JAAH 3 (3) pp.

321–336 Intellect Limited 2012

Journal of Applied Arts & Health

Volume 3 Number 3
© 2012 Intellect Ltd Miscellaneous. English language. doi: 10.1386/jaah.3.3.321_1

Catherine Butler
Sesame Institute

‘The Song is You’: How music

works in Sesame therapy for
clients with dementia

Abstract Keywords
It is increasingly being recognized, both empirically by carers and through rapidly Sesame
advancing research in music psychology and neuroscience, that music can assist music
the well-being of people living with dementia. In this article I show my work as a Laban
Sesame practitioner, demonstrating my therapeutic use of music and giving examples movement
of how it speaks to the needs of this client group, including those of self-expression dementia
and relationship; and I show how music fits into the Sesame context of Drama and neuroscience
Movement, which includes Laban Fundamentals. I give an introduction to Sesame
beginning with a vignette from one-to one work that illustrates our practice. I describe
a group therapy session from a series, explaining the Sesame session structure and
the use of music in relation to this. I detail effects I noted as participant/observer,
and my subsequent reflections; I refer throughout to pertinent literature including
some recent neuroscientific research.

Introduction
The ever-growing number of people with dementia and the need to care
for them and improve their lives has spawned research in many areas apart
from the pharmacological. Among these is research into the use of music:
articles have been published by music psychologists, music therapists and

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other clinicians concerned with the practice of music therapy in relation to

these clients: (e.g. Aldridge 1993; Bannan 2008; Ridder and Aldridge 2005;
Svansdottir and Snaedal 2006). There has also been a pilot study employing
both qualitative and quantitative research methods (Wilkinson et al. 1998)
looking at Sesame therapeutic practice that employed a variety of creative/
expressive arts, for the same client group. My article describes the first research
focusing on the use of music in Sesame sessions for clients with dementia, and
it is entirely qualitative research. It is an introductory study, and I intend to
follow it with more detailed research on particular aspects of music in relation
to my client work and observations.

Origins, method and setting of the research

I was first inspired to write about this special client work when I read Oliver
Sacks’ wonderful case studies of patients in connection with music (Sacks
2007), and realized that I could contribute much to this subject from what
I was experiencing as a Sesame practitioner. My previous academic training in
philosophy had already given me an interest in questions of the self, in terms
of its relation to body and movement particularly Merleau-Ponty (1962).
The sessions from which the samples below are taken were part of a year-
long funded research project concerned with the effects of music on clients
with dementia, and the relation of this to published research germane to
the topic. My stated focus is on the use of music within Sesame therapeutic
sessions, but it will be seen that movement is involved in this, so I also refer
to literature on movement. There is a substantial body of research on both
of these, and I give specific references at relevant points in the article and
in two sections at the end. My research was undertaken through a grant to
the Sesame Institute by the Terpsichore Trust, a charity that funds projects
related to therapy through the creative arts. This grant was given to promote
publication of articles by Sesame practitioners that would inform the wider
public of the nature and efficacy of our work, as well as being a resource
for practitioners themselves.
The research was carried out in the Mental Health Unit of a private
Residential Care Home where I had been employed for some years. My client
work included a weekly group therapy session, and one-to-one sessions.
My research methodology, within qualitative research, is in the form of case
study, informed by the principles of heuristic enquiry. In such enquiry, the
practitioner/researcher reflects deeply upon the experience gained during
the research of effects on both client and self, and what emerges in relation-
ship between the two – this seems to me essential for a researcher engaged
in ‘participant observation and interaction’ (Barber 2006: 74–80). In research
involving clients with dementia, ethical considerations are obviously impor-
tant, and this was noted and approved by the Sesame/Terpsichore panel
when they examined and passed my original research proposal, and then
the research results I submitted to them. Written consent was obtained both
from the Home (the Care Manager and the Head of the Mental Health Unit)
and from all families of clients who would participate in the research project.
I had shared with the families the purpose of the research and that it was
intended for publication, and gave assurance that group members’ anonymity
would be safeguarded. Several told me how glad they were that the beneficial
effects of this kind of therapeutic work for people with dementia, effects that
they had seen when visiting, should be more widely known – an example

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of such statements is given in the commentary on the group session below.

Confidentiality is maintained by the use of clients’ initials. I made client notes
and observations on the effects of the therapy as participant/observer. These
were transcribed; then followed further reflection upon my observations and
relation of these to what I discovered in the literature, ultimately leading to
the commentary. I have chosen to give one sample session from the series
of group sessions, as each produced extensive notes and comment, and I
want to show the full richness of content and reflection from just one session.
I will now employ a vignette from the one-to-one sessions to help introduce
Sesame practice.

Sesame drama and movement therapy

Vignette:
These are notes from a session with B, a long-term client with Alzheimer’s,
who had recently suffered what was possibly a slight stroke. As a result her
movement had become severely restricted and she had great difficulties in
communication.

We had selections from ‘The Magic Flute’ (Mozart 1995). I’d said
‘Something magical for today’ – she opened eyes wide, said ‘Oh!’
and rubbed her hands together. With ‘Der Vogelfaenger bin ich
ja’/‘I am indeed the birdcatcher’ she said ‘Good, good!’ clapped her
hands and stamped her feet lightly, as if dancing. Later (during ‘Schnelle
Fuesse’/‘Swift feet’ ‘… Das klinget so herrlich’/‘That sounds so lovely)
she exclaimed ‘Perfect!’; and then ‘I feel, I feel …’; and ‘We can …’
during ‘Ein Maedchen oder Weibchen’/‘A sweetheart or a wife’. We did
some hand-rhythms together, and on her own she moved her fingers –
‘twinkling’ them, holding them horizontally in front of her and waggling
them (it looked like casting a spell) – I mirrored this. She applauded at
the end, and said ‘Thank you’ when I was leaving.
Today she could focus to the extent that we were able to start looking
at her pictures and family photographs again; and her speech was much
improved from last time. When I said I would see her again soon, she
said ‘Absolutely!’

I was working with this client using the Sesame Approach, which sets out to:

• Engage the ‘imagining psyche’ of the client through the chosen form and
material, leading to increase of focus, energy, and response: openings of
communication whether verbal or non-verbal.
• Build relationship and trust.

This extract demonstrates B’s engagement through her attention, her body
movement, and her words; her trust in our therapeutic relationship is shown by
our work together and her affirming speech. The Sesame Approach demands
careful choice of art form(s) and material for particular clients, whether one-
to-one or groups. I chose the art forms (music and movement) and material
shown above for B because I knew B loved Mozart, and we had used ‘The
Magic Flute’ before her recent setback. I felt that if anything could revivify her,
it would be this story and music, with its magical symbolism, rhythm and joy.

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The Sesame Approach was devised by Marian (‘Billy’) Lindkvist, who

founded the Sesame Institute. She chose the name ‘Sesame’ when she was
pioneering drama and movement therapy in the early 1960s. It is taken from
the story of Ali Baba, in which ‘Open Sesame’ is the key to entering a cave
and finding the treasure within. Our purpose is to assist such an opening,
in psychological terms, for each client. The full-time Sesame training was
first established in 1976 and has been at the Central School of Speech and
Drama, London, since 1986. All practising Sesame Drama and Movement
Therapists must now be Health Professions Council registered. A recent infor-
mation leaflet produced by the Sesame Institute (UK and International) says
of the Sesame Approach that it is a form of therapy that draws upon the art
forms of drama, play, and movement, all of which facilitate ‘relationship and
non-verbal communication in a safe environment’ (Sesame Institute 2010).
A unique aspect of Sesame is ‘movement with touch and sound’, devel-
oped by Marian Lindkvist as an intuitive way of working with clients who
are restricted in their movement, by observing and ‘reading’ the client’s body
language, joining with it and potentially helping to extend their movement.
It was found to have application to a considerably wider range of clients than
the severely disabled, and is now incorporated in much of our Sesame work.
The Sesame Approach is also used as a resource alongside psychotherapy and
counselling, and at the start of my work with B ‘talking therapy’ was involved.
By the time of the above session with B several years later, Sesame art forms,
especially movement, had come to play an important part; and ‘movement
with touch’ is exemplified by our hand-rhythms together and my mirroring
of the movement initiated by B. There is also an element of drama, using the
story-theme of ‘The Magic Flute’, to which B’s playful character naturally
responded. Visiting the client two or three times a week, beginning at a time
when her dementia was not far advanced, I got to know as much as I could
about her, including her tastes in music, which was very important to her.
This obviously helped my choice of material over the long term, and what
emerged from one session would help inform the choice for the next.
The ‘safe environment’ referred to above is a key provision for the clients,
provided by the person of the therapist, the art forms used, and the structure of
the session. Trust in the therapist is essential: Sesame therapists prepare them-
selves for each session, clearing themselves to come into the space, to enter
the world of each client or group. They can do this as a result of their training,
their personal psychotherapy and supervision. The right material to be brought
will consider the client’s life, character, culture, tastes and current situation.
This will be woven into an appropriate session structure of preparation, the
central work, and resolution, during which the therapist will also be following
and responding to the clients’ own process. Through the therapist’s constant
practice of these disciplines, reflections and attitudes, a trusting relationship is
engendered. My relationship with B was well established by the time of the
session from which the vignette is taken, and she showed her confidence in
this relationship and its continuance by her response to what was offered; she
felt known and valued in herself, important for a sense of well-being.
Training in the Sesame Approach has both theoretical and experiential
learning; these include the bases of Jungian psychology, elements of Peter
Slade’s Child Drama (related to play), theories of human development and
Laban Movement Principles. Jung developed the technique of ‘active imagi-
nation’, which aids the therapeutic process by working with the images and
symbols that emerge from the psyche, whether through dreams or creative

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arts (or both); these could be ‘dramatic … visual, acoustic, or in the form of
dancing, painting …’ (Jung 2001: 132–33). In Sesame sessions, we work in
this ‘oblique’, metaphorical way through all the art forms we employ.
A vital part of our Sesame training is in gaining understanding of the funda-
mental principles of movement, as expounded by Rudolf Laban (a pioneer
of movement exploration) so that we come to experience what is expressed
‘through the moving body’. We learn through weekly sessions about this
moving body, the energies of the body that he called ‘Effort’, the body and
its relationship to the spatial environment, and relationship to others through
movement. We develop our own expression through movement, and discover
how we can express roles and understand symbols and metaphors that
emerge imaginatively through the moving body. We learn how to observe
closely and follow the movement of others: ‘In the context of working thera-
peutically with movement, the more we can discover about our own move-
ments the more our capacity for understanding others will deepen’ (Cooper
1996: 25). In a previous edition of the Journal of Applied Arts and Health,
Dita Federman explored increase in kinaesthetic ability of trainees in Dance
Movement Therapy and the development of empathy, as an essential thera-
peutic tool, with reference to Laban (Federman 2011: 137–54). Movement and
dance therapies generally are ‘centred on Laban’s understanding of the corre-
lation of Jungian psychology with an individual’s effort behaviour’; Laban’s
‘vision of his work in therapy’ began while he was still a young artist in Paris
in 1902, when he drew and observed the movement patterns of the inmates
of an ‘insane asylum’ (Preston-Dunlop 2008: 273, 14). During Sesame training
we are required to note our movement observations after each session; these
are given detailed feedback by supervisors on our clinical placements. In these
ways we become practitioners who ‘after training, continue to record their
observations as a form of de-briefing, using their records to think about the
progress of clients and to work with them in supervision’ (Suter 1996: 51);
these movement observations will be seen to play an important part in my
notes and commentary on the sample session.
Movement is constantly present in my Sesame work, because movement
underpins music, drama and play. More fully, as Laban said, ‘… all expression,
whether it be speaking, writing, singing, painting, or dancing, uses movement
as a vehicle … [it is all] outward expression of the living energy within’ (Laban
1948: 98–99). When I hold sessions in which music is the main element, and
I am working with clients such as these who have become limited in their
capacity to use verbal expression, movement stimulated by the music is a
central method of understanding and communication in the group. Movement
can even be a more telling form of expression than the verbal: Laban said
‘Each phase of a movement, every small transference of weight, every single
gesture of any part of the body reveals some feature of our inner life’ (Laban
1960: 22). Central to Laban’s thinking was that:

This inner life is expressed through movement, whether consciously or

unconsciously … movement is the bridge between a person’s inner life
and the external world … this bridge very often resembles a loop, for
what happens in the outside world affects us internally and significant
internal movement will affect how we present ourselves in the exter-
nal world … internal change will be made visibly manifest: movement
experience [has] the power to initiate change and growth …
(Thornton 1996: 79–80)

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The Sesame Approach links Laban’s symbolic nature of movement and

Jung’s work with image and symbol as part of the therapeutic process
(mentioned above).
In group movement work we see dynamic change in the individual: ‘grad-
ually, members of the group discover the rhythms with which they are most
familiar. They begin to model and imitate one another’s movements, discov-
ering new rhythms and widening their movement vocabulary’ (Thornton
1996: 88). Susi Thornton was here describing her Sesame trainee group, but
I have found that it applies equally to developments in my client group over
the time of our series of therapy sessions. As infants, ‘We first experience
ourselves through movements of the body’, and ‘[children’s] movement is
free, confident, and uninhibited’ (Cooper 1996: 18). Similarly a therapy group
using the Sesame Approach offers a safe space to explore and find freedom
through movement, by which ‘we gain a confident sense of ourselves’ (Cooper
1996: 19). In work with clients with dementia, supporting the client’s sense of
self is a central aim; and group movement builds relationship.

The structured Sesame session

Whatever the materials used in a Sesame session (e.g. story, images, music),
the basic structure is the same. As with story, there is a beginning, a middle
and an end: we expand this to Focus, Warm-up, Bridge-in, Main Event, Bridge-
out and Grounding. This structure will be explained with reference to the sample
group session below. I have included a brief commentary for each section that
reflects my later thinking, and where appropriate I give the rationale for my
choice of material.
Before all my sessions, I come to the room where the clients are assembled,
greet each one individually, ask carers about any group members not there, and
introduce myself and what we do as a group to any new residents present – giving
them the choice of participating or not as they wish. For clients such as these,
deprived of so much independence, to have a choice is already affirming of self.
Over several years before I began the research project, there had come to
be a core of residents who regularly attended the therapy group. Most were in
their seventies or eighties; J was over ninety. All had some level of dementia,
mostly later stage. The session described below was held with this core group
as it was for the year’s duration of the project: J, G, P, S and C (plus A and
F, on ‘respite’ care, i.e. giving the regular carers at home some respite). They
were all English except for F (Prussian).

‘You are My Heart’s Delight’ (Lehar 1929): Sesame group therapy

session of 4 December, 2009
Before the session:
Notes

The Unit was still ‘all over the place’ with Christmas decorating half-
done; staff [carers] coming in and out of the lounge, maintenance men
banging about with ladders in the hall: but right from the start there
was a strong feeling of the group, to which A and F contributed – they
had attended on several previous ‘respite’ visits. A came in to join the
group, worried, ‘mother’ mentioned, but with the presenting problem
of her not knowing whether/when she was going home, being collected

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(by husband). F was also restless and looking for ‘Mutter’ [Mother] again.
A tried to calm her – said ‘sit down by me’. J was watching the situation,
asked me straight away, and very clearly, ‘What are you going to do?’ I
said whatever was to be done we’d do it together. G was frowning, said
he did not know ‘whether I’m coming or going’. I said to him that the
great thing was that he was here with us now, and we’d be together
until tea; he said ‘Right, that’s alright then’ and sat down.

Focus: In Sesame sessions, the focus is a reaffirming of our relationship, group

and one-to-one, and the trust we have built; and an introduction to the theme
or story of the session.

Notes

All were eventually gathered in the circle, and after greeting each one by
name, I said ‘It’s beginning to look quite festive – so today we’re going
to Vienna’ (smiles all round). During the session I showed them winter
photographs of Vienna, famous buildings, fiakers, etc.

Commentary
In this session the theme was ‘Vienna’. I chose this because of the season; this
connects clients to what is happening in the society and the world from which
they are removed, so addressing one of their many losses. The photographs of
Vienna at Christmas Market time I had taken with this client session in mind,
to accompany the music. Recent research in music cognition has shown that
when music is presented ‘with an audio-visual stimulus providing context’,
a part of the brain central to emotion shows increased activity, which is not
found ‘when positive or negative music is presented alone, suggesting that
real-world context aids in building a more meaningful emotional representa-
tion, capable of differentially engaging the amygdala’; to me this could apply
to images (such as the photographs), story or other Sesame materials ‘from
another sensory modality’ (Levitin and Tirovolas 2009: 220). It could also apply
to song – music carrying its own context in words. Also it is worth noting that
the ‘context aids’ in the published study were ‘neutral’ as regards positive or
negative emotion, and S. Koelsch posits how much stronger this influence
could be if the aids ‘also have a strong positive or negative emotional content’,
as is often the case with Sesame material (Koelsch et al. 2009: n.p.).

Warm-up: In this section, we start to engage with the body and raise the
energy through movement – I have found it is good to use a piece of music
with at least moderate tempo and a strong pulse, in duple time.

Notes

I put on our first piece of music – the Harry Lime Theme (Karas 1949)
from The Third Man (1949). As soon as the music started, A was with
it, coming away from her worry – and everyone was tapping, doing
some sort of rhythm, whether with hands on the table, with feet in
some way, or whole body movement: F stood and was dancing, with
alternate lifts of shoulder and hip, and most were singing the tune
[which has no words], singing all together, while doing their individ-
ual movements in rhythm.

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Commentary
The Harry Lime Theme (Karas 1949) has the strong pulse required, engaging
and arousing the group at once, and I regularly use it for the warm-up
when I do a ‘Vienna’ session. Clients give me a sense of setting out on a
walk cheerfully during this, by their facial expressions, by humming or
‘dum-de-dumming’, and by movements such as the raising of shoulders
alternately, which several have done on different occasions.
Another engaging factor in this piece is that it comes from a film (set in
Vienna) that was very popular when these clients were still young, just after
the Second World War (The Third Man, 1949). When those on ‘respite’ are
present, they can often talk about this film, which draws the focus of the core
group, evidenced by nods, etc., and the stimulus sometimes enables them to
join verbally in the reminiscence. Those on ‘respite’ are usually more physi-
cally as well as cognitively able, and the core group members can often mirror
their movement and increase their own movement vocabulary, so increasing
both verbal and non-verbal communication (cf. Thornton 1996b on dynamic
change in ‘The Sesame Approach’, above). Many times I have seen this galva-
nize the group and draw it together, increasing eye contact between the
members and the visitors, so including them. In the session I describe, rela-
tionship, group process and support were all significant even before the focus,
and from the start the music spoke to this.
Bridge-in: Here we begin to open up the theme (in this case Vienna) and work
towards the central material of the session. I try to make it a preparation for
some of the intense experience that is likely to follow.
Notes
The session went on with this same level of participation: many singing
with a selection of Richard Tauber song recordings starting with ‘Vienna,
City of My Dreams’ (Sieczynski 1913) my announcement of which
had been greeted with enthusiasm. [As well as Vienna photographs,
I showed them one of the singer, and there was a warm response].
A spoke of how her mother loved Tauber …
Commentary
‘Vienna, City of My Dreams’ (Sieczynski 1913) not only refers to the theme,
but also touches imagination, memory and emotion, and it often stimulates
verbal comment and reminiscence from those able to give these (see ‘A’ in
notes above), and non-verbal expression in response from others. Richard
Tauber’s voice evokes emotion not just through memories and associations,
but also through his expressive way of singing. As regards showing photo-
graphs, client response here supports Koelsch’s claim that response to music
can be stronger when another, emotionally charged context aid is presented –
see under Focus, above (Koelsch et al. 2009: n.p.).
Main Event: This is the part of the structure for which we have been preparing,
when the clients are supported in becoming deeply engaged with and moved
by the material offered.
Notes
… and when we came at the centre of the session to ‘You are My Heart’s
Delight’ (Lehar 1929), A sang right through the song, with intense
expression (also from J and G).

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Commentary
The preparation in the Bridge-in was followed by a group of Viennese songs
performed by Richard Tauber, with strong emotional impact, at its core ‘You
are My Heart’s Delight’ (Lehar 1929). This was Tauber’s ‘signature’ song, which
would have been well known to my clients, and would symbolize Tauber –
and perhaps that time of their lives – for them. The song is by Franz Lehar as
were others in this section; in a recent BBC Radio 3 programme, Lehar was
quoted as saying he wanted to write music that reached ‘the peoples of the
world’, and ‘appeal to people’s emotions, and touch their hearts’ (This Week’s
Composer 2011). His success in this is shown in my (mostly English) clients’
response, so engaged were they in the songs as evidenced above.
Another point about this selection: I have observed that songs with ‘You
are’ in the opening line (in German it is ‘Yours is’, similar emphasis) tend to
‘hold’ the clients, they often close their eyes as if going into themselves, and
sing with intensity; but at the same time these are occasions, also, when they
sing most together, as a united group. Here is support for the sense of self in
every way. I also feel that the intense, lyrical melodies of these songs play a
vital role in this effect, as well as on the clients’ expressive behaviour, and this
is another area for further musical research.
Bridge-out: Now we begin to move away from the most intense and emotion-
ally exploratory section, through chosen material that, together with my
therapeutic ‘holding’ and the therapist-client and whole group relationships,
continues to support clients in their expression of their experience of the
session and feelings raised by it.

Notes

After Tauber, ‘Wiener Blut’ – the full Strauss waltz, orchestral (Strauss
1873). There was so much movement and singing along to the succes-
sive melody sections of the waltz, all participants in their own move-
ment styles, but also movements differentiated with each section, so that
it became like a story told by each, and a conversation among them all.
G ‘conducted’, as often. J started with hands side by side palms down,
a flowing movement in figure of eight shape, then joined her hands,
one holding the other, and continued the figure of eight movement. I
mirrored this and said ‘couples dancing together’, and she danced them
[in the waltz rhythm]. F was able to do a little waltzing with me on her
feet, which the group followed with their eyes, smiling.
Commentary
In this part of the group session, the waltz music adds an extra dimension to
bridging-out. The waltz, as I will show later, is a most powerful tool in my use
of music in Sesame therapy; I have seen such strong effects with it that it is
another area in which my own research continues, overlapping with that on
the effects of duple and triple metres. In the context of the Sesame session it
reflected the holding and relationship elements and contributed to the fulfil-
ment of the aims of self-expression and communication.
J’s hand movements and the whole group’s movements in the bridge-
out demonstrate these effects. Holding and relationship are symbolized by
J’s joining of her hands to move together, and after my mirroring and verbal-
izing of this, hand-dancing in the waltz rhythm. When I danced round the
room with F, the rest of the group were dancing with us. Self-expression and

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communication were shown by each doing his/her own movement patterns

for the successive sections of the waltz, expressing the self of each; but these
patterns came together in the waltz rhythm, with each looking at others and
‘speaking’ to them through movement. For those for whom moving is now
barely possible, movement can be communicated in this way; Sacks quotes
such a client: ‘I partake of other people, as I partake of the music. Whether it
is others, in their own natural movement, or the movement of music itself, the
feeling of movement, of living movement, is communicated to me. And not
just movement, but existence itself’ (Sacks 1991: 282).
Grounding: This last part of the Sesame session structure takes us back out
into the everyday world, from the imaginative world where we have been.
Notes

We finished with the ‘Radetzky March’ (Strauss 1848), and there was
rhythmic expression from all, with hands as well as foot-tapping (P did
both simultaneously). C did the ‘drawing-up and letting-go’ movement
with her hands, performed sharply in time with the rhythm.
There had been so much to do with twos, pairs: as well as the waltz
with ‘couples dancing’, there had been A and F at the start, later F and
C consulting and moving furniture together; G as often needed affir-
mation about how things were ‘working’ – he demonstrated with two
fingers as if walking, then turning them upside down. A last pair inter-
action: at the end, F went to join P at the tea-table, put her hand on
his arm and he took her hand; I went and helped her pull out the chair
to sit by him – he turned to me, said ‘Thank you – so kind’, and wept.
The carers arrived with the trolley and we [the group] had tea and cake
together.
Commentary
For the group session on Vienna, I use the Radetzky March (Strauss 1868),
an iconic piece from the Austro-Hungarian Empire, which I have found
speaks strongly to clients of whatever culture. It has a very strong rhythm with
which we can march back (by whatever hand, foot, or other ‘tapping’) to that
everyday world – symbolized by the return of the carers with tea.

Further observations on the effects of the waltz

I referred in the ‘bridge-out’ section above to the strong effects I have noted
when I use the waltz in a therapy session. I want to expand on this here, refer-
ring to the sample session and also using evidence from other sessions, and
relating it to wider research.
As indicated in the session commentary, the waltz is effective in a variety
of ways.
First, in a waltz we hold one another and we move with one another –
it is a dance of relationship. It has been noted that lullabies (from various
cultures – e.g. Brahms’ lullaby, Rock-a-Bye Baby or the Yiddish Rozhinkes
mit Mandeln) are often in ¾ time, and this early association with being
held, soothed, supported – and loved – can be conveyed by waltz rhythm. I
had an individual client who loved ‘The Godfather Waltz’ (Rota 1972) – he
said ‘It’s like a mother rocking her baby to sleep’ and would replicate that
movement when we played it. When I used ‘Wiener Blut’ in an experiential

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session for counselling students, one (who had never heard it before, and
had felt inhibited about movement) said of his response ‘I started to relax,
and I wanted to sway’; he also said that my participation – going to each one
and offering to dance with them – ‘really helped – I felt able to join in and
move’. This response is also seen in the sample session with J’s hand move-
ments of flowing, swaying side to side (figure of eight), and joining hands
and ‘dancing’ them together in the rhythm, which as I said above shows
holding, and relationship.
Secondly, the waltz has factors that contribute to self-expression and
communication, for the individual and the group. The sections of ‘Wiener
Blut’, as of Strauss waltzes generally, are differentiated in musical structure
and expression, but cleverly connected and developing one to the next. This
includes the ultimate return to the first main theme, with a powerful feeling of
resolution in the ending. Strauss is patently the master of the waltz form. In
another session in this series, in which I used ‘Tales from the Vienna Woods’
(Strauss 1868), G, as often, ‘conducted’ the whole waltz, with differentiated
movements according to each section’s mood, tempo, etc. I have seen other
group members as well as myself watch him and mirror his movement or
respond to it with their own – then a group ‘dance’ can evolve. When we
came to the climax in the finale, G raised his hands high above his head, then
leapt to his feet and almost shouted ‘That’s a marvellous crescendo’. A note of
elucidation concerning G’s process: he was captain of a ship – one of those in
respite care observed, on seeing him conducting, ‘He’s still the captain’. G will
say to me after strong engagement in a group session ‘We’re a good team’;
and latterly during the series of sessions ‘This is very good – we need to do
this’; or ‘We must keep this, we mustn’t lose it’ (I say to him that we will not).
Also: ‘This is wonderful – music – excellent performance – it’s magic’. G’s wife
joins us sometimes, and has observed that his singing and engagement with
the music is exceptional; these days there is so little ‘expression’ from him,
she says, and music seems to be the only thing that gets through to him now.
From a neuroscientific viewpoint, Thaut discusses how ‘emotional reactions to
the music can function as a mediating response by arousing psychophysiolog-
ical reactions, which may enhance and facilitate the experience of emotions
and mood states’ (Thaut 2005: 117). G has become more not less engaged in
the sessions, and has developed new expressive movement patterns, as well
as more verbalization of his responses – and he plays an important, enabling
part in the group. Therapeutically, here is change and growth, in individual
and group process.
‘Music both communicates and induces emotions’: one way it does this
is by the use of ‘contrast effects’, shifts such as ‘anticipation and resolution’
and ‘urgency and relaxation. The temporal patterns created by such shifts
mirror our emotional lives … like music, our emotional lives are dynamic and
nuanced’ (Thompson 2009: 5). Thaut says that the ‘process of tension release
in perception of music has been mentioned by many theorists as the basis
for the affective experience in music’ (Thaut 2005: 5), and explores aspects of
this, and especially rhythm and pattern, in relation to neuroscientific research.
These perspectives from music psychology and neuroscience accord with my
reflections on the responses of my clients, having observed their changes of
expression through movement during the waltz.
A last and related factor for ‘Wiener Blut’ in particular: it is quintessentially
Viennese – it means ‘Vienna Blood’ – in its own musical expression (the ‘Viennese
espressivo’), and provides a significant image and vehicle for the theme of the

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session. I am greatly indebted to a conversation I had on 23 February 2011 with

Professor Mag. Walter Deutsch, Hon.President of the Austrian VolksLiedWerk,
for further elucidation of what makes the special emotionally expressive quality
of such Viennese music. We agreed on the effect of rubato (and other flexibility
with tempo, notoriously characteristic of the Viennese style of performance,
exemplified by the Vienna Philharmonic). But Professor Deutsch revealed to
me, with musical illustrations he played on the piano, the importance of chro-
matic inflection in the composition itself, differentiating it from the Austrian
folk music to which it can be related. A clear example of this is the first theme
of ‘Wiener Blut’, which employs the chromatic throughout, and on the record-
ing I used (Strauss 1873), strong rubato is combined with the chromatic inflec-
tion to enhance the effect. Simonton comments on the contribution of melodic
originality to the emotional expressiveness of music – ‘An excellent example
is chromaticism, or the use of notes beside those that define the theme’s key.
Chromatic notes are often used to express emotion’ (Simonton 2001: 216); yet
as Gabrielsson and Lindstrom point out later in the same publication, ‘There
is surprisingly little and fairly tentative research on intervals’ as regards their
influence on emotional expression (Gabrielsson and Lindstrom 2001: 242).
Thompson looks at the current state of research (with reference to Cooke,
Kivy, Langer, Hevner, Huron, Sloboda and others) into the emotional quali-
ties of music, and concludes that they ‘reflect the combined influence of several
sources, including psychophysical cues, expectancy mechanisms, and indirect
sources of musical emotion’ (Thompson 2009: 149). ‘Wiener Blut’ delivers all
this; its chromatic inflection and rubato I would see as particularly related to
‘expectancy mechanisms’ (cf. Thaut on ‘tension and release’, above), drawing,
even seducing the participant into the embrace of the waltz.

Music with movement in relation to some recent

neuroscientific research
Recent and continuing research in neuroscience relates not only to the effects
I have seen with my use of music in therapy but also to our understand-
ing of the efficacy of Laban movement and interpretation work – and it is
clear that work with music and movement are (literally) vitally connected.
Archaeology has shown that music has been made with instruments for as
long as and wherever there have been human beings – it is most likely that
singing predated instruments (perhaps even language). As a bonus to the
great pleasure it brings, neuroscientists have posited that in evolutionary
terms music may well have had survival value: ‘intensely pleasant emotional
responses to music’ have similar effects (such as ‘shivers-down-the-spine’) to
‘other euphoria-inducing stimuli’, and so link music with ‘biologically rele-
vant, survival-related stimuli via their common recruitment of brain circuitry
involved in pleasure and reward’ (Blood and Zatorre 2001: 11818). A client in
a group session once said to me ‘You bring us to life’, and the way we used
music played a great part in that.
My sessions include music together with movement, reflecting the very
nature of music: ‘in every society of which we are aware, music and dance
are inseparable … The embodied nature of music, the indivisibility of move-
ment and sound, the anthropologist John Blacking writes, characterizes music
across cultures and across times’ (Levitin 2007: 257). Because of the integral
relation of music to movement, clients are helped by music to give expres-
sion to the self and its emotions in a non-verbal way, actually an essential,

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pre-verbal way, through movement. My understanding of that expression

through movement is facilitated by the now widely known ‘mirror neurons’.
Recent neuroscientific work shows how motor and visceromotor centres in
the brain are involved in a ‘mirror neuron mechanism [that] embodies that
modality of understanding which, prior to any form of conceptual and linguis-
tic mediation, gives substance to our experience of others’ and is a ‘necessary
condition for empathy’ (Rizzolatti and Sinigaglia 2006/2008: 190–93). We can
mirror the movement of others with our own bodies (which has its own effect
on the communication of emotions), but even observation alone will ‘produce
signals toward sensorimotor structures so that the corresponding movements
are “previewed” in simulation mode’ (Damasio 2003: 115) and still under-
stood through the mirror neuron mechanism. This mechanism is activated by
‘information from the visual areas, providing descriptions of faces or bodies
expressing emotion’ and the mechanism ‘immediately codes these descrip-
tions in the corresponding emotive mode’ (Rizzolatti and Sinigaglia 2006/2008:
189). Research has recently begun on the relation of this mirroring mecha-
nism to observation according to Laban movement principles, such as I use
in all my work (e.g. Berrol 2006). Illustrations can be given from the sample
session above: in the Bridge-out notes and commentary I record my observa-
tions of J’s hand-movements and my mirroring hand-movement response,
and give some movement analysis of this; and I refer throughout to my obser-
vations of the group’s own mirroring in movement. At a 2010 conference at
Central School of Speech and Drama, ‘Playing the Other’, a Jungian analyst
who teaches on the Sesame full-time course spoke of degrees of activation in
these neurons: practice will develop this, and the skills of observing and phys-
ically mirroring (mimesis) interact and boost one another. This applies to our
Laban training, and then to our continuing experience as practitioners. A final
note on the mechanism: when I present the music to my clients, I too move,
and ‘perform’, both in singing, and miming the playing of the instruments
we are hearing. What I express through my ‘performance’ will also affect my
clients’ sense of emotions involved, through the mirror neuron mechanism.
The therapist needs to be aware of this, and it is another area that needs to be
looked at in further research.

Conclusion
I have shown in this article how music can work in Sesame practice, using the
Sesame session structure, and fulfilling the objectives of the Sesame Approach
in therapy as outlined by the Institute. I hope also to have introduced Sesame
to those who may not know of it. By my examples of notes from client sessions
as participant/observer, and my later reflection and commentary on these
observations, I have demonstrated how music used specifically in the Sesame
therapy context works for clients with dementia. Music speaks to them, leads
to movement and the feeling and expression of self, and relationship and
communication with others. In Sesame sessions including music, there are
all these elements, contained in therapeutic ‘holding’ by a trusting relation-
ship with the therapist in a tried and integrated session structure. The Sesame
practitioner can bring in all his/her Jungian, Laban, play, ‘movement with
touch’, and drama training and experience; he or she has the potential to use
a variety of art forms and materials that can serve to increase engagement in
the often strongly emotive work of the therapy session. I hope that the impor-
tance of this mode of therapy will increasingly be recognized, and that it will

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be employed more widely. I have also noted areas of correspondence between

what I have experienced as a Sesame practitioner and some recent directions
and findings of research in neuroscience and music psychology, and indicated
where further research could be fruitful.
It is the positive effects I have seen in and experienced with my clients that
drove me to begin this research, and now to continue it in more detail in rela-
tion to this fast-developing field. For those with dementia, ‘Music is no luxury
… but a necessity, and can have a power beyond anything else to restore
them to themselves, and to others, at least for a while’ (Sacks 2007: 347).

Acknowledgement
I would like to thank Sven Koblischek formerly of Musikhaus Doblinger,
Vienna, for directing me to Professor Mag. Walter Deutsch.

References
Aldridge, D. (1993), ‘Music and Alzheimer’s disease – assessment and therapy:
Discussion paper’, Journal of the Royal Society of Medicine, 86: 2, pp. 93–95.
Bannan, N. (2008), ‘“Singing for the Brain”: Reflections on the human capa-
city for music arising from a pilot study of group singing with Alzheimer’s
patients’, The Journal of the Royal Society for the Promotion of Health, 128: 2,
pp. 73–78.
Barber, P. (2006), Becoming a Practitioner Researcher, London: Middlesex
University Press.
Berrol, C. F. (2006), ‘Neuroscience meets dance/movement therapy: Mirror
neurons, the therapeutic process, and empathy’, The Arts in Psychotherapy,
33: 4, pp. 302–15.
Blood, A. and Zatorre, R. (2001), ‘Intensely pleasurable responses to music
correlate with activity in brain regions implicated in reward and emotion’,
Proceedings of the National Academy of Sciences of the United States of America,
98: 20, pp. 11818–23.
Cooper, D. (1996), ‘Beginning with the body’, in J. Pearson (ed.), Discovering
the Self through Drama and Movement: The Sesame Approach, London:
Jessica Kingsley Publishers, pp.17–26.
Damasio, A. (2003), Looking for Spinoza: Joy, Sorrow, and the Feeling Brain,
New York: Harcourt.
Federman, D. J. (2011), ‘Kinesthetic ability and the development of empa-
thy in dance movement therapy’, Journal of Applied Arts and Health, 2: 2,
pp. 137–54.
Gabrielsson, A. and Lindstrom, E. (2001), ‘The influence of musical structure on
emotional expression’, in P. Juslin and J. Sloboda (eds), Music and Emotion:
Theory and Research, Oxford: Oxford University Press, pp. 223–248.
Hays, T. and Minichiello, V. (2005), ‘The meaning of music in the lives of older
people’, Psychology of Music, 33: 4, pp. 437–51.
Jung, C. (2001), On the Nature of the Psyche, London: Routledge.
Karas, Anton (1949), ‘The Harry Lime Theme’, in Wien, Du Stadt meiner
Traume, 2003,
Hamburg: The International Music Company, serial no. LC12281. Compact disc.
Koelsch, S., Siebel, A. and Fritz, T. (2009), Functional Imaging of Emotion with
Music (draft chapter of forthcoming book forwarded to me by Stefan
Koelsch), n.p., Oxford: Oxford University Press.

334
 The Song is You

Laban, R. (1948), Modern Educational Dance, London: Macdonald and Evans.

—— (1960), The Mastery of Movement, London: Macdonald and Evans.
Lehar, F. (1929), ‘You Are My Heart’s Delight’, in My Heart and I, Richard
Tauber, 1996, EC: Conifer Records Ltd, serial no. LC2727. Compact disc.
Levitin, D. (2007), This is Your Brain on Music: Understanding a Human
Obsession, London: Atlantic Books.
Levitin, D. and Tirovolas, A. (2009), ‘Current advances in the cognitive neuros-
cience of music’, The Year in Cognitive Neuroscience 2009: Ann.N.Y.Acad.
Sci., 1156, pp. 211–31.
Merleau-Ponty, M. (1962), Phenomenology of Perception, London: Routledge
and Kegan Paul.
Mozart, W.A. (1995), Die Zauberflote (The Magic Flute) – Highlights,
Philharmonia Orchestra and Chorus conducted by Otto Klemperer,
London: EMI Records Ltd. Compact disc.
Preston-Dunlop, V. (2008), Rudolf Laban: An Extraordinary Life, Alton: Dance
Books.
Ridder, H. and Aldridge, D. (2005), ‘Individual music therapy with persons
with fronto-temporal dementia: Singing dialogue’, Nordic Journal of Music
Therapy, 14: 2, pp. 91–106.
Rizzolatti, G. and Sinigaglia, C. (2006/2008), Mirrors in the Brain: How our
Minds Share Actions and Emotions, New York: Oxford University Press.
Rota, N. (1972), ‘The Godfather Waltz’, in Music of Italy (1999), London:
Cooking Vinyl, serial no. LC7180. Compact disc.
Sacks, O. (1991), Awakenings, Basingstoke and Oxford: Pan Macmillan.
—— (2007), Musicophilia: Tales of Music and the Brain, London: Pan
Macmillan Ltd.
Sesame Institute (2010), ‘Drama and movement therapy: The sesame appro-
ach’, London [published 2010].
Sieczynski, R. (1913), ‘Vienna, City of My Dreams’/’Wien, Du Stadt meiner
Traume’, in Wien, Du Stadt meiner Traume, 2003, Hamburg: The
International Music Company, serial no. LC12281. Compact disc.
Simonton, D. K. (2001), ‘Emotion and composition in classical music:
Historiometric perspectives’, in P. Juslin and J. Sloboda (eds), Music and
Emotion: Theory and Research, Oxford: Oxford University Press, pp.205–222.
Strauss, J. (I), (1848), ‘Radetzky-Marsch’, in 2002 New Year’s Concert, Vienna
Philharmonic conducted by Seiji Ozawa, 2002, Germany: Philips. Compact
disc.
Strauss, J. (II), (1868),‘Tales from the Vienna Woods’/ ‘Geschichten aus dem
Wienerwald’, in NewYear’s Concert 1990, Vienna Philharmonic conducted
by Zubin Mehta, Austria: Sony. Compact disc.
—— (1873), ‘Vienna Blood’/’Wiener Blut’, in 2002 New Year’s Concert,
Vienna Philharmonic conducted by Seiji Ozawa, 2002, Germany: Philips.
Compact disc.
Suter, G. (1996), ‘Drama as therapy: Some basic principles’, in Pearson, J. (ed.),
Discovering the Self through Drama and Movement: The Sesame Approach,
London: Jessica Kingsley Publishers, pp. 46–51.
Svansdottir, H. B. and Snaedal, J. (2006), ‘Music therapy in moderate and
severe dementia of Alzheimer’s type: A case-control study’, International
Psychogeriatrics 18: 4, pp. 613–21.
Thaut, M. (2005), Rhythm, Music, and the Brain: Scientific Foundations and
Clinical Applications, Abingdon: Routledge.
Reed, Carol (1949), The Third Man, London: British Lion Films.

335
Catherine Butler

BBC Radio 3 (2011), ‘This Week’s Composer’ [Radio broadcast], BBC Radio 3,
30 December.
Thompson, W. (2009), Music, Thought, and Feeling: Understanding the Psychology
of Music, New York: Oxford University Press.
Thornton, Sam (1996), ‘Laban and the language of movement’, in J. Pearson
(ed.), Discovering the Self through Drama and Movement: The Sesame
Approach, London: Jessica Kingsley Publishers, pp.78–83.
Thornton, Susi (1996), ‘Dance as you’ve never danced before!’, in J. Pearson
(ed.), Discovering the Self through Drama and Movement: The Sesame
Approach, London: Jessica Kingsley Publishers, pp. 84–93.
Wilkinson, N., Srikumar, S., Shaw, K. and Orrell, M. (1998), ‘Drama and move-
ment therapy in dementia’, The Arts in Psychotherapy, 25: 3, pp. 195–201.

Suggested citation
Butler, C. (2012), ‘‘The Song is You’: How music works in Sesame therapy for
clients with dementia’, Journal of Applied Arts & Health 3: 3, pp. 321–336,
doi: 10.1386/jaah.3.3.321_1

Contributor details
Cath Butler (B.A. Oxon) has an M.A. in Philosophy (Lancaster), and an M.A.
in Drama and Movement Therapy (Sesame) from CSSD, is currently Chair of
the Sesame Institute Council, and is continuing research into music, move-
ment and the psyche, alongside private therapy practice.
Contact: Sesame Institute (UK and International), Christchurch, 27 Blackfriars
Road, London SE1 8NY, UK.
E-mail: cbutler@phos-theatre.co.uk

Catherine Butler has asserted her right under the Copyright, Designs and
Patents Act, 1988, to be identified as the author of this work in the format that
was submitted to Intellect Ltd.

336
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