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From Music Therapy – Intimate Notes – case studies compiled by Mercedes Pavlicevic

Based on an interview with Claire Flower of the Nordoff-Robbins Centre in London and the Guildhall School of Music

I started working with Sinead after I had been there for a year. She was then nearly six, and was in the class for the children with more physical disabilities. Molly, her class teacher felt that Sinead was getting increasingly frustrated at not being able to communicate. Molly felt that she understood a lot, made sense of everything going on around her, and was getting upset and becoming quite withdrawn. That was the referral... the whole system is ad hoc because the place is so small.

Sinead was brain damaged at birth, and has cerebral palsy. She is bright and completely knobbled physically. She is in a wheelchair, has very little use of arms and fingers, poor head control, Poor eye control - and she has no verbal expression of her own.

When I started to see Sinead in music therapy, I worked together with Sarah, the speech therapist. We felt that Sarah could help to facilitate movement, help her access some of the instruments, and would understand Sinead and her attempts at communicating a bit more than I did. It was an absolute disaster.... I was worried of what Sarah was going to make of music therapy: she hadn't worked with a music therapist before, I hadn't worked with a speech therapist before, and we launched in without thinking about any of this. We didn't talk about our expectations: what Sarah's role would be, what the sessions would be like, how directive or not Sarah or I would be - and I was very unconfident about dealing with any of that. So we ended up with a very mixed idea of what was going to happen in these weekly half-hour sessions.

I had never worked with a child with those disabilities. There was so little she could do! She couldn't play anything independently, she wasn't using her voice at all, she would look at instruments to indicate what she wanted to play... for a long time we battled. We would offer Sinead the choice of instruments, she would show us which instrument she wanted to play, she would look, be very excited, be very clear as to which one she wanted, and we would go through this huge palaver of arranging instruments so she could play them.

Once we were all set up, I would be ready to play at the piano, we'd all be ready to start - and her mouth would go down. The one really strong communication she had was 'no'! Her mouth would turn down and that would be it. She was not going to play. And it was awful - it felt so mixed. She would come to the music therapy room every week, look really excited and be very clear about what she wanted to play, and then once it was there, she wouldn't play.

If Sarah tried to help her, support her arm, move her arm or her hands, Sinead would pull back and go into spasm, and then it was really hard to work with her. And look daggers at us. And where the difficulty came between myself and Sarah was in our way of thinking about what was going on, and of dealing with it. Sarah felt that this was about Sinead making a choice and communicating something, and if you've said you want to play this, then let's play it. My thinking was more about the feeling of it: how confusing that Sinead is saying, 'yes I want to play' and 'no I don't want to', and what is this all about. Sarah's concern was to get her to play, and mine was much more that it would be nice If she did play, but what is going on here.. . what's happening, in the room, now, between the three of us……………..

On reflection, it seems that we just got into this cycle of wanting Sinead to 'do' things. We wanted her to be a music therapy client, we wanted her to play, to sing - the idea of music therapy giving her another way of communicating seems so grandiose! It didn't take into account who she was, at that point! Music therapy emphasized so much that she couldn't do. She could choose something, but when it was there she couldn't play it. Her disabilities were being accentuated....

For me, the experience of sitting there with Sinead, week after week, feeling that I could do nothing... that I was supposed to be offering her something, and I had nothing to offer her that she wanted. I couldn't find a way to work with her, I couldn't do anything. I felt frustrated, limited and disabled... that was what it came to. It took me a while to get to that point. But that was really where I'd ended up: that this was what it was like to be her - people try to do things for you, to you, you feel that you can't do it, can't do anything, you feel paralysed! There it was! That was exactly the feeling, and this is the reality of her physical state.

Sinead: The duet

I was quite relieved to be on my own with Sinead. I was pregnant and was going to be going off for maternity leave at the end of that third term.

I had been having ongoing supervision, and in that third term I went back to what Sinead was doing. Here and now. We are trying to meet, we don't really need the instruments, we don't need another person, we just need Sinead and me. Whatever music comes out of that, we will do. I started just to play with her breathing. So simple really. If we were sitting in silence, then I would use the phrasing of her breathing. She understood straight away - she got it... I got it!!

Then everything happened very quickly. She started changing her breathing or holding her breath and then breathing again and enjoying the music going with her breathing .... she started to laugh... we both started to enjoy it, and started to make a game of it! And also I could reflect much more directly any movements that she did make - any little movements of her arm. If she was sitting next to me at the piano if she put her hands on the keys but they didn't actually make a sound, then I worked with the movement as though she had made a sound – actually reflecting that back musically. She started to use her voice a little bit – it just came out of the breathing. She was starting little sighing sounds, and those got a little stronger, and we began to have a dialogue between us in the music. Which was simple at first: Sinead made a sound, then I, then her. This developed quite rapidly....

Her voice started to change. She started to find this really gutsy voice, whereas everything had been little breathy sounds. She found a much deeper voice. . . and began to make more distinct sounds like 'yes…………………………..

….And also I assume an intention from her. I expect a communicative intention from her in what she is doing. So even when she is only moving her fingers lightly on the piano, I take that as her actually playing the piano, because that tiny movement is the most that she can do. I draw her into the music in that way, make her part of it as much as possible. I amplify some of what she does, I take little things and make meaning out of them, I make them part of the framework of the music. I expect a response from her! I wait at the end of phrases for her next movement or sound; I think about giving weight to what she can do - and I value her communications. I wait, I listen, I pare things down to the size of frame that she operates within. . .. Really trying to meet her where she is, without. . . all that earlier stuff about offering her instruments to play and getting her to play the way that I wanted her to!

I was imposing my language, without waiting to find out hers. . ……………….

Sinead worked with Rosie, another music therapist who did a locum for me for a whole year. I don't know very much about what they did, but they did start writing some songs together. Sinead was starting to use Rebus charts to communicate (with pictures on) and would often bring those into the sessions and show Rosie what she’d been doing at the weekend, people she'd seen, and they started to make songs together... some of the songs were wistful. That is what I know about their work: lots improvisation, lots of vocalizing, not so much other instruments. . ..