Moments of Synchronization - Schumacher & Calvetnchronization - Schumacher & Calvet

7/24/2019 Moments of Synchronization - Schumacher & Calvetnchronization - Schumacher & Calvet

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Karin Schumacher and Claudine Calvet

Music Therapy with Children based on Developmental Psychology, Using

the Example of Synchronization as a Relevant Moment1

Abstract

Insights gained in the area of developmental psychology through infant- and attachment

research in the past few decades are invaluable in providing an orientation for the work with

children with pervasive developmental disorder, especially those on the autistic spectrum.They supply a theoretical basis for understanding all disorders, which are accompanied by a

relationship disturbance and give clear indications as to acting methodically in music therapy.

Using the example of so-called relevant moments within a music therapy session,

synchronous moments and their impact on affects are analysed in this article; in this

context, synchronized moments are seen as moments in which two persons during shared

musical play play exactly in time with each other. The meaning of the phenomenon of

synchronization is explained from the point of view of developmental psychology and

illustrated with examples from music therapy practice. The AQR-Instrument 2is applied as

an evaluation tool for the assessment of the relationship quality in connection with the

phenomenon of synchronization3.

The History of Music Therapy Approaches Based on Developmental Psychology

Music therapy with children with pervasive developmental disorder, who display

abnormalities in their social, interactive and communicative abilities (ICD-10, F 84) brings up

the question of the origins of the human ability to build up interpersonal relationships even

in the typical healthily developed child.

1in Stiff, U./ Tpker, R. (2007): Kindermusiktherapie - Richtungen und Methoden. Gttingen: Vandenhoeck &

Ruprecht (p. 27 - 61), translated by Andrea Intveen and Gloria Litwin2Assessment of the Quality of Relationship3Special thanks to the Karajan Zentrum Wien (Karajan Centre Vienna), which has made the project Musicand synchronization possible through the provision of research funds


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Looking into the topic of the prenatal development of sense perception and of the question

how the ability to integrate sensory impressions comes about which still also keeps brain

researchers occupied today was a logical consequence of this train of thought and had an

impact on my music therapy approach (Schumacher 1994): Music-, movement- and speech

games, which are developed completely from the point of view of the child, create a

structured atmosphere of stimulus exposure and help to integrate the individual sensory

impressions. The infants need to be cradled and held, which dates back to pre-natal time, and

the relevance of early playful mother-child interactions for acquiring the ability to establish

interpersonal relationships (Schumacher 1996, p.105) influence the music therapy approach

with children who suffer from a severe lack of the ability to form a relationship.

In 1990 a constant and intensive exchange of mutual knowledge and practical experience in

the area of music therapy with children who are profoundly impaired in their ability to relate,

began through the collaboration of the music therapist Karin Schumacher and the

developmental psychologist Claudine Calvet. While Claudine Calvet provided her knowledge

and research results gained in dealing with the topics of early childhood, Karin Schumacher

contributed her experience accumulated in decades of working in music therapy with children

who have autism. The music therapy work resulting from this collaboration has been videoed

and examined and analysed systematically by both researchers since 1990.

The examination of the self-concept, as formulated by the infancy researcher Daniel Stern

(Stern 1985, 2000), initially led to interpreting the clinical picture of autism from the point of

view of infancy- and attachment theorists (Bowlby, Ainsworth, Grossmann) and formed a

basis for methodical interventions in music therapy (Schumacher 1996, 2004). The realization

that only co-ordinated perception and emotional regulation through the other person lead to

the ability to establish interpersonal relationships and that this ability is the basis for any kind

of development led us to focus on the development during the first year of life up to the onset

of speech. The exploration of the observable characteristics typical for each developmental

stage, showed that children with pervasive developmental disorder dont display (or if so,

only to a limited degree) congenital characteristics, such as eye contact, the ability to imitate,

vitality affects, which occur already at birth in healthy children. Can music therapy assist in

catching up with a development that has been disrupted at such an early stage, i.e. can it help

to undo the resulting disturbance?


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Can the ability for inter-subjectivity and empathy, which is a central precondition for the

ability to establish interpersonal relationships and relies on a coordinated perception of the

world, as well as a coherent perception of ones own body and a secure sense of ownership,

be caught up on at a later developmental stage? (see Kohuts definition of the self-concept,

cited by Milch 2001, p.292). We were able to discover and observe this continuous progress

of building up the ability for organization during the analysis of the videoed long-term

music-therapy processes.

Elementary Music Elementary Instruments Elementary Ways of Playing

The music therapy approach described here, which is based on developmental psychology,

has its foundations in an understanding of music, which Carl Orff calls elementary music.

Likewise, the developmentally oriented Orff music therapy approach is based on this concept.

Orff defines this term as follows: Elementary music never means music on its own, but it is

connected to movement, dance and speech. It is a kind of music, which one has to be actively

involved in and into which one is included not as a listener, but as a fellow musician (Orff

1963, p.16). Even if the term elementary keeps bringing up lengthy discussions (Jungmayr

1992) it is still helpful the way Orff defined it. The term elementary music refers to a

methodological approach, which doesnt separate the various media of expression that we

have as human beings. If music, movement, speech and scenic play are understood as part of

one and the same thing, the result is a smooth transition between bodily, vocal and

instrumental expression. Likewise, a physical sensation can be depicted scenically and

accompanied musically. Not the medium of expression, but the way we view the person we

are working with is artistic. Musik, the Greek term, which Orff has revived as a basis for

his definition, means the entirety of artistic expression of the human being in word, tone,

gesture, movement with instrumental support. If I behold and perceive a patient in terms of

his body, movement and mood, the result of this process can be expressed musically, and

therefore also made audible, and resonates back to the patient. This resembles a glance into

the mirror, but the emotion, which is hidden behind this reflection, is especially emphasized.

In the definition of the term elementary music by Hermann Regner (1988, p.97) the word

elementary is seen from the angle of relating and encounter:


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Music is not elementary because it is easy to play or can be sung along quickly; it is

elementary once it can elicit an echo in the musician or in the listener, once something

reverberates inside a person and when a connection occurs between the music and the person.

Regner adds: Such elementary encounters are very lucky indeed. They can happen when the

right kind of voice sounds inside a person, who is tuned into it and when there is a mutual

opening up between person and music. According to Wolfgang Klafki, the elementary is

what is mutually revealed (Klafki 1961). For us, elementary means something with a closely

knit texture, something simple, but by no means simplistic. The vocabulary of an infant is

simple, but never insignificant or even valueless. From the childs point of view, often one

word stands for a very complex event ("car") or for an emotional experience with a very wide

scope (Mum and Dad). What attachment theorists call sensitivity is in actual fact the

ability to understand these simple words, as well as interpreting them correctly and

responding to them promptly. To establish a musically sensitive contact, to respond

adequately and in a comprehensible way to a physical, vocal or instrumental expression can

be called elementary when it uses the same kind of vocabulary, when it picks up and

incorporates the sounds, tone sequences, motifs, but especially also to the timbre of the childs

expressions with its rhythms, which are not yet structured in terms of timing and easy to

repeat. Incorporating means in this context, the shaping and moulding of an elementary

musical expression, developing it into a playing style and thereby creating a space for playing.

This requires a sense of form and an ability to shape, which the child doesnt yet have.

According to the definition formulated by C. Orff the following applies: Elementary music is

pre-cognitive, doesnt know complicated shape or architecture, but it is characterised by small

progressions, ostinati and small rondo forms [] (Orff 1963, p.16). It must be easily

comprehensible, in order for the child to be able to grasp it. As opposed to pedagogical work,

such a kind of form is not presented as a ready-made product, but it evolves spontaneously

from the vocabulary expressed by the child. This kind of spontaneously developed musical

form is part of the know-how of the therapist and can sometimes also be artistic. The

instruments used, which are described as elementary instruments, have attributes, which are

regarded as especially valuable from a developmental psychology point of view. As described

elsewhere (G. Orff 1984, Keller 1996, Schumacher 2000), these instruments are not only the

so-called Orff-Instruments, but they include all musical instruments which are easy to play

from the point of view of playing technique, as introduced into therapeutic work from non-

European countries, by instrument makers and inspired by self-made instruments within thelast few decades.


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With all these elementary instruments, the process of sound production can be easily

observed. The player can see, feel and at the same time hear what kind and intensity of

movement produces which kind of sound. Via the direct physical relationship an inner

relationship is built up with the instrument, the self -produced sound, and the music (Regner

1988, pp. 85, 86). What is important with all these kinds of instruments is the fact that they

have a good sound and rich resonance, in spite of their sturdy design and the fact that they are

easy to play. Instruments which are stored in an inadequate way and are left un-tuned

unintentionally create the impression that they do not belong to anyone, and thereby lose

value. The smaller the instrument, the more effort has to be made to offer it to the patient as a

precious medium for expression. The manifold misunderstandings of so-called elementary

music often stem from a lack of knowledge on the side of those music therapists with a

classical instrumental training, who havent really dealt with these kinds of instruments for

themselves, and who only offer them to their patients for playing. They themselves hold on

to their instruments which they have been playing for decades, and avoid the adventure and

challenge provided by these different kinds of sound experiences. Another misunderstanding

can be observed where music therapists with a lack of instrumental training use these easy

to play instruments and just play them any old way. Especially the amateur, the patient,

senses this lack of connection and will quickly lose interest in an instrument offered in this

way. From our point of view, especially elementary instruments, which we use as a

medium in music therapy, have to be learned seriously and in such a way that they serve as a

personal medium for expression for us therapists and that we can handle this multi-faceted

sound world in a creative way. Only when this is achieved can we offer these instruments to

patients purposefully and in a way that furthers expression and dialogue.

An elementary way of playing is a musical expression which can be transparent enough to

be grasped and understood by the child and the amateur, and which allows an encounter on

the same level, and with the same musical means. Of course the therapist will with the help

of his musical know-how and on the basis of his intervention choose a holding harmony, an

embracing melody or a musical key that creates a certain mood, but the closer he stays to the

musical means of expression of the patient, the more this will strengthen the patients sense of

self. The music therapist tries to tease the music out of the patient (Schumacher 1994, p.13)

and avoids bringing himself4to centre stage with his music.

4Translators note: Although the masculine form of music therapist is used almost throughout the text (due tothe direct translation from the German), both male and female therapists are included. The same applies to allreferences to the child with a masculine article.


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Indication, Methodological Approach and Goals of Music Therapy Based on

Developmental Psychology

Music therapy based on developmental psychology works towards the development,

improvement and maintenance of the ability to form interpersonal relationships and thereby

focuses on the emotional-cognitive aspects of the childs developmental stage. Insights into

the development of socio-emotional skills, as described by the infancy researcher Daniel Stern

and the developmental psychologists Stroufe (1996) and Als et al. (1980), knowledge of

possible psychopathological processes, deficits and of disturbances and traumata resulting

from these build the theoretical basis for this approach and model. Emotional experiences are

influenced by our primary caregivers, therefore the most important contacts during the first

year of life and have a life-long impact. The development of a good sense of self as basis

for the ability to engage in dialogue is of central importance. The term self, frequently

used in the discussion of topics related to the psychology of the self is vital for the approach

described here, which focuses on experiences. The self concept formulated by Heinz Kohut

on the basis of depth psychology means that the self develops out of a coherent long-term

configuration based on earliest self-object experiences, as well as congenital and

environmental factors. The core tasks of the self consist of being the centre of initiative and

recipient of impressions and integrating motivational systems and experiences. The self

strives to further its own development, to follow its own path and to give its own personality a

central destination, which brings about a sense of purpose. The own actions in a persons

individual path of life are experienced by the self as a continuum, both in terms of time and

space and the person has a sense of being a self in relation to being an independent centre of

his or her own initiative and sensory impressions (cited by Milch 2001, p.292).

In terms of self development, in music therapy, the patients own experiences and those in

relation to the therapist through the medium of music play a central role. Not only when

working with children with a pervasive developmental disorder, but everywhere where

learning is not possible with the usual pedagogical means, it is necessary to focus on the

ability to establish relationships, and thereby the development of the self in addition to

focusing on organic-functional aspects in terms of a developmental and depth psychology

point of view. On looking at the self of the child in this way, the following questions arise:

"how old is the child in relation to its emotional development? Which characteristics can be

observed and which ones can be sensed?"


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The following overview shows the most striking symptoms, which occur, when the ability to

form interpersonal relationships is disturbed. Assumed causes as well as aspects of disease

perception are added to this list.

The incapability to establish and maintain relationships goes along with distress resulting

from the inability to express oneself, as well as emotional isolation. A lack of the experience

of perceiving ones own body as coherent and therewith as the source of actions leads to the

inability to experience feelings and actions as something belonging to and caused by ones

own person. Self-efficacy and authorship are not experienced. As a result, the ability to share

desires and interests with another person, in terms of inter-intentionality and inter-

attentionality is not developed and as a main symptom, the world is chronically being

functionalised. The ability to share feelings with another person, which is so vital for the

ability to form an interpersonal relationship, can not be built up without this basis. The lack of

communicative speech resulting from these deficits is one of the main indications for non-

verbal music therapy.

Table 1: Impaired ability to form interpersonal relationships

from the caregivers point of view from the patients point of view

Symptoms andpossible causes

Observable consequences Frequently occuring

consequences and individual

experience of the disturbance

Lack/disturbance of

social relationships:

- Disturbed gazeand inability toimitate

Disturbed emotional

development also causes

cognitive learning impairment

- Permanent stress in cases ofover- stimulation or lack ofstimulation

Striking emotionalcharacteristics :

- Apparent absenceof affect

- Lack of exchangeof affect

- Facial expression hard to

interpret, no gestures- Lack of vitality affects- Lack of affect attunement, the

caregiver is not experiencedas being helpful

- lack of differentiated

emotional experience- No expectation to experience

regulation particularly ofintense affects through acaregiver


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Aggression:

- Auto-aggression

- Aggression againstenvironment- lack of pleasure

- Misunderstanding due tolimitation in areas of expressionand communication- Pleasure - especially shared

pleasure - in terms of inter-

affectivity is not present as adevelopmental catalyst

- Isolation,

- Depression

- Lack of motivation

Stereotypic

behaviour/repetitive

play:

- Lack of ability to

play in an explorative

and sociable manner

- Impaired ability to process

perceptions

- Disturbed perception of ownbody

- Fear, chaos, mental overload- compulsively sticking to onesown settled orderSense of being driven- Restlessness and dissatisfaction

Speech impairment:

- Absence of speech

- speech is notcommunicative

- natural consequence of theemotional-cognitive disturbancementioned above- Impairment of the ability to

form symbols and understand

symbolic meaning

- Distress caused by inability toexpress oneself

- Isolation

- Learning impairment

However, music therapy can not and will not help improve speech in the first place, but it will

treat the emotional deficits, which can cause the inability to speak or a disturbance of speechin terms of its communicative potential. The element of pleasure has to come to the fore, so

that spaces for playing can emerge, which are so vitally important as a breeding-ground for

any kind of development (Papousek 2003, Schumacher 1994).

Since any cognitive-emotional development is only possible on the basis of an interpersonal

relationship, music therapy based on developmental psychology will often be indicated as a

basictherapeutic intervention. The indications include all disease patterns and disturbances,

which go along with an impairment of the ability to form interpersonal relationships andwhich are assumed to be rooted in the pre-and postnatal period up until speech acquisition.

The methodical approach results from these deficits and disturbances. The appropriate music

therapy interventions, which are especially applicable in working with children with pervasive

developmental disorder, and with autism in particular, imply a lack of development of the

ability to engage in dialogue.

The inability to partake and imitate, to resonate in terms of an inter-affective engagement, is

taken into account. Instead of offering invitations like Look, participate, imitate, play along,the medium of elementary music is offered in combination with an adequate therapeutic

stance. Interventions that offer music as a medium, which envelops, creates an atmosphere,


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integrates the areas of perception and attunes affects, proceed exactly from how the child feels

and can take effect without using dialogue (Schumacher and Calvet 2005).

Picking up the tempestuous affects, which mostly come about through distress caused by the

inability to express oneself, and the treatment of auto-aggressive and aggressive behaviour

happens through understanding the often chronic conflicts with the social environment via

affect attunement and the shaping of affects in connection with bodywork, through

appropriate songs commenting on the childs behaviour, and also verbal interventions if

passive and active speech is present. Only when affects are regulated to an extent that the

child can focus on something for example his own expressions self efficacy and

authorship become goals in the music therapy process. Picking up any kind of expression in a

holding and mirroring manner and incorporating it into playing styles is meant to further the

emergence of the subjective self and to bring about self awareness. The active

inactivity of the therapist is an important basic attitude and takes the place of the

enveloping and empathic therapeutic stance. Only when the child experiences himself as

the initiator of his own actions will he include the therapist into his focus of perception and

finally experience him as a counterpart. It is only then that the interventions begin to take

the shape of a dialogue. It is only then that it makes sense to invite the child to engage in

shared play. The ability to participate and imitate can only be expected once this

developmental stage has been reached.

The aim of music therapy based on developmental psychology, is to promote the ability to

experience, maintain and finally to enjoy interpersonal relationships. The basis for this

ability is formed by emotional skills. According to Sterns model of the self concept, music

therapy aims at the development of the perception of an emerging, a core- and a subjective

self. Only when the characteristics typical for each of these stages have occurred, the

emotional ability to form interpersonal relationships can be developed (Stern 1989,

Schumacher and Calvet 2005). In the terminology of infancy research, these emotional skills

are described with expressions such as exchange of vitality affects, auto-affectivity and

inter-affectivity (Stern 1989, Schumacher 1999, 2004). The most important experiences,

which go along with these skills and are enhanced by them, is a co-ordinated atmosphere of

stimulus exposure - which takes the perceptive disturbance into account - , affect

attunement and affect regulation, which are closely connected to sensory impressions in

the musical process, i.e. they become audible and perceptible. A sense of self as a basisfor learning through dialogue will develop via the repeated experience of authorship and


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self-efficacy. Characteristics of a healthy mother-child-relationship as described here by

Tronick will occur: Coherence, synchronicity and reciprocity (Tronick 1989). The following

chapter at first deals with the topic of synchronization (a synonym for synchronicity) from

the point of view of developmental psychology.

The Phenomenon of Synchronization

They were trying to play the same note, with the same kind of dynamics, the same kind of bow stroke, sound and expression

[.]. After they had succeeded in doing this, they already saw each other in a different light. After all, they had lived an

experience together. And this was the really important thing about this encounter (Barenboim in: Guzelimian 2004, p.27).

Daniel Barenboim had invited young musicians from Arabic countries and from Israel to Weimar to play music and discuss

topics, in order to make a contribution towards mutual convergence and understanding.

The phenomenon of synchronization fascinated us when analysing videoed long-term

therapy processes, as it was obviously related to relevant moments in therapy. Music

therapists had already dealt with this phenomenon and have described and examined it in

different ways from a psychological and a physiological point of view (Neugebauer 1998,

Gindl 2002). The music therapist Gisela Lenz , who was involved with the work of the group

of researchers around Daniel Stern, reminded us of the connection between the phenomena of

relevant and synchronized moments (Lenz and Moreau 2003).Since 2001 we have been tracking these moments systematically in the course of five long-

term therapies. The results of this work are shown here from the point of view of music

therapy and developmental psychology. We pursued the following questions: Which kinds of

synchronization exist, how do these relevant moments come about (interventions), what kind

of impact do they have on development and how can they be proved? Prior to the discussion

of these questions, some basic insights of developmental psychology will be summarised, and

important concepts will be explained.

Insights from Developmental Psychology and Attachment Theory

In the beginning of the 1960s, developmental psychology was primarily concerned with the

time-related and physical dimensions of the phenomenon of synchronization.

Already in 1963, Condon observed that infants and mothers have synchronized experiences

directly after birth. The infants movement adjusts to the mothers voice. It was assumed that

this ability already occurs in the uterus (Condon and Sander, 1974). This phenomenon was

also observed in adults. While they interact, they keep showing signs typical for

synchronization: When one person speaks and the other listens, their movements are


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synchronized. Condon (1980) even speaks of dance-like movements. Listening and speaking

create a continuum, which connects both partners. Mutual observing and responding succeed

one another within fifty milliseconds (Condon 1980). Likewise, the body postures of the

interacting persons show synchronized moments. If these moments are missing entirely, this

indicates that the interaction isnt really a good one and that the partners are not really in

contact with one another.

Lewis and Rosenblum (1977) describe the time-related correspondence of vocal expressions

between infant and mother, which can already be detected at the age of three months. Already

in 1974, Stern et al. observed this kind of synchronized vocalisation (so-called coactions),

which is typically connected to positive excitement. These vocalisations, which occur

simultaneously, are to be distinguished from alternating vocal expressions, in terms of a

question-answer type of interaction (turn-taking). In 1980, Rosenthal described the

vocalisations of infants, which fall in line with the mothers (join in). What is interesting is

the fact that the frequency of the synchronized vocalisations is four times as high as that of the

alternating vocalisations at the age of four months. Only once the ability for inter-

attentionality occurs, the frequency of synchronized moments decreases and an increase in the

question-answer patterns can be observed. At the end of the 1970s, developmental psychology

was increasingly concerned with the connection between the interaction styles of mothers and

children and the quality of attachment, which is established during the first year of life

through the daily experiences of the infant with his primary care giver.

First answers were given by Bowlbys (1958) and Ainsworths (1969) attachment theories. It

was possible to predict the quality of the attachment with its two main categories of secure

and insecure attachment at the age of twelve months on the grounds of the sensitivity

(Ainsworth et al. 1974) of the caregiver during the interaction. In this process, the sensitivity

defined according to the perception of, the correct interpretation of and the prompt and

adequate responding to the childs signals (Ainsworth in: Grossmann 1977) elicits positive

interaction experiences. When this takes place, synchronized moments occur. Isabella and

Belsky (1991) examined the development of this phenomenon in children with secure and

insecure attachment. They found a high frequency of synchronized moments, especially in

children between the ages of three and four months. In securely attached children, even at this

early age interaction is well organized and gains in predictability through the experience of

synchronized moments. Numerous researchers confirm that these synchronized moments are

typical for the development of a secure attachment.


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Asynchronous sequenceswere frequently observed in insecurely attached sets of mothers and

children, who were never able to make the experience of synchronized exchange during the

[childs] first year of life. These children experienced more frequently that their caregiver

didnt respond promptly and adequately to their signals, or they didnt perceive the signals of

the caregiver due to impairment. The caregivers were not really involved in the interaction,

and when they were, they often interrupted their childrens activities or over-stimulated them.

Kempton (1980) had already observed how synchronization failed in adult conversational

partners, who did not accept each other. When disagreements occurred, no successful

interaction developed and synchronization did not come about. The avoidance of visual

contact between the interacting parties was the most striking aspect. In distorted

synchronization, the time-related structures within the body or between two interacting

persons are minimally shifted. Condon (1980) observed this with a number of behaviour

difficulties in children, such as autism or also dyslexia. He stresses the connection between

synchronization and a sense of emotional closeness. Since the experience of synchronized

moments always ties in with an experience of emotional closeness, the emotionality of the

persons involved is being changed.

As an example, he describes a family with twins. One of the girls was diagnosed with

schizophrenia. The mother was strikingly often moving in a synchronized way with the

healthy girl, but wasnt able to offer this experience to the sick girl. Every attempt the girl

made to bring about a synchronization of body posture with her mother was immediately

interrupted by the latter. Here Condon describes a consistent pattern of non-verbal rejection

and points out, in what a significant way the experience of synchronization influences the

development of trust or mistrust and how it can have a negative impact on the identity of the

self.

The Phenomenon of Affect Attunement

In 1989, Daniel Stern described the phenomenon of affect attunement, which is closely linked

to the phenomenon of synchronization, in his book: The Interpersonal World of the Infant.

Affect attunement is seen as the ability to read an emotional state of another person and to

adopt it. The aim of affect attunement is to create a bond between emotional states and to

express the mutuality of inner experiences. Looking at the definition of synchronization,

which describes a time-related correspondence, one finds that affect attunement means an

even further-reaching, emotional correspondence, which is seen especially in parameters suchas intensity and dynamics. As Condon describes, simultaneous actions, movements and play


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lead to a jointly experienced mood, a kind of emotional contagion, which is experienced

as emotional closeness. Accordingly, emotional development means, that the phenomena of

contagion (vitality affects, once eye contact is established), which consist of sliding into the

affective state of the other person, lead to a mutual affective exchange. The congenital ability

to establish eye contact is closely connected to emotional development. Only when

appropriately stimulated (see sensitivity), will the infant be able to regulate eye contact

independently and to maintain his attention with an inner state of calm. Only when this takes

place, can positive affect be exchanged and synchronized moments can occur more often. The

frequent experience of positive affect leads to a longer positive emotional exchange with the

caregiver. This is the basis for the development - as described by Stern - of the congenital

ability for affective resonance in terms of vitality affects and imitation, of the capacity to

share attention with another person (inter-attentionality) and to seek reassurance (social

referencing), which leads to the ability to read the other persons emotions. The capacity for

inter-subjectivity and empathy results from this. In the last few years, brain research has

confirmed the importance of synchronized moments (Bauer 2002, Hther 2004). In the

revised edition of his book The Interpersonal World of the Infant (2000), D. Stern describes

two biological mechanisms, which come into action directly after birth: Adaptive

oscillators and so-called mirror neurons (Stern 2000). They are not only responsible for the

synchronization of movements between people, but also for the ability to co-experience the

emotions which another person feels while involved in an action.


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The Phenomenon of Synchronization from a Music Therapy Point of View

From a music therapy point of view, a synchronized moment is a relevant moment, since

it is not only a phenomenon, which can be clearly detected and described, but also goes along

with a relevant emotional change, when it comes to achieving the therapeutic goals described

above.

Through a long-term study - an analysis of the therapy process of five children over the time

span of two to four years - we were able to track the forms of synchronization mentioned

below. In the following chapter, the description5of these different types of synchronization

will be illustrated with practical examples. Two different kinds of synchronization are to be

distinguished:

(1)In intra- (self-) synchronization the time related-structures are attuned within a

persons body, i.e. facial expression (mimic) and body (limbs, torso), move in exact

correspondence, up to the split second. As soon as a verbal expression comes in, it is

also coordinated with the body movements (Condon 1963). The perception of the core

self depends on the ability to connect the whole body and all body movements

organically. Only this sense of self-coherence (Stern 2000) makes it possible to

integrate experiences and is regarded as a basis for inter-synchronization.

(2)Inter-(actional) synchronizationis the exact correspondence of the time-structures of

two or more people. Although the human being potentially has the capacity for intra-

and inter-synchronization from birth, it can happen that these abilities are not

apparent, or if so, only in a disturbed way. Therefore, we are concerned with analysing

the context of the correspondence of these time-related structures, both within the

body and between therapist and child. We are especially interested in the affective

attunement of two people, which comes about through the time-related

correspondence, and which can especially occur in shared musical play. In this case

we are talking about inter- affective synchronization.

Forms of Synchronization

Type:Intra (or self-) synchronization and inter-(actional) synchronization differ in where

they happen. In intra-synchronization the focus is on the perception of ones own body, in

inter-synchronization on the experience of the rapport, which happens between two or

more people.

5See also the educational film: Searching for shared time, (2004), which is a result of the project supported bythe Karajan Centre Vienna.


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Level of Expression:Synchronizations can be brought about through different modes of

expression. They can happen physically, instrumentally and/or vocally. In inter-

synchronization, the different levels of expression can coincide with one another.

Place and Form: We distinguish between Modal and inter-modal interventions

(inter-modal connection), whereby synchronized moments will occur on the appropriate

level of expression. Modal means that the body movement of one person exactly

matches that of the other. Vocal, as well as instrumental expressions of one person exactly

correspond to the vocal and instrumental expressions of the other.

In contrast to this, cross- or inter-modal means the exact correspondence of a body

movement with a vocal and/or instrumental expression and vice versa. In this process we

distinguish between whether or not the perception and the ability to partake is present in

terms of finding a common way of playing (phrasing) (see also lack of tuning in).

Mental attunement between to persons means that they have the same idea, which

happens in a simultaneous verbal expression.

Duration: Depending on the duration of synchronization, we distinguish between so-

called discrete and obvious synchronizations. Synchronization, which happens

discretely, appears coincidentally. It comes about unintentionally and hardly enters

consciousness. However, an obvious synchronization is easy to observe, as it lasts longer

and is followed by a visible emotional change. This points towards the possibility, that

this phenomenon may be realised to a certain extent.

Intention: Synchronized moments can occur due to a one-sided or mutual desire,

following attunement. They are elicited intentionally by the child, following an inner

need, or by the therapist, who assists in bringing about a synchronized moment through an

appropriate intervention.


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Music as a medium:The synchronized moments described here, occurred during

improvised music, i.e. music that was made up spontaneously. But synchronization can

also occur during other activities, such as dancing for example to music listened to

together or reproduction of music. Classical musicians experience synchronized

moments when interpreting pre-composed pieces of music, which have been notated.

These moments are experienced as relevant or even especially beautiful and

satisfying.

In Search of Shared time

In the following scenarios, excerpts from therapy sessions with children at the ages of

eight to ten years, who are diagnosed with pervasive developmental disorder, especially

different degrees of autism, are shown. Sequences, in which the different types of

synchronization described above become apparent, are described. The scenes show how

synchronized moments come about through certain interventions. The following important

early childhood experiences can be caught up on with this kind of experience:

- the experience of affect attunement

- coordination and integration of sensory impressions

- awareness of ones own body

- the experience of self-efficacy and authorship

- the experience of mutuality in terms of interests and desires and

- the experience of shared pleasure

The perception of rhythm, intensity and form is regarded as congenital (Stern 1989). The

ability to pick up on and differentiate these musical parameters is a precondition for the

capacity to experience synchronized moments. Even such basic skills can be disturbed in

children with autism. However, experience shows, that the ability to perceive sensations is

mostly developed to a degree, which allows the child to experience synchronized moments

via specific music therapy interventions.

In order to point out the loss of development of the self during the first year of life, we

headlined the scenes with In search of shared time, in the style of the title of Marcel

Prousts novel: In search of lost time. Likewise, the search for shared sensations, especially

body sensations, for tones sung together, rhythms played together and instrumental sounds

created together, as well as shared mental states, which can not be recorded on video, isdemonstrated. However, a shared interest, which occurs synchronously, can be read from the


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body language and finally becomes audible in music. The fact that synchronized moments are

sought for, but cant yet be found, becomes apparent through the lack of tuning in. In joint

musical play, the latter is facilitated through the shared experience of a musical pulse and

through involuntary joint breathing. If a child isnt familiar with this experience, the

synchronized moment will only happen by special coincidence. Synchronized moments cant

be forced or practised, but certain music therapy interventions will increase the likelihood of

their occurrence. The aim is to develop inter-subjectivity and the ability to form interpersonal

relationships through experiencing and tolerating synchronized moments.

Not yet Searching for Synchronization

Developmental Psychological Aspect:The emerging self with its characteristics of a-

modal, cross- and trans-modal perception, eye contact and imitation through perception of

facial expressions, as well as vitality affects, which show the infants emotions, can be

disturbed or not developed appropriately in children with autism. The following scenario

describes the lack of intra-synchronization, which hampers the emergence of synchronized

moments and with it the coming into existence of interpersonal relationships, and which is

probably linked to an inability to coordinate the different areas of perception.

Fritz, an eight-year old boy who doesnt speak, shows characteristics typical for a child with autism. He takes no notice of the

music therapist, who is present in the room, he stares out of the window, he produces a strange vocal probably guttural creaking noise, and he constantly keeps repeating certain hand movements ( a kind of vertical flapping-into-one- another and

rubbing of the hands). All these utterances and movements are not coordinated time-wise. Each of these expressions has its

own rhythm. I choose to use my voice and I accompany myself with an ostinato on the glockenspiel, while I also musically

pick up his guttural sounds. Since Fritz doesnt show a clear reaction he only slightly accelerates his stereotypical hand

movements I withdraw. I improvise a type of music, which doesnt put the child further into the centre of attention, but

gives the room a different atmosphere.

Intervention:The stereotypical behaviour which Fritz has developed shows a lack of intra-

synchronization and the inability to make contact, which is linked to it. This leads to personalisolation. As is usual when the patient doesnt make any contact offers or doesnt accept the

same, the therapist can express his or her feelings of counter-transference in music. Feelings

of being lost and looking for something to hold on to influence the mood of this improvisation

and reflect the atmosphere elicited by the child (see also Schumacher 2005).

Implications:Even if Fritz doesnt offer any recognisable signals, it is well possible that he

perceives the therapists attitude of acceptance of his behaviour and that he does hear the

music played for him.For a further positive development it is vitally important that the child

senses that he doesnt have to fulfil any expectations, and that he is not put under pressure.


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Synchronized moments cant be forced or produced. They can only happen. But the

therapist can prepare the potential ground for synchronized moments through his or her

intervention (enveloping).

Discrete Synchronization

Developmental Psychological Aspect:A lack of relatedness can cause depending on the

basic mood apathy, restlessness or hyperactivity. In children with autism, this disconnection

and assumed emptiness is mostly filled with stereotypical behaviour.

Norbert paces the room restlessly. I try to pick up the rhythm of his gait and make it audible on the xylophone. Suddenly, he

turns around, and I simultaneously accompany this turn with a glissando. He briefly pauses, and his gaze sweeps past me, as

though he was going to say: Well, what was that, then? Then he continues walking as though nothing had happened.

Intervention:Making movement audible is a difficult intervention, as the movements are

often uncoordinated, un-rhythmical and difficult to predict. It is important that rhythm and

intensity correspond.

Implications:No matter how discrete this moment is, it is certainly not worthless,

because as a therapist I have the clear impression to have touched - and thereby reached

the child, even if an obvious reaction doesnt follow. Interventions, which aim at

synchronized moments, should initially not be offered too often.

Characteristics:

Level of Expression: Body Instrument

Place and Form: inter-modal without a sense of phrasing

Duration: discrete

Intention: one-sided (initiated by the t)

Synchronization and Stereotypical Behaviour

Developmental Psychological Aspect:The so-called core-self with its characteristics of

authorship (self efficacy), self-coherence, self-affectivity and self-history has not developed in

an undisturbed way in children with autism. The child is lacking the ability to perceive his

own body as the centre of his will, as the origin of his actions and to experience his own

feelings and perceptions. This ability to perceive oneself and ones own history has to be

developed. Stereotypical behaviour is an attempt to replace a lack of body awareness and

body coherence in a compensatory way.


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Florian, an eight-year old boy who is not able to speak, doesnt look for eye contact. Sitting on the floor, he stereotypically

plays with a piece of string, while rocking to and fro over and over again. While doing so, he occasionally utters high-pitched

tones. I sit down behind him, join in with the movement and try to give his vocal expressions a vocal frame. I reproduce his

tones and shape them. Florian notices and accepts the shared movement, and a joint rocking motion emerges. His vocal

expressions take on the same time-related structure; he breathes in the same rhythm. This physical and vocal attunement lasts

for several minutes and synchronized moments keep happening.

Intervention:The picking-up of the stereotypical rocking movement is characterised by an

exact correspondence of rhythm and intensity. The vocal intervention takes the pitch and

intensity of the expression and timbre of the childs utterance into account. Synchronized

moments keep occurring in this process, which lasts several minutes. They are seen in the

simultaneous performance of the same movement and the singing of the same note in thesame pitch and with the same intensity and expression. Simultaneity emerges and phase

balance is initiated through the therapists formative offer.

Implications:Florian doesnt only tolerate the therapists intervention, but he engages in it

for several minutes. However, he doesnt yet give the therapist a signal which implies the

presence of an inter-subjective development. He doesnt yet make eye contact for social

referencing and the process of tuning in, e.g. through breathing in together or motioning priorto the beginning of a new phase, is missing. The synchronized moments are integrated into his

stereotypical behaviour.

Characteristics:

Type: Intra- and inter-synchronization

Level of Expression: Body voice

Place and Form: modal, emerging sense of phrasing

Duration: ObviousIntention: One-sided (initiated by the t.)

Synchronization and the Emergence of the Other

Developmental Psychological Aspect:Linking the different areas of perception is regarded

as a basis for the development of inter-subjectivity. Stereotypical motor behaviour seems to

help to bring about the missing intra-synchronization. If the child succeeds in integrating the

different areas of perception, a structure emerges, which makes the perception of the

environment possible. The child looks for the source of the music that can be heard and in

doing so, discovers the therapist. Often, this is followed by the first incidence of eye contact.


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Florian likes jumping on the trampoline and does so excessively. The therapist picks up the rhythm of his movement

exactly and integrates it into an improvised piece of music. Over and over again, she goes along with his irregular

pauses and movement impulses. Suddenly, he falls down in exact correspondence to the chord played on the piano.Afterwards, Florian pauses and listens to the music. A direct gaze over to the camera person and to me follows.

Intervention:The child engages in self-stimulating behaviour and - with his jumping -

activates his sense of proprioception. The latter is connected with the acoustic system

through the musical accompaniment. In this situation, rhythm, intensity and phrasing also

have to correspond exactly to the childs movements, whereby synchronized moments can

be elicited.

Implications:Florian accepts this structured atmosphere of stimulus exposure and

senses the connection made with him. His gaze over to the therapist at the end has the

quality of social referencing, whereby one of the typical characteristics of beginning inter-

subjectivity is established.

Characteristics:


Level of Expression: Body instrument

Place and Form: cross-modal, sense of phrasing through pause

Duration: Obvious

Intention: One-sided (initiated by the t.)

The search for synchronization made more difficult: The problem of the lack of

tuning in as an indicator of the fact that inter-subjectivity hasnt been developed yet

Developmental Psychological Aspect:The awareness of the difference between I and

You is an important precondition for the development of an inter-subjective self. The

need for a relationship leads to the use of the caregiver for the fulfilment of ones own

needs. Due to an increase in eye contact, the interest in the other person grows. Only bit

by bit, the latter emerges as a being separated from the own self. In this context, the need

for repetition is especially apparent.Tanja, a nine-year old girl with strong auto-aggression, who is not able to speak, developed the need for synchronized

moments through the affect attunement she often experienced. Although she observes me closely, she cannot yet involve


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me into her vocal expressions, which emerge suddenly. The appropriate preliminary signals, such as gaze, gesture or

breathing in together are missing. Therefore, the synchronized moments dont yet succeed properly, and I always lag

behind a little. In spite of this, Tanja discovers the shared experience with pleasure. She initiates the contact through

gaze, gesture and vocal sounds, but without preparation, so that it is not quite predictable for me. She cant yet

participate in a conclusion I am trying to introduce over and over again. In spite of this, suddenly - thanks to my quick

reaction - a synchronized moment becomes possible. The result is pleasure, a glance over to the camera person and a

moment of astonished eye contact with me.

Intervention:The vocal expressions, which are produced without inhalation, i.e. without

tuning in, are picked up and shaped by the therapist with the same timbre, expression and

intensity. Even if the child doesnt yet participate in any phrasing, it is important to shape

this musical exchange.

Implications:The unconscious search for synchronized moments becomes apparent in

the urge for repetition. The pleasure in a successful synchronization proves the

emotionally positive change resulting from it.

Characteristics:


Level of Expression: voice voice

Place and Form: modal, no participation in phrasing

Duration: Obvious

Intention: mutual

The obvious interest in synchronization. The emergence of tuning in as a sign of

developed inter-subjectivity

Developmental Psychological Aspect: Children, who have developed autistic behaviour

due to hospitalism, are more willing to engage in an interpersonal relationship again when

a stable relationship offer is made. The possibility of musical expression provides the

opportunity to experience the missing affect attunement and with it the experience of

affect regulation. The urge to catch up with this experience becomes apparent in the wish

to repeat such phases of joint screaming or singing.

Marian, an eight-year-old boy with speech delay, who experiences great distress due to the inability to express himself,

also tries to use his voice to elicit synchronized moments. Through direct eye contact and an obvious sign of tuning in,

rapport and a sense of togetherness can develop. At the end of the scene he repeats the inhalation, which has the purpose

of tuning in, and observes exactly, whether I follow him. Even over a greater physical distance, synchronized moments

succeed and are now linked and shaped through gestures. Musical pitch, intensity and form are exactly attuned to each

other. Marians gaze, which is usually rather controlling, now takes on an interested expression, and he begins to

imitate. Lasting interpersonal contact emerges.


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Intervention:Since the child gives obvious signs of tuning in, obvious vocal

synchronizations develop. In this context it is the therapists task to completely respond to

the childs initiative and desires and to act and play music in a way that the child comes to

the fore as the initiator of his expressions and suggestions in terms of phrasing.

Implications:The conscious search for synchronized moments doesnt only become

apparent in the urge for repetition, but the question of ones own existence is at the centre

of attention. In this case, the child is exploring whether the therapist really follows his

impulses. He wants to know whether he is the author of the vocal expressions and whether

he is experienced as a person.

Characteristics:


Level of Expression: voice voice

Place and Form: modal with phrasing

Duration: Obvious

Intention: one-sided (initiated by the ch.)

The Successful Synchronization

Developmental Psychological Aspect:The coordination of proprioceptive and acoustic

areas of perception brings about the experience of intra-synchronized moments.

The latter open up possibilities to perceive the environment and with it the other person

in this case the therapist. If she manages to [musically] hit the spot both in terms of the

rhythm and the underlying affect, she will support the child in perceiving the connection

between affect and action within himself. When I verbally describe and interpret his

action in singing (via the song lyrics), feelings of mutual understanding become

possible. The narrative self, which Stern only added to his self-concept at a later stage,

and which develops during the time after speech acquisition, is thus stimulated throughstory telling.

Since the capacity to understand speech is developed before the onset of active speech, it

is possible to create understanding on a mental plane.

Florians head- and hand movements, which are strikingly uncoordinated, dont match (disturbed intra-synchronization).

They cause a palpable ambivalence within me, in terms of making contact. His hands say yes, and he hits a wooden

bar with beaters, while his head says no with the appropriate shaking gesture. I pick up the rhythm of his hand

movements exactly, while in the lyrics of the song made up to this rhythm, this ambivalence which I can perceiveclearly is mentioned. Initially, Florian responds to the synchronized moments, which emerge during the joint musical

play, by abruptly terminating his play. However, after a short pause he very consciously re-initiates the joint play, which


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now lasts for a prolonged period. He responds with glances in my direction, which become increasingly longer, with a

mischievous smile and vocalisations of pleasure. A clearly visible moment of tuning in leads to a clear, jointly

performed beginning of a concluding period of shared musical play.

Intervention:In this situation, the combination of inter-modal connection (Florianplays, the therapist sings) and improvised song, which interprets Florians actions,

provides a correspondence on various levels. Synchronized moments arise through beating

of the same rhythm and the corresponding rhythm of the song, the lyrics of which are

probably understood. This two-part intervention contains two planes, the musical-

sensory one and the mental correspondence.

Implications:The initial termination and later re-initiating of the joint play shows that in

this case, emotional closeness is not only tolerated, but consciously sought for again. The

positive emotional change becomes apparent in the facial expression as well as frequent

vocalisations of pleasure.

Characteristics:

Type: Intra- , then inter-synchronization

Level of Expression: instrument/action voice with instrumental accompaniment

Place and Form: inter-modal with phrasing

Duration: Obvious

Intention: mutual, initiated by both the t and the ch.)

Research: The AQR-Instrument for the Assessment of the Quality of Relationship

In searching for an evidence for the efficacy of music therapy work, initially, moments in

therapy, which showed a quantum leap in development, were examined. In the course of

ten years, a tool for observation and assessment was developed with the help of these data,

the so-called AQR-Instrument, which serves the assessment of the quality of

relationship. This instrument underwent a reliability test, and at present the question is

examined, in what other areas of application of music therapy it can be used.

This instrument consists of four scales. In each scale, seven to eight different relationship

qualities are distinguished, which are also called modi. They are differentiated

according to exact characteristics. In the book Indikation der Musiktherapie bei Kindern

und Jugendlichen6 (Frohne-Hagemann and Ple-Adamczyk, 2005) these relationship

qualities are called contact-modi. Each modus corresponds to a certain developmental

stage and can therefore also be used for diagnostic purposes.

6Indications of Music Therapy for Children and Adolescents


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Each of the four scales focuses on a certain aspect of occurrences in the areas of

expression and relationship building. The first focus was the handling of musical

instruments and with it the instrumental expression (Schumacher 1999, 2004). It was easy

to distinguish from other phenomena of expression, but it revealed the disturbed

relationship with objects musical instruments included especially found in children

with autism.

Afterwards, we examined the voice and all the pre-verbal expressions in terms of their

relationship quality (Schumacher and Calvet-Kruppa, 1999). Children, who showed

neither instrumental nor vocal expressions, gave us the idea to increasingly look at the

body and its emotional phenomena of expression (Schumacher and Calvet-Kruppa, 2001).

The fact that the emergence of a quality of relationship can depend on the therapists

intervention, shifted the focus to the therapist and his intervention techniques

(Schumacher and Calvet 2005). Each of these scales follows the same developmental

psychological structure and highlights the essential characteristics of each developmental

stage and the relationship quality connected to it. While working on this assessment tool

we kept noticing special moments, which had a strikingly positive impact on

development.

The eight modi correspond to the development of the self during the first year of life,

but in the therapeutic context they dont necessarily occur in chronological order.

- Modus 0: (seeming) absence of contact, contact resistance

- Modus 1: contact-response

- Modus 2: functional-sensory contact

- Modus 3: in contact with own self, sense of self, self perception

- Modus 4: contact with the other person (inter-subjectivity)

- Modus 5: relationship with the other person (inter-activity)

- Modus 6: encounter (inter-affectivity)

- Modus 7: verbalising/reflecting

If this instrument is used to analyse the scenarios from music therapy practice described here,

the following can be observed: The experience of synchronized moments triggers affects,

which need to be regulated. To this end, the child needs another person, who shares this

emotional world with him and who helps him to integrate these new affects. This otherperson in this case the music therapist is usually not immediately accepted as an affect-


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regulator by children with autism. The emotional closeness arising through synchronization

is often not tolerated straight away, and therefore the child temporarily seeks other

solutions, until he or she will finally integrate the affects that go along with the experience

of synchronized moments and will perceive them as supportive in the process of forming

relationships.

By means of accurate analysis we were able to discover that the way the child with autism

responds to a synchronized moment, depends on his or her developmental stage. Children,

whose quality of relationship (QR) is estimated as belonging to Modus 1, are likely to initially

only perceive the synchronized moment very briefly. Either the children respond with a brief

pause their behaviour resembles a kind of freezing, as though they were struck by

lightning. They react as if they had burned their fingers on a hot plate, and the consequence is

that in lightning speed they avoid further contact. Or else the response appears like the

occurrence of the synchronized moment and the affect that goes along with it, isnt really

admitted. The childs gaze goes straight past the therapist and immediately afterwards, he or

she physically turns away, as though nothing had happened. However, the therapist senses

clearly that something did happen.

In children who are especially disturbed (modus 2), auto-aggressive behaviour can occur like

a knee-jerk reaction. For example, the child may briefly bite the back of his own hand in order

to regulate the affect that suddenly emerges.

Children, whose QR is assessed as belonging to modus 3, have already experienced the

synchronized moment in their own actions, as is the case in intra-synchronization. They are

able to integrate the affective experience, which is now connected to an inter-synchronized

moment, and will continue with their explorative behaviour, which is linked to curiosity, but

also to a certain inner calm. Good hand-eye-coordination, a concentration, which is directed

towards ones own body or an object, is apparent.

Children, whose QR is assessed according to modus 4 also extend their attention towards an

object. The therapist shares this interest of the child (inter-attentionality or joint attention) and

thereby enters into the same affective state, which is one of focused alertness. In contrast to

the previous developmental stages, in which the body and the affective state of the child were

at the centre of attention, at this stage there is a mental connection that can trigger shared

synchronized affective moments. What is interesting is the fact that the search for

synchronized moments is most frequent in modus 4. The increased perception of the other

person, due to the experience of synchronization, is the breeding ground for emerging inter-subjectivity.


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Children, whose QR lies in modus 5, have experienced that the new feelings that go along

with synchronization are not destructive for them. Now they are not looking for synchronized

experiences any more, but accept and integrate these moments. Synchronized play is replaced

by play in dialogue form. A typical characteristic is the fact that the frequency of glance

increases, whereby a natural flow of exchange of eye contact develops.

Children, whose QR is in modus 6, enjoy synchronized moments. This shows in prolonged

sharing of positive emotions during play. Characteristic is a lively alternation between

dialogue- and synchronized play, but also separate play, which always merges together again,

accompanied by enthusiasm for playing and mutual initiatives.

In conversation with children (modus 7) it becomes clearly apparent, whether body posture

and tone of voice of both partners show analogies, relatedness and even synchronized

moments. The vital point is that a person communicating by means of speech also has to have

experienced synchronization in order to be able to create contact through his speech in a

meaningful way (see Condon 1980).

In addition, synchronized moments can be shown through musical notation or also through

the notation of movement (Laban-notation)7,but this is very time-consuming. Video

recordings and possibilities of notation complement one another and raise seen from the

neutral viewpoint of the notating musician or the dance therapist very interesting questions

in relation to the development and the emotional-cognitive impact of synchronized moments.

All these possibilities can contribute to the enlightenment of the understanding of this topic.

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