeijsters (2005) asserts that “when there is a change in the musical act, then there is a change in the intra-and /or interpersonal process” (p. 85).

The music is in a slow tempo (about 45 beats per minute) as Gloria sings about playing the piano:

Overall the music has a kind of sentimental quality to it, as if supporting the idea of remembering a past event. The melody from the piano is slightly louder than the harmony, so that it stands out from the harmony. This melody that I play after Gloria has sung “what she's thinking” has a melodic rhythm that does not match Gloria's exactly, but matches the unspoken words I have in my mind. I do not say it aloud but I play the rhythm 'what is she thinking':

It is a musical commentary on Gloria's musical and emotional expression. My intention is to support reflection and keep the process going, a process that includes both musical creation and emotional exploration.

Gloria continues to sing about her mother:

Gloria sings this lyric with two tones, C and Db. I create two harmonies, Gb major and Bb min 9. The relationship between the melody tones and the harmony creates a tonal ambiguity. The Gb chord combined with the C sung creates the sound of the Lydian mode. This has both a more hopeful and questioning tone than the minor chord. The Lydian mode is often used to create a sense of mystery and wonder, hope and opportunity. Throughout the course of treatment I utilized it to both trigger and enhance imagery. The Bb minor creates a quality of sadness, yet there is also a blend of warmth and comfort with the C being a ninth in the chord. The harmonic ambiguity created both within each chord and between the two chords reflects the questioning content of the lyric that remains unanswered. It also leaves open tonal possibilities.

The music is dramatic, and open ended. As she sings “because I didn't try”, a countermelody from the piano descends down to the C she is singing, conveying a sense of companionship in the music as we travel to the same note together. It also adds to the intensity of the word “try”, animating the conflict that Gloria feels as she remembers disappointing her mother by not practicing the piano. The tone that ends both the melody that Gloria sings and the countermelody from the piano is not the tonic but a step away.:

Gloria continues as the chord progression establishes the minor key of Bb minor:

Gloria shifts her attitude and sings content related to her conflict with her mother, who felt she did not practice the piano enough:

In response to Gloria's vocal statement I play a harmonic response with a similar melodic rhythm, playing a melody a third above what Gloria sang. The dynamic is louder and the articulation sharper, in effect intensifying her sentiment while making it more harmonious:

After hearing these chords played at a forte dynamic, Gloria shifts her subject back to singing about the piano and then returns to the conflictual topic, her mother:

After hearing her melodic phrase about her mother, I repeat it starting on the same tone that she did, both to let her know that I hear her and also to encourage her to continue to reflect on the question. I play it again in octaves and then Gloria does continue to ask herself about her mother:

Gloria repeats might she be rejoicing on Bb as I play a Bb minor harmony:

The minor chord with the tonic note being sung lends the music a sad quality. So as she sings about the possibility of entertaining the notion that her mother might be rejoicing, the music I play has a quality of sadness that suggests that it may not be “possible.” Realizing the influence my accompaniment could have, I change its sonority with clinical intention. In the space after Gloria finishes her phrase, I do not repeat the melody as Gloria sang it as I had earlier, but play a melody that ascends while harmonizing it with a major chord, the Gb chord that we heard earlier:

Since the Gb major chord is closely related to the Bb minor chord (they share two common tones and the Gb is the natural harmony on the sixth step of a Bb minor scale), the music at this point can still be heard in the context of minor, even as we hear the major chord. Instead of Bb minor sadness, playing the major chord and the melodic motion manifest to a hopeful sound, reflecting my sense that it may be possible for Gloria to feel more hopeful about her mother. I am modeling a musical experience for her to try out as she sings the words expressing her desire to feel more positive about her mother.

Gloria's lyric content expresses her desire for a better relationship, but the limited tones in her melody are sung with weak support, resulting in a vocal quality that indicates a lack of emotional involvement. She is singing what she hopes without truly believing it. My implicit intention as music therapist is to create the opportunity for Gloria to try out the experience of singing about her mother as a more positive, supportive presence. My challenge is to create the emotional qualities in the music of possibility, without exceeding Gloria's current tolerance level.

The music cannot be too hopeful, too major. This would impede Gloria's investment in the music and hamper the sense of mutuality needed in creating meaningful music together. It has to leave the situation more fluid than that, and the close relationship between the Gb major chord and the Bb minor chord allows for that. The music can easily shift back to the Bb minor tonality even as the Gb major chord is sounded. The word “possible” utilized by Gloria in the lyric is a strong influence on the direction that I take at the piano after hearing it. It is a key word that stands out in terms of therapeutic significance. I am trying to create possibilities in the music that have a more hopeful quality to support a new possible perspective regarding Gloria's relationship to her mother. I make a strong musical intervention that has a clear clinical intention. I continue to use the Bb melody tone as Gloria sings “the depression has lifted,” but I do not continue the harmonic progression to Bb minor:

Gloria has made a powerful statement that is hopeful and I want to reflect this. I harmonize by staying on Gb major chord, adding a major seventh to the chord as the progression moves, and then harmonize the last melody note of the phrase with a new major key of Db major. Gloria is still singing a Bb melody note. The Bb note in relation to the Db major chord is a major sixth. This gives the music a happier quality as Cooke (1959) describes, matching the lyric content that Gloria created regarding her acknowledgment that she is less depressed. Db is the relative major of the Bb minor key established earlier. So the major chord has a strong relationship to the minor key.

Gloria pauses as I continue to play melody notes to accentuate the harmonic tonal presence of Db major, playing tones that clearly establish tones of the Db major scale:

The notes in Db major move in an ascending direction. My intention here is to suggest to Gloria that she can indeed experience her mother in a more positive light; that she can sing about her mother with less sadness. Even as she sings the same tone, she can experience a new context for it, just as she can consider her mother's attitude with a new emotional framework. Gloria sings the same lyric again and it is interesting to note that as she starts to sing it her first two melody notes are higher than her often repeated Bb tone. But she falls back to the Bb melody tone and repeats it. Perhaps her musical reaction triggered an incipient response but she was not psychologically ready to sing a tone away from the Bb and she returns to it.

She returns to her less hopeful consideration regarding her mother, singing the words “see her” with a descending interval of a minor third ending on the Bb. The word-music combination here - the word “see her” with the melodic interval of the minor third - suggests to me that it is not right to continue with the new Db major tonic. It was premature. Gloria was not ready to move from her emotional stance which was reflected in her tonal choice and lyric content, and I shift back to Bb minor:


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Uncharted Waters

November 4, 1997

There were times when Maria experienced strong feelings of fear as we began to make music, and the lyric content containing imagery of being lost in the ocean ("Uncharted Waters") was a way that Maria found to express words related to these feelings. Singing together gave Maria the sense of safety and support she needed to not only talk about the fear, but also to express her feelings while experiencing feelings of fear. Maria explained that facing and working on her fears in this way was only possible through music.

  • We might think we are lost
  • We are in uncharted waters,
  • The sailing is not always smooth The darkness
  • We are in uncharted waters
  • We may feel like we are lost
  • No I don't want to see these sights
  • No I don't want to see these sights
  • I want to know where I am and where I am going
  • We are in uncharted waters, we are in uncharted waters We are in uncharted waters, we are in uncharted waters We will see sights that are frightening
  • We will see sights that are frightening
  • We will see sights that are frightening
  • Go ahead go ahead
  • God won't leave you God won't leave you
  • Go ahead nothing can separate us from the love of God
  • Not the water not the fear not the darkness, nothing
  • Not height nor depth, nor powers nor principalities
  • Nothing, not fear, not darkness, not uncharted waters no nothing, can separate us from the love of God

The lyric, "we will see sights that are frightening", relates both to the emerging emotional states that could emerge for Maria in the current session as well as in future sessions, and situations outside of the sessions. Maria commented that the music allowed her to access feelings and imagery about significant events in her life that could not be accessed verbally. She recognized the power of the experience and thus was willing to enter into "uncharted waters." It is interesting to note that Maria sang "we may think" and "we may feel that we are lost," but not that we actually are lost.

As the improvisation came to a close she sang about God to comfort herself and find solace, something she has done in several of the improvised songs.

The music contained both tender consonant tones and dissonant tones with shifts of tonal centers and at times the whole tone scale is utilized. This amplifies the quality of "feeling lost" which is sung about, and mirrors the emerging sense of apprehension as to what the future holds. The singing together and warm harmonies provide support at the same time. A blend of emotional qualities is contained within the improvised song that shifts and transforms as the music unfolds.

Scared and Paralyzed

January 26, 1998

“Scared and Paralyzed” was a blues improvisation that grew out of an exploration of a frightening dream Gloria had about two hats. She described the dream as triggering feelings of being scared, paralyzed and frightened. In the session she decided to name each hat and joked about the names, singing them with a vocal quality and phrase structure that suggested a blues form to me. The experience became a paradoxical one as the song contains fearful imagery yet has celebratory and joyful qualities as Gloria sings in the blues style and laughs heartily while creating the words and melody.

  • We can name each hat
  • Scared and paralyzed
  • Scared and paralyzed
  • I can put on my scared hat
  • I can put on paralyzed
  • Scared and Paralyzed
  • Scared and Paralyzed
  • Scared and Paralyzed (Laughing in time to the music)
  • Scared and Paralyzed
  • My two hats
  • Scared and Paralyzed
  • We've been to this one before
  • She lifted each hat and looked inside
  • She lifted up each hat and looked inside
  • And what do you think she saw?
  • A label
  • Scared and Paralyzed
  • She put on scared first
  • And she started shivering in her boots
  • Scared and Paralyzed
  • A pair of hats floating around
  • Scared and Paralyzed
  • This is so silly
  • Scared and Paralyzed
  • A pair of hats floating in the elevator
  • She put on paralyzed
  • She put on paralyzed
  • She stood straight
  • She looked out
  • She was paralyzed with laughter
  • Scared and Paralyzed
  • A pair of hats floating in the elevator
  • Scared and Paralyzed (laughing)

Paradoxical experiences where contrasting qualities were contained within one song form were particularly noteworthy for Gloria and seemed to have special clinical significance. Her psychological stance around a particular issue or feeling seemed to shift or expand after these experiences.

All My Life

May 20, 1998

This is an improvised song in which Gloria describes her life long struggle to become more of a participant in life and less constricted by her conflicts. In the song she acknowledges that she has made progress but recognizes that it is still a challenge for her. As we start, Gloria actually cues me by snapping her fingers to indicate she would like me to infuse the music with a pulse.

  • All my life I have tried to be here
  • All my life I have tried to come into the light
  • It has been a long journey
  • All my life I have tried to come out of the dark
  • All my life I have walked with my crutches with my chains
  • With my blindfolds
  • All my life I have tried to throw them away
  • All my life I have tried to cut the chains
  • Slowly one by one I have taken them off
  • Slowly one by one they have fallen away
  • All my life, I have tried to take the chains off
  • To walk without the crutches
  • All my life I have tried
  • All my life

There There

June 9, 1998

This excerpt contains examples of the many attitudinal and emotional shifts that can take place within the stream of an improvisation. Gloria sings of how she can take a superficial stance towards the world, and how this is a kind of protective shield, a “bubble” that hides her authentic feelings. She sings of the pain she is in, and then sounds angry as she blames herself for the condition she is in.

Much of Gloria's frustration is expressed here not by singing but by speaking the words. She has a conversation with herself, taking on an impatient tone as she criticizes herself for having the same complaints again and again, using the pronoun 'I' in describing her pain and 'you' in expressing her frustration in dealing with the same issues again and again. There is also a dialogue taking place between us. This is because Gloria uses quite descriptive imagery and as she pauses I play particular musical elements in response to the words. She in turn responds to my music and continues her lyric creation.

In general the music from the piano supports her shifting attitudes, playing repetitive music as she sings of her repeated complaints, and also animates her expression by adding sharply attacked single notes that are dissonant and trigger Gloria to sing with more energy, at a louder dynamic and higher pitch. This seems to shift Gloria's expression from a more cognitive experience to a more emotional one. The music helps to sustain this difficult emotional state. Then in a mutual fashion the music slows and becomes tender as Gloria shifts her attitude from disgust and anger to tender and sad. She takes on the position of God in her lyrics, singing comforting words of nurturance. Gloria cries as she sings. The excerpt ends as Gloria sings about God, and the music shifts to a Gospel style.

  • Another thrill
  • I hide so you can't see me (Gloria snaps her fingers)
  • And I go for another thrill
  • I hide
  • so you can't see me

In a swing style, Gloria sings happily about her self defeating behaviors. When she celebrates her shortcomings in this way, the swing style often helps her to become unstuck and more creative in the sessions. Rather than complain about the fact that she was driven to hiding from the world, here she brings out the sense of satisfaction that she derives from hiding with the quality of her vocal expression. There was a slight sense of irony in her attitude at this point. We both were aware that hiding was not something to reinforce. Yet in this instance the paradoxical experience of fusing happy music with this problem fueled her to explore it more deeply.

  • I hide
  • so you can't see me
  • I hide
  • so you can't
  • so you can't
  • see me

The music changes here and Gloria's story unfolds as she creates imagery describing her desire to move past the isolated stance she often takes in relating to the world, and what lies inside her when she removes her outer “bubble”.

  • I step
  • out of the bubble
  • I'm a mess
  • I've been cut and slashed
  • I'm bleeding
  • I'm throwing up

As the imagery becomes more graphic and violent, Gloria's voice becomes more detached. She begins by talking rather than singing.

  • My knees are weak
  • My ankles can't hold me up very well
  • Everything's fine

Gloria often commented critically about her ability to relate to others as if everything was “fine” when in fact she was experiencing emotional pain. She also knew there were times when she could keep the fact that she was in emotional pain from her own consciousness as she went about functioning in her daily life. Now she has a dialogue between her “I” and her “you”.

  • Everything's fine
  • But I'm bleeding
  • You did it to yourself
  • You did it to yourself, who the fuck cares?

Gloria often battled with her intense self criticism and judgment of herself. Two perspectives have clearly emerged. One persona is describing the pain and asking for help, and the other impatient, holding back and judging.

  • I'm bleeding,
  • I can't walk,
  • I'm bleeding
  • I can't walk
  •  
  • What's the use of helping you?
  • There's no use in helping you
  • There's no use to help you because
  • You're just going to do the same thing again
  • Why should I help you any more?
  • You keep coming in this room all bloody
  • Oh you keep coming in this room all bloody

Gloria often worried that she came to music therapy and described the same issues over and over. It was difficult for her to find a way to accept and be patient with her exploration of issues that did not easily resolve. She was also worried that I would become tired of hearing the same issues. It may have been that her words represented her fears of what she projected I might have felt as she kept “coming in this room all bloody”. By taking all of her expressions seriously and supporting them musically I attempted to help her to dissipate her worry that I would eventually tire of hearing about her painful issues.

  • I'm supposed to wash you up and put bandages and ointments on you
  • Comb your hair, wash your face
  • Give you a place to sleep,
  • Comfort you,
  • Talk to you
  • Listen to you
  • Play music for you

The quality of expression and the music start to shift here to a more gentle tone.

  • Cuddle you and say “there, there my dear”
  • “There, there my dear it's going to be ok”
  • “There, there my dear it's going to be ok”

At this point a song form with a predictable meter and pulse has been established. Gloria is singing now in a tender way.

  • Oh my dear
  • oh my dear
  • Rest with me it will be ok
  • Oh my dear it'll be ok
  • I'll wash your face
  • I'll dry your tears
  • I will bind up your wounds
  • I'll wash your face

There is a quality of nurturance in Gloria's voice at this point as she sings with reference to the Bible and God's perspective.

  • I'll clean you off,
  • I'll bind up your wounds
  • I'll comb your hair
  • Rest my dear
  • Rest my dear
  • The broken pieces have
  • Such sharp edges
  • They've cut you my dear
  • Oh rest my dear
  • Oh rest
  • Oh rest
  • Oh rest my dear one
  • Oh rest
  • I'll wash your face
  • I'll bind up your wounds
  • I'll comb your hair
  • Oh rest, rest in my arms
  • I know what you've been through
  • I know what you've been through
  • Oh rest, oh rest, oh rest my child
  • God doesn't leave us, God doesn't leave us

Another shift in perspective occurs and now Gloria sings about God, reflecting on the words she has just sung from God's perspective. The music shifts to a soft gospel feel.

  • God doesn't leave us no matter what I do
  • God doesn't leave me, God doesn't leave me, God doesn't leave me

The intensity and contrasting qualities of emotion contained in an improvisation that lasted over nine minutes combined to create a powerful experience for Gloria. At times the experience was physically exhausting for both participants. There was also a sense of relief and physical release. The pacing within the session was an important factor in modulating the emotional intensity.

When the issues she was wrestling with were daunting, Gloria's ability to express from different perspectives was the key to enable her to continue her process.

Detailed Description and Analysis

Since much of the improvisation in “There, There” contains dramatic imagery, and the form of the interaction between us is call and response, this example led to the emergence and consideration of specific ideas regarding how the words Gloria chose and the quality of how she expressed them influenced the music that I played. The example begins with Gloria snapping her fingers as she sings. The music has a jazzy swing feel here and Gloria sounds happy, as if she takes pride in her ability to hide:

Knowing her issue regarding her conflict about hiding emotionally, about not being noticed but wanting to be noticed, contributes to my consideration of her lyrics and the significance of them for Gloria. The fact that Gloria's pitch is not entirely accurate and her vocal quality is a little wobbly is also information that I note. The swing feel has often bolstered Gloria in the past and connects her to her body as she sings:

Even as the jaunty swing feel continues, dominant ninth chords move in parallel motion containing a minor seventh interval that contributes to a more dissonant sound. This functions as a subtle form of questioning to Gloria regarding her attitude about what she is singing. The chords happen after each short phrase that she sings, creating a subtle call and response form between her melody statement and an answering harmonic statement. This foreshadows much of the form between her melody and my harmony throughout this improvisation. As I play a walking bass Gloria sings a melismatic phrase on the word “can't,” a kind of bluesy sound that she sings with a sense of satisfaction:

There is some dissonance in the harmony and in combination with the bass this creates a momentary minor chord where there had previously been a major chord in the progression. There is also a subtle clash between her melody tone D and the E which is at the top of the harmony. The bass plays some tones out of the key, hinting at breaking out of the form. This is an example of a blend of emotions in the music as Robinson (2005) describes. The music is both predominantly happy and subtly questioning.

Gloria starts to sing slightly softer and holds her last tone even longer, changing the phrase structure of the melody. I respond by playing fewer notes, and the overall effect is that the music begins to lose some of its rhythmic drive. Gloria leaves space in her melody after this last note and I slow down and then completely stop the walking bass. Gloria sings this last “see me” with a gentle, vulnerable vocal quality. Keeping the same key of D major, I switch the style of the music and the emotional mood here.

I play a melodic fragment A and then F# that breaks the swing feel, holding both tones. The tempo slows and I play the D chord in second inversion in an open voicing, giving the chord a less stable quality. I then move the A up a half step from the fifth to Bb. I play the same movement an octave lower:

This half step motion upward is clearly heard, and then Gloria utters:

I continue the harmonic motion of a half step rising to represent the idea of stepping. The tone is a dissonance, and not in the key of D major. It is a step out of D major, mirroring a step out of the bubble.

Tones that are dissonant are added to the harmony off the beat, creating a messy sound:

In response to the lyric “cut and slashed,” I move from the major triad to dissonant intervals moving down on the keyboard. The downward direction relates to the idea that being cut and slashed would trigger falling. The fact that Gloria's voice also gets softer and falls in dynamic, also contributes to the descending direction of the tones at the piano. The form of our musical interaction is call and response, as Gloria creates a lyric, and I respond, while sustaining tones from the piano between the interactions:

The contrast between the dramatic lyric and the hollow, almost numb tone that Gloria uses to say the word “bleeding” more than sing it, triggers a musical countertransference in me. Rather than mirror the hollow tone, I respond to the painful verbal image her words evoke, playing forcefully with clusters in a higher register of the piano:

It is if I am saying “this is a terrible thing, the fact that you have been cut and slashed and now you are bleeding.” This is an example of a musical commentary as Robinson (2005) describes, the music commenting on the persona presented by the voice.

My music continues to convey turmoil, yet Gloria speaks the words rather than sings them with a kind of hollow detachment, with a hint of disdain:

In response to the lyric about her knees and ankles lacking support, I move to the low register, the supporting component of the piano, and play dissonant tones and intervals. The fact that the bass is moving and has dissonant tones creates a quality of instability, and this relates to the lyric describing her unstable ankles. The last harmonies that I play in the pause contain the tritone interval, amplifying the sense of instability:

Gloria sings “everything's fine”, in a high register with notes somewhat related to the harmony I have just played. In response I play the melodic rhythm of everything's fine, using Gloria's last pitch as the first pitch of my phrase, and end with an ascending interval of a tritone, which gives the melody a quality of not being fine, of being strange, of being unstable. It is also noticeable because it goes up. My melody has highlighted and magnified the incongruity between the words that Gloria has sung and her vocal and musical expression. Gloria hears this melody from the piano and immediately picks up on the strange melody with the tritone:

Again I take the melody and echo it, moving it to different tonalities so that there is a questioning quality in the musical commentary. It is as if the music is saying, “everything is not fine; something is wrong, and we are not sure what is happening”. This is reflected in my lack of a clear tonal center and the emphasis on the tritone.

At this point Gloria speaks. In response to Gloria bringing back the bleeding lyric, I bring back the dissonant clusters from the first time she used the words:

The repeating musical response to the repeating lyric statement gives the music a form. It also emphasizes the musical aspect as a contrast to the fact that Gloria has again gone back to saying rather than singing the lyric. The first time I created this cluster it was a spontaneous, unpremeditated reaction. This time it is somewhat more controlled, as I am returning to it with intention. The music continues:

Now Gloria uses the word “you”, responding to the character that was bleeding. This character has little empathy for the bleeding character:

It is striking that Gloria curses, as it is extremely rare for her. I sense the intensity of her turmoil. I continue the dissonant thematic music first used when Gloria first mentioned her bleeding. At the end of the phrase I play a D in the bass, the key that the entire improvisation began with:

I start to play a bass line, creating a slight sense of pulse, without establishing a definitive tempo:

The lyric “I can't walk” triggers my response to abort the establishment of a pulse. Music with a pulse would not support the idea of not being able to walk. Instead I hold a minor chord with dissonance as Gloria continues to sing on the one tone D, wavering slightly below pitch as she sings:

Gloria's melody stays on the one pitch D as she sings “I can't walk.” I sense that the lack of direction described in her lyric is reflected in the lack of a melodic direction. On the word “walk” Gloria's pitch is slightly below the D. In response I play a C# in the middle register of the piano and the grounding D tone in the bass. I then move this D-C# major seventh interval up a third to an F#-F:


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Open Up My Arms (1 & 2)

September 21, 1999

“Open up my arms” refers to the desire on Gloria's part to embrace the world, and accept the life enhancing activities and possibilities that can bring her more satisfaction. One of the issues Gloria sang about was her tendency to hide and her ambivalence about being noticed. She recognized that her self-defeating behaviors were a way to keep her from being in the world in a more fulfilling way. During clip one Gloria began to cry. Several times during the improvisation process Gloria stayed connected to the creative process of improvising and singing while also feeling strong emotion and crying.

  • It's a real illness this compulsive overeating
  • It's a real illness, it's a real illness
  • Oh these compulsions, they're real
  • They make you sick
  • They take away your soul, your heart, your spirit
  • It's a real illness
  • It's a real illness, real illness
  • Real..oh
  • Oh..oh..oh..oh..oh (singing a nonverbal melody)
  • Oh..oh..oh ..oh.. oh (after her singing, therapist plays melody, she cries)
  • It's pretty
  • Ooh..ooh..ooh....ooh
  • I open up my arms, I sing my song
  • I open up my arms (soft moans after the phrase)
  • Ooh..ooh....ooh.. ooh (therapist sings after her phrase ends)
  • I open up my arms (therapist joins in singing)
  • I open up my arms,
  • I say stop hiding
  • I open up my arms
  • I say stop hiding
  • I open my arms
  • I ask you to come in
  • I ask you to come in
  • I open up my arms
  • I ask you to come in

Later in the same session (clip two) Gloria sang about what triggered her crying during the singing.

  • Why did that make you cry?
  • Why did that make you cry?
  • Well Alan, first thing I think of is
  • It made me cry, cause you listen to me deeply
  • You listen to me deeply
  • You listen to me deeply
  • Can you tell me why else it made you cry?
  • Can you tell why else it made you cry?
  • We'd like to know. Yea? We'd like to know?
  • We'd like to know
  • Well maybe the other reason is that there's pretty in me
  • Like you said
  • There's pretty in me
  • Getting shtupped down
  • Getting kept in jail
  • With all that eating
  • All that desperation
  • What's pretty in me
  • Not showing
  • Not coming out
  • What's pretty in me
  • Buried under, buried under, buried under
  • An earthquake of food
  • Sadness, buried under
  • An earthquake of food
  • Sadness, desperation, repetition
  • Buried under an earthquake of food
  • Sadness, desperation, repetition
  • An earthquake of food
  • Leaving me pinned, chained, locked, crushed, smashed
  • An earthquake of food
  • How can I open my arms
  • If I'm crushed, smashed, pinched, constrained, eheww
  • How can I open my arms
  • If I'm buried under an earthquake of food
  • Repetition, oh how can I fly
  • How can I open my arms
  • Oh, another earthquake victim
  • Ahhhahhmm, Badoobadowaybadadoo
  • I'm going to open my arms
  • How I want to open
  • To open, to open my arms
  • That's why I was crying
  • I want to open my arms
  • I want to sing my song. Ohh
  • Open your arms (therapist sings)
  • I'm buried under an earthquake of food
  • I want to open my arms
  • Sing your song (therapist sings)
  • I'm buried under
  • Open your arms (therapist sings)
  • I'm buried under
  • I want to open my arms
  • I want to open my arms and sing

Gloria often sang questions to herself as she reflected on her experience. Playing the melody on the piano that Gloria sang triggered her intense emotional reaction. During times of intense emotional expression I supported Gloria by singing with her, often playing in a blues form, and creating a solid harmonic accompaniment so that she could feel confident knowing the future direction of the musical form.

The Relationship Between Music and Words in Clinically Improvised Songs

This article shares findings from Dr. Turry’s doctoral research and includes a table summarizing the clinical significance of the musical interactions that took place during the creation of improvised songs. It addresses commonly asked questions regarding the qualities of particular musical elements and their application in music therapy. Though Dr. Turry does not adhere to a prescriptive approach when improvising songs, he found particular musical tendencies related to emotional expression in the way that he and Maria collaborated to create music. (Please note that the pseudonym Gloria is utilized in the article.)

SEE MORE

Music Psychotherapy and Community Music Therapy: Questions and Considerations

“As an improvising therapist and a Nordoff-Robbins clinician, I have been immersed in a culture that values entering into the unknown. The sense of diving into the process is further amplified and intensified when it is shared publicly. Though the program is predetermined, our reaction to it, as well as that of the audience, is unpredictable. Perhaps one motivation to share this material publicly for Maria is that she wants to create a sense of empathy within the audience by feeling the music and living the experience with a depth that a simple narrative explanation cannot enable. I can understand this. When presenting, it is invariably more powerful and effective to include actual music from a session than to try to explain what occurs in the session. Hearing the musical process as it unfolded allows the audience to enter into this experience, and allows Maria and I to re-enter it, as the intensity of sharing it with others brings it to life.”

-Alan Turry

Read the full article online at Voices Journal >