Our vocal and clarinet interactions and exchanges evolved into a musical game of hide-and-seek with Ben hiding behind the curtains as I crept nearer and nearer to him, the sound of my clarinet giving him a clue as to how close I was getting. I also sometimes played the mouthpiece alone – a loud and vibrant sound that Ben found comical.
Being able to move around the room freely whilst playing the clarinet supported the development of this shared music-making and helped Ben to explore and tolerate shared interaction. Ben’s confidence in relating to and trusting others increased, and our hide-and-seek turn-taking game came out from behind the curtains as Ben gained a curiosity and confidence in exploring the other instruments in the room. Eventually Ben invited me to play the bongos with him, demonstrating something of how far things had come from the opposite sides of the room and behind the curtains.
Case vignette: Michael
I began working with Michael, 45, when he was referred to the adult community mental health service for support with his increasingly isolated lifestyle. Michael was diagnosed with post-traumatic stress disorder, depression and anxiety. Music therapy aimed to help Michael build confidence to feel safe with others and re-engage with the community.
Having taught himself the keyboard, Michael had spent the best part of several years playing for long hours at home on his own. Though committed to music therapy, Michael struggled to relate to me in our sessions: his instrument of choice was a large electronic keyboard set at full volume and mostly set to textured synthesised sounds. Michael was confident performing to me in his own particular musical style of busy patterns at varying tempos, and he played continuously with no obvious pulse; alternatively he would play songs that he had composed. Michael’s music was difficult to engage with, and he seemed to maintain a musical wall of defence around himself.
Most instruments I played to meet Michael in his music were rendered powerless and ineffective as he sped up and slowed down or stopped suddenly, only to then start a different sequence of chordal structures. I chose to introduce my clarinet in our sessions, and this was accepted by Michael, but a competitive dynamic arose. I knew I needed somehow to play in parallel to Michael’s music, to gain his interest and trust not by acknowledging his patterns – which seemed to feel like hijacking to Michael – but by being a non-threatening ‘other’. This was achieved by providing contrapuntal motifs at the ends of phrases as Michael performed his songs, or inserting a few trills, or long-held notes over his busy keyboard playing.
Gradually, over a few weeks, Michael seemed to expect me to play my clarinet in this way, and began to leave longer gaps between his phrases for me to play; he sometimes even imitated my clarinet motifs in his music. Over time the improvisations took on a symphonic, soundtrack feel to them; there was less anxiety and he was able to listen and accept my music as complementary to his own, rather than threatening. Michael was then able to acknowledge the shift in the music verbally and to relate some of his musical defences to his fear of society.
From the beginning, Michael had been dismissive of the percussion instruments in music therapy and it took my use of a sufficiently complex instrument in the form of the clarinet to make a connection with him. The challenge with Michael had been for him to hear and accept me. If I played the piano, it was heard as an attack on his skill and sound perhaps, and was probably too close emotionally in some way. The clarinet was my instrument; separate and distinct from Michael’s keyboard, yet as meaningful to me as his keyboard was to him. We could be two people conversing, but through our own chosen, personal instrument that we both had our own way of playing. Michael played patterns and songs dear to him, and I improvised around his structure. Eventually he could improvise, share and acknowledge something of the experience with me.
Case vignette: Group
I currently use my clarinet regularly in a group for people with severe to profound and multiple learning disabilities. The group’s music is often very much centred around people’s personal vocal and body sounds. I find that by blowing air through the clarinet, rather than sounding notes, I can acknowledge breathy sounds from all group members that so often become a very important part of sessions for this group. I can also offer something with a unique tone that has become my non-verbal voice in the group.
When I am assessing clients or when I sense an uncertain quality to the dynamic in the therapy room, I know that I can pick up my clarinet and explore the situation with confidence. Alongside the personal and emotional connection I have with playing the clarinet, I can rely on the tone of the instrument to match, acknowledge and support the client in their playing, particularly when they play chordal instruments – piano, keyboard, guitar even – in such a way that they become increasingly absorbed in their playing, filling the room with a dense texture of sound. Playing the clarinet can state my presence subtly or not so, depending on the need, and can challenge or tenderly coax a response as appropriate. I consider the clarinet an instrument for many eventualities that is a more flexible alternative to my voice, yet as personal, unique and communicative.
The clarinet in a family’s loss
Colette Salkeld
I have been playing the clarinet since the age of eight, and prior to training as a music therapist I worked as a professional clarinettist for a number of years. I have always felt the clarinet was an extension of myself, a means of personal expression, a way of conveying meaning beyond words. Since working as a music therapist I have found that the clarinet seems to allow me the freedom to respond empathically and to be physically closer to the clients, particularly in group work.
Case vignette: Artem
Artem was a five-year-old boy from Ukraine who was in the terminal phase of cancer. I was asked to see him during my first week in a new music therapy post and was told that he had only a matter of weeks to live. I was aware of the work of Nigel Hartley at St. Christopher’s Hospice and the importance of supporting the whole family at this stage in a child’s life, and because the work was in Artem’s room my intuitive response was to take my clarinet.
Session 1: Lullabies and dreams
When I first met Artem he was lying in his hospital bed, in a private room, with his father sitting beside him. Because of the nature of his cancer, Artem had lost the ability to use his limbs and also his voice. His only means of communication was his eyes. To say ‘yes’ he would look up, and to say ‘no’ he would look down. I was aware that I was coming in to this family’s life at a very sensitive time and I did not want to appear as an uninvited guest. Artem’s play specialist, who had worked with him for a number of months and had made the referral for music therapy, introduced me and stayed for the first session. In this way she provided the link, as someone whom they could trust.
To begin with, I sat beside Artem and sang hello to him, and following this Artem’s father supported him in strumming on the guitar. Artem communicated that he enjoyed this and during this time I improvised vocally, to support his playing. The play specialist then said that Artem had wanted to become a soldier and loved marching music. It was at this point that I used my clarinet for the first time and, supported by his father, Artem beat his hand on the drum. Again, Artem said that he liked this. It was interesting as I found myself standing and marching as I improvised on the clarinet, almost as though we were in a marching band, soldiers together. In this way the music seemed to reflect Artem’s dreams, his wishes. Shortly after this Artem began to yawn and to close his eyes, and I improvised a lullaby on the clarinet as he drifted off to sleep.
Session 2: Storytelling
When I arrived for the next session Artem lay in his bed and this time his mother sat on one side, his father on the other and a family friend was also sitting in the room. Through the interpreter I was told that Artem wished to play the guitar and the drum once again. He then wanted me to play the clarinet. As I improvised, Artem’s mother stroked his head, holding his hand and as he gazed into her eyes she told him a story. I will never know what the story was, but it struck me that her words and phrases seemed to reflect the musical phrases of the clarinet and the highs and lows of the melodic line seemed to be mirrored in the intonation of her voice. It was also remarkable that we ended the ‘story’ together. I have often wondered since that day about how it was