The Role of Improvisation in Music Therapy

Improvisation refers to a spontaneous performance of music or other arts without previous preparation or any written notes and is considered to be a natural way of music making. Music therapy is the use of music to cure or to bring relief to ill or troubled clients. It is uncertain how music does cure pain, but it has been proven effective in many situations and with many different illnesses.

The history of improvisation begins in the medieval era when singers were trained to improvise additional lines over religious liturgical chants as they were performed.

In Western classical music, e.g. in early renaissance music, improvisation has its roots, before the invention of musical notation when music was shared and passed on to the following generation through oral tradition. In the baroque period, notation was introduced and standardised although improvisation was still highly valued. As in the present, it was routinely taught as a part of learning how to play an instrument.

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Players often improvised preludes, fugues and other pieces during performances. During these improvisational activities, figured bass and the addition of ornaments were often used. In the classical period, composers began to be more specific about notating exactly how they wished certain aspects of their pieces were to be played, for example by adding cadenzas and ornaments.

Players were again expected to be able to improvise in pieces such as sonatas, themes and variations or fantasy. In the following romantic period, performers still improvised composed pieces and parts of pieces during performances, for example Liszt enjoyed improvising pieces based upon themes suggested by the audience (written on scraps of paper before the performance).

The practice of improvising an introductory piece to establish the key and set the mood also became popular. However, as memorised performances became more popular and much more commonly used, improvisation began to decline. By the end of the nineteenth century, improvising had pretty much disappeared from all performances. In the current musical situation, improvisation has almost completely disappeared in Western music with composers being very specific in notating exactly how they want their music to be performed. Although improvisation has diminished in this genre it is widely used in other genres such as jazz and blues.

Music therapy is the clinical and evidence-based use of music interventions to accomplish individualised goals within a therapeutic relationship by a professional therapist. The aims for a music therapy session is to; promote wellness, manage stress, alleviate pain, express feelings, enhance memory, improve communication and promote physical rehabilitation (American Music Therapy Association, 2019). Music therapists are trained to assess an individual/groups physical, cognitive, social, emotional, and communication abilities which they then use to design a series of sessions to meet the needs of that individual or group. The content of these sessions varies from client to client and depends on the needs of the individuals or people within the group. Some sessions include improvisation on instruments or through singing, listening to music, writing songs, discussion of lyrics and developing musical skills through learning to play an instrument. As these sessions progress, music therapists provide ongoing evaluations of the client’s development and are involved in the further session planning (Levine Music, 2019). For example, Paul Nordoff and Clive Robbins worked together in the 1950/60’s to develop a technique where they could use music to overcome people’s difficulties because they believed everyone can respond to music no matter what their disability is or how ill they are. They used music to communicate with people, to help them change their lives and to live a more creative and useful life. The techniques that Nordoff and Robbins developed, now form the basis for modern music therapy methods (Clarissa Sabillena, 2010).

Improvisation can be classified under two main headings. Firstly referential improvisation is where a person improvises in a way to portray a non-musical reference for example a feeling or an image. Alternatively non-referential improvisation is where a person improvises without reference to anything other than the sounds used or music in general. Under these headings there are many different subheadings such as instrumental referential which is the creation of music on a musical instrument according to a given reference; song improvisation which is creating lyrics, melody and accompaniment to a song; and vocal non-referential which is creating a vocal piece without words or images. There is also body improvisation which is creating different types of body sounds; mixed media which is creating a piece with any combination of instruments, vocals or body sounds; and conducted improvisation which is creating a piece by giving cues to one or more improvisers.

Improvisation is used in music therapy to help clients feel connected and be able to communicate with their therapist and with the world around them. It is a way of the client and therapist relating to each other and can involve the client making up music, while singing or playing an instrument, therefore creating a melody, rhythm, song or instrumental piece. The therapist can then repeat the improvised passage in response or can respond to it in a musical way which allows a ‘musical’ conversation to continue between the two participants.

Improvisation and music therapy interact in many different ways. It involves improvisation by the client, therapist or both and the two parties imitating or copying the others improvised passage. The aims of improvisation include: establishing a communication between the therapist and client; providing the client a way of expressing themselves and showing their feelings; exploring the ways in which a client is able to show themselves in relation to others; allowing the client to develop relationships and group skills; and to be creative and express themselves. It also hopes to stimulate the patient’s senses especially in terms of their cognitive skills (Bruscia, 1998). To achieve the above aims, the therapist can use a variety of improvisational techniques such as; imitating which is a basic technique of empathy in which the therapist copies or repeats a client’s response; reflecting which is a technique where the therapist expresses the same moods or feelings presented by the client; rhythmic grounding which is achieved by establishing a steady beat/rhythm supporting the clients improvising; dialogue which is a process where the therapist and client communicate through their improvisations and accompanying which is a technique where the therapist supports the clients improvisations by giving an accompaniment that consists of rhythm, melody and chord progressions (Bruscia, 1987 and Wigram, 2004). Kim, Wigram and Gold found when comparing improvisational music therapy with general play sessions, that children with Autism Spectrum Disorder (ASD) demonstrated more instances of emotional expression and social engagement when engaged in music therapy sessions than in play sessions (Kim, Wigram and Gold, 2009).

Another improvisational technique was used by Mary Priestley. She explored the use of improvisation in psychotherapy with verbal adults. Using a psychodynamic approach, with piano, percussion instruments and vocal discussions, she based her improvisations on the concerns of the clients at the time encouraging them to improvise sound portraits of their feelings, events and relationships. Her approach to improvisation is now well known in Analytical Music Therapy (Mary Priestley, 1975, 1994). Music in Hospitals and Care (MiHC) is a charity that provides music therapy in all aspects of care to bring live music to people not able to access concerts. They actively promote communication and a connection with the listeners by being versatile and adaptable and using improvisational techniques to respond to their listeners’ responses. A particular project they have recently been involved with is in the ICU-Hear at Manchester Royal Infirmary in 2017. Therapists used music with the patients in the intensive care units to block out hospital noise. This successful project is now being rolled out across the UK (Lucy Thraves, 2018).

There are many other examples of successful programmes involving improvisation, one of these was at the Mandeville School in London where the app called ThumbJam was used through iPads, as they provided a large display, which when securely fixed could easily be accessed by students with physical and learning disabilities. The students could hear the music they were producing, which stimulated them greatly and spurred them on to improvise their own music. An advantage of this application was that it provided a musically sounding instrument with backing tracks and allowed students who had profound and multiple learning disabilities to play an instrument and join in with the rest of their peers. When accompanied by other instruments the students enthusiastically made their own music and this helped them to develop their musical ability and self-confidence (Carrie Lennard, 2016).

Strange as it might seem improvisation can also be used as a form of music therapy with people who are hard of hearing or even deaf. Deaf people can ‘experience music’ by feeling the vibrations of musical instruments through the air or through the floor or by touching the speakers emitting the music. The National Orchestra of Wales have done many workshops where deaf children have not only enjoyed their music but have joined in and played with the musicians. For example, the orchestra have encouraged deaf children to sing into microphones and feel the sound they produce coming from the speakers. The children have thoroughly enjoyed this and have improvised their singing to experience the sensation of their ‘voice’ issuing from the speakers. Two deaf boys even improvised a rap tune to accompany music produced by the orchestra which they picked up from the speakers that were playing the music from the orchestra (Guest Blogger, 2013).

As shown, improvisation has many uses and advantages when being used in music therapy although there are ways in which it could be improved upon or built on further. For example, it could be used to help improve the speed at which babies and toddlers with hearing and/or speech difficulties or with ‘speech processing problems’, e.g. under 18 months, learn to communicate and talk, or for older children/people who haven’t yet learnt to talk clearly and have problems with vocalisation. The music therapy used would be improvised and would be tailored to feed off the responses the client gives and be adapted to reinforce correct vocalisation. This very early intervention could possibly help the youngsters to progress more quickly in the development of their vocal sounds.

Improvisation could also be used with people who have difficulties understanding/vocalising the English language, such as very young or older people who are from a foreign country and find learning the new language hard. These people could work with therapists and improvise in a conversation style using singing between them and could begin to learn English through imitating, an improvisational technique or even by initially vocalising sounds or musical phrases to train their brain to the sounds of typical English phonemes. Another possible use of improvisation in music therapy is to help people diagnosed with Post Traumatic Stress Disorder (PTSD). The ability of the therapist to use improvisation techniques with service personnel or people who have lived in war zones to encourage them to express their emotions through music could hopefully help them relieve/recover from the stresses of PTSD. Improvisation is a highly valuable aspect within music therapy. There is a multitude of other possible applications which could be developed.