Music Therapy

WHAT IS MUSIC THERAPY?

Music therapy is an interpersonal process in which the therapist uses music and all of its facets-physical, emotional, mental, social, aesthetic, and spiritual-to help clients to improve or maintain their health. In some instances, the client's needs are addressed directly through music; in others they are addressed through the relationships that develop between the client and therapist.

WITH WHOM IS MUSIC THERAPY USED?

Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance abuse, communication disorders, interpersonal problems, and aging. It is also used to: improve learning, build self-esteem, reduce stress, support physical exercise, and facilitate a host of other health-related activities.

WHERE DO MUSIC THERAPISTS WORK?

Music therapists work in general hospitals, psychiatric facilities, schools, prisons, community centers, training institutes, private practices, and universities.

WHAT DO THE CLIENTS DO IN MUSIC THERAPY?

What makes music therapy different from every other form of therapy is its reliance on music. Thus, every session involves the client in a musical experience of some kind. The main ones are improvising, re-creating, composing, and listening to music.

• In those sessions which involve improvising, the client makes up his or her own music extemporaneously, singing or playing whatever arises in the moment. The client may improvise freely, responding spontaneously to the sounds as they emerge, or the client may improvise according to the specific musical directions given by the therapist. Often the client is asked to improvise sound portraits of feelings, events, persons, or situations that are being explored in therapy. The client may improvise with the therapist, with other clients, or alone, depending on the therapeutic objective.
• In those sessions which involve re-creating music, the client sings or plays precomposed music. This kind of music experience may include: learning how to produce vocal or instrumental sounds, imitating musical phrases, learning to sing by rote, using musical notation, participating in sing-alongs, practicing, taking music lessons, performing a piece from memory, working out the musical interpretation of a composition, participating in a musical show or drama, and so forth.
• In those sessions which involve composing, the therapist helps the client to write songs, lyrics, or instrumental pieces, or to create any kind of musical product, such as music videos or audiotape programs. Usually the therapist simplifies the process by engaging the client in easier aspects of the task (e.g., generating a melody, or writing the lyrics of a song), and by taking responsibility for more technical aspects (e.g., harmonization, notation).
• In those sessions which involve listening, the client takes in and reacts to live or recorded music. The listening experience may focus on physical, emotional, intellectual, aesthetic, or spiritual aspects of the music, and the client may respond through activities such as: relaxation or meditation, structured or free movement, perceptual tasks, free-association, story-telling, imaging, reminiscing, drawing, and so forth. The music used for such experiences may be live or recorded improvisations, performances or compositions by the client or therapist, or commercial recordings of music literature in various styles (e.g., classical, popular, rock, jazz, country, spiritual, new age).
• In addition to these musical types of experiences, music therapists often engage clients in verbal discussions. Clients may be encouraged to talk about the music, their reactions to it, or any thoughts, images, or feelings that were evoked during the experience. Clients may also be encouraged to express themselves through the other arts, such as drawing, painting, dance, drama or poetry. Music therapy sessions for children often include various games or play activities which involve music.

DO THE CLIENTS HAVE TO BE MUSICIANS?

No, clients do not have to be musicians to participate in or benefit from music therapy. In fact, because most clients have not had previous musical training, music therapy sessions are always designed to take advantage of the innate tendencies of all human beings to make and appreciate music at their own developmental levels.

• Music therapists believe that all individuals, regardless of age or musical background, have a basic capacity for musical expression and appreciation. This basic capacity does not require the special talents or extensive training that highly accomplished musicians have, but rather stems from general learnings and achievements that occur during the normal process of human development. Put another way, the process of human development prepares everyone to be a music-maker and music-lover–at a basic, but not necessarily professional, level. This basic or normal capacity for music includes the potential for learning to: sing, play simple instruments, move to music, react to the elements of music, perceive relationships between sounds, remember music, image to music, and ascribe meaning to musical experience.
• Of course, in clinical situations, music therapists often encounter clients who have physical or mental impairments that interfere with these basic musical potentials. In fact, much can be learned about the nature of the client's impairment by assessing which of the basic musical potentials are missing or inadequately developed. For example, a client with a communication disorder may be unable to: sing, articulate lyrics, reproduce rhythms or melodies, order sound sequences, or participate in a musical ensemble–depending upon the specific nature of the disorder.
• Care is always taken to adapt music therapy experiences to the capabilities of the client and to avoid anything that might cause harm or unnecessary pain of any kind. Music therapists also screen clients who may have adverse psychological or psychophysiological reactions to musical participation. Another important concern is the client's preferences with regard to types of musical activities, style of music, and medium of expression.

WHAT DETERMINES HOW THE MUSIC WILL BE USED?

Music therapy sessions are designed with several factors in mind. First and foremost, the therapist has to select the types of music experience to be used according to the goals of therapy and the needs of the client. Each of the music experiences described above requires something different from the client, and has a potentially different effect. For example, improvising and composing are both creative, but one is done extemporaneously and the other is not. Moreover, the improviser produces his/her own music, while the composer relies upon a performer. Continuing in this comparison, creating one's own music is quite different from re-creating or performing music already composed by someone else. A performer has to faithfully convey the musical ideas of another person, while an improviser or composer deals only with his or her own ideas. Finally, listening is quite different from the other types of music experience because it involves taking in and receiving the music, without being actively involved in its creation or production. The listener is active in a different way from the improviser, composer, and performer.

• The therapeutic implications of these differences are myriad. For example, improvisation is most appropriate for clients who need to develop spontaneity, creativity, freedom of expression, communication, and interpersonal skills–as these are the basic requirements of improvising. Many different clients manifest these needs, from emotionally disturbed children to acting out adolescents, and from developmentally delayed children to adults with psychiatric disorders. Improvising enables these clients to communicate and share feelings with others, while also helping them to organize their thoughts and ideas in a meaningful way.
• Re-creative experiences are most appropriate for clients who need to: develop sensorimotor skills, learn adaptive behaviors, maintain reality orientation, master different role behaviors, identify with the feelings and ideas of others, or work cooperatively towards common goals–as these are basic requirements of singing or playing pre-composed music. For example, individual singing lessons can help individuals who have speech impairments to help improve their articulation or fluency. In contrast, group singing can build reality orientation in elderly individuals, or help mentally retarded people develop adaptive behavior, or build cohesiveness in a dysfunctional family or group.
• Playing instruments can help physically disabled clients to develop gross and fine motor coordination. When combined with reading notation, playing instruments can help learning disabled children to develop auditory-motor or visual-motor integration. With emotionally disturbed children, instrumental ensembles can be used to overcome behavior problems and to control impulsivity. Instruments can also help mentally retarded individuals to better understand the world of objects.
• Activities involving composing music are used with clients who need to learn how to make decisions and commitments, and to find ways of working economically and within certain limitations. Often the idea expressed in a composition is a thought or feeling which is important to the person's life. Perhaps the best example is song-writing. With hospitalized children, writing songs can be a means of expressing and understanding their fears, and then leaving them there on the paper! Song-writing can also provide adults dying of cancer with a container for expressing their feelings–about life and death–while also serving as a parting gift to loved ones. Clients with drug or alcohol addictions often find group song-writing to be an excellent vehicle for examining irrational beliefs and fears, and for documenting their intention to change.
• Music listening experiences are used with clients who need to be activated or soothed physically, emotionally, intellectually or spiritually–as these are the kinds of responses that music listening elicits. For example, hospitalized patients find music listening helpful in relaxing, reducing stress, managing pain, and regulating body functions such as heart rate, breathing. It can also be arousing, energizing, and reassuring. With psychiatric patients, listening to songs invariably accesses ideas and thoughts that need to be examined and discussed, while also bringing to the surface feelings that need to be expressed and shared. With individuals in psychotherapy, music listening can be used to stimulate images, fantasies, associations, and memories, all of which contribute immeasurably to the process. And with elderly individuals, listening to music can facilitate structured reminiscence or a review of their lives.
• With learning disabled and mentally retarded children, perceptual listening tasks can be used to build auditory processing skills. Listening to songs and following the lyrics can also help these children to learn and memorize colors, numbers, vocabulary, behavior sequences and a host of other academic subjects. Finally, with all client populations music listening is of inimitable value in bringing about spiritual highs or peak experiences. Such experiences instill hope and courage, while reaffirming the beauty of life.
• The subtle and wonderful thing about music therapy is that, in actuality, every musical experience can be adapted to meet a broad spectrum of client needs. For example consider how: improvising can be adapted to explore experiences of structure as well as freedom: re-creating music can be adapted to encourage free self-expression as well as compliance with the score; composing can be adapted to require spontaneity as well as planned decision-making; and listening can be adapted to be active as well as passive, or physical as well as intellectual.

WHAT DO MUSIC THERAPISTS ACTUALLY DO?

Working as a music therapist essentially involves preparing, conducting, evaluating and documenting sessions with clients. Working with a client usually begins before the first session. The first step is to collect the necessary background information by reviewing any written records or referrals that may be available. Then in the first session, the music therapist usually conducts an assessment to determine the client's strengths and therapeutic needs. In a music therapy assessment, information on how the client makes, responds to, and relates to music is collected and analyzed, and then related to other aspects of the client's life. Based on the assessment findings, the music therapist formulates goals, sometimes with input from the client, the client's family, other professionals, or an interdisciplinary team of clinicians. Care is taken that the goals are realistic enough to be accomplished within the time frame set for therapy. Once goals have been set, the music therapist makes a treatment plan outlining possible strategies and music experiences that might be helpful in meeting the client's needs. In institutional settings, a meeting is usually held to coordinate treatment efforts and to formulate a program plan. As a result, the client is placed in individual, family, or group sessions, and the treatment phase of music therapy begins. Then after working with the client for a sufficient time, the music therapist conducts periodic evaluations to determine whether the methods of treatment are effective and whether the client is making any progress in reaching the prescribed goals, When necessary, adjustments are made in the goals or methods. Finally, when the time comes for ending therapy, the music therapist prepares the client for leaving and helps to bring some kind of closure to the process.

In addition to these clinical procedures, music therapists may have other responsibilities, depending upon the work setting, the client populations, and the therapist's job requirements. In hospital settings, music therapists may develop listening programs to meet various patient needs, produce shows or various kinds of musical events involving patients, arrange for patients to attend concerts in the community, or direct various kinds of recreational or therapeutic activities. In schools, music therapists may consult with classroom teachers or develop group music programs for special students. In the community, music therapists may consult with psychologists or psychiatrists, or provide musical instruction to special children. Music therapists working in institutions also have other duties such as ordering necessary equipment and supplies, and maintaining them. As will be discussed later, music therapists may also have positions which require administration, supervision, consultation, or teaching.

WHAT QUALITIES SHOULD A MUSIC THERAPIST HAVE?

Individuals who go into music therapy are typically musicians who have a sincere desire to use their love and talents for music to help others. Often there is an equal interest in music and psychology or medicine.

• Musicianship is an essential quality. Being a music therapist requires an in-depth understanding of the power of music, and the ability to reach others through singing and playing instruments. Music therapy students can major in any performance medium, however most training programs place additional emphasis on piano, guitar and voice, as these media are used most frequently in the clinical setting. Music therapists also have to have a breadth of musical knowledge and ability. They are frequently called upon to know about or perform classical music as well as country, rock, jazz and popular styles.
• The successful music therapist is in good physical and mental health and has the motivation, stamina, and maturity necessary for working with exceptional individuals in a therapeutic way. It goes without saying that a therapist has to be a sensitive and caring person who can accept differences in others. Just as important, a therapist should also have the self-awareness and emotional stability needed to enter a helping relationship with individuals who have problems. The best therapists are those who have healed themselves! This is why therapy is often recommended as an essential experience for therapists, both during training and at various times during their clinical career. Music therapists should receive music therapy themselves!