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Inter-Active Listening: Re-envisioning Receptive Music Therapy L ’écoute inter-

Inter-Active Listening: Re-envisioning Receptive Music Therapy L ’écoute inter-active : la musicothérapie réceptive fait peau neuve SarahRose M . Black, MA, MMT, MTA Music Therapist, Princess Margaret Cancer Centre and Kensington Health, Toronto, ON, Canada Abstract The interactions and dynamics between client and therapist in receptive music therapy as defined by Bruscia (1998) are often complex and multi layered. This paper, which is based on a phenomenological narrative inquiry that investigated the music therapy experiences of four adults diagnosed with metastatic cancer, challenges and re-envisions current notions of the practice of receptive music therapy. Inter-active listening (Black, 2013) is discussed as alternative terminology with which to speak about the interactive processes that occurred during the interventions. The results of the study are described, focusing on two participants and the dynamic and dyadic intersubjective space that was created as a result of the use of this music therapy approach. Implications for the field of music therapy are discussed. Keywords: receptive music therapy, inter-active listening, intersubjectivity, phenomenology, palliative care Résumé Les interactions et les dynamiques entre le client et le thérapeute dans la musicothérapie réceptive telle que définie par Bruscia (1998) sont souvent complexes et multidimensionnelles. Cet article, basé sur une recherche narrative phénoménologique qui examine les expériences en musicothérapie de quatre adultes avec un diagnostic de cancer métastatique, défit des notions courantes de l'exercice de la musicothérapie réceptive tout en nous les faisant réenvisager. L ’écoute inter-active (Black, 2013) est discutée en tant que terminologie alternative laquelle devrait être utilisée afin de parler des processus interactifs qui subviennent à l’intérieur des interventions. Les résultats de l’étude sont décrits en se concentrant sur deux participants et Canadian Journal o f Music Therapy oo Revue canadienne de musicothérapie, 20(Z), 32 l’espace intersubjectif dynamique et dyadique qui a été créé par le biais de cette approche musicothérapeutique. Des implications pour le domaine de la musicothérapie sont discutées. Mots clés : musicothérapie réceptive, écoute inter-active, intersubjectivité, Receptive music therapy is defined as an approach during which clients in individual music therapy listen to music and respond silently, verbally, or with another modality (Bruscia, 1998). While receptive music therapy is used frequently with a wide variety of client populations (Grocke & Wigram, 2007), the complexity of the interactions and dynamics between client and therapist are not necessarily embodied in the word receptive. In this paper, which is based on a phenomenological research study that I conducted on a palliative care unit in a cancer care hospital, I seek to re-envision and expand the term receptive music therapy in order to more accurately reflect the dynamic interactions of this approach. I suggest the term inter-active listening (Black, 2013) as an alternative descriptor for receptive music therapy, and I give examples of dyadic and interactive relationships between two research participants and the music therapist during inter-active listening. I also discuss the concept of an intersubjective space—defined as the joint consciousness of interacting individuals (Scheff, 1990)—within this music therapy approach. Questioning the Notion of Receptivity On an acute palliative care unit where quality of life is critical (Hilliard, 2005) and hope for a good death is important (O’Rourke & Dufour, 2012), verbal communication is often limited; therefore, receptive music therapy is a frequently used intervention. Yet the more I engaged in receptive music therapy, the more the word receptive felt limited. Many clients were verbal and willing to participate in conversation and musical dialogue, but more than half of the clients were either actively dying or unable to speak, and in these instances, extraordinary moments of connection were a regular occurrence. There was interaction through the music regardless of whether the client was playing, singing, or even speaking. This raised questions for me about who was receiving and who was giving in terms of music therapy. The word receptive describes an act of receiving, which naturally implies that there is also an act of giving. While initially this inquiry felt like a battle with semantics, I noted that clients who Canadian Journal of Music Therapy oo Revue canadienne de musicothérapie, 20(2), 33 were not responding verbally still appeared to be sending a range of cues such as changes in breathing patterns and eye contact. It is my premise that the relationship between therapist and client should always be acknowledged as a dyadic, two-way exchange of information. While the intentions of the receptive interventions were for the client to "receive” the music, indicators of awareness and connection from the client were also being received by the therapist. Can it always be said that a client is receiving music, based purely on the fact that it is being played or sung in their direction? What about the concept of reception in terms of the therapist? The concept of intersubjectivity emerged from the results of a phenomenological research study I conducted on a 12-bed acute palliative care unit, which demonstrated that it is essential to acknowledge the impact of receiving information from and being connected to the client, as the therapeutic relationship is dyadic, dynamic, and active. Intersubjectivity is defined both as the joint consciousness of interacting individuals (Scheff, 1990) and as the constitution of psychological systems within which emotional experience always takes form (Orange, Atwood, & Stolorow, 1997). Understanding these dynamic therapeutic moments within a framework of an intersubjective space allowed for the contextualization and deeper understanding of the interactions. In the music therapy literature, the presence of intersubjective space is highlighted and discussed in the ways in which a therapist senses aspects of the client and the client senses the therapist (Kenny, 2006). Kenny suggested that the deep intersubjective space in which clients and therapists engage is of paramount importance in the therapeutic relationship and that we must regularly ask ourselves who and what we represent in that space. Orange, Atwood and Stolorow (1997) described intersubjectivity as a metatheory of psychoanalysis in that it examines and connects two subjectivities in the system they create and from which they emerge. In music therapy the therapist and client are the two subjectivities and the session is the system they create. In both the literature on psychoanalysis and music therapy, the concept of intersubjective space plays a critical role in understanding the therapeutic relationship. The term inter-active listening (Black, 2013), which I created as a result of this research study, is supported by and grounded in the theories of intersubjectivity and was created to highlight the dyadic and active nature of the interactions experienced through the study. Grocke and Wigram (2007) provided clear and detailed descriptions on how to work receptively with clients, including step-by-step protocols for the use of visualization and imagery, music for relaxation, song lyric discussion, as Canadian Journal of Music Therapy oo Revue canadienne de musicothérapie, 20(2), 34 well as vibro-acoustic applications, but they do not address the contributions from the client that arise out of this receptive work. A review of the music therapy literature on this topic suggested that little has been written about the dynamic presence of interaction within receptive music therapy. While the use of this music therapy approach in palliative care is quite common, clients who may not be singing, speaking, or even making eye contact during musical interventions are still sharing a great deal of information, as is the therapist. Inspiration for the Phenomenological Research Study As a music therapy intern on an acute palliative care unit, I was involved in many intense and engaging interactions that sparked an interest in the dynamics between client and therapist, particularly during receptive music therapy. Because of the extent of the use of receptive music therapy for this client population, 1 developed a research question based on many hours spent processing the experiences I was having with clients. The focus became the clients’ experiences of this style of intervention. As the research questions evolved, I focused on examining the lived experiences of clients receiving music therapy on an acute palliative care unit towards the end of their lives. The primary research question sought to examine the lived experience of music therapy (specifically inter-active listening between client and therapist) for a person at the end of life on an acute palliative care unit. Secondary questions probed what exactly inter-active listening looked like in music therapy, how it could be defined, and how inter-active listening might affect the therapeutic space. Methodological influences for the study were phenomenology, modified grounded theory, and narrative inquiry, and recruitment was done through purposive sampling. This study was approved by the University Health Network and Wilfrid Laurier University research ethics boards. Data collection took place over a three-week period. Participants were recruited for this study based on the following criteria: (1) they were inpatients on the palliative care unit; (2) they had a Palliative Performance Scale (PPS) rating of 60% or lower; and (3) they were able to consent to participate in the research process. While this client population was unique in the sense that they were all admitted to an acute palliative care unit for cancer care, the techniques used (within the uploads/Finance/ inter-active-listening-re-envisioning-receptive-music-therapy.pdf