Following this improvisation, I asked through the interpreter if the family might like to sing a song in their native tongue. Artem’s father asked if he could play my guitar and tentatively he began plucking a melody line. It was at this point that the room began to glow, rather like candles being lit on a dark night as first Artem’s mother and then each member of the family and the interpreter joined in, singing with the guitar. As they sang, I wove a harmony on the clarinet, connecting and empathising without words. Once again, Artem and his mother gazed into each other’s eyes and she stroked his head. It was very moving, an acknowledgement of Artem’s cultural heritage and a brief piece of Ukraine in London.
Session 3: Goodbye
My third session with Artem and his family was to be the last time that I saw him. When I entered the room he seemed pale and lethargic. The room was full of family members, with his mother, father, two other adults and another child sitting around the bed. I asked Artem’s mother if she wished me to call the interpreter and she said strongly, ‘But music is universal, you can talk to me and I understand.’ I wondered if she wanted to keep this session between the family and myself. Maybe the interpreter would feel like an intrusion. Her comment also reminded me of the previous session when she and I had connected so strongly in the storytelling.
After I had sung hello to Artem, his father took the guitar and once again Artem’s mother began to sing a Ukrainian song. Just as in the previous session I took my clarinet and wove a harmony to support their music. This time I felt that I was supporting the family in their loss, the music enabling them to share together in their grief in a culturally appropriate way. As she sang, Artem’s mother became very tearful, choking on her words. Following the song she allowed me to comfort her and to acknowledge the pain of her loss. Following this exchange she asked me if I could play the Beatles song ‘Yesterday’. As we sang and played this symbolic song she gave an ironic laugh as the tears flowed. I then sang goodbye to Artem to end the session.
I was not aware at this point that this would be the final time I would see him and his family. I feel immensely privileged to have had the opportunity to meet Artem and his family at such a precious time. I believe that the choice of the clarinet enabled me to draw near to them and support them in their loss, especially when my relationship with them was so brief. Shortly after this session Artem and his family returned home where he ended his days in a hospice.
Finding a different voice
Henry Dunn
I first fell in love with the clarinet as a young boy, at the age of about eight or nine. Some family friends were having a musical evening at their home, and I heard someone playing the clarinet. I immediately decided that I had to learn, and fortunately my parents supported me in that aim. I worked my way through the graded exams, but wasn’t able to improvise, despite my love of jazz. That changed as an adult, and I discovered that I could improvise and create my own music, expressing myself through the voice of the clarinet. I now find that my playing in jazz informs and improves my playing in therapy, and vice versa, although the purposes are very different – the former to entertain, the latter to express emotion, no matter how unpleasant it may sound.
This ability to improvise developed on a working party at a beautiful Christian community in North Devon when I was about 20 years old – we were gathered round a piano, playing songs, and I suddenly found myself playing notes on the clarinet without really knowing where they were coming from. For this reason improvisation also has a strong spiritual element for me, reaching a very deep, unconscious part of myself. This in turn is reflected in the psychoanalytically informed approach I have to music therapy, which seeks to find the unconscious dynamics behind people’s musical expression. I find myself drawn to depth, musically, spiritually and psychologically.
When I was 30 I embarked on my music therapy training and found that the piano and the clarinet were equally valuable in my work. I find the piano helps most in providing structure and containment, but it feels, to me at least, quite a masculine instrument. The clarinet gives me access to a more tender, fluid, feminine voice, with a greater pitch range than my rather low singing voice. This can be particularly useful when working with people whose mother was absent or abusive. They can experience a maternal voice that is caring and responsive, expressing unconditional positive regard (Rogers 1957).
Although I use the piano a lot of the time, finding it very expressive and valuable, I sometimes observe a tendency to use it defensively, with it creating a physical barrier between the client and myself. It can also be connected with my expertise on the piano compared to that of the client, who might feel intimidated and unable to use the piano to express themselves. The clarinet, although also requiring expertise, doesn’t seem to have that effect, as it mirrors the voice closely and reveals a vulnerability in the therapist that the piano might not. If I become emotional in our shared music, this will affect my breath, which will affect my playing. My tone may crack or seem a bit wobbly, reflecting the way I feel. This is in response to the client’s emotion and can happen without conscious thought, in the moment. I feel that the clarinet is my voice in a way that the piano never could be, and that this vulnerability on my part gives the client permission to also become vulnerable. It is this sense of joint openness that can be so powerful in music therapy and is perhaps harder to achieve with verbal therapies.
The clarinet is also very portable. I can move around with it and not be fixed to the spot as I am on the piano. I can sit on the floor and play, or I can chase round the room playing it. It is also useful in environments where there is no piano or keyboard.
Case vignette: Julie
Julie, a woman in her 50s, was referred to me owing to her anxiety and her bipolar disorder. Not long into our work she was given a diagnosis of breast cancer, which spread to her spine. She loved to hear the clarinet, either played by me or in recordings that we listened to in order to aid relaxation. She particularly liked listening to Mozart’s Clarinet Concerto.
During our improvisations she played a variety of percussion instruments and requested that I play the clarinet. Sometimes she would stop for a while and just listen to me play. I found that I could respond very quickly on the clarinet to any changes of mood, tempo and volume, and it was easier to sit facing towards her than it would have been at the piano. Playing the clarinet seems to give a greater intimacy – it is more an extension of me than the piano, as it is my breath that is making the music, with less of a mechanical gap between the player and the resulting sound than on the piano. I could then non-verbally express care and compassion in a way that felt more powerful and warm than words alone.
Julie had been estranged from her mother for several years and did not want any contact with her. It occurred to me that the maternal sound of the clarinet was providing some kind of substitute for this. It also enabled me, as a male therapist, to provide an element of maternal function that would not otherwise be accessible to me.
I often use the clarinet to mirror vocalisations of clients who are non-verbal. The communicative vocalisations are reflected back in a more musical form, moving from mirroring to affect attunement (Stern 1985). I am taking the client’s emotional communication and transforming it in a way that is still recognisable but also distinctly mine. This sense of shared meaning, balanced by an awareness of the other, can be a crucial development in therapy. For clients with autism, this type of exchange can help to develop the ability to relate to another as a distinct and separate person who attends to, and responds empathically to, their emotional communication. In addition, the expressive qualities of the clarinet can encourage clients to move from a monotone voice to one with more variation in pitch and expressiveness. It can encourage non-verbal dialogue that is playful and creative, and that is able to convey a wide range of emotions.
I have also used the clarinet with children who have suffered trauma to the brain or were born with an underdeveloped brain. For example, I worked with a young boy who had nearly drowned, suffering hypoxia. He was left in a virtually comatose state. I played my clarinet to fit with his breathing and eye movement, and there was some small sense of reciprocation in the way his breathing and eye movement changed with my playing. I also worked with a six-month-old baby whose brain scan