We’re excited to have Molly Hicks, MMT, MT-BC write this guest post about her experiences as a music therapist, and practitioner and teacher of yoga. For her bio, please refer to the Contributors tab at the top of the page. Please feel free to leave comments here to continue this discussion. It is our intent that this will initiate a new series of posts exploring the integration of music therapy with other healthcare practices and disciplines at the end-of-life. If you feel this speaks to your current practice, please feel free to reach out to us about contributing.
I recently completed yoga teacher training after being a practitioner since my adolescent years. The primary goal of obtaining my teaching certification was to grow in my own practice and understanding of the rich discipline and lifestyle that is yoga, but I was also curious about the possibilities for integrating yoga into my hospice and bereavement music therapy practice. Although a recent job change and resulting opportunity to develop a new music therapy program has focused my clinical priorities in a different direction, I’ve been reflecting on how yoga practice and philosophy has informed my music therapy practice and philosophy. Although yoga is complex and multi-faceted, two of its main elements are breathing disciplines (pranayama) and postures (asana). The practice of breathing and moving mindfully on my yoga mat shifts the way I think about and navigate through the world, which necessarily affects my life as a music therapist. This impact extends from an increased sense of centeredness to better awareness of breath when I sing. Additionally, when I examine and apply concepts contained within yoga philosophy to related aspects of music therapy, my understanding of my work is expanded. I will illustrate this through discussion of how the koshas, loosely understood as the five layers of self, may shed additional light on the therapeutic triangle at end of life.
In general, yoga focuses on fostering conscious breathing and uniting breath with movement. Putting the breath first in this equation is intentional. A teacher of mine reiterates often, “Without the breath, there is no yoga.” Prana, the Sanskrit word for breath, means “life force,” underscoring its importance. Specific breathing disciplines, or pranayama, are practiced separately from or along with yoga postures. Pranayama is necessary in part because it is so easy to breathe in a manner that is shallow and automatic. This natural human tendency diminishes prana and interferes with our ability to be centered. Dirgha pranayama, or complete breath, is a practice I value for bringing my mind back to the present moment, helping me feel embodied, and preparing my singing voice. This practice involves taking deep, full breaths, visualizing the breath entering the lower, middle, and upper parts of the lungs and emptying in reverse order. When repeated, it becomes a meditation, taking on an entrancing rhythm that serves to focus and ground me. This pranayama guides my attention to the parts of my body that support and produce my most valuable instrument, leading to a greater reverence for my lungs, diaphragm and vocal chords as they work together. Increased vocal awareness and support helps my voice to be richer, more dynamic, and more responsive to the client’s shifting needs. Conscious breathing affirms my life force and that of my clients, and plays a part in renewing my energy to continue working in end of life care.
Most people think of a series of movements, or postures, when they hear the word “yoga.” Yoga postures are sequenced to stretch and build strength in the body’s major muscle groups. But postures are actually a means to an end. In Sanskrit, the term for yoga posture is asana, meaning, “to sit.” Historically, yoga postures were done for the main purpose of preparing the practitioner’s body to remain in seated meditation for long periods of time. Doing yoga postures while breathing mindfully is a type of rehearsal for the everyday work of moving consciously through life’s experiences and interactions. For instance, if I can maintain deep breaths while on the mat in a twisted posture, I can breathe deeply off the mat when I feel figuratively “twisted.” Breathing through the challenges presented by a series of postures prepares me to sit in the present moment with my clients, witnessing both their struggles and revelations. Building physical strength fortifies my emotional self and allows me to be with discomfort, which is essential for sustaining continued work in hospice. It is important to me to engage in a series of postures daily, but I am also able to perceive the benefits of yoga after only a short time on the mat. Even when I’ve practiced for a mere 15 minutes, I notice a positive difference in my level of relaxation and grounded-ness during the workday. This has great implications in the area of guiding meaningful music therapy sessions. My body and mind have less tension, which helps my overall energy to flow more freely and improves my ability to do everything from making intuitive decisions about interventions to playing guitar without getting a knot in my shoulder. Therefore, practicing yoga postures is good for my body, but is just as important in facilitating my life off of the mat, including my work as a music therapist.
The observable and lived results of yoga practice can be positive and far-reaching, as illustrated by how these benefits have translated into my music therapy work. But I have also been influenced by yoga philosophy, which has provided a new theoretical lens through which to view music therapy. The concept of the koshas comes to mind as an especially useful, holistic model with which to make this link. The koshas are understood as the five layers contained within the physical, subtle, and casual bodies of each individual. The practice of yoga uncovers the pearls of wisdom and moments of joy within each kosha: annamaya (physical), pranamaya (breath), manomaya (thoughts/feelings), vijnanamaya (intuition/wisdom) and anandamaya (bliss/soul). Through movement and breathwork, the yoga practitioner engages in an ongoing inquiry, shifting awareness from one kosha to the next while maintaining a mindset of loving-kindness. There is no particular sequence through which the koshas should be navigated. This may be compared to the exploration of different aspects of self in a therapeutic setting. The inquiry of the koshas can be challenging, especially when blocks of stagnant energy are encountered. The guidance of breath empowers the yoga practitioner to examine and work with these blocks, rather than giving in to the urge to escape the associated emotions and sensations. A parallel can be drawn to how the therapist guides the client to work through resistance. In addition to these brief examples, the koshas can also serve to further illuminate the role of each actor in the therapeutic triangle (client ßà music ßà music therapist).
The client’s changing physical body, often the main visual reminder of impending demise, makes the annamaya kosha an obvious focal point for energy. However, through music therapy clients frequently and successfully rise above the limitations of their bodies to spend time exploring other koshas. For example, a client who experiences increased physical relaxation in response to music and imagery may begin to connect more easily with the pranamaya kosha. This increased breath awareness may bring the client in touch with emotions present in the manomaya kosha, perhaps opening the door for musical life review and processing of anticipatory grief. The client may access vijnanamaya kosha as a part of internal and external processing of thoughts and memories related to the music, extracting wisdom from their experiences by viewing them from a different vantage point. This has the potential to lead to existential work at end of life, as the client may spend more time considering the meaning of life and what happens after death. Working through these questions offers the potential to awaken the anandamaya kosha, which may provide a deeper connection to the universal human experience.
Perhaps easiest to conceive of is how music engages each of the koshas, as music can be a full body experience. Music produces physical responses within the annamaya kosha such as reduction of pain, visible relaxation, affective changes, and rhythmic movement. The breath of the pranamaya kosha is impacted by such influences as tempo, active engagement in singing, and directive relaxation techniques. Music engages the manomaya kosha when thoughts and feelings arise in response to musical elements like dynamics and timbre, are triggered by lyrical themes, and emerge out of past experiences as well as those occurring within the therapeutic relationship. Turning to the vijnanamaya kosha, music can contain deep meaning and wisdom that provides comfort and context for exploring end of life issues. Finally, there are aspects of music that extend beyond definition and category, and related encounters with music that occur within the anandamaya kosha and can only be described as blissful.
My knowledge of the koshas assists me in moving through my yoga practice and guiding others through theirs. In addition, I find the lens of the koshas helpful in the continual process of self-awareness as a therapist. Being physically present and aware of the annamaya kosha is crucial to authenticity and establishing a relationship with the client. Furthermore, I need my body to be healthy in order to use my instruments to their full potential. Moving to the pranamaya kosha, my breath and energy must be in my conscious awareness to allow me to remain present in my physical body and support my singing voice. Checking in with the thoughts and feelings contained in the manomaya kosha allows me to identify countertransference and help shed light on the evolving therapeutic process. Awareness of these dynamics frees me to tap into my intuition and respond to shifts in the clinical environment, engaging vijnanamaya kosha. I encounter the anandamaya kosha as a powerful flash of clarity and connection, wherein I am reminded of my link to each of my clients and every other human being, a reminder that I am part of something much larger than myself.
My hope is that many of my clients can encounter that sense of transcendence during music therapy. Similarly to yoga, music has the power to at once root us to the earth and set us free to glide through the skies. Both music and yoga guide me back into the present moment, where I can recognize where I am in life and work on letting go of what might happen next. I am assured that continued practice in this area will serve me well when I face my own death. I am also immensely comforted by the words of Swami Ram Tirth, who shares a breathtaking perspective on the transcendent potential of the dying process, verses infused with essences of yoga and music:
“Oh death, go and strike my body: I have millions of bodies to live in. I will dress myself in the moonbeams, in the gauze made of fine silvery threads, and pass my time in tranquil rest. I will sing my songs in the form of hill streams and brooks, in the form of the rolling waves; I will move on…Lo, I go, I go, with nothing in my possession.”