The use of Music is Not Necessary | Can Therapy be Non-Directive ? (4/5)

Reflections on inter-subjectivity, inner healer intelligence, influencing and music in the context of psychedelic therapy

Please note that this article is divided into five parts, which are published sequentially and are ideally read in chronological order:

Part 1
Psychotherapy is never non-directive | Reflections on inter-subjectivity

Part 2
Music is always directive | Reflections on the therapeutic function of music

Part 3
Psychedelic therapy is highly directive | Reflections on the use of music in psychedelic therapy

Part 4
The use of music is not necessary | Reflections on the use of silence

Part 5 (PENDING PUBLICATION)
Healing often requires direction | Reflections on Inner Healer Intelligence

Part 4 | The use of music is not necessary

Reflections on the use of Silence

In the previous chapters, I argued that any therapy incorporating music will, by definition, have increased directive qualities. While the influence of music happens primarily in a pre-linguistic, non-verbal manner, it impacts the subjective experience of the listener in very significant ways.

I introduced a more nuanced perspective on selecting music, highlighting that its directive influences exist on a spectrum—from the subtle and gentle to the strong and authoritative. 

With this in mind, I often encourage therapists to reflect on the following question: “Will this particular individual or group, in this specific moment, benefit from being influenced?” 

While the potential of integrating music into psychedelic therapy is needless to say very significant, it is equally important not to assume that every session should be filled with music — or that music is even necessary at all. In fact, without doubt, there are use-cases where it is likely that the individual or a group is better off without any music being played.

Since music inherently influences the listener's subjective experience, we must recognize that such influence will simply not always be beneficial, and can in fact at times be counter-therapeutic.

For example, music could unintentionally steer the client(s) awareness away from certain therapeutic processes or experiences, under-utilising the opportunities of the session. Music at times can block access to certain therapeutic experiences all-together.

Therefore, at first therapists should always and consistently evaluate whether providing a certain musical direction is suitable for a particular moment in the session or not. These decisions will be guided by your way of working (your therapeutic framework), your understanding of the individual needs and the present experience of your client(s), and last but definitely not least, the instincts and intuitions therapists will have around music-selection, critically informed by their level of work experience.

Sometimes, the most impactful intervention given to your client(s) will be the absence of music, a pausing of implicit suggestions to modify the person’s subjective experience. A break in being asked to move. 

Or, to continue the metaphor previously introduced: like the calm that follows when the ocean wind dies down entirely, enabling the sailing boat to just stay and float around peacefully in one place for a while.

What would therapists need to think about when wanting to incorporate periods of silences in the therapy sessions? This is the theme that I will further explore and unpack in this part of the article.

I will start by providing an overview below, of the different kinds of value that not playing music can bring to the sessions.

Following this, I will share a handful of additional considerations and suggestions. These include elements that do not only relate to silence, but to the acoustic qualities of your sessions more broadly speaking, and how addressing these can improve the overall quality of the therapy experiences. Take note that some of the points raised may be much more relevant than others, depending on your method, the type of psychedelic medicine, etc.

The different ways silence can support the therapeutic experience for your patient(s), can be categorised into five distinct areas:

1. Re-sensitization

2. Integration

3. Non-music work

4. Check-ins and Pauses

5. and Stillness.

1. Re-sensitization

Renewal of openness to experience

Periods of silence can serve as essential "pit stops" that re-sensitize your clients’ “ears”  to the music. Or to be nerdy and more precise, the neurons in their cochlea and auditory cortex. These contrasts will make a subsequent reintroduction of music more impactful, allowing the music to be experienced with a renewed freshness. There can be a deeper awareness and appreciation of the multi-layered sonic subtleties of the music when it returns. Importantly, this also can facilitate a renewed openness for the allowing or accepting of the influence of music on their subjective experience - and thereby its therapeutic impact.

2. Integration

Time for consolidation of experiences

Silence can provide a less structured, unguided period of time to process the care-seeker’s flux of experiences. Therapeutic work is highly non-linear, and we need to acknowledge that integration is by no means confined to the post-session period, but happens continuously. Silence can at times give more space for this. Like a “rest-and-reflection” period after periods of work. The peace after the confrontation. The recollection after immersion. The integration after the dis-integration. Enabling this in-session “integration time” can prove crucial for consolidating what has been uncovered, experienced, revealed. Insights can be embodied in a way that the presence of music might at times not allow.

3. Non-music work

Space for other kinds of therapeutic work

Silence also creates space for other valuable therapeutic opportunities. For example, in some cases the process of healing will be much better supported through an interaction with the therapists. Some situations require not a transpersonal, but a personal relationship. Allowing implicit learning experiences to heal from a trauma that originates in a social context, for example, will at times depend on this possibility. This bucket of “non-music work” can also include verbal processing, somatic or body-oriented techniques, guided meditations or imagery work, or simply holding space for the client's emotions.

4. Check-ins and pauses

Times for brief engagements or toilet breaks

This one may for some sound a bit redundant at first, but I came to see this not to be under-estimated. By no means do I imply to have lengthy periods of chit-chat, but talking over the music can at times be very disruptive. Short periods of silence can give you just about that extra insight into how the therapeutic journey of your client is unfolding, while reducing a potential negative interference. I have also come across cases where patients literally stopped blocking out bodily signals, not picking up a need to go to the bathroom, and this being a hidden cause of the felt unrest. In a dystopian but not entirely unlikely future scenario, that I hope (and currently would think) we manage to avoid, these “pop-corn breaks” can also become the moments for patients to be flooded with commercial advertisements from sponsors or partners from the private clinic in question. 

5. Stillness

An invitation to “be here now”

Finally, silence can function as an invitation to deepen the presence of the present moment, offering a chance for clients to detach from the mental currents of the past or future. Allowing a stillness within to be witnessed and deepened more fully. Similarly, in psychotherapy, these moments can be referred to with the concept of therapeutic silence, or the “pause” grown in mindfulness practice. This is an internal place is of potentiality, nurturing the not unrelated concept introduced by Winnicot of a“potential space”. Someone recently pointed out Gestalt therapists can refer to this via the term “fertile void”, which is a literal translation from a concept originating in Zen Buddhism and described as Shunyata - A “fertile” or “swollen” emptiness, hat holds both "nothing" and "everything" simultaneously.  Or, from a more somatic or psychodynamic therapy perspective, this invitation to be more present with the moment as it is, can help reveal defence mechanisms. These can be either expressed in the body, the feelings or the mind, but their enactment in response to silence can help clarify why an individual is not able to be present fully and in an embodied, integrated manner (i.e. why there may be a dissociative response from the here and now).

In summary, while music holds great power and potential to facilitate meaningful therapeutic experiences, the conscious decision for moments where no music is played can be just as important and transformative. 

By thoughtfully balancing sound and silence, therapists can foster a richer, more responsive, more considerate therapeutic environment. There are however a few pretty important footnotes and bits of advice to attach to this point. Do’s and Don’ts one might say. I will list them below, including concrete examples and practical suggestions that can potentially improve your practice. Importantly, you will find that the population you’re working with displays a vast variation in how relevant these points can be for each of them.

Below I discuss the following considerations:

1. Set expectations

2. Prevent noise-pollution

3. Optimise human presence

4. Thoughtfully design the session room

1. Set expectations

Educating your clients about the role of music and silence in therapy helps setting the right expectations and ensuring a most constructive therapy process.

Things to avoid: 

• Failing to educate your clients about your use of music and silence can lead to confusion. For example, they might mistakenly think there is a technical issue, such as a malfunctioning sound system. 

• Skipping a conversation about how music guides the therapeutic process can make your clients feel less prepared or their hopes and fears around music to be unacknowledged. It is also likely to compromise the ideal and most therapeutically constructive attitude with their evolving experience (musical and beyond).

• As an extension to this point, not explaining what the significance of silence beholds, might cause silences to be treated as a gap between music tracks, waiting for the next piece, rather than an integral part of the session.

Things to consider:

• Explain the role and your intentional use of music.

• Explain the role and your intentional use of silence. 

• Share examples of how silence might be experienced as supportive.

• As well as examples of how this might be experienced as challenging.

• Outline what can (and cannot) be expected during the sessions.

• Suggest and practice ways of relating with silence. 

• Use the same acoustic signals indicating the start and ending of each silent period.

2. Prevent noise-pollution

Be aware that, unless you are performing your therapy rooms in an extremely well-isolated and sound-proof chamber - there is rarely true silence. Grow an increased awareness of the environmental sounds unique to your therapy room(s), their “sonic signature”. No matter how subtle or obvious, these can bring new challenges to be managed carefully.  

Things to avoid: 

• Overlooking potential noise sources like street traffic, conversations from adjacent rooms, or hallway footsteps can easily disrupt or derail the therapy sessions.

• Sounds can also indicate the nearby presence of other people, and thereby create a sense of boundary violation, lack of privacy and unsafety.

• Background noises such as the buzzing from AC’s, ventilators, laptops and other household machinery, should not be underestimated. In psychedelic states of consciousness these can quickly become whole worlds in themselves, with the potential for distraction, anxiety and stress.

• Relying on music to cover up disruptive background sounds without addressing the noise source can limit your freedom and reduce the effectiveness of your therapeutic work.

• Relatively empty rooms with hard surfaces will further amplify any sound and also engender a sense of “coldness” of the room.
  
  

Things to consider:

• Invest in soundproofing measures, such as thicker curtains, acoustic panels, or weather stripping around doors and windows, to minimise external noise from entering the room.

• Use soft furnishings like rugs, carpets, and upholstered furniture to absorb sound within the room, reducing echo and creating a quieter environment.

• Spend time in the therapy room during different times of the day to identify potential noise disturbances and take measures to address them. Sit quietly, or make long sound recordings you can inspect afterwards.

• When the sound sources cannot be undone, you can prepare your clients for the possibility of certain ambient sounds. By helping to normalise these sounds as part of the settings, these in turn can more easily be ignored.

• You might also want to consider to schedule sessions during times of the day with the least likelihood for noise pollution.

3. Optimise human presence

The presence in the therapy room by you, co-facilitators or in case of doing group work, the group, all have an impact on the experience. And even more so during periods without music. Even the smallest sounds that you usually may not think much of, can for some people and for some moments in psychedelic therapy sessions bring patients “out of their process” entirely. 

Things to avoid: 

• Ongoing bodily movements, such as fidgeting, tapping, or shifting in a way that produces sudden noises.

• Shoes that squeak or make noise on floors, or wearing other clothing materials that could become a source of noise.

• Avoid bringing tools, devices, or materials that might make noise when used, obvious examples include phones, laptops, but includes any other material that can rustle or clatter when used, such as for example plastic bags, plates and cutlery, paper work, etc

• When working with colleagues or groups, failing to address the collective impact of your presence and to agree on your best practices, can exponentially increase the likelihood for a disruptive presence, such as whispered conversations, rustling blankets, or the crinkling of certain materials.

Things to consider:

• Opt for soft-soled shoes or walk around on socks or barefoot.

• Add soft mats or rugs to areas where tools or equipment might be placed. This helps reduce the noise from setting down objects, making movements in the room quieter.

• Remind yourself to move mindfully, especially during silent periods.

• For group or collaborative sessions, provide a clear list of guidelines, such as a no-talking policy or blacklist of certain materials.

• Select chairs and furniture that are stable and quiet when moved or adjusted. You can also consider adding felt pads to chair legs and table feet to further minimise noise.

• Set the tone for the session by modelling your presence for your colleagues or participants. 

4. Thoughtfully design the session room

The design decisions of the therapy room has a crucial effect on the sound quality of the room, and consequently the capacity for your client(s) to relax, feel safe and feel private. 

Things to avoid: 

• Walls, floors, and ceilings made of hard materials like tile, glass, or concrete can reflect sound, leading to echoes and a lack of warmth.

• Sparse furniture and decor can result in a lack of sound absorption, making the room feel sterile and amplifying noise.

• An open-concept design can allow sound to travel freely, compromising privacy and creating distractions.

• Thin walls or inadequate insulation can allow outside noise to penetrate, disrupting the therapeutic atmosphere.

• Variations in ceiling height can create uneven sound distribution, affecting how sound is experienced in the room.

Things to consider:

• Incorporate carpets, rugs, and upholstered furniture to absorb sound. You can also consider wall or ceiling coverings like acoustic panels or fabric.

• Introduce textured decor, such as wall hangings or curtains.

• If possible, design separate areas within the room using screens or partitions that can contain sound and provide an extra sense of privacy.

• Use soundproofing materials for walls and ceilings, and ensure windows and doors are well-sealed.

• Aim for a rectangular room rather than square, as this can help with sound distribution. 

• Consider varying the ceiling height or using angled ceilings to improve acoustics.

• Adding plants can enhance the acoustic quality of the room, in addition to their presence bridging a connection with the natural world.

A few final words of caution and nuance

While this section emphasises the therapeutic potential of silence, it is equally important to recognize that, for some individuals and at certain times, music will be perceived by them as a crucial necessity. Music often becomes an important source for structure and continuity, when the usual (psychological) structure and continuity is fading away. Some have suggested to me that periods of silence should only be introduced in later sessions, once clients have more experience with the process. However, I feel confident that adhering to such a protocol can greatly compromise the therapy experiences for some people, for the various reasons this part of article has introduced. Instead, I encourage any therapist working with music and silence, to always carefully consider the individual’s ego strength and how much they may rely at times on the non-verbal support that music provides.

Secondly, as I pointed out before, but to just be methodical: you will find great variation in your population. Variation in how the presence of music and silence requires to be balanced, as well as variation in the responses to the qualities of the silence that is unique to your space.

Finally, I need to clarify that my intention is not to suggest that therapists should be overly cautious or tiptoe throughout their entire sessions. A therapeutic space should definately feel natural and include some of the normal, everyday sounds of life. My aim in offering the above considerations is simply to help raise awareness of the various sonic elements that can influence the therapeutic experience, and can do so significantly when working with non-ordinary states of consciousness. Nothing here is to be taken black-and-white. For example, it may very well be that one of your patients would have an experience of profound awakening by deep listening to tone colours and rhythms of the air conditioning machine.

The intention here is to stimulate deeper levels of thoughtfulness and to help ensure facilitators have sufficient control over the variables that they need to have some degree of control over. My hope is also to stimulate creative thinking in how we might best design our modern equivalent of a ritual space, that truly helps patients to temporarily move “away from the mundane into the profane”.

The details here are often very determining. And sadly, this thinking has clearly been absent in most if not all of our modern day health care facilities. The resurgence of and the eventual integration of psychedelic therapy in the present societal structures, will necessitate some kind of revolution on this front. And I envision such “re-recognition of the significance of the subjective experience in health care” can have significant and valuable carry-over effects to other domains of care.

Considerations around sound and silence are without doubt one of the domains that is maybe most likely to be overshadowed again if we are not careful.

This brings us to the final part of this article to be published next. In that chapter, I will synthesise the key points discussed throughout, while drawing connections to foundational concepts and areas of consensus in the field. For instance, how does the idea of an endogenous healing process integrate with our understanding of the therapeutic role of music?