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The New Music TherapistrsquosHandbook Second EditionSuzanne B Hanser

Chapter 1An Introduction to Music Therapy

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Chapter 1An Introduction to Music Therapy

Iam a music therapist To me thatmeans that I bring out the creativespirit in everyone I see I find theirmusic the part of them that is freethe part of them that sings the part of

them that is rhythm We all have this music It shows itself whena song ldquocomes into our headsrdquo or when we tap a toe to musicWhen we are unable to think or speak or move or be who weonce were we still have this music It helps us express andcommunicate It helps us feel good It moves us often deeplyalways naturally

The impact of music on human behavior has been discussedand documented throughout history The significance of musicin both our cultural heritage and our daily lives has beenaffirmed through countless examples of its power References tomusicrsquos universality magic and myths confirm the belief thatmusic is a potent human influence Some have boldlypronounced that music defies the laws of nature with itsldquocharms to soothe the savage beast to soften rocks or bend aknotted oakrdquo (Congreve 1697) In fact the claims for its beautyhave been so greatly magnified that music is purported to exertsupernatural force The endorsement of writers from ancienthealers to Biblical authors has led to a belief that the capabilitiesof music are mystical and incomprehensible

Thus the field of music therapy falls prey to the assertion thatthe effects of music cannot be explained To the contrary muchof the impact of a musical experience is observable and measur-

1

able The constituents of a response to music may be isolatedand it is possible to establish a cause and effect relationshipbetween music and behavior The effects of the ldquoartrdquo of musicare thus substantiated through scientific methodology

What guides my work as a music therapist is my own musi-cianship and an intuitive sense of how music affects the people Iserve They may try a new behavior focus on a talent or abilityor find a positive force within that allows them to overcomecertain limitations or problems The process is complex It isalso based upon scientific principles objective observation andsystematic assessment of the personrsquos needs

A considerable body of experimental and clinical researchexamines the effects of music in its many forms includingperforming instrumental and vocal music listening composingimprovising moving to conducting analyzing or talking aboutmusic The clientele benefiting from music therapy is likewisevaried encompassing young and old acutely and chronically illeducationally physically socially and emotionally challengedThe settings range from large residential treatment centers forthe severely challenged and hospitals to schools community-based programs and clinics for individuals with specific or short-term problems As aid is sought for whatever ails people musictherapy demonstrates its ability to help an ever-increasingnumber of individuals

Because the scope of music therapy practice is so broad it isdifficult to define the field Bruscia devotes an entire book toDefining Music Therapy (1998) His working definition statesldquoMusic therapy is a systematic process of intervention whereinthe therapist helps the client to promote health using musicexperiences and the relationships that develop through them asdynamic forces of changerdquo (p 20) The specialized application ofmusic as therapy will vary depending upon the setting the ther-apist and the selected technique Even the function of musicmay be quite different as the music therapist encounters eachnew clinical problem Common to every music therapy programis that it applies one of the many forms of music as its primarymedium and is based on the needs of the clients it serves

2

The New Music Therapistrsquos Handbook

Music Therapy with Children and Adolescents

Thanks to the Education for All Handicapped Children Act of1975 Public Law 94ndash142 children in the United States areprovided a free education in their least restrictive environmentAs the law is currently implemented under the Individuals withDisabilities Education Act (IDEA) music therapy is mentionedas a Services-Program Option which may be a related servicewritten into a childrsquos Individualized Education Plan (IEP)Children with special needs may be referred for music therapyto meet communication cognitive sensory-motor or percep-tual-motor social emotional and psychological needs Musictherapists work to remediate skills change specific behaviorsimprove existing conditions or teach new skills through musicalexperiences Adolescents and young adults have anIndividualized Program Plan (IPP) to guide their referrals Thisdocument is based on the same format as the IEP and serves thesame function for the adult with a disability

According to ldquoA Descriptive Statistical Profile of the 1998AMTA (American Music Therapy Association) Membershiprdquo(AMTA 1998) music therapists serve the following children (inorder of frequency)

bull developmentally disabled bull behaviorally disordered bull emotionally disturbed bull physically disabled bull school age population

(may be inclusion classes andmainstreamed children or adiverse collection)

bull multiply disabledbull speech impairedbull autisticbull visually impairedbull neurologically impaired

(children and adults)bull hearing impairedbull substance abuse

(children and adults)

3

An Introduction to Music Therapy

bull abused or sexually abused (children and adults)

bull early childhoodbull dual diagnosed

(children and adults)bull head injured

(children and adults)Other populations include children with Rett Syndrome

AIDS eating disorders medical needs burns bereavementDownrsquos Syndrome premature birth and neonatal needs spinalcord injuries Williams Syndrome In some cases non-disabledchildren also receive music therapy

Developmental DisabilitiesThe most frequently served clinical population in children isdevelopmental disabilities This diagnosis refers to disorderswhich originate during childhood and continue indefinitelyaffecting functional abilities substantially One common devel-opmental disability is mental retardation According to theDiagnostic and Statistical Manual (Fourth Edition) of theAmerican Psychiatric Association (1996) mental retardationappears in mild moderate severe and profound forms For thementally retarded child music therapy attempts to create anenvironment of fun and enjoyment in which those who gener-ally associate learning with failure are able to achieve successWhile learning a simple song or finger play recipients of musictherapy are simultaneously improving eye contact attentionspan direction-following verbal imitation memory fine motordexterity and auditory discrimination These outcomes aretypical of goals established for music therapy By pairing wordswith tones and sentences with melodies therapists improvecommunication through speech and language (Cohen 19921994 Humphrey 1980 Madsen Madsen amp Michel 1975Popovici 1995 Rejto 1973 Seybold 1971 Walker 1972)

The music setting also offers opportunities for mentallyretarded children to learn social and motor behavior They gainself-awareness through movement to music and social interac-tion through group music therapy Musical experimentation andstimulation nurture responsiveness to the surrounding environ-

4

The New Music Therapistrsquos Handbook

ment in the most profoundly retarded child The music thera-pistrsquos goal of ldquoincreasing responsiveness to the surrounding envi-ronmentrdquo may be observed as the child moves to a soundstimulus such as a ringing bell The therapist might look forturning the head in the direction of the sound gazing at the bellreaching for it grasping it sounding the bell and imitatingpatterns of bell-ringing Even at this most basic level awarenessis initiated and maintained preparing the way for the develop-ment of more complex skills

The literature is replete with successful applications of musictherapy techniques in recognizing the potential of developmen-tally disabled persons (Carter 1982 Dorow 1982 Graham ampBeer 1980 Jellison 1996 Madsen 1981) Even in the mostpervasive developmental disorder music therapy enhancesfunctional abilities while simultaneously enriching creative andexpressive capacities Enabling individuals to participate insome way at their own level of competence a music experiencechallenges growth through developmental stages using asuccessndashoriented medium

Music has the advantage of demanding attention that a visualstimulus cannot because it intrudes immediately through earsthat cannot be closed voluntarily This phenomenon coupledwith the nonthreatening nature of musical exploration and audi-tory stimulation may be most applicable for the child with apervasive disorder or delay An autistic child who has previouslyshunned human interaction may begin to communicate with atherapist who provides positive music experiences Clinicalimprovisation is used extensively to enhance communication andexpressivity as well as to develop more interactive social skills inautistic children Through music therapy they may encountertheir first close relationship with a non-family member

Behavioral DisordersThe next most frequent population treated by music therapistsis children with behavioral disorders These disorders includechildren with attention deficit or disruptive behavior disorderswho have problems in social behavior which are extremeenough to interfere with the learning process The behavioraldisorders classification also refers to children who have conduct

5

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

able The constituents of a response to music may be isolatedand it is possible to establish a cause and effect relationshipbetween music and behavior The effects of the ldquoartrdquo of musicare thus substantiated through scientific methodology

What guides my work as a music therapist is my own musi-cianship and an intuitive sense of how music affects the people Iserve They may try a new behavior focus on a talent or abilityor find a positive force within that allows them to overcomecertain limitations or problems The process is complex It isalso based upon scientific principles objective observation andsystematic assessment of the personrsquos needs

A considerable body of experimental and clinical researchexamines the effects of music in its many forms includingperforming instrumental and vocal music listening composingimprovising moving to conducting analyzing or talking aboutmusic The clientele benefiting from music therapy is likewisevaried encompassing young and old acutely and chronically illeducationally physically socially and emotionally challengedThe settings range from large residential treatment centers forthe severely challenged and hospitals to schools community-based programs and clinics for individuals with specific or short-term problems As aid is sought for whatever ails people musictherapy demonstrates its ability to help an ever-increasingnumber of individuals

Because the scope of music therapy practice is so broad it isdifficult to define the field Bruscia devotes an entire book toDefining Music Therapy (1998) His working definition statesldquoMusic therapy is a systematic process of intervention whereinthe therapist helps the client to promote health using musicexperiences and the relationships that develop through them asdynamic forces of changerdquo (p 20) The specialized application ofmusic as therapy will vary depending upon the setting the ther-apist and the selected technique Even the function of musicmay be quite different as the music therapist encounters eachnew clinical problem Common to every music therapy programis that it applies one of the many forms of music as its primarymedium and is based on the needs of the clients it serves

2

The New Music Therapistrsquos Handbook

Music Therapy with Children and Adolescents

Thanks to the Education for All Handicapped Children Act of1975 Public Law 94ndash142 children in the United States areprovided a free education in their least restrictive environmentAs the law is currently implemented under the Individuals withDisabilities Education Act (IDEA) music therapy is mentionedas a Services-Program Option which may be a related servicewritten into a childrsquos Individualized Education Plan (IEP)Children with special needs may be referred for music therapyto meet communication cognitive sensory-motor or percep-tual-motor social emotional and psychological needs Musictherapists work to remediate skills change specific behaviorsimprove existing conditions or teach new skills through musicalexperiences Adolescents and young adults have anIndividualized Program Plan (IPP) to guide their referrals Thisdocument is based on the same format as the IEP and serves thesame function for the adult with a disability

According to ldquoA Descriptive Statistical Profile of the 1998AMTA (American Music Therapy Association) Membershiprdquo(AMTA 1998) music therapists serve the following children (inorder of frequency)

bull developmentally disabled bull behaviorally disordered bull emotionally disturbed bull physically disabled bull school age population

(may be inclusion classes andmainstreamed children or adiverse collection)

bull multiply disabledbull speech impairedbull autisticbull visually impairedbull neurologically impaired

(children and adults)bull hearing impairedbull substance abuse

(children and adults)

3

An Introduction to Music Therapy

bull abused or sexually abused (children and adults)

bull early childhoodbull dual diagnosed

(children and adults)bull head injured

(children and adults)Other populations include children with Rett Syndrome

AIDS eating disorders medical needs burns bereavementDownrsquos Syndrome premature birth and neonatal needs spinalcord injuries Williams Syndrome In some cases non-disabledchildren also receive music therapy

Developmental DisabilitiesThe most frequently served clinical population in children isdevelopmental disabilities This diagnosis refers to disorderswhich originate during childhood and continue indefinitelyaffecting functional abilities substantially One common devel-opmental disability is mental retardation According to theDiagnostic and Statistical Manual (Fourth Edition) of theAmerican Psychiatric Association (1996) mental retardationappears in mild moderate severe and profound forms For thementally retarded child music therapy attempts to create anenvironment of fun and enjoyment in which those who gener-ally associate learning with failure are able to achieve successWhile learning a simple song or finger play recipients of musictherapy are simultaneously improving eye contact attentionspan direction-following verbal imitation memory fine motordexterity and auditory discrimination These outcomes aretypical of goals established for music therapy By pairing wordswith tones and sentences with melodies therapists improvecommunication through speech and language (Cohen 19921994 Humphrey 1980 Madsen Madsen amp Michel 1975Popovici 1995 Rejto 1973 Seybold 1971 Walker 1972)

The music setting also offers opportunities for mentallyretarded children to learn social and motor behavior They gainself-awareness through movement to music and social interac-tion through group music therapy Musical experimentation andstimulation nurture responsiveness to the surrounding environ-

4

The New Music Therapistrsquos Handbook

ment in the most profoundly retarded child The music thera-pistrsquos goal of ldquoincreasing responsiveness to the surrounding envi-ronmentrdquo may be observed as the child moves to a soundstimulus such as a ringing bell The therapist might look forturning the head in the direction of the sound gazing at the bellreaching for it grasping it sounding the bell and imitatingpatterns of bell-ringing Even at this most basic level awarenessis initiated and maintained preparing the way for the develop-ment of more complex skills

The literature is replete with successful applications of musictherapy techniques in recognizing the potential of developmen-tally disabled persons (Carter 1982 Dorow 1982 Graham ampBeer 1980 Jellison 1996 Madsen 1981) Even in the mostpervasive developmental disorder music therapy enhancesfunctional abilities while simultaneously enriching creative andexpressive capacities Enabling individuals to participate insome way at their own level of competence a music experiencechallenges growth through developmental stages using asuccessndashoriented medium

Music has the advantage of demanding attention that a visualstimulus cannot because it intrudes immediately through earsthat cannot be closed voluntarily This phenomenon coupledwith the nonthreatening nature of musical exploration and audi-tory stimulation may be most applicable for the child with apervasive disorder or delay An autistic child who has previouslyshunned human interaction may begin to communicate with atherapist who provides positive music experiences Clinicalimprovisation is used extensively to enhance communication andexpressivity as well as to develop more interactive social skills inautistic children Through music therapy they may encountertheir first close relationship with a non-family member

Behavioral DisordersThe next most frequent population treated by music therapistsis children with behavioral disorders These disorders includechildren with attention deficit or disruptive behavior disorderswho have problems in social behavior which are extremeenough to interfere with the learning process The behavioraldisorders classification also refers to children who have conduct

5

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

Music Therapy with Children and Adolescents

Thanks to the Education for All Handicapped Children Act of1975 Public Law 94ndash142 children in the United States areprovided a free education in their least restrictive environmentAs the law is currently implemented under the Individuals withDisabilities Education Act (IDEA) music therapy is mentionedas a Services-Program Option which may be a related servicewritten into a childrsquos Individualized Education Plan (IEP)Children with special needs may be referred for music therapyto meet communication cognitive sensory-motor or percep-tual-motor social emotional and psychological needs Musictherapists work to remediate skills change specific behaviorsimprove existing conditions or teach new skills through musicalexperiences Adolescents and young adults have anIndividualized Program Plan (IPP) to guide their referrals Thisdocument is based on the same format as the IEP and serves thesame function for the adult with a disability

According to ldquoA Descriptive Statistical Profile of the 1998AMTA (American Music Therapy Association) Membershiprdquo(AMTA 1998) music therapists serve the following children (inorder of frequency)

bull developmentally disabled bull behaviorally disordered bull emotionally disturbed bull physically disabled bull school age population

(may be inclusion classes andmainstreamed children or adiverse collection)

bull multiply disabledbull speech impairedbull autisticbull visually impairedbull neurologically impaired

(children and adults)bull hearing impairedbull substance abuse

(children and adults)

3

An Introduction to Music Therapy

bull abused or sexually abused (children and adults)

bull early childhoodbull dual diagnosed

(children and adults)bull head injured

(children and adults)Other populations include children with Rett Syndrome

AIDS eating disorders medical needs burns bereavementDownrsquos Syndrome premature birth and neonatal needs spinalcord injuries Williams Syndrome In some cases non-disabledchildren also receive music therapy

Developmental DisabilitiesThe most frequently served clinical population in children isdevelopmental disabilities This diagnosis refers to disorderswhich originate during childhood and continue indefinitelyaffecting functional abilities substantially One common devel-opmental disability is mental retardation According to theDiagnostic and Statistical Manual (Fourth Edition) of theAmerican Psychiatric Association (1996) mental retardationappears in mild moderate severe and profound forms For thementally retarded child music therapy attempts to create anenvironment of fun and enjoyment in which those who gener-ally associate learning with failure are able to achieve successWhile learning a simple song or finger play recipients of musictherapy are simultaneously improving eye contact attentionspan direction-following verbal imitation memory fine motordexterity and auditory discrimination These outcomes aretypical of goals established for music therapy By pairing wordswith tones and sentences with melodies therapists improvecommunication through speech and language (Cohen 19921994 Humphrey 1980 Madsen Madsen amp Michel 1975Popovici 1995 Rejto 1973 Seybold 1971 Walker 1972)

The music setting also offers opportunities for mentallyretarded children to learn social and motor behavior They gainself-awareness through movement to music and social interac-tion through group music therapy Musical experimentation andstimulation nurture responsiveness to the surrounding environ-

4

The New Music Therapistrsquos Handbook

ment in the most profoundly retarded child The music thera-pistrsquos goal of ldquoincreasing responsiveness to the surrounding envi-ronmentrdquo may be observed as the child moves to a soundstimulus such as a ringing bell The therapist might look forturning the head in the direction of the sound gazing at the bellreaching for it grasping it sounding the bell and imitatingpatterns of bell-ringing Even at this most basic level awarenessis initiated and maintained preparing the way for the develop-ment of more complex skills

The literature is replete with successful applications of musictherapy techniques in recognizing the potential of developmen-tally disabled persons (Carter 1982 Dorow 1982 Graham ampBeer 1980 Jellison 1996 Madsen 1981) Even in the mostpervasive developmental disorder music therapy enhancesfunctional abilities while simultaneously enriching creative andexpressive capacities Enabling individuals to participate insome way at their own level of competence a music experiencechallenges growth through developmental stages using asuccessndashoriented medium

Music has the advantage of demanding attention that a visualstimulus cannot because it intrudes immediately through earsthat cannot be closed voluntarily This phenomenon coupledwith the nonthreatening nature of musical exploration and audi-tory stimulation may be most applicable for the child with apervasive disorder or delay An autistic child who has previouslyshunned human interaction may begin to communicate with atherapist who provides positive music experiences Clinicalimprovisation is used extensively to enhance communication andexpressivity as well as to develop more interactive social skills inautistic children Through music therapy they may encountertheir first close relationship with a non-family member

Behavioral DisordersThe next most frequent population treated by music therapistsis children with behavioral disorders These disorders includechildren with attention deficit or disruptive behavior disorderswho have problems in social behavior which are extremeenough to interfere with the learning process The behavioraldisorders classification also refers to children who have conduct

5

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

bull abused or sexually abused (children and adults)

bull early childhoodbull dual diagnosed

(children and adults)bull head injured

(children and adults)Other populations include children with Rett Syndrome

AIDS eating disorders medical needs burns bereavementDownrsquos Syndrome premature birth and neonatal needs spinalcord injuries Williams Syndrome In some cases non-disabledchildren also receive music therapy

Developmental DisabilitiesThe most frequently served clinical population in children isdevelopmental disabilities This diagnosis refers to disorderswhich originate during childhood and continue indefinitelyaffecting functional abilities substantially One common devel-opmental disability is mental retardation According to theDiagnostic and Statistical Manual (Fourth Edition) of theAmerican Psychiatric Association (1996) mental retardationappears in mild moderate severe and profound forms For thementally retarded child music therapy attempts to create anenvironment of fun and enjoyment in which those who gener-ally associate learning with failure are able to achieve successWhile learning a simple song or finger play recipients of musictherapy are simultaneously improving eye contact attentionspan direction-following verbal imitation memory fine motordexterity and auditory discrimination These outcomes aretypical of goals established for music therapy By pairing wordswith tones and sentences with melodies therapists improvecommunication through speech and language (Cohen 19921994 Humphrey 1980 Madsen Madsen amp Michel 1975Popovici 1995 Rejto 1973 Seybold 1971 Walker 1972)

The music setting also offers opportunities for mentallyretarded children to learn social and motor behavior They gainself-awareness through movement to music and social interac-tion through group music therapy Musical experimentation andstimulation nurture responsiveness to the surrounding environ-

4

The New Music Therapistrsquos Handbook

ment in the most profoundly retarded child The music thera-pistrsquos goal of ldquoincreasing responsiveness to the surrounding envi-ronmentrdquo may be observed as the child moves to a soundstimulus such as a ringing bell The therapist might look forturning the head in the direction of the sound gazing at the bellreaching for it grasping it sounding the bell and imitatingpatterns of bell-ringing Even at this most basic level awarenessis initiated and maintained preparing the way for the develop-ment of more complex skills

The literature is replete with successful applications of musictherapy techniques in recognizing the potential of developmen-tally disabled persons (Carter 1982 Dorow 1982 Graham ampBeer 1980 Jellison 1996 Madsen 1981) Even in the mostpervasive developmental disorder music therapy enhancesfunctional abilities while simultaneously enriching creative andexpressive capacities Enabling individuals to participate insome way at their own level of competence a music experiencechallenges growth through developmental stages using asuccessndashoriented medium

Music has the advantage of demanding attention that a visualstimulus cannot because it intrudes immediately through earsthat cannot be closed voluntarily This phenomenon coupledwith the nonthreatening nature of musical exploration and audi-tory stimulation may be most applicable for the child with apervasive disorder or delay An autistic child who has previouslyshunned human interaction may begin to communicate with atherapist who provides positive music experiences Clinicalimprovisation is used extensively to enhance communication andexpressivity as well as to develop more interactive social skills inautistic children Through music therapy they may encountertheir first close relationship with a non-family member

Behavioral DisordersThe next most frequent population treated by music therapistsis children with behavioral disorders These disorders includechildren with attention deficit or disruptive behavior disorderswho have problems in social behavior which are extremeenough to interfere with the learning process The behavioraldisorders classification also refers to children who have conduct

5

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

ment in the most profoundly retarded child The music thera-pistrsquos goal of ldquoincreasing responsiveness to the surrounding envi-ronmentrdquo may be observed as the child moves to a soundstimulus such as a ringing bell The therapist might look forturning the head in the direction of the sound gazing at the bellreaching for it grasping it sounding the bell and imitatingpatterns of bell-ringing Even at this most basic level awarenessis initiated and maintained preparing the way for the develop-ment of more complex skills

The literature is replete with successful applications of musictherapy techniques in recognizing the potential of developmen-tally disabled persons (Carter 1982 Dorow 1982 Graham ampBeer 1980 Jellison 1996 Madsen 1981) Even in the mostpervasive developmental disorder music therapy enhancesfunctional abilities while simultaneously enriching creative andexpressive capacities Enabling individuals to participate insome way at their own level of competence a music experiencechallenges growth through developmental stages using asuccessndashoriented medium

Music has the advantage of demanding attention that a visualstimulus cannot because it intrudes immediately through earsthat cannot be closed voluntarily This phenomenon coupledwith the nonthreatening nature of musical exploration and audi-tory stimulation may be most applicable for the child with apervasive disorder or delay An autistic child who has previouslyshunned human interaction may begin to communicate with atherapist who provides positive music experiences Clinicalimprovisation is used extensively to enhance communication andexpressivity as well as to develop more interactive social skills inautistic children Through music therapy they may encountertheir first close relationship with a non-family member

Behavioral DisordersThe next most frequent population treated by music therapistsis children with behavioral disorders These disorders includechildren with attention deficit or disruptive behavior disorderswho have problems in social behavior which are extremeenough to interfere with the learning process The behavioraldisorders classification also refers to children who have conduct

5

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

disorders oppositional defiant disorders hyperactivity orother non-specific behavior problems These children are oftenreferred to music therapy to enhance self-awareness self-expression or self-esteem Active music behavior such asplaying an instrument and singing necessitates using the voiceand body in a clearly structured manner to produce the desiredmusical product The childrsquos ability to generate socially appro-priate behavior which is incompatible with inappropriate behav-iors accounts for further success of music as therapy (Madsen ampWolfe 1979) While engaged in positive creative efforts a childoften gains self-control and a concrete emotional outlet

At another level feelings which are misunderstood or difficultto describe verbally may be experienced through the expressivemedium of music Children may be referred to music therapy inorder to assess the nature of their emotions Asking a child toexpress a particular feeling by playing an instrument may seemindirect but it often reveals a degree of emotional arousalwhich can be observed and explored Facial affect nonverbalbehavior or ldquobody languagerdquo while performing music offer anonthreatening starting point for understanding emotions

Learning DisordersLearning disorders comprise impairments in specific academicareas One remediation approach is a music teaching modelwhich works through parallel behaviors in the learning ofmusical skills For instance a child who has difficulty coordi-nating movements of the right and left side of the body candevelop this ability through moving to music using arms andlegs synchronously Playing increasingly more complexmelodies on the piano with hands separately and then togethercan develop such coordination Visual tracking required intranslating written music to the keyboard is similar to the left-to-right eye movement necessary for reading words The abilityto listen to others and respond cooperatively at a precise timewith a previously learned musical part is required for participa-tion in a musical ensemble With the motivation to producemusic children often succeed in mastering musical skills whileimproving such conceptual correlates Thus children with

6

The New Music Therapistrsquos Handbook

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

learning disorders may benefit in many ways from the demandsof these structured musical experiences

Music may also provide an opportunity for children to processan auditory stimulus and respond to it appropriately This audi-tory-motor match such as a personrsquos answer to a spoken question can be developed effectively through auditory discrim-ination training with music At the extreme musicians wholearn to tune string instruments recall lengthy melodies orname the pitches of sounds they hear show a remarkably finely-tuned set of discriminations

Motor Skills DisordersChildren who have motor skills disorders may be delayed inmotor development or display problems in gross or fine motorcoordination They may be referred to music therapy becauseplaying instruments necessitates varying degrees of motor andeye-hand coordination as well as breath control when playingwind instruments To dance one must move in specified waysintegrating various parts of the body in a smooth rhythmicfashion Listening to music may involve self-discipline anddiscrimination skills while the experience evokes imageslearned responses (such as clapping along) and individualcreative reactions (such as free improvisational movements)Music therapists also assist in the rehabilitation of more severeneuromuscular and skeletal disorders of many types One tech-nique is to use rhythmic and musical cues for specific move-ments and for body relaxation

Communication DisordersChildren with communication disorders benefit from musictherapy in several ways Clearly singing involves speech andlanguage and more specifically auditory memory pitch-matching and fluency Vocal and wind instrument trainingprovide a creative context for specific exercises which may beused in collaboration with speech therapy Goals includeimprovement in articulation inflection breathing and pacing ofspeech

Nonverbal children are especially good candidates for musictherapy Without the obvious means of communication that

7

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

most of us use they need to learn other methods to expressthemselves Music therapists are adept at offering augmentativecommunication and computer-assisted music methods to enablethese children to express feelings and thoughts through music

Sensory ImpairmentsChildren with sensory impairments may have problems withvision hearing or both Children with hearing impairments areaided by the sensory stimulation of music and vibratoryrhythmic cues offered in music for speech and body move-ments As improbable as it may seem at first there is consider-able clinical evidence of the efficacy of music therapy withchildren who are deaf Children who are visually impairedbenefit from music therapy when they develop their auditoryand musical abilities Their music therapists also contribute tomobility training when unsure or rigid movements becomemore fluid and natural through intervention with music

Physical ChallengesOther physical challenges comprise conditions whereinimpaired physical development or functioning includingsensory impairments are sufficiently severe to interfere withnormal functioning When a physically challenged child or adultis referred to music therapy the objective is often to demon-strate to clients that they are capable of performing or creatingmusic heretofore deemed impossible By modifying musicalinstruments and using adaptive music technology music thera-pists have shown that the sense of worth may be greatlyenhanced in a person who is able to produce pleasant soundsMusic therapists have witnessed the joy of quadriplegics whoperform for enthusiastic audiences on specially-adapted guitarsand the immense pride of people in wheelchairs who learn todance by using mobile parts of their bodies

Certain physical therapy manipulation with repetitive move-ments set to music yields a cheerful experience which moreclosely resembles play than work Music offers incentive tocomplete uncomfortable exercises as the client executes thenecessary movements more smoothly and rhythmically Musictherapists work collaboratively with physical therapists to

8

The New Music Therapistrsquos Handbook

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

develop creative treatment approaches for their clients Multiplyhandicapped children likewise succeed with a creativeapproach which emphasizes onersquos abilities and strengths asopposed to the often more obvious disabilities and weaknesses

Children in Inclusion ClassroomsAs a group-oriented intervention music therapy accommodatesdifferent levels and abilities bringing out the best in every childwho participates Music therapy provides a wonderful opportu-nity for children with special needs to interact positively withchildren in the typical classroom as they learn together in inclu-sion classes (Gunsberg 1988 Hughes Robbins McKenzie ampRobb 1990 Humpal 1991)

Special Applications to AdolescentsThe various disorders and conditions described above are gener-ally diagnosed or recognized in childhood but they also affectadolescents and in some cases adults Many music therapistsspecialize in adolescence and have expertise in the unique chal-lenges facing individuals at this stage of development Some workwithin a family therapy model helping parents and childrencommunicate about their preferred music and the meaning ofthat music Another technique is family improvisation used as ametaphor for understanding patterns of interpersonal interactionwithin the family or among peers Music therapists also assistadolescents in understanding the mechanisms that contribute tosuch problems as eating disorders by becoming more aware oftheir emotions through expressive music activities

Music Therapy with Adults

Medical ConditionsThe psychological impact of having a medical condition or illnessis often overlooked in the search for a medical treatmentTreatment may call for hospitalization surgery or other proce-dures which tend to provoke anxiety in most people Theemotional reaction to even the most inconsequential sicknessperhaps requiring bed rest alone may be traumatic for some Forothers illness triggers a full-blown mental disorder Music thera-

9

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

pists have designed procedures for inducing relaxation whichboth ameliorate the anxiety associated with illness or hospital-ization and divert attention away from pain or discomfort Thesetechniques have been applied to a wide variety of clinical popu-lations in medicine and dentistry (Froehlich 1996 Standley1986 1996) Patients have responded well to the point of over-representing the effects as in a young woman who exclaimed ldquoIcouldnrsquot have had that baby without musicrdquo (Hanser Larson ampOrsquoConnell 1983) Often the need for medication or restraint isminimized when music therapy is introduced

Applications in the general hospital are expanding rapidlywith the acknowledgement that the connection between mindand body is strong The impact of psychology on physical illnesshas been documented and music therapy procedures have beenshown to be efficacious strategies for coping with pain andanxiety People with chronic illnesses can share meaningfulexperiences in music therapy groups where emotionalresponses are drawn out and discussed Some individuals learnnew musical skills and begin to appreciate another dimension oftheir lives Others are aroused through more passive musicalinvolvement or introduced to new coping strategies throughmusic-facilitated stress reduction Dramatic research indicatesthat comatose patients may begin to respond when backgroundmusic is provided contingent upon their slightest physicalmovement (Boyle amp Greer 1983)

Mental DisordersMental disorders have been classified by the AmericanPsychiatric Association (1996) as clinical disorders personalitydisorders or mental retardation general medical conditions andpsycho-social and environmental problems A primary treat-ment modality is psychotherapy in which music plays a uniquerole Music therapists of a wide variety of philosophical persua-sions have applied music successfully to psychotherapeutictechniques (Arnold 1975 Hadsell 1974 Madsen 1981Maultsby 1977) They have capitalized on the nonverbalaspects of musical expression as a means of observing under-standing and changing feelings and emotions (Tyson 1981Unkefer 1990) The music therapy setting becomes a micro-

10

The New Music Therapistrsquos Handbook

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

cosm eliciting interactive social behavior which may be shapedas therapy progresses Reactions to and perceptions of musicdiscussions of musical themes and problem-solving in a musicalcontext are parallel behaviors for responding to similar situa-tions outside the therapy environment Dealing with theseissues in the supportive and positive music setting can assist theperson in tackling the real problems

Another therapeutic aspect of music is the meaningful contentand affect conveyed to the listener through musical composi-tions Individuals may begin to understand their own feelingswhen they listen to a song which expresses similar ideas Adiscussion of Simon and Garfunkelrsquos ldquoBridge Over TroubledWaterrdquo may yield new insights into sources of support while itpresents options for adjusting to troubling circumstances

Images evoked by music listening provide increased under-standing Guided Imagery and Music (Bonny amp Savary 1973Bonny 1994) has been used to promote deep relaxation aheightened sense of awareness and what has been reported tobe an altered state of consciousness The therapeutic potentialof the vivid images evoked by the combination of musicalstimuli and verbal guiding are just beginning to be tappedSpecial applications of music therapy extend to such conditionsas posttraumatic stress disorder and to those who have beenvictims of abuse and trauma Forensic psychiatric settings alsoemploy music therapists People who are unable to processpainful material find a way to access emotions by engaging inmusic experiences which bring out spontaneous nonverbalexpression Improvisation songwriting and lyric analysis arepopular music therapy techniques In all of these instances themusic therapy setting offers a structure within which cognitivesocialemotional and overt behavior may be revealed examinedand changed Perhaps herein lies its power

Correctional PsychiatryWorking with both juvenile offenders and adults who are incar-cerated in a correctional facility music therapists play animportant role in rehabilitation The structure provided throughmusic therapy allows offenders to participate in healthy posi-

11

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

tive experiences learning to deal with impulse control interper-sonal dynamics and self-awareness

Neurological RehabilitationMusic therapists work with individuals who have sustained atraumatic brain injury stroke and conditions such asHuntingtonrsquos and Parkinsonrsquos diseases by assisting in theretraining of lost abilities aiding the recovery process andteaching adaptive and coping strategies (Lee 1989 McIntoshBrown Rice amp Thaut 1997)

Community Music TherapyAs community-based treatment and education become morewidespread music therapists have begun to offer services topeople who do not have a diagnosable problem but wish to copewith the stresses and pain that they experience every dayOthers desire to realize their potential and develop their self-awareness or expression through music Music therapists arewell-trained to meet their needs and have developed programsfor relaxation and self-actualization (Giles Cogan amp Cox 1991)

In addition there are a number of people with special needswho are interested in learning how to develop their voices orplay musical instruments Individuals with conditions such asWilliams Syndrome generally have considerable musical abilityand require music lessons from someone like a music therapistwho is knowledgeable of their unique learning requirementsThis direction in music therapy practice is reflective of thegrowing interest in recognizing the musical potential in all of us

Music Therapy with Older Adults

Gerontology is the study of late life and its associated character-istics Music brings energy and life to many people whoapproach late life with loss of cognitive or physical functioningnot to mention the loss of loved ones or vocational identityFeelings of worthlessness and despair are transformed into pridewhen people are shown that they are still capable of beingcreative and can learn new skills Often too involvement inmusical experience which is reminiscent of a joyous time can be

12

The New Music Therapistrsquos Handbook

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

extremely revitalizing (Bright 1981 Clair 1996 Hanser amp Clair1995 Smith amp Lipe 1991) The most withdrawn and confusedpatients suffering from dementia due to Alzheimerrsquos disease andrelated disorders are able to participate actively in musictherapy sessions As music demands reality-oriented behaviorin the present without risk of failure even the most cognitivelyimpaired older adults master musical tasks with enhanced self-respect (Brotons Koger amp Pickett-Cooper 1997 Koger Chapinamp Brotons 1999)

Too often older adults are given the message that they haveoutlived their usefulness The losses which naturally accompanythe aging process contribute to a weakening self-concept Theseperceptions may soon be overturned when individuals are giventhe opportunity to cooperate in a musical endeavor enabling someto perform some to compose some to accompany some to listenand everyone to employ the highest level of creative potential

At the End of LifeMusic therapy holds a special place in the process of preparingfor death Individuals who are dying find a way to express whatthey are feeling through choosing music to hear sing or performand by composing songs with the help of the therapist Familieswho participate together in music therapy transform this difficulttime into an experience of unifying creative expression withtheir loved one (Lee 1995 Mandel 1993 Martin 1991)

Conclusion

The preceding survey of clinical problems has presented asampling of music therapy practices for identified needs ordisorders Of considerable challenge to the health care profes-sional however is the prevention of such difficulties Nomusical vaccine has been or could ever be found for a particulardisease One wonders if people who listen to a piece of relaxingmusic at the end of a stressful day play an instrument as ameans of self-expression or channel excess energy into musicalparticipation in an ensemble are at lower risk for distress

This overview of music therapy has disclosed only a few of themyriad of effects produced by music It is significant that the

13

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

claims regarding the strength of music in affecting behavior arenot based merely on the casual observations of a single witnessbut rather are backed by wide and varied evidence generatedthrough scientific research With this foundation the musictherapist proceeds to develop an individualized program foreach client or therapy group

The New Music Therapistrsquos Handbook focuses on the clientand helps the therapist decide upon the most appropriate andefficacious methods It presents a model for music therapy treat-ment planning with individuals who have such conditions asdevelopmental disabilities behavioral learning motor skills andcommunication disorders sensory impairments physical chal-lenges and illnesses mental disorders and geriatric conditionsIt also describes applications with people who are dealing withthe stresses of ordinary life or coping with the discomforts thatall of us encounter at some time in our lives The book isdesigned for students and practitioners of music therapy whoparticipate in the development of individualized treatmentprograms presenting examples of people who benefit frommusic therapy services It steers the therapist through thecourse of planning implementation and evaluation offeringclinical practice guidelines and real music therapy cases Thisapproach borrows from principles of music therapy and thebehavioral sciences to demonstrate an objective and ldquodata-basedrdquo view of music therapy

Summary

This introduction to the field of music therapy presents applica-tions to a variety of clinical settings For children with develop-mental disabilities music therapy teaches social motoracademic and conceptual skills It offers opportunities for self-expression self-esteem and self-control for children with behav-ioral disorders The acquisition of musical skills in a child with alearning disorder brings parallel developments in perceptual-motor and cognitive areas The positive creative aspects ofmusic learning offer incentives for freer movement rhythmicunderstanding and enhanced sense of worth in children withmotor skills disorders The melodic and rhythmic elements of

14

The New Music Therapistrsquos Handbook

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy

speech are enhanced in individuals with communication disor-ders and people who are unable to use speech learn new waysto express themselves Children with sensory impairments orphysical challenges develop their talents and strengths throughmusic therapy Medical patients divert attention from pain whileattempting to deal with their illnesses People with mental disor-ders respond to the nonverbal metaphor established in themusic therapy setting Geriatric patients become involved in acreative reality-oriented experience which may be revitalizingand reminiscent of joyous times These populations representone segment of the clientele who can benefit from the use ofmusic therapy

Key Words

Alzheimerrsquos disease (dementia of the Alzheimerrsquos type)A progressive degenerative disease with insidiousonset characterized by multiple cognitive deficitsand significant decline in functioning

Attention deficit disorderA disorder characterized by maladaptive inatten-tion hyperactivity or impulsiveness which resultsin pervasive and clinically significant impairmentSome symptoms should have presented beforeseven years of age although it may be diagnosed inadulthood

Auditory discriminationThe ability to hear similarities and differencesbetween sounds

Auditory memoryThe ability to retain and recall that which is heard

Auditory-motor matchThe process whereby awareness of sound results ina movement or response

Autistic An individual with autistic disorder beginning ininfancy which is characterized by self-absorptionpreoccupation with inanimate objects andordysfunctional destructive or ritualistic behaviors

15

An Introduction to Music Therapy