Attunement: How to create a therapeutic relationship

In my studies to become a music therapist, Our class was assigned to read an article by influential music therapist Mercedes Pavlicevic titled ‘A child in time and health’.

In this article I was enticed by Pavlicevic’s account of observing a session, another music therapist is at a piano playing while a child energetically dances her way around the space. Pavlicevic observes that the music perfectly matches her movement and what Pavlicevic calls her ‘vitality’, and in doing so connects with the child, communicating to her that she is seen, heard and held by the music.

I would come to know this scenario in my own observations and eventually my own sessions as the technique of attunement.

Attunement is one of the main ways therapists connect with participants/clients/musicians and it is the foundational aspect of the therapeutic relationship.

The importance of attunement was first observed in the innate interactions within the infant-caregiver relationship. Attunement through eye contact, facial expressions, sounds and preverbal singing between infants and caregivers is what creates infants first experiences of emotions and play. Research has since emerged showing that during moments of attunement, neural activity between caregivers and infants synchronises, literally becoming in tune with each other. The quality of these early interactions has a huge influence on babies development. As music therapists we aim to attune to our participants in a similar way, using music to mimic these early experiences in order to meet the emotional, social and cognitive needs of our participants.

Music is a uniquely powerful way to attune to another person, the elements of music have immense potential to communicate and resonate with participants sense of self and how they are feeling. The main elements of music used in music therapy are Rhythm, Melody, Harmony, Timbre (sound of the instruments) and Dynamics.

Music therapists attune to the energy/vitality of their participants. This usually begins with listening and observing and then playing in a way that matches how the participant is engaging with the environment set up. This can look very different depending on the participant.

For example, consider a participant who is more reserved and unsure when they initially start music therapy, I might attune to their presence by playing soft, slow, simple melodies on an instrument like a guitar or piano. This can be improvised, or played within the framework of a familiar song. Guitar and Piano provide opportunities for offering reassuring rhythms and timbres while slow and simple melodies communicate the participants need to be given lots of time and space.

As a participant opens up and shares more of who they are either verbally or in their playing and interactions with the space, I continue to adapt and respond, continuing to attune to their changing energy/vitality, this might look like adding more instruments, playing louder, with a groovier beat or playing sweet or more dissonant harmonies.

Something transformative happens when someone hears themselves accurately reflected back by another person in music, it helps to build a sense of ‘self and other’, as well as an embodied affirmation of being accepted and celebrated for who you are in any given moment without judgement. These outcomes of attunement become the basis of connection and trust from which a therapeutic relationship can be formed.

There is so much more information and theory around the understanding and use of attunement, but I hope this introduction gives some some insight into what’s going on inside the mind of music therapists. Here is a link to more information and the science behind attunement in early life and beyond.