Music the best form of Therapy.

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Music therapist uses a wide range of musical instruments in a session. As opposed to many people’s impression of a music therapist who simply ‘pick up a guitar and sing to a group of client’ or ‘turn on the loudspeaker and play classical music tracks’. Music therapy is so much much more than that.

In a music therapy session, instruments ranges from the usual piano and guitar, to tuned percussion like marimba, xylophone, glockenspiel, metallophone to untuned percussion like gong, cymbals, wood blocks to a variety of drums. And of course depending on the primary and secondary instruments of each music therapist, instruments varies a lot as well. There are therapist who uses Western instruments as well as any other culture’s instruments as well- bassoon, harp, accordion, double bass, horn, Erhu, zither… name it, there must be a therapist who’s using it in their session right now. It all depending on the music therapist as well as the client’s preference, and whether the instruments can achieve the therapeutic goals in a session.

I guess it’s actually more important to group the untuned instruments into their materials:

Wood/Bamboo: wood blocks, claves, guiro, rainstick, shakers, maracas, castanet.

This group of instruments is easy to handle and use, can be well blended in with other instruments. They seems to carry a ‘neutral’ feel and personality, they are what I considered as the very ‘groupy’ instruments. Some clients might see these as ‘kiddy’ instruments as they probably have used them back in school’s music lesson.

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Metal: Agogo, cymbals, gong, bell tree, chimes, Cabasa, conga, handbells, singing bowl, tambourine, triangle.

These instruments are loud, able to cut through the group. From my experiences, whoever has these instruments usually loves banging on them loudly and love the attention it creates. Or the other side of the spectrum is that people would completely avoid these metallic instruments and they simply want to blend in with the group and not wanting to be heard. This could be due to cultural background, upbringing, personality, the needs to hide or express oneself or the feeling caused by these instruments.

Membranophone: Bongo drum, African Djembe, Middle Eastern Darboka, snare drum, bass drum, ocean drum, Indian Tabla, Chinese Drum, Japanese Taiko drum, frame drum, bodhran.

Drums are the essential instruments specially for adults client, due to their appropriate size and the ability of handling strong physical impacts, they are the perfect instruments for expressing strong emotions.

The African Djembe is my personal favourite instruments to be used in the music therapy session, it has a solid bass, great for grounding and containing the group and providing a ‘secure base’ for the group to explore other instruments as well as feelings.

I’ve recently discovered the Darborka and totally fallen in love with the sound, it seems to be a gentler instrument compared to the Djembe using the whole hands and arms, the Darborka is able to produce sophisticated rhythms with the tips of the finger.

Different types of drums are cultural specific, with each type specifically associated with an ethic group e.g African, Middle Eastern, Indian, Chinese, Scottish, Western and thus it is the easier, more accessible way to get in touch with a client’s cultural background.

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Melodic instruments: marimba, xylophone, glockenspiel, metallophone, tongue drum, harp, melodeon, melodica, accordion, recorder, boomwhackers.

My favourite one from this category must be the metallophone, the bigger the better. Its warm and resonating tones are enough to fill the whole room, also providing a sustaining sound that acts as a container for whatever the client creates. You can take the metal bars away to create specific modes and scales for the client to play in a failproof improvisation.

I remember in one of my most memorable case that I’ve worked with in the psychiatric hospital, the client with depression first walked into the room and said ‘All these instruments (pointing to the melodic instruments) are too nice.’

These melodic instruments are often associated as the ‘nice sounding’ instruments, you cannot play a wrong note with these. However there are pros and cons with these ‘nice sounding’ instruments, depending on the client and the goal of therapy, they might be ‘too nice’ at time for a client who has the needs to express and release some darker and intense emotions. One thing for us as a music therapist to always bare in mind is that, we are not there in a session to create nice sounding music and improvisation.

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Strings instruments: Guitar, harp, ukulele, violin, viola, cello etc…

These are powerful instruments in the music therapy setting, they have the abilities to dominate a group and become the center of attention just like the piano. On the other hand, these seem to have the power to directly touch a soul.

Musical actions in the music therapy setting convey much more than the sound and the music we create together; the use of different musical elements as well as the choice of instruments and patterns of musical interaction all seem to have the ability to manifest an individual’s unconscious by acting as transference/countertransference trigger, defensive and projective devices. This is when music becomes much more than just the sound that you hear.

Woodwinds and brass instruments: Clarinet, bassoon, flute, saxophone, trumpet, trombone, horns etc.

These are normally used only if they are the music therapist’s primary or secondary instruments. They have the advantage of creating long sustaining notes to connect some seemingly random sounds created by some clients. They are also great instruments for imitating the human voice, seems to be more effective in initiating nonverbal conversation with a client especially children. The only downside of using these instruments is the fact that the therapist won’t be able to sing and talk at the same time when interacting with the client musically.

Musical Instruments as projective devices and transference trigger

As a music therapist trained under the psychodynamic music therapy tradition, i strongly believe that different instruments can act as a projective device and transference trigger. The client’s choice of instruments are not random, they are representative of a person’s personality, cultural background, feelings, mood, relationship patterns etc.

According to Bruscia (1998 p.6), each instrument or the use of voice and body sound has its own projective significance, providing different ways to express transference. ‘The voice extends the physical self and projects a sound identity of the inner self’ whereas ‘instruments extends the visible self, displace the feeling self, and extend the audible self…displace feelings onto objects-and project its inner self through various sound identities

Two clinical examples by Ahonen-Eerikäinen (2007) illustrated the transference presented in music therapy group evoked by musical dialogue.

The first case vignette titled ‘Arguing Electric Guitars’ (p. 147), group members were involved in a free improvisation with their chosen band instruments. A member who chose the bongo drum was feeling anxious and played very softly, as he was seated in-between two electric guitar players’ arguing musical dialogue. Upon the therapist’s verbal prompting, the client was able to associate the musical experience to his past experience as a child, avoiding involvement with his drunken parents fight and argument by staying as quiet as possible in the closet.

A second case vignette titled ‘Soundless Instruments’, in musical improvisation, a group member always chose small and quiet percussion when the other members chose regular band instruments. She was confronted verbally by another group member of not allowing herself to be heard by others, the confrontation allowed her to make a connection with her family setting where she was not given opportunities to express her opinion. The client was unconsciously repeating her past experience by her choice of instrument and ways of playing in a group, it is through verbal discussion with the therapist and group members she was able to come into realization and able to experience a different response of being heard in a supportive group setting (p. 150).

It is worth noting that these case materials can never be overgeneralized, a musical instrument that represent particular feelings and associated with specific character and personality might only be true for one particular client, as a music therapist it is always important not to have any presumptions in understanding clients. However, through years of clinical experiences, I believe a music therapist can still understand the symbolic meaning and be able to guide the client into exploring specific issues regarding the choice of instruments.

Also published on Medium.

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