use of music and sound to enhance the therapeutic setting, The

Perspectives in Psychiatric Care, Jul-Sep 2003 by Torre, Mary Ann La

Integrated Perspectives discusses the concepts of an integrated psychotherapeutic approach to patient care and explores some of the underlying principles that make it beneficial.

Much of what goes on in a therapy session is determined by language and verbal communication. Language is the system we use to send and receive messages. It is the vehicle for assessment and intervention, and forms the basis for much of the supportive change that occurs in the therapeutic relationship (Fine, 2001). Underlying this system of words is the sound itself-the vibration of tones, the quality it evokes, the resonance it has to both mind and body. In sessions, sound is often used only through words, but there is a whole array of other ways to incorporate sound into the therapeutic relationship to enhance the resonance between client and therapist and to promote healing.

To appreciate the power of sound itself, it is important to understand its effect on mind and body. Sound is a vibration, and as Gaynor (2002) points out, "We are all systems of vibratory matter" moving in rhythm and resonance to each other (p. 71). This vibration touches every part of our body, so that sound is heard not only with the ears but also through our skin and bones and every cell (Brewer, 1998). Sound is a form of energy, and research is showing how different types of energy can directly effect the cells' receptivity to information (Pert, Dreher, & Ruff, 1998). Sound is also a manifestation of breathing, as well as a way to reenergize the breath so that working with sound can revitalize and heal on many levels. Sound creates the vibration allowing us to synchronize to one another, to breathe and blend together. When sound is properly mobilized, it can synchronize the human body toward greater harmony and balance (Gaynor).

Looked at in this way, it is surprising that sound is one of the most underused of the mind and body tools. A therapeutic session often works only with the tone and timbre of words to convey meaning and emotion rather than with the wide range of sound approaches that can be considered such as vocal toning, singing, and music. Such approaches fall into two categories: those that involve the client directly in music making, and those that involve listening to vibrational sounds rather than making them (Brewer, 1998). Both approaches seem to be successful with a whole gamut of problems from high stress to schizophrenia. The choice of one approach over the other has less to do with a specific diagnosis and more to do with the therapist and client's own level of comfort (Gaynor, 2002). A decision to incorporate different sound approaches into the therapeutic session involves an understanding of how to go about doing this effectively, and a willingness to follow wherever the sound takes a client.

Direct Music Making: The Use of the Voice to Tone and Sing

Involving a client directly in making tones and sounds adds another dimension to the therapeutic interaction and can help resolve tension and emotions by providing a new avenue of expression. Using vocal sounds and toning is a very old art that dates back to ancient civilizations when singers would chant one note for hours at a time to see the effect this note had on their minds and body (Khan, 1988). In recent years, research has found that using the voice to make tones and sounds helps to release tension and give expression to something that may not yet have a precise conscious meaning for the client (Beaulieu, 1987).

Finding a tone that gives sound to a feeling allows the client to experience this emotion from another place, while increasing the flow of breath and resonating specific body areas to which the sound is directed (McClellan, 1991). This tone can be a sigh or a moan or a hum; often, in the beginning, before the client feels comfortable enough with making sounds, it may be almost inaudible (Goldman, 1992). In fact, as Gardner-Gordon (1993) shows in her book on the healing voice, it is often possible to begin with the sound of the breath by asking a client to make a sound as he/she exhales. As this activity is repeated several times, the sound becomes longer and more sustained, with the client feeling comfortable enough to play with the sound and find those sounds that are pleasing or cleansing or soothing in some way. Allowing a client to express sound in this free, unstructured manner encourages spontaneity and gives permission to express whatever is within. Using sound and toning in a therapy session enhances the opportunity to express what may be difficult to verbalize through language.

A similar effect can be produced by stringing a few tones together and singing them, for singing allows us to "exercise our breath and simultaneously become our own instrument of self expression" (Gaynor, 2002, p. 101). This activity may be more difficult than toning a single note, since singing often carries with it a value judgment of performance; but with support and encouragement, clients can discover their own voice and explore the wide range of emotions that are reflected in the sounds that they combine.