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MUSIC THERAPY & AUTISM

Saturday 17th June 2006, Winchester

Our 10 th annual conference attracted more delegates than ever, and it proved to be a highly inspiring and thought-provoking day.

In choosing Music Therapy and Autism as our title this year, we gave ourselves a greater focus on a specific topic than in previous years, and the size of the audience indicated this had been a popular decision. In adding ‘…the spectrum of life’ to the title we wanted to get across that being autistic is not wrong in a right world, but more like ‘being a cat in a doggy world’ (Donna Williams), and that, to a certain extent, we are all on the spectrum.

At the conference we gained incredible insights into what life is really like as an autistic person. We were then prompted to think about our creative responses and heard from professionals who had drawn theories from their own experiences.

LOGICALLY ILLOGICAL: INFORMATION AND INSIGHT INTO AUTISM - ROS BLACKBURN

Ros Blackburn – Biography

Ros is an adult with autism. At 3 months old she appeared withdrawn, isolated and very much in a world of her own. At 6 months she was diagnosed profoundly deaf, which later proved to be far from correct. Finally at a year old she was diagnosed very severely autistic but with average intellectual ability. Now at 36, Ros tends to feel that although many areas of her autistic condition have remained very severe, others, such as her severe Language delay, have disappeared almost completely. Ros has given many talks and presentations about her autism to professional audiences throughout the UK .

Presentation Summary – Logically Illogical

Ros described the many aspects of living and working with autism, wowing the audience with her invaluable insight into her own autistic world. She talked about labels how changing these makes no difference to the condition: “ESN is now considered passé / bad, but is SEN really fine?” She used humour, too:“ …as a ‘ consumer’ of services I can say I have certainly bitten many psychologists and teachers but I haven never consumed a whole one…”!. She described the meaning of ‘autism’ from AUTOS Greek meaning ‘self’, and sought to correct public preconceptions by outlining the major difference between autism – not wanting social contact, and Aspergers – needy for social contact. Autism and Aspergers should not be considered on the same spectrum

She talked of social skills being teachable as apposed to sociability which is not. The human condition is one of fear and a need for comfort. Fear affects rationing, mood, behaviour and function. This is exaggerated in autism as each new situation has to be learnt before the fear is gone, and even returning to a previous situation is never exactly the same as it was the first time. There can be no assumptions, only facts. Names, body language and facial expression are all very important and need to be taught. Autistic people need time – loads of it – to piece together all the millions of bits of information available in each new or slightly new setting. The difficulty with this has nothing to do with intellect, but with processing information and it results in considerable problems with transitions. However, being autistic must not exempt a person from change – they need to hear ‘that’s unfair’ / ‘wait’ / ‘no’. Some organisations working with autistic children bend over backwards to avoid any waiting for them, but to do this does not help them to function in the non-autistic world.

Ros gave graphic examples of her experiences, talking about her history from her early diagnosis to the present time and discussing some of the practices that played an invaluable part in her progression: her parents, both doctors, knew she was intelligent, but couldn’t prove it. They restricted her access to food, providing only water, until she showed them what she wanted - until she communicated, and she having then taken her father’s head to the fridge door and hit it hard against it, they now insisted she use words to explain what she wanted. In so doing she began to speak. She praised her parents for their continual support.

Ros described the fun she has as well as the ways in which her autism continues to restrict her life. Her upfront honesty was refreshing as well as amusing. Asked why she gave these talks, she replied: “I’m not interested in you knowing about autism… it gives me money so I can go ice-skating and trampolining…”. Her talk illustrated the problems of having an uneven profile of strengths and weaknesses, where often the strengths mask her very real difficulties and needs.

Ros may feel far more passionate about going trampolining and ice-scating than whether or not we get to know about autism, but we did learn a considerable amount through her personal insights and the unforgettable way in which she presented life on the autistic spectrum.

WORKSHOP SESSION: AMALIA BRIGHTMAN

AmaliaBrightman – Biography

Amalia originally trained at the Nordoff-Robbins Music Therapy Centre. In the last few years she has been working as co-therapist alongside a State Registered Drama & Movement therapist. She also attended Laban movement courses and a variety of Drama and Movement Seminars. Ongoing individual and group supervision with various creative arts therapists as well as the experience of being a client in Transpersonal and Jungian Psychotherapy enabled her to incorporate symbolic, relational, emotional, psychological and spiritual aspects of the Arts Therapies into her clinical work. She was also able to explore music and movement strategies during music therapy sessions with children and adolescents on the Autistic Spectrum.

Workshop Summary – Forming therapeutic relationships using a music and movement approach

Music is very much felt in the body. Fundamental musical elements such as rhythm, melody and dynamic energy are expressed in body movements, gestures and sounds and form a profile of the child’s responses and ways of being. Music therapy forms part of the creative arts therapies, which focus on the personal, social, emotional and creative development of the child / adolescent. It is a process in which the child is at the centre and where the therapist is enabling innate musical responses to develop building a vocabulary based on musical elements, promoting self-expression, communication and interactions.

The workshop consisted of 2 main parts:

• T.E.A.M approach: Trust, Empathy, Assistance and Meaning. Participants explored music & movement interventions looking at relating and expressing through body, rhythm and sound, based on these four clinical aspects and considered applying this to the clinical area of autism.
• Autism and Relationships: working with various social patterns such as partners and in groups,
• gross and fine motor movements combined with specifically chosen musical elements, developing a non-verbal vocabulary.
• Putting sounds to gestures to enable connections and inner musicality to emerge. The objective was to increase awareness through sensory stimulation to promote alertness, developing mutual acceptance, self expression, communication and interactions.
• Six Themed musical experiences: Group improvisation on themes from a poem by an anonymous medieval Irish writer (Sun, Moon, Wind, Earth, Sea, Heavens). See photo at the beginning of this Conference section. This final part was most effective musically. Feedback was less positive concerning the earlier exploratory work expected of participants in this workshop, but it is doubtful if the final group improvisations would have had such emotional depth and freedom of expression had it not been for these warm-up exercises.

 

 

The wonderful duo, ‘Tant’, performed at lunchtime. ‘Tant’ consists ofHMS therapist Owain Clark on Celtic Harp and Jon Leadbeater on tabla and percussion.We recommend their beautiful CD which they kindly had on sale on the day for £10, proceeds to HMS, now often to be heard drifting out of the HMS office…

 The afternoon kicked off with our music therapy key-note presentation:

 

 

 LINKING AND THINKING IN MUSIC THERAPY WITH AUTISTIC CHILDREN – JACKIE ROBARTS

Jackie Robarts – biography

Jackie is a Senior Lecturer & Senior Therapist at Nordoff-Robbins Music Therapy, London , where she teaches Clinical Improvisation and Musical Resources on the Masters training program. Both in the National Health Service (on the CAMH teams for both St. George’s and SW London NHS Trusts) and at the Nordoff-Robbins Centre, London, where she also works with adults, she has many years’ experience of working with children on the autistic spectrum, children with special needs, with psychiatric problems with a focus on eating disorders, elective mutism and emotional-behavioural problems relating to early trauma and sexual abuse. She works with parents, families, and multi-disciplinary teams in education, health and social services. Jackie has held two successive Research Fellowships at City University , London , where she is completing a doctorate on ‘Clinical pathways in music therapy with autistic, abused and anorexic children’. Her work is informed by infancy research on early communication, linked with psychodynamic and neurobiological understanding of affect regulation in building coherence of self. Her findings have been published as chapters and papers in many music therapy books and Journals. She has presented widely to interdisciplinary and music therapy audiences in the UK , Europe , USA , Japan , and most recently in Qatar .

Presentation Summary – ‘Linking and thinking in music therapy with children across the autistic spectrum'

Jackie examined creative-constructive functions of music therapy in regulating emotions and shaping experiences of self and self-in-relation with special reference to autistic children and children who are hard to reach. Discussing experiences from her own music therapy practice, Jackie explored an interdisciplinary model of clinical pathways to illuminate music therapy processes in the development of mind and meaning with children across the autistic spectrum.

Jackie began her presentation with 2 quotations from Ros Blackburn, 2004, Awares: ‘So why, if I can be shrewd, is my bracket so limited? Maybe it is because I cannot work out what is going on in the world around me. I can’t piece sensations together. How often are people with autism given the time to put all the pieces together? Virtually never! This has nothing to do with the intellect. I just need masses of time’, and: ‘In so many ways, there is nothing strange about autism. We are all human. It is true that a huge part of our role as professionals or carers is to impart information. But even more important is to equip people with autism with coping strategies. Expose them to lots of different situations. Help them see the whole, rather than the detail. I am … a word ‘junkie’ – it is non-verbal communication I find hard.’

Jackie pointed to some of the aims of music therapy for children with autism:

• Getting to know each child’s characteristics – personal style, ways of experiencing the world, individual strengths and needs
• Working with parents and siblings – contributing to and keeping in touch with the whole picture of the child’s and family’s world
• Augmenting positive/tolerable experiences of self and other through music using early play strategies in individual and small group work
• Helping develop emotional internalization of communication by assisting emotional regulation
• Musical-temporal shaping of experience: imitation, initiation, repetition within a spontaneously evolving interaction
• Freeing from habitual or fixated behaviour – helping the child ‘switch off’ from compulsions
• Increasing tolerance of new experiences – NB the physicality of mental experience.

Explaining how music therapy can ‘help to prevent shutting out the world’, Jackie emphasised the importance of physical-emotional regulation in music therapy:

• Music can influence the visceral levels of being that are beyond words
• The music therapist apprehends and responds to the flow of ‘vitality affects’ of human expression, musically working with their dynamic expressive forms
• Music can regulate emotional response and arousal states, helping to develop the child’s capacity to take in, to assimilate experience
• Music can mediate emotional experiences, building forms of shared meaning and symbolic expression but not necessarily for all children

Music and musical instruments augment a bodily sense of self:

• They resonate and give sound to an individual’s ‘being’ and ‘doing’
• They augment and extend experiences of self and self-in-relation through tonal-rhythmic field of sympathetic resonance and through the architecture of musical form
• Using musical instruments in play can facilitate externalising core motivations: neuro-physiological, physical, emotional, mental.

Jackie summarised her presentation by saying: ‘The power of music therapy resides in our careful listening, waiting, attending and witnessing, in order to learn from our clients more about music’s therapeutic potential and how to use it creatively and sensitively for each individual. We need to be open to infinitely varied ways of linking (piecing together) that may help autistic children cope with our and their differences. We need to be open – broadly and deeply attentive – in our thinking about all that music therapy brings into play.’

 At this point Beccy showed excerpts from the DVD which had been acquired by HMS for this conference, of Donna Williams’, Australian autistic authoress of Nobody Nowhere and Somebody Somewhere, from a talk she gave in Oxford ’05. Although following Donna’s verbal outpouring was exhausting, her main message was highly relevant: that being autistic is not wrong in a right world, but more like ‘being a cat in a doggy world’. Nobody Nowhere is to be filmed in England soon.

 'FELLOW TRAVELLERS' - musical ‘snapshots’ and reflections from a journey with a young autistic client through music therapy - LEIGH WARREN-THOMAS

Leigh Warren-Thomas - Biography

Leigh qualified from the Guildhall School of Music and Drama in 2002.  She was inspired to train by her experiences of working in a mainstream high school, initially as a librarian and subsequently, a learning support assistant. Children often revealed serious personal difficulties through casual conversations with her. "I believe they came to talk to me because I was perceived as more approachable, being a non-teacher. What frustrated me was that I was powerless to do anything to help them". Since qualifying, Leigh has worked as a music therapist in many community settings with both children and adults through Hampshire MusicSpace.

Presentation Summary - 'Fellow Travellers'

Leigh shared some reflections from a journey through therapy with a young, autistic client, using music to illustrate aspects of the journey and offered some thoughts about what happened and how the music and their relationship developed alongside each other.

Leigh writes: ‘My work with an adolescent male student, whom I shall call Clive, was based at a school offering residential care and education for young people on the autistic spectrum who additionally have learning disabilities and present challenging behaviour. Before observing him in class, I’d read Clive’s referral form which described his difficulties using terms we all recognise. This seemed like quite a list of labels and it evoked in me expectations of a difficult client: autistics, ADHD, Challenging behaviour, Learning disabled, No meaningful language. I then observed Clive in class and was powerfully struck by his chaotic presentation and wild energy. I thought ‘what will I be able to do with this person? Where on earth do we start?’.

In the early sessions I experienced in Clive many characteristics of a very young child. His presentation in these sessions seemed to combine 3 main facets:

• the open curiosity and love of exploration which is typical of small children
• a sense of shyness (withdrawal)
• vulnerability.

I felt quite pleased with how the work began. Clive was revealing different aspects of himself and seemed to find the experience enjoyable. There were some sessions which felt very difficult – Clive sometimes seemed unreachable. When unsettled or withdrawn he would chew anything he could find, even licking the rug on the floor. I felt the best thing to do was to wait for him to respond to a musical holding – a quiet pulse on a hand drum and soft, wordless vocalisations. Reflecting on this now, these sounds are similar to those heard by a baby whilst still in the womb – a heartbeat and a mother’s voice.

Weeks and months went by – although no two sessions were ever the same and the work didn’t’ feel particularly ‘stuck’, I began to question how valuable a long-term continuation might be. Clive seemed to enjoy his sessions but there was often a very scattered feel to our interactions. One morning, after we had been working together for just over a year, Clive came for his sessions and our journey changed direction. The session began very quietly. Clive seated himself at right angles to me an began to play the cymbal with his knuckles. He had used the cymbal before ‘in passing’ but this had a specifically intentional feel about it. He watched me in a focussed manner as he played and waited for my answer. There is a lot of space between our cymbal and voice sounds, underpinned by a drum pulse. I had a sense that Clive was thinking about and realising the reality of our contact – he seemed to understand the cause of his cymbal playing ad the effect of my voice. Our sounds are controlled and quiet but inside I am incredibly excited. It seemed that in Clive’s consciousness the concepts of call and response, cause and effect, had become embedded in his musical relating. He had show clear awareness of me and my sounds, and an understanding of how they were related to and affected by his own. This evidence of intentional communication and awareness of self in relation to another seemed very important in the context of Clive and his diagnosed difficulties.

Another 9 months further on Clive had used his voice very freely before but today produced new, strongly musical sounds, repeating shaped phrases and leaving spaces for me to respond. Interspersed with these were taps on the cymbal with Clive looking at me when I sang my response. His teacher had accompanied Clive that day. She caught my eye just as they were leaving’ we were both deeply moved by what we had just experienced.

We finished working together early this year, after nearly three years of therapy. During this time we had prepared for many breaks but Clive was always told that I would come back afterwards, and we would see each other again. So with such an ending in sight I was concerned that Clive should understand as best he might that a fixed amount of time remained for us to be together, and that he would know that when we said our final goodbyes, I would not be coming back. I used a series of photographs to help Clive count down our last four sessions, showing him 4 pictures on a board at the beginning of a session, then removing one at the end. In the last session Clive seemed quiet and subdued; his sounds felt disordered or disorganised, which perhaps reflected a tumult of feelings, or indicated a struggle with ideas, as if he didn’t’ know what he wanted to say or who to say it. After our goodbye song I stood beside him to show him the final picture – he grabbed it, pushed me aside and ran from the room.

Clive had had to risk trusting a new person in a new place and a new situation; I had had to risk taking off my therapy L plates and try to bear the ‘not-knowing’. I feel that through the music we learned to trust ourselves and each other, and travelled as fellows.

 Leigh’s was the final presentation of what, according to the atmosphere on the day, the enthusiastic response of delegates and the written feedback HMS has subsequently received, was a most informative, thought-provoking, inspiring and moving day. One music therapist delegate even confessed they would rather come to Hampshire for our conferences than go to London for those run by our professional association and the British Society, because of content, accessibility and overall value for money!

Thanks to all who helped to contribute to an amazing day.

Please look out for our next annual conference, June ’07.