Part 4: Achieving Self-Regulation

I have written about self-regulation several times and have given a couple of visual examples on video. This week in my series on Music Therapy I hope to connect some of the dots. I have often talked in my newsletters about the humanistic approach in which I believe wholeheartedly. Although Music Therapy is “evidence-based”, I tend to avoid that term so that people can understand the humanistic qualities of Music Therapy instead of perceiving it as a rigid scientific formula. Music Therapy is evidence-based and individualized, as is any other therapy that is obtaining optimal results. I personally have witnessed, and have had parents of clients relay to me, experiences of other “evidence-based” practices having little positive effect. My belief about this is not that the practice itself is invalid; however, if the simplest humanistic qualities are forgotten when approaching our clients, results will inevitably be poor and possibly stressful. Practices that achieve maximum positive response are not “magic”, although when it feels that way, one can be certain it is most productive. Explanations can be scientific and humanistic. I believe witnessing results are much more profoundly revealing and truthful than reading results of a formula repeated hundreds of times.

How do we accomplish self-regulation in Music Therapy? First, the child must be able to attend. This may or may not take some time. Following, discriminating, and identifying all become part of organizing. Here self-regulating may overlap some, but then one can move onto comparing, conceptualizing, and recalling sensory stimuli.

As the therapist, up to this point, has followed the client and given his or her world structure and meaning (Part 3: Music the Organizing Tool,, the therapist has essentially used music as a powerful non-verbal way of communication. A pathway to gently enter the client’s world gives the client the safety, security, and meaning that the client needs for entering ours. The shrouded life on uncertainty can be lifted. Music now holds the child’s attention and gives the child the capacity to concentrate. The child can then begin to work.

In previous weeks, my client “Eddie” had slipped into some form of discomfort, becoming unregulated, behaviorally difficult to handle, and generally unhappy. By the continuous use of his “Click-Clack Song,” “Eddie” adapted to his recent nuances. At this point, nothing was demanded of “Eddie,” only reflected and structured. “Eddie” slowly decreased the need for such “atypical” behavior. He did not need to take his socks off or squeeze Playdough to feel alive and safe. As these sensory needs were met and accompanied by the same predictable tune, “Eddie” was allowed to feel safe and secure and begin to become aware of and enjoy moments of happiness ( “Eddie” began to work again, dancing to the music, jointly taking turns, playing the recorder, responding to “ready, 1, 2, 3, play.” “Eddie” began to move beyond the point at which he left before deregulation. “Eddie” began to vocalize when he had a need, sequentially opening his mouth with babble (instead of a closed-mouth cry of frustration) when he desired something, or even just out of happiness. Music is now not only a predictable stabilizing experience, but one that taps into the client’s emotions. Through the emotions, the urge to communicate and share arises most strongly. Vocalizing or singing to the music is now the most direct expression of himself, his emotional life, and mental life, and is apparent in its physical, vocal, integrated, and intimate expressive act. Vocalizing to the music is a joint activity between the therapist and the client. In learning to control and predict the timing of sound, “Eddie” will improve his ability over time to integrate sequences of sound. Most recently, “Eddie” sings an “ee” sound at the appropriate time as the therapist plays two measures of the “Click-Clack Song” to “Eddie’s” brother’s spinning, then two measures of singing “squeeze”. “Eddie” instinctively sings in tandem with the therapist for the two measures of “squeeze.” “Eddie” is moving from babble to controlled, imitated sound.

Situations may still arise that take “Eddie” to those uncomfortable sensory seeking states. Typically, he may even demonstrate his frustration in recognizing the detailed messages of sound and their meaning, but not yet being able to deliver it back in the way he wants. He does not have enough control over sounds to do this yet. However, as long as “Eddie” makes these developmental gains, even as his behavior may temporarily fall back to situational issues (like all of us), he has developed enough stability and regulation to pick up and continue development after temporary sensory needs are met.

When a client reaches this point of self-regulation, the therapist can then begin to more purposefully set a structured session instead of always following. All of us, when under severe stress, need to have some stress relief before we are able to follow directions or give it our all.



Dr. Dorita (Dori) S. Berger, PhD, MT-BC, LCAT

The question is, are there “permanent” alterations to his behaviors, or are they changed only as long as the session takes place? Do the changes you say happen in your sessions extend into his daily life? Self-regulation is not just a matter of cognitively choosing to “regulate” — it’s a matter of internal, physiologic regulation and pacing that must take place, that can extend beyond the clinical setting.


Yes, Dorita, I’m sorry that was not clearly stated in the newsletter. The development that has occurred does carry out into daily life. He will continue to have times of stress where he made need help (like us all). However, the developmental changes that have occurred will not be lost, but will remain. I have worked with a couple of clients with whom I did not see for a couple of years. Some have gone through change, and may have some difficulty, but the changes that were made remain. We can pick up right where we ended. By the way, I have seen your DBT coarse on sensory integration and plan on taking it in January. Looks to be very interesting. Love that kind of material!


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