Countertransference responses of one music therapist to autistic echolalia

ABSTRACT

Introduction: In this article, the continuation of a previous study, we explored the phenomenon of echolalia in children with Autism Spectrum Disorder (ASD) from the perspective of one music therapist.

Method: We micro-analyzed the music therapist’s responses to the echoing of three clients in 40 interaction segments that occurred during music therapy, focusing on their musical and interactive characteristics. We interpreted these responses as stemming from countertransference reactions to the phenomenon of echolalia.

Results: The music therapist’s responses were interpreted and classified into six categories, according to their interpersonal and musical attributes: (a) ignoring the client’s echolalia, (b) exhibiting boredom, hyper-activity, and/or despair, (c) attempting to control the situation, (d) attempting to teach the client, (e) using the echolalia to communicate with the client, and (f) showing empathy.

Discussion: In the discussion, we attempted to interpret the findings as processes of countertransference and addressed the importance of mapping and understanding the therapist’s reactions to the phenomenon of echolalia. Practical implications for caregivers working with children with ASD were suggested.

KEYWORDS:

• Echolalia
• autism spectrum
• microanalysis
• countertransference
• music therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ The term “loudness” refers to how loudly or softly the therapist sang or spoke. Changes in the element of loudness are commonly referred to as “dynamics”.

² In “rhythmic elements” we refer to the element of time in the therapist’s utterances: how fast she spoke or sang (tempo), whether there was a clear division of time in her speaking or singing (meter and pulse), and whether there was a discernable rhythmic pattern in her speaking or singing.

³ As to changes in the timbre or tone quality of her voice, although potentially useful and telling about countertransference (Warnock, 2011), these were quite difficult to pinpoint and to measure with the technological tools we used, and thus were not addressed in this study.

⁴ The Developmental, Individual-differences, & Relationship-based model (also known as the DIR® model), co-founded by Dr. Stanley Greenspan and Dr. Serena Wieder, is a dynamically oriented approach that integrates multi-disciplinary treatment for children with ASD and other special needs (Greenspan & Wieder, 2006).

⁵ Date of ethics committee approval – 2 September 2013.

⁶ Incidentally, audio- and video recordings of sessions have been an intrinsic part of NRMT clinical practice since the early work of the pioneers, Nordoff and Robbins. NR practitioners routinely analyze, or “index”, both client and therapist inter-responsiveness.

Additional information

Notes on contributors

Maya Marom

Dr. Maya Marom has been a music therapist since 1998, with experience in working with various client populations: adolescents with learning disabilities, adult psychiatry, oncology, older adults, and hospice. In 2005, she started working with clients on the autism spectrum, and it had since become her preferred, and sole, client population. She works with elementary school children, diagnosed with high-functioning ASD. She is currently a level 3 DIR® practitioner and works towards completing the final stage of certification in this model. The current paper summarizes one part of her PhD research, from Bar Ilan University, Ramat Gan, Israel. Since graduating Bar Ilan, she has been teaching music therapy courses at the David Yellin Academic College of Education in Jerusalem and advising music therapy fieldwork trainees. E-mail: [email protected]

Avi Gilboa

Dr. Avi Gilboa is a music therapist with experience working with autistic children, hospitalized children, and children with ADHD. He is Chair of the music department at Bar-Ilan University and senior lecturer at the music therapy program in this department. Among the projects he heads is a musical dialogue program between Arab and Jewish students and Meitarim - a center initiating musical-communal projects. Dr. Gilboa supervises many MA and PhD students at Bar-Ilan University, some of which are part of the music therapy program, others – in the more general fields of music psychology and music education. Dr. Gilboa publishes articles in various music therapy journals and lectures about his studies and projects in national and international conferences. E-mail address: [email protected]

Ehud Bodner

Prof. Ehud Bodner is a full professor of psychology (since 2016) at the Interdisciplinary Department of Social Sciences and the Music Department, Bar Ilan Univesity, Ramat Gan, Israel. He is also a Clinical and a Medical Psychologist and a supervisor in both fields. He is working in private practice with younger and older patients, suffering from various anxiety disorders, somatization, depression, and personality disorders. In the field of psychology of music, he is studying emotion regulation through music in younger and older adults. In the field of Gerontology, his research concentrates on models delineating the relationship between ageism and other perceptions of aging, personal resources and various aspects of health and mental health among older adults.