Prologue: Musicality in Psychotherapy and Psychoanalysis

When Joe Lichtenberg and I talked about an issue of Psychoanalytic Inquiry focusing on musicality in psychotherapy and psychoanalysis, we envisioned essays about the importance of paralanguage in the therapeutic process. Known also as prosody or vocalics, paralanguage refers to “measures of speech that are content free” (Harper et al., 1978, p. 20), and include elements such as: pitch; variability in pitch; volume; variability in volume; pauses while one has the conversational floor; switching pauses (latency to respond to another’s vocal communication); rhythm; speech rate; dysfluencies, etc. (Paddock & Nowicki, 1986). In particular, I imagined papers that eloquently rhapsodized about the importance of prosodic channels of communication in forming and maintaining the therapeutic alliance, communicating empathic attunement, warmth, and genuineness from the analyst – as well as how both patient and analyst sang together to compose melodies of mutual meaning (Aron, 1996).

Indeed, recent studies indicate that paralanguage (or, how we say what we say): can powerfully convey positive emotions (Kamiloglu et al., 2020) and is influential in the social-cognitive development of infants (Beebe & Lachmann, 2002, 2014; Jaffe et al., 2001; Saint-Georges et al., 2013; Shute, 2006); communicates negative mood in serious psychiatric conditions (Cummins et al., 2015; Hall et al., 1995; Marmar et al., 2019; Rice et al., 1969; Starkweather, 1967; Tang et al., 2022); can be significantly impaired in persons with Autism Spectrum Disorder (Leung et al., 2022; Zhang et al., 2022), Attention-Deficit Hyperactivity Disorder (Köchel et al., 2015), and Alexithymia (Goerlich-Dobre et al., 2014); can convey a speaker’s gender (Leung et al., 2018); can communicate interpersonally influential attitudes (e.g., authoritativeness, confidence, sarcasm, complaints, superiority, etc.) (Guyer et al., 2021; Mauchand & Pell, 2021, 2022; Mitchell & Ross, 2013; Sorokowski et al., 2019); can in some instances predict strength of therapeutic alliance and rapport (Ambady et al., 2002; Bartels et al., 2016); is an important channel for delivering empathic messages in psychotherapy (Kykyri et al., 2017; Weiste & Peräkylä, 2014); helps people to decode accurately emotional states in others (Couper-Kuhlen, 2012; Geso & Ickes, 1999; Hall & Schmidt, 2007; Kraus, 2017; Ogden, 2006; Zaki et al., 2009); can convey genuine sincerity and intent to assist (Packwood, 1974; Van Zant & Berger, 2020; Wang et al., 2021) or the opposite (Fish et al., 2017); is valuable in predicting best and worst psychotherapy sessions (Buchholz, 2016; Duncan et al., 1968). Indeed, in a controlled set of experiments, over 50 years ago researchers demonstrated that over one-third of the impact people have on each other can be attributed to the musicality in our vocal interpersonal communications (Mehrabian & Ferris, 1967).

Notwithstanding these empirical findings, there is a longstanding tradition in psychoanalysis of lionizing verbal interpretation, and neglecting variables that convey the vast majority of impact in interpersonal relating, nonverbal and prosodic channels of communication (Burgoon et al., 2010; Knapp et al., 2021; Matsumoto et al., 2013). However, consistent with what has been called the relational turn, psychoanalysts have begun to consider the “something more” than what they convey to patients via the verbal or lexical channel (Knoblauch, 1997, 2000, 2021; Lyons-Ruth, 2000; Lyons-Ruth et al., 1998; Nebbiosi & Federici-Nebbiosi, 2008; Ogden & Fisher, 2015; Stern et al., 1998). It is in that relational spirit, that this issue of Psychoanalytic Inquiry focuses more explicitly on the vocalics of interpersonal interaction.

Mary Jo Peebles, Ph.D., ABPP, ABPH, starts us off with a wide-ranging essay that embraces the messy ubiquity of what she calls un-worded communication, explores the historical origins of psychoanalysis’ focus on the lexical channel at the expense of the rhythm and musicality that characterize human relating, grounds her discussion in biology and physics, and challenges us to be engaged with patients in a disciplined manner that remains aware of, receptive to, and appropriately porous to the non-worded messages sent in relationship.

The next two papers zoom in more precisely on how one can use non-lexical aspects of speech to effect social-cognitive change.

Heather Ferguson, LCSW, describes her relationship with a sexually traumatized young adult, a treatment that could easily have been disrupted by the necessity to cease in-person work and yield to telehealth (Zoom) sessions. Drawing upon her musical skill as a rock ‘n roll drummer – and in particular, her sensitivity to rhythmic synchrony – she discovers a way to connect with her patient “through” the screen and create an effective and mutually vitalized presence.

Diana Thielst, M.D., (a pseudonym for reasons that become apparent upon reading her essay), describes how she used her skills as a professional musician to painstakingly teach her autistic daughter language. Specifically, using a disciplined approach presenting auditory stimuli like volume, pitch, rhythm, and pairing them with objects and concepts, she writes about how this process taught her profoundly autistic daughter to correctly interpret and express herself in language.

The last two papers zoom out, and explore how music – and musicality – carries affect, meaning, and an opportunity for intersubjective experience and emotional growth.

Ilene Philipson, Ph.D., Psy.D., and D. Bradley Jones, Psy.D., LCSW, write a personal and engaging essay on the music of Stephen Sondheim, someone whose work was deeply meaningful and emotionally restorative and consolidating to their respective senses of Self (Lachmann, 2022). Further, they write movingly of how Sondheim was able to draw audiences in to formulate their own un-formulated subjective experiences, confront the complexities and ambivalences in their own lives, convey the complicated richness of life and relationships, and engage people in moments of implicit relational knowing. Indeed, they identify Sondheim as the relational psychoanalyst of the American musical theater.

Finally, Philipson and Jones invited Matt Aibel, LCSW, to respond to their paper, and he does so with disarming honesty. Reflecting on what he experiences as Sondheim’s power to help us all better understand ourselves – who we are now and how we got to be who we are – he writes of how the composer’s musicality gave him opportunity to meaningfully mourn recent losses and appreciate the beauty in everyday lived experience.

As you can see, each contributor owns the word “musicality” uniquely, and increases our appreciation for auditory and vocalic sensibility.

In life, generally.

In psychotherapy and psychoanalysis, specifically.

John R. Paddock, Ph.D., ABPP

Issue Editor

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No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

John R. Paddock

John R. Paddock, Ph.D., ABPP, is a licensed psychologist based in Atlanta, Georgia (see: www.johnrpaddockphd.com). He is Adjunct Professor of Psychology in the Emory University Department of Psychology and Adjunct Professor in the Department of Psychiatry and Behavioral Sciences, also at Emory. He teaches courses on the Analyst’s Use of Self and Psychoanalytic Approaches to Psychopathology in the Emory University Psychoanalytic Institute. He is a graduate of the psychoanalytic training program at the Institute of Contemporary Psychotherapy + Psychoanalysis (ICP+P) in Washington, DC. Dr. Paddock is on the Editorial Board of Psychoanalytic Inquiry.