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The Theory and Practice of Vocal Psychotherapy

Reviewed by Julie Sutton, PhD. Works with severely disturbed adults at the Centre for Psychotherapy Belfast, for John, Lord Alderdice (consultant psychiatrist) and Prof Paul Williams (psychoanalyst).

It is always welcome to open a new book written by an experienced colleague. Diane Austin’s much anticipated publication details not only her theoretical and clinical practice, but is also packed full of her years of work and life experience. I think it is an intensely personal book, and on reading it, one feels close to her passion and commitment to the work, to music, and to people.

Austin structures her book as implied in her title, in terms of theory and clinical practice, but beyond this the content is complex. In the first half she draws upon the physical, philosophical, theoretical and technical aspects of vocal work, viewed from the different stances she has integrated into her method. In the second part practical and specific areas are addressed, and a range of questions posed about vocal psychotherapeutic work. I think these questions are also relevant and pertinent to music therapeutic work in general and I will return to this later in the review.

Characteristic of Austin’s work, the client is always present and there are case examples throughout her book. I discovered that the ‘songs of the self’ in the title are not only those of her clients, but also of herself, and clinical material is presented along with Austin’s personal reflections upon the ways in which she makes use of her own ‘self’ in the clinic room. This depth of the therapist’s personal engagement and its contribution to the therapeutic process is a fundamental characteristic of our work, but detailed reflection about this is often absent from music therapy publications. It is well represented here.

Austin’s theoretical chapters are presented through clinical examples and reflections upon this work within different perspectives. Chapter 1 gives a developmental view of ‘voice’ and its place in our lives, after which is a section about the concept of ‘breath’, including practical ideas about breathing and ‘toning’. This is taken further into musical thinking about the prosodic qualities of the speaking voice, drawn together with more clinical material. In Chapter 2 we are given a sense of her discovery of and linking with Jungian analytic work and particularly the artistic ideas that arose from this, in for example, the use of myth, archetypes, and the concept of the wounded healer that has been such an important influence on her work. There is then a shorter chapter relating to object relations theory, with reference primarily to Klein, Winnicott and Miller. Austin describes developmental needs and the place of play in exploring different perspectives of ‘self’. This is reflective of Austin’s post-training exploration and willingness to engage in life-long learning, an important message to students and recently-qualified therapists as well as experienced practitioners. Chapters 4-6 focus on the theory of trauma, intersubjectivity and counterfransference, again brought to life with clinical material, while raising a number of questions that relate to developing one’s identity as a therapist. Austin’s chapter on countertransference is a strong statement about her therapeutic stance and takes a broad definition encompassing many aspects of the effect of the client on the therapist and vice versa, re-visiting theoretical influences noted earlier in the book.

The second part of the book is as varied as the first, with thoughts about setting up private practice (Chapter 7), the use of song (Chapter 12), and technical aspects relating to resistance, intervention, vocal holding and free association (Chapters 8-11). The book ends by bringing the focus back to the therapist’s responsibility in the therapeutic process (Chapter13). Throughout this half of the book clinical material again introduces and illustrates the technical area being explored, and there are many practical ideas, thoughts and advice. Austin’s style and method of work are evident throughout, along with her reasoning and process of discovery. She pays due attention to the importance of assessment and the central place of music in her initial conversations with prospective clients. She also touches on the tension between music and words, proposing a musical model with an interweaving of both elements, where the one can “overlap and complement” the other (p118).

Integrated into the clinical material that runs as such a strong thread through Austin’s narrative are many important technical and theoretical observations and questions. A few of these are outlined below:

In the taking of Cindy’s history (Chapter 1), Austin stresses the need for space and time for the traumatised individual to tell their story, and how a slowing down of time in the room is important to ensure that the client does not become too overwhelmed and flooded with sensations and feelings. Her words, “going slowly helps them to digest the feelings that emerge” (p17) seem to me to relate to theories of mentalisation and intersubjective space, here appearing jargon-free, and given simply and clearly. Later in the book, Austin indicates that she agrees with Bion, another object relations theorist, in the sense of remaining open to what may emerge unexpectedly, allowing her attention to be caught throughout a session by different thoughts and sensations, but not necessarily acting on them (p119), and further develops this idea in relation to the therapist’s personal desire to intervene (p129-130). Austin takes the final part of Chapter 4 to consider the bridge that music can open up between the conscious and unconscious inner world, noting the ways in which defences can be breached, and touching on the complex issues of temporality and repetition that are pertinent to traumatic material (p78). In one paragraph are separate theoretical ideas that in themselves merit detailed exploration, introduced directly and clearly. I felt this left the reader free to remain there, or to think on, without being shown a particular route via references. At other points, references are provided, allowing the reader to investigate further, such as in thinking about the therapeutic relationship and intersubjectivity in Chapter 5. In this same chapter Austin challenges some analytic ideas about therapeutic stance and boundary, making a case for how and when to use self-disclosure, and how the therapist utilised their personality, referencing in the next chapter Yalom’s observation that “the most elegant and complex instrument of all – the Stradivarius of psychotherapy practice – the therapist’s own self” (p99).

All of these examples show how Austin is talking about complex processes in everyday language. This directness and clarity of text makes the book immediately accessible and increases one’s sense of connection between reader and author. It is important to note that however informed by a variety of analytic stances, music is never far away, and Austin’s descriptions of musical material are vivid, with musical examples available from her website. There are also musical ideas and musical thinking underlying the text throughout the book and in Austin’s own writing style.

One critique of this book could be that it is primarily concerned with individual work. While there is enough depth and detail of the method to suggest how vocal psychotherapeutic work can be appropriated for groups, perhaps a further volume might address and also do justice to this lack (for example, Austin’s workshop and training methods). There are also many different technical and theoretical ideas in each chapter, and while Austin’s personal stance is a strong linking factor, for some readers this may be distracting. It is part of the challenge of a single text about a method of work and range of clinical experience that so much information is available. Personally, I felt that Austin was successful in relaying her position and attitude to the work, but I read the publication over an amount of time that enabled me to work with the material in digestible portions. I am also familiar with Austin’s work and I think this gave me another insight into the text.

Austin is a passionate voice about the voice and sometimes this could suggest a neglect of other forms of therapeutic connection, such as in her statement, “the most healing connections seem to occur through the voice” (p19). As Austin is concerned about communicating her views and methods of vocal psychotherapy it is understandable that this focus is present. Her personal links with the voice are also a significant influence on this stance. However, once or twice this did leave me wondering about other kinds of ‘healing connections’ that are non-vocal and yet powerfully present. In this way, I found Austin’s book stimulating and leading to further thinking, because many descriptions of her clinical work were not only concerned with ‘voice’, but more with essential therapeutic presence. In Austin’s case, perhaps this is achieved primarily through an embodied voice, whereas for other therapists, it might be an embodied pianist, or percussionist, or cellist, and so on. The common feature linking all music therapists is what I would describe as the embodied listener. This idea is a significant part of her book, present in and between the lines of the text, and something that, for example, she touches directly on in her memory of her own therapeutic work (p182-3).

The extent of Austin’s clinical experience makes this a book packed and alive with information, ideas, clinical material and reflections. At times the confines of single chapter make it a task to keep strictly within the topic, and Austin’s enthusiasm and passion comes through at these points, taking the reader into related areas, or expanding further via clinical material. Rather like her work, the theme develops, variation evolves and the theme becomes transformed. I rather enjoyed these changes of melody, and I suggest treating the text as essentially musical and free-flowing, bearing the overall theme in mind, and remembering that it is indicative of Austin’s method that her theoretical underpinning is as varied as her experience. I believe this to be true of all experienced practitioners, and it is very welcome to see a publication where this is recorded. With a growing amount of edited, multi-authored texts, a book so closely identified with one therapist is a welcome edition to the international music therapy library.

Austin’s style is her own, and particularly if unfamiliar with her work, this may or may not be to everyone’s taste. I personally can see no problem with this, because of the clarity of clinical material and the stance taken, and I value Austin’s honesty and openness. As noted previously, much of this book is written in jargon-free language, which would make it accessible to any reader, whether familiar or unfamiliar with psychoanalytic theory. It is also grounded in experience and theory, and for this reader provided stimulus for further reflection and questioning. The directness of style in Austin’s writing keeps the reader’s interest and has passages that are deeply moving. There is also a richness in aspects of the stories of the people we are introduced to (Cindy, Susan, Terry, Peter, Courtney, Brenda, Sandy, Jill, Akiko, Ann, Donna, Fred, Phyllis, Pam, Karen, Liz, Jon, Deb, Sandy, Lauren, So-Jin, Emily, Courtney, Joseph, Vicky, Lynn, Michelle, Julie, Nan, Suzy, Yuriko, Sara, Sarah, Marie, Karaar, Tania, Leslie, Sue, Jenna, Mary, Meg,) as well as, of course, Austin’s invitation for us to view her own travelled path.

I would recommend this book to those wanting a publication that makes links between the human condition, music, music psychotherapy, therapeutic stance and the necessary inner work of the therapist. It is also the story of clients met and worked with in private practice over two decades. There is, rightly, an American flavour to this work, but while writing styles, work settings and structures differ in other countries, Austin’s emphasis on what takes place in the space between and within therapist and client are directly relevant to any practising therapist.

Austin’s ‘final thoughts’ open up again the personal narrative of the therapist, called to or summoned up by the client. This transference area is one that we know requires of us great care and delicate attention. We are all aware of the need for therapeutic boundaries in order to ask ourselves honestly, whose music are we playing? When it is only ‘our music’, we are no longer present for the client. When it is only the client’s music, we disappear, and we can also ask, how is my music being heard? As Austin noted in Chapter 8, when we play too much, or too little, or too fast, or too slow, the client may not be able to be present, but only through our depth inner listening will we be alerted to the meaning of such spaces in the room. Being affected by our clients is integral to our work. Our countertransferential responses and struggles are the work and Austin does not shy away from this area, yet never departing from the music.

At the end of the book a challenge is presented to us: can we move beyond our trust of theory and technique, to connect with a truly spontaneous part of ourselves? We cannot be in this place without having studied and integrated theoretical thinking. It is a place where we no longer ‘know’, where we might be surprised, shocked, taken aback or amazed, where we may also be genuinely of service both as a musician therapist and human being, and become changed by the experience. It is where self-insight and theoretical grounded-ness is essential, why supervision is a fundamental part of our work (eg p91), and why our own personal therapeutic work is, as Austin noted from her introduction onwards, indispensable.


Bion, W. (1967) “Notes on memory and desire” In: Melanie Klein Today, Vol.2, Mainly Practice ed. E. Spillius. London: Routledge 1988, pp17-21

Sutton, J. & De Backer, J. (2009) ”Music, Trauma and Silence: The State of the Art” The Arts in Psychotherapy 32(2) pp75-83 (Special Edition: Trauma)

Williams, P. (2007) “The worm that flies in the night” British Journal of Psychotherapy 23(3) pp343-364

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