MTT5 3 Hughes

Music Therapy Today
Vol. V (3) May 2004
What happens in music

therapy: An ecological
approach and a theoretical
model
Hughes, Philip
SRAsT(M), PhD
ABSTRACT
This paper will first examine the perception of music in a music therapy
session with reference to ecological psychology and music psychology. A
summary is given of the complicating factors such as clients’ past experi-
ence of music, but also associations with musical idioms and the sounds
of the instruments. This serves as a reminder that the theoretical posi-
tions (for instance music psychotherapy and ‘music as therapy’) which
therapists use to inform their work, could lead to idealisations of a
‘messy’ reality. Notwithstanding this, a theoretical model is presented of
what music therapists might be doing when they work in the two media of
words and music, drawn from the author’s experience of mathematical
modelling. The concept of bi-level optimisation is put forward as an
analogy for the way the therapist has to think in two media at once, or at
least in the same session, and ‘optimise’ the distance between therapist
and client in both media, at the current point in the process of the ther-
apy. A separate but related model is given of insight and resistance in
music therapy, using ‘catastrophe theory’. The ideas may be of particu-
lar relevance to music therapists working in psychiatry and/or with psy-
chosis; a clinical vignette is used to illustrate this.
1
Hughes, P. (2004) What happens in music therapy: An ecological approach and a theoretical model. Music Therapy
Today (online) Vol. V (3) May 2004, available at http://musictherapyworld.net
INTRODUCTION
This paper has two strands, both motivated by the big question “What is
music therapy?” As a relatively recently qualified therapist, I have found
myself inevitably trying to work out my own response to this question, in
the process of finding and consolidating my way of working in clinical
practice. Thus as models of what happens in a music therapy session
they are personal to me, and there is always a danger they will seem
obvious, or “so what?” The ideas will serve their purpose if they provoke
some thought, and perhaps clarify some of the assumptions we
sometimes make.
As a UK-trained music therapist I use improvised music as a means of

non-verbal communication. In the search for a theoretical framework for
this tradition of music therapy, (at least) two contrasting positions have
emerged. In one the importance of verbalising where appropriate or
possible is stressed, so that a model of a talking therapy, often but not
always based on psychoanalysis, is vital. The other stresses the
therapeutic value of music itself, so that it may be impossible or
undesirable to try to verbalise what has happened in the music.
In this first section I want to point out the ways in which music therapy
doesn’t quite fit into any particular theoretical framework, while in the
second section I fail to resist the temptation to provide my own
theoretical framework. Music therapy has always been a ‘practice’, and
the value of a framework will be in stimulating ideas in practitioners,
whilst the limitations of such frameworks should always be
acknowledged.
INTRODUCTION 2
THE IMPORTANCE OF CONTEXT

By analysing the ‘context’ of a music therapy session, I hope to under-
stand the different expectations and preconceptions which therapist and
client bring to the experience. Clearly, there is a therapeutic context
which we as therapists hope to set. Defining this will in effect be yet
another definition of music therapy: my attempt at this would be the con-
text of a developing relationship between therapist and client, expressed
through music and (where appropriate) words, in which the therapist’s
interventions are aimed at helping the client to achieve greater under-
standing of his or herself. This definition of the different roles of thera-
pist and client will vary slightly according to therapists’ theoretical
orientations.
However, there will be other contexts, expectations and preconceptions

that intrude, that need to be overcome and/or acknowledged. At a basic
level, we have associations that are brought to mind by any sound or
instrument. The field of ecological psychology deals with how we
perceive our daily environment, including sound. Gaver (1988 and 1993)
has written about sound in this way, giving a framework for ‘everyday
listening’: sound provides information about the environment, in terms
(for instance) of the speed, size, direction of an approaching car.
Categories of sound were suggested as produced by vibrating solids,
gases and liquids, also the source attributes (interaction type, material,
configuration e.g. shape/size). Gaver asked subjects to identify a range
of everyday sounds, which they did very accurately. He also included
some ‘implausible’ sounds, such as someone walking across a floor
covered in newspaper; this was identified as walking on snow or gravel,
or rhythmically crumpling paper – one person correctly identified the
sound, and then rejected it as impossible.
THE IMPORTANCE OF CONTEXT 3

The conclusion is that we use sounds to make sense of our world at quite
a basic level, and it certainly seems likely that those associations will stay
with us even when we know that they are produced by musical
instruments. In my experience, clients can compare the sounds of the
instruments directly to everyday noises such as a door shutting, and this
is perhaps trying to make sense of the somewhat strange experience of a
music therapy session in terms of things they know well. Again, because
the focus in the session is on sound, there may be a heightened awareness
of outside noises which can be used consciously or unconsciously to
distract from the process of therapy. Gaver’s categories of sound
production and source attributes have their parallels in the categories of
musical instrument, although the correspondence is not always exact –
obvious examples are the rain-stick and ocean drum, producing quite
convincing watery noises using non-watery substances.
Ecological psychology also has something to say about our perceptions

of musical instruments as objects. Palmer et al. (1989) carried out four
experiments where adults and children tried to identify the picture of an
instrument which was played on a recording. Results were better for
Western than the unfamiliar Chinese instruments, but identification of
the family of each instrument was quite good (chordaphones,
aerophones, idiophones and membranophones). The authors suggest an
interpretation based on ‘affordances’, being in this case the combination
of substance and surface layout specifying how the instrument should be
played. Gibson (1977) defined ‘affordances’ as “specific combination of
the properties of its substance and its surfaces taken with reference to an
animal”.
One conclusion from the Palmer et al. experiments seems to be that

people are quite good at identifying how a sound was produced. This
may be somehow related to the observation that clients in music therapy

often display an affinity or preference for one instrument or class of

instrument, although part of the process of therapy may be in beginning
to explore more varied musical expression. Another client of mine had a
fascination with the cymbals to the exclusion of any other instrument,
and in the early phase of therapy would quite happily have played them
on his own for the full session. My challenge was to find a way to move
this fascination with a particular sound towards more interactive music-
making.
The other finding of the Palmer et al. experiments was that there were, as
expected, cultural factors: the instruments from the subjects’ own culture
were easier to identify. Clearly, a client will find some instruments in a
music therapy room familiar, and some less so. Leading on from this, the
client’s previous experience of those instruments will influence their
perceptions. Some percussion instruments may seem childish if they
were last seen in school music; the piano or the therapist’s other
instrument may bring associations of unsuccessful music lessons, and
hence feelings of failure. The issue of skills and the perception of the
therapist as a teacher is one of the commonest hurdles for client and
therapist to overcome.
The cultural perception of instruments also leads, of course, to the issue

of the musical cultures of the music therapist and client. Music therapy
trainings help therapists to improvise in as flexible a way as possible, but
it is inevitable that they will be most comfortable in idioms which they
are familiar with. There are various examples in the music therapy
literature (for example Henderson 1991, Loveszy 1991, Mereni 1996,
Pavlicevic 1994) where the importance of being able to adapt to an idiom
from another culture is discussed. Whilst a therapist cannot necessarily
become an instant expert in another idiom, for instance to the extent of
learning unfamiliar instruments, he or she will probably be able to use the

skills they have to respond sensitively to the client’s particular form of

musical expression.
The musical backgrounds of the two parties are only one facet of course
of the cultural issues involved in a therapeutic encounter. Other issues,
which of course overlap with the talking therapies, are verbal cultural
issues – whether therapist and client share the same first language, and
whether there are different cultural assumptions about verbal
interactions. Within British culture, there are many subtle differences in
the way people interact verbally and many clues that we give away about
our social class, ethnic background and regional allegiances – for
instance, people from the North of England often say that they have a
more direct, friendly style of verbal interaction than those from the
South. As music therapists we are interested in musical communication
but there are other non-verbal communications to be aware of, such as
our body-language, and the way we dress.
These are all contexts which might be seen as ‘obstacles’ to the ‘pure’
communication in words or music which we might be aspiring to. Seen
positively, they may provide fruitful work for therapy, in that the
exploration of obstacles to a relationship is the beginning of the
exploration of that relationship. At the least, I suggest they need to be
acknowledged. I defined a context at the beginning of this section which
might be the one which the therapist is ‘aiming’ for: a developing
relationship between therapist and client, expressed through music and
(where appropriate) words, in which the therapist’s interventions are
aimed at helping the client to achieve greater understanding of his or
herself. To arrive at this context, music has to be understood as
communicative, and that what the client plays may have emotional
significance and meaning. Clearly this achieved principally by ‘doing’,
by responding musically to the actions of the client. However, given that

there is no universal agreement within music therapy on how to interpret

the ‘meaning’ of a musical interaction, different therapists will approach
this problem in different ways. If the musical communication is seen as
having sufficient meaning in itself, and indeed is ‘untranslatable’ into
words, the client may be encouraged to play without much recourse to
words. Other therapists may encourage the client to try to put into words
what ‘happened’ in the music, the feelings which may have been aroused.
FIGURE 1. Contexts in Music Therapy

A THEORETICAL MODEL
TRAFFIC AND I spent some years in my first career, developing computerised models of
MUSIC THERAPY
traffic, predicting in particular the way people choose routes, and the
impact on delays on roads. The model of music therapy which follows is
based very loosely on mathematical ideas from that field, but I feel it is
important to stress at the outset what should be obvious, that it is not a
mathematical model in the same way, but an analogy which I have found
helpful and interesting. For myself, of course, there is also a pleasing
symmetry in bringing together ideas from the two diverse parts of my
working life.
There are at least two problems in traffic which involve ‘bi-level

optimisation’, in other words trying to find the ‘best’ set of variables in
two problems at once. For instance, the set of traffic flows on different
roads through a town is assumed to obey the rule that drivers are trying to
minimise their journey time. The set of demand variables, on the other
hand, represents the number of people who want to travel between each
possible start and end point in the network. This (we assume, again) will
depend on the cost/time of the journey, so people choose their shopping
trips for instance based on length of journey, as well as factors such as
the choice and cost of purchases. The most accurate prediction will be
found by satisfying both the demand and the flow assumptions at the
same time, yet this is mathematically very difficult. We can find a
solution by solving first the demands and then the flows, and repeating
until there is no change, and this will usually yield a ‘good’ solution, but
not necessarily the ‘best’.
Since I began my second career in music therapy, I have been fascinated

by the relationship between words and music. I now wonder whether the
communication in these two media has something in common with ‘bi-
A THEORETICAL MODEL 8
level optimisation’. The optimisation represents the therapeutic aims of

the therapist, who is trying to find the best place in the musical
relationship and (at the same time) the best place in the verbal
relationship, for the current phase of the therapeutic process. The best
places in music and words may be quite different – for instance the
closeness which is achieved in a musical encounter may be difficult to
transfer immediately into words. Because we operate in one medium at a
time, it may be difficult to see the best overall place to be, just as in the
traffic problem.
DISTANCE IN A The quality of a relationship clearly has many facets, positive and
RELATIONSHIP
negative, which we might be able to call ‘variables’; I would like to
project these many dimensions onto one, and call it ‘closeness’. A client
is often referred because they find it difficult to achieve closeness in
words, so the scenario where the musical relationship is closer than the
verbal one may be common and appropriate, especially in the early
stages of therapy; however, I suggest that this imbalance becomes
uncomfortable if it is sustained. On the other hand, if the verbal
relationship is much closer than the musical one, it is possible there is a
temporary resistance to the client expressing themselves musically.
Again though, there are implications if this position is sustained:
presumably the sessions are then operating more as a talking therapy, and
should be acknowledged as such. In figures 34-36, these possibilities are
shown by the lengths of the arrows joining the client and the therapist
FIGURE 2. Communication in words and music
FIGURE 3. Closer in music than words
FIGURE 4. Closer in words than music
If the ‘distances’ in words and music were plotted, we could show the
three positions mentioned above in graphs:
FIGURE 5. Graph – As close in words and music
FIGURE 6. Graph – Closer in music
FIGURE 7. Graph – Closer in words
A CLINICAL I found the concept of distance and closeness in a therapeutic relationship

ANECDOTE
very helpful while I was training, when I saw a man with schizophrenia
for nine months. He would often attend for part of the session, and
would also periodically miss sessions; I felt there was a game between us
as I tried to guess which sessions he would miss, and that I was gaining
greater understanding as I was more able to predict this. Often we would
achieve a closeness in one session, but I would be able to predict that he
was likely to miss the next one. This feeling that he could only tolerate
closeness on his terms, and for a certain amount of time, extended to
individual pieces of music; there were many times when we had just
found a common music, when he would suddenly put down his
instrument, leaving me ‘stranded’.
The comparison between the verbal and musical relationships is

illuminating here as well; often he would object violently to an
interpretation, or even storm out, and I had to work out whether my

verbal abilities were indeed wanting, a real possibility especially as I was
still training, or whether he found the insight too threatening, in the same
way that the musical closeness seemed to be threatening. Verbal
communication became easier as the musical relationship developed, but
was probably led by progress in the musical communication.
INSIGHT AS A To extend these graphs, we now include the ‘optimisation function’,

VARIABLE
which in simple terms is ‘the thing we are aiming to maximise’. In music
therapy, again this could be represented by many variables, which I will
ruthlessly project onto one, called ‘insight’. We can imagine a graph of
the level of insight possible for different positions in the musical and
verbal relationships; when this is plotted above the 2-dimensional surface
of the graphs in Figures 37-39, we have a contoured landscape. As
therapists we are trying to find the highest point of this landscape at the
current moment - to help the client to the maximum level of insight
possible at that stage of therapy. So the graph of insight is not static –
one possible scenario may be for the maximum to be for some time
where the two people are close in music but not in words, to then move to
closeness in both, and then to a healthy separation as the client works
towards an ending.
FIGURE 8. The best place is closer in music
FIGURE 9. The best place is closer in words
FIGURE 10. The best place is equally close in words/music
HIERARCHICAL Without stretching the traffic analogy too far, there is one more
CONSTRAINTS
comparison which may be interesting, or indeed we may decide that the
analogy breaks down here. In bi-level optimisation problems, the two
problems are often not completely ‘equal’; in the traffic example, once
the demands are fixed, the flows can only take a certain range of values,
so they are ‘constrained’ by the demands. In music therapy, an
analogous statement might be that what is possible in the verbal
relationship is determined by what has happened in the musical
relationship. Some therapists will agree with this statement more than
others; I am not sure I agree with it, if it were to be taken as operating in
every moment of every session. There must surely be times when the
musical relationship is not progressing, and a verbal intervention moves
things forward. On the other hand, as a summary of what is possible over

the progress of therapy, perhaps the hierarchical view is a statement that
as music therapists we are (generally) trained in musical more than in
verbal communication.
CATASTROPHE Catastrophe theory was developed in the 1970’s first by Rene Thom
THEORY, INSIGHT
(1975), and then by others including Christopher Zeeman (1977), my
AND RESISTANCE
supervisor for an M.Sc. in mathematics. The arresting title refers to
sudden (rather than particularly negative) change; in nature many step-
changes occur as a result of continuous changes in other variables, which
were difficult to model mathematically before catastrophe theory. As
catastrophe theory was popularised, it was used to model phenomena in
the social sciences, where the variables are less quantifiable; a layman’s
summary of such applications is given in Woodcock and Davis (1978).
In this tradition, I will use a ‘cusp’ catastrophe model to extend the

previous model of music therapy to include resistance. In Figure 10
below, the surface is akin to a piece of paper, folded in an S-bend at one
side, but not the other; it represents the possible states open to the client
(at the current stage of therapy). As ‘communication’ increases, the
client moves along the sheet of paper from the right-hand end. If
resistance is low, then the client can move smoothly up the piece of paper
and to increased insight. If resistance is high, however, there is a point
where the client needs to ‘jump’ to the upper part of the paper, and where
of course the therapist’s help is particularly needed. Perhaps the
therapist’s intervention at this point is to let the client know that they are
not in fact bound by the two-dimensional surface of the paper!
FIGURE 11. Catastrophe theory graph illustrating resistance
This graph could be viewed as embodying the overall resistance in music

therapy, or else we could think of a pair of graphs of musical and verbal
resistance. For instance a client could encounter greater resistance in
words than in music (or vice versa at different parts of the process).
NON-VERBAL Clearly the ideas described above apply most naturally to clients who are
CLIENTS
physically able to communicate verbally. So therapists working in
psychiatry may find the ideas more interesting, compared for instance
those working with clients with severe learning disabilities, or advanced
dementias. However, often clients’ receptive language is much better
than their spoken language; the communication may be ‘one-way’ and as
therapists we make judgments as to what kind or level of verbal
relationship may be possible. One valid position is that the musical
relationship is the one which empowers the client and puts them on an
equal footing with the therapist - to use many words oneself emphasises
the client’s disability. This position does not of course preclude the fact
that we are thinking in words about the relationship when we reflect
afterwards, and in supervision.
FIGURE 12. Model of communication with a learning disabled

client
CONCLUSIONS
This paper has attempted to point out the ways in which clients’ and
therapists’ perceptions impinge on the process of music therapy. The
pure ‘transference’ model of psychoanalysis and the purity of the
experience of musical communication may be ideals which we try to
facilitate, but do not achieve, even though we may come close. The
second half of the paper used some mathematical ideas to give pictorial
views of how music therapists may be working within music and words
at the same time. The writing of this paper been enjoyable, in bringing
together ideas from my previous career with my present one, and helpful,
CONCLUSIONS 21
in clarifying and developing my thinking on the process of music

therapy.
ACKNOWLEDGMENT
The author is indebted to Dr Philip Barnard of the Cognitive Brain
Sciences Unit, Medical Research Council, Cambridge, for some
illuminating conversations in the early stages of writing this paper, in
particular, in pointing out relevant parts of the psychology literature and
helping to clarify my thoughts as to how they might apply to music
therapy.
Philip Hughes is a music therapist, currently working for Rampton

Special Hospital, in forensic psychiatry, and in private practice with
children and adults with learning disabilities.
Correspondence may be addressed to the author by email

(p.hughes10@ntlworld.com) or at the following address: Arts Therapies
Department, Rampton Hospital, Woodbeck, Notts. DN22 0PD.
REFERENCES
Gaver W.W. (1988) Everyday listening and auditory icons. Unpublished
doctoral dissertation, University of California, San Diego.
Gaver W.W. (1993) What in the world do we hear?: An ecological
approach to auditory event perception. Ecological Psychology
5(1), 1-29, Lawrence Erlbaum Associates.
Gibson J.J. (1977) The theory of affordances. In R. Shaw and J.
Bransford (eds.), Perceiving, acting and knowing: Toward an
ecological psychology, (pp. 67-82), Hillsdale, NJ, Erlbaum.
Henderson H. (1991) Improvised song stories in the treatment of a
thirteen-year-old sexually abused girl from the Xhosa tribe in
South Africa. In K. Bruscia (ed.), Case Studies in Music Therapy,
(pp. 207-217), Pennsylvania: Barcelona Pubs.
ACKNOWLEDGMENT 22
Loveszy R. (1991) The use of Latin music, puppetry, and visualization

in reducing the physical and emotional pain of a child with severe
burns. In K. Bruscia (ed.), Case Studies in Music Therapy, (pp.
153-161), Pennsylvania: Barcelona Pubs.
Mereni A.-E. (1996) ‘Kinesis and Katharsis’: The African traditional
concept of sound/motion or music: its application in, and
implications for, music therapy. British Journal of Music Therapy
10(1), 17-23.
Palmer C.F., Jones R.K., Hennessy B.L., Unze M.G. and Pick A.D.
(1989). How is a trumpet known? The “basic object level”
concept and perception and perception of musical instruments.
American Journal of Psychology 102(1), 17-37.
Pavlicevic M. (1994) Between chaos and creativity: music therapy with
‘traumatised’ children in South Africa. Journal of British Music
Therapy, 8(2), 4-9.
Thom R. (1975) Structural Stability and Morphogenesis: An Outline of a
General Theory of Models. Reading: Benjamin.
Woodcock A. and Davis M. (1978) Catastrophe Theory. Penguin Books.
Zeeman E.C. (1977) Catastrophe Theory, Selected Papers 1972-1977.
Reading: Benjamin.
This article can be cited as: Hughes, P. (2004) What happens in music
therapy: An ecological approach and a theoretical model. Music Therapy
Today (online) Vol. V, Issue 3, available at http://musictherapyworld.net
REFERENCES 23

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Music Therapy Today

Vol. V (3) May 2004

What happens in music

As a UK-trained music therapist I use improvised music as a means of

THE IMPORTANCE OF CONTEXT

However, there will be other contexts, expectations and preconceptions

THE IMPORTANCE OF CONTEXT 3

Ecological psychology also has something to say about our perceptions

One conclusion from the Palmer et al. experiments seems to be that

THE IMPORTANCE OF CONTEXT 4

often display an affinity or preference for one instrument or class of

The cultural perception of instruments also leads, of course, to the issue

THE IMPORTANCE OF CONTEXT 5

skills they have to respond sensitively to the client’s particular form of

THE IMPORTANCE OF CONTEXT 6

there is no universal agreement within music therapy on how to interpret

FIGURE 1. Contexts in Music Therapy

THE IMPORTANCE OF CONTEXT 7

There are at least two problems in traffic which involve ‘bi-level

Since I began my second career in music therapy, I have been fascinated

level optimisation’. The optimisation represents the therapeutic aims of

FIGURE 2. Communication in words and music

FIGURE 3. Closer in music than words

FIGURE 4. Closer in words than music

FIGURE 5. Graph – As close in words and music

FIGURE 6. Graph – Closer in music

FIGURE 7. Graph – Closer in words

A CLINICAL I found the concept of distance and closeness in a therapeutic relationship

The comparison between the verbal and musical relationships is

interpretation, or even storm out, and I had to work out whether my

INSIGHT AS A To extend these graphs, we now include the ‘optimisation function’,

FIGURE 8. The best place is closer in music

FIGURE 9. The best place is closer in words

FIGURE 10. The best place is equally close in words/music

things forward. On the other hand, as a summary of what is possible over

In this tradition, I will use a ‘cusp’ catastrophe model to extend the

FIGURE 11. Catastrophe theory graph illustrating resistance

This graph could be viewed as embodying the overall resistance in music

FIGURE 12. Model of communication with a learning disabled

in clarifying and developing my thinking on the process of music

Philip Hughes is a music therapist, currently working for Rampton

Correspondence may be addressed to the author by email

Loveszy R. (1991) The use of Latin music, puppetry, and visualization

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