Vocal psychotherapy

1. Introduction

Version followed: Diane Austin's Vocal Psychotherapy (also called Austin Vocal Psychotherapy, AVPT) as set out in The Theory and Practice of Vocal Psychotherapy: Songs of the Self (Jessica Kingsley, ©2008; the publisher lists the paperback as April 2009), with detail from Austin's published interviews (Approaches 2010; Voices 2011; Enhance Life with Music podcast) and Wright's 2016 review of Austin's techniques. Source status: the book's chapter list is taken from the British Library record, the terms vocal holding, free associative singing and psychodramatic singing from the publisher pages, Austin (2004) from its ProQuest record, and the vocal holding and free associative singing steps from Wright's page-cited summary of the book (pp. 149–151, 158–159). The book's chapters on resistance (ch. 8), vocal interventions (ch. 9) and vocal holding techniques (ch. 10) are not paraphrased directly; procedural detail comes from Austin's own interview statements and page-cited summaries [uncertain where marked].

Vocal Psychotherapy is a depth-psychological, voice-centred form of music psychotherapy developed by Diane Austin (DA, ACMT, LCAT; Music Psychotherapy Center, New York; formerly NYU). Austin defines it as using breath, natural sounds, vocal improvisation, songs and dialogue inside the client-therapist relationship to bring about intrapsychic and interpersonal change [source: Approaches 2010; Voices 2011; BAMT course listing]. The client makes, listens to and makes sense of their own vocal sounds to reach unconscious material, memories, images and feelings; the method draws on regression, re-enactment and transference/countertransference [source: JKP publisher page].

How change happens (Austin's account): the relationship is the main healing factor; singing together builds safety and trust, lets the client regress to unmet developmental needs and have them met (being sung to, mirrored, heard), moves the client from the head into the body, and lets pre-verbal and defended feelings surface and be integrated. Repetition lets feelings sink in [source: Voices 2011]. Theory draws on Jung (parts of the self, individuation), object relations and Kohut (mirroring at any age), trauma theory, intersubjectivity and psychodrama (the double) [source: Voices 2011; UBC Press table of contents].

Professional frame: this is an advanced, post-qualifying method for music therapists. Austin runs a two-year certificate in Vocal Psychotherapy and Depth Psychology through the Music Psychotherapy Center, New York, in New York and as an international distance programme (UK cohort advertised via BAMT; earlier distance programmes in Vancouver and, for 12 years, Seoul; the international multicultural programme in England began in 2018 [source: BAMT podcast ep. 51]). Entry: qualified music therapists or therapists with a comparable skill set, by interview [source: BAMT listing; Voices 2011; Peterson podcast]. A 2025 review by a UK AVPT teacher-in-training describes the training as a two-year, process-based experience and says almost all trainees already hold a master's in music therapy [source: Warnock 2025]. Training includes in-person experiential intensives, online reading seminars and supervised practice with a volunteer client [source: Peterson podcast]. A 2024 university activity record of a training week names the model's components as Vocal Holding Techniques© and Free Associative Singing©, working through breath, natural sounds, vocal improvisation, songs and dialogue [source: Karl Landsteiner University record]. Austin states that free associative singing "really requires advanced training" plus personal therapy and supervision [source: Voices 2011]. Practise it under your own registration: in the UK, HCPC-registered music therapist (BAMT); in the US, MT-BC (CBMT/AMTA), plus a state psychotherapy or creative-arts-therapy licence where required (Austin holds the New York LCAT) [synthesis for the regulator mapping] [uncertain]. A verbal psychotherapist without music therapy training and Austin's certificate should not use vocal holding or free associative singing as regressive depth techniques. Breathing with a client, or listening to a song the client brings, is within ordinary psychotherapy [synthesis]. Module titles and training hours are not given here [uncertain].

2. Framework

This is not a manualised, phase-numbered protocol. Austin teaches a developmental sequence for vocal holding and says it is "NOT and never should be a recipe" [source: Voices 2011]. What follows is the structure her sources describe, with session-level organisation marked as synthesis.

Format and setting. Individual, usually long-term, in-depth psychotherapy in private-practice or clinical settings. Therapist sits at the piano (or another harmonic instrument) beside the client, in separate seats [source: Peterson podcast; Wright 2016]. The client guides content and pace and the therapist responds with sung and spoken interventions, so a session is closer to a sung psychotherapy hour than a sequence of activities [source: Warnock 2025]. Austin regards the whole session, even an all-talk hour, as an improvisation [source: Approaches 2010]. Session count: the sources used give no standard session length, frequency or number of sessions. Austin mentions a client who "comes every week", and other work she describes runs for about a year or longer [source: Voices 2011]; weekly sessions of ordinary psychotherapy length are therefore a reasonable default, not a protocol [synthesis]. The book's 13 chapters are in two parts: Part I, theory (the voice; Jungian psychology; object relations; trauma theory; intersubjectivity; the primacy of countertransference); Part II, clinical practice (7 Beginning a Practice; 8 Resistance in Vocal Psychotherapy; 9 Vocal Interventions; 10 Vocal Holding Techniques; 11 Free Associative Singing; 12 Songs; 13 The Therapeutic Process: Connection) [source: British Library catalogue record; UBC Press TOC]. Chapters 7–10 are not paraphrased here [uncertain].

Typical session arc [synthesis drawn from Approaches 2010; Peterson podcast; Wright 2016]:

Arrival and talk: what the client brings; listen to the speaking voice as music.
Breath: attunement and grounding, especially if anxiety blocks sound.
Toning / natural sounds: sound emerges on the exhale.
Vocal holding: two-chord container; non-verbal improvised singing (unison, harmony, mirroring, grounding).
Free associative singing, if words arise and the client has enough ego strength.
Settling: lullaby-like vocalising, resourcing statements or a known song.
Verbal processing, including (selectively) the therapist's countertransference.

Developmental stages within vocal holding [source: Voices 2011; Approaches 2010; Wright 2016 citing Austin 2008 pp. 146–151]. Two versions exist in the sources: in the 2011 interview Austin names three stages, unison, harmony and grounding, and then mirroring; Wright's summary of the book (pp. 149–151) gives two phases, unison and harmony, with mirroring and grounding as techniques inside the harmony phase. This guide follows the interview's three-stage order and treats mirroring as a technique usable in any stage. Either way, Austin says the order is not fixed and the client can return to unison when needed:

Unison (merging): goal is a safe, symbiosis-like connection for clients who lacked attuned early care.
Harmony (separating within connection): goal is felt separateness while still joined; includes mirroring.
Grounding (rapprochement): therapist holds the root; the client explores away and returns, like a toddler checking back with a caregiver.
Free associative singing: words enter; the emphasis shifts from containment to momentum and change.

Criteria for moving on [mostly synthesis; sources say only that the order is flexible and the client may return to unison when needed — Wright 2016 citing Austin 2008 p. 150]:

Unison → harmony: the client sings with ease, breath is free, and they start to vary pitch or show curiosity about their own line.
Harmony → grounding: the client tolerates different notes without collapsing back or stopping, and their improvisation moves away from yours.
Holding → free associative singing: words or phrases appear spontaneously; the client can step back and reflect afterwards; there is no history of uncontained regression or psychosis (Austin: unsuitable without enough ego strength to regress safely [source: Approaches 2010]).
Move back a stage at any sign of flooding, dissociation or shame.
Some clients start with a structured song and some go straight to free associative singing [source: Voices 2011].

3. Guiding principles

Relationship first. Austin calls the relationship "the most important part of the healing process" [source: Voices 2011]. Practical meaning: the music serves the connection, not a performance goal.
Not a recipe. Follow the client; never force a method [source: Voices 2011]. Practical meaning: choose the intervention from what the client needs now, not from stage order.
Safety and choice. The client can always decline; a method fails if the client feels unsafe [source: Wright 2016]. Practical meaning: offer, don't instruct; agree a stop signal.
Never force singing. Instruments, talking, or singing later are legitimate routes [source: Approaches 2010]. Practical meaning: treat reluctance as information, not failure.
Singing skill not required. The two-chord frame makes it "hard to make a mistake" [source: Peterson podcast]. Practical meaning: say so explicitly to anxious or trained singers.
The whole session is music. Speech melody, breath, movement and face count as part of the improvisation [source: Voices 2011; Approaches 2010]. Practical meaning: listen to how things are said as well as what.
Layers of listening. Attend to voice, body, countertransference and intuitive images [source: Approaches 2010]. Practical meaning: track all four while singing.
Countertransference as a primary instrument. [source: Wright 2016 citing Austin 2008 p. 88; Voices 2011]. Practical meaning: use what you feel in your body to shape sung interventions, after checking whose feeling it is.
"Whose feelings are these?" If a feeling leaves you once the client owns it, it was theirs; if it stays, it is yours to sit with [source: Voices 2011]. Practical meaning: a quick self-check before you voice a feeling.
Intersubjectivity: equal, different roles. Austin is more transparent and brings more of herself in, while keeping her role [source: Voices 2011]. Practical meaning: limited, purposeful self-disclosure.
One foot in, one foot out. Go into deep material with the client while staying grounded [source: Peterson podcast]. Practical meaning: keep your breath and pulse steady while matching their affect.
Neutrality is questionable when singing together. [source: Wright 2016 citing Austin 2008 p. 103]. Practical meaning: own your musical influence and discuss it.
Regression in the service of repair. Being sung to and mirrored can meet early needs; Kohut-style mirroring is needed at any age [source: Voices 2011]. Practical meaning: allow younger states inside a firm container.
Repetition lets feeling sink in. [source: Voices 2011; Wright 2016]. Practical meaning: repeat a key phrase rather than moving on quickly.
Breath and body before content. Reconnecting with the voice requires re-inhabiting the body [source: Wright 2016 citing Austin 2008 p. 20]. Practical meaning: ground before difficult material.
Therapist resilience and boundaries. Feel intense emotion without being flooded; positive mother transference can be "a very slippery slope" [source: Wright 2016; Voices 2011]. Practical meaning: personal therapy, supervision, firm frame.
Watch your own resistance. Using music to avoid talking, or avoiding music from low musical confidence [source: Approaches 2010]. Practical meaning: ask yourself why you chose music or words this time.
Self-supervision by recording. Austin records sessions (with consent) and found her own judgemental speaking tone that way [source: Approaches 2010; Voices 2011; Peterson podcast]. Practical meaning: get written consent; for minors, parental permission.
Mother tongue. Singing in the first language can bring feeling closer [source: Wright 2016 citing Austin 2008 p. 161]. Practical meaning: invite it, and you need not understand every word.

4. Intervention inventory

The interventions below are the ones named in the sources used. Austin's book has chapters titled "Vocal Interventions" (ch. 9) and "Vocal Holding Techniques" (ch. 10) (titles from the British Library record) that are not paraphrased here, so they may contain techniques not listed here [uncertain]. Steps are written in my own words. Example language is illustrative unless quoted. Room set-up for everything below: a harmonic instrument (piano, or guitar/keyboard), two chairs side by side or angled so the client need not face you, a door that closes, and sound-proofing or a neighbour agreement so the client is not inhibited [synthesis].

Hearing and voice safety (applies throughout) [synthesis]: screams, wails and loud sustained toning in a small, hard-walled room can reach levels that are uncomfortable for both people. Keep the piano soft under loud voices, add soft furnishings, and let the client turn away or cover ears. Stop sounds that hurt the throat (hoarseness, pain, coughing). Teach release on the exhale rather than pushing. Refer persistent hoarseness to an ENT or voice clinic before further loud work. Clients with tinnitus, hyperacusis or hearing aids need lower volume and a say over the instrument's loudness.

4.1 Breathwork (opening and attunement)

Purpose / when: grounding and attunement before any singing, especially when anxiety blocks sound; calming the nervous system; moving from head into body [source: Approaches 2010; Peterson podcast; Wright 2016 citing Austin 2008 p. 20].
Steps: (1) Invite the client to sit with feet on the floor and notice their breath without changing it. (2) Breathe audibly yourself, a little slower than the client, and match your rhythm to theirs first. (3) Offer a counted pattern; Austin describes something like in for four, hold for four, then a longer out-breath, lengthening the exhale over time [source: Peterson podcast]. (4) Link the out-breath to letting go of tension. (5) Notice shallow, held breathing as a way of controlling feeling, and name it gently if useful [source: Peterson podcast]. (6) Move to toning when the exhale is free, or stay with breath for the whole session if that is what is possible.
Example language (illustrative): "Let's take a breath together. No sound yet, just the out-breath." Austin's own cue: "let's take a breath" [source: Voices 2011].
Watch for: breath-holding, light-headedness (shorten counts and stop counted breathing if dizzy), panic in clients for whom breath focus is a trauma reminder (offer eyes open, a hand on the chair, or an object to hold) [synthesis]. Working when: longer exhales, shoulders dropping, spontaneous sighs.

4.2 Toning (sustained vowel sounds)

Purpose / when: often the opening sound of a session; restores bodily balance, releases tension, and offers a low-risk first sound [source: Wright 2016 citing Austin 2008 pp. 29–37; Approaches 2010].
Steps: (1) From breathwork, ask the client to let a sound ride the last few out-breaths. (2) Suggest an open vowel or a hum; any pitch is fine. (3) Join with your own tone so the client is not exposed alone [source: Wright 2016]. (4) Keep it sustained and unhurried, without melody. (5) Let the client vary vowel, pitch and volume. (6) Ask what they noticed in their body.
Example language (illustrative): "On the next out-breath, let a sound come with it. An 'ah' or a hum, whatever comes out. I'll do it with you."
Watch for: self-consciousness (go quieter, sound together, turn chairs); throat squeezing (return to breath). Working when: the sound becomes fuller and longer, and the client reports warmth, vibration or emotional release.

4.3 Natural (primal) sounds and playful sounding

Purpose / when: giving voice to pre-verbal states and to feelings that have no words: groaning, sighing, moaning, wailing, screaming; and play: babbling and nonsense sounds [source: Voices 2011; Wright 2016 citing Austin 2008 p. 133]. Austin describes a client's deep-breath "Ahhh" at session start as more primal than toning, and an emotional release [source: Voices 2011].
Steps: (1) Normalise: these sounds have no social setting, so most adults have suppressed them [source: Wright 2016]. (2) Model a sigh or groan yourself first. (3) Invite the client to make the sound that fits how they feel right now. (4) Mirror or accompany it with a sound or a soft drone. (5) Let primal sounds shift into recognisable emotions (fear, sadness, grief, anger) [source: Voices 2011]. (6) For playful sounds, use babbling or nonsense syllables back and forth.
Example language (illustrative): "If that tiredness had a sound, what would it be? I'll make one too."
Watch for: perfectionist or performance-trained clients who cannot make "ugly" sounds [source: Wright 2016]; screaming that strains the voice or alarms neighbours (agree on volume limits beforehand); escalation into flooding (go back to breath and holding) [synthesis]. Working when: the sound changes character, tears or laughter come, and the client reports relief.

4.4 Vocal holding: setting up the container

Purpose / when: Austin's core improvisation method (developed from 1994): two chords plus the therapist's voice make a stable, consistent, safe musical environment for improvised singing; it forms a bond, can be reparative and supports positive mother transference [source: Approaches 2010; Voices 2011].
Steps: (1) Choose two chords; Austin uses I and IV, not I and V, because V suggests an ending while I–IV keeps the music moving [source: Peterson podcast]. A drone can be used instead [source: Voices 2011]. (2) Choose a key that sits in the client's comfortable range; move keys to follow their pitch [synthesis, consistent with the requirement to play across keys — Wright 2016]. (3) Play a slow, rocking, lullaby-like alternation and keep it steady and predictable [source: Voices 2011; Wright 2016 citing Austin 2008 p. 147]. (4) Invite the client to sing on single syllables or vowels rather than words [source: Wright 2016]. (5) Join with your voice (see 4.5–4.8). (6) Keep the pattern going so the client never has to fill silence alone; let the client's body rock if it does.
Example language (illustrative): "I'm going to play the same two chords over and over. You can't get it wrong. Sing on 'ah' or 'la', anything at all, and I'll sing with you."
Watch for: the trance-like, intimate quality Austin describes [source: Wright 2016 citing p. 147] can deepen regression fast; keep eyes and contact available. Skilled singers may relax because the repetition removes "getting it right" [source: Wright 2016]. Working when: the client's breath and phrasing settle into the rhythm and they sing for longer stretches without checking with you.

4.5 Unison singing

Purpose / when: early in holding, or whenever the client needs merging, safety and being joined; for clients who lacked an attuned early caregiver [source: Wright 2016 citing Austin 2008 pp. 149–150; Voices 2011].
Steps: (1) Over the two chords, sing exactly the client's note and vowel. (2) Follow their pitch movements closely and a fraction behind. (3) Match volume and timbre. (4) Stay in unison until the client starts to vary or seems settled. (5) Return to unison later whenever the client seems frightened or alone.
Example language (illustrative): none needed; sing. Afterwards: "What was it like to have someone right there on the same note?"
Watch for: symbiotic transference and countertransference [source: Wright 2016]; clients for whom closeness is threatening (enmeshment, abuse by a caregiver) may need harmony or more distance from the start [synthesis]. Working when: sounds soften and lengthen and the client reports feeling held or accompanied.

4.6 Harmony

Purpose / when: experiencing separateness within relationship, after unison feels safe [source: Approaches 2010; Wright 2016 citing p. 149].
Steps: (1) Move from the client's note to a consonant interval (third or sixth) above or below. (2) Keep your line simple and supportive. (3) Move back to unison if the client loses their note or stops. (4) Gradually allow more independence in both lines.
Example language (illustrative): afterwards, "I moved to a different note. How was that, being two voices?"
Watch for: the client abandoning their own note to copy yours (stay in unison longer); anxiety at separation. Working when: the client holds their own line while you sing a different one.

4.7 Mirroring

Purpose / when: within harmony or at any point: the client feels heard and confirmed; Kohut-style mirroring [source: Voices 2011; Approaches 2010].
Steps: (1) Let the client sing a short melodic phrase (e.g. on "la"). (2) Sing it straight back, the same contour, rhythm and feel. (3) Leave space for their next phrase. (4) Keep the chords going underneath.
Example language (illustrative): "You sing a little phrase and I'll sing it back to you."
Watch for: mirroring that feels mocking or like an exam (soften, keep it warm, vary slightly) [synthesis]. Working when: phrases grow longer and more personal, and the client starts leading.

4.8 Grounding

Purpose / when: a home base for exploration; links to rapprochement, like a toddler moving away and checking back [source: Voices 2011; Peterson podcast; Approaches 2010].
Steps: (1) Sing and hold the root of the current chord (or a sustained tonic) steadily. (2) Invite the client to wander anywhere with their voice. (3) Do not follow; stay put. (4) Notice when they return to your note and let that be welcome. (5) Shift your root as the chord changes, keeping it simple.
Example language (illustrative): "I'll stay on this one note. Go wherever you like, and come back to it whenever you want."
Watch for: clients who cannot leave your note (go back to harmony) or who never return (check for dissociation, see 4.19). Working when: the client ranges more widely and returns freely.

4.9 Free associative singing

Purpose / when: grew out of vocal holding when words began to enter. Like Freud's free association but sung, with the therapist also singing and adding to the "musical stream of consciousness"; aims to reach unconscious images, memories and feelings [source: Approaches 2010; Voices 2011; Wright 2016 citing Austin 2008 pp. 158–160]. Austin says it is unsuitable for clients without enough ego strength to regress safely [source: Approaches 2010], and that it needs advanced training, personal therapy and supervision [source: Voices 2011].
Steps [source: Wright 2016 citing Austin 2008 pp. 158–159, except where marked]: (1) Keep the two-chord holding pattern going. (2) When the client sings a word or phrase, or brings a theme, mirror it back (4.7). (3) Invite them to keep singing whatever comes to mind, with no rhyme or sense needed, trusting that it will lead to unconscious images, memories and feelings. (4) Use repetition (4.10) and doubling (4.11) to deepen what emerges. (5) Shape the accompaniment for momentum and change: vary dynamics, tempo, rhythm and chord extensions (4.12). (6) Austin says a whole session can be sung [source: Voices 2011]; usually let the singing end naturally, settle (4.18), then talk [synthesis].
Example language (illustrative): "Keep singing, and let any words come. They don't have to make sense. I'll be singing with you."
Watch for: rapid regression, flooding, intrusive memories, loss of the observing self; switch back to non-verbal holding or breath, or stop and talk. Working when: the client reaches feelings or images they had not spoken before and can reflect on them afterwards.

4.10 Repetition

Purpose / when: within free associative singing, to intensify the affect of a word so its meaning sinks into the body; moves the client from head to body [source: Wright 2016 citing Austin 2008 p. 160; Voices 2011].
Steps: (1) Pick out a word or phrase that carries feeling. (2) Sing it back several times, or invite the client to repeat it. (3) Let the melody and dynamics change as the feeling grows. (4) Stop repeating once the feeling is fully present.
Example language (illustrative): sung, "So tired... so tired... so tired..."
Watch for: repetition turning mechanical or overwhelming. Working when: the voice changes (cracks, deepens, softens) and feeling shows.

4.11 Doubling (the double in first person)

Purpose / when: borrowed from psychodrama (Moreno): the therapist sings in the first person ("I") as the client, voicing feelings they may not yet be able to say. Austin realised while studying psychodrama that "acting as a double" described what she was already doing in free associative singing [source: Voices 2011; Peterson podcast; Wright 2016 citing Austin 2008 p. 160]. Terminology: the publisher's blurb names "psychodramatic singing" among the book's improvisation techniques [source: JKP and Hachette pages]; the term does not appear in the 2011 interview or in Wright's review, which speak of "the double". A 2025 review describes psychodrama methods in AVPT as singing about, to or as a significant person (see 4.15) [source: Warnock 2025]. How the book itself defines psychodramatic singing could not be checked [uncertain].
Steps: (1) Sit beside the client (doubling position). (2) Using empathy, intuition and countertransference, sing a short first-person line that might be true for them. (3) Leave room. The client either repeats it if it fits or changes it. (4) Accept corrections fully. Austin notes that even a corrected double deepens the process because the client moves further into the feeling [source: Peterson podcast]. (5) Keep doubles short and tentative.
Example language (illustrative): sung, "I'm so alone in this." Austin's example of a first-person reflection: "I feel lonely" [source: Peterson podcast].
Watch for: doubles that are really your own feeling or agenda (check "whose feelings are these?"); a compliant client who repeats everything (ask them to change a word, or ask afterwards what did not fit). Working when: the client corrects, extends or repeats the line with feeling.

4.12 Musical interventions in the accompaniment

Purpose / when: during holding and free associative singing, to reflect and support the client's process. Containment remains, but the emphasis shifts toward momentum and change [source: Wright 2016 citing Austin 2008 pp. 146–160].
Steps: vary (1) dynamics (soft to support fragility, fuller to support anger); (2) tempo; (3) rhythm and rests (silence to let a phrase land); (4) chord substitutions and extensions (7ths, 9ths, 11ths, 13ths) for colour and emotional nuance; (5) dissonance to create contrast or match conflict; (6) keys, to follow the client's pitch [source: Wright 2016].
Example language (illustrative): none; this is musical. Afterwards: "I noticed the music got louder when you sang about him. What was that like?"
Watch for: the music leading the client somewhere they did not choose; return to the plain two chords if unsure. Working when: the client's singing responds to and uses the change.

4.13 Singing the countertransference

Purpose / when: Austin works with induced countertransference (what she picks up in her body and gut) and sometimes names these feelings in song [source: Voices 2011].
Steps: (1) Notice a feeling or image in yourself during singing. (2) Ask whose it is. (3) If it seems to belong to the client, offer it in song as a tentative double (4.11) or a sung observation. (4) If it stays with you after the client responds, treat it as yours and take it to supervision.
Example language (illustrative): sung, "There's something heavy here... so heavy."
Watch for: your own history (Austin describes her own critical-mother countertransference being triggered by a client's judgemental voice [source: Voices 2011]). Working when: the client recognises the feeling as theirs.

4.14 Singing to or as the inner child

Purpose / when: for attachment injuries and pre-verbal wounds: re-parenting and reparative experience [source: Voices 2011].
Steps: (1) Agree the focus in words first. (2) Set up holding, often unison, lullaby-like. (3) Invite the client to sing to their younger self (comfort, reassurance) or as that younger self (needs, fears). (4) You can double the child's voice or sing the comforting voice, whichever the client chooses. (5) Close with settling (4.18) and adult-self reorientation.
Example language (illustrative): "Would you like to sing to the little one, or let her sing? I'll be with you either way."
Watch for: overwhelming regression; dependency on you as the good parent (transference "slippery slope" [source: Voices 2011]). Working when: the client can soothe themselves and reports compassion for the younger self.

4.15 Singing parts of the self, including confronting abusers

Purpose / when: Jungian parts work in song: clients sing different aspects of the self and can confront their abusers; new parts are mirrored and affirmed so they can be integrated. Austin's example: a client in her 50s first sang her anger, and Austin mirrored and affirmed it [source: Voices 2011]. This is also where the psychodrama methods of AVPT sit: singing about, to or as a significant person in the client's life [source: Warnock 2025]; possibly what the publisher calls "psychodramatic singing" [uncertain]. Jungian shadow work is part of AVPT training [source: Warnock 2025].
Steps: (1) Identify the part or the figure in talk. (2) Agree that the abuser is addressed in imagination only and that the client controls distance and can stop. (3) Over holding chords, let the client sing to the figure or as the part. (4) Double and mirror to strengthen the emerging part. (5) Settle and debrief; ask how this part can be in daily life.
Example language (illustrative): "That angry part hasn't had a voice before. Do you want to let it sing? I'll back you up."
Watch for: retraumatisation, dissociation, shame after anger; only do this with a stable client and a strong alliance [synthesis]. Working when: the client reports strength, and the new part shows up in later sessions.

4.16 Resourcing with essence statements

Purpose / when: choice and empowerment; sung "I feel", "I want", "I need" statements build self-awareness and identity. Austin presents naming an aspect of the self as the first step in separating from it [source: Wright 2016 citing Austin 2008 p. 160 and Austin 2004 p. 85].
Steps: (1) Over two chords, offer a stem. (2) The client completes it in song, repeating and varying it. (3) Mirror and repeat to anchor it.
Example language (illustrative): sung, "I need..."; spoken, "Finish it any way that's true right now."
Watch for: clients who cannot name any need (offer "I don't know what I need" as a valid start) [synthesis]. Working when: the statements become more specific and felt.

4.17 Gratitude singing

Purpose / when: a resourcing practice Austin adapted from 12-step programmes; the client sings what they are grateful for over a simple two- or three-chord structure [source: Wright 2016 citing Austin 2008 p. 161].
Steps: (1) Simple chords. (2) Invite a sung list of small gratitudes. (3) Mirror lightly.
Example language (illustrative): "Let's sing a few things that helped today, even tiny ones."
Watch for: use as a bypass of grief or anger (time it after, not instead of, difficult work) [synthesis].

4.18 Settling: lullaby-like vocalising

Purpose / when: after intense work, non-verbal lullaby-like sounds help the client settle and integrate [source: Wright 2016 citing Austin 2008 p. 161].
Steps: (1) Slow and soften the two chords. (2) Hum or sing a gentle line, or invite the client to. (3) Let it fade; breathe together; then talk.
Example language (illustrative): "Let's let the music get quiet before we stop."
Working when: breath slows and the client is present and oriented.

4.19 Responding to dissociation in singing: the return cue

Purpose / when: dissociation is a common trauma symptom; Austin can feel clients "leaving" during singing and sings a return cue, then may use movement and breath afterwards [source: Voices 2011].
Steps: (1) Notice signs (flat or distant voice, fixed gaze, loss of rhythm, no response). (2) Sing a cue to come back, using their name and the here and now. (3) Change the music to firmer, clearer chords. (4) After singing, stand, move, stamp feet, breathe, and orient to the room. (5) Talk about what happened and agree a signal for next time [steps 3–5 partly synthesis].
Example language (illustrative): sung, "Maria, come back to the room... feet on the floor... I'm here."
Watch for: repeated dissociation means the work is too deep or too fast; return to breath and songs.

4.20 Body rhythms and movement as music

Purpose / when: Austin treats foot-stamping, body rhythms, movement and facial expression as part of the music, and asks what they express [source: Voices 2011].
Steps: (1) Notice a movement. (2) Reflect it musically or verbally. (3) Invite the client to amplify it or give it a sound.
Example language (illustrative): "What are your feet saying?" [source: Voices 2011, Austin's question].

4.21 Singing in the mother tongue

Purpose / when: a second language can create emotional distance; first-language sounds may carry emotional memory. Austin describes a client who wept when she first sang in Japanese [source: Wright 2016 citing Austin 2008 p. 161].
Steps: (1) Ask about first language(s) at intake. (2) Invite singing or free associative singing in it. (3) Mirror sounds and melody without needing to understand. (4) Ask afterwards what came up, with translation only if wanted.
Example language (illustrative): "Would you like to try that in Japanese? I don't need to understand the words."

4.22 Songs the client brings: listening together

Purpose / when: clients bring songs or recordings; the pair listens and discusses music and lyrics; Austin calls this "quite an intimate moment" [source: Voices 2011; Approaches 2010]. Songs can carry projections and transference [source: Wright 2016 citing Austin 2008 p. 179].
Steps: (1) Invite the client to bring a song that matters. (2) Listen together without commentary. (3) Ask what drew them, which lines matter, and who it reminds them of. (4) Track transference themes (e.g. a song addressed to "you").
Example language (illustrative): "Play it for me. I'd like to hear what you hear in it."
Watch for: musical trauma triggers [synthesis]: a song tied to an abuser, a funeral, a cult or religious setting, or forced performance can trigger strong reactions. Ask at intake about music that is off-limits, check before playing anything, and keep volume moderate.

4.23 Singing known songs; songs as transitional objects

Purpose / when: pre-composed songs are safer than improvisation because the lyrics are familiar and the client controls more of the feeling; a song can comfort at session endings or between sessions and be taken away to sing when needed [source: Wright 2016 citing Austin 2008 pp. 179, 185]. Some clients start with a structured song [source: Voices 2011].
Steps: (1) Choose a song together. (2) Sing it with simple accompaniment, sharing or alternating lines. (3) Explore meaning afterwards. (4) For a transitional song, agree when the client will sing it during the week.
Example language (illustrative): "Is there a song you'd like to take with you this week?"

4.24 Non-singing routes

Purpose / when: Austin never forces singing; some clients prefer an instrument or talking, and singing may come later. In one case a pianist began to sing while playing, which paralleled her growing sense of self [source: Approaches 2010].
Steps: offer instrument improvisation, speaking-voice work, or talk; leave singing as an open option.

4.25 Verbal processing and selective sharing of countertransference

Purpose / when: after music, to integrate the experience; Austin sometimes shares her countertransference with clients during processing [source: Voices 2011].
Steps: (1) Ask what the client noticed in body, feeling and image. (2) Link it to their history and to the relationship. (3) Share your own response only if it serves the client [synthesis on criteria].
Example language (illustrative): "When you sang that line I felt very young and small. Does that fit anything for you?"

Not Austin's: warm-ups attributed by Wright to Thiermann (2011, p. 39), not to Austin: "motor lips" (air and sound blown through closed lips), slides or sirens on "ng" to find vocal breaks, and melodic mirroring, described as throwing a sound ball back and forth; they often bring laughter, and clients must feel safe and free to decline [source: Wright 2016]. They are useful icebreakers but are not part of Austin's model as far as can be verified. Thiermann's full reference could not be traced [uncertain].

5. Handling problems

Austin's book has a chapter titled "Resistance in Vocal Psychotherapy" (ch. 8; title from the British Library record); its content is not paraphrased here [uncertain]. Austin's view, as quoted from her 2004 dissertation, is that some clients need to be actively guided through resistance into unconscious feeling (see below). Guidance below is tagged by source; untagged steps in a [synthesis] item are my own.

Anxiety about singing, or refusal to sing. Austin may work this through or take it as a sign another modality is needed; she often starts with deep breathing when anxiety blocks singing, and never forces singing [source: Approaches 2010]. Concretely: begin with breath (4.1), then toning together (4.2) with you sounding first; turn chairs side by side; stress that two chords make mistakes nearly impossible [source: Peterson podcast]; offer an instrument or talk (4.24); revisit later.
Perfectionism and performance-trained clients. They may not allow "ugly" or primal sounds [source: Wright 2016]. The repetitive holding structure reduces pressure to "get it right" [source: Wright 2016 citing p. 147]. [synthesis]: give explicit permission for "wrong" sounds, model a crack or groan yourself, and avoid their trained repertoire at first.
Intellectual defences and staying in the head. Austin describes clients so defended that years of talk therapy did not reach feeling; singing can bypass the critical observer, and repetition and time let feelings sink in [source: Voices 2011]. Use repetition (4.10) and doubling (4.11); keep words few.
Client feels too exposed early on. Use ordinary talk-based techniques until safety builds [source: Wright 2016 citing Austin 2008 p. 95]. Songs are safer than improvisation (4.23).
Clients who need active guidance. Some clients "need to be actively guided through resistance" into unconscious feelings and unfamiliar territory [source: Wright 2016 quoting Austin 2004 p. 96, her NYU dissertation]. [synthesis]: name what you hear ("your voice drops every time you mention your father"), and propose one concrete sung step while keeping their right to refuse.
Overwhelm, flooding and retraumatisation [synthesis, building on Voices 2011]: stop words; return to non-verbal holding in unison; soften and slow the chords; breathe together; orient to the room; then talk. For the next session, agree a stop signal, shorter excursions and a settling ritual (4.18). Repeated flooding means move back a stage or pause depth work.
Dissociation. Sung return cue, then movement and breath [source: Voices 2011]; see 4.19.
Regression beyond what the client can hold. Free associative singing is unsuitable without enough ego strength [source: Approaches 2010]. [synthesis]: screen before regressive work for psychosis, mania, active self-harm or suicidality, current abuse, severe dissociative disorder, and substance intoxication. With these, keep to breath, songs and structured holding, alongside the client's wider care team.
Suicide or self-harm disclosed in song [synthesis]: stop singing and assess in words using your service's standard risk-assessment and safety-planning procedure; resume music only once the client is stable.
Transference and dependency. Vocal holding readily creates a positive mother transference; Austin calls it a "slippery slope" and requires personal therapy, supervision and resilient boundaries [source: Voices 2011]. [synthesis]: hold time boundaries firmly, interpret idealisation gently, and plan endings well ahead.
Countertransference confusion. Use Austin's check: does the feeling leave once the client owns it? If not, sit quietly with yourself and take it to supervision [source: Voices 2011]. Self-supervise from recordings [source: Approaches 2010].
Therapist resistance. Using music to avoid hard verbal processing, or avoiding music from low musical confidence [source: Approaches 2010]. Ask in supervision which you tend toward.
Ruptures [synthesis]: e.g. a double that felt intrusive, harmony that felt like abandonment, or a mirrored phrase that felt mocking. Stop the music, name your part, ask what it was like, and offer to return to an earlier, safer form (unison, a known song). The repair itself is reparative work in this model's relational frame.
Non-adherence (transitional songs not sung, sessions missed) [synthesis]: treat it as material, not failure; check whether the song became linked to something painful; make the between-session task smaller or drop it.
Musical trauma triggers [synthesis]: songs, hymns, lullabies or a parent's style of singing may be tied to abuse, shaming ("you can't sing") or forced performance. A client's tone may carry a critical parent's voice, as in Austin's "my mother's voice" case [source: Wright 2016 citing Austin 2008 p. 44]. Ask at intake about music and singing history, including any off-limits songs, and go slowly with lullaby-style holding if early care was abusive.
Hearing and vocal strain [synthesis]: see the safety note at the top of section 4. Keep loud work brief and agreed in advance, and refer persistent hoarseness to a voice specialist.
Children and young people [synthesis; the sources used describe adult practice, and Austin notes that recording minors requires parental permission — source: Peterson podcast]: obtain parental consent and the child's own assent; follow local safeguarding and mandatory-reporting duties for any disclosure; never treat a song, sound or image as evidence of abuse; use short, playful formats (call-and-response, known songs) rather than deep regression; involve carers as appropriate.
Recording [source: Peterson podcast; Approaches 2010]: get explicit, written, revocable consent; store recordings securely; destroy them per policy.
Physical contact: none of the sources used describes touch; Austin works through voice, breath and closeness of seating. Note that she says shared vocal vibration "can feel similar to being physically touched" [source: Wright 2016 citing Austin 2008 p. 30], and that she matches a client's rocking with the music (pp. 147–148), so vocal holding can feel intimate without any contact: check in about closeness and seating distance, especially with clients who were abused [synthesis]. If the client wants a hand on the shoulder during holding, agree it in words first, keep it optional, tell them they can say stop at any moment and check again before each use; respect cultural and trauma-related preferences [synthesis]. Never use sexual touch or touch near the genitals, and let the client withdraw consent to any contact at any time [synthesis].

Sources

Sources used:

Books cited (used through page-cited summaries):

Austin, D. (2008; paperback listed April 2009). The Theory and Practice of Vocal Psychotherapy: Songs of the Self. London: Jessica Kingsley. Page numbers cited via Wright (2016).
Austin, D. (2004). When words sing and music speaks: A qualitative study of in depth music psychotherapy with adults. Doctoral dissertation, New York University (ProQuest 3110989). Cited via Wright (2016) for pp. 85, 96 and 199; record only.
Thiermann (2011). Cited via Wright (2016, e.g. p. 39) for warm-up exercises; the full reference is not given in the sources used (it is not a chapter of Baker and Uhlig's 2011 Voicework in Music Therapy) [uncertain].

← Previous · VIII-059Culture-centred music therapy Next · VIII-061 →Liberation music therapy