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INTRODUCTION Songs in Psychotherapy

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 INTRODUCTION

Songs in Psychotherapy

Kenneth E. Bruscia

Rationale

A song is any piece of music featuring vocalization of a melody, rhythm, or poetic

text. As such, a song is the outcome of various ways of vocalizing, including humming,
rapping, melodic speaking, singing, improvising, or composing. As implied in the title,
the term “song” is often used by therapists interchangeably to refer to the song itself
and/or or to the song experience, that is, what a person does to engage in the song.
However, each term can also be used separately and specifically to point to a specific
clinical utilization or significance. Thus, when reading this introduction and the cases
that follow, the reader must take note of when “song” is being used interchangeably with
“song experience” and when it is used specifically to refer to the outcome of the song
experience.
A fundamental question to ask before delving into the therapeutic applications of
songs is: what is the nature of songs and song experiences that leads us to believe that
they have any therapeutic potential?
“Songs are ways that human beings explore emotions. They express who we are
and how we feel, they bring us closer to others, they keep us company when we are
alone. They articulate our beliefs and values. As the years pass, songs bear witness to
our lives. They allow us to relive the past, to examine the present, and to voice our
dreams for the future. Songs weave tales of our joys and sorrows, they reveal our
innermost secrets, and they express our hopes and disappointments, our fears and
triumphs. They are our musical diaries, our life stories. They are the sounds of our
personal development” (Bruscia, 1998a, p. 9).
Similarly, each song experience also has its own clinical significance. To sing is to
give voice to ourselves, to bring the song to life within our own bodies, and to lay out
and interpret its verbal and musical messages to the listener. To sing is to express and
release our inner world within a safe container. In contrast, to improvise or compose a
song is to create our own container and literally fill it with whatever contents of our life
we want to share; both are ways of finding an aesthetic way to capture the essence of
our inner and outer worlds, and sharing them with others. When we create a song, we
also have an opportunity to hear the beauty and ugliness of our life. And when we
discuss or re-write a song, we have an opportunity to either doubt, question, and even
reject the contents of the song, or identify with the song and use it as a validation of our
own life experiences.
Because songs have such meaning and significance in our lives, they provide an
easy access to our emotional world, and to the thoughts, attitudes, values, and
behaviors that emanate from it. For this reason, songs can greatly facilitate the process
of psychotherapy, and provide an important vehicle for therapeutic change. The most
common goals for using songs in psychotherapy are: greater self-understanding and
acceptance, self-expression and the appropriate release of feelings, value and belief
clarification, healthier emotional life, improved relationships with others, greater
meaning and fulfillment in life, and spiritual development.
Songs and song experiences can be used as the primary modality of therapy, as an
integral but brief part of every session, or occasionally as needed. They are used within
the context of both music psychotherapy and verbal psychotherapy: to provide access
to a particular therapeutic issue, to provide a medium for working through or resolving
the issue, and to provide an opportunity to represent or consolidate the entire
therapeutic process.
Within the session, songs can be used in myriad ways. The client may identify or
recall a song that is pertinent at any point in the therapy process, the client may then
sing (and perhaps record) the song, or the client and therapist may listen to the
recorded song and discuss its potential significance. Or the client may actually
improvise or compose songs with the assistance of the therapist. What follows is a
description of methods and techniques for presenting songs and song experiences to
clients within a therapy setting. These methods and techniques may overlap
considerably within the same session. They may be used singly or in various
combinations within the same session, depending on client need and the goals of
therapy, as well as the natural flow of the song activity or experience.

Methods and Techniques

Song Selection (or Song Choice)

The client identifies or recalls a song that has significance or special meaning in
relation to him/herself, a significant other, or any aspect of the therapy process. This
can happen in many ways. The therapist may ask the client to think of a song related to
a particular topic or theme, or the therapist may present a list of songs and ask the
client to identify one or more that are most meaningful or pertinent. Or the song may
simply come into the client’s awareness during a session. The therapist may also select
a song that he or she thinks will be helpful for the client to experience in some way.
Song selection is the first step in using many song methods, and therefore is usually
followed by another method, such as performing, listening to, discussing, or re-writing
the song. Techniques of song selection include:
Consciously induced song recall: the therapist asks the client what song comes
to mind in reference to a particular topic or issue arising in the therapeutic
process (Diaz de Chumaceiro, 1998).
Unconsciously induced song recall: a song unexpectedly comes into the client’s
(or therapist’s) awareness during a session, or in response to a particular topic or
feeling arising in the therapeutic process (Diaz de Chumaceiro, 1998).
Song communication: The client is asked to choose, identify, and then share a
song that reveals something about him or herself or a song that has special
significance or meaning for the client. The song may be concerned with the
client’s beliefs or feelings, or a song that relates to a particular period of life, a
particular person, or a relationship. The song may also depict or describe how
the client sees him or herself, thereby revealing the client’s own personal identity.
Cases 11 (Martin) 16 (Whittall) illustrate the clinical significance of the client
choosing songs to sing or play in the therapy session. The therapist may also
make a “song communication” for the client. Here the therapist composes or
chooses a song that provides some kind of therapeutic message to the client.
Case 15 (Uhlig) shows how the therapist created a special song for her client to
communicate that she had and would take “time” for him. In another case, Uhlig
asked the client to bring in songs that described the different parts of her
personality, and then they both sang them.
Song Dedication: The therapist asks the client to select a song to dedicate to a
significant other in the client’s life, and then client present it to the person. A
 version of this can be found in Case 6 (Hilliard and Justice), who had the client
designate songs to give to particular friends of his as a remembrance.
Song Collage: The client selects and sequences songs or excerpts thereof in
order to produce a recording that explores autobiographical or therapeutic
issues. One example is a “song legacy,” where the client puts together a series
of songs or pieces of music as a remembrance or parting gift (Dileo & Dneaster,
2005). Case 6 gives an example of this kind of legacy. In case 16 (Whittall), the
therapist made a tape of songs selected by the client to leave as a remembrance
of her.

Song Performance (or Singing)

The client, therapist, or both sing an existing song as a means of experiencing,

expressing, and exploring the feelings and ideas contained in it. When we sing a song,
we “live” in the words and music of the person who wrote the song. We literally walk in
their shoes. We step into the song-writer’s place, we voice words the lyricist wrote, and
we sing a melody that was composed to express the meaning of the words. But while
we are identifying with the lyrics or music that has been “given” to us, we also have an
opportunity to bring our own life experiences to bear. We can give the words and music
our own interpretation, and going even further, we can explore many different ways to
interpret the song until we find the one that suits our own particular identity or life
experience. The song is something that is “given,” it has a certain topic or message, it
examines a particular life situation, and it unfolds like a story or poem within a certain
structure. But when we sing it, we find ways of living in or being with the song’s many
messages. We put our own emotional “twist” on the topic or message, we take our own
perspective on the situation, and then we work the boundaries of the structure that has
been given to find our own feelings, and to give the song our own “identity.” We literally
find and create ourselves within the boundaries provided by the words and music. Most
of the cases in this book involve singing existing songs. A very interesting example is
Case 7 (Kaser) where the client explores myriad feelings through karaoke singing of
many different songs.
When we sing one of our own songs, a song that we have created previously, we
are given a chance to revisit what we had tried to express about ourselves when we
wrote it. Sometimes we still feel the same way and singing the songs gives us a chance
to re-visit our thoughts and feelings and to re-experience them again moment by
moment. Sometimes we have moved on in one way or another, and we are reminded
how we were or how we previously thought and felt in contrast to where we are today.
An excellent example is Case 9, (Logis) which gives a moving account of how Maria
sang an entire concert of songs for her friends that she had improvised previously in
therapy with Alan.
An important aspect of every song is that there are at least two parties involved, the
person singing and the person or group being sung to or sung for—not only someone in
the room, or someone in our lives, but also the intended “receiver” of the messages
given in the lyrics. We can consider every song as an implied dialogue, and we can
interpret them as dialogues with ourselves, significant others, or the world at large, or
we can see the dialogue as consideration of two differing ideas or people. Thus, when
the client or therapist sings a song in therapy, it is important to explore who is singing to
whom, or the dynamics implicit in the lyrics, or the dynamics of the singing or
performing in the therapy room. Clarifying the receiver in this way makes the song a
form of communication for the client.
Sometimes singing a song can be a preparation or rehearsal for expressing how
one feels to another person who is not in the room. In therapy, clients are given
opportunities to sing songs that express their true feelings toward another person with
whom they have difficulty communicating. They can sing songs of anger, or love, or fear
to the person without the person being present, and this eventually helps them to
express themselves more directly in the future.
Clarifying the dynamics implicit in the song and its performance, that is, identifying
the “sender,” “receiver,” and/or “audience” for a song, enable the client to make a
therapeutic “song communication” (See below). This technique is akin to the “empty
chair” used in Gestalt Therapy.
All of the cases in this book involve clients and therapists singing to one another, to
characters in the lyrics, to significant others, and to the world-at-large, yet each case
reveals a different context or reason for the significance of both the singing and the
song.

Song Discussion

The client(s) and therapist sing or listen to a song selected by client or therapist,
and afterward discuss any or all aspects of the song itself or the client’s reactions to or
relationship with the song. Then client and therapist try to connect the song or the
client’s reactions to the client’s life and the therapeutic issues at hand. Different
techniques include:
Song Reminiscence: The client sings or listens to a song (selected by client or
therapist) that is associated with the client’s past. While listening, the client is
asked to bring forth memories from the period; then client and therapist discuss
the memories and their therapeutic significance (Bruscia, 1998).
Song Regression: The client sings or listens to a song about childhood or youth,
and is guided by the therapist to re-experience or relive a particular period, event,
or situation in the past. Often the client is in a relaxed state (Bruscia, 1998).
Lyric Analysis: After experiencing a live or recorded song, the client and therapist
examine potential meanings of the lyrics, and then arrive at an interpretation that
best fits the song, the client, or therapeutic situation.
Song Discussion: After listening to a song, the client and therapist explore the
various thoughts, feelings, memories, or images that the client experienced
during the song, whether related to the music, the lyrics, or neither. The focus is
on whatever arises while the client listens to the song. The therapist facilitates
the discussion by asking about various layers of reactions, physical, emotional,
mental, and spiritual.

Song Improvisation

The client, therapist, or both extemporize melodies, lyrics or songs that portray
what the client and/or therapist is feeling or experiencing in the moment, or what issues
are emerging in the therapeutic process or their relationship. Therapist and client may
take any roles that they find meaningful: each may lead or follow with either the melody,
lyrics or musical accompaniment, singing or playing alone or together. The singing and
the song emerge as the therapeutic process unfolds moment to moment, and the client-
therapist relationship takes shape in sound.
This book provides several examples of how improvised singing or song
improvisations can be used in psychotherapy. Techniques of implementation include:
Extemporaneous client-therapist dialogue with therapist accompaniment: The
therapist and client sing as if they were talking to one another, while the therapist
provides an accompaniment. See cases 1 (Austin), 3 (Dvorkin), 5 (Henderson),
 13 (Robarts), and 15 (Uhlig) for examples. The dialogue may be a
free-association or a more organized dialogue around a particular focus. The
focus may be here-now experiences in the therapy session or the thoughts and
feelings the client is bringing to therapy. The song improvisation can also be
evoked by presenting a song title and then asking the client to improvise a song,
or to ask the client to improvise the song around an event, image, feeling, or
significant person. This technique and the next are descendants of the recitative
and aria in an opera. The recitative moves the story along through “speech song”
or “sprechgesang” accompanied by a few intermittent chords. In speech song,
each syllable is given one tone, and the dialogue moves ahead quickly. In
contrast, the aria provides a character the opportunity to reflect upon the situation
and express his or her ideas or feelings about it. Here the syllables are given
more tones (i.e., they are melismatic), and the melody and accompaniment are
more concerned with expressing the underlying emotions.
Client-improvised solos with therapist accompaniment. Cases 9 and 10 by Logis
and Turry provide an example of this technique. Maria makes up words and
melodies extemporaneously, either about her here-now experiences in the
therapy room or about thoughts and feelings about people or events in her life,
while Alan improvises a piano accompaniment to elaborate, support, and extend
Maria’s melody and lyrics.
Improvised Song Stories. The client and/or therapist improvise music that tells a
story. The story may be a well-known one, or it can be one created by the client
before or during the improvisation. In case 5 (Henderson), therapist and client
explore the client’s feelings by improvising a story created by the client while
playing with puppets. Instruments can be selected and played by the client and
therapist to symbolize a character in the story.
Improvised Play or Games. The therapist and client improvise singing while
creating a play scenario or game. Instruments are often used to stand for
elements of the scenario.
Improvised Poem Settings. In Case 2 (Boone), a forensic patient writes poems to
bring into therapy and then improvises an instrumental his own accompaniment
to them for the therapist.
Reflective Vocal Improvising. The therapist improvises a song as if talking to him
or herself about the client, reflecting what the client may be doing or feeling. This
technique is also called soliloquizing.

Song Parody

The client is asked to re-write part or all of the lyrics for an existing song. Assisted
by the therapist, the client changes words, phrases or the entire lyrics of a pre-
composed song, while maintaining its basic melodic and harmonic structure. This
technique is also called “lyric substitution.” Case 8 (Krout) gives an example of
bereaved adolescents changing the words to an existing song, entitled “Our Paths to
Peace.”
A song parody has very important clinical implications. In rewriting the lyrics of a
song, the client is literally given the chance to change “what is” or the meaning of what
is “given.” The existing lyrics usually represent the way things are, or the way someone
says they should be, whereas the rewritten lyrics express the way the client wants them
to be, or thinks they should be. The only structure that is “given” is the melody.
Contrast this metaphor with singing an existing song, where the client’s feelings
have to align with both the lyrics and the melody of the song, and with song-writing
where the client has complete freedom to create both.

Song Writing

Therapy centers around the client(s) composing lyrics, melody, accompaniment, or

a complete song, with the musical support and assistance of the therapist. In creating
the song, clients are given an opportunity to construct a story or poem about
themselves, a particular life situation, event, feeling, relationship, or therapeutic issue.
And most importantly, the client is given an opportunity to create or decide upon how
this story or poem is set to music. The song is like a poem or story of the self, that
comes to life in its musical presentation. The process of song-writing is not as
extemporaneous as improvising a song, for each lyric, tone, rhythm, and chord have to
be considered, and ultimately the client has to decide about what the song will say and
how it will sound. An important aspect of song-writing is that the lyrics and/or music are
written, notated, or recorded in such a way that it can be re-created and performed by
the client and/or therapist. In Case 12 (Pavlicevic), a client writes a song and brings it
into the group to be performed. In case 14 (Smith), a woman’s struggle against
depression and suicide is documented through the songs that she writes with the help
of her therapist.

Orientations to Songs

At least five theoretical orientations have been used by music therapists when
using songs. They are: cognitive-behavioral, psychodynamic, humanistic, and socio-
cultural. Each orientation conceives of the song and the song experience in different
ways, and offers different explanations for their therapeutic utilization and meaning.
Each orientation will be discussed briefly here.

Cognitive-Behavioral

In the cognitive-behavioral orientation, the song itself is considered a therapeutic

stimulus, reinforcer, mediator, or response. When used as a stimulus, the therapist uses
any or all aspects of the song to elicit or modify the client’s mood, thoughts, attitudes,
feelings, beliefs, or emotions. Or, when the song is well-liked or brings enjoyment to the
client, the therapist can also use the song to reinforce target outcomes of therapy.
When used as a mediator, the therapist uses the song to activate previous associations,
memories or learning that the client has already attached to the song. And when used
as a therapeutic response, the song is considered the outcome of the therapeutic
process, as when the client sings or writes a song as a manifestation or confirmation of
what has been learned or changed as a result of therapy.
The song experience (e.g., the process of singing, writing, listening, etc.) in a
cognitive-behavioral orientation is a context for eliciting or rehearsing the target
response. More specifically the target thought, attitude, belief or feeling are incorporated
in the song experience in a way that encourages or even requires the client to exhibit
that target response.

Psychodynamic

In a psychodynamic orientation, a song is a projection or symbolic representation of

the self, other, or self-other relationship—as we conceive them consciously, or as they
are manifested unconsciously through introjects. The content and nature of these
projections and representations vary substantively depending upon whether we are
creating, co-creating, or recreating the song, the “dynamics” implicit in the song or song
experience, and whether we are projecting from words to music or from music to words.
Thus, the song experience influences the projections and representations embedded in
the song.
Songs and song experiences are consciously and unconsciously associated with
significant events, people, experiences, and periods in life, and with their concomitant
thoughts and emotions. These associations are unique to each person. Thus, each
person has a song history that provides glimpses into the person’s biography.
Moreover, songs and song experiences are developmentally nested according to
the needs they serve to a person at various stages of life. Thus, certain songs and song
experiences typify certain developmental stages, and these songs and experiences can
be used to access conscious and unconscious material from those periods. This
developmental nesting further reinforces the unique relationship that each person
develops with songs and song experiences.
Song experiences such as singing, listening, or composing are “transitional spaces”
in which clients can explore, discover, experience, and even change various aspects of
self in relation to the world. Going even further, the way the client engages in the song
experience is a projection of how the client engages in that aspect of life presented by
the song. For example, the way the client sings is a projection of how the client usually
expresses feelings, including not only those feelings embedded in the song, but also
other feelings; the way the client goes about interpreting a song is a projection of how
the client interprets other aspects of his or her world; the way a client changes a song is
a projection of how the client goes about making changes in other arenas of life; and
how the client creates a song is a projection of how the client builds a container for
examining and expressing aspects of his or her life.

Humanistic and Existential

Whereas songs are primarily about conscious and unconscious representations in

a psychodynamic orientation, in a humanistic orientation, songs are about personal and
interpersonal contact and congruence. Songs provide opportunities for clients to be in
contact with themselves and others, while also exploring the congruence of their
feelings and the ways they express them verbally and nonverbally. Songs are equally
important for the therapist. They provide a vehicle for the therapist to be in contact and
empathize with the client, while also providing opportunities to accept and offer positive
regard to the client in a genuine and congruent way.
Within this perspective, the songs and song experiences of the client are hardly
ever interpreted by the therapist; instead, the client is continually invited to be in contact
and congruent with all aspects of the song and song experiences, as perceived by the
client. The central question is whether the song and song experience are genuine
expressions of the client. When interpretations are indicated, client interpretations are
always given credence over the therapist’s.
When an existential flavor is added to the humanistic perspective, songs and song
experiences go beyond contact and congruence to include issues of power, freedom,
responsibility and will—all of which are subsumed under the construct of authenticity.
When taking this orientation, the therapist and client explore these kinds of authenticity
questions—within the content of the song, and in the moment-to-moment song
experience:
If the client has the ability or power to do something, does she acknowledge or
deny that ability or power in the song or song experience? Conversely, if the
client does not have an ability or power, does she acknowledge or deny the lack
thereof?
 If the client has the freedom to do something, does she acknowledge or deny
having that freedom in the song or song experience? Conversely, if the client
does not have a certain freedom, does she acknowledge or deny the lack
thereof?
If the client has a responsibility to do something, does she acknowledge or deny
this responsibility in the song or song experience? Conversely, if the client does
not have responsibility for something, does she acknowledge or deny the lack
thereof?
If the client has the will to do something, does acknowledge or deny this
willingness in the song or the song experience? Conversely, if the client does not
have the will to do something, does she acknowledge or deny her unwillingness?
Authenticity then is acknowledging who one is and is not and what one has and does
not have; inauthenticity is denying who one is or is not and what one has and does not
have.
Of course, these four areas of authenticity interact. For example, one can be
authentic with regard to power, but inauthentic with regard to responsibility, or one can
be authentic with regard to responsibility but inauthentic with regard to freedom or
power.

Socio-Cultural

In the socio-cultural orientation, songs are a collective phenomenon as much as if not

more than an individual one. Songs are an expression of beliefs, values, and concerns
of groups, societies, nations, and cultures, and often they belong only to that collective
entity. They are unique manifestations and expressions of collective identities and
rituals. Thus, songs serve myriad and different functions within every group, and are
also interpreted differently between groups.
Given their socio-cultural nature then, songs and song experiences of individuals must
be considered contextually, that is, in light of the specific group or community to which
each individual belongs. Thus, a client’s song or song experience cannot be understand
only within the context of personal history, or personal projections and representations,
instead all collective influences and underpinnings must also be considered. Similarly,
concepts of contact, congruence, and authenticity, and how these concepts are
manifested in songs or song experiences may be more specific to a collective identity
than the individual client.
The socio-cultural orientation is concerned with being culturally sensitive to the
client. In music therapy, this means that the therapist must be aware of the music of the
client’s culture, and its meaning and role in the client’s society; and just as important, it
means that the therapist be aware of how therapy is conceived in the client’s culture,
and its significance and role in the client’s society.
Songs can also go beyond a collective identity to be regarded as archetypal. When a
song is regarded as archetypal, it is not merely the expression of an individual, group, or
community, it is an expression of the human condition itself. The song or experience
reflects universal experiences of humankind, and emanate from the inherited, collective
psyche of the species.

Issues in Understanding and Interpreting Songs

Based on the above discussion of orientations, it becomes clear that many

variables and perspectives must be considered if the therapist is to understand or
interpret a client’s song or song experience. When taken together, however, certain
basic approaches emerge.

Meaning of the Lyrics

The first and probably most basic question is what is the meaning of the lyrics? The
answer depends on the level of interpretation. When interpreted on the individual
(psychological) level, the lyrics provide insight into the client’s personal world, and
depending on orientation, that personal world can be conceived in terms of target
outcomes, unconscious projections and symbolic representations, transitional objects
and space, personal and interpersonal contact, genuineness, and authenticity. The
lyrics may also typify a particular developmental stage which must be considered when
understanding the client’s relationship to the song in the present.
When interpreted on the socio-cultural level, the lyrics provide information on the
beliefs and values of a particular group, community, nationality, religion, organization,
society, gender, or age bracket. When interpreted on an archetypal level, the lyrics
reveal aspects of the human condition, life, the nature of the universe, etc.
The answer also depends on who is interpreting what. Are the client and therapist
interpreting what the original lyricist meant? Are the lyrics being interpreted in terms of
how the song was sung? Is the client interpreting what the therapist’s song means? Is
the therapist interpreting what the client’s song means?

Music

Several questions can be explored: What feelings or emotions are expressed in the
melody, voice, rhythm, and accompaniment? Are the various musical parts congruent
with one another? How do these musical feelings fit with the lyrics?

Personal Associations

Several questions are pertinent: Is the song associated with the client’s past or
present? Was it popular during a particular period in the past, or was it a song learned
in childhood? Is the song associated with particular events or people? Is it associated
with a particular developmental stage? Is it a song that is hated or preferred, and why?
How frequently was/is the song heard or sung?

Dynamics

Considering the lyrics, who is singing what to whom, and for what purpose? With
whom is the client identified? Considering the music, how are the various elements,
parts and musicians organized in relation to one another? Is the singer singing solo,
with one other instrument, or many? Are there back-up singers? How are the various
instruments balanced in relation to one another? Are there contrapuntal melodies or
rhythms? With which part is the client identified?

Reactions

How does the client react when singing or listening to the song? Are there visible
physical or emotional reactions? Does the client shut out the song? Are there phrases
or lines in the lyrics that are particularly moving or disturbing? Does the client identify
with the song? Are there paradoxical reactions? Do the lyrics articulate unspoken
wishes of the client?
 Final Comments

Songs and song experiences are rich in therapeutic potential. They serve myriad
psychological, social, cultural, and spiritual functions. They are an integral aspect of
individual development and collective evolution. They emanate from and become
attached to important events, people, and periods in our lives, and as such become an
integral part of our life story.
Songs are also unifying. They marry music with word, and voice with instrument.
They unite sound and image in the world of symbols—personal, cultural, and
archetypal. They bring together nonverbal and verbal ways of being in the word,
musically and personally. They form a special union between singer and listener, and
they unite all members in their presence. And ultimately, songs unite the mind, body,
and spirit—which in itself is a healing experience.

References

Bruscia, K. E. (1998a). An Introduction to Music Psychotherapy. In K. Bruscia (Ed.),

The Dynamics of Music Psychotherapy, pp. 1–15. Gilsum NH: Barcelona
Publishers.
Bruscia, K. E. (1998b). Defining Music Therapy (Second Edition). Gilsum NH:
Barcelona Publishers.
Dileo, C., & Dneaster, D. (2005). Music Therapy at the End of Life: State of the Art. In C.
Dileo and J. Loewy (Eds.), Music Therapy at the End of Life, pp. xix–xxvii. Cherry
Hill NJ: Jeffrey Books.

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