The girl with the fretboard and the boy in the wheelchair

The stories on these pages are excerpted from a new book on the arts in Singapore - Art Hats In Renaissance City: Reflections & Aspirations Of Four Generations Of Art Personalities - edited by Renee Lee and published by the World Scientific Publishing Company. A music therapist shares stories of two of her clients and muses on the bonds that form when people make music together

Music opens many doors. Very often, once the music is played, there is a shift in the energy. A sullen or indifferent face becomes interested and animated, a flat expression is transformed into smiles and, sometimes, laughter is triggered.

J was a teenager living in a state residential facility when I first met her. She was usually by herself, and her peers usually left her alone. One of the staff referred her for music therapy as she had low self-esteem and was very interested in music, particularly in learning the guitar.

We started individual sessions. She was usually sullen and distant, but music transformed her and made her smile.

We started with single chords, and soon progressed to four chord changes one after another.

Her motivation and focus was really extraordinary. I have seen many youth (including the macho male with an intimidating swagger and a piercing stare) give up on the guitar because of the numbing pain in the initial weeks from fingers pressing the strings on the fretboard. Here, a quiet girl was bravely taking on the fretboard by its horns, relentlessly practising away!

Being wholly in tune with another person in music therapy is a very intimate and powerful experience. It is as if the rest of the world fades away. It is a powerful moment of synchronicity, which in the next second, might slip away. When the moment comes, I intend to be totally present for the client.

My focus was not solely on whether J was strumming the correct rhythm, but also on whether she was feeling more confident about herself, and how she responded to praise and encouragement. Earlier on, she ignored praise, seeming not to know how to respond. Week after week, we played and sang her requests, even howled together, while strumming frantically to upbeat songs. Her requested songs initially had themes of teenage angst and betrayal, but later on the songs were about leaving pain behind, of standing up after failing down, of courage and hope.

Naturally, over time, she was creating more resonant sounds with stronger and better fingering with practice. She was making chord transitions more smoothly, and she was better coordinated playing and singing at the same time.


Music therapist Ng Wang Feng believes music is perfect for any human condition and that there is a song for every mood and every nuanced experience. PHOTO: NG WANG FENG

Self-mastery does wonders to one's self-esteem, and musical mastery is one great avenue to nurture self-confidence! In our journey of 19 sessions over eight months, she gained confidence in herself and responded positively to praise. After our last session, we hugged and she smiled proudly.

I am drawn to relate about another client, H, with progressive muscle weakness. In a year of group music therapy sessions, this quiet and mild-mannered young man blossomed into a confident, vocal group member who started to offer witty comments, and he surprised everyone (staff included) with animated facial expressions.

When I first assessed him, he shared that he did not really listen to music much. His interest was more art than music. He also had very limited hand strength and range of motion. Weekly, in our group music therapy sessions, I offered various music-making opportunities using small handheld percussion and melodic instruments, which allowed even those with very limited range of motion to manipulate mallets to sound instruments and keep the beat, and play rhythmic patterns.


The stories on these pages are excerpted from a new book on the arts in Singapore – Art Hats In Renaissance City: Reflections& Aspirations Of Four Generations Of Art Personalities – edited by Renee Lee and published by the World Scientific Publishing Company.

H gamely took the first step by attempting each experience I offered, and within a few months, he was indicating his instrument preferences - he knew which instruments allowed him to express his musicality better, which mallets were easiest to hold and so on. I also introduced into our sessions a primary school music lesson staple - the recorder.

He started to give me specific directions on how to position the tray table to support his holding of the recorder, and keeping his posture as erect as possible, to allow for easy breathing. He was highly motivated in playing the recorder, even though he might have contributed to the collective group groan whenever I announced it was time for the recorder.

I was thrilled and privileged to be able to see H transform. His physical functioning was maintained and his confidence improved significantly.

As for him completing his mortal journey on Earth, I was unprepared. His passing was rather abrupt, which left peers and staff who worked closely with him completely stunned. Just a week before his passing, in the last group session together, he was singing along with enthusiasm, and playing instruments competently, keeping a mean beat with all his might! I attended his wake, and said goodbye. I started looking at other members in this group with new eyes - thinking, this day could be the last; for anyone, me included.

Being human is being mortal. We are told that death is inevitable. But what of it? Cherish the moment? Exactly! We all probably know that we should do that, but do we do it?

Music is, by definition, a phenomenon that happens in time, with a clear beginning and ending. When we are in music, we are in time. We are literally "in the moment'".

Being wholly in tune with another person in music therapy is a very intimate and powerful experience. It is as if the rest of the world fades away. It is a powerful moment of synchronicity, which in the next second, might slip away. When the moment comes, I intend to be totally present for the client.

CASE IN POINT: WHAT IS PROGRESS IN MUSIC THERAPY?

Other clients have not made their musical liking quite as obvious as J. I am recalling another client, N, from a special education setting. I could not really tell whether he enjoyed the sessions if not for his dedicated mother, who tracked her son's every blink and breath. She told me that if he did not like something he would frown.

By the time I saw him, he was wheelchair-bound and increasingly unresponsive due to his progressive physical deterioration.

He needed physical assistance to play instruments and to move his hands. He did not resist, and I hardly saw him frown during our time together. His mother and teachers told me that he liked the sessions. His lack of obvious responses led me to ask what, if at all, the therapy did for him. Did he "progress" in music therapy?

Typically, progress is defined as an improvement. Now, it is important to also look at how music therapists state therapeutic goals and objectives. Music therapy is a systematic process of intervention aimed at promoting health using musical experiences within the context of a therapist-client relationship (my modified version of Bruscia's widely used definition of music therapy). Goals generally point to a direction of "improving" some aspect of health, for example, physical or cognitive functioning.

For some clients who have degenerative conditions, physical maintenance goals are pertinent. Hence, progress is made when functioning is maintained. It is important to note that music therapists also focus on quality of life, without which life may not be worth living for some of our clients and patients who face bad news or overwhelming obstacles every day. And of course, the goal is to "improve quality of life'", which then the music therapist might track, for example, by having the client report on his or her perceived quality of life using a rating scale.

THE FINAL POINT: MY EVOLVING MUSIC THERAPY PHILOSOPHY

After less than a decade of clinical work and being with clients (some whose progress seemed stalled and some who made amazing progress), I began to see things a little differently.

It began to dawn on me that while I offered opportunities for growth and interaction in my music therapy sessions, I had no real sway over how my clients responded. Theoretically, I had intended to accept and embrace my client wholly, just the way she or he is.

However, I had also expected that my client would make significant progress over the treatment period and would feel disappointed, confused and inadequate when a client did not make progress according to my "plan'".

This would qualify as countertransference as it stems from the psyche of the therapist himself or herself. (In transference, the therapist is picking up on how the client is feeling; hence, is the client feeling disappointed, confused and inadequate?)

As I started to understand more about unconditional love and accepting everything as it is, I began to take to this as an approach to life. It is no longer something restricted to the treatment room where the humanistic music therapist receives and accepts the client with unconditional positive regard.

I am learning that everyone is simply being the way she or he knows how. Being human, to me, is being able to relate to fellow human beings with empathy.

More importantly, it is about recognising that however they appear or behave, they are trying their best all the time.

With increased detachment (reduced personal attachment to outcomes), I find that I am a more loving therapist and human being. Needless to say, the journey towards being more loving and compassionate has its ups and downs. Luckily, I never get to veer far from this path as I periodically get timely reminders from someone I meet in my day-to-day life, whether he or she be a client, a colleague, or a friend.

Music is perfect for any human condition. There is a song for every mood, every nuanced experience. If there is no song, it is possible to make something up the very instant. The music therapist can be right there with the client, with a guitar in hand, or another instrument. Most of us love music, so the music therapist is primed for success and making connection with clients. For those of us who do not particularly enjoy music or music-making, do not worry; the music therapist will understand and respect that - but know that most people do.

•Ng Wang Feng is a board-certified music therapist. She is also the founding president of the Association for Music Therapy (Singapore) and a professional member of the American Music Therapy Association.

A version of this article appeared in the print edition of The Sunday Times on July 05, 2015, with the headline 'The girl with the fretboard and the boy in the wheelchair'. Print Edition | Subscribe