“He just doesn’t listen to me!” “She never understands what I’m going through!”

There I sat, their psychotherapist, sandwiched between this couple who had been married at least 50 years. The husband, a Vietnam veteran with metastatic cancer, longstanding PTSD, and increased impairments from dementia. The wife, a full-time caregiver and retired school administrator, stressed out and facing her own increased cognitive challenges. This marriage, woven together by three children, many grandchildren, five military deployments, countless life celebrations and family funerals. Their love language: arguing.

Of course, they didn’t call it fighting—they saw their “discussions” as spirited debates. Seeing their faces brighten when they talked over each other almost felt like eavesdropping on covert foreplay. They vaguely reminded me of my own grandparents, except now I couldn’t sit back and watch bemusedly from the roomy backseat of Poppy’s Lincoln.

As their therapist, I had to engage, mediate, and navigate their needs. I had to assert therapeutic neutrality, balancing both parties’ perspectives while also managing my own viewpoints and biases.

“Neutral” conjures a sense of complete objectivity, impartial and dispassionate, that rarely exists in realistic realms of human experience. When I work with couples or families, instead of completely removing myself from the conflict, I focus on how to acknowledge, validate, and work with all perspectives in the room, even if some disagreements can never be fully resolved.

It doesn’t always come easily. When I trained in geriatrics, I had little coursework in family and couples therapy and no idea what working with families would be like. Referrals typically called for individual therapy, but patients often wanted loved ones in the room—or, in the presence of dementia, needed them there.

Complex dynamics led family members to try to curry favor with me, seeking validation that they were the “correct” party. Boundary setting became even more crucial. Who was my primary patient? Did they even want family therapy? I work in a medical system designed for veterans, which typically favors their needs, even with built-in caregiver supports. How do I ensure I’m addressing the needs of spouses or other family caregivers, while also staying true to the veteran patient?

Literature on “therapeutic neutrality” is sparse, but reading what’s out there offered me a helpful framework to start from. I was particularly drawn toward psychologists Charles Gelso and Katri Kanninen’s definition. They posit that effective therapeutic neutrality occurs when the therapist “takes an observer position in the relationship…refrains from taking sides in the patient’s inner struggles…[and] does not take sides in the patient’s relational struggles.”

One of the major challenges of any kind of therapy with multiple people is that it challenges therapeutic rapport: If I align with one person, I run the risk of pushing against another. Family therapists Mark Butler and colleagues offer a solution: maintaining a stance of dynamic neutrality, in which the “therapist invites and facilitates each person in gaining an empathic window on others’ experience and perspective and then holding their partner’s experience equally valid with their own and equally significant to relationship success.”

In my work with families and couples navigating complex medical issues, I had, without fully realizing it, already been employing this technique, taking extra time to observe all viewpoints and not jump to conclusions.

This is especially essential when I am a part of family meetings among patients, family, and medical providers in the hospital. Once, I found myself and three doctors jammed into every crevice of a small hospital room, hashing things out with a patient and two of his sisters. Nobody was happy. Not the patient, who was frustrated by a prolonged hospital stay and wanted to relocate to one of his sisters’ houses. Not his sisters, who wanted to move him to an assisted living facility. Not the medical and psychiatric teams, who wanted to send him to a skilled nursing facility for rehab and likely longer-term care, whether he wanted it or not.

They debated what should happen next. The patient couldn’t stay in the hospital indefinitely, for medical and financial reasons. But he also still needed a lot of help managing his pain and completing personal care such as toileting, bathing, and dressing.  Everyone in the room was frustrated and overwhelmed.

I sat and listened, and tried to balance the complex facts with each party’s opinions, feelings, and needs. Everyone wanted a solution—their solution—so badly, that no one, least of all the patient himself, was heard and respected. Rather than offering solutions, I mediated, trying to create time and space for each person to talk. We did not come up with an answer, but we made progress in listening.

The conclusion the group reached several days later—trying out a skilled nursing rehab location close to the patient’s home and family, with eventual plans to transfer home—wasn’t perfect, but the meeting reset the conversation to a place of greater equity and inclusivity.

Neutrality helped me balance the needs and limitations of a difficult reality. In a space of narrow choices, this one was best aligned with the care the patient wanted.

With the Vietnam vet and his wife, this notion of neutrality as observation helped me reconnect the couple with the things that brought them together in the first place. Rather than leaning into their disagreements and arriving at judgments about who was right, we took trips down Memory Lane. We discussed how they met in college, set up by friends, and how they have been arguing for decades. They talked about what they admired and found attractive about each other. They remembered their accomplishments, their goals, and their mutual commitment.

I don’t approach therapeutic neutrality with a cold, dispassionate lens. Instead, I try to find ways to use curiosity, exploration, and observations of points of connection to help couples, families, and medical teams work through conflict. Rather than focusing on how someone wants another person to change, I use prompts to help people rediscover what they value, and how the people around them bring them closer to it. I’ve learned that my job, as a neutral therapist, is to help patients and their loved ones strengthen their bonds.

The post How Does a Therapist Stay Neutral? appeared first on Zócalo Public Square.

But March 2020 was also a month of reflection. I was finishing up work on a book—and I was thinking about the people I was writing about, and the many echoes between their experiences and what we were collectively living through.

For the past 10 years, I have investigated how French classically trained musicians used their art to cope with the traumas of World War I, a conflict that killed a generation of French men, and millions of women and children. I’ve read thousands of letters and hundreds of diaries, memoirs, and autobiographical novels; I’ve looked at dozens of psychology and physiology texts, compositions, and music method books. This window into people living in wartime and interwar France made me realize that they understood music-making as an embodied therapeutic practice with tremendous potential to console. Their stories have a crucial role to play today, too, as the world reckons with the pain and traumas inflicted by the pandemic.

Like many of us coping with COVID today, people in World War I-era France experienced trauma with a lot of not-knowing and uncertainty. News coverage of the war in French newspapers was extensive, but most in France weren’t getting the whole story. People on the front lines knew what was really happening, but weren’t always permitted to talk about it; for instance, civilians whose loved ones had been killed often waited months to have deaths confirmed.

Combined with the disruption of everyday social interactions, the zone of silence surrounding wartime experiences led to intense isolation. And to make things worse, French culture looked down upon talking about trauma. “Too much” public mourning was deemed disgraceful. The salon hostess and amateur musician Marguerite de Saint-Marceaux wrote in her diary that the composer Maurice Ravel and his brother “were distraught” and “couldn’t remain upright” at the funeral of their mother: “Both were in utter turmoil, incapable of reaction or self-control. A lamentable and distressing spectacle at this time when heroism displays itself as naturally as breathing,” she sniped—and she was their friend.

French doctors, scientists, and members of the military viewed traumatic responses as moral weaknesses. Newspapers recounted contemporary debates about the harsh electrotherapy “treatments” inflicted on soldiers who reported trauma and injury but whose wounds had no visible signs. In this context, there was little room for expressing feelings. As a result, music became a vital way for people to cope with trauma.

How French musicians coped with the traumas they experienced took many forms. Public performance venues in France closed promptly at the conflict’s outset in August 1914, and as a result musicians’ “normal” ways of connecting with one another, through live performance, were brought to a screeching halt. So they found alternative venues for music performance, often in their homes or in other informal settings. When they couldn’t find instruments, they made them out of whatever materials they could find. Musicians didn’t always expressly recognize that they were using music as a coping tool, but they likely had some sense of what music could do for them. While music therapy wasn’t yet an institutionalized discipline during World War I, French psychologists understood mind and body to be intimately connected. Given these musicians’ familiarity with psychological theories of their time, many realized that the embodied nature of making music—that it requires people to move their bodies in the act of creation—gave it the power to soothe.

At the turn of the 20th century, French art music, inspired by post-Romantic composers like Richard Wagner and Richard Strauss, was largely lush and dissonant with little rhythmic regularity. But during the war French musicians began to compose and perform extremely rhythmically regular “neoclassical” music that, in its predictability and repetitive patterns, soothed their bodies and distracted their minds. For example, after their husbands died in the first months of the war, the pianist Marguerite Long and the violinist Hélène Jourdan-Morhange, previously known for performing the lush music of Claude Debussy and Gabriel Fauré, turned to repetitive music filled with ostinati—continuously repeating musical phrases—and regular rhythms that allowed them to move their bodies in a soothing groove. Much of this music was either from the 18th century or written by their friends Maurice Ravel, Jean Roger-Ducasse, Francis Poulenc, and Germaine Tailleferre, all of whom had either participated in or lost loved ones in the war.  According to the French journalist Raymond Escholier, Long reported that when she sat down to play the Andante movement of the Piano Concerto in G Major, written for and dedicated to her by Ravel, she was “so moved by it” that she had tears in her eyes, particularly in the part of the movement that features a great deal of rhythmic regularity provided by constant 32nd notes.

Musicians’ private writings also suggest that music-making fostered personal relationships that helped them cope with trauma. In a letter to Nadia and Lili Boulanger, the musician-soldier Jacques de la Presle wrote in 1916 that “in a small place of rest we make music—voilà, one of our joys. You can see that for the souls submitted to such a hardship, music is the great and principal consoler.” Many other musicians, especially those serving on the front lines, concurred, including Ernest Mangeret who confided that “a few moments of leisure permitted me to become myself again” when he found a piano in a half-demolished house. “[W]e went down into the basement (you can understand why!),” he wrote, “and when the evening came, we came together, several friends, in order to make a little bit of music.”

Music-making also offered a way to remember what life had been like before the war. The cellist Maurice Maréchal, who enlisted in 1914, wrote in his letters and diary that performing with friends on the front lines and listening to phonograph recordings reminded him of his pre-war life at the Paris Conservatoire—allowing him to step out of his traumatic military life for just a moment. For others still, performing, composing, and organizing concerts brought visceral reminders of friends and family who had died. The composer and teacher Nadia Boulanger, for instance, reworked pieces written by her younger sister Lili, who died of intestinal tuberculosis in 1918, and performed them in concerts for the rest of her life.

Musicians’ experiences in 1910s and 1920s France remind us that today, as we struggle with the trauma of COVID-19, we must take into account the inextricability of mind and body. Psychologists like Bessel van der Kolk, Stephen Porges, Resmaa Menakem, and Peter Levine have recently underlined how trauma becomes, to use van der Kolk’s phrase, “lodged in the body,” and recommended body- and movement-oriented practices—such as yoga, theater, and yes, music-making—to help counter trauma’s negative effects.

Music holds incredible potential for helping people cope—and indeed, we’ve already seen it take on this role during COVID. As musicologist Emily Abrams Ansari has noted, using music as a tool for remembering past times, people, and places became commonplace during the first months of the pandemic. Similar to how French music lovers of the 1910s and 1920s embraced familiar music, many people in lockdown also turned to nostalgic music that reminded them of earlier times, evidenced by a substantial increase in Spotify playlists based on music from the ’50s, ’60s, ’70s, and ’80s.

While we should embrace the benefits that music brings, we must also heed the darker lessons of the World War I-era during this pandemic and going forward. The toxic masculinity that surrounded the expression of grief and trauma back then still resounds today. In the 21st century, we must be thoughtful and ethical in how we engage with one another, as well as with music and sound. We shouldn’t expect people to “get over” trauma quickly. Rather, we need to push for cultural, societal, and policy change that prioritizes mental and emotional health. People in positions of power—government officials, police officers, teachers, school administrators—need training to deal with trauma effectively. Mental health care—including music and sound therapy—needs to be made more accessible to anyone who might benefit from it. Musicians and the music industry must reckon, too, with the ways music has been used as a weapon of control, punishment, exploitation and coercion.

If we can be mindful of how we engage with music, sound, and trauma, though, we can produce new ways of thinking about our ethical engagements with one another.

At its best, music can restore and rejuvenate the body and mind. And there’s some comfort in knowing that people who respond emotionally to music will always find a way to make music, no matter how difficult it may be. Just as World War I-era musicians made music wherever they could, often in houses and churches that had been destroyed by bombs, in the spring of 2020, I was heartened to see musicians of all stripes cultivating Zoom performances to provide themselves and others with comfort, whether through performing classical pieces like Aaron Copland’s “Appalachian Spring” or hymns in the Sacred Heart singing tradition. Even the simple act of singing can do wonders. Alone in my bungalow with my two cats, I’d sing to them their favorite songs—“You Are My Sunshine” and Leonard Cohen’s “Hallelujah”—and find myself suddenly feeling more alive and less alone.

The post When Music Became Therapy in Interwar France appeared first on Zócalo Public Square.