A few years ago, with a group of psychotherapists and doctoral students at the Psychology Institute from the Universidad Católica in Santiago de Chile, we started a qualitative research project about “The Voice in Psychotherapy”. The intention was to investigate on the importance of voice tone from therapist and patient within the psychotherapeutic context. We developed two questionnaires, one for each group, and applied them to 25 experienced psychotherapists and 20 out-door patients with depressive and anxious disorders. We also realized in-depth-interviews with two external therapists and three of the patients who had participated in the study. The first part of the study was realized in Santiago de Chile, the second one in Berlin in collaboration with music therapy students from the Master Program in Music Therapy at the Universität der Künste (Bauer et al., 2009). As a music therapist and clinical psychotherapist I found it especially interesting and promising to get information about how patients and therapists perceive the “music” contained in therapeutic discourses. We wondered if both, patients and therapists, would recognize emotions or intentions from the voice tone and if they would use their own voice consciously in the therapeutic relation.
Voice tone is considered one of the non-verbal communication channels used by human beings beside gesture, body movement and facial expression, between others. The different qualities of the human voice tone like pitch, volume, rhythm, speed and intensity, influence human interaction from the very beginning of life (Altmann, 2001; Malloch, 1999; Papousek, 2007; Stern, 1991; Trevarthen, 2002). Basic research on emotions with adults has shown the link between different vocal qualities and expression and recognition of emotions, although no one-to-one-association could be shown between a special vocal quality and a specific emotion (Gobl & Ni Chasaide, 2002; Johnson et al., 1980; Bänzinger & Scherer, 2005). In the clinical context a group of Anorexia Nervosa patients would not differentiate between emotions listening to different voice tones (Kucharska-Pietura et al., 2003). There is also an important correlation between voice tone and treatment outcome in the physician-patient relationship and nurse-patient relationship: the more supportive voice is perceived the greater the patient’s satisfaction, perception of control and medication adherence (Hall et al., 1996; Haskard et al., 2008; Rosenthal, Blanck & Vannicelli, 1984).
What we found was that therapists and patients were conscious about many aspects of the voice tone, their own as well as the voice tone of the other. Therapists emphasized on diagnostic aspects, e.g. pointing out the characteristics of the depressive voice tone (slow and low) and the effect of this tone on themselves (getting aggressive, bored or changing voice tone to change atmosphere). They also described in a very detailed manner the use of the voice tone as a tool, pointing out therapeutic intentions like stimulating, holding and intensifying , or the intention of regulating the ongoing of a session, using different voice tones for the beginning, the middle and the end . Patients pointed out the effect that their therapists´ voice has on them (feeling recognized, ashamed, sad, stimulated, motivated, but also getting sick) and the voice tone they prefer (warm, supportive, authentic, calm, deep but also firm and serious). They do not like the aggressive, sharp or too slow voice tone or an emotionless and cold one, which is as if therapists don´t really worry about them. A voice tone which is too sweet always makes them nervous and even aggressive. At the same time patients seem to use their own voice tone to selfregulate their affects and mood - especially rage and sadness - by changing voice tone and to regulate the relation with their therapists. Getting louder together may occur when they are getting very close in their opinions and falling into silence may happen when they feel distant and without sharing the same opinion. In concordance to the previous study with therapists (Tomicic et al., 2009), patients described their therapists’ voices as a medium to attain therapeutic aims, pointing it out as a tool for mood regulation, motivation, stimulation, as a medium to obtain information, but also to accentuate the role of the therapist, speaking louder and firmer.
The results of our study show that voice tone is an important nonverbal communication element, which people are aware of in their contact with others. Our patients showed to be very attentive to their therapists’ voice tone. They were able to describe their own ways of regulating and reacting through voice tone as well as their therapists’ ways of doing so. Patients were aware and even quite conscious about the relevance of voice tone in psychotherapy, and recognized it as a potent medium for self regulation and as a therapeutic tool.
As far as I know there are no empirical studies in music therapy about the perception of voice tone during the session. For the moment it could be interesting to look straighter at this phenomena and to create awareness on the own voice tone as well as on the patients one. Many of us use a very friendly therapeutic voice tone, almost always. Our results show that we must be able to show also a firm way of doing, speaking and being. It seems that “the other” needs both, the warm and supportive “motherlike voice tone” as well as the clear and determined “fatherlike voice tone”. As trainees of music therapy students the results means to include this knowledge in our teaching context, in theoretical seminars as well as in practical training sessions and supervision. Patients are very sensible, they listen carefully and claim for a congruent therapist, able to show authenticity through his/her voice tone as well as to hold and (re)direct them. Our conclusion is that we need more systematization of this aspect of therapeutic communication and more research on the same topic, in psycho therapy as well as in music therapy.
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