interaction themes in music therapy: definition and delimitation

Aalborg Universitet

Interaction themes in music therapy

definition and delimitation

Holck, Ulla

Published in:Nordic Journal of Music Therapy

Publication date:2004

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Citation for published version (APA):Holck, U. (2004). Interaction themes in music therapy: definition and delimitation. Nordic Journal of MusicTherapy, 13(1), -19.

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Nordic Journal of Music Therapy, 2004, 13(1) 3

RESEARCH ARTICLESNordic Journal of Music Therapy, 13(1) 2004, pp. 3-19.

Introduction

In music therapy interventions for children withsevere functional limitations, including childrenwith severe autism, one of the primary goals is todevelop the children�s ability to participate insocial interaction and communication (Nordoff &Robbins, 1977; Alvin, 1978; Robarts, 1998;Schumacher, 1999). This can happen on manylevels, depending on the degree of severity ofthe children�s functional limitations, as well astheir chronological and mental age (Wigram, 1999).

Research has proven that music therapy has a

Interaction Themes inMusic Therapy: Definitionand Delimitation

AbstractBased on a doctoral study, the author presents a type of music therapy interaction called�Interaction Themes.� These are developed from session to session and often appear in musictherapy interventions with children with severe functional limitations, especially children withautism. Although the Interaction Themes are characterised by a relatively simple and self-generated content, they have an essential function because they contain the child�s and musictherapist�s joint interaction history. They make up the context within which it is possible to createmeaningful interaction with a client group whose expressions are often difficult to understand.The article describes the characteristics and functions of Interaction Themes, compares thephenomenon with music therapy case literature and delimits it in regard to other types of musictherapy interaction with this client group. The results are described through qualitative analysismethods applied to clinical video material, including member checking, negative case analyses,and pattern-generalisation.

Keywords: children, autism, severe functional limitations, interaction, context, andmeaningfulness.

Ulla Holck

ULLA HOLCKPh.D., graduated in music therapy at AalborgUniversity (1988) and in body psychotherapy at aprivate education (1992). She has worked withadolescents with severe autism and adolescents withemotional and behavioural disturbances. In 2002 shedefended her Ph.D. dissertation in music therapy atAalborg University. She holds positions as AssistantProfessor at the Department of Music and MusicTherapy, Aalborg University, and as a researcher atthe Child and Adolescent Department at AalborgPsychiatry Hospital. Contact address: Institut formusik og musikterapi, Aalborg Universitet,Kroghstræde 6, 9220 Aalborg Øst, Denmark.E-mail: [email protected]

Nordic Journal of Music Therapy, 2004, 13(1)4

positive effect in helping children with severecommunication difficulties to improve theircapacity for social and pre-verbal skills such asresponse, initiative, turn-taking, imitation andvocalisation (Müller & Warwick, 1993; Bunt, 1994;Edgerton, 1994; Aldridge et al., 1995; Plahl, 2000;Elefant, 2002).

While often the relative quantity ofcommunicative behaviours increases, it can stillbe hard for the therapist to interpret and respondto them as such in an ongoing interaction.Analysis of interactions between adults andyoung handicapped children (among others thosewith autism and Down�s Syndrome) show thateven the child�s own parents can have problemsin understanding responses because of theirfrequently weak, random, or ambivalent character(see Rogers, 1988 for a review). At worst theproblem is twofold: the child shows no sign ofunderstanding the adult�s initiative, and the adultcannot read the child�s reactions as meaningfulbecause they seem to occur without context.

Developing an isolated child�s desire and abilityto engage in communication requires creating aninteraction form that both partners findmeaningful and enjoyable (Klinger & Dawson,1992; Schuler et al., 1997). At moments when thissucceeds, both partners seem to perceive andfollow each other�s actions, and a mutual andplayful interaction can be created (Rogers, 1988).In this way, meaningfulness refers to interactionswhere both partners contribute to thecontinuation of the interaction because it seemsto be meaningful to do just that � even when wecannot know what precise meaning the interactionhas for the child.

From this perspective, one reason for musictherapy�s capacity to engage these children couldbe the way it can facilitate the creation offrameworks for meaningful interaction. In aqualitative doctoral study involving videoanalyses of music therapy interventions with thispopulation (Holck, 2002), I explore some of theconditions through which this happens, combinedwith extended micro analyses of patterns ofinteractions, showing mutuality, expectations, and

other signs of meaningful interactions.The background for this is an interest in seeing

movement from no interaction to a kind ofmutuality in work with this population.Theoretically, my approach is informed bycommunication theories and infant research,pointing out the importance of a joint context(e.g., Littlejohn, 1999) understood as a jointinteraction history (Stern, 1989) as a basis formeaningful interaction. In music therapy thesepoints are strongly emphasised by Even Ruud(1990), who highlights the gradual developmentof (private) codes between client and therapist asone of the assumptions for a meaningfulinteraction. The music therapy case literaturegives lots of examples of gradually developedshort repeated musical forms or motifs having acentral position in courses of music therapy withchildren with severe communication difficulties,most often children with autism (Nordoff &Robbins, 1977; Alvin, 1978; Birkeback & Winther,1985; Agrotou, 1988; Lecourt, 1991; Friis, 1993;Brown, 1994; Bunt, 1994; Howat, 1995; Wigram,1997; Robarts, 1998; Di Franco, 1999; Schumacher,1999; Oldfield, 2001).1

The findings from my doctoral study presentedhere correspond well with this case literature, butat the same time offer a more broad way ofunderstanding the motifs as frameworks formeaningful interaction, called Interaction Themes(Holck, 2002). The article focuses on this part ofthe research only, leaving the micro-analyses out.Since I believe the issue to be relevant for manyclinicians, the article includes case vignettes fromthe material rather than purely documenting thefindings.

Method

To investigate the research question, a qualitativedescriptive approach was used within a multiplecase design. Video recordings were made of fivemusic therapists� work with six children withsevere functional limitations, three of whom hada diagnosis within the autistic spectrum. The

1 See (Holck 2002 pp. 93-137) for an extended literature review.

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therapists were primarily trained in the analytictradition (Priestley, 1994). For each child, foursessions were recorded, and in all cases musictherapy interventions had been running for sometime. This material formed the main data (togetherwith therapist interviews), from which sampleswere subsequently selected for more detailedanalysis.

The choice of samples was made from theidentifiable interaction history between the childand therapist in the form of observableexpectations on the part of the child and therapistwithin the interaction. Review of the videorecordings resulted in the identification of specificsequences of four-five minutes length, where themusical material had a simple and self-generatedcharacter. Furthermore, the children themselvesinitiated these sequences, or were very active andshowed signs of recognition and mastering.Through systematic video analyses, including acomparison of the sequences, it became possibleto define and delimitate Interaction Themes withinthe interaction.

For the analysis of the sequences severalqualitative analysis methods were used(Alvesson & Sköldberg, 1994; Lincoln & Guba,1985; Silverman, 1994), adapted to the existingdata material. The part of the analysis from whichI present results here includes cross-comparativeanalyses, where the Interaction Themes found inthe material are compared across time, place, andpersons in the material and later related to existingmusic therapy case literature (pattern-generalisation). Parts of the data material that donot completely concur with the found patternsare considered and discussed (negative caseanalysis) and through interviews the musictherapists� response is added to the analysis(member check) (Lincoln & Guba, 1985).

Results

The analyses of the video recordings show fourwell-developed Interaction Themes that arepresented below. In the fifth case, thedevelopment of an Interaction Theme did notseem to be either possible or important. This

example is presented as a �negative case� (seeabove) as part of defining the delimitation of theInteraction Theme as a clinical phenomenon, andwill be discussed later. In the sixth case, which isnot included here, there were signs of an emergingInteraction Theme, which took form shortly afterthe time of recording.

Interaction Themes as Clinical FindingsAnalysis of first subject in the study, calledKarsten, gives the first example of an InteractionTheme. Karsten is a 9-year-old hyperactive boywith infantile autism and severe mental retardation.Verbally, his developmental age is assessed to be8 months, while in other areas it is deemed higher.At the time of recording he has been attendingmusic therapy for two years.

On the video we see Karsten come into theroom and go straight to a large drum � a so-calleddrum table. He plays a few energetic amorphousbeats while he and the music therapist sit oppositeeach other. When the therapist�s gesturescommunicate that she is ready, Karsten changeshis beats and starts playing a small rhythmic motif,whereupon the therapist plays a complementaryrhythm (see table 1, example 2).

Their interaction is built around Karsten�s smallrhythmic motif, as the motif provides a secureinteraction basis and a kind of bridge betweenshort improvisational events. For example,Karsten often interrupts the interaction withpronounced tempo changes or by fingering thedrumskin, after which the therapist stops playing.In light of Karsten�s pathology and normalbehaviour, this can be expected. The point is thateach time he returns to his small motif, often inthe original tempo, the interaction can continue.

Generally Karsten is not very visually awareof others, but in these situations he glances overat the therapist, or her hands, possibly inanticipation of her impending participation. Whilethis interpretation is speculative, the therapistnevertheless reacts very quickly to these smallcues. At one point, she breaks into a big smile,when Karsten, after having completed a short solo,makes a vocal sound and a single beat towardsthe middle of the drum. She clearly sees this as akind of invitation (turn giving) to start playing

INTERACTION THEMES IN MUSIC THERAPY � DEFINITION AND DELIMITATION


again. Inversely, Karsten reacts several times tothe therapist�s initiatives by short �outbursts�on the drum, for example when she begins to singor imitates his playing style.

Seen from the outside, there is no doubt thatthe two of them have a series of expectations tothe interaction, built up from session to session.Whether or not Karsten has intersubjectiveexpectations of the music therapist as a person isnot known, but on the other hand he shows clearexpectations to the music and actions (�this iswhat we usually do together�).

The sequence with this Interaction Themeoccurs at the beginning of the sessions and lastsabout five minutes. After this, Karsten ends it byrunning over to another instrument. Compared tothe rest of the session, the time spent at the drumtable is generally when Karsten is most sociallyactive for the longest time.

As a part of member checking, I interviewedthe therapist about the development of theInteraction Theme, and its significance for thetherapy. She explained that during the first

sessions Karsten had wandered aimlessly aroundthe room, playing all of the instruments. A fewtimes he had reacted to her initiatives, but onlysporadically. When she acquired the drum table,Karsten went straight to the drum, and playedwith great enthusiasm. Instead of trying to matchhis �chaotic wall of sound�, she placed a singleloud beat in the middle of all his sound. Later inthe same session, Karsten stopped and made asingle beat after the therapist�s beat, subsequentlyrepeated once, before playing chaotically again(table 1, example 1). Contrary to other moments ofcontact between them, this happened again inthe following session, identifying for the first timesomething the therapist came to rely on fromsession to session. After a few sessions, Karstenbegan to initiate this turn interaction and anemerging mutuality in interaction was born.

The recurring turn interaction naturally heldgreat significance for the therapy. Gradually theinteraction chains became longer, and the smallrhythmic motif described above was developed.While in the beginning there were small, sporadic

ULLA HOLCK

Example 1: Karsten�s Interaction Theme approximately one year before time of recording

Example 2: Karsten�s Interaction Theme at time of recording

Example 3: Karsten�s Interaction Theme approximately one year after recording

Table 1: The development of Karsten�s Interaction Theme



islands of interaction in an otherwise chaotic wallof sound, at the time of recording an ongoinginteraction between them was possible, with onlyshort interruptions by Karsten.

About a year later, their interaction haddeveloped further to the extent that they tookturns playing different short rhythmic motifs,while the other person waited (table 1, example 3).Compared to the early form, this was a much moreadvanced turn interaction with imitations andvariations in Karsten playing, as well as turnlengths that matched the therapist�s. This meansthat Karsten understood both how to wait forthe end of the therapist�s turn and how to limit hisown playing, which is a great contrast to the�chaotic wall of sound� that characterised thefirst many sessions.

Definition of Interaction Themes as a ClinicalPhenomenonSimilar sequences could be found in therecordings of music therapy with three otherchildren (see below). Contrary to Hello andGoodbye songs that often are of a conventionalcharacter and typically are presented by the musictherapist, these sequences bear the mark of aparticular child and therapist�s cooperation. Oftenit is the child who initiates the sequence, as itfrequently occurs during the beginning phase ofa session when the intensity of interaction isrelatively high.

On the surface the four sequences are verydifferent � the children are different, just as themusic therapists each have their own personaland professional backgrounds. When comparingthe underlying structure and function of thesesequences, there are, however, commoncharacteristics that prompted me to develop anddelimit Interaction Themes as a clinicalphenomenon with this client group. Interactionpertains to those aspects having to do with theactions, while Theme pertains to the content ofthose actions. The term �theme� is not to beunderstood in the musicological sense, but ratheras an interwoven structure of musical figures andmovement, creating a theme for interaction.

Table 2 presents four central characteristics ofInteraction Themes. Points 1 and 2 describe the

content of Interaction Themes and theirdevelopment, while points A and B describe theirfunction and significance in the interactionbetween child and therapist.

As it appears, an Interaction Theme is both aresult of a joint interaction history that developsgradually between child and therapist and at thesame time a frame for the continued interactionbetween them. This offers a perspective fromwhich to understand music therapy interactionwith these children, inspired by Ruud (1990) andStern:

Relationships are the cumulative constructedhistory of interactions, a history that bears onthe present in the form of expectationsactualised during an ongoing interaction, andon the future in the form of expectations(conscious or not) about upcoming interactions(Stern, 1989, pp. 54-55).

Commonly one says that the music therapist�sknowledge of the child is important for thetherapeutic process. But by focusing on a jointinteraction history created by both, I point outthat the knowledge goes both ways, so that thechild also has expectations towards the therapist� and that these are created through joint actions.

As in the example of Karsten, the jointinteraction history can be seen through theirmutual reactions. This made it possible for themusic therapist to react to even very small signsfrom Karsten as being socially directed to her,and even this very severely autistic boy smiledwhen she imitated him, glancing (expectantly?) inher direction just before she imitated or reactedto his initiatives. In this way a joint interactionhistory created a context for the interaction thatmade meaningful continuation possible (point B).

Applying the Definition of Interaction ThemesAnalyses of three other subjects in the studyshow the breadth of form and function in theInteraction Themes.

Mikkel is a 5-year-old boy with a diagnosis ofatypical autism (according to ICD-10) and generalretardation. At the time of recording he can sayten words, among others �Two� and �Music.�


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Compared to Karsten, he is less sociallywithdrawn, but on the other hand he gets verypassive if not stimulated vigorously, for examplephysically. During the first sessions Mikkel didn�treact at all to the therapist�s initiatives. His firstmove was to climb up on a trampoline and jump ina sitting position, which the therapistaccompanied with a Swedish dance melody thatshe later only used during these sequences.When Mikkel stopped jumping every now andthen, the therapist also stopped playing, but ittook a long time before Mikkel showed signs ofunderstanding the connection. However,gradually he did start to point at the piano afterclimbing onto the trampoline, and later he alsosaid �Music�!

After a few months of sessions, the therapistbegan to make sudden breaks in the music, to seewhat would happen. After a few sessions Mikkelreacted, and subsequently the therapist could relyon Mikkel stopping when she made a break in themelody. At the time of recording (after nine monthsof music therapy), an Interaction Theme hasdeveloped, where the therapist makes her suddenbreak, and Mikkel then stops jumping and says�Two� (his cue to start the music again). TheInteraction Theme is robust enough for thetherapist to �tease� by not starting immediately,after which Mikkel smilingly repeats his �Two�and starts jumping again.

Compared to Karsten, Mikkel�s visual cues aremuch easier to read, and although his use of theword �Two� is idiosyncratic, it does have aconventional character. Still, it was through thedevelopment of just this Interaction Theme thatthe interaction began to have a mutual and thusmeaningful character. Once Mikkel had formedexpectations to the interaction, he could reactmeaningfully to the therapist�s diversions, suchas her teasing (point A).

It was only on the trampoline that the therapistachieved such meaningful interaction with Mikkel.Apparently the movements, music and the suddenbreaks gave him the arousal that was necessaryfor his continual interest and active participationin the interaction (point B).

The third example of an Interaction Theme isfrom a case of a 13-year-old girl Mette with severe

mental retardation and severe autistic features.This girl had some language skills, but was proneto echolalia. In music therapy with Mette, anInteraction Theme was developed where the girland the music therapist took turns saying �EEE�on a rising or falling glissando, while stroking theother one�s hair or cheek. The glissandi had aprosodic character that can be described asinviting, inquiring, wondering, stating, etc.

Compared to the other Interaction Themes,this one is very unique, and has its owndevelopment history, that is too extensive to bedescribed here (according to Mette�s mother,Mette only makes these glissandi in musictherapy). The Interaction Theme bears the markof these two specific persons and their interaction,where the therapist has been especially sensitiveto Mette�s initiatives and ideas, and given theminteractional meaningfulness.

The last example is from music therapy with a 2½-year-old boy Eigil, with general mentalretardation but without autistic features. Eigil wasreferred to music therapy because he showed nointerest in communicating and could becomeconfused and bite himself when othersapproached him. In music therapy, however, Eigiland the therapist very quickly developed a solidInteraction Theme that ensured the developmentof Eigil�s communicative potential.

As with Mikkel, movement had greatimportance for Eigil. As soon as he sat on a spacehopper (a large rubber ball), he began to makesounds of delight. His sounds were withoutpauses, so the therapist began to interrupt Eigilafter three jumps/glissandi, first by stopping hismovement and later vocally. Soon Eigil got theidea, and after only five sessions (at the time ofrecording), they took turns singing a short three-note melodic motif with an accent on the last note.They began to use different vocal sounds, andafter six months Eigil was singing along with hitson the radio, getting quite a few of the words.

As it appears, Eigil�s social and communicativepotential was much greater than the otherchildren�s described above. (I haven�t yet shownthe sequence with Eigil to anyone who didn�t findinfectious his spontaneous enthusiasm forjumping and singing with the therapist.) Still, it



was only through the development of anInteraction Theme that he and the therapist couldmeet in a meaningful way and thus ensure thedevelopment of this potential.

As a whole these examples show thatInteraction Themes as a clinical phenomenon canbe generalised across four cases of music therapywith different children and music therapists. Thedevelopment of the Interaction Themes happenedwithin different time spans. With Karsten, whohad the most severe diagnosis, it took about ayear, but after that the Interaction Themedeveloped quite extensively, in the light of thisboy�s severe communicative difficulties. Incontrast, it took only five sessions with Eigil, butwas then dissolved again after having fulfilled itsrole later on (see below).

Discussion

The identification and analysis of InteractionThemes in the material raises some interestingpoints for discussion. In particular, searching forcomparative examples in the literature helpssupport the definition and clarification of whatan Interaction Theme is, and how it occurs. Thisis a way of contextualising the findings from myown study and the conclusions I have been ableto draw by correlating with previous clinicalexamples. While the music therapists in this studyare primarily trained in the analytic tradition, themusic therapy literature reports the phenomenaof Interaction Themes to be present in manymodels of improvisational music therapy. In thefollowing examples from Creative Music Therapyand Orff Music Therapy this is presented in somedetail before a more overall discussion.

Interaction Themes Related to the Literature:The Case of EdwardThe first example from the music therapy literatureis from Nordoff and Robbins� classic case of 5-year-old Edward. It is described in CreativeMusic Therapy from 1977 and illustrated withcassette tape recordings. Many music therapistshave been inspired by this case, which can beseen by the series of articles in the Nordic Journalof Music Therapy (1998-2000). In these articles,

the focus is primarily on the first session of theEdward case. In contrast, I will focus on the latersessions, where a Hello-theme gradually isdeveloped between Edward, Paul Nordoff, andClive Robbins. The development of the theme isdescribed in Nordoff and Robbins� book (1977),and can be heard on the tape recordings from theninth session (called example 3a-3i on the tape).

The sequence that includes what I see as anInteraction Theme is begun by Edward (by hisown initiative) leading Clive to a bench, climbingup on it, and then up into Clive�s lap (Nordoff &Robbins, 1977, pp. 31-32). Where he got this ideais not explained in the text, but from this positionEdward is able to sustain a vocal dialogue withPaul based on a two-note motif on �A-wo� (Hello).The Interaction Theme apparently found its formfrom the 7th session, but according to the text,there were signs of the theme starting earlier on.

In the first tape excerpt (3a) from the ninthsession, one hears Paul playing and singing awelcome song, �Good-morning,� in a flowingstyle. Suddenly Edward sings a distinct �A-wo�on the 6th-5th tone of the scale, and a small songdialogue between Edward and Paul emerges. In alater example (3f), Edward sings a new rhythmicmotif, a three-note rising motif on staccato-EEEsounds, and after a song dialogue with the newmotif, Edward returns to his two-note descendingmotif on �Awo.� This is all repeated, but nowwith four notes (3g). The new motifs make up akind of variation section, where Edward and Paulreturn afterwards to the familiar �Awo�-motif (akind of rondo).

What is so fascinating about this case is firstthe interaction between Edward�s initiatives andPaul�s ability to �seize� them musically so that adialogue can emerge, and second Edward�s wayof using Clive, so that he can receive physicalholding. For, although the Interaction Theme hasthe disadvantage that it requires a strong mancapable of holding a very active 5-year-old forlonger periods of time, it is fascinating to see howEdward provides for himself what he needs.

Regarding the four characteristics ofInteraction Themes that I have listed in table 2,this is clearly an example of a repeated motif thatEdward returns to, supplemented by a specific

ULLA HOLCK


gesture or bodily position (point 1). In addition, itis an Interaction Theme that bears the mark of allthree persons, so that it has a personal form (point2). Edward shows signs of musical expectationvery quickly (point A), as heard in his variationsfollowed by the �Awo�-motif. In the Edward case,Nordoff and Robbins do not refer to theexpectation aspect, perhaps because of Edward�sbright musical apprehension. But generally, theystress the importance of repetition for creatingsecurity and forming the musical relationship.Correspondingly, also in the Edward case, Nordoffand Robbins do not address some of the aspectsI refer to in point B, probably because they findEdward relatively easy to read. In other casedescriptions, however, they describe childrenwhose reactions seem so chaotic and unclear thatunderstanding what they are expressions of canbe difficult. But as soon as there are themes thatthe child remembers and expects it becomes easierto understand his/her expressions (see for exampleNordoff & Robbins, 1971, p. 55).

It appears, then, that there are severalsimilarities between these points and the fourcriteria I have listed for Interaction Themes. Onthe other hand, there are, of course, many aspectsof Nordoff and Robbins� extensive work thatcannot be described as Interaction Themes, forexample because the child has the ability to usemore conventional musical activities, such assongs, as discussed later. With regard to childrenwith serious communication difficulties, KennethAigen, in his research on Nordoff and Robbin�swork, names several examples of small musicalgames, themes, song and working motifs (Aigen,1998, p. 234). Some of these are similar in contentand function to Edward�s �Awo�-motif � forexample Walker�s �signature pattern� (p. 134),while others are made up of small sentences sungto the child to evoke a response, for example�Where is Terry?� or �Beat the drum!� (p. 86).Where the first types of interaction can bedescribed as Interaction Themes, the last onesare a part of a set of response-evoking techniquesthat normally characterise the beginning of musictherapy with this group of children.

In practice, these two types of interaction areof course not precisely separated, and it is not

until the child is actively creative, that one canspeak of an Interaction Theme. (As the suddenbreak in Mikkel�s music therapy didn�t becomean Interaction Theme until he had contributed tothe forming of it.) Where response-evokingtechniques primarily are guided by the adult�s wishfor response, with an Interaction Theme, mutualityincreases. In my empirical material, it was thechildren, who initiated the Interaction Theme (justas Edward did), and the joint interaction historygave the interactions a quality of mutualknowledge and expectation. Phenomenologicallyspeaking these are, therefore, two quite differentkinds of interaction.

With this delimitation in mind, there is no doubtthat many Interaction Themes appear in the workof Nordoff and Robbins. Edward�s �Awo�-motifis a clear example, and at the same time it isfascinating, seeing that the interaction took placebetween two music therapy pioneers and a littleboy in Pennsylvania forty years ago!

Interaction Themes Related to the Literature:The Case of MaxThe second example of an Interaction Themecomes from the Orff-based German music therapistKarin Schumacher, who has worked with autisticchildren for many years. The example is from thecase of Max, whom Schumacher has described indetail in her first book from 1994, and who also isseen in the video accompanying her latest bookfrom 1999.

Max is 7 years old and has a diagnosis ofinfantile autism and mental retardation. His onlyverbal expression is �Mama,� and communicativeinitiatives happen without eye contact. After twoyears of therapy, Max and Karin developinteraction, where Max swings back and forth ina large hammock. He sits on the side of thehammock, while Karin stands beside him andguides the hammocks movements with a rope(Schumacher & Calvet-Kruppa, 1999, video I,modus 5). The hammock is parallel to a wall, andMax hits the wall with a mallet, giving a singlebeat each time the movement takes him close toit. In the breaks between Max�s beats, Karin singsand beats a small rhythmic motif on the wall. Inlater sessions, she holds a drum in her hand that



they take turns playing small rhythmic motifswhile Max continues to swing back and forth inthe hammock. Now he has begun to sing the samesmall motifs that he plays.

Schumacher (1994) calls this type of interactionPlayform [Spielform], which she defines asrepeated interaction developed from session tosession between child and therapist. She worksdeliberately towards creating a Playform with eachchild, by starting with the child�s �interest,�which, for an autistic child, can be a certainmovement pattern or way of handling aninstrument. Despite the often idiosyncraticcharacter of the Playforms, Schumacher is veryconscious of giving them a clear and recognisableform, because their primary function is to bringabout something that can be repeated, so that itgradually creates a memory in the child thatappears as expectation of what is going tohappen (Schumacher, 1994, 1999).

It appears that there are many similaritiesbetween these Playfoms and my concept, just asthe above example with Max clearly is anInteraction Theme. The biggest difference,however, is that Schumacher in her conceptincludes more types of interaction than I do inmine. She describes, for example, a Playform inthe early sessions with Max where he is rollingon the floor in a plastic cone. In contrast I stressin point 1 (table 2), that an Interaction Theme isbuilt around a musical figure that the childactively helps to create. The case with Max showsthat the Playforms become more musical, but as astarting point her concept is more inclusive thanmine.

That the child and adult create a joint interactionhistory together (my point 2) is very clearlyilluminated by Schumacher (1999), who furtherconnects the development of repeated Playformswith the development of a core self and self-history, according to Stern (1985). Schumacherstresses the connection between Playform,recognition, expectation, and the possibility ofdeveloping interaction around theme-and-variation. The idea of developing a Playformtogether with the child is to build something that

can be expected, that they both can return to(point A).

According to Schumacher, the developmentof a Playform shows in itself an increased socialcompetence in a child, but, at the same time, it is a�practice field� for social interactions. The caseof Max shows clearly that he becomes graduallybetter at helping to keep the interaction going(point B). Schumacher points out further that thePlayform makes it easier for the therapist to readand attune to the child�s actions, but she doesn�tmention that the Playform as a common frame forinteraction also can make it easier for the child tounderstand the therapist�s actions as meaningful.

Besides the specific differences betweenSchumacher�s and my concept (point 1), thepoints of agreement on the significance orfunction of jointly created repeated interactionsequences are evident (point 2, A and B). However,theoretically the phenomenon is seen in differentcontexts, as Schumacher emphasises Stern�s(1985) theory on the self, while I emphasise acommunication theory perspective with a commonframe of understanding as a prerequisite formeaningful exchange. Thus I look more at thefunction as such, and I do not assume in mydefinition that development of an InteractionTheme necessarily points to a general self-development of the child. Despite this difference,the description of the clinical phenomenon assuch is very similar, which has been confirmed byKarin Schumacher (as a kind of member check).2

Related Concepts in the Music TherapyLiteratureThe Edward and Max cases show that it is possibleto find very clear examples of Interaction Themesin the music therapy literature. In the remainingcase literature, as mentioned in the introduction,many descriptions can be found of repeatedinteraction forms in improvisatory music therapywith children. These can, to a greater or lesserdegree, be conceptualized as Interaction Themes,although they seldom are described in as greatdetail as the Edward and Max cases includingaudio and video examples. In the following, parts

2 At the 4th European Congress, 1998, Leuven, Belgium.

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of this case literature will be discussed. I haveonly included literature that discusses themeaning of repeated forms or motifs,corresponding with point 2, A and/or B in mydefinition of Interaction Themes (table 2).

Table 3 presents examples of the phenomenom(1) through a simple, thoroughly described case(Agrotou, 1988; Lecourt, 1991; Bunt, 1994;Schumacher, 1994; Robarts, 1998), (2) throughseveral comparable cases (Nordoff & Robbins,1977; Alvin, 1978; Brown, 1994; Oldfield, 2001),and/or (3) through theoretical reflection connectedto case-vignettes (Aigen, 1998; Bunt, 1994;Pavlicevic, 1997; Robarts, 1998; Schumacher,1999).

Most of the music therapists mentioneddescribe the development of specific musicalfigures that are repeated and used with a particularchild. In a case with a hearing-impaired boy, Bunt(1994, pp. 83-97) describes how they createmusical games together that gradually evolve intoa whole series of Musical Events. Bunt (1994)and Wigram (1997) both use the idea of Leitmotif� a concept similar to Alvin�s (1978) SignatureTune, that refers to short rhythmic motifs that arecharacteristic for each child�s playing.Correspondingly, Brown (1994), Oldfield (1995,2001) and Robarts (1998) describe (without namingthe phenomenon) the development ofrecognisable musical motifs in cases with autisticchildren and youths.

On the more general level, Pavlicevic (1997)points out that many clients create their own (oftenidiosyncratic) invariant musical structures andoften also common invariant structures with themusic therapist. Moreover, improvisations canstart from (and return to) a so-called Point ofReference, that can be a musical structure, a motif,or a mood.

For other music therapists, it is not a specificmotif, but rather a musical playing rule (a �given�)that makes up the repeated interaction form.Agrotou (1988) describes a case with returningCo-active Episodes of musical turn interactionand in a later article Agrotou (1993) compares theseCo-active Episodes with ritualised play.Correspondingly, Lecourt (1991) describes thedevelopment of different Sound Games, in a case

where the dominant �move� was alternation.As seen above, the development of simple

repeated interaction sequences in music therapywith children with severe functional limitations,especially with severe autism, is a widespreadphenomenon in improvisational music therapy(point 1). The predominance of examples from theautistic spectrum may have to do with the factthat this area generally dominates the child musictherapy literature. It can also be due to the factthat development of Interaction Themes takeslonger and is more significant in music therapywith severely autistic children, and therefore isdescribed more than in other cases. However, Iwould be inclined to believe that InteractionThemes are found in improvisational musictherapy with different client types within thegroup of children (and adults) with severefunctional limitations. This is, however, an areafor further research.

The above-mentioned authors differ as towhether or not they emphasise the historicalaspect (point 2), or have considered the meaningof developing a repeated interaction form (pointsA and B). Generally, music therapists with manyyears of experience with the same client groupdiscuss the phenomenon the most, no doubtbecause comparison across different casesinevitably arises over time. Karin Schumacherdescribes the phenomenon most clearly. However,none of the authors include other clinical examplesfrom music therapy literature to generalise thephenomenon beyond their own practice.

But, as shown here in the review of theliterature, Interaction Themes as clinicalphenomena in music therapy can be generalisedacross time (forty years), place (countries) andpersons (children of different ages and diagnoses,and music therapists with a western culturalbackground but different educationalbackgrounds).

When comparing case literature within thisclient group that contains musical notation of thechild�s playing (Nordoff & Robbins, 1977; Alvin,1978; Birkeback & Winther, 1985; Agrotou, 1988;Friis, 1993; Brown, 1994; Howat, 1995; Oldfield,1995; Schumacher, 1999), it becomes noticeablehow similar the motifs are to each other, and how

ULLA HOLCK


similar they are to the Interaction Themes foundin the material on Karsten, Mikkel and Eigil,described in the beginning of the article. In lightof this, it can be concluded that InteractionThemes with these children often come to consistof 1) accompaniment to jumping or swinging, 2)sudden breaks, 3) turn interaction, 4) instrumentalrhythmic motifs, and 5) vocal 3-note motifs,sometimes ending on an accent. However, theInteraction Theme with my third subject, Mette,is exceptional; stroking each other�s cheek/hairwhile making prosodic legato vocal sounds willnever be typical music therapy interaction.

Although interaction with these children oftendevelops similar characteristics with differentchildren, it is important to stress the fact that theparticular Interaction Theme is developed locallybetween child and music therapist. Many of thesechildren have difficulties learning externalinteraction structures, which is why the musictherapist must use the child�s own expressionsas a starting point, and gradually give them form,so that they can be used interactively. (That this�form-giving� bears the mark of the therapist, andthus has a cultural or conventional form, is shownby the similarities between the many InteractionThemes.)

Delimitation of the Interaction Theme as aClinical PhenomenonWhen introducing a new concept which describesa phenomenon that clearly is a typical occurrencein improvisational music therapy with children withcommunicative difficulties, it is natural to askoneself, what isn�t an Interaction Theme? And,even more relevant, when is the development ofInteraction Themes, as defined here, not relevantin clinical work?

In the description of the four characteristics ofInteraction Themes, they are seen as simplemusical figures, repeated over and over again withsmall variations. This means that moresophisticated referential use of music cannot beseen as Interaction Themes as described here.With more well-functioning children, thedevelopment of a joint interaction history may

not be necessary to be at all able to read eachother�s actions as meaningful (point A), just as itmight not be a problem to perceive each other�scues in order to keep the interaction chaincontinuing (point B). As seen earlier, it is withclients who have the greatest communicativedifficulties that these simple musical figures aredescribed as significant in the case literature. Buteven staying with this client group, developmentof Interaction Themes is not something to be takenfor granted. Either because the therapist doesn�tuse improvisation (point 2), or because creatingan Interaction Theme does not seem relevant orisn�t possible in the clinical work.

Regarding the development of hypotheses,Lincoln and Guba (1985) mention negative caseanalysis as a method with which to test how wellthe preliminary analysis results match the datamaterial. Intrigued by this, I reviewed my datamaterial and found an example of this from thefifth subject of the study; Mathias. He is a 4-year-old boy with general mental retardation, aswell as an attention disorder similar to severeDAMP.3 His receptive language (understanding)is on a 2-year-old�s level, while his expressivelanguage skills are somewhat better.

As early as the 5th session, Mathias reactedmuch more quickly and adequately to the suddenbreak than Mikkel (described above). On the otherhand, Mathias seldom could hold his attention toone thing for more than one minute at a time, oftenonly 10-20 seconds. With his extensive attentiondisorder Mathias was distracted by even verysmall variations. At the same time; simple activitiesbored him. This combination made thedevelopment of an Interaction Theme impossible(points 1 and 2). On the other hand, when themusic therapist played a familiar children�s song,Mathias sang along enthusiastically and it could(almost) hold his attention throughout all theverses.

Although Mathias�s language abilities didn�tcorrespond to his age, they were much better thanthose of the other children, because he couldexpress himself meaningfully within the context.In this connection, it is interesting that both Mette

3 Deficits in Attention, Motor control and Perception (combined Motor Perception Dysfunction and AttentionDeficit Disorder).



and Eigil�s therapists reported that the childrenlost interest in the Interaction Themes as theybecame more interested in singing children�ssongs. Compared to the music therapy literature,this suggests a developmental axis from response-evoking techniques, to creating InteractionThemes and possibly further to participation inthe conventional forms and narratives of songs.Some children move through this whole axisduring the course of music therapy (as Mette andEigil), while others get as far as the InteractionTheme, which is then developed and refined(Karsten and Mikkel, Edward and Max). Still othersstart with songs or other more conventionalmusical activities.

This puts Interaction Themes into adevelopmental psychology perspective � not inregards to actual age but rather developmentalage, and thus verbal-symbolic capacity.4 If it ispossible to use conventional interactionstructures, such as songs, music games, playingrules, etc, there is (probably) no reason to createan Interaction Theme. The child is already able toparticipate in a common (symbolic) world ofmeaning. However, for children who havedifficulties grasping communicative intentionalityand, even more, for making themselvesunderstood, the creation of an Interaction Themecan be the only way of creating a joint frame forinteraction. Because the child himself contributesto the interaction, no matter how idiosyncraticthis contribution may seem, the Interaction Thememakes it possible to develop this particular child�sbasic social and communicative abilities.

Conclusion

As it has been shown, it is possible to define anddelimit Interaction Themes as a specific type ofmusic therapy interaction with children with severecommunicative difficulties. Interaction Themes asa phenomenon can be generalised across time(forty years), place (countries with a westernculture) and individuals (children with differentdiagnoses, music therapists with different

educational and cultural backgrounds).In the empirical material that was the basis for

my research there was a predominance ofInteraction Themes in work with children withinthe autistic spectrum. This pattern is repeated inthe case literature, which can be due to this area�spredominance in child music therapy literature.Another possible explanation is that thedevelopment of Interaction Themes takes longerand has more significance in music therapy withseverely autistic children, and therefore isdescribed more often than in cases of childrenhaving fewer communicative difficulties. Afterhaving become acquainted with the phenomenon,several of the music therapists involved reportedthat Interaction Themes often occur in musictherapy with non-autistic children, showing thatthis area needs further research. Thegeneralisation of this concept to differentpopulations is therefore important to consider,for example in music therapy with adults withdifferent types of communicative difficulties,where undoubtedly Interaction Themes (asdefined above) will also emerge in therapyprocess.

Through the four characteristics, I havedefined and delimited Interaction Themes as aphenomenon. Further, the negative case analysisshows the delimitations of Interaction Themesand puts them into a developmental psychologyperspective. Thus, for two of the children in theempirical material, Interaction Themes only appearin a phase until the children start to show interestin songs and their narratives, while for others theyform the basis of the therapy. With a larger clientgroup it could be interesting to investigate thisfurther, and, for example, see what characterisestransitions between these phases.

In conclusion, I will comment on the processof discovering Interaction Themes, as well as thecase literature review, which gives the impressionof a much more well-documented and explicitphenomenon than is actually the case.

My interviews with the music therapists duringmember checking showed that these therapists,prior to my research, weren�t aware of Interaction

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4 Because of the scope of this article a comparison of Interaction Themes with newer developmental psychology isnot possible (for further reading, see Holck, 2002).


Themes as a general phenomenon, even thoughthey knew of each other�s work. On the other hand,each one of them knew, of course, in whichsequences the child was most active � thereforethey suggested that I place the cameras at anangle so that sequences later found to containInteraction Themes were recorded in the bestpossible way! None of us were aware of this atthe time of recording, but seen retrospectively,this is a kind of �pragmatic validation� of theclinical significance of Interaction Themes. In lightof this, it is interesting that it wasn�t until muchlater in the course of my research that I discoveredthe presence of Interaction Themes in my ownwork with autistic adolescents, several years ago!My implicit experience had thus guided theresearch process through theory and analysis,so that the tacit knowledge was made explicit.

In the same way, the case literature revealsInteraction Themes as inevitable and, at the sametime, implicit. Music therapists describe just thistype of interaction because they experience it assignificant. But at the same time, the phenomenonas such often occurs implicitly, with Schumacher�s(1994) Playforms as the most important exception.The case literature reveals a lack of crossreferencing in identifying the general prevalenceof Interaction Themes in clinical reports.Accordingly, it was only through a more detachedobservation of others� music therapy sessions,that I became aware of this specific phenomenon.

When Interaction Themes are so widespreadwith this client group, I assume it is because of aneed to create a common context for interactions,without the symbolic-semantic content that thesechildren often don�t understand. This could be apossible explanation (among several) as to whymusic therapy often has such a great effect onthis client group. Through music it is possible tocreate an auditory and interactive context wherethe child experiences communicative actionssuch as turn taking, turn giving etc., possibly asa bridge to more conventional communication.These speculations of course need furtherresearch. Through the descriptions, the definition,and the delimitation in this article, I hope to havecontributed to an increased awareness of theapplicability of Interaction Themes in clinical

practice as well as a theoretical reflection on theirpotentials in music therapy.

Acknowledgements

I would like to thank the children, parents, andmusic therapists, without whose permission andparticipation this research would not have beenpossible. Also thank you to all of the musictherapists who, through their case descriptions,made generalisation of Interaction Themespossible. And, finally, a warm thanks to ProfessorLars Ole Bonde for his valuable consultation andfor the support of the Ph.D. Training Programmeled by professor Tony Wigram, department ofMusic and Music Therapy, Aalborg University.

References

Agrotou, Anthi (1988). A Case Study: Lara.British Journal of Music Therapy, 2(1), 17-23.

Agrotou, Anthi (1993). Spontaneous RitualisedPlay in Music Therapy. In: Heal, M. &Wigram, T. (Eds.). Music Therapy in HealthEducation, pp. 175-192. London: JessicaKingsley Publishers.

Aigen, Kenneth (1998). Path of Development inNordoff-Robbins Music Therapy. Gilsum, NH:Barcelona Publishers.

Aldridge, David, Dagmar Gustorff & LutzNeugebauer (1995). A Preliminary Study ofCreative Music Therapy in the Treatment ofChildren with Developmental Delay. The Artsin Psychotherapy, 22(3), 189-205.

Alvesson, Mats & Kaj Sköldberg (1994).Tolkning och Reflektion. Vetenskapsfilosofioch Kvalitativ Metod [Interpretation andReflexion. Philosphy of Science andQualitative Methodology]. Lund:Studentlitteratur.

Alvin, Juliette (1978). Music Therapy for theAutistic Child. Oxford: Oxford UniversityPress.

Birkeback, Merete & Ulrike Winther (1985).Musiktherapie mit Autistishen Kindern[Music Therapy with Autistic Children].



Beschäftigungstherapie und Rehabilitation,2, 113-118.

Brown, Sandra (1994). Autism and MusicTherapy - Is Change Possible, and WhyMusic? British Journal of Music Therapy,8(1), 15-25.

Bunt, Leslie (1994). Music Therapy. An Artbeyond Words. London: Routledge.

Di Franco, Gianluigi (1999). Music and Autism.Vocal Improvisation as Containment ofStereotypes. In: Wigram, T. & Backer, J. D.(Eds): Clinical Applications of MusicTherapy in Developmental Disability,Paediatrics and Neurology, pp. 93-118.London: Jessica Kingsley Publishers.

Edgerton, Cindy Lu (1994). The Effect ofImprovisational Music Therapy on theCommunicative Behaviors of AutisticChildren. Journal of Music Therapy, 31(1),31-62.

Elefant, Cochavit (2002). EnhancingCommunication in Girls with Rett Syndromethrough Songs in Music Therapy. Unpubl.Ph.D. thesis, Aalborg Universitet.

Friis, Barbara Z. (1993). Det indre udtryk.Dybdepsykologiske aspekter i musikterapi[The Inner Expression. Aspects of DepthPsychology in Music Therapy]. Unpubl.Licentiat thesis, Aalborg Universitet.

Holck, Ulla (2002). �Kommunikalsk� samspil imusikterapi. Kvalitative videoanalyser afmusikalske og gestiske interaktioner medbørn med betydelige funktionsnedsættelser,herunder børn med autisme [�Commusical�Interplay in Music Therapy. Qualitative VideoAnalyses of Musical and GesturalInteractions with Children with SevereFunctional Limitations, including Childrenwith Autism]. Unpubl. Ph.D. thesis, AalborgUniversitet.

Howat, Robin (1995). Elisabeth: A Case Study ofan Autistic Child in Individual MusicTherapy. In: Wigram, T., Saperston, B. &West, R. (Eds.). The Art and Science of MusicTherapy: A Handbook, pp. 238-257. London:Harwood Academic Publishers.

Klinger, Laura & Geraldine Dawson (1992).Facilitating Early Social and Communicative

Development in Children with Autism. In:Warren, S. F. & Reichle, J. (Eds.). Causes andEffects in Communication and LanguageIntervention, pp.157-186. Baltimore: Paul H.Brooke�s Publishing.

Lecourt, Edith (1991). Off-beat Music Therapy:A Psychoanalytic Approach. In: K. E. Bruscia(Ed.). Case Studies in Music Therapy, pp. 73-98. Phoenixville, PA: Barcelona Publishers.

Lincoln, Yvonna S. & Egon G. Guba (1985).Naturalistic Inquiry. London: SagePublishers.

Littlejohn, Stephen W. (1999). Theories ofHuman Communication. Belmont, CA:Wadsworth Publishing Company.

Müller, Pierrette & Auriel Warwick (1993).Autistic Children and Music Therapy. TheEffects of Maternal Involvement in Therapy.In: Heal, M. & Wigram, T. (Eds.). MusicTherapy in Health and Education, pp. 214-243. London: Jessica Kingsley Publishing.

Nordoff, Paul & Clive Robbins (1971). Therapyin Music for Handicapped Children.London: Victor Gollancz.

Nordoff, Paul & Clive Robbins (1977). CreativeMusic Therapy. Individualized Treatment forthe Handicapped Child. New York: The JohnDay Company.

Oldfield, Amelia (1995). Communicating throughMusic: The Balance between Following andInitiating. In: T. Wigram, B. Saperston & R.West (Eds.). The Art and Science of MusicTherapy: A Handbook, pp. 226-237. London:Harwood Academic Publishers.

Oldfield, Amelia (2001). Music Therapy withYoung Children with Autism and theirParents. In: D. Aldridge, G. Di Franco, E. Ruud& T. Wigram (Eds.). Music Therapy inEurope, pp. 73-88. Rom: ISMEZ/Onlus.

Pavlicevic, Mercedes (1997). Music Therapy inContext. Music, Meaning and Relationship.London: Jessica Kingsley Publishers.

Plahl, Christine (2000). Entwicklung förderndurch Musik. EvaluationMusiktherapeutischer Behandlung[Development through Music. Assessment ofMusic Therapy Treatment] (Unpubl. Ph.D.thesis, 1999). Münster: Waxman.

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Priestley, Mary (1994). Essays on AnalyticalMusic Therapy. Phoenixville, PA: BarcelonaPublishers.

Robarts, Jacqueline Z. (1998). Music Therapyfor Children with Autism. In: Trevarthen, C.,Aitken, K., Papuodi, D. & Robarts, J. Z.(Eds.). Children with Autism. Diagnosis andInterventions to Meet Their Needs, pp.172-202. London: Jessica Kingsley Publishing.

Rogers, Sally J. (1988). Characteristics of SocialInteraction between Mothers and theirDisabled Infants: A Review. Child: Care,Health and Development, 4, 301-317.

Ruud, Even (1990). Musikk som kommunikasjonog samhandling [Music as Communicationand Interplay]. Oslo: Solum Forlag.

Schuler, Adriana, Barry M. Prizant & Amy M.Wetherby (1997). Enhancing Language andCommunication Development: PrelinguisticApproaches. In: Cohen, D. J. & Volkmar, F. R.(Eds.): Handbook of Autism and PervasiveDevelopment Disorders, pp. 539-571. NewYork: John Wiley & Sons.

Schumacher, Karin (1994). Musiktherapie mitAutistischen Kindern [Music Therapy withAutistic Children]. Stuttgart: Gustav FisherVerlag.

Schumacher, Karin (1999). Musiktherapie und

Säuglingsforschung [Music Therapy andInfant Research]. Frankfurt am Main: PeterLang.

Schumacher, Karin & Claudine Calvet-Kruppa(1999). Video: The Instrumental ExpressionI+II. Berlin: The Authors and Stonehead Cut.

Silverman, David (1994). InterpretingQualitative Data. Methods for AnalysingTalk, Text and Interaction. London: SagePublishers.

Stern, Daniel N. (1985). The Interpersonal Worldof the Infant. New York: Basic Books.

Stern, Daniel N. (1989). The Representation ofRelational Patterns: DevelopmentalConsiderations. In: Sameroff, A. J. & Emde,R. N. (Eds.). Relationship Disturbances inEarly Childhood, pp. 52-69. New York: BasicBooks.

Wigram, Tony (1997). Musicoterapia: Estructuray flexibildad en el proceso de musicoterapia[Music Therapy: Structure and Flexibility inthe Music Therapy Process]. In: P. d. Campo(Ed.). La Músico como Proceso Humano, pp.171-189. Salamanca: Amarú Ediciones.

Wigram, Tony (1999). Assessment Methods inMusic Therapy: A Humanistic or NaturalScience Framework? Nordic Journal ofMusic Therapy, 8(1), 7-25.


interaction themes in music therapy: definition and delimitation

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