Healing young patients with music

A room full of musical instruments. Nadia moves around in it. The ten-year-old beats on drums, cymbals and a gong. She lets out cries. Her music therapist stands at the side, accompanying her on the xylophone. She plays little answers to Nadia's wild playing and gives musical impulses. But the girl seems to ignore this attempt to make contact.

As a viewer, you imagine the hyperactive child in her everyday life, how Nadia is offended, how she is told to be quiet, how her environment may suffer. You wonder how the therapist can stop this tempestuous girl, who is banging against the frame drum with incredible force.

In the Safe Place, a child learns to regulate their feelings outside of the therapy room.

This scene is a video sequence created as part of the music therapy training programme at Zurich University of the Arts (ZHdK). Sandra Lutz Hochreutener looks at the screen. She is the head of the Masters of Advanced Studies in Clinical Music Therapy at the ZHdK and has been practising herself for 36 years. «The therapist can take it,» she comments on the sequence with Nadia.

A therapy room is not the place for criticism and control. On the contrary: if the child's behaviour is to change, a safe place must be created for the girl. «A child needs to feel accepted and protected so that it can show all sides of itself: the wild, harmonious or the naughty ones.»

The music takes the first step

Then comes an important moment in the film. Nadia realises that the therapist is repeating her tap on the cymbal on the xylophone. The girl pauses, makes eye contact, hits the cymbal again and immediately stops the reverberation to hear whether her playing receives a response again. When the xylophone sounds, Nadia lets out a joyful whoop.

A small step has been taken, the beginning of a relationship between Nadia and her therapist, a first arrival in a space that is to become the girl's safe place. The aim is for the girl to internalise the safe place. Then she will also be better able to regulate her feelings and socialise outside the therapy room. Such a process can take a long time.

The safe place forms the basis for therapeutic work, says Sandra Lutz Hochreutener and talks about a girl from her practice. Fear dominated her life due to early childhood trauma. It was no different in the therapy room. «I said, okay, you can build yourself a hut and hide in it, and you can also take a soft toy with you.»

For weeks, the girl hid in her house made of chairs, blankets and cushions throughout the therapy. «Over time, there was contact from the inside out: The girl played notes on the flute and I responded from the outside with another flute. This slowly led to contact.» This developed into instrumental «conversations». Mutual visits followed, until one day the girl set up a place for them both instead of the hut. She would have said casually that she «no longer needed the roof».

Communication through closed doors

Music has the advantage over talking that it touches and stimulates several senses at the same time. You can hear the sound, feel the vibration, see and feel the instruments in their different sizes and materials. And music appeals both physically and emotionally. «If I play a small note in the back corner, it affects everyone else in the room, even if we're not looking at each other,» says Sandra Lutz Hochreutener. «That's why it's also an effective tool for people who are closed off. The shell that is all around is gently broken through with the music.» As in all psychotherapy, there are also a variety of methods in music therapy that are used individually for each patient.

Improvisation is central: playing beyond right or wrong. Improvisation can help to reduce tensions or overcome obstacles. It is also used to approach a topic in therapy. It is often followed by role play or dialogue. Improvisation opens up a «creative space in which transformation and renewal can take place», writes Sandra Lutz Hochreutener in her book «Spiel-Musik-Therapie». The book is based on 540 audio protocols from her practical work, which she analysed. The case studies impressively demonstrate the diversity and possibilities of music therapy.

So-called «spontaneous singing» helps children to find words to express themselves.

Songs also play an important role - especially in combination with improvisation. The so-called «spontaneous singing with lyrics» is a fun form that makes it easier for children to find words to express themselves. A video recording shows a girl sitting opposite her therapist. They both have a guitar. The seven-year-old is rhythmically strumming the strings. The therapist follows the movement exactly and makes her guitar sound in a harmonious sequence. This provides a musical foundation. The girl sings into a microphone: «Hello dear friends, I'm so alone.»

The girl finds words that express her own feelings. Yet she hardly shows any physical emotion. In her spontaneously invented song, she meets a dog, a husky. «Hello, dear friends, I'm so alone» becomes the refrain. Finally, the girl goes into the forest with the dog. There is an evil robber. The flow of the song is suddenly interrupted. The situation obviously symbolises a trauma. The therapist doesn't stop, but plays an interlude on the guitar. «When speech dries up, the melody carries on,» writes Lutz Hochreutener in her book.

The girl actually comes up with a solution during the musical interlude: «Husky, I'll sit on you and then we'll run away quickly.» And the therapist reinforces the solution: «We'll run, run, run, run, run away.» After the song, the otherwise shy girl shouts «Hello!» into the microphone as loud as she can. She notices how the instruments echo in the room. Then she screams again and again.

Back to Nadia. Three months have passed since her first wild therapy session. A new film shows the same place. After ten therapy sessions, it seems to have become a safe place for Nadia. She plays rhythmically on the lotus flute and the therapist supports the rhythm with the drum. Nadia tries to play other instruments at the same time as the flute. She succeeds. But then she loses the rhythm she has been repeating for so long. She goes to the therapist, who continues to play gently. Nadia puts her ear to the drum and joins in again. It is a new quality of relationship that the girl experiences here. «They understand each other,» the viewer thinks and is touched.