Smile! The Importance of Affect

Affect in Music Therapy

In preface to this post, I want to define the word “affect” as it is used here. In psychiatric or psychological terms, affect basically refers the emotions expressed non-verbally by a patient or client. For example, you might hear or see terms such as flat affect (showing no emotion at all), blunted affect (showing little emotion), labile (shifting between intense emotions) or full range (appropriate display of emotions).

PC: Craig Toron

In the music therapy world, you hear many of the previously mentioned affective descriptions, and you might also hear things such as “bright affect” or “positive affect”, which essentially means pleasant expression, often accompanied by smiles, even laughter.

Eliciting a brightened affect from your client is generally regarded as a good thing. In fact, it could even be an objective, especially in a psychiatric or behavioral health setting. We know that smiling makes us feel good, and so at that very basic level, we know we are accomplishing something when we get smiles from our clients. But what I wish to focus on in this post is the role our own affects, or facial expressions, play in that process.

I regard my affect as an important therapeutic tool, maybe even more so than my guitar. My affect is the first thing a client or patient sees, and it’s the non-verbal signals I send that shape a client’s initial impression of me. I firmly believe that a first impression can significantly influence the rapport-building process.

Though I don’t practice this per se (not that it would be a bad idea!), I’ve thought about the characteristics I want to convey non-verbally when first encountering a client. I try to project two things: confidence and sincerity. I think this results in feelings of safety and trust, which sets the foundation for a therapeutic relationship. And this is applicable to more than just first encounters. Many of my clients have Alzheimer’s or other dementia diseases. I have to gain their trust every time I see them, and maintain it throughout a session.

I am fairly convinced that my non-verbal communication is the most important factor in maintaining rapport with my clients. Our non-verbal signals are interpreted at a subconscious level, and those interpretations manifest themselves as feelings. How a client feels around me is going to significantly impact the therapeutic relationship.

In addition to rapport-building, affect can be useful in the execution of music therapy interventions. I’m sure you’ve used facial expressions as a form of non-verbal prompt (like raising your eyebrows). I find that varying my affect can keep people engaged. Think about the exaggerated expressions you use with children – they serve a purpose! Additionally, people have a tendency to imitate or mirror the expressions of those around them. In other words, smiling is contagious!

I’ve been reflecting on this for the last couple years, and felt validated when Andrea Cevasco, Ph.D., MT-BC (University of Alabama) published an excellent article on this topic in the Journal of Music Therapy. The article is entitled, “Effects of the Therapist’s Nonverbal Behavior on Participation and Affect of Individuals with Alzheimer’s Disease During Group Music Therapy Sessions” (2010). I highly recommend checking out the study.

What her findings essentially suggest is that non-verbal behavior, affect, and proximity elicit a positive affect when used effectively and in combination, as opposed to those elements on their own. I would like to discuss the article more, but this is already such a long post!

Thanks for reading! I would like to know: how do you use facial expressions as a therapeutic tool with your clients? What other insights do you have on this topic?