From Whiteboard to Keyboard: The Role of Visual Aids in Online Music Therapy

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Crystal Luk

Music therapists have used visual aids to support communication, to support structure and to encourage exploration of clients’ emotions in clinic-based sessions. Are these benefits transferable to online practice? While online practice provides continuity during the pandemic, it also presents challenges including the latency between devices and the lack of shared instruments and resources between therapists and clients. This requires therapists to adapt and discover new ways of collaborating musically with our clients. This presentation explores how the use of visual functionality on virtual meeting platforms may foster musical connection with clients in the absence of ‘real-time’ improvisations.

Presentation Description:

This presentation will explore the role of visual aids in online Music Therapy sessions featuring 2 case studies with children with emotional difficulties. Opportunities of experiential activities and reflective discussions will also be provided.

The presenter will first set in context the challenges faced by music therapists in online sessions, including the time lag and the lack of shared instruments and resources in online sessions. However, online sessions also opened new opportunities. For instance, the use of digital visual aids is made possible by virtual meeting softwares, such as Zoom. Past literature has highlighted that the use of visual aids can support communication (Gadberry & Sweeney 2017; McCarthy & Geist 2014), support structure (Mayhew 2014) and encourage exploration of clients’ emotions (Mahn 2003) in clinic-based Music Therapy sessions. The use of visual aids in online sessions can provide a shared object of reference between therapists and clients that facilitate music-making and emotional exploration.

The first case study will demonstrate the process of music-making with an adopted 9-year-old girl through creating graphic scores. Prior to the transition to online session, we used to have imaginative play using musical instruments and shared objects of references. Moving sessions online meant we had to find new ways of interacting with each other playfully. We utilised her interest in different functionalities available on Zoom and created graphic scores using the shared whiteboard function as a guide of our music. The client was empowered by this exercise and we would take turn playing music according to the annotation on the graphic score, followed by verbal reflection of the experience.

Following the first case study, past literature on graphic notation of music in Music Therapy sessions will be discussed (Bergstrom-Neilsen 1993; Cohen and Giloa 2012). Short audio and visual examples of using graphic scores will be provided and practical steps of using whiteboard on Zoom will be demonstrated. There will be opportunities for some live attendees to create and respond to graphic scores. A discussion on the attendees’ experience will follow.

The second case study will demonstrate the use of customised emojis—graphic symbols that represent different emotions—to facilitate emotional recognition with a 10-year-old girl with anxiety disorder. The therapeutic goal is to support her to gain awareness in her emotions and to recognise physical sensations of high affect emotions, such as fear, anger and frustration, before she experiences emotional eruptions that lead to physical aggression towards herself and her loved ones. At the beginning of each session, I shared the customised chart with a list of 16 emojis on the screen and invited the client to circle the emoji(s) that represented her feelings on the day using the annotating function of Zoom. The client was encouraged to explore how her chosen emoji may sound like on the piano. The client was then able to reflect verbally on the bodily sensation she associated with a certain emotion, e.g. ‘frustration is an always buzzing, never-ending sound’.

Following the second case study, past literature on the use of emotion icons in therapeutic settings will be discussed (Erin 2018; Van Dam et al 2019). Van Dam et al’s study in 2019 suggested that adolescents using mental health services experienced an increased self awareness and a sense of empowerment when using emojis as a self-assessment tool for their moods. As such, the use of emoji may continue to be an age-appropriate resource when working with adolescents when clinic-based sessions resume again. Live attendees will be invited to design an ’emoji’ chart suitable for clients on their current caseload, followed by a discussion.

Towards the end of the presentation, there will be a brief discussion on the benefits and challenges of using visual aids, the range of clients who may find the use of visual aids empowering in online Music Therapy sessions, as well as the potential legacy of using digital resources to support clinic-based work in the future.

Learner Objectives:

  • Provide individualised Music Therapy experience to address client’s self-awareness and insight
  • Integrate current technology and interactive media
  • Utilize imagery
  • Develop advance technology and interactive media skills


Target Audience:

Students, Entry-level professionals, Experienced professionals

Presenter Biography:

Crystal Luk, MA, is a HCPC registered neurologic music therapist based in London, UK. She has experience working with children affected by life-limiting conditions at family homes, schools, hospitals, hospices and now online. Crystal is interested in discovering innovative ways to maximise clients’ experience in different settings.