The Infinite Music of the Therapeutic Relationship

Stephen Westcott

Derived from his 2011 dissertation, Stephen combines in this article the relational focus of his therapy training with his personal interest in how being a musician may affect his psychotherapeutic practice.

If we accept that each client, therapist and therapeutic relationship is a unique, evolving process that is mutually influencing, I wondered what might be the similarities and differences between this and music creation and performance. I wondered also whether or not we (and the client) are perhaps the instruments in the room and if this may be of use as a frame for the work and therapeutic relationship. Would attending to ourselves as instruments be a way, to quote Cooper, to stay “attuned, not to any one set of assumptions, but to the unique, unpredictable, indefinable individuals that we meet in the therapeutic encounter” (Cooper, 2010:183).

I became interested in the similarities between music and therapy through attachment theory and the idea of feedback. Feedback in musical terms occurs when the signal or sound being played out of speakers is loud enough to be ‘heard’ by a microphone or the pickups on an instrument. This creates a loop where the signal is added to itself and thus becomes infinite. This can result in an unwanted, disruptive squeal for a sound engineer (and the audience!), or a purposefully created, musical and infinitely evolving note for an electric guitarist (take a bow Jimmy Hendrix and many since).

The perpetual resonance in the therapeutic relationship was something I wanted to explore in myself and in therapists who are also musicians. From my study, I found parallels: the listener is in relationship with the music in the same way the therapist is with the client; the therapist can choose to play a receptive or active role; in the same way we can choose to just listen to music or join in with it. Our taste in music may be dependent on when, where and how we were brought up, as well as the particular wiring of our brain (which is also plastic), but music is still ultimately subjective and, like the interpretation of a therapist, may move a client or miss the mark entirely, depending on timing and context. My curiosity is whether those trained in music, but not music therapy per se, would be using these principles in the therapeutic setting.

Music 1

Knoblauch (2000) approaches this from the angle of an improvisational jazz musician and therapist. I was, however, also interested in the views of musicians who may not come from this background and may only play music from written scores. I was curious as to how this may or may not have entered into the way they frame their therapeutic work.

The use of sound and the language of music as therapy are, of course, more in line with music therapy. However, the research of others has brought this idea into the realms of psychotherapy via neuroscience, attachment theory and infant-mother research. The paths may split in terms of the language and tools used, but the impact and relatedness has, perhaps, a similar therapeutic outcome.

We train to hold a sense of what is happening in the moment, but also how this may fit into the larger context. I may have a client whose anger is triggered by a number of different situations, but in the search for understanding, we may come across much earlier events that resonate or act as an unconscious trigger. These re-enactments provide the possibility for reflection and change. This has been a foundation for Freud’s transference/countertransference ideas (Freud, 1912). The interpersonal field of the therapy room can be likened to a potential space for the ‘music’ or ‘song’ of therapy to emerge, described by Winnicott (1958:243-54) as the transitional space in which to ‘play’, where mutual affect and communication on many levels, leads to the emergence of themes and narrative.

Bowlby (1988:3) stated that the ability to “make strong emotional bonds to particular individuals [is] a basic component of human nature”. Ainsworth et al (1978) developed the ‘strange situation’ observation to determine the influence of early attachments to caregivers on infants. The categorisation of responses to the experiment from the ideal secure attachment to a variety of insecure attachments has provided the ground for others to study the communicative aspects of non-verbal and verbal interactions. La Barre (2001:181) describes the situation with an adult client where better attunement is powerful enough to create the fear “of the feeling of the flow back and forth between us” in the client. Clearly, this is a potent phenomenon, and as empathy in all its forms is at the core of the therapeutic relationship (Rogers, 1951) and is currently again at the centre of study on human relationships (Baron-Cohen, 2011), our ability to connect with our clients is one of the most fundamental and transformative tools at our disposal.

The therapeutic situation is still essentially two (or more) people in a room communicating on many levels simultaneously. The ability for the therapist to be attuned to self and client simultaneously ‘helps the client feel, process, manage and get a sense of themselves in a particular emotional state’ (Carroll, 2011:32). As Schore (2003:85) also states ‘the key is whether the therapist can auto (self) regulate their own negative state enough to act as an interactive regulator for the client.’ Mitchell describes the infinite contact and mutual influence beautifully: “Interpersonal relational processes generate intrapsychic relational processes which reshape interpersonal processes reshaping intrapsychic processes on and on in an endless Möbius strip in which internal and external are perpetually regenerating and transforming themselves and each other.” (Mitchell, 2000:57)

The Chiron body psychotherapy school depicts this model in terms of the vertical and horizontal. Both therapist and client (to a lesser conscious extent) are making contact or ‘looking’ inwards or vertically whilst at the same time making contact horizontally with each other (Carroll, 2009:99).

As a musician, I had noted this parallel process; when playing with another musician or group of musicians one is always focused both on what one is playing and also what everyone else is playing in a continuous dual process. The music that arises is the result of this interconnecting matrix – something is created that is more than the sum of the parts. We are playing and being played at the same time.

Music 2

Malloch and Trevarthen (2009) have studied and documented the innate musicality of infant communication. Infants respond and are enchanted by sounds, movements and songs from their mothers long before language has any meaning for them (Trainor, 1996). From as early as the 7th month of gestation, unborn babies can recognise distinctive features of song or music played by instruments. The social aspects of this for humans appears to differ from other animals in complexity although baby chicks have been found to respond physically to the soothing effects of music (Panksepp and Bernatzky, 2002). Animals communicate with emotional sounds (which could be described as musical) and we are only just beginning to understand the qualities and depth of this language. Our own use of language is preceded by proto-language where manual gestures are linked to vocalisations (Blood and Zatorre, 2001). This Youtube video nicely demonstrates this point.

These communications increase in complexity until language evolves, but even then we don’t lose the ability to detect the tone, rhythm and other pre-verbal cues as we move into the world of words. Trevarthen and Malloch believe this communicative musicality is intrinsic to our emotional well-being as mammals, and that it serves to connect us to others: “…companionship, affirms one’s social identity and creates unforgettable narratives of feeling in community” (Trevarthen and Malloch, 2002: 14).

If, say, we agree that we are all inherently musical in our communications and that this does not require musical training, this musicality becomes the organising principle by which communication becomes more complex. In music therapy, this principle is relevant to engage with clients through music and thus learn self-awareness and the ability to express mood or affect. Again, although music therapy was not the focus for my research it is necessary to mention its obvious application in that context and its potential to reach those who may not have as much access to spoken language.

Knoblauch (2000) explores the dynamics of the therapeutic relationship more directly in musical terms and, as a jazz musician, his interest is in the improvisational aspects of the relationship, as well as the musicality of the use of language and voice. The focus is perhaps more on dialogue (although the non-verbal is considered) and, as with infant observation research, he breaks verbal communications, initially, into the musical components of rhythm and tone.

As Sheldrake (1988) and many others before have noted, rhythm is in everything, from the vibration of atoms, through the rhythm of the heart beating, to the cycles of plant growth and seasons to the life cycle of stars. We are aware of these cycles both consciously and unconsciously. In therapy, there are cycles to the themes in the work moving from background to foreground, within one session only or over many sessions over weeks and months. In music, rhythm is of course the heartbeat of any piece and more complex pieces will have various rhythms operating at different levels of scale and in counterpoint. If the therapist can ‘keep time’ with the client’s various rhythms, the work feels fluid, whereas interruptions to these cadences can be useful markers of rupture or tools for change.

Knoblauch (2000) defines two types of time or rhythm frequency: listening time and action time. Listening time is the space where we can pay attention to the pace, spacing and intensity of the words. It’s a more reflective space. This is more at the level that Stern (2010:135) would perhaps define as the narrative level and could be where we are able to process the multiple streams of information into something more condensed.

The second level, action time, is at the timeframe of milliseconds. At this level, we resonate in real time to the information on an affect or non-verbal level. Stern (2010:135) refers to this as the local level. Therapist moves with client in the continuous feedback loop of information. As this affective experience comes into the awareness of the therapist, there is the opportunity to use rhythm to regulate the client.

And so our construct of the world and the other is also based on our sense of how things occur in time – the pace and rhythm of how we experience resonates on a feeling level before being organised at more complex levels of awareness.

As noted by infant researchers, the musicality of therapy is also evident in the tone of voice of the client and therapist. A client may radically change the intonation, pitch or timbre of their voice moment to moment, providing insight to a changing internal world. We, or the client, may hear someone else’s voice in their words, or the voice of a younger self when recalling particular events. For the therapist, tone can be a way to bridge the gap between the words of an intervention and the intention behind it.

Gianna Williams (1997) provides an example of tonality: “I find myself speaking in a quite soft tone of voice. I try to avoid incisive words, preferring to use a ‘pastel’ rather than a ‘primary colour’ type of language. So I probably gave Sally more help with the tone of my voice than with the actual content of my verbal communication…”
(Williams, 1997:119)

As we move up to higher levels of organisation of music and musicality, so we move from the notes/words and spaces between the notes/words to the larger themes of the composition and our place in it. Both client and therapist co-create narratives or themes in which we move in and out in smaller or larger loops of time. In an attempt to see them from new angles dependant on the context or prevalent mood of the moment, these themes can be improvised around. Neuroscience research also shows neural pathways and plasticity in the brain which ‘can be changed by doing something differently, imagining it differently, seeing another doing it, or by hearing about it in words’ (Stern, 2010:135). Perhaps therapy and supervision allow this process of change.

Consonance and dissonance
Over time the therapeutic relationship develops and we begin to create more complex musicality between us. What may have started as stilted conversation and talking over one another may develop into flowing turn taking and the finishing of sentences or ideas for each other. Consonance and dissonance may begin to emerge in dialogue. In musical terms, these describe the relative stability of groups of notes played in harmony, chords or interval; or how things sound either ‘right’ or ‘wrong’ to us in music. This again is influenced by culture and what we learn to expect…as Ball (2010) puts it: “Many classical-music traditionalists would deny that they enjoy dissonance. The word conjures up the jarring sound-worlds of Stockhausen and Boulez, who, to these listeners, seem to delight in finding ways to combine notes that set your teeth on edge. ‘Oh no, they’ll say, give me Chopin or Beethoven any day’. This merely illustrates why consonance and dissonance are two of the most misunderstood and misrepresented concepts in music.” (2010:165).

Music 3

We find these feelings of matching, or not matching, in the therapeutic world. The therapist uses their senses to see, hear or feel whether there is a mismatch between what may be demonstrated, said or felt. Dissonance in the therapeutic relationship can be useful to highlight suppressed feelings for clients, but can also be the result of a rupture in the relationship or of ‘missing’ the client. This may seem to be unhelpful, but could also signal a point at which change occurs; a particular pattern of relating may be broken up, which could perhaps allow the chance to see the pattern ‘from the outside’, paving the way for a new pattern to emerge. It can also be the place of ‘not knowing’ (Bion, 1961) for both therapist and client, enabling the creativity to move the work into a new area and open up new possibilities.

Implications for Therapy
The findings and literature search from my research suggest that the musicality and listening skills acquired by musician/therapists may be usefully applied in training for therapists as an extension to techniques such as the transference relationship, active listening and mindfulness. The attention to affect-regulation through rhythm, tone and resonance would add to the body of work already existing. It may also be useful to purposefully think of ourselves when in the room with the client as an instrument attuned to these qualities. It also seems the relationship is a co-created process, similar to the creation and expression of music. If, as the research suggests, the client’s willingness to participate in that process is an important factor in the work, then facilitating that involvement through the interplay of communication at many levels would seem to be therapeutically important. Using the musicality of this interplay in the moment could be a powerful tool. To give another brief example here’s a clip of Dave Grohl (Nirvana’s drummer) talking to David Letterman and describing the musical version (between 3:38 and 4:00). At the same time their interplay shows the turn-taking dynamics:

The results may also underline the importance of experiential learning for practitioners; in the room we are operating at Stern’s ‘local level’ (2010) and there is often no time for reflecting on theory. The ability to identify and utilise moments of ‘meeting’ or ‘missing’ the client – as part of the process of deepening the relationship – is one developed through experience. This is already a part of many trainings, but perhaps there is something more to be added to the profession and the art by looking through the lens of relational musicality. If we can play and be played in the room like Jimmy Hendrix’s feedback note, we may well improve the outcome for both participants.

Stephen Westcott is a BACP accredited psychotherapist providing individual and couples counselling and psychotherapy from an integrative perspective in Crouch End and Kings Cross. He provides clinical supervision from an integrative perspective for both individual therapists and groups, and is also a musician.


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Image: Music All The Way by Tanti Ruwani


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