Download Group Supervision in Music Therapy

Music
Therapy
1984, Vol. 4, No. I, 29-38
Group Supervision
in Music Therapy
BRONX
GILLIAN STEPHENS
PSYCHIATRIC
CENTER
The subject of supervision for the music therapist is becoming
increasingly important in light of growing concern and interest in the
music therapist’s training and development after formal education is
completed. The type of supervision most useful for music therapists
is, therefore, important to address. In this article, the rationale for a
music therapy supervision group which combines verbal and musical
elements is presented. Who might benefit from such a group, what
tools are available, the supervisor’s role, and a possible model are
subjects for discussion. The integration of verbal and musical
elements is explored and techniques of the music therapy super­
visory process are illustrated.
As the field of music therapy expands and a high degree of profes­
sionalism comes to be the norm, music therapists are beginning to focus on
the necessity for further development, training, and support after formal
education. Professionals in the field are becoming increasingly aware of
the need for affirmation and guidance, and for a forum where the ongoing
expansion of knowledge and, particularly, knowledge of themselves in
relation to clinical work, can take place.
In the fields of social work, psychology, and psychiatry, participation in
some form of individual or group supervision has become standard
practice. Music therapists, recognizing the need for support and further
development, have often turned to supervision offered by clinicians in
these related fields. Here they find opportunities for growth and under­
standing of individual and group process, transference and counter­
transference issues, and leadership style, and encouragement in develop­
ing observational skills.
Music therapists have, however, discovered certain drawbacks to this
type of supervision. The lack of understanding of the supervising clinician
as to the nature of music therapy and the specific problems that occur for
the music therapist often put the music therapist in the position of
once again explaining what music therapy is and justifying its purpose. In
fact, supervision may begin to mirror the on-the-job experience of being
the “odd one out.”
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Sometimes a music therapist in this situation begins to view music
therapy as simply a translation of verbal techniques into musical activities,
or musical improvisation as only a mirror of group dynamics. The music
becomes secondary and the identity of the music therapist may become
confused. What can then be overlooked is that which is special to music
therapy itself: the music. The original inspiration which guided the
therapist to the field of musical therapy becomes lost; in this there is a loss
to both clients and potential clients. Words alone cannot duplicate the
spark of a smile in the depressed client at the sound of music. How can one
explain in words the strength of a chorus of voices in a chant of cele­
bration?
Music therapy is a unique discipline. Clinicians must develop and
nurture this understanding and identity to bring the field of music therapy
to its fullest expression. Music therapists need to understand process. work
through issues, and observe group dynamics in a way different from
therapists who use the verbal idiom alone. These elements must affect the
therapist’s musical self. The music therapist needs to know when to use
words and when to use music, and to know what in the music is not in the
words. The answers to these questions cannot be found in verbal discus­
sion alone; they must be discovered in a combination of verbalization and
musical encounter and creation. Music therapy supervision can help the
professional develop these aspects.
OVERVIEW
The supervisory experience has been described well and often by those
in related professions. In the social work literature, Austin (1979) writes.
“Because social work deals intimately with person& conflict, pathology;
and lack of adjustment, which may have parallels in the supervisee’s own
life experience, the content itself stimulates introspection and subjective
reactions. Hence, learning about people, in order to help them, is a highly
charged emotional experience. Learning is made usable, largely, through
the support of a positive supervisory relationship which leads the worker
to new insights about people, including himself” (p. 57). The samecould be
said of the music therapist’s experience.
Therefore, rather than deal extensively with the interpersonal dynamics
of the supervisory process, which authors such as Wallerstein (1981) have
capably described and analyzed, I will focus on the elements unique to the
supervision of the music therapist.
McGinty (1980) states that her “findings suggest that many clinical
decisions must be made without the support of experienced supervision
and imply that professional isolation exists in many music therapy
positions” (pp. 154-155). The situation is therefore very difficult for the
music therapist. Lacking regular stimulation, support, and sharing with
other professionals, the music therapist can easily become discouraged,
disillusioned, or confused.
Supervision should strive for a balance of elements: a forum where new
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ideas and personal growth can flourish while at the same time providing a
resource of knowledge and experience. A balance must be found between
developing the therapist’s musical intuition and supporting the intellectual
understanding of the therapy process on a verbal level.
A supervision group offers possibilities for exploration on three levels
which an experienced supervisor can integrate in a way that lends
immediacy to the learning process. The first level is that of the specific
content of material presented by the therapist, such as questions,
techniques, and process. The therapist’s personal connection to the
material and to his or her own musical expression constitutes the second
level. The third is the development and process of the supervision group
itself. The supervision group is, of course, itself a group. It can be used as a
striking illustration of group dynamics and process, although the focus
should be on the immediacy of the learning rather than on a prolonged
exploration of the group process.
Zetzel (1979) writes, “Supervision
involves a special type of inter­
personal human relationship, in which the emotional factors concerned
bear certain important resemblances to (and equally important differ­
ences from) the client-worker or patient relationship” (p. 46). In order for
supervision to be most effective, therefore, the therapist’s own feelings
must be studied and understood.
Music is a rich pathway to such an exploration. By encouraging
musical exploration, supervision can guide the future of music therapy. It
is vital, then, to explore the subject of music therapy supervision: to
discover what issues can be addressed and what tools are available, and to
develop appropriate models for a music therapy supervision group.
THE SUPERVISION
GROUP
When the focus of a music therapy supervision group is primarily on
developing the clinician’s ability to observe, understand, and facilitate the
music therapy process, the group can be valuable to clinicians working
with a variety of populations. These elements have more to do with the
therapist’s growth than with the population with which he or she works. It
is therefore possible to include in the same supervision group a music
therapist working with psychiatric adolescent patients, one working with a
geriatric group, and one working with a group of university students. The
central issues are related.
The actual techniques used in therapy play a less important role, but are
also important. An activity designed for children may be an inspiration for
a session with an adult. A particular way of using a song with a psychiatric
population may become a good method for tailoring a song to suit the
needs of a medically hospitalized population.
content
In general, any professional issue can be part of the supervision group’s
work. Concerns might include clinical issues such as group process, indi-
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vidual process, transference and countertransference, leadership, manage­
ment of a case, and decision-making.
The group can also serve as an arena in which to discuss the practical
aspects of music therapy work, such as the planning of workshops and
strategies for the development of a music therapy program. The sharing of
techniques and inspirations about music therapy can and should occur.
Most importantly, the group is a place to deepen one’s personal under­
standing of music therapy and gain fluidity with musical expression as it
relates to group leadership and understanding clients. The group setting
reinforces members’ identity as music therapists as well as providing an
affirmation of the value of their work.
Integration of Verbal and Musical Work
The integration of verbal aspects with musical elements is a necessary
part of the supervisory process. The work has been divided into four
distinct situations, making it easier to analyze theelements involved and to
understand what an approach using words, music, or their combination
will accomplish. In practice, of course, the supervisor must be flexible in
moving from one approach to another.
Verbal->verbal.
At times, the therapist needs to analyze a series of
events, both musical and verbal, in the course of therapy. He or she wants
to understand the events more clearly and choose a direction for future
work. Words are the most effective medium to address content specifics
and to choose a direction based on this knowledge. The events are verbally
reported; a verbal conclusion is reached. Later, music can help get in touch
with the feeling of the process.
For example, the therapist may wish to study a group in terms of its
cohesion in order to discover where the group is, what particular events
have led to this point, and how group cohesion can be further developed.
He or she is encouraged to look at the events in order to discover con­
nections, or a lack thereof, among group members. These events can be
analyzed in a single session or over time. Techniques that encourage group
cohesion can then be discussed. Once the therapist sees the specifics
clearly, activities for the therapy session can be explored musically. The
work then becomes verbal->verbal->music.
Music->verbal.
In the second situation, the therapist uses his or her own
playing to uncover material which itself becomes the focus of discussion.
For example, a client’s musical production may be duplicated when the
therapist is unsure of the client’s message and in what direction to take the
work. This is an opportunity to work from the therapist’s musical intuition
to gain greater insight into the client’s expression. The therapist is encour­
aged to play as the client played, shaping his or her body posture and
movement to the remembered image of the client. The muscles, the arms,
the fingers re-create the client’s experience. The rhythms, dynamics, and
phrasing are imitated. After this re-creation, there is usually much material
to discuss. Feelings may arise which were not previously recognized. The
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therapist may discover possible directions toward which to encourage the
client; interpersonal dynamics can also be discussed.
Music+music.
Here, the therapist works from the music and is encour­
aged to let the music lead to a possible solution. The therapist may be
encouraged to play as the client played in order to discover, in an organic
way, where the music leads. For example, the therapist may want a client
to move from rigid playing to a freer expression. By playing in this rigid
style and observing the transitions necessary in order to move smoothly
into a freer style, the therapist may come to respect the client’s difficulty.
He or she may find a more gradual way of encouraging the client in the
direction of freedom of expression, rather than trying to force an abrupt
transition.
Verbal->music.
In the fourth combination, music is used to deepen the
therapist’s understanding of a particular issue or to help the therapist
come more in contact with him/herself regarding specific issues. A
therapist, for example, may be quite adept at observing the interpersonal
dynamics of a group and discussing group process, yet may exhibit a
certain distance from the material - an inability to be truly present as a
leader in the moment. Thus the therapist’s work reveals a lack of spon­
taneity and a rigidity of style. The music therapist can be encouraged to
explore musically his or her feelings about being a leader and to notice
where he or she feels cut off. Movement and breathing are used to
strengthen the therapist’s musical expression. The therapist is encouraged
to take to individual therapy any personal material which may need more
in-depth work.
The Role of the Supervisor
It is important to analyze the supervisor’s role to understand how he or
she can best help the music therapist. There is an art to supervision.
Sometimes the therapist needs specific suggestions or techniques. Some­
times the therapeutic process must be explained. But more often it is a
longer, less obvious process of guiding the music therapist to look more
closely at what he or she already sees, to listen more closely to what he or
she already hears.
The supervisor can be most helpful by indicating the path for the music
therapist but not walking it for her or him. As described in the previous
section, the supervisor should be sensitive as to when music and when
words are most effective in guiding the therapist. This helps the music
therapist to exercise this intuition.
Through the openness of the questions asked by the supervisor, the
music therapist begins to have a framework for uncovering his or her own
knowledge. The supervisor must know when to encourage the therapist to
step back from the specific events and when to become immersed in the
work.
The supervisor’s questions can direct the therapist to see the gestalt of
the group’s interaction. “What is happening in the process over time with
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this group?” “What did the group do last week?” “What was the individual
playing or speaking of before this event? Is there any connection?”
The supervisor can lead the therapist into the material with questions
such as, “What would you have liked to play and didn’t?” and “What was
missing for you in the session?“, and by encouraging the therapist to play
music.
A Model
In developing a music therapy supervision group the supervisor has the
unique opportunity to put his or her beliefs in the power of music into
practical application. The musical and verbal work must be integrated in
an active way in order to capture the totality of human emotions. This is
particularly true in light of our knowledge of left and right brain functions
and the ways that music and verbalization interact. Combining verbal and
musical processing stimulates a broad range of exploration of the various
aspects of thought and feeling.
The fact that musical and verbal processing of material arecombined in
supervision should encourage the therapist to develop the fluidity of
movement between verbal and nonverbal modes necessary to his or her
work as a music therapist. Movement from verbal to nonverbal, from
sequential to simultaneous, from analytic to synthetic is fostered. (These
examples of left and right brain functions are suggested by Springer and
Deutsch in Left Brain, Right Brain, 1981, p. 185.)
In a model music therapy supervision group, each session is divided into
four parts:
1. “Gathering” music: The session begins with music freely played by
group members on a variety of instruments or with the voice. This is time
for focusing and self-awareness. It may be a point of slowing down after a
hectic day or a place to energize oneself. Beginning in this way helps the
supervision to be more focused and has the potential to help the work to be
more dynamic.
2. Statement of work: The group members have a chance to briefly
share what their needs are for that particular session.
3. Focus on issues: This is the heart of the supervision, where an inte­
gration of verbal and musical idioms helps the participants address rele­
vant issues.
4. Musical closure: This final improvisation of several minutes can be a
time of renewal through musical creation, a time to focus again on a
particular need brought to light during the supervisory session, or an
acknowledgment of support. This music is a reaffirmation of music as the
root and inspiration for the work of the participants, both as therapistsand
as group members.
This model is not intended to be fixed; deviations are both desirable and
necessary. However, it is a good concept to keep in mind and refer back to
periodically, since there is a tendency to drift away from musical expres­
sion into completely verbal supervision. When this occurs for an extended
period of time, the supervision tends to lack richness and vitality.
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Group Supervision
THE SESSION
The supervisory group’ is comprised of six music therapists working
with a variety of populations and age groups, including children and adults
in psychiatric settings, a group in a nursing home, and a group of univer­
sity students.
One by one, the group members arrive. It is February and dark outside.
Some are laughing, some look very tired. Some lie on the floor and begin
stretching. Others are sitting with eyes closed. John looks very tired
tonight. Susan lets out a groan from her place on the floor, beginning the
improvisation. Some voices move into a melodic line. Shelley begins to
play the flute in a rhythmic way and several of the group members and the
supervisor are drawn to percussion instruments. Agroup rhythm begins to
emerge. Susan sits up and joins her voice in a melody. The playing con­
tinues for several minutes and then fades.
The group is now sitting, each member having “arrived” in his or her
individual way. John tells the group of his concerns about the co-leader in
his student group. Jean has a new song she would like to present to the
group, having used it for the first time in the nursing home this morning
with mixed results. Susan needs feedback on her individual work with an
adolescent at the psychiatric center.
The group begins with John’s need, since it appears to be most pressing.
John describes a situation in which his co-leader has a very relaxed style.
John, on the other hand, is usually very outgoing. He says he is feeling
discouraged and inadequate in his leadership skills. The group verbally
offers various suggestions as to how he could imorove his relationship with
-his co-leader.
The group begins to think of this issue musically. What are the musical
dynamics of this relationshin? What are the qualities of the two sounds side
by side? The supervisor suggests he find instruments to ill&rate the inter­
action between himself and his co-leader. He chooses a medium-size drum
for himself and resonator bells for his co-leader. He plays lightly and
tentatively on the drum, mostly with his fingertips. To play his co-leader,
he runs the mallet up and down the bells blending all the tones together.
When he finishes, the group reflects verbally upon what they have heard.
Shelley points out that he picked a large instrument for himself but played
it very quietly. “It didn’t have your usual vitality to it.” Robert observes
that the co-leader’s sound is unclear. “All the notes run together. There’s
no definition.” John seems to agree with these two comments. “I feel my­
self holding back. There’s nobody to bounce off out there. I don’t think I
really know where my co-leader is coming from.”
The supervisor suggests that he play again as he would like to if he
didn’t hold back, and then play the co-leader’s response. This time, his
whole body becomes involved. A characteristic expressivity and creativity
appear. His face seems to relax and some color comes into his cheeks. It is
The group described is a
compositeof actual groups
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clear that he is enjoying himself. Now he moves to the bells, striking them
two at a time. They begin to take on a sharp tone. John continues the
dialogue several minutes and then says, “I felt my energy return while I was
playing. I don’t feel so tired now.” He describes the dialogue. “I feel some
anger from my co-leader when I change. It’s not going to be easy to be
myself. It’s safer for me to be quiet. But it’s just not me! Right now I feel it
might be better to risk conflict than to go on as I’ve been going,” Susan
comments, “Your co-leader seemed to come alive when you were stronger.
There was more definition. I wonder if maybe he wouldn’t welcome in
some way your becoming an individual. “The discussion continues further,
exploring some of John’s feelings about the co-leader. John says he’ll bring
a follow-up next week.
Susan now presents the adolescent with whom she is doing individual
work. He often “plays the clown” in groups, Susan says. He was referred to
her to deal with the recent death of his father through the medium of music,
which he loves. In individual sessions Susan describes how she plays the
piano and he plays drums. His musical phrases are fragmented. Appar­
ently he has no trouble imitating rhythms or playing a consistent beat, but
he chooses to move around frequently. “I can only get him to stick to a
rhythm for a few seconds. I’ve tried several techniques with limited results
and am getting frustrated that he doesn’t improve. What am I doing
wrong?”
Susan is asked to play the drums as the client plays. She performs with
vitality. Upon ending, she says, “I feel energized but unsatisfied. I’m not
getting into things. That’s exactly it. I don’t know why I can’t get him to
delve in.”
The supervisor asks her to go back to this playing and at some point keep
one rhythm going. As she does this, her face changes markedly, looking
pained. She plays for a while and then stops abruptly. “Keeping that steady
rhythm I almost wanted to let out a cry-a
wail - perhaps even tears.
And then I was quickly aware of being watched and wanting to hide.
That’s where I stopped.”
The possibility of this experience being close to that of the adolescent is
discussed. In imitating his musical expression and playing his part, Susan
may have touched a thread to her client. Her own resistance to experi­
encing this pain is explored. What becomes evident is that Susan’s tech­
niques are not at fault in this case, but that what she is seeing is the depth of
the resistance and this adolescent’s need to hide himself. Once Susan
understands the resistance in this poignant way - through her own
musical discovery - she can respect the slow changes of her client. She can
offer support for his musical and emotional unfolding.
What began as a simple discussion of techniques has moved to a deeper
level. Susan can see that even a brief lengthening of phrase is an important
movement for her client. It is a moment of testing to see if it is safe to feel
and to share. With Susan’s accepting his creation and encouraging slight
changes, the groundwork may be established for him to musically share
some of the pain he is feeling, and perhaps later to share it in words.
Group Supervision
37
There is enough time for Jean to share her song. She hands out instru­
ments and energetically begins to play the guitar and sing. Interacting
constantly, moving from one to another to encourage the group to sing
more or play louder, she smiles continuously to encourage us further.
“OK,” she says, “what do you think? It’s fun but I’m exhausted! “The group
tells her how hard she seems to be working and that maybe the group
should do more of the work. One member shares that she felt intruded
upon at times. Jean begins to think about ways to tone down her style for
her clients and for herself.
It is time to close and John says, “I feel like starting, to celebrate having
found my energy again,” and with characteristic enthusiasm, adds, “Also
for all of us to celebrate ourselves. You know, we all work really hard and
we forget how much we’re helping people.”
A dance-like improvisation of flute, voices, drums, and guitar ends the
session.
CONCLUSION
In supervision, I observe patterns of group dynamics and work with
transference and countertransference issues and the needs for particular
activities for particular stages in the group process. Most importantly,
though, in supervising music therapists I see affirmed again and again the
power of music. After suggesting a particular musical exercise, I may
suddenly seein the playing an opening up of the therapist in an entirely new
way. I may have thought that I understood the dynamics between the
therapist and client but suddenly seean entirely unexpected result. Where I
have decided as an observer that a client is feeling a particular way, the
therapist’s role-play brings out new and surprising sounds and the
therapist-as-client touches a feeling opposite to the one I had imagined.
I am struck with how endlessly new supervising continues to be. I learn
again and again that I don’t have all the answers but I become better and
better at ways of listening for them. I become enriched by the creativity of
the music therapists I supervise. I can’t sit back with my knowledge. I
become jolted by the question, “Why?“, or stopped short by the statement,
“I have a different idea.”
Supervising becomes a rich terrain for both my growth and that of the
music therapist supervisee. It is a place to delve into things, turn some
things inside out and set others in order. It is a place where I have the
opportunity to affirm what I believe as a music therapist: that there is a
unique power in the combining of music and words and that the music
therapy supervision group should encompass those areas which can be
touched in a music therapy session. In supervision, as in therapy itself, the
music can lead to new discoveries, deepen awareness, celebrate­ and heal
both the client and the therapist in each participant.
Gillian Stephens. MA, CMT. holds a Master’s
University. She studied at the Gestalt Therapy
Ghana and Nigeria. She is currently coordinator
Psychiatric Center, is a member of the faculty
private practice. Former Board Member of the
she now serves as Chairperson for Publications.
degree in Music Therapy from New York
institute and studied rhythm and ritual in
and supervisor of Music Therapy at Bronx
at New York University. and maintains a
American Association for Music Therapy,