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

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

Listening to Sounds and Music

Allowing a client to listen to music while in a session, whether for relaxation or to expand awareness, is another approach. This can be equally as effective as clients making the sounds themselves, for music has a powerful effect on mind and body. Studies have shown that it decreases the stress response and induces relaxation (Watkins, 1997), and enhances higher cognitive functioning (Rauscher, 1995). Once again, the rhythmic pattern of sounds vibrate the body and activate stored memories (Steckler, 1998). Since listening is a nonverbal event, the client does not need to think about it but can just experience the free flow of thoughts and images that arise. These images then can be expanded on in discussion or with other relaxation techniques. Depending on the client's needs or the therapeutic focus, the therapist may choose to select a piece of music that matches the mood of the client (Howard, 2001), or may use a nonrecognizable melody with no harmonic progression as a vehicle for relaxation and contemplation (Brewer, 1998). The music may be used to begin the session or at the end as a way of promoting integration. Obviously there are many possibilities once the concept of music has been introduced into the therapeutic setting.

Combining music with other supportive therapies such as guided imagery is another consideration. Studies have shown that music seems to enhance the imagining experience, particularly if both music and script support the client's own memories (Snyder & Chlan, 1999). Selecting the type of music that would be most conducive to this supportive work seems to depend on the personal choice of the client, since music likes and dislikes vary widely (Snyder & Chlan). Also, it seems that clients who have enjoyed listening to music and include it as part of their life experience respond better to this musical approach (Gerdner & Swanson, 1993).

Case Study

Jane was a 38-year-old nursing student with a husband and two children. Early in the second year of her studies she began to experience extreme exhaustion and depression, feeling overwhelmed and frightened that she would not be able to continue with her studies or take care of her family. Jane evidently had always been able to take care of everything, and this sudden change and debilitation made her afraid that she was "going crazy and might have to be hospitalized."

At the same time it was clear that when she was functioning, she spent all her time responding to her family's needs while sacrificing her own, feeling that she was not truly worthy to receive until everyone else had been taken care of. She seemed aware that this pace contributed to her exhaustion and depression but felt powerless to do it any other way. In sessions, she would sigh frequently when describing the pressures of her day and how overwhelmed and tired she was.

When asked to take a deep breath and make that sigh as loud as she could, Jane initially seemed surprised at the request, but complied. She wasn't comfortable with making a loud sound, but after repeating this activity a few times, the sigh began to get louder. As the sigh got louder it began to take on a different characteristic and sound more and more like a moan. The moan got louder, and it was as if Jane was using the sound to hear her feeling of sadness.