Music therapy can help people with autism spectrum conditions in several ways. It provides an additional form of communication and allows clients to express themselves creatively. The relationship between client and therapist is fundamental, and can act as a template for other relationships. Music therapy addresses the core impairments of autism by facilitating social interaction, communication, and imagination in a structured yet free environment. Case studies demonstrate how music therapy creates a safe space for clients to explore and express emotions, develop trust, and reduce anxiety and problematic behaviors.

1. Music Therapy
and
Autistic Spectrum Conditions
Henry Dunn
Music Psychotherapist
Devon Partnership NHS Trust

2. How To Become An Autism Expert
(V1.2)
So you want to be an autism expert. Maybe you've got a few misguided ideas about
what autism is, and you want to spread them. Maybe you've got an autistic relative that
you want to cure. Maybe the idea of helping the poor unfortunate disabled really
appeals to you, or maybe the idea of the recognition appeals to you. Maybe you're an
autistic person who still thinks you're defective. Maybe you've got a sadistic streak and
like to hurt people who either won't talk back or whose credibility you can undermine.
Maybe you want an easy power trip. Maybe you're a eugenicist who wants to remove
anyone who isn't normal from the face of the earth...
No matter who you are, if you follow the following steps and guidelines...
...You, too, can become an Autism Expert!
From an article by Amanda Baggs on www.autistics.org

3. A definition of Autism
Autism is a life-long developmental disability affecting
social and communication skills. People with autism often
have accompanying learning disabilities but, whatever
their general level of intelligence, they will share a
common difficulty in making sense of the world in the way
most people do. In most children with autism some types
of skills will be better than others so that their development
will not only be slower than usual but will also be uneven
and different from most children with learning disabilities.
National Autistic Society

4. Who “discovered” Autism?
Leo Kanner Hans Asperger
1894 – 1981 1906-1980
Made his Made his
discovery in discovery in
1943. 1944.

5. Diagnostic Criteria
Triad of impairments
2. Social interaction
3. Communication
4. Imagination
Other, associated, problems can include
sensory processing difficulties and
difficulties with physical co-ordination.
NB, this may change soon when DSM V is published.

6. Autism is a Spectrum!
Autistic Spectrum usually understood in
terms of I.Q.
Kanner’s or Classic Autism at lower end.
Asperger’s at high end, though some
consider Asperger’s to be a separate
condition.
I think the concept of a spectrum subverts
the idea that people with autism are
somehow “bland” or emotionally flat.

7. Autism is: being present in this world,
But not entirely of it.
I am one step removed and curled,
The switch just doesn't click.
I perform the role of my perception,
And play many parts so well.
But minus files for my redemption,
My part in life I cannot tell.
Life is like a video,
I watch but cannot partake.
My uneven skills are but an echo,
Of the frustrations which I hate!
However, my focused use of time and space,
I would not give away.
I know that I am especially placed,
For some developed career one day!
Wendy Lawson
www.mugsy.org/wendy/

8. Different theories about causes.
• “Refrigerator mother” Bruno Bettelheim (1967)
• Maternal anxiety Tinnbergen (1983)
• Brain deficiencies Rutter (1983)
• Genetic factors Szatmari and Jones (1991)
• “Theory of Mind” Baron-Cohen et. al. (1995)
• Probably a mix of factors – mother is first mirror for child
(see for example, Winnicott), but can only mirror what
she is offered.
• For Jungians, perhaps an anima deficit?

9. Neurotypical v Autistic
Most people are “polytropic”:
• Able to multitask/think about more than one
thing at a time
• Able to transfer from specific to general
• Can think creatively and flexibly
• Can understand metaphor

10. People with autism are often “monotropic”
• Only able to focus on one thing at a time
• Not able to generalise from the specific
• Inflexibility of thought
• Unable to understand metaphorical language

11. Video – A is for Autism
Channel 4 1992

12. Common Myths
• All people with ASC have no creativity.
• People with ASC have no empathy or
“Theory of Mind”.
• People with ASC are not interested in
forming relationships.

13. What is Music Therapy?
• Fundamental to all approaches, is the development of a
relationship between the client and therapist. Music-
making forms the basis for communication in this
relationship.
• Client and therapist take an active part in the sessions
by playing, singing and listening. The therapist does not
teach the client to sing or play an instrument.
• Much of the music is improvised, thus enhancing the
individual nature of each relationship. The therapist aims
to facilitate positive changes in behaviour and emotional
well-being. He or she also aims to help the client to
develop an increased sense of self-awareness, and
thereby to enhance his or her quality of life.
from British Association for Music Therapy website www.bamt.org

14. Psychotherapy Influences
• primacy of therapeutic relationship.
• based on mother-infant relationship, the
first musical relationship (Daniel Stern).
Concept of Affect Attunement.
• significant relationships may be acted out
in client-therapist relationship.
• transference/countertransference

15. Different levels of work
All these occur within the therapeutic relationship
psychological
physical
developmental
social
spiritual

16. Music Therapy and the triad of
impairments
• Social interaction Music therapy is based on
forming a relationship between client and
therapist. This can act as a template for other
relationships, and a way to explore the idea of
relationship in a very safe place. Alvarez talks of
“reclaiming”, “greening” and awakening.
• Communication Music provides an
additional form of communication. The therapist
attends closely to, and responds to, the client in
a way that encourages further communication.

17. • Imagination The use of music encourages the client
to engage in a creative, imaginative process, with the
support of the therapist. They can move away from a
ritualistic use of instruments to a more flexible,
creative use. This can also develop more creative,
less rigid, thought and behaviour patterns. The
therapist needs to know when it is helpful to enter the
client’s world, accompanying the rituals, and when it
is right to discourage this. Alvarez suggests that
countertransference is a useful tool in deciding this.
• see “Live Company”, Anne Alvarez: Routledge 1992

18. Other Ways Music Therapy can
help
• Open/closed systems – unlike words,
music can do both at once.
• Structure and freedom
• Distance and contact
• Relationship through art form
• Client centred

19. Case Study - R
• Autistic spectrum, severe learning
disabilities
• High levels of anxiety and self-injurious
behaviour, some of it sexualised
• Often wore a tight headscarf – sensory
stimulation
• Echolaic speech, often telling herself off

20. • Sessions had predictable structure
• R liked to sing sometimes, asked me to
play “Ain’t No Sunshine When She’s Gone”.
This song seemed to connect with her
feelings of loss about not living with her
mother any more.
• It was hard to create a safe space for R,
due to her anxiety. I used various methods
to allay this – e.g. large sand timer,
predictable structure.

21. R was increasingly able to stay in the room,
and to express her emotions, sometimes
very tearfully. There was a growing sense of
trust in our relationship, and a sense that the
therapy sessions were a safe place where R
could explore and express her feelings. I
noticed a decrease in her levels of self-
injurious behaviour, and an increasing ability
to reduce her own anxiety levels.

22. Case Study - N
• Autistic spectrum, severe learning
disabilities, non-verbal
• Referred after the death of his mother,
with whom he had a very close
relationship
• Music Therapy provided a safe place for
him to express his feelings of loss in a
non- verbal form

23. Music therapy provides:
• a safe place away from home
environment
• predictability and freedom
• a form to express emotions, which for
N could change very quickly.
• Using Affect Attunement I am able to
help N to have his feelings heard and
responded to.

24. Working Systemically
• As one of the professionals involved with
N, I attended regular meetings convened
by the Clinical Psychologist in the
Additional Support Team. This ensured
that all relevant information was shared,
and that we could share best practice.

25. A Case Study
Music Therapy work with an
autistic boy

26. The Therapy Room

28. Introduction to “J”
• Autistic and severe learning disabilities
• 11 years old
• No verbal communication
• Variety of vocalisations
• Taps and flicks objects constantly

29. The Early Sessions
• Brought by speech therapist
• Found it hard to stay in room, becoming
distressed
• Worked in corridor, gradually making
contact
• Moved into room
• After six sessions able to stay alone

30. Theme: Progress
Developing relationship creating safe place
Joint play able to show distress
as well as happiness
Physical contact musical contact
Emotional contact

31. Theme: Distance
important to give J space -
let him initiate contact
Physical distance emotional distance
Room large enough sometimes J doesn’t want to
for J to retreat be really close and intimate
J sits on work surface
I stay at piano I allow him to be more
“autistic”
I continue to respond to him
musically, enough to let him
know I’m still there

32. Theme: Contact
emotional
physical
musical (feeds into and fed by both)
Contact can be with
Me instruments
aspects of himself
affectionate “non-autistic”/autistic flicking
sign of relationship need for reassurance checking environment
genuine warmth difficult life stage need to feel safe
(adolescence)
J needs safe, consistent relationship and environment in which he can confront and express
confusing emotions and developments

33. Further reading
Music Therapy with Adults with Learning
Disabilities
ed. Tessa Watson, Routledge (2007)
Mental Handicap and the Human Condition: New
Approaches from the Tavistock
Valerie Sinason, Free Association (1992)
The Interpersonal World of the Infant
Daniel Stern, Karnac (1985)
Playing and Reality
D.W. Winnicott, (1971) various editions available
Jung: Selected Writings
Anthony Storr, Fontana (1983)
The Carl Rogers Reader
ed. Kirschenbaum and Henderson, Constable (1990)

34. Useful websites
• All Wales Autism Resource www.awares.org
• Resources for Autism www.resourcesforautism.org.uk
• Research Autism www.researchautism.net
• National Autistic Society www.nas.org.uk
• Autism Research Centre www.autismresearchcentre.com
• Jacqui Jackson www.jacquijackson.com
• Wendy Lawson www.mugsy.org/wendy/