Music Therapyand

Autistic Spectrum Conditions

Henry Dunn

Music Psychotherapist

Devon Partnership NHS Trust

How To Become An Autism Expert

(V1.2)So you want to be an autism expert. Maybe you've got a few misguided ideas about what autism is, and you want to spread them. Maybe you've got an autistic relative that you want to cure. Maybe the idea of helping the poor unfortunate disabled really appeals to you, or maybe the idea of the recognition appeals to you. Maybe you're an autistic person who still thinks you're defective. Maybe you've got a sadistic streak and like to hurt people who either won't talk back or whose credibility you can undermine. Maybe you want an easy power trip. Maybe you're a eugenicist who wants to remove anyone who isn't normal from the face of the earth...No matter who you are, if you follow the following steps and guidelines...

...You, too, can become an Autism Expert!

From an article by Amanda Baggs on www.autistics.org

A definition of Autism

Autism is a life-long developmental disability affecting social and communication skills. People with autism often have accompanying learning disabilities but, whatever their general level of intelligence, they will share a common difficulty in making sense of the world in the way most people do. In most children with autism some types of skills will be better than others so that their development will not only be slower than usual but will also be uneven and different from most children with learning disabilities.

National Autistic Society

Hans Asperger1906-1980Made his discovery in 1944.

Leo Kanner 1894 – 1981

Made his discovery in 1943.

Who “discovered” Autism?

Diagnostic Criteria

Triad of impairments

1. Social interaction

2. Communication

3. Imagination

Other, associated, problems can include sensory processing difficulties and difficulties with physical co-ordination.

NB, this may change soon when DSM V is published.

Autism is a Spectrum!

Autistic Spectrum usually understood in terms of I.Q.

Kanner’s or Classic Autism at lower end.

Asperger’s at high end, though some consider Asperger’s to be a separate condition.

I think the concept of a spectrum subverts the idea that people with autism are somehow “bland” or emotionally flat.

Autism is: being present in this world,But not entirely of it.I am one step removed and curled,The switch just doesn't click.

I perform the role of my perception,And play many parts so well.But minus files for my redemption,My part in life I cannot tell.

Life is like a video,I watch but cannot partake.My uneven skills are but an echo,Of the frustrations which I hate!

However, my focused use of time and space,I would not give away.I know that I am especially placed,For some developed career one day!

Wendy Lawsonwww.mugsy.org/wendy/  

                                            

Different theories about causes.

• “Refrigerator mother” Bruno Bettelheim (1967)• Maternal anxiety Tinnbergen (1983)• Brain deficiencies Rutter (1983)• Genetic factors Szatmari and Jones (1991)• “Theory of Mind” Baron-Cohen et. al. (1995)• Probably a mix of factors – mother is first mirror for child

(see for example, Winnicott), but can only mirror what she is offered.

• For Jungians, perhaps an anima deficit?

Neurotypical v Autistic

Most people are “polytropic”:• Able to multitask/think about more than one

thing at a time• Able to transfer from specific to general• Can think creatively and flexibly• Can understand metaphor

People with autism are often “monotropic”

• Only able to focus on one thing at a time

• Not able to generalise from the specific

• Inflexibility of thought

• Unable to understand metaphorical language

Video – A is for AutismChannel 4 1992

Common Myths

• All people with ASC have no creativity.

• People with ASC have no empathy or “Theory of Mind”.

• People with ASC are not interested in forming relationships.

What is Music Therapy?• Fundamental to all approaches, is the development of a

relationship between the client and therapist. Music-making forms the basis for communication in this relationship.

• Client and therapist take an active part in the sessions by playing, singing and listening. The therapist does not teach the client to sing or play an instrument.

• Much of the music is improvised, thus enhancing the individual nature of each relationship. The therapist aims to facilitate positive changes in behaviour and emotional well-being. He or she also aims to help the client to develop an increased sense of self-awareness, and thereby to enhance his or her quality of life.

from British Association for Music Therapy website www.bamt.org

Psychotherapy Influences

• primacy of therapeutic relationship.

• based on mother-infant relationship, the first musical relationship (Daniel Stern). Concept of Affect Attunement.

• significant relationships may be acted out in client-therapist relationship.

• transference/countertransference

Different levels of work

All these occur within the therapeutic relationship

psychological

physical

developmental

social

spiritual

Music Therapy and the triad of impairments

• Social interaction Music therapy is based on forming a relationship between client and therapist. This can act as a template for other relationships, and a way to explore the idea of relationship in a very safe place. Alvarez talks of “reclaiming”, “greening” and awakening.

• Communication Music provides an additional form of communication. The therapist attends closely to, and responds to, the client in a way that encourages further communication.

• Imagination The use of music encourages the client to engage in a creative, imaginative process, with the support of the therapist. They can move away from a ritualistic use of instruments to a more flexible, creative use. This can also develop more creative, less rigid, thought and behaviour patterns. The therapist needs to know when it is helpful to enter the client’s world, accompanying the rituals, and when it is right to discourage this. Alvarez suggests that countertransference is a useful tool in deciding this.

• see “Live Company”, Anne Alvarez: Routledge 1992

Other Ways Music Therapy can help

• Open/closed systems – unlike words, music can do both at once.

• Structure and freedom

• Distance and contact

• Relationship through art form

• Client centred

Case Study - R

• Autistic spectrum, severe learning disabilities

• High levels of anxiety and self-injurious behaviour, some of it sexualised

• Often wore a tight headscarf – sensory stimulation

• Echolaic speech, often telling herself off

• Sessions had predictable structure

• R liked to sing sometimes, asked me to play “Ain’t No Sunshine When She’s Gone”. This song seemed to connect with her feelings of loss about not living with her mother any more.

• It was hard to create a safe space for R, due to her anxiety. I used various methods to allay this – e.g. large sand timer, predictable structure.

R was increasingly able to stay in the room, and to express her emotions, sometimes very tearfully. There was a growing sense of trust in our relationship, and a sense that the therapy sessions were a safe place where R could explore and express her feelings. I noticed a decrease in her levels of self-injurious behaviour, and an increasing ability to reduce her own anxiety levels.

Case Study - N

• Autistic spectrum, severe learning disabilities, non-verbal

• Referred after the death of his mother, with whom he had a very close relationship

• Music Therapy provided a safe place for him to express his feelings of loss in a non- verbal form

Music therapy provides:

• a safe place away from home environment

• predictability and freedom

• a form to express emotions, which for N could change very quickly.

• Using Affect Attunement I am able to help N to have his feelings heard and responded to.

Working Systemically

• As one of the professionals involved with N, I attended regular meetings convened by the Clinical Psychologist in the Additional Support Team. This ensured that all relevant information was shared, and that we could share best practice.

A Case Study

Music Therapy work with an autistic boy

The Therapy Room

Introduction to “J”

• Autistic and severe learning disabilities

• 11 years old

• No verbal communication

• Variety of vocalisations

• Taps and flicks objects constantly

The Early Sessions

• Brought by speech therapist

• Found it hard to stay in room, becoming distressed

• Worked in corridor, gradually making contact

• Moved into room

• After six sessions able to stay alone

Theme: Progress

Developing relationship creating safe place

Joint play able to show distress

as well as happiness

Physical contact musical contact

Emotional contact

Theme: Distance

important to give J space - let him initiate contact

Physical distance emotional distance

Room large enough sometimes J doesn’t want tofor J to retreat be really close and intimate

J sits on work surface

I stay at piano I allow him to be more “autistic”

I continue to respond to him musically, enough to let him

know I’m still there

Theme: Contact

emotional

physical

musical (feeds into and fed by both)

Contact can be with

Me instruments

aspects of himself

affectionate “non-autistic”/autistic flicking

sign of relationship need for reassurance checking environment

genuine warmth difficult life stage need to feel safe

(adolescence)

J needs safe, consistent relationship and environment in which he can confront and express confusing emotions and developments

Further readingMusic Therapy with Adults with Learning

Disabilities

ed. Tessa Watson, Routledge (2007)

Mental Handicap and the Human Condition: New Approaches from the Tavistock

Valerie Sinason, Free Association (1992)

The Interpersonal World of the Infant

Daniel Stern, Karnac (1985)

Playing and Reality

D.W. Winnicott, (1971) various editions available

Jung: Selected Writings

Anthony Storr, Fontana (1983)

The Carl Rogers Reader

ed. Kirschenbaum and Henderson, Constable (1990)

Useful websites

• All Wales Autism Resource   www.awares.org                       • Resources for Autism www.resourcesforautism.org.uk• Research Autism               www.researchautism.net • National Autistic Society    www.nas.org.uk• Autism Research Centre www.autismresearchcentre.com• Jacqui Jackson www.jacquijackson.com

• Wendy Lawson www.mugsy.org/wendy/