morse

March 6, 2013

By: Examiner.com

Audrey Morse is a music therapist at an inpatient psychiatric hospital in Midtown Manhattan. She holds a Master’s degree in music therapy from New York University. She began playing the piano when she was 7 years old. She is also quite experienced in playing the fiddle. She was required to choose an orchestra instrument in 4th grade. Her mother chose the violin for her. She played for a year before she saw Itzhak Perlman on television. At that point she realized that she wanted to be a violinist. She also played at Carnegie Hall with the New York Youth Symphony when she was 12.

“I was very serious about wanting to become a classical violinist in my childhood and teens.” She told me. “I studied with teachers from Juilliard and spent summers at Aspen and Meadowmount schools. By the time I got to college, I grew disillusioned with the classical scene, feeling like auditions were only about showcasing technique, and I ended up doing my Bachelor’s in math.”

She lived in London, England for several years, where she performed with a variety of bands. She moved back to the United States and eventually got her Master’s in music therapy at NYU. After that she completed post grad training at Benedikte Scheiby’s Analytical Music Therapy institute in New York. Audrey currently plays with the Greenwich Village Orchestra, occasionally taking on freelance chamber music and wedding gigs.

I asked her how she got into her chosen field. She told me that she got into music therapy when she moved back to New York from London. There are many forms of music therapy. Audrey is trained in Analytical Music Therapy, a form in which improvised music is used symbolically to explore the patients’ inner lives and provide them with the inclination for psychological growth.

“I was drawn to the concept of Analytical Music Therapy (AMT) ever since reading Mary Priestley’s books while I was working on my Master’s degree in music therapy at New York University.” She began. “I liked the clarity of her writing, and the techniques she described appeared to have real depth – a way to connect musical communication with the purposefulness of one’s life via symbolic expression. Personally I have long felt that it was more natural to express myself through my violin playing and my musical compositions than it was to put words to my feelings.”

After working for a year in a nursing home with dementia patients, she took her current hospital position. Today she runs music therapy groups, in an inpatient setting, at a hospital in New York City. The patients in her groups are being treated for the acute manifestations of psychiatric illnesses such as schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorders.

Audrey was more than cooperative when I interviewed her, supplying me with enough information to fill a library. She was very excited about being interviewed as she wants to spread the word about this relatively new, and little-known, profession. With only 6000 music therapists in the United States, most people are not aware that music therapy is a real profession. So what exactly does a music therapist do?

Audrey improvises with patients in a group setting, and guides them back and forth from discussion to live music, so it is partially verbal psychotherapy. Not only is Audrey improvising with her instrument, but the patients are actually improvising with their instruments as well so the sessions are completely unpredictable from day to day. She says her role varies upon the circumstances as she is making music along with them. She has to be very aware of how her own playing influences the group music.

This dynamic factor of the therapeutic process stems from the musical relationship she has with the patients. As there are no right or wrong notes in free expression, she makes every effort to relay that idea to her patients. As a music therapist, the violin shows her expression too. This is the main reason why music therapy differs from verbal psychotherapy – the therapist is not a neutral entity. That’s why it’s so important to have training in music therapy, to be aware of the transference/countertransference dynamics that arise in the joint music making. It is not a traditional jam session that any musician could lead.

The patients are presented with variety of easy-to-play instruments, mainly percussion. They are given the opportunity to play the instrument of their choice during the session. How they choose to play is also a great assessment technique, seeing where they are in the course of their illness. The groups work well for both assessment and therapeutic treatment.

For obvious reasons, Audrey keeps a less expensive violin at the work place. If patients show interest in playing her violin she will allow that too. She encourages expression as a form of therapy. The violin can be a powerful tool for the patients to express themselves with, and also a great way for Audrey to be expressive in her musical interventions.

Audrey plays the violin in support of the patients improvising on percussion instruments, and occasionally it is one of many instruments that they choose as a means for self-expression. She shows them the basics of holding the violin and bow, and allows them to be free creatively while they explore the instrument. However, she stresses to the patients that she is a therapist, not a teacher.

She often uses the keyboard and guitar, as they are harmonically complete, though she also plays all the instruments available to the patients. The presence of her violin also has a significant influence on the group.

“Not only is it my primary instrument,” she says, “I feel I have greater control of timbres and phrasing than on a keyboard, so I can communicate emotionality much more effectively. Also, in a setting where patients’ concentration spans and frustration tolerance are often low secondary to their presenting symptoms, the novelty of a live violinist can be a useful means of grabbing their attention, allowing me to make clinically indicated musical interventions on my violin.”

The primary focus is what the music means to the patient. People will put into music what they cannot verbalize. Music is an important way to communicate. Have you ever heard a musician make his or her instrument “talk”? Have you ever watched a live music performance where it seemed as though the musicians were carrying on a conversation with their instruments? This is one of the guiding principles of music therapy.

To give you an idea of what a music therapy session is like, here is an excerpt from an article that Audrey wrote titled “The Use of Analytical Music Therapy in an Inpatient Psychiatric Setting”. The names have been changed to protect the patients’ identity:

Andy, 35, had schizophrenia and initially presented with bizarre delusions, e.g. about his responsibility for making rainbows and keeping the universe in order. After a few weeks on medication he no longer verbalized these delusions, and though he was socially isolated from his peers, he no longer appeared so internally preoccupied.

The group began with the patients choosing their instruments from a selection in the middle of the room. The initial musical section is an assessment tool, particularly with regards to the patients’ rhythmic organization and interpersonal relational abilities. I have frequently found that there is a correlation between cognitive and rhythmic organization in psychiatric patients. The patients’ choice of instrument is itself symbolic and also an assessment tool.

I sang my directive to the group, asking for one volunteer to lead the music while the others continue to play their instruments and support the leader. The leadership experience allows for the experiences of empowerment, of being in control of the situation, and crucially of being heard, so that the members feel that what they communicate has importance. Structuring the session in this way also builds group cohesion – the patients must work together by listening to each other, an important coping skill for when they leave the structured hospital environment…

Andy was the next leader, and he also played a metallic xylophone. He began by playing two notes a whole tone apart in the upper register. Darlene said, “That’s happy birthday,” and Andy laughed self-consciously and said, “I messed up.” He continued playing, first riffing on two notes close together, then expanding his range to the instrument’s higher and lower ends. I considered Andy’s course of hospitalization – initially he had been quite talkative about his delusions during the groups, but later he had become much quieter. This music was the most communication he had shown since he had restarted his medication.

I chose to support Andy on my violin. This is my primary instrument and with it I have greater control of shading of timbres through my bowing than on a percussive keyboard. I rarely use it in the beginning of a drum circle group due to its limited capacity in creating harmonic structure and lack of bass, but I like to use it mid-group, by which time the notion of musical communication is less novel and the members’ natural curiosity about the instrument does not turn the group into a performance. Its emotional range is vastly greater than the keyboard, which is why I felt drawn to it to support Andy in facilitating his emotional communication.

During Andy’s music, I felt a strong somatic (affecting the body) reaction to the music, when I suddenly felt sleepy and bored. I was aware of my role as a resonator; my body functioning as an instrument that picked up Andy’s affective disconnection.

In my musical reaction, I chose to stay in the lower range of my violin, playing a pattern of alternating between two notes a whole step apart in recognition of his initial musical contribution. I chose to reduce my own range in order to not interfere with his exploration of his instrument’s range. Andy stopped playing after a few minutes and asked questions about the names of the xylophone keys. He asked which notes were higher and which were lower. Carl was eager to impart his knowledge about music theory, and after Carl spoke I asked Andy what his thoughts were about high and low. He smiled and said he tried to play both high and low.

Audrey has been a music therapist for 7 years now. She says it can be a stressful environment due to the acuity of the patients’ illnesses and that they often are demanding of her attention. It is a very demanding to be constantly working with new patients. On average, patients don’t stay for more than two or three weeks. A typical group session is 10-12 patients. Some patients have a very short attention span and can only sit in the group for a few minutes. They can leave when they want. There are times when the improvised music, produced during the session, can trigger painful memories and emotions.

“I find my work as an AMT practitioner immensely rewarding.” She concludes. “I enjoy using my musical creativity in a non-judgmental way, and I appreciate that the therapeutic process is not completely one-sided. Learning to pay attention to the transference/countertransference dynamics continually challenges me to work on my own personal insight. I am a classically trained musician, and becoming a music therapist helped me become less focused on the perfectionist aesthetic qualities in music making and allowed me to reconnect with my own inner music and have fun in the creative process. Although not all of the patients on the unit choose to participate in the music therapy groups, those who do generally give me positive feedback about their various experiences, from the joy of discovering their inner creativity to the relief in finding awareness that they exist as holistic beings not solely defined by their psychiatric diagnoses.”

For more information about music therapy, visit the American Music Therapy Association web site at http://www.musictherapy.org

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