Walk so silently that the bottoms of your feet become ears. - Pauline Oliveros |
As a clinician who is working in the fields of music therapy, music psychotherapy, and sound therapy, I've noticed distinctions and similarities along the path. The nature of music and sound comes from the simple fact that everything is vibrating on a molecular level and therefore the very core of any healing work using sound and music stems from this fact. Sound is simply vibration and music could be defined simply as sound that is organized through our unique and collective listening experiences. Some say that music is organized sound but I’m not sure how to define what “organized” means. I believe that music is what we decide it is...thinking of John Cage here for a minute...or more aptly, for 4 minutes and 33 seconds! In this monograph, we’ll look at both the similarities and differences of these practices.
LISTENING
Listening is the essence of our work in music therapy and sound therapy. It is the most fundamental and most essential aspect of our work in healing. Without it, we simply cannot enter a healing space in an integrated, authentic way. Listening is our first act of compassion.
Healing modalities including those using sound and music, i.e., vibration (frequency, tone, rhythm, timbre, texture, pulse - everything that is perceived as "music") are most potent when intention and connection are present. Healing often finds its potency in the liminal space that exists between client and therapist, thought and action, conscious and unconscious states, Alpha and Theta brainwave states, sonic events and what we perceive silence to be, and movement events and what we perceive stillness to be. Sun Ra said it best - "Space is the place" or as Miles Davis said, "It's not the notes you play, it's the notes you don't play."
From a body-mind perspective and in somatic psychotherapy practices, we work with liminal space as the natural homeostatic or neutral state - the state of equanimity that exists in all of us. It can be difficult to access this natural and accessible place of balance after an illness, traumatic event, neglect, or being told stories that create an internal narrative which translates into energies that aren't always beneficial and consequently create an imbalance in the body and mind.
When working with our clients in music therapy or sound therapy, we are inviting the homeostatic state to come to the fore. This takes time. There is no "fixing" anything. We simply allow space for the unfolding and unwinding of pain and trauma to occur in the time it takes to do so through the work. We take our time to listen to the physical body, the voice, the mind, the emotional and energetic body and work with what is being presented in the moment. Therapists hold our clients in the highest regard to mirror an authentic experience and provide a nuanced approach to change and transformation over time.
The phenomenon of "entrainment" brings forth the natural homeostatic state that can be achieved by meeting the client’s own rhythm - where they are energetically, in the music, and so on, and allow for the natural state of ease to manifest over time. Entrainment is an important factor when we connect with our clients, our students, our family members, our friends, and even with parts of ourselves. In essence, we are inviting those in our company to entrain with us through sound, through breath, movement, eye contact, silence, and our own bio rhythms. We are taking into consideration these bio-rhythms of the mind, heart, and body and these rhythms are matched and then in due course shifted to establish connection, release, balance, and a sense of belonging and safety. Entrainment doesn't always occur right away between therapist and client for a variety of reasons including resistance, chronic illness, and other factors but through continued unconditional positive regard on our part as therapists, healers, etc., the possibilities of connection through entrainment can facilitate deep healing.
"THE 3 Cs"
There are core values in therapy using sound and music which I call the "3 C's" in sound and music therapies:
Compassion, Creativity, and Curiosity.
We as healing arts practitioners utilize these 3Cs in our work all the time, without necessarily naming them as such, but nonetheless, they are ever-present in the healing process.
Compassion is evident in how we hold one another in high regard. We cannot help another’s healing journey without it. We often work with clients who are in a great deal of pain physically, psychologically, emotionally, energetically, and it’s implicit upon us to tap into our compassion, even when faced with countertransference when working with a client and, for reasons that are sometimes quite subtle or blatantly obvious, we are met with our own resistance to the work or even to the client. It’s when we are able to tap into our compassion that we can find a meeting point, that liminal space that is in the place where loving kindness, unconditional positive regard, and authentic connection live.
Creativity is a multi-faceted word and sometimes can bring up feelings of self-doubt or “stuckness” if we’re not feeling particularly “creative” at times. However, the creative act happens every day in some way. We are always improvising, listening, responding spontaneously, figuring things out on the fly, navigating, producing, learning, and sharing. These are key components to creativity! The creative spirit is endlessly curious and some favorite words include “Yes!” and “Let’s...” When we are in a creative flow state, we are connecting to a part of ourselves that is disciplined, open, connected. When working with our clients with their creativity, it’s an invitation for them to tap into a part of themselves that engages in finding the edges when making or thinking about things, discovering new ways of engagement, tapping into a part of themselves that is not thought-based, ego-based, or even linear.
Curiosity helps us to check our judgements at the door. When we are genuinely curious, we are no longer limited by any pre-conceived notions or judgmental thoughts, and rather, the possibilities of who our clients are and want to be, what they need, what their strengths or areas for growth are, and how we might be able to help them on their healing journey are endless. Curiosity facilitates growth, wonder, awe, and the vastness of healing potential in our clients. Curiosity helps clinicians and clients learn, develop, dig deeper, and open.
The 4 facets in western music therapy, according to music therapist, Dr. Kenneth Bruscia are: Receptive, Re-Creational, Compositional, and Improvisational. These 4 facets can be integrated into sound therapy as well in the way we work with our clients and are always informed by the 3Cs. Music therapists, Paul Nordoff and Clive Robbins worked with children who were living with physical, or cognitive challenges with the idea of the “music child” in which it is understood that we are all inherently musical and have music in us. The two music therapists would match the sound, energy, tone, and rhythm of the child, not only mirroring the lived experience in the moment but holding it as sacred thus providing the opportunity for the child to
simply be the perfect being they are inside of and with the music. This matching of mood is called the Iso Principle, coined by psychiatrist and music therapist Ira Altshuler, in which the music therapist meets the client where they are emotionally in the moment through the music, which then helps to facilitate change over time through entrainment.
As music psychotherapists, we incorporate both verbal and musical approaches with our clients. In sound therapy, our work is not necessarily described by these methods although they may take place within a sound session naturally. More often than not, a sound therapy session is in the realm of Receptive music therapy in which the client is receiving sound and vibration from the therapist. Music therapists work with all 4 methods – sometimes within one session.
The Re-creative method focuses on singing and playing music that is already composed and the client is engaging in a variety of ways with a pre-composed piece of music in the session. That engagement can take a bunch of directions. Sometimes a therapist might invite a client to re- word the lyrics to a song in order to help create a new shift in consciousness using a particular song that can help navigate a difficult situation using this method and singing a “new” song with devised lyrics that the client creates. That is one of many examples of Recreative music therapy.
The Compositional method in music therapy or in sound therapy sessions occurs when a client and therapist work on an original piece of music or a song in the session and create an end “product” that the client can keep. The composition can also be recreated as in a live performance or recording. The composition can also be a kind of transitional object for the client during the termination process in therapy. Some medicine melodies that might spontaneously occur within a sound therapy session could be deemed kinds of compositions.
Improvisation is in my opinion the method that interweaves all the methods as it is apparent in our listening experiences, our compositions, and our recreation of songs. Improvisation in music therapy invites the client and therapist to make music in the moment that is spontaneous and immediate. The improvisation might represent certain aspects of the client’s life or struggles or issues they are facing, letting the music represent the feeling states or perhaps even family or friends. The improvisational experience is often validating, relieving, and can act as a mirror and support to the feeling state.
Instruments - There are psychodynamic aspects inherent in all musical instruments and the voice. These aspects can include shape, size, timbre, tone, texture, color, volume, etc. and can be investigated in a more analytic way between the therapist and client to examine parts of the self, family dynamics, ego states, trauma histories, and more. When in conversation with our clients, we invite a multitude of possibilities to be explored in order to provide an opening into self- actualization, acceptance, and wellbeing. As sound therapists, we tend to use a variety of instruments in our sessions that facilitate deeply relaxed state. That said, what if we gave our clients a choice of some sounds/instruments that they feel attuned to before we start the session and then when they are in repose and in a deep listening state, the instruments they chose become an integral part of the healing work that becomes more unique and personal for that session.
Before each session – whether music or sound therapy – we check in with our clients to see what is going on for them in the moment and what they would like to work on. The session can go in many different directions but the first step in all healing work is LISTENING.
We deeply listen to how our clients feel, what they are noticing, what energy shifts occur, what imagery is coming up if any, etc. Listening is the beginning of true connection and transformation and all the work subsequently comes from the act of listening first.
For my music therapy or psychotherapy clients, the sessions can take many different directions and although some are goal-oriented, what is at the core of the therapy is the process of listening and connecting. We witness, reflect, and help facilitate self- actualization, relief of symptoms and shifts in conscious and un-conscious behavioral patterns over time and as our rapport and connection with our clients deepen, so does the work.
In a sound session, the journey is also unknown in terms of what will come up and be noticed in the session, however the client may be in a more neutral and passive position of sitting or lying down. Sound sessions are often goal-oriented to achieve relaxation, grounding, ease of pain or distress of symptoms and many sound sessions are singular or periodic, unlike psychotherapy or music therapy which can be on an ongoing basis, allowing for a depth of connection and continued unfolding and unwinding to occur. In both sound and music therapy sessions we often engage in voice work to help our clients connect somatically, with their breathe and with their own relationship to their voice.
All music therapists must adhere to a standard code of ethics and best practices as identified through the CBMT (Certified Board of Music Therapists) and the AMTA (American Music Therapy Association). Music therapists attend accredited undergraduate and graduate training programs in higher education, obtain national board certification and even licensure in some states. Many sound practitioners attend training programs ranging from a weekend-long introduction like Sound School, to a 9-month intensive and variations therein. Some sound trainings offer certificates of completion for the amount of hours the course offers.
One main difference between a sound and music therapy session is physical touch. Sound practitioners sometimes use hands-on methods and in this respect, the hands become another pair of ears, listening beyond the scope of aural hearing. This is always with consent of course.
Music therapists and music psychotherapists who in the state of New York are often licensed creative arts therapists, (LCAT) don't make a habit of touching their clients unless we deem it a necessary intervention for the safety of the client (i.e., a client in distress who may try to hurt themselves or others during a session). All therapists should have at least verbal consent to touch in order to ensure that ethical practices and safety are an integral part of every session. Intake forms for sound and music therapy should include consent to touch and touch should be consented to before each and every session.
DEEP LISTENING
Deep Listening, a term used by many and coined by composer and music pioneer, Pauline Oliveros, is a key element in both music and sound therapy. Pauline’s definition of Deep Listening is:
“
We listen to our clients in distress or in an anxious or depressed or pain state is our first act of compassion, connection, and non-judgmental observation. In a music therapy session, we listen to all aspects of what is happening in the session including what is being shared, the vocal timbre, body posture, language, as well as the quality of the music, the instruments chosen, the choice of song if exploring lyric analysis of a song, the way in which our clients engage in the musical act, etc. In a sound session, we look at similar things but the way in which a client is receiving sound is noticed by the practitioner as subtle energetic shifts, somatic responses,
going below the surface of what is heard, expanding to the whole field of sound while finding
focus. This is the way to connect with the acoustic environment, all that inhabits it, and all that
there is.”
breath, heart rate, the energy coming from the body, imagery that comes up during the session for both client and practitioner, and the way in which the sound instruments (bowls, forks, etc.) respond as well. In sound practices, we are working with the bio-energetics of the clients, and intuition is a vital component in the work as well. Again, not so different from music therapy in many ways, but it is in the subtle response shifts in the bio-field that we look for and listen for in a sound session. This is also apparent in GIM (Guided Imagery in Music) in which a client enters an altered state through programmatic music listening and guidance of a music therapist. During the altered state, the client speaks to the therapist about what they are experiencing and the music therapist writes it down in real time as they continue to facilitate the music and the trajectory of the sonic journey. Afterwards, the client and therapist discuss the journey and the client is invited to create a mandala that represents the imagery that came up. This mandala is then shared in the session as well as a point of reference and reflection.
Resonance
Resonance comes from the latin root, resonare, meaning “re-sound” or “echo.”In sound and music therapy, (as well as in performance) our instruments are an extension of our energy and there are responses in the instruments themselves to that energy. When a bowl or fork is placed on the body or near the body, the resonance of the instrument is felt and listened to by the practitioner and the client, and we look at/for the somatic and energetic response of the client an in ourselves. I would say that this transpersonal approach is at the core of a lot of sound therapy work.
When an instrument (bowl, fork, tingsha, monochord, etc.) is placed on or near the body, we listen for the way a person's breath shifts, how the person lets go of tension in a certain part of the body, how to work in concert with the energy of the bio-field, meeting our client where they are energetically, allowing the music and vibration of both client and therapist to become entrained. By listening with the whole body, the sound practitioner and music therapist can tap into a person's energy and this informs us of possible trauma stored in the body, negative belief systems getting stuck somatically, symptoms of depression and anxiety, and physical pain. It all comes down to how we help facilitate connection and a sense of belonging within the music and sound, and our job as therapists or sound practitioners is to help reintegrate and re-invite connection with the body-mind-spirit.
Frequencies, Intervals, and Tunings
There are many theories about the importance of musical intervals, certain frequencies, tuning systems (A 440 vs. 432, Just Intonation vs. Equal Temperament) and other methods by which sound affects us and how we affect sound.
The Schumann Resonance, the frequency of the earth’s vibration at a rate of approximately 8Hz, is a resonant frequency relating to the Alpha-Theta brainwave states between 4 and 12Hz. Many sound practitioners work with this concept using instruments such as tuning forks that correspond to these states. The tuning forks create a vibration when struck that are both felt and heard sonically starting at a rate of 32Hz, and moving to 64Hz, then 128 Hz, and 256 Hz. Much of the work based on the Schuman Resonance is theoretical and not necessarily always empirical and our clinical work is more often measured using qualitative evidence. However, in some instances, especially in the measuring of heart-rate, autonomic nervous system, and brain-wave states, some quantitative data demonstrates significant changes in the body, brain, and heartrate that are immediately measurable and therefore help us to understand how sound and music affect change.
Music and Mindfulness -
Many peer reviewed studies are available that discuss the effects of mindfulness meditation on the autonomic nervous system (ANS). When we incorporate sound and deep listening in our mindfulness practice such as Mindfulness Based Stress Reduction (MBSR), the effects are noticeable in terms of the efficacy of experiencing a parasympathetic nervous system response in clients.
A key element of sound work and sound in meditation is the musical drone. All living beings, in their core essence, are in fact the embodiment of sound. The heartbeat is our own rhythmic drone. The blood-flow, respiratory, circulatory system and central nervous system are all engaged in a symphony of movement and vibration and this is why the body-mind in humans and other animals can entrain to drone-based music.
This phenomenon of our bodies being in their very essence, sound, is evinced in the study of Cymatics by showing how matter reacts to and entrains with sound. This is demonstrated through working with the Chladni Plates in which powder or sand is used to show the reaction to different frequencies measured in hertz. This is also evinced in the way we see a body of water
respond to vibration. Since we are largely made of water, the body is a kind of repository for sound. There are more and more instances now of sound waves being used to detect certain diseases and treat medical issues as well as the break-up cancer cells and cataracts. Ultrasound has been used effectively since the 1960s for the purpose of diagnosing and treating symptoms.
Sound Baths/Meditations/Journeys
Many sound bath meditations/journeys or other sound healing practices incorporate drone-based instruments such as gongs, large hanging bells, metal and crystal singing bowls, long chimes, Indian shruti boxes, the human voice, breath, binaural beats, tuning forks, didgeridoo, polyrhythmic drumming, chant, overtone singing, mantras, prayers, etc. The repetition of sounds done intentionally and with proper technique and skill, can facilitate a parasympathetic nervous system response through activating the vagus nerve, also known as the wandering nerve, that is part of the parasympathetic nervous system. This parasympathetic response is also known the Rest and Digest state. When recovering from illness, trauma, or stress, our nervous systems can go into a sympathetic response also known as fight or flight. The vagus nerve, when stimulated, can help us enter the rest and digest state and eventually into a homeostatic state.
In conclusion, the correlation between sound work and music-centered music therapy comes down to mindful, Deep Listening, unconditional positive regard, non-judgmental observation, the 3 Cs of curiosity, compassion, and creativity and more importantly, loving kindness for the complexity of the human condition of which we are all a part.
INSTRUMENTS:
There are wonderful instruments in the world from which to choose to use in therapeutic sound practices, so it is important that you not only know the origin of the instrument, the cultural heritage, the history, legacy, and playing technique, it is important to be aware of cultural appropriation, respect of culture and understanding of applications of certain instruments from cultures outside of your own. It is also important to know the sources from where the instruments come and make sure that the people from whom we are buying instruments or goods are reputable, honest, ethical, and engaged in fair trade. Just because you find something on Amazon or find a "great deal!" somewhere doesn't mean it's a good idea to buy an instrument so buyer beware and also aware so that the instruments you have in your tool kit have the energy you would want to bring into any healing work you are giving or receiving!

The instruments I use are resonant drone-based instruments. Below is a list of some of the instruments I use in meditations and in individual sound and music therapy sessions as well.
CRYSTAL SINGING BOWLS I work with both alchemy bowls and quartz crystal bowls in my sound meditations and find their potency in the interval relationships between tones as well as the continual drone in playing which focuses the mind, allows the body to relax, and move energy in the bio-field. Be careful not to buy bowls from China as the materials are not always pure and the manufacturing suspect in terms of the working conditions of the factories.
"FEELTONE INSTRUMENTS" Monolinas
Monchair
Sansulas
HandPans
Monolinas are drone/overtone, stringed instruments with the deeper bass strings and perfect 5th strings on the bottom. The way the Monolina is played can bring forth rich overtones and the instruments can be placed on the body, both front and back to be able to feel the sound. Monolinas come from the FeelTone company based in Germany. Contact me for distribution information or to purchase an instrument.
The Monchair is similar to the Monolina but it is a chair with strings on the back that send a deeply relaxing and grounding vibration throughout the body.
Sansulas are a type of mbira or kalimba (also known as a thumb piano) in which the actual instrument is imbedded into a synthetic resonator.
TUNING FORKS I work with BioSonic Tuning Forks with my clients and in sound events. Tuning forks can be used to work with the neuro-endocrine system, in working with bi-lateral stimulation for trauma work, and on the body for relief of pain or to unblock patterns using vibration.
HIMALAYAN SINGING BOWLS These bowls are also known as standing or resting bells.
They are often played gently or with some more intense striking and may also be played by rubbing a mallet around the outside rim which allows the bowl to "sing" in a sustained tone which can elicit a relaxation or alpha brainwave response. The oncologist, Mitch Gaynor who tragically passed a couple of years ago, wrote two seminal books about his clinical practice using Tibetan singing bowls with some of his patients to help the healing process before, during and following treatment.
If you are interested, read "Sounds of Healing: A Physician Reveals the Therapeutic Power of Sound, Voice, and Music" The metal bowls I use are from different distributors. There are many good, reputable sellers out there but be careful as there are some people who are capitalizing on the sound bath trend who will sell anyone anything! Email me for referrals.
SHRUTI BOXES Shruti Boxes come from India and are pronounced (Shru-ti). In India, the shruti is the smallest audible interval and there are 22 shrutis in a western scale half-step. Shruti is a Vedic word meaning "what is heard" or "what is revealed" so when we use the shruti box drone, we connect to a deep listening place where connection and revelation can happen. They are musical drone instruments often used in vocal and instrumental accompaniment. I have several sruti boxes from Ron Kravits of Music in the Moment or from Keshav Music located in upstate, NY.
RAV HAND PANS RAV Vast hand pan drums are resonant drone and melodic instruments in various keys and modes. I purchased mine from Music in the Moment but you can find them online anywhere these days.
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