The Measurement of Not Knowing
by Matt Davis, Music Therapist

Around a year ago I was visiting a six year old boy, John (named changed), in a special needs unit in a mainstream primary school in East Cornwall. John had been referred for presenting with
Asperger’s type symptoms.

John was articulate and was able to read, and liked books, which was often a distraction as the sessions were held in the school library, with John often preferring to choose a book to look at rather than take up any of the instruments. In fact, the aim of the sessions quickly became to develop a sense of shared play of any kind, musical or not. Music did not seem to engage John particularly but after a few sessions we got into the ritual of sitting at the piano together and I would play a soundtrack to the book John had chosen. This was often humorous but seemed somehow un-shared and that I was ‘performing’ a task for John – being a ‘story jukebox’.

Eventually John started to use some puppets that were sometimes in the room, and every week he would seek them out so he could bring them along. These puppets would generally be subjected to being killed and hurt in various ways. It’s possible John was recreating something he had seen in adult video games, but really I had no idea as to what purpose this playing out of violence was serving. What was clear was that John wanted me to see it and that it contained an aspect of play – of make-believe. Both of these things felt significant and a development
of what had happened so far. It was imaginative, it was playful, and it was a communication.

Still, however, there was very little, if any, shared music. Reports from the school was that he was doing ‘really well’. He was also generally willing to attend music therapy, not always with overwhelming motivation, but in general happy to come. These positive signs, as well as John’s ‘performing’ in the sessions, was what kept things going, although I really had no sense of clarity as to where we were, or how to continue.

In addition to the ‘violence’ acted out upon the puppets John would sometimes bring a baby doll and care for it in a very nurturing way. That he was able to display an internalised nurturing, and therefore inherently affective experience, was very positive. What I felt was missing, however, was a sense of relatedness between us – of an attachment of some kind – a sense of a shared experience. I knew John had some kind of relationship with the sessions but it felt very impersonal – almost like it was half an hour of ‘free time’ rather than a space of interaction, even of a very small amount. It often felt as though I could leave the room and John would barely notice.

what I felt was missing was
a sense of relatedness

After a year our sessions were due to end. This was something that was forced upon us but we had a few weeks to prepare. Four weeks before our last session, John sat at the piano and played a little. This was a huge development in terms of us sharing a musical space. I had told John at the start of the session that we would be ending in a few weeks. His music seemed quite melancholic and when we had finished playing I noticed what I thought might be a glimmer of sadness flit across his face. As therapists we are trained to notice such minute details – and our own
responses to them. It felt significant to me so I made a mental note:
“I’m having that” I thought, “I might have imagined it but that felt very emotional.”

It felt safe enough to check in with John about what was going on for him. I said I thought he’d looked a bit sad and asked how he felt about the sessions ending. John started to cry and came over to put his head on my shoulder. “Who will come to sing me songs every week?”

This was a level of emotional communication, attachment and affectivity I had never thought I would see from John in our sessions – never thought possible. The whole nature of the therapy had been centred around the sense that this was somehow missing. Had I missed it? What was it that had meant something to John?

I think so much of what we do as therapists is based on not knowing – or at least trying to articulate something that we can never truly know. Most of the time I was completely lost as to how to enter into a shared, interpersonal, playful space with John. And in that sense a lot of the time the sessions felt like a failure.

For the final few sessions I talked over the ending with John, and we were able to approach it in a very positive way, with some tears and a genuine feeling of warmth and affection. Looking back
it seems the most important element of the therapy was ‘turning up’, that there we were every week – the same time, the same songs; that we were holding together that experience of not knowing, of feeling lost.

At present it feels as though health care is more and more at the mercy of the pressures of privatisation: competition and valorisation. And though music therapy is finding solutions to a problem
it has always faced – how to evaluate itself, we should somehow confront the pressures for music therapy to vindicate itself as a measurable intervention related to comparable units of time. ‘Time’ in therapy can stand still, run at a different tempo. It’s a space that necessarily needs to be exempt from black and white categorisations such as cause and effect: I do this, you will be able to do that.

With John we ended with a sense of relatedness and emotional recognition – the aims we set out to achieve. Most of the time, though, was spent ‘not knowing’, and how to measure that?