Gerardo Manarolo,
psychiatrist, psychotherapist, music therapist

In music therapy "listening" is a way of studying and analysing the client and a specific intervention technique.
This paper concerns three aspects of music therapy: the music therapist’s repertoire, the assessment of the patient, the intervention (the session) and listening in music therapy.

Receptive music therapy has often been considered a passive approach method identified by pseudo- pharmacological aspects; as we know, sound/music (s/m) listening is a complex process, anything but passive and capable of setting profound internal changes into motion in certain contexts. More over, meaningful listening on an emotional level overtakes the cultural connotation of a piece of music, interacting with codes and symbols belonging to the individual person; this aspect makes any statistical effort (aimed at identifying more musically therapeutic pieces) and any pseudo-pharmacological use of the listening proposal futile. Instead, it could be stated that the model of listening imposed by the various contemporary forms of "media" is characterized, conversely, by standardisation and passivity; the incessant auditory stimulation which typifies our daily lives pollutes our thinking, masks our silences and conditions us to preset responses.
Listening in music therapy could therefore aim at recovering a silent dimension where we can attempt a "re-education", a rediscovery of our personal ability to listen actively, meaning taking in and creatively processing the signals, expressions and communications from our surroundings.
In the field of music therapy, listening is a way of studying and analysing a potential user and a specific intervention technique.
My essay will deal with three aspects inherent to listening in receptive music therapy: the s/m repertoire, the evaluation (the sound probe sequence and the client’s music) and the applications.

The repertoire
The music therapist must have a specific s/m repertoire at his disposal to use both for evaluative ends (to study a potential user’s way of listening) and to carry out specific interventions (receptive music therapy). It is therefore necessary to define some key criteria for the music therapist’s discography; these are s/m criteria, they refer to the potential "function" of a piece of music, the affective-emotional tonality which identifies it, the cultural connotation and/or the symbolic value it has. The identification of these criteria as parameters with which to classify the various pieces in our discography and also as categories to be filled, also explains which musical aspects and which semantic values may be useful in music therapy (in other words, identifying the need to possess certain s/m material in our repertoire and specifying the particular semantic potential of this material also explains a procedure for taking into care and treatment, a procedure which underlines the symbolic values of the s/m language).
Now we will examine the various parameters in detail.
a) From a s/m point of view, the music therapist’s repertoire must include the following categories:

- formal characteristics: predictable/not predictable (in the repertoire pieces of music whose development is predictable must be present alongside unpredictable pieces);
- structural characteristics: vertical organisation (monody, chord structure, polyphony, hetero-phony), horizontal organisation (diatonic scale, modal, chromatic, scales from non-Western cultures); music is structured as a succession of sound events, horizontal organisation, and as a simultaneousness of sound events, vertical organisation. These organisations are divided by different methods and criteria in relation to the musical genre and to the culture of origin;
- organic: orchestra, quartet, soloist;
- vocalism: male/female/child, choir/soloist, pitched voice/non-pitched voice, "senile" voice;
- agogics: uniform/with variations/irregular; - dynamics: uniform/with variations/irregular;
- genre: medieval music, polyphony of the 1500s, the Baroque, the Classical period, Romanticism, Twentieth century music, Contemporary music,
jazz, rock music, pop music, ethnic music, opera, functional music, music for children, rap, techno, house, jungle, reggae;
- archetypical sounds; heartbeat, breathing, lallations, water;
- daily sounds: domestic/urban.

b) Potential functions of the music
From this perspective the listening proposal appears to potentially capable of inducing a change in state; the possible functions are essentially of two types: activating, relaxing.

c) Emotional-affective tonality
Every piece has a particular "colour", every music expresses a particular emotional- affective tonality (more or less defined, sketchy or ambiguous); we can thus identify certain areas in which the various pieces of music can be placed (with all the shades and variations of each case): serenity – joy, nostalgia – sadness, mystery – fear, the tragic, ironic – grotesque, strength – euphoria.

d) Contents
Music can contain specific extra-musical references within it; these can have symbolic explanations or, more simply, they may be caused by specific socio cultural connotations. In any case, it is always the individual user who favours one route over the other and this is in relation to his sound/music identity and his biography; the contents represented must pertain to these themes: the maternal, the paternal, Eros, Thanatos, the transcendent.
The repertoire is defined and identified within a self-focussed group; as musical material to analyse and weigh up, it uses the listening choices proposed by the participants themselves and put together according to emotional criteria ("the music of the heart"). The group should identify and work through the different s/m identities of its participants in order to compile a structured s/m repertoire (as the result of different musical appreciations), rich in emotional and symbolic worth (as an expression of a "group" journey). In this way we will have musical selections which are not neutral, but expressive of the music therapist, his musicality and his history (this aspect plays a fundamental role from a relational point of view); moreover, the music therapist will possess a deeper knowledge of this repertoire, knowledge he has gained from the group encounter.
The group journey proceeds through various phases:
- identification of the s/m range which best expresses the s/m appreciation of each individual participant (their most listened to and most loved music);
- analysis of the semantic value and of the formal and structural features of these pieces (what they talk about and how they talk about it); analysis of the relationship that the proponent establishes with them (the reason for this choice;)
- evaluation of each individual sequence and selection of music to include in the music therapist’s repertoire (the selection follows three criteria: every piece must have codes within it that can be decoded even using general categories; every piece must have a duration of no less than 3’ and no more than 7’; the parameters described above must be fulfilled).
In the event that the collectively chosen repertoire does not comply with the above criteria, it is the group’s duty to trace the missing musical material, critically "confront" it (why is it missing?) and include it in the repertoire.

The evaluation
(the sound probe sequence and the client’s music) The evaluation of a potential user’s s/m characteristics from a musicological and psychological point of view (the psycho-musical balance) includes a phase dedicated to listening; this phase involves hearing a s/m sequence proposed by the music therapist (with the analysis of the related associations) and listening to a sequence proposed by the patient (their most loved and most listened to music) with a subsequent analysis of the semantic aspects and the strictly musical aspects.

a) The sound probe sequence The music therapist develops the sound probe sequence using his repertoire, his discography; this sequence should include within it part of the elements which define and order the repertoire (f rom s/m elements to cultural and symbolic ones).
Actually, we need to present a listening journey to the client which, while expressive of the music therapist’s s/m identity, is also extensive and structured; only in this way will the client be able to find something that concerns him in it. We define this listening journey the "sound probe sequence" as it is not a test but a proposal which explores the client’s ways of listening and which also presents the music therapist in its s/m characteristics.
It is clear that the compilation of the sound probe sequence cannot keep to the differentiation criteria provided for the repertoire (as they are too extensive); a reasonable reduction of the criteria is therefore proposed, preserving the fundamental categories.

1) S/m aspects
- formal characteristics: predictable / unpredictable;
- organic: orchestra / quartet / soloist;
- vocalism: female/male/choir/soloist;
- agogics: uniform/ with variations;
- dynamics: uniform/with variations;
- gen re: formally- defined classical music (Classical, Romantic, early Twentieth century), non- representational music (historical avant-garde, electronic music, etc.), song, ethnic music;
- archetypical sounds: water, heartbeat.

2) Potential functions
- activating;
- relaxing

3) Emotional-affective tonality
- serenity / joy; 
- nostalgia / sadness;
- mystery / fear.

4) The cultural/symbolic connotation
- Mater;
- Eros;
- Thanatos.
The sound/music material included in the sequence will thus be defined by its characteristics (musical, emotional, symbolic and cultural ) .
However, beforehand we don’t expect and we don’t look for a specific response (a certain response must always correspond to a certain music); rather, it is the relationship that each listener establishes with the material, a relationship conditioned, as we have already seen, by biographical aspects and by the sound/musical identity of the listener himself, that is the subject of our study, as it is the real defining element of the various responses. The sound probe sequence must respect some formal criteria:
- the sequence must not contain more than 6 pieces or extracts;
- the overall duration must not be more than 30-45 minutes;
- the piece which concludes the sequence must be similar to the opening piece (thus proposing a circular structure); 
- the initial piece must be characterised by pleasant, gratifying and containing aspects (for example, regular rhythmic modulation, tertiary tempo, a cantabile melodic line, richness of timbre, a major key); 
- presence of a certain level of variation.
The sequence of the different pieces must reflect a logical structure, a possible route planned by the music therapist. In the construction of this route, it is important to evaluate the attempted response of a hypothetical listener, seeking to create a balance between reassuring pieces and pieces which require a greater personal involvement in order not to inhibit and not to saturate the client (pieces which are too challenging could inhibit the listener; on the other hand, pieces which are too gratifying could saturate him and lead to indifference).
A s/m sequence constructed following the above instructions allows us to mark out different symbolic and cultural areas and to observe what kind of relationship our client establishes with them. Subsequently a statistical evaluation of the responses given during the listening of the s/m sequence must be performed.
As we have said, although respecting the general parameters previously described, the choice of music to include in the sound probe sequence is subjective or, at best, the task of a working group which in this way expresses the various s/m identities it is made up of. We should therefore "gauge" such a selection by comparing the s/m sequence with a vast and homogenous listening sample. This procedure allows us to understand the "semantic potential" innate in the various pieces and to critically evaluate our experience with respect to them.
We can therefore identify the most frequent responses in percent to each piece and the connected s/m elements; by doing so we can define a reference sample to which we can compare the responses obtained in clinical practice.
Once the "sound" sequence has been developed in this way, we must propose it to our client. The verbal delivery could be as follows: "Now you will listen to six pieces of music and some sounds; after each hearing there will be a pause; you can write whatever each piece and each sound brings to mind; you can write while you listen or during the pause between one piece and the next. If you don’t want to write you can tell me, after each hearing, what has come to mind. Feel free to tell me if you have any difficulty." 

b) Study of the record (the client’s words)
Having define some general coordinates relative to the structuring of the sound/music sequence, we must ask ourselves how to treat the material produced by the client, that is, his words, "the more or less genuine outcome" of the musical listening.
These are the elements to be taken into consideration:
1) the manner of description: in what way, with what style the subject verbally works through the feelings evoked by the listening (for example we can find an articulate and consistent prose, sign of an intellectual elaboration; images and emotions that can be directly related to the listening; or a still inhibited and lacking style; the subject could express himself in the first or third person; his expressive style may be constant or may change in relation to different pieces). It is not possible to identify a direct correlation between the way of describing and the way of listening. In fact, in order to understand the latter more precisely it would be essential to analyse the path that led from the listening to the verbal elaboration: an articulate style could be indicative of an intellectualisation which distances the listening experience, but also of true listening, culturally elaborated afterwards; just as an expressive style through images can testify a person’s ability to let themselves be permeated by the music, but at the same time it may be a rejection behaviour;
2) metaphors, adjectives and nouns: the categories used to express one’s own experience (visual, motor, tactile, anthropomorphic, naturalistic…) express the subject’s own psycho- sensorial and conceptual configurations in individual and/or conventional relation to sound-symbolic and semiological aspects in the pieces;
3) present and recurring themes: identification of the contents expressed and of their possible recurrence and modulation in the various pieces.
Also in this case, evaluating the relationship that these themes have with musical listening (specific and/or non-specific) is essential;
4) relationship with the semantic potential of the various pieces. The associations formulated by clients can reflect a generic and non-specific common meaning or, on the other hand, they can appear to be individual, capable of adding a subjective variation to the common feeling, or again show themselves not to be the result of a habitual listening experience. The appearance of original elements in the interaction with certain pieces rather than others, the choice of attributing a particular meaning rather than another to pieces with a certain level of ambiguity, high-lights how on such occasions the listener finds himself faced with sound/music elements which are meaningful to him and which cause him to slip from the conventional to the subjective level.
Thus we can observe:
- sound/music configurations which are particularly meaningful for the client; 
- personal themes evoked and represented by these configurations.
In these cases we come into contact with subjective sound/music symbolism and with important aspects of the sound/musical identity. Finally, the considerations which emerge from the evaluation of the listening record are shown to the client with the aim of extending and validating the analysis of his sound/music identity.

c) The client’s music When possible the client is asked to put together a musical selection which is representative of the music he prefers, to listen to and to analyse together. 
In this analysis it is important to specify the semantic areas defined by the various pieces and to identify what connections there are between them (continuity, repetition, breaks, oppositions).
Afterwards we can look for the sound/music elements connected to the above themes. Using a similar method to that of the "sound" sequence, also in this case we seek to identify the themes which emerge and the ways they are expressed.

a) Prerequisites to enter into treatment
In order to enter into receptive music therapy treatment a client must have a sufficient command of verbal communication and an even minimal introspective and elaborative ability (the latter referring to the ability to take in a stimulus and to give it back modified); the client must also possess an ego function which allows him, even if to a very limited extent, to respect the framework of the treatment, the setting, no matter what; his defensive structures must not be excessively rigid and/or primitive.

b) Recommendations for treatment
It will be decided to refer a client for individual receptive music therapy treatment if the following aspects are present:
1) the need for a warm and containing care programme;
2) reasonable introspective ability of the client; 
3) profound and genuine relationship with music. 
On the other hand, a client will be referred for group receptive music therapy treatment in the presence of these aspects: 
1) the need for a warm and containing care programme;
2) poor introspective ability and greater attention paid to the external reality; 
3) interest in music but not necessarily in a profound and genuine way.

c) Individual treatment 
The aspects which govern an individual treatment are as follows:
1) the agreement (what the music therapist does, how he does it, what is the role of the user, how long will it last, how much does it cost, what could the results be, what are the user’s expectations);
2) the frequency: weekly or twice-weekly;
3) the duration: 60’ of which 15’ for listening to the client’s music;
4) the supervision: weekly or fortnightly; 
5) the role of the music therapist: 
- in each session he suggests listening to one or two "musics" (no more); the music therapist speaks to the client through his/her music and must therefore be "clear" in the themes (musical, cultural, emotional) communicated (it is obvious that, other than the communicative- relational aspects that we have underlined, there are also sensory-perceptive aspects that remind us that music is also a "stimulus");
- the music therapist reacts to the client’s sensations in relation to the listening proposed and provides a verbal reference, withholding judgement but highlighting the characteristics of the client’s "experience" and/or his musical tastes (the emphasis of one aspect rather than another depends on the music therapist’s training, whether inclined towards the musical or the psychological, his s/m identity and aspects of transfer and countertransfer);
- listens to the client’s musical choices, high-lighting the "what" and the "how", asks the client to give reasons for his choice (this aspect also depends on the music therapist’s training, his s/m identity, aspects of transfer and countertransfer).
6) the choice of music:
- the initial evaluation of the client (the psycho-musical balance) allows a "theme" to be high-lighted (this can be specifically musical and metaphorically refer to the client’s reality, or can refer to this directly);
- the music proposed tends to refer, at least initially, to this "theme", belongs to the music therapist’s repertoire and, lastly, is connected to the transfer and countertransfer aspects already present in the initial contact; 
- As treatment proceeds the "theme" may encounter changes, both in relation to the progress of the music therapy intervention, and in relation to the material that has emerged during the sessions. The music proposed (both by the music therapist and the client) will take on a new symbolic importance connected to the specificity of the client/ therapist relationship as well as to the evolution of the story of this relationship.

d) Objectives of individual treatment
We can distinguish:
- a specific objective (determined by the client’s characteristics); 
- an overall objective, aimed at developing the clients’ "listening" skills, intended/ understood both in a strictly sound/music sense and in a metaphoric sense (listening to oneself, listening to oneself listening, listening to the other by himself).

e) Group treatment
The aspects which govern group treatment duplicate most of the points related to individual treatment; however, some elements are specific: 
- the composition of the group: it is advisable that the group has a moderate lack of homogeneity; the number of clients can be between six and ten, and must possess a sufficient ego function; no more than one client with serious problems can be included (for example isolation, withdrawal or intense cases of projection);
- the role of the music therapist: the music therapist puts more time aside for listening to the music of the members of the group (30’), he/she highlights their diversity by encouraging an element of comparison, exchange and integration.

f) Objectives of group treatment 
We can distinguish: 
- a specific objective in relation to the group’s characteristics; 
- an overall objective aimed at encouraging a group journey that can go from socialisation to integration.

g) Verification
The verification criteria are highly qualitative. Each session sees the presence of an observer who, keeping to the particular methodology for direct participative observation, writes a report.
Each week, this observation report, together with the listening material proposed is discussed and examined in a supervision group. Intersubjective comparison thus allows the treatment to be examined from a complex and multidimensional perspective which takes care to read the transfer and countertransfer aspects, like the methodological and operative aspects, that have emerged (and at times acted) during the session. 

* This work is an extension and revision of the paper presented at the Conference "Assisi 2000: Musicoterapie a confronto" ("Assisi 2000: Comparing Music Therapies").

Sound/music (s/m) listening is a complex process, anything but passive and capable of setting profound internal changes into motion in certain contexts.

The music therapist must have a specific s/m repertoire at his disposal to use both for evaluative ends and to carry out specific interventions

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