Music: Adapting to Client Preferences and Process
As already outlined, the music used in Medicine Sessions can have a significant impact on the client’s experience. Recent research has shown that music had both “welcome” and “unwelcome” influences on client’s subjective experiences (Kaelen et al., 2018).
Welcome influences included the evocation of personally meaningful and therapeutically useful emotion and mental imagery, a sense of guidance, openness, and the promotion of calm and a sense of safety (Kaelen et al., 2018).
Conversely, unwelcome influences included the evocation of unpleasant emotion and imagery, a sense of being misguided, and resistance (Kaelen et al., 2018).
Working with Unwelcome Experiences
At times when a client wants to change the music, health professionals may ask them to first reflect on whether this desire is motivated by wanting to move away from an uncomfortable feeling or memory that the music is stimulating (which could have therapeutic value) or whether it’s simply not right for their process at this time.
If it’s the former, then the health professional should encourage the client to stay with the uncomfortable experience and support them in this process. If it’s the latter, then the health professional may change the music or pause it as per the client’s request (Mithoefer, 2015).
Prepare Music Setup in Advance
Music needs to be prepared ahead of sessions, and music selection during sessions must never distract health professionals from the relationship with clients. Health professionals should have the music that they are going to use selected and organized in advance of the Medicine Sessions. Health professionals are also expected to prepare and test audio equipment prior to Medicine Sessions.
Acoustic Configuration
A combination of headphones and synchronous ambient speakers with separate volume control are preferred in order to maximize the client’s comfort and agency, to ensure experiential continuity when headphones are taken off, for the music to be felt physically (listening with the body, and not only through the ears), and for the health professionals to be able to hear the music simultaneously with the client. Further to this, speakers need to be positioned such that the ‘spread’ of the sound minimizes localization of the music source within the room (and hence, awareness of the room).
Volume
The volume of the music should generally be loud for the deeper portions of the Medicine Sessions but never uncomfortably loud. The aim here is to fill the auditory perception of the listener as such that the richness, details and dynamics of the music can be fully experienced. Soothing music, when it is ambient music or that played towards the beginning and end of the session, may at times be played at low volume. Health professionals are encouraged to check in with the client to ensure the volume of music is suitable for them.
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The Role of Silence
Despite the significance of music in psychedelic-assisted therapy, the entirety of Medicine Sessions should not necessarily be completely filled with music. Music is best viewed as a therapeutic tool, and like all tools, its usage must be informed by insights in when and when not to use the tool. As much as some music can be healing, some music can also be harmful–especially in the vulnerable state that clients can find themselves in during Medicine Sessions.
The Role of Silence
In addition to deciding which music to use, health professionals must also always ask themselves if it is appropriate to provide music at any given point in time, particularly if the music ends up being dissonant with the client’s experience and therapeutic needs.
The Role of Silence
The absence of music, at times, may be the strongest therapeutic intervention one can give: not playing music equals the absence of stimulation and changing of the subjective experience. Although clients could also experience the absence of music as a diminishing of the experience, clients often also describe silence in between songs as important “pit stops” and “breaks on the journey”. Silence also provides a heightened opportunity for meaningful health professional-client interaction and dialogue, and silence may form a critical desensitizing contrast with the periods where music is played again, making the new music more ‘freshly’ experienced.
Health Professional Tip
What are some examples of cues from clients or the energetic space that let health professionals know when silence is needed?
Unfortunately, there are not many clear cues that let health professionals know when silence is needed. It is very hard to make any predictions as it really varies from client to client. Health professionals should remain attuned and should continue checking in with the client to determine when silence is needed.
Musical Resistance
Mendel Kaelen has identified and described three different types of musical resistance which can occur during a Medicine Session (Grob & Grigsby, 2021). Below are some examples and possible interventions that could be used in place of music.
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Musical Resistance Type 1
The music may be dissonant with the client’s internal experience and therapeutic needs. The music is out of tune with the subjective experience: it is a mismatch and experienced as a disruption.
Intervention: Therapy as Dialogue
When resistance arises during a session, a combination of dialogue with the client and therapeutic intuition can determine the appropriate insight into the situation and response. When the music is dissonant with the client’s subjective state, this may be the most straightforward scenario in which the health professional has the responsibility to match the present feeling states and therapeutic needs with music (i.e. optimise affect attunement). Analogous to usual client-centred verbal dialogues in psychotherapy, where the health professional listens attentively and reflects back to the client their observations in a dynamic and interactive fashion, so do health professionals in psychedelic-assisted therapy have the responsibility to ensure that music is adequately “attuned” to the client’s dynamically unfolding experience and psychotherapeutic needs.
Example
An example of this may be that a client is experiencing sadness within the session, but the music is presenting as happy, joyful, or upbeat. When this occurs, it would be important for the health professional to adjust the emotionality of the music to match the client’s experience.
Musical Resistance Type 2
The music may be disliked because of a lack of personal connection with its genre or because of finding the music aesthetically abrasive.
Intervention: Therapy as a Collaboration
When the music is rejected due to disliking of the music style or qualities, the client may be encouraged to listen to the music ‘with new ears’, beyond liking or disliking, to redirect the focus on the immediately present imagery, thoughts, and feelings that the music is evoking (which could hold therapeutic significance). When this occurs, the music may also be adapted in order to:
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Respect the listener’s aesthetics
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Prevent conflicting client-health professional power-dynamics
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Promote an interpersonal therapeutic alliance
Within this, it is also important to be mindful of the client’s trauma history and relationship to choice. The health professional must consider this within the context of their relationship and the established trust between them to know when it might be important for the client’s preferences to be respected despite the potential therapeutic value of what the music may be evoking.
Example
An example of this could be that a client expresses that a piece of music has some religious or cultural affiliation that is off-putting to them. When this occurs, the health professional must determine whether the music may be evoking something meaningful for the client and that they would be best to support the client to remain open and curious to the music and what it may evoke or if it’s just not a good aesthetic fit for the client and should be changed.
Musical Resistance Type 3
The music may evoke images, thoughts, or feelings that are challenging and overwhelming, yet the experience may hold therapeutic significance.
Intervention: Therapy as an Exploration
When experiences of resistance occur in relation to challenging but therapeutically meaningful psychological material, a constructive relationship with the experience can be increased via client-centred reassurance and an encouragement to explore the experience interactively and curiously.
Example
A particular piece of music may elicit an uncomfortable emotional experience in a client, and they may ask to change to the music to be more happy or upbeat. When this occurs, the health professional ought to leave the music as it is and encourage and support the client to accept and connect to the uncomfortable emotion that is arising. In practice, breathing methods, physical contact, and encouragement for emotional release are often used in these situations.
References
Haden, M. (2019). Manual for Psychedelic Guides.
Mithoefer, M. C. (2015). A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder. MAPS. https://maps.org/research-archive/mdma/MDMA-Assisted-Psychotherapy-Treatment-Manual-Version7-19Aug15-FINAL.pdf