Autism

Building a relationship – working with Clare, a 6 year old with Autism

December 20, 2023

It has been a full year since I qualified as a music therapist from Roehampton and joined the Ealing Music Therapy (EMT) service team. This year, I have thoroughly enjoyed working for this service and look forward to many more happy years at Ealing Music Therapy.

My first clinical role was to work as a Music Therapist at Springhallow School. I have learnt a lot in my first year at Springhallow and have been fully supported by the staff.

I was given the opportunity to present my work from Springhallow at our Annual General Meeting. It was a privilege to present my work in front of my peers, colleagues and other people that joined us in the meeting. This was the first time that I had presented my work since I finished university. As a result, I felt apprehensive about the presentation but felt fully supported by my colleagues.

In this blog, I have written a case study based on that presentation that was titled ‘Building a Relationship’.

Building a relationship

Clare was a 6 year old with a diagnosis of Autism. She attends a school for pupils aged 4-16 years with a diagnosis of Autism and the pupils at the school have learning disabilities ranging from moderate to severe.

Clare is sensory seeking and often seeks out her own motivators. This results in her having fleeting and self-directed behaviour. She is able to engage in her own activities for long periods of time, but needs support to attend adult led activities.

Reasons for referral

Clare had attended music therapy in previous academic years. During this time, the staff noticed that she was making positive steps of progress with her communication. For example, she enjoyed singing and saying new words. Her parents also noticed these positive changes at home too.

Clare rarely demonstrates joint attention and it was felt that music therapy could assist Clare in continuing to develop her communication skills and joint interactions.

Finding our way

Clare was always keen to come to music therapy. However, she generally became very anxious during transitions and change. She therefore needed some time outside in the play area before coming to the music therapy room. In our initial sessions, Clare began cautiously. She did not want to play the same instruments with me and whenever I presented an instrument to her, she looked, then ran to the other side of the room. When I attempted to play the piano with her, she moved my hand away. She also covered her ears whenever I attempted to sing any songs.

Although it was very difficult to engage with Clare, we did manage to briefly interact during the early sessions. Clare enjoyed saying words that I would repeat. Whenever I repeated the words that she would say, she would change the word and wait for my response.

This interaction provided Clare with a response that was not just imitating her words, but a form of back-and-forth communication.

This interaction was the beginnings of a developing therapeutic relationship and showed us the potential music therapy would have for Clare.

Developing our relationship

As the sessions continued, I would follow Clare around the space in an attempt to get some musical interaction, however, she would run from one end of the room to the other. I decided to let Clare be free to express herself in the therapy space and to stop following her in a forced attempt to engage. Instead, I sat at the piano with a percussion instrument and attuned with her through the musical imitations of her movements, the words she was saying and melodies she’d hum to herself. As a result, the dynamic of the sessions began to shift and Clare began to initiate different musical responses between us.

By providing a safe and therapeutic environment for Clare to freely explore, allowed a developing relationship to emerge. By facilitating Clare’s wants and needs, Clare was able to manage her anxieties and begin to communicate and musically interact with me.

Musical Interaction

Since Clare enjoyed exploring the therapy space, I set up the instruments at either end of the room and in the middle. I also put some cards and puppets on a chair with the songs she enjoyed singing. During this point in the music therapy sessions, Clare would go straight to the chairs that contained all the various cards and song choices. I would be sat in front of the keyboard and Clare would walk over to me saying the first name of the song. Once I began to sing, Clare would run across the room with the card in her hand and fall on the floor. As I was singing, I’d interrupt the song by musically mirroring Clare’s movement which elicited a response from Clare in the form of laughter. This interaction lasted for the whole session with Clare often coming next to me, making eye contact, smiling and attempting to communicate what she wanted.

This interaction facilitated prolonged joint attention between us on the same task. During these interactions, it seemed that I had become a secure base for Clare which facilitated her creative play in the therapy space before she’d return to me.

Summary of the work

Clare is nine months into her music therapy sessions. In this time, she has demonstrated a developing therapeutic relationship with me. Within this relationship, Clare has been free to explore the therapy space and demonstrated independence and creative play. This therapeutic environment has facilitated and encouraged her to communicate with me verbally and musically. Clare has shown joint attention and interactions in the various musical tasks and has been able to manage her anxieties. This has been achieved through song singing, free improvised musical dialogues and creative play.

By Robert Simonis, Music Therapist

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