Case vignette: Tim
Three-year-old Tim, who has a diagnosis of autistic spectrum disorder, gets up from the piano, which we have been playing together, and wanders to the other side of the room. He has no speech, but glances at the clarinet on top of the piano and then at me. I know exactly what he is communicating to me: ‘Come on, do what you usually do, pick up your clarinet and walk around the room with me.’ As soon as I start playing the clarinet he grins broadly. We march around the room together and I improvise a tune to match our walking pace. Then he lies down on the floor and kicks his legs in the air. I play a version of ‘Row, row, row your boat’ while his mother holds his legs and sways from side to side. Occasionally I stop playing to join in with the singing, but incorporate low trills on the clarinet to add excitement when the ‘crocodile’ appears. We repeat several variations of the song and on the third time, when we leave a gap before the dramatic ‘scream’ at the end of the song, he makes a tentative vocal sound, looking quite surprised that he has done this. His mother looks at me and grins; we are both delighted that Tim is starting to use his voice.
In later sessions Tim masters the technique of producing a sound by blowing the recorder or a reed horn. This enables us to have clarinet and horn dialogues and further encourages Tim to use his voice.
For Tim the clarinet is associated with a moment in the music therapy session when he moves around the room and I take his lead and follow him while playing at the same time. This is particularly useful for Tim, who finds it hard to remain seated or focused on any one activity for very long. He has always been interested in the clarinet, making good eye contact and smiling whenever I start playing. Tim’s mother is proud of her son’s particular interest in this slightly unusual instrument. It is also useful for me to be able to alternate playing and singing because it means I can use words in the songs, but then continue the tune on the clarinet to maintain the musical line and Tim’s interest. Tim recognises the sounds of the words and can occasionally be prompted to vocalise himself, but he needs the clarinet sound accompanied by my movements to maintain his interest.
Case vignette: Ella
Figure 1.3 Listening to that special sound
Ella is also three years old. She has profound and multiple learning disabilities, is very restricted in her movements, has severe epilepsy and is partially sighted. She does not sleep well, so both she and her mother are often quite tired. She can sometimes move her arms and hands a little to strum the guitar, or to scratch or tap a drum. She will also occasionally vocalise. For Ella the high point of the session is usually when her mother holds up some wind-chimes for her and I play the clarinet. Like Tim, she will nearly always smile when I start playing, and will sometimes get very excited, kicking her legs and moving her hands towards the chimes. At other times she plays more quietly and both she and her mother look sleepy. I try to match her mood while improvising, keeping the melodic line flowing and ‘open’, playing in pentatonic or modal keys. I know that high notes, squeaks and glissandi often make her smile, while lower, legato phrases help her to relax. In addition, the fact that I can bend the pitch of the notes to match her vocalisations is often useful. Ella’s mother is also affected by the clarinet. Like Tim’s mother, she takes pride in Ella’s interest in this instrument and is always pleased when Ella becomes engaged and interactive.
Case vignette: Group
In my weekly group of five children with a variety of emotional difficulties (Asperger’s syndrome, eating disorders, Tourette’s syndrome, attention deficit disorder) the children eye my clarinet case with suspicion. I have just suggested that there might be a rabbit in the case… but after some discussion allow them to convince me it must be a musical instrument. We establish that it is a clarinet and I ask them to guess how many pieces it consists of. One little boy who is six and has been to the group before shouts out ‘seven’ and is delighted when I put the instrument together and show he is right. I play a short tune, the children listen and I then suggest that they shut their eyes and guess how many notes I have just played by putting their hands in the air and showing a number.
Later in the group, my music therapy student who is a violinist gets out her violin and we form two teams, half the group play the xylophone when they hear the violin, the other half play the metallophone when they hear the clarinet. At first we take it in turns to play to make it easier for the children, but then we overlap and intermingle so they really have to listen.
Here I use the children’s interest in a slightly unusual instrument packed in a box to gain their interest and enthusiasm. The fact that it is a single-line instrument makes it easy for the children to distinguish and listen to how many notes I am playing. It is then possible for them to listen both to the violin and the clarinet and play as a group.
Clarinet characteristics in music therapy practice
An attraction to the particular sound of the clarinet
It was generally felt that many clients were attracted to the sound of the instrument and would either specifically request it, or show pleasure when it was played. One clarinettist wondered whether the clarinet sound was a maternal sound, or whether it caused special types of vibrations. For some clients it was particularly important that the clarinet was a ‘proper’ instrument rather than an educational school percussion instrument.
Eliciting vocalisations
All of the clarinettists felt that the tone quality of the clarinet is similar to the voice. The clarinet was successfully used to encourage clients to vocalise and then to have non-verbal dialogue with the client using both the clarinet and the voice. The instrument was also used to mirror intonation and match the speaking voice. In addition it was mentioned that the expressive qualities of the clarinet could help clients with monotone voices to introduce more variation in their spoken voices.
Mobility
All four clarinettists mentioned the fact that playing the clarinet in music therapy sessions allowed them to be mobile, either to walk around the room with the client, or to be by their bedside or on the floor. This is also mentioned in the existing literature (Salkeld 2008, p.151 and Oldfield 2006a, p.34).
The therapist’s own instrument
All the clarinettists felt it was important to play their own instrument and that some clients particularly valued the fact that the clarinet was the therapist’s personal instrument.
Playfulness
Three clarinettists mentioned using the clarinet to be playful with their clients, running around the room, playing ‘peek-a-boo’, or accompanying movements in a humorous way. One clarinettist mentioned engaging a group of children by getting them to guess what was in the clarinet case and how many pieces it was divided up into.
A physical link between the therapist and the client
It was mentioned several times that the clarinet can be played directly opposite the client, which can be an advantage when attempting to interact or communicate. Clients would sometimes touch the bell of the clarinet to feel the vibrations, and the instrument could provide a physical link between the client and the therapist.
Combining the clarinet with other wind instruments such as reed horns
Clarinet playing can provide an incentive for clients to master the technique of blowing, and then create an opportunity for turn-taking and exchange. It helps that wind players have to stop playing at times to take a breath, and these pauses can then be used to dramatic effect. This is clear from the case material in this chapter, as well as from the previous
