Lullabies and Play songs

Theoretical Considerations for an Early Attachment Music Therapy Intervention through Parental Singing for Developmentally At-Risk Infants

By Marianne Bargiel

[Editors note: The article presented here is republished from the Canadian Journal of Music Therapy Vol. IX, no. 1 2002 with the kind permission from the publisher and the author. The article is translated from french to english for Voices by Shannon Venable.]

Summary

Following an overview of the literature on the musical predispositions of the newborn and on the development of attachment, this article elaborates a theoretical rationale on which is proposed a model of early intervention with parental singing. The author first looks at the links between regulation of affect and attachment, also taking a look attachment pathologies and how they inform us about healthy attachment. Then, the functions of Infant-directed speech (langage parental), and also by extension, Infant-directed singing (chant parental) are looked at in terms of their developmental impacts over the baby's regulation of affect. The suggested music therapy program is presented as a clinical articulation of a usually natural behaviour within parent-child dyad. Considering the importance of early intervention in order to prevent the crystallisation of dysfunction or its contamination over the whole development of the young child, this intervention model aims at recreating, preferentially with the parent's participation, the favorable relational conditions for a resumption or a continuation of the developmental sequence for the baby whose attachment is at risk because of endogenous or environmental reasons.

Introduction

This study considers the impact of lullabies and play songs, as well as parental singing in general. The theoretical considerations presented concern the elaboration of a program of early intervention in music therapy for infants whose attachment development appears to be at risk. The article begins with a review of the regulation of affect in the development of attachment and of attachment pathologies. It then considers the musical predisposition of the infant, in particular his or her auditory perception of the musical and vocal affect. A description of the form, content, and function of parental singing follows as a conclusion to this survey of the exploratory horizon and elaboration of a preliminary model of intervention for attachment within the parent-child dyad through the reactivation or optimization of the natural mechanism of parental singing.

The Regulation of Affect in the Development of Attachment

The regulation of affect is a continual process involving the emotional patterns of the individual in constant relation to the demands of the environment (Cole, Michel, & O'Donnell Teti, 1994), through which is created a process of a fundamentally adaptive nature (Cassidy, 1994). Several attachment models presuppose the existence of a biological predisposition in the baby to transmit signals and a biological predisposition in the parent to respond to these signals, all within the context of a process of regulation of the affect of the infant through the parent as intermediary (Ainsworth, 1973, Bowlby, 1989, & Lamb, 1981 in Kumin, 1996).

Kumin identifies four phases of the regulation of affect commonly evoked through diverse theoretical approaches (psychoanalytic theory, theory of object relations, self-psychology, and developmental research on infants). The first phase arises from the perception of danger, whether anticipated or experienced. In the second phase, a process of communication signals emerges. The reception of these signals develops in the third phase. The final phase consists of the mediation of danger through a defense mechanism geared toward reducing the experience of the anxiety. During the first months of the infant's life, the parent acts as an auxiliary ego in assuring the reception and the mediation of the baby's signals of anxiety. The parent's role is therefore fundamental in the development of the regulation of the affect of the infant because he or she reads the baby's signals and offers the infant the optimal appropriate stimulation; he or she assures a modulation of the sufficient alertness to permit the baby to stay organized (Field, 1994). If the development follows its normal course, the baby's ego becomes structured so that it can gradually take over to receive autonomously its own signals through the mediation of adaptive defense mechanisms (Kumin, 1996).

Shapiro and Stern (1989 in Kumin, 1996), on the other hand, hold that the infant's perceptual device is preset at a neurological level so that his or her attention is preferentially directed at the face or voice of his mother as a partial object. The study of the visual-facial signals of the newborn in early social development shows that the mother's face acts as a powerful environmental stimulus for the baby (Stern, 1974 in Schore, 1994). Babies demonstrate very early on an intense interest for the maternal face, following its look within the space (Izard, 1991 in Schore, 1994) and, at two months of age, the period that corresponds to the symbiotic phase according to Mahler, he or she stares at the mother's face with increasing attention (Maurer & Salapatek, 1976 in Schore, 1994). This might assist with the development of the object bond, the fundamental organizer of emotional, cognitive, and psychosomatic needs from early infancy to adulthood (Kumin, 1996). Hofer (1990, in Shore, 1994) suggests that the homeostatic individual systems of the baby and the mother are connected in a symbiotic state that allows for the mutual regulation of their vital endocrine systems and central nervous systems. Cole, Michel, & O'Donnell Teti (1994) refer in turn to the relation with the parent as a dyadic co-regulation. "Dyadic mirroring gaze transactions thus induce a symbiotic, psychobiologically attuned affect-amplifying merger state in which a match occurs between the expression of rewarding, arousal accelerating, positively hedonic internal states [.] This process of interpersonal fusion thus generates dynamic 'vitality affects' (Stern, 1985) (p. 82, Schore, 1994)." To describe this form of innate and archaic interrelation that exists within the infant before he can differentiate himself from his mother, Kumin refers to the terms pre-object state and prerepresentational stage. "Percepts (organized sensations), motor recognitions (actions which occur with familiar sights or sounds), and affective states are ingredients of this early [prerepresentational] organization (p. 114, Kumin, 1996)." This pre-object state permits interrelations of an essentially preverbal, sensory-motor, affective, and concrete nature that, at a neurological level, are founded on intermodal processes. Kumin (1996) sustains in effect that the perceptual system of the infant functions in a more global way rather than through a specific sensorial modality. The information received in the interrelational context might therefore be interpreted according to its qualities and characteristics more than according to the format (sound, visual, etc.) in which it reaches the baby's brain.

The Pathologies of Attachment

Attachment theories designate three types of attachment according to the constancy and reliability of the parental response to the infant's signals (Ainsworth, 1985 in Kumin, 1996). While a consistent response, that is to say quick and appropriate, facilitates the formation of a secure type of attachment, an inconsistent parental response contributes to the establishment of an uncertain or ambivalent attachment. In the case of a systematically rare or inadequate response, the formation of an avoidance type of attachment may occur. Kumin (1996) establishes a tie between the problematic types of attachment described by Ainsworth and certain severe adult psychopathologies such as anxiety problems (ambivalent attachment, associated here with the inconsistency of the response to signals of anxiety in the individual as an adult) and chronic depression, schizoid states, and psychosomatic problems (avoidance attachment, associated here with the negation of signals of anxiety in the individual as an adult). Certain emotional patterns might develop so that they interfere with the functioning, that is to say they interrupt other processes (e.g., attention, socialization) or block the regulation of the emotional experience and flexibility of expression. The deregulation of affect is therefore central to the deployment of psychopathology (Cole, Michel, & O'Donnell Teti, 1994).

Segal (1997, in Kumin, 1996) describes a multitude of situations that might eventually prevent the development of attachment through interruption or interference of the preobject relation:

For example, the infant may suffer an inborn anatomic or biochemical brain dysfunction that disturbs its capacity to process, experience, and regulate affect. Or the nature of the baby's distress is not amenable to extinction despite good enough caretaking, as in, for example excruciating pain from chronic illness that can be mitigated but not fully soothed by any quality or amount of holding. Or an internal disturbance may alter the infant's perception of the mother, distorting her capacity to respond adequately to need; such internal disturbance may lead to disturbances in the actual interact with the mother, which may then exacerbate the innate disturbance. Or the mother's actual capacity for good enough attunement may be temporarily impaired, disturbed, or limited because of family crisis, depression, or narcissistic injury [.] (p. 157, Kumin, 1996).

According to Kumin (1996), these situations correspond to the experience of a decathexis in the baby, or of a disinvestment on the part of the mother, and might lead to a significant narcissistic wound. Tyson and Tyson (1990 in Kumin, 1996) have demonstrated that the simulation of a maternal decathexis of only a few minutes (through the simple absence of facial reactions in the mother) is sufficient to sustain in the baby a level of dramatic distress (searching for the mother's look, physical agitation, and eventual retreat). "Decathected individuals cannot regulate their own affects, cannot receive their own signals of danger, and unconsciously treat the distressed parts of themselves as nonexistent (p. 165, Kumin, 1996)." The narcissistic wound that is engendered in this way creates in turn a disturbance of the ego that can hinder the formation and even the permanence of identity because without environmental mediation, there is not any internal support for the creation of mental representations, of internalized object relations, of ego defenses, of impulse neutralization, or of principles of reality. We observe then in the individual as an adult an incapacity to invest a representation of themselves (e.g. taking care of themselves) and to establish an integrated body image, that which might lead to poor self-esteem, an enduring narcissistic rage, and deep separation anxiety (Kumin, 1996). Furthermore, there might occur a persistent effect on representational thought and memory, typical of traumatic situations as Kunsta and Cohen understand them, that is to say when there is a failure to meet the needs of the infant (1983 in Kumin, 1996). In effect, the emotions act as self-organizing systems that incorporate out of necessity the cognitive and socio-contextual processes (Lewis & Douglas, 1998). At a sufficient intensity, emotions always activate or affect cognitive activity. "Emotion promotes coupling or linking up among conceptual elements, catalyzing their integration into larger wholes that are semantically meaningful. Emotion is thus the condition, or control parameter, for cognitive self-organization (p. 162, Lewis & Douglas, 1998)."

The Musical Predisposition of the Infant

"Musical skills that are evident in infancy, well before they have obvious utility, can be considered predispositions (p.3, Trehub, 2001)." The notion of musical predispositions in humans assumes there is a biological basis for music. A marked skepticism still exists on the part of the scientific community in general, as displayed, for example, by Pinker (1997 in Peretz, 2001). Nevertheless, the researchers who dwell in detail on the musical phenomenon observe through the entire world its importance in cultural transmission, ceremonies, work, and childcare. Furthermore, as Trehub (2001) notes, we might assimilate competence with performance, that is to say that the musical capacities of the average person without formal musical training are remarkable if we take into account the complexity of tasks needed for grasping a musical sequence enough to march in tempo with the feet, reproduce melodic segments with words, or sing along in harmony.

In fact, the distinction of the melodic contour is the dominant characteristic in listeners of a very young age (Trehub, 2001). Babies can distinguish a change in the melodic contour even when a distraction or delay of 15 seconds separates the original melody from the melody of comparison. They can also distinguish changing intervals in a brief melody that conforms to the musical conventions of their culture. A nine-month-old baby is capable of detecting an out-of-tune note in a scale at unequal intervals (e.g., tonal scales or ancient modes compared to scales through tones); this suggests that babies treat the heights of sounds by regrouping them as adults do. Babies of a prelinguistic age already demonstrate a hemispheric specialization in the brain for music with a preference in the right ear-and therefore of the left hemisphere because the auditory nervous system is arranged at an intersection between the two hemispheres.

The Affective Perception of the Infant for the Parental Language and the Parental Song

Two types of sources of emotion are connected to music: emotion intrinsic to the music and extrinsic emotion (Sloboda & Juslin, 2001). In the first place, most of the musical systems are structured according to an inherent stable pole, of a central note (e.g., keynote), through a tie to those other notes that are generally perceived as more or less unstable. The human emotional system typically responds through a variation of dynamic intensity from affective tensions to relaxations following the relative distance of the musical elements from the original pole (Bharucha, 1994 and Krumhansl, 1990 in Sloboda & Juslin, 2001). In the second place, the source of emotion might be associative, or extrinsic, when an emotional event is encoded in memory at the same time as the music and when the further identification of that music is sufficient to evoke, through conditioning, the recollection of the event or at least the affect initially associated with that event (Waterman, 1996 in Sloboda & Juslin, 2001). These associations are very diverse and generally idiosyncratic because they are intimately tied to the personal history of the individual.

Emotional perception in music (intrinsic emotional source) appears quite early on and is very likely innate (Masakata, 1999 in Peretz, 2001). For example, the four-month-old infant demonstrates a marked preference for consonance (Zentner & Kagan, 1996 in Peretz, 2001). In the adult, the decrease of the level of dissonance, or the augmentation of the level of consonance, corresponds to the activation of paralimbic structures associated with positive emotions (Blood, Zatorre, Bermudez & Evans, 1999). At three years of age, the child recognizes the joy in the music elaborated by its culture, and around six years he or she can identify sadness, fear, and anger (Terwogt & Grinsven, 1988, 1991 in Peretz, 2001). Dalla Bella and colleagues have demonstrated that at five years the child utilizes lively or slow character in tempo to base his or her emotional judgment on the distinction of joyful and sad musical extracts, and that at six years, like an adult, the child utilizes at the same time the signs of the tempo and the mode (major/joyful and minor/sad) to attribute an affective value to a musical extract (Dalla Bella, Peretz, Rousseau & Gosselin, 2001). There exists therefore at the same time a constancy and a remarkable precociousness concerning the emotional recognition in the music, one that corroborates the results of studies on babies' recognition of facial expression and is therefore linked to the core of the theory of biological predisposition (Peretz, 2001).

Moreover, babies can decode vocal expression much more than facial expression (Oatley & Jenkins, 2001 in Juslin, 2001). For example, a sad vocal expression is associated with a slow rhythm, a weak intensity, a weak intonation, and less energy in the high frequencies of the harmonic spectrum, parameters that the baby can recognize at an early age (Juslin & Laukka in Juslin, 2001). Besides, the utilization of songs in childcare is very widespread (Trehub, Schellenberg, 1995 in Tregub & Trainor, 1998) and is a practice that has roots in ancient and universal oral tradition. Furthermore, the human brain has cortical regions that are highly selective and specific for the perception and treatment of the human voice (Belin, Zatorre, Lafaille, Ahad, & Pike, 2000).

In the literature, scholars utilize the terms motherese speech or infant-directed speech (IDS) to designate the distinct way that adults as well as preschool-age children address babies (Kitamura & Burnham, 1998; Trehub, 2001). I have translated this term arbitrarily in French as "langage parental" (parental language).Based on the results of a series of experiments with six-month-old babies, Kitamura and Burnham (1998) have demonstrated that babies respond more to the affective qualities of parental language than to its linguistic characteristics, this having led them to think it might express a phylogenetic evolution of the primate's use of graduated vocal signals. Humans therefore share with other species the capacity to extract from the vocalizations of fellow creatures information about their identity and the affective tenor of their message (Belin, Zatorre, Lafaille, Ahad & Pike, 2000). We have known for around twenty years the distinct acoustic parameters of parental language: the voice is more high-pitched, with more of the higher variations, a slower rhythm, shorter enunciation, and longer pauses (Fernald & Simon, 1984 and Stern, Spieker, & McKain, 1982 in Kitamura & Burnham, 1998). This particular prosody, which nicely accommodates the attentional and perceptual immaturity of the baby (Fernald, 1992 in Kitamura & Burnham, 1998), is presented in an almost universal manner (Papousek, Papousek, & Symmes, 1991 in Kitamura & Burnham, 1998). Additionally, babies demonstrate a positive affect when they hear a text pronounced with a positive affect (Fernald, 1993 in Kitamura & Burnham, 1998). Kitamura and Burnham (1998) have identified three developmental hypotheses regarding the function of parental language: to engage and maintain the (limited) attention of the baby; to permit emotional communication and socialization; and to facilitate language acquisition.

[.] if there is a reduction in the communication of affect, then the course of language development will be slowed, suggesting that the infant's motivation to learn to communicate is influenced by the heightened affective salience of the caregiver's speech. Further, this feature of maternal speech has the capability of regulating or modulating infant behavior. (p. 235, Kitamura & Burnham, 1996 in Kitamura & Burnham, 1998)

From this perspective, parental language is therefore an essential component in the baby's regulation of affect and in the development of object ties.

Lullabies and Play Songs-the Survival Function of Parental Singing?

We have seen how all societies possess a distinct musical genre dedicated to calming babies or putting them to sleep from the moment of their birth. This transcultural genre, designated as the lullaby in Western societies, privileges certain sonorous patterns such as humming, syllables without signification, onomatopoeia, the repetition of syllables, and the diminutives of words (Trehub & Trainor, 1998). In reference to the term parental language as we have defined it above, we utilize as a musical counterpart the expression parental singing. This evokes a repertoire of lullabies and play songs (translated in French as "chansonnettes" in the original text) habitually drawn from a traditional source and directed toward a very young listener with the specific objective of calming or stimulating. But like the term infant-directed speech, it also refers to a typical manner of singing that, expressively, is systematically different from the adult's regular manner of singing. According to Trainor, Clark, Huntley, and Adams (1997 in Trehub, 2001), parental singing is higher-pitched, slower, and possesses a greater vocal emotional quality than regular singing that is not addressed to a baby. This typical style is found not only in the mother, but also in the father (Trehub, Unyk, Kamenetsky & al., 1997 and Trehub, Hill, & Kamenetsky, 1997 in Trehub, 2001) and in preschool-age children who sing to their little brother or sister (Trehub, Unyk, & Henderson, 1994 in Trehub, 2001). Bunt and Pavlicevic (2001) denote in the literature on infant psychological development (e.g., Papousek, 1996) the existence of a musical code at the heart of the interaction between newborns and their mother:

In addition, they 'tune in' to subtle shifts in vocal timbre, tempo, and volume variations, and with their mothers negotiate and share a flexible musical pulse between them, constantly adapting their tempo, intensity, motion, shape, and contour of their sounds, movements, and gestures in order to 'fit' and to communicate with one another. (p. 193, Bunt & Pavlicevic, 2001)

According to Trehub, Unyk, and Trainor (1993 in Trehub, 2001), adults without formal musical training can very easily distinguish a lullaby among two melodies of the same culture and tempo, as well as identify a lullaby in a foreign culture. The simplicity of the structure and repetition evoked by Unyk, Trehub, Trainor and Schellenberg (1992 in Trehub & Trainor, 2001) are probable indicators for identifying this musical genre. In general, the text of children's songs is distinguished by the use of a process of repetition (Dissanayake, 1992 in Trehub & Trainor, 1998). There is an abundance of phrases, words, syllables, repetitive rhymes, and a play on consonants or vowels through repetition of initial syllables or liberal alliteration of the traditional rules of semantics. Foreign or ancient words, liberal alterations of pronunciation, and syllables without signification are also utilized frequently. Repetition is also found in the melody: repetitions of refrains, of musical phrases, and of notes are sometimes congruent with repetitions in the text. Play songs take place later in the child's development, toward the end of the first year (Suliteanu, 1979 in Trehub & Trainor, 1998). They are more lively and often incorporate body percussions to mark the beat, gestures that accompany the text and the child's participation, and a diminished emphasis on vowels and greater use of consonants through a play on sounds using rhyming, alliteration, and repetition.

There is a great interindividual diversity in parental singing, but a surprising intra-individual stability (Trehub, 2001). Within an interval of two weeks or more, the singing of a mother to her baby varies less than a semitone and less than three percent in tempo (Bergeson & Trehub, 2001 and Trehub & Bergeson, 1999 in Trehub, 2001), which is below the variability reported in adults outside of the parental context. These usually memorize intervals varying within an average of 2 ½ tones and around eight percent in terms of tempo comparing to the original recording. This stability in the adult in a parental situation might be explained by the ritualized nature of parental singing whereas the process of memorization might be state-dependant (Levitin, 1994 and Levitin & Cook, 1996 in Trehub, 2001), This reminds us of the notion of extrinsic musical emotion described by Sloboda and Juslin (2001). On the baby's part, we observe that he or she listens to parental singing with a heightened level of attention relative to the adult's normal singing (Masataka, 1999; Trainor, 1996 in Trehub, 2001). Moreover, at six months, babies demonstrate a more sustained interest in their mother's singing on video than to her language (Trehub & Nakata, 200 and Nakata & Trehub, 2000 in Trehub, 2001).

Fewer studies focus on the relationship between the baby's arousal, in comparison to attention, and parental singing (Fernald, 1991 in Trehub, 2001; Trehub & Trainor, 1998). Nevertheless, parental singing seems to act as a regulator of alertness, as suggests the Shenfield and Trehub (2000 in Trehub, 2001) study that analyzed the saliva samples of six-month-old babies before and after a ten-minute-long episode of parental singing. The measures of cortisol levels, known as an indicator of the intensity of stress, showed a significant variation inversely proportional to initial cortisol levels. The infants who had a more elevated initial cortisol level displayed a lower rate of cortisol after listening to the parental singing, while infants who had a lower initial cortisol level displayed, on the contrary, a higher rate. These results suggest therefore that the singing might serve as a regulator of alertness by reducing the state of alertness in the baby who has an elevated level of cortisol, or vice versa.

The lullaby evokes a variety of functions: song of love and praise toward the child, song to lighten the work of parenting, magical incantation that increases the sense of the parent's control and invokes sleep in the baby, or outlet for the adult's difficulties to a listener who does not understand the words (Trehub & Trainor, 1998). Farber (1990 in Trehub & Trainor, 1998) describes Babylonian and Assyrian lullabies dating from the first century BC that say babies' tears disturb the divine order. But in all likelihood, the primary and concrete function of the lullaby is to calm or induce sleep in the baby. In comparison, the objectives of play songs are more didactic (e.g., learning alphabetical or numerical sequences) and have the benefit of stimulating the young child. Schore (1994) considers that parental singing permits a gradual increase of the tolerance to the affective tension, a major developmental task in the first year of life, and that this leads to an increased tolerance of intense positive affects of joy and excitement typical of the age in which the child becomes mobile and visual contact becomes the primary way of connecting with the mother. In summary, these elements have as a common denominator the maintenance of the closeness in the parent-child dyad and the optimization of alertness and development in the baby. Trehub (2001) sustains, moreover, a hypothesis in which parental singing has a survival function and serves to promote the affective ties between the baby and the parent. The favorable effects of the singing on the levels of arousal of the infant (reduction of tears, induction of sleep, increase in the positive affect) might stimulate the recurrence of this parental behavior and thereby counterbalance the physical and psychological burden of childcare, favoring in this way attachment and, consequently, the well-being of offspring who are so vulnerable during the first years of life.

A Music Therapy Model of Early Intervention through Parental Singing

The section that follows proposes a preliminary model of music therapy intervention for parent-child attachment that attempts to integrate the principal theoretical considerations discussed thus far. The music therapist is particularly designated as a professional who implements interventions and is specifically trained to: a) observe and note the sonorous parameters of physical and vocal expression (e.g., rhythmic patterns, heights of sounds, vocal timbre, etc.); b) manipulate the sonorous parameters in order to facilitate adapted responses in terms of the affective processes (e.g., regulation of the affect) or cognitive processes (e.g., preferential attention, etc.); and c) measure the behavioral changes induced by a given sonorous intervention.

The program provides for one or two initial evaluation sessions with the parent-child dyad that will lead to a complete initial music therapy assessment. Different profiles of parents and children may benefit from the program. From the list of situations that are liable to interfere with the development of the attachment proposed by Segal (1997 in Kumin, 1996), the intervention can address those dyads in which the baby has delayed development due to an organic etiology (anatomical or biological) that disturbs the child's capacity to process, experiment with, or regulate his or her affect; a level of distress caused by a chronic painful illness, or by intense or recurrent discomfort. It might similarly address those dyads in which the parent demonstrates either a temporary incapacity to adjust in coregulation with his or her baby due to a family crisis or depression, or a distress attributable to a personal narcissistic wound or any other chronic psychopathological condition. The initial assessment needs therefore to equally aim at the relational and object capacities of the parent and infant, as well as the objectal dynamic with respect to the dyadic relationship. Outside of the classical elements for evaluating in therapeutic counseling (purpose of the consultation, motivation and receptiveness of the parent, etc.), the principal items to explore are: a) the parent's propensity to establish and sustain an attachment bond with his or her child and vice versa; b) the level (frequency, duration, intensity) of visual contact between the parent and child; c) the presence and level of adaptation of spontaneous parental language (expressivity, synchrony, etc); d) the presence and level of adaptation of spontaneous parental singing (vocal timbre, sonorous volume, range, tempo, imitation of the sounds of the baby, etc.); e) the representation and level of pleasure that the parent has his or her own voice, the act of sing, or his or her overall musical history, and his or her relationship to music (musical genogram, musical preferences, musical forces, techniques, or talents, potential traces of trauma associated with music or with singing or speaking voice, the presence of amusia or musicogenic epilepsy, etc.); the presence of congenital amusia, musicogenic epilepsy, or of a peripheral hearing difficulty in the infant; and g) the quality of the object tie in the parent, the nature of his or her past and present attachment relationships and his or her capacity for affective self-regulation. As with all evaluations of this type, the assessment might highlight difficulties requiring a parallel or primary therapeutic intervention-or even legal if an abuse situation is identified-other than that which is in question here, in which case the appropriate references need to be made (e.g., a major episode of depression in the parent or infant might warrant a medical opinion; shaking baby syndrome; etc.). That said, the evaluation is undertaken in a therapeutic context from the beginning, through direct interaction with the dyad rather than according to a formal and exclusively verbal evaluation procedure.

The dyadic modality is preferable to that of a group, at least initially, in order to minimize the sonorous level of the environment and to facilitate the detailed observation of the baby by the parent and the therapist. However, a second stage may be offered in the form of an open support group for maintaining the musical repertoire of the parents and their motivation to use this medium by sharing their results with others. Taking count of that which represents the temporal dimension in the life of a baby, we propose biweekly sessions for ten weeks for the initial stage (twenty sessions), at the end of which a second music therapy assessment is completed. The sessions might subsequently take place weekly, or, as needed, continue biweekly for a second period of ten weeks. A third music therapy assessment will then evaluate the effectiveness of the intervention. At this time the parent can be offered the opportunity to participate in an open group of parental singing and, if necessary, given the necessary references for other family resources, individual therapy, etc.

The intervention plan evidently depends on the needs identified at the time of the initial assessment and focuses in turn on the parent and the child. On the side of the parent, for example, it might include, without being limited to, the following general objectives: a) to understand the importance of parental language and of parental singing in the baby's development; b) to initiate spontaneous attachment behavior; c) to have the reflex to respond vocally to the baby's sounds and signals of anxiety; d) to enrich his or her lullaby and play song repertoire; e) to become conscious of changes in the affective state of the baby and of his or her levels of anxiety and arousal; f) to recognize the need of the baby for increased or limited stimulation; g) to synchronize a vocal response adapted to the baby's signals of anxiety; h) to maintain a sustained interaction with the baby (or with the therapist); etc. Certain general objectives might be common to both parent and infant (e.g.: b) to initiate spontaneous attachment behavior or g) to maintain sustained interaction). The plan for intervention also takes into account objectives that are specific to each dyad participant. For example, the general objective "b) to initiate spontaneous attachment behavior" might operationalize by "humming in rhythm with the baby's movements" on the part of the parent, by "leading his or her gaze toward the music source" for the infant or also, "smiling in response to the expression of a positive affect" on the part of one or the other. In a more general manner, the intervention will aim at assisting the parent with facilitating "the infant's information processing by adjusting the mode, amount, and timing of information to the infant's actual integrative capacities" (p. 86, Papousek & Papousek 1984 in Schore, 1994) and with increasing the chances for the latter to live the experiences of cathexis.

In terms of procedures, each session comprises three phases: to begin with, a moment of exchange (the baby's recent developmental achievements, changes in family life, observations and reactions to parental singing since the last session), followed by the interaction, literally speaking, of the parent-baby-therapist triad in the verbal and singing modes, and, to finish, the preparation of the parent to continue with certain distinct elements of the session. Knowing that the experience of cathexis tends to generate for the baby "vitality affects" (Stern, 1985 in Shore, 1994), the therapist should try to sustain precisely this, more at a sufficient quality than quantity, by increasing the extrinsic sources of musical emotion through parental singing. But since the feeling of joy inversely increases the search for contact and the impression of unity with the object (Schore, 1994), the accent is placed not only on the playful dimension of the vocalization and on the pleasure of the singing, but also in parallel on the induction of positive affects in the baby and in the parents through the intrinsic emotional properties of the music. Thus, among other things, can be privileged the use of tonal melody, of major mode, more upbeat tempi, and of consonance for the superimposed voices and for harmonic musical accompaniments. We must remember, however, that these elements are inspired by a body of research that is still very recent, limited, and sparse. It is not, therefore, a question of making a strict, prescriptive use and of limiting it. Furthermore, the preferences of the parent and of the child take precedence above all. It is also important to keep in mind the fact that the threshold of the baby's arousal is normally much lower and that it is necessary during prolonged interactions for the child to periodically break visual contact according to brief cycles of attention/inattention; it is also important that the parent modulate the sonorous, visual, and tactile stimulation in a sensible manner in order to avoid potentially disorganizing levels (Schore, 1994).

Among the most utilized techniques, we mention first of all the importance of behavioral modeling by the therapist while he or she is speaking or singing with and for the baby or with and for the parent, thus acting as an auxiliary ego for the one and as needed for the other. Listening to recorded songs selected by the parent or by the therapist is equally utilized as reading the words of songs on paper and the repetition of a new repertoire. Last, but not least, improvisation from the baby's movement and voluntary or involuntary sound constitute a dominant aspect of the program. The techniques of clinical improvisation described by Bruscia (1987) are utilized as much through instrumental play as through vocal play. Notably, as Pavlicevic remarks, clinical improvisation has numerous similarities with the "dynamic forms" (p. 5, Pavlicevic, 1990) characteristic of mother-child interaction. In accordance with the musical experience and ease of the parent, the therapist might also encourage him or her to improvise the words along with a recognizable melody, or to create their own melodies to their liking. The exploration of certain dimensions such as the past relational experiences of the parent might also at certain moments be advantageously supported by role-playing and improvisation with instruments. The musical repertoire groups together traditional songs, lullabies, and play songs of all cultures, of musical material conceived specifically for children, of songs composed by the therapist or by the parent, along with vocal improvisations. In these last three categories, we privilege the following musical and paramusical elements: a) repetition in the text: phrases, words, syllables or rhymes; b) repetition in the music: rhythmic and melodical cells, the alternation between refrain and couplet, musical phrases, or reiterated notes; c) foreign or ancient words; d) free modification of words and syllables without signification.

Contrary to other types of music therapy programs, one does not find here in the musical equipment a large instrumentation since we aim more at reproducing concretely a real-life situation than engaging in projective therapeutic work through the medium of sound. A tambourine and some rattles and sound blocks might be used, but the dyad would most likely benefit from the use of the baby's own sound toys or of other familiar objects from around the house to play along with the song or evoke responses to the sound environment. Nevertheless, around ten instruments of various formats and materials might be reserved for the role-playing work or to support the emotional investment of the parent who has difficulty letting go of his or her inhibitions enough to sing or vocalize. An audio cassette or compact disc player is also equally necessary, as well as a book of traditional songs, lullabies, and play songs in a written format that can remain open to the desired page without the help of hands (which will be occupied with the baby) and easily added to from week to week. In summary, the program's equipment needs are modest and incidentally permit the music therapist to visit the familial environment if necessary (e.g. for the initial assessment or to facilitate access to therapy when there are young siblings).

Conclusion

The theoretical elements seem to converge to justify the utilization of parental singing in order to support the emergence or the consolidation of a secure attachment in infants who are developmentally at-risk. The cohesive and socializing function of music, combined with lullabies' and play songs' function in regulating affect and arousal, might together contribute to achieving a natural, simple, and economical familial approach. Very certainly, due to the universality of parental singing, there must exist within the pool of music therapists, psychologists, occupational therapists, speech therapists, and special educators pieces of empirical knowledge concerning such a type of work with the parent-infant dyad. However, the application of a structured model is apparently still to be experienced with infants showing signs of slow development that might be attributable to, or aggravated by, a difficulty with the level of attachment.

Without pretending to have a miracle cure, we pose the hypothesis that such an intervention with the infant and his or her parents might help the infant to develop minimal intrapsychic structures that could lead to the development of a secure attachment founded on an object bond. By inscribing this in a non-invasive and non-medicalized philosophy, we reckon that intervention through parental singing can facilitate the alliance of work with the parent or parents entirely to their own benefit on their own terms for regulating their own affect, as well as acting at a very fundamental level in the prevention of mental health problems and within the familial and societal nucleus. It is very evident that only experiment will testify to the soundness of the hypothesis presented. We hope that this theoretical description will inspire, or at the least encounter, the experience and intuition of clinicians and researchers interested in early childhood development.

Acknowledgments

The author wishes to thank Ms. Irene Gericke, ATR, adjunct assistant professor in the Creative Arts Therapies Masters program at Concordia University for her persistent interest in music therapy. This article is based on research supplied by the Fonds pour la formation de chercheurs et l'aide à la recherche (FCAR), now Fonds québécois de la recherche sur la nature et les technologies (NATEQ).

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Voices: A World Forum for Music Therapy (ISSN 1504-1611)