The Musicality of the Psychotherapeutic Voice: Confessions of an Honorary Irishman 

by Professor Brett Kahr

Copyright © 2020, 2021, by Professor Brett Kahr.
Please do not quote without the permission of the author.

“Why doth iarring voyces ∫o much di∫content the eare.”
[“Why do jarring voices so much discontent the ear.”]

(Wright, 1601: 251)

As a very young psychology trainee in my early twenties, I decided to embark upon my own personal psychoanalysis. Keen to find a truly skilled and kindly Freudian practitioner, I registered for as many conferences and lectures as my full-time student diary would permit, hoping that, by doing so, I could “check out” some very senior clinicians.

One sunny Saturday morning, back in the early 1980s, I attended a seminar in Central London, delivered by a distinguished Consultant Psychiatrist from the Tavistock Clinic who offered a very wise and compassionate presentation about his clinical work, which impressed me greatly. This gentleman conveyed himself as a psychoanalyst of considerable experience, modesty, and friendliness, who shared his expertise in a most generous and enriching manner. Unlike many of his colleagues, he did so in a very soothing vocal style. He talked slowly, calmly, thoughtfully, and memorably, and I soon became quite intrigued.

He also spoke with a most pleasant, musical Irish accent; and I eventually discovered that although this psychoanalyst had worked for decades in Hampstead, in North London, he had actually grown up in Dublin.

Everything about his man impressed me, from his attitude towards his patients to the actual tones of his speech. Not long thereafter, having developed a powerful Freudian infatuation, I plucked up the courage to telephone him for a preliminary consultation; and in due course, I embarked upon a multi•year psychoanalysis at a frequency of five sessions per week. I enjoyed the analysis tremendously and I would like to think that this intensive immersion into the psychotherapeutic process made me not only a much better clinician in my own right but also a much sturdier and more creative person.

It may amuse readers to know that, after a few years of daily visits to this man’s consulting room in Hampstead, only a stone’s throw from the Tavistock Clinic where I trained as a student and then worked as a member of staff, I soon began to imitate my Irish psychoanalyst’s voice – quite unconsciously, it must be said. In fact, although I have never spent more than a day or two in Ireland at any one time, many people who met me back then would often ask, “So, Brett, are you from Dublin? How long have you been living in England?” Through my unconscious identification, I had, no doubt, begun to incorporate certain vocal qualities of my wonderful psychoanalyst and yearned to speak exactly as he did.

Having enjoyed such an enriching relationship with my psychoanalyst over the years, and having retained some of his vocal musicality, I would very much like to believe that I might still qualify as an honorary Irishman!

Regardless of one’s theoretical orientation – whether humanistic-integrative, existentialist, systemic, psychodynamic, and so forth – those of us who work in the mental health profession have no shortage of skills and qualities and insights which we bring to our consulting rooms. As colleagues will know only too well, each of us strives to demonstrate our reliability with good timekeeping; moreover, we endeavour to adhere to appropriate professional boundaries to ensure the physical and psychological safety of our patients; additionally, we cultivate our fine memories so that we can recall all the details of our patients’ complicated life histories; and, furthermore, we do our very best to unravel and interpret the hidden meanings of our patients’ communications. Perhaps, above all, each of us, as psychotherapeutic practitioners, works very hard to convey appropriate tenderness and curiosity and concern through our facial expressions, our questions, our comments, and, through the very atmosphere that we create.

But what about the tone of our voice? In spite of having toiled in the psychological trenches for more than forty years, I know of few, if any, teachers or supervisors who have commented upon the vocal qualities of their trainees. Indeed, many clinical supervisors might berate a student by exclaiming, “You really should have asked about such-and-such”, or “Why didn’t you link this dream to that early childhood trauma?”, or “You ought to have given the client more space before interpreting”, and so on and so on.

Although we invariably focus, often in very great detail, upon the content of the work of our supervisees, we rarely ever comment upon the sound or the style of their physical voices. And although we might advise our students to read more professional papers, or to write up their case notes in more detail, I do not know of a single psychotherapy trainer, myself included, who has ever lambasted a trainee: “Your voice is too harsh … too loud … too monotone. You really need some vocal coaching or some singing lessons!”

Fortunately, most of our colleagues do speak in a thoughtful and pleasant manner but, from time to time, I have encountered members of our profession who talk in very muted tones and who seem to have no capacity to communicate their thoughts in a full and rich timbre. Many seem not to know that they actually possess a diaphragm which might allow them to vocalise in a much more resonant style. Sometimes, those with very muted voices have led very mediocre lives and have made few, if any, contributions to the field. I have always wondered whether these softly spoken colleagues have actually helped their patients to own the full authority of their voices and whether their patients might unconsciously identify with such inhibition and passivity and remain somewhat gloomy, if not depressed.

While some colleagues speak in too meagre a tone, other colleagues communicate in too harsh a manner. I shall never forget one noted London psychoanalyst who spoke entirely in augmented fourths. For those with a musical background, just imagine a human being who articulates each and every sentence by alternating between a middle C and an F#. That particular person not only talked in a deeply unpleasant manner but also managed to irritate all of her colleagues by being very destructive and markedly anti-collegial while serving on committees. I find it hard to imagine that such abrasive vocality does not reflect or reveal the underlying, unprocessed aggressivity of this complicated person.
It has always surprised me that, in spite of the fact that all psychotherapists have proven ourselves to be great listeners, we may not always be great talkers. And although the professional literature brims with no shortage of publications about how to listen to the unconscious, we boast very few contributions about how to speak in particular tones or in particular styles. Some years ago, the distinguished American relational psychoanalyst and jazz saxophonist Dr. Steven Knoblauch (2000) published a truly trailblazing book entitled, The Musical Edge of Therapeutic Dialogue – one of the few worthwhile contributions to this important subject. But, in spite of the originality and utility of this tome, which I heartily recommend, we cannot always interrogate ourselves or our colleagues about something so amorphous and fleeting as the human voice.

Indeed, I cannot think of a more difficult topic about which to write than that of the psychotherapist’s tonality and resonance and timbre. How on earth can one demonstrate the importance of vocal qualities in the context of a written communication, with no attached audio track? Nonetheless, in spite of the challenge of theorising about the voice, I would, at least, wish to place this underappreciated topic on our conversational agenda so that each of us might begin to think about this aspect of our work in much more detail.

As we know, ugly sounds and brutal noises can drive us insane; and a parent who yells at a child can, of course, induce great fear and harm. I recently read a most compelling memoir, written by the American ballet dancer Robert La Fosse, who recalled one of his rehearsals with the great choreographer Agnes de Mille. According to La Fosse,

Agnes had one especially irritating habit. She’d lean on her cane, watching rehearsals with an eagle eye, then suddenly, without warning, she’d bang on the mirror with this monster ring she wore on her left hand. The piercing sound was totally unnerving. It got our attention all right! Even in the midst of the most chaotic rehearsals, we’d stop dead in our boots.

(La Fosse and Wentink, 1987: 87)

In similar vein, Richard Rodgers, the famous Broadway composer, known for his musicals such as Oklahoma!, South Pacific, and The Sound of Music, recalled that his father, Dr. William Rodgers – a somewhat vitriolic physician – could induce great fear, simply by speaking: “Though his anger was rarely turned on me, the strength of his voice frightened me so that even today a loud voice makes me uncomfortable” (Rodgers, 1975: 7). Upon reading this reminiscence, it seems unsurprising that Richard Rodgers, the son, ultimately came to devote his life to the creation of beautiful musical sounds as a landmark composer – an art form that he could control, and which provided a pleasant contrast to the ugly noises produced by his father.

Happily, most mental health professionals refrain from banging our wedding rings on mirrors in the middle of psychotherapeutic sessions, and few of us will become so angry that we induce fear in our patients. By contrast, most of us comport ourselves with sufficient sensitivity so that our voices do, in fact, become part of the healing process.

But perhaps we need to foreground this topic more fully.

Professor Sigmund Freud made brief, passing references to the voice in some of his most iconic case histories (e.g., Freud, 1895a, 1895b, 1905, 1909), and he knew, only too well, the difficulties of losing one’s voice. For instance, in 1910, after he had contracted influenza, he wrote to his Hungarian colleague, Dr. Sándor Ferenczi, lamenting the fact that, as a result of his illness, his voice had disappeared (Freud, 1910). But in spite of his sensitivity to human vocality, Freud and the other iconic founders of our profession did not engage systematically with the details of human speech, especially from a musical perspective.

We do know, however, that during the 1940s, a little-known Manhattan-based psychoanalyst, Dr. John Thurrott, offered some rather sage observations about the role of the voice in the psychotherapeutic encounter. As Thurrott explained to his patient, Lucy Greenbaum (later known as the memoirist, Lucy Freeman), “Actors control their voices as they portray feelings of pleasure or pain” (Quoted in Freeman, 1951: 263). He then underscored that psychoanalytical workers, by contrast, “betray our feelings unconsciously by tone and tempo” (Quoted in Freeman, 1951: 263). He also emphasised that, regrettably, “Some use their voice as a weapon, to whip others. Some use it as a concealed weapon” (Quoted in Freeman, 1951: 264). Dr. Thurrott became quite sensitive to the tonality of the human voice, in part, because of his own pleasant speech. As his patient reminisced, “It was not what he said so much as how he said it. His voice was always even, compassionate, rich with wisdom – truly an invitation to trust” (Freeman, 1951: xiv). This little-remembered portrayal provides us with an important reminder that our patients and clients benefit not only from our wise cognitive insights but also from the very style in which we verbalise our words.

As we know, when a mother or, indeed, a father coos to a newborn baby, this proves to be a vital developmental experience. The pleasant voice provides not only a Winnicottian holding environment but also a facilitating environment as well (cf. Winnicott, 1955, 1956, 1959, 1960, 1962, 1963a, 1963b, 1963c, 1963d, 1963e, 1963f, 1965, 1969, 1986) which welcomes the infant into the world, and which helps the young child to grow. Likewise, a warm-hearted and containing psychotherapeutic voice might well be of great importance for the unfolding of a rewarding encounter between a clinician and a client. Some years ago, I wrote a short chapter about the key ingredients of the psychotherapeutic process, focussing at some length on what I came to describe as the “tonal factors” (Kahr, 2005: 10) of treatment, examining not only the pitch of our voice but also its volume, its cadence, its flow, not to mention our use of words, grammar, sentence structure, and the wealth of our vocabulary. I elaborated upon this theme subsequently in my book on How to Flourish as a Psychotherapist (Kahr, 2019).

The voice of the psychotherapist, like that of the attentive, kindly parent, can both “hold” and “facilitate” the growth of the patient and ensure a greater sense of attachment security and understanding. Years ago, a male patient collapsed on my psychoanalytical couch in tears, having recently received a very cutting telephone message from his cruel mother on the answering machine. He described his mother’s voice as “deafeningly acidic” (Quoted in Kahr, 2005: 11) and this broke his heart. I listened quietly and permitted this man the space in which to cry and to express his anger, and, in due course, he whispered to me that, unlike his mother, “You have a firm voice, but it never explodes. Thank you.” (Quoted in Kahr, 2005: 11).

I regret that I have not written more about the quality of our speech over the years, and I very much hope that colleagues might be inspired to help us all flesh out this vital, but underexplored, aspect of our work in greater detail.

The voice of the psychotherapist not only soothes and stimulates and heals, but it also attracts clients into our offices and, on a very pragmatic level, thus increases the size of our clinical practice. Over the years, quite a considerable number of patients have told me that, while searching for a psychotherapist, they had rung my answering machine, just to hear a sample of my voice, and that, owing to what many regarded as my pleasant, “honorary Irish” tones, a number of these individuals decided to request a formal consultation. I only wish that I could encapsulate the precise features of those tones which proved so appealing to these prospective patients, but I cannot do so readily. I can, however, underscore that the voice has certainly played a vital role in welcoming new clients into my consulting room.

Not only does the voice of the clinician play a potentially vital role in our work but so too does that of the patient or client. Many years ago, the distinguished British physician, Dr. Thomas Horder – one of Donald Winnicott’s teachers at St. Bartholomew’s Hospital in London during the Great War and beyond (Winnicott, 1978; Kahr, 1996; cf. Neve, 1983) – noted that the tonality of the patient often provides the medical practitioner with important diagnostic data. As he explained, “Voice sounds are, in general, of less service in diagnosis than are breath sounds: For this reason they are by some observers wholly discredited. But to do this is to forfeit a valuable means of obtaining clinical data” (Horder, 1918: 84). Thus, for those of us who have devoted our careers to the practice of mental health, we might be able to learn a great deal about our patients by the qualities in their voices. Moreover, we might well be in a position to monitor any changes in our patients’ mental structures over time by noticing an improvement in the vocal qualities of the women and men and children with whom we work (whether volume, speed, timbre, and so forth). When we have the privilege of noticing such alterations over time, whether a more robust voice or a more mellifluous one, we can thus obtain some further helpful data about the progress of our clients, knowing that the tonality of these individuals might well be among the best of diagnostic radars (cf. Winnicott, 1931, 1936, 1971, 1977).

The role of the voice in human psychology has preoccupied our forefathers and foremothers for centuries. One need only glance at the works of the great playwright William Shakespeare to appreciate the vital role of our vocal resonance in human interactions. For instance, in The Tragedie of Hamlet, Prince of Denmarke, written circa 1599 to 1601, the eponymous Danish prince exclaimed, “Pray God your voice, like a peece of vncurrant Gold, be not crack’d within the ring” (First Folio, Actus Secundus, Scena Secunda, lines 442-444). Likewise, in Shakespeare’s As You Like It, also written circa 1599, the character of “Corin”, an elderly shepherd, emoted, “And in my voice mo∫t welcome ∫hall you be” (First Folio, Actus Secundus, Scena Quarta, line 85). Thus, for the Bard of Stratford-upon-Avon, the human voice could either represent something shrill which could be “crack’d” or, by contrast, could serve as a source of great “welcome”. One need not be a literary scholar to appreciate the obvious parallels with the voice of the clinical psychotherapist.

When conducting an assessment of a new patient or client, we have an obligation to take a full history; to investigate whether the patient might, in any way, pose a risk to himself or herself or to someone else; to monitor our private countertransference responses; to establish a treatment contract (e.g., regular days and times of meeting, an affordable fee, and so forth); and to begin to forge a working alliance, thus creating an atmosphere of trust and safety in which our new visitor can become sufficiently comfortable to share his or her most painful secrets and most aggressive fantasies and anxieties. But we also have an opportunity to listen carefully to the resonance and mellifluousness of the patient’s voice (or lack thereof), as a source of further data. Likewise, we have an opportunity to use our own vocal tonality to help establish an atmosphere in which psychological work may unfold.

Although we deploy our voices throughout every single session of our psychotherapeutic work, few of us have written about this instrument, few of us have theorised about it, and few of us have examined the voice of the clinician, as well as that of the patient, with any degree of intensity or detail. I make no claims to be an expert on this topic. Instead, I simply wish to help highlight the potential role of vocality and other tonal factors in the unfolding of psychological work and I hope that this short contribution might stimulate further collegial discussion.

Clearly, when, in my twenties, I became an honorary Irishman, I did so not only out of admiration and respect for my very own Dublin-born training analyst, but also because I found his voice so soothing that I hoped I could incorporate something similar into my own clinical work and into my very own physicality. Consequently, in view of my admiration for the Irish voice, I look forward to discussion and collaboration with my colleagues across the waters in the hope that each of you might help to shed some light on this much neglected, but essential, aspect of our daily clinical encounters.

Professor Brett Kahr is Senior Fellow at the Tavistock Institute of Medical Psychology in London and, also, Visiting Professor of Psychoanalysis and Mental Health in the Regent’s School of Psychotherapy and Psychology at Regent’s University London. He has authored fifteen books and has served as series editor of an additional seventy titles. His single-authored books include: How to Flourish as a Psychotherapist; Bombs in the Consulting Room: Surviving Psychological Shrapnel; and, most recently, Dangerous Lunatics: Trauma, Criminality, and Forensic Psychotherapy. Professor Kahr can be contacted at Kahr14@aol.com.

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