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Music Therapy

Music therapy is recognised as being applicable to a wide range of healthcare andsocial contexts. Since the first edition of Music Therapy: An art beyond words, ithas extended into areas of general medicine, mainstream education and communitypractice. This new edition revises the historical and theoretical perspectives andrecognises the growing evidence and research base in contemporary music therapy.

Leslie Bunt and Brynjulf Stige document the historical evolution of musictherapy and place the practice within seven current perspectives: medical,behavioural, psychodynamic, humanistic, transpersonal, culture-centred andmusic-centred. No single perspective, individual or group approach is privileged,although the focus on the use of sounds and music within therapeutic relationshipsremains central. Four chapters relate to areas of contemporary practice acrossdifferent stages of the lifespan: child health, adolescent health, adult health andolder adult health. All include case narratives and detailed examples underpinnedby selected theoretical and research perspectives. The final two chapters of thebook reflect on the evolution of the profession as a community resource and theemergence of music therapy as an academic discipline in its own right.

A concise introduction to the current practice of music therapy around the world,Music Therapy: An art beyond words is an invaluable resource for professionals inmusic therapy and music education, those working in the psychological therapies,social work and other caring professions, and students at all levels.

Leslie Bunt is Professor in Music Therapy at the University of the West ofEngland, Bristol. He is a Primary Trainer in Guided Imagery and Music and afreelance conductor. Leslie’s current practice and research interests focus on musictherapy and adult cancer care, and his previous books include The Handbook ofMusic Therapy, co-edited with Sarah Hoskyns (Routledge, 2002).

Brynjulf Stige is Professor in Music Therapy at the Grieg Academy, University ofBergen, Norway. He was founding editor of the Nordic Journal of Music Therapyand founding co-editor of Voices: A World Forum for Music Therapy. His previousbooks, including Invitation to Community Music Therapy, co-authored with LeifEdvard Aarø (Routledge, 2012), have explored relationships between musictherapy, culture and community.

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Music TherapyAn art beyond words

Second edition

Leslie Bunt and Brynjulf Stige

Routledge~ ~~o~:~~n~~~up LONDON AND NEW YORK

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Second edition published 2014by Routledge27 Church Road, Hove, East Sussex, BN3 2FA

and by Routledge711 Third Avenue, New York, NY 10017

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2014 Leslie Bunt and Brynjulf Stige

The right of Leslie Bunt and Brynjulf Stige to be identified as authors of thiswork has been asserted by them in accordance with sections 77 and 78 of theCopyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced orutilised in any form or by any electronic, mechanical, or other means, nowknown or hereafter invented, including photocopying and recording, or in anyinformation storage or retrieval system, without permission in writing fromthe publishers.

Trademark notice: Product or corporate names may be trademarks orregistered trademarks, and are used only for identification and explanationwithout intent to infringe.

First edition published by Brunner-Routledge 1994

British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication DataBunt, Leslie, author.

Music therapy : an art beyond words / Leslie Bunt and Brynjulf Stige. –Second edition.

pages cmIncludes bibliographical references and index.

1. Music therapy. I. Stige, Brynjulf, author. II. Title.ML3920.B85 2014615.8�5154–dc23 2013042864

ISBN: 978-0-415-45068-3 (hbk)ISBN: 978-0-415-45069-0 (pbk)ISBN: 978-1-315-81798-9 (ebk)

Typeset in Timesby Keystroke, Station Road, Codsall, Wolverhampton

Contents

Acknowledgements ix

Introduction: formation and form 1Exposition: the vision that informed the first edition 1Transition: considerations and collaboration 2Development: music therapy in a new key 3Recapitulation: outline of the new edition 4

1 The growth of music therapy 5Introduction 5The emergence of music therapy in the United Kingdom and the

United States 5Paths of development in contemporary music therapy 10Further historical and cultural reference points 12What is music therapy? 15Redefining music therapy 17Activities in music therapy 19Areas of music therapy practice 22The evolution of a new professional discipline 24Concluding points 27

2 Music therapy examples and perspectives 29Introduction 29An individual session 29A group session 33Tools for thinking about music therapy 37Music therapy in medical perspectives 38Music therapy in behavioural perspectives 40Music therapy in psychodynamic perspectives 41Music therapy in humanistic perspectives 43

Music therapy in transpersonal perspectives 45Music therapy in culture-centred perspectives 47Music therapy in music-centred perspectives 49Concluding points 51

3 Sound, music and music therapy 54Introduction 54Music as resource for action 55Timbre 57Pitch 60Loudness 62Duration 65Silence 68Rhythm 70Melody 73Harmony 75Concluding points 78

4 Music therapy and child health 80The young child: sounds, rhythms and music 80Music therapy with a baby and her family: the story of Alex 83Synchrony, communication, attachment and participation 85Music therapy contexts and related research: part one 88Music therapy with a pre-school child: the story of M 90Attunement and play 96Music therapy contexts and related research: part two 99Concluding points 102

5 Music therapy and adolescent health 104Young, wild and free? Adolescents and music 104The practice of music therapy with adolescents 107Gregorio’s process in music therapy: the first phase 110Gregorio’s process in music therapy: the second phase 113Gregorio’s process in music therapy: the third phase 115Researching experiences and effects 117Reflections on emotional aspects of music therapy 120Working with human rights and social resources 122Concluding points 124

6 Music therapy and adult health 125The adult musical profile 125Music therapy and the many pathways of adult life 126

vi Contents

Music therapy and the adult with learning disabilities 128Approaches to music therapy and adult mental health 132Research on music therapy and adult mental health 135Music therapy in the everyday world of rehabilitation 137Interdisciplinary research on music and rehabilitation 140Music therapy, adult cancer care and palliative care 143Concluding points 147

7 Music therapy and older adult health 149‘Crown of life’ . . . nothing left to lose? Older adults and music 149Music therapy practice and research with older adults 151The story of Jon’s first encounter with music therapy 154Musical and emotional encounters in professional context 157Aurora: the story of a senior choir 160Music, care and social capital in a world of conflicts 164Concluding points 167

8 The profession of music therapy: a resource for the community 169Introduction 169A day in the life of a music therapist 170The professional as responsible member of society 173Sustaining collaborative cross-professional work 177Promoting music as a resource for health and well-being 181Further challenges to the contemporary music therapist 183Possibilities of the music therapy profession 185Concluding points 190

9 The discipline of music therapy: towards an identity of hybridity? 192Introduction: Orpheus as emblem 192The discipline as the ‘invisible college’ of music therapy 195Some tensions and contradictions 196Reflections on the evidence-based practice debate 201Reflections on challenges of representation 204Towards a culture of hybridity? 206Developing the discipline of music therapy 209Concluding points 213

Epilogue: music therapy: an art beyond words? 216

References 221Name index 245Subject index 248

Contents vii

Acknowledgements

One of the privileges of being a music therapist is the opportunity to workmusically with people who have much to teach about courage, endurance andbeauty. Our warmest thanks go to all the patients and participants from whom wehave been learning over the years. There is also a large group of colleagues andfriends who deserve our gratitude. The community of music therapy – the‘invisible college’ we talk about in Chapter 9 – has been an extremely importantsource of inspiration for us. We thank the many students we have worked withover the years.

Special thanks go to Brian Abrams, who read the whole manuscript and gave usinvaluable feedback on the potential relevance and usefulness of this book. Wealso want to express our special thanks to the other music therapy colleagues whohave read and commented on various chapters of the manuscript: SimonGilbertson, Denise Grocke, Bob Heath, Sarah Hoskyns, Jane Lings, KatrinaMcFerran, Hanne Mette Ridder, Daphne Rickson, Gro Trondalen, Cathy Warnerand Barbara Zanchi. Thanks to all for constructive critique and suggestions. Weare especially grateful to Barbara Zanchi and Simon Gilbertson for providing casenarratives and additional material. Thanks to Kate Cullen for compiling the index.We thank members of our families and friends for their continual support,especially Susan Pontin, who read every word of the whole manuscript more thanonce and contributed greatly in the stylistic integration of our two voices. LauraBunt commented constructively on a final draft of a chapter, Torgeir Stige helpedus with the two figures in Chapter 8 and Christopher Gray answered one of ourscientific questions. Our appreciation goes to the editorial team at Routledge,Joanne Forshaw and Susanna Frearson, for their patience and trust. Finally but notleast, we thank our readers, who may be the beginner music therapist or the curiousenquirer. Our imagined dialogues with you have helped us retain focus and havenurtured reflections on what music therapy is and could be.

IntroductionFormation and form

Exposition: the vision that informed the first edition

Music therapy is a relatively new profession. It is being increasingly recognised ata time when there has never been such a variety of music available to so manypeople. These two statements summarised the situation in 1994 when the firstedition of this book was published. The first statement remains true even thoughthe changes and developments in the past twenty years have been enormous. Thesecond statement is truer than ever. Music’s availability in contemporary societycreates many new possibilities for music therapy but also new responsibilities.

Most people today have access to music. We may go regularly to listen to musicin concert halls, jazz clubs or opera houses, or at folk or rock festivals. We mayperform music as members of a local choir, band or orchestra. Music of all stylesis also available at the push of a button in the comfort of our own homes orincreasingly, in this digital age, as we move about our daily business, not onlylistening to our own preferred music but also being exposed to background musicin cafés and shops. Music is likewise very much a feature of our experience of thecinema and it plays a major part in the advertising industry. Increasing ease oftravel opens up opportunities to meet people from all corners of the globe, to listento, take part in and learn about more music from different cultures, including fromoral-based traditions. Since the publication of the first edition, the invention of theinternet has made it easier to explore music from all over the world. We wouldneed more than our one lifetime to become familiar with a small fraction of all ofthis music.

Our preferences for music are based in culture yet are individual, relating to ourpersonal and musical histories. And we seldom meet people who report no likingfor any kind of music whatsoever. What are the connections between us andmusic? The answers are many and include the pleasure gained from listening; thewarmth and sense of togetherness from being part of a group making music; thestimulus and satisfaction from regular practice and rehearsal; the intellectualdelight of exploring the intricacies of musical forms and structures; the physicalenergy released within our bodies by both playing and listening to music, inspiringus often to move and dance. At the root of all these reasons lies the fact that musiclinks with our innermost emotional, spiritual and most private selves, and yet isalso a social experience. Music helps us to feel more human: what is essential

about our humanity can be found in our music. We have these private responsesbut music can also bring us into very close and immediate contact with the peoplearound us, connecting us with both the past and the immediate future. Without ourinvolvement as either listener or player there would be no music. We are thenecessary factor in giving rhythmic, melodic and harmonic meaning to the varyingfrequencies, durations and intensities that make up the physical world of sound.

A central theme of both editions is that these needs, connections and uses ofmusic can form an important contribution to present-day health and social care. Achild may have a language problem or an adult may be depressed. In a musictherapy session the potential exists for the person to become an integrated part ofthe music – to move, during the time playing or listening, into a world beyond theverbal and physical. People of all ages can become engaged in exploring a widerange of musical activities: participating in an improvisation; listening to andtalking about music; performing in a band or choir; creating or re-creating a songor piece of instrumental music. Music is very flexible and music therapists canadapt it to connect with people of all ages and abilities, helping them to make useof music in individual or group settings.

How much has music to offer a child or adult with a learning disability orimpairment of any kind? Can music help people overcome or cope with mentalhealth issues? Does singing help a person with dementia? What is it about musicthat can be used as a form of health promotion, or a healthy antidote to thecontemporary pressures of life?

Transition: considerations and collaboration

The profession of music therapy has developed considerably since the first edition.Areas of practice and different kinds of activities continue to evolve. The therapyspace is opening up as therapists become increasingly aware of the social andcommunity contexts in which music therapy is practised. Music therapists arebeing called upon to explore different kinds of music, including those producedby advanced computer technology. There are demands to provide evidence and toaccount for the impact of any period of therapeutic work. These have led, over thepast few decades, to a growth in research and publications incorporating a widerange of methodologies.

Leslie and Brynjulf first met in 1986 and have been in regular contact since themid-1990s. In preparing the second edition, Leslie wanted to maintain the overallform and layout of the 1994 version, particularly the emphasis on case narratives,and to update the text with some of the significant developments in practice,research and theory-building. This new writing partnership between Leslie andBrynjulf evolved through a series of meetings at various international events andsubsequent dialogues. We explored and debated our shared values about musictherapy and established some core themes that we hoped to make more explicit inthis new edition. We did not wish to privilege any one specific approach to musictherapy practice but were conscious of wanting to include more cultural and socialaspects.

2 Introduction: formation and form

Development: music therapy in a new key

In this second edition, several ideas and perspectives discussed in the first editionwill be highlighted and developed further: how people of all ages with differentneeds make active use of music; how relationships and transactions are developedthrough music; how the ecology of human development requires awareness aboutits social, cultural, spiritual and political contexts. ‘Ecology’ here refers to thereciprocal influences between individuals and their environments.

The notion of lifespan development offers an alternative to traditions that focusmostly on human development in childhood. A lifespan perspective allows for anoutlook where possibilities for growth in every phase of life are considered. Towork with adults in music therapy, for instance, goes beyond repairing what mighthave once gone awry. A lifespan perspective invites us to examine challenges, forwhich people need inner and outer resources. These resources can be exploredecologically. In facing a developmental challenge the question is not just whetherthe individual is ready but whether the whole resource system is strong enough. Ifthe system is strong, challenges can lead to personal growth, whether the person is2, 22 or 82. In a weak resource system, if the challenges are too many or too large,they might convert to risks and lead to ill health, impaired quality of life andreduced coping. The range and intensity of challenges, our access to resources andour capacity to use them constructively in collaboration with others determinewhat paths we will be taking and whether or not we will need or want professionalsupport.

The ecological perspective that informs our writing does not exclude those thatare narrower or more focused. We seek to present a range of perspectives andtraditions within music therapy, but will not favour individual or small grouptreatment as the main modes of practice. We will also discuss practices that aremore collaborative or communal in their approach, with an additional focus onlearning and health promotion. For music therapists there are many reasons to beinterested in positive health and health promotion, as the chapters of this book willilluminate in various ways. When a person’s ill health is the focus, we wish todifferentiate between ‘illness’ and ‘disease’ or ‘disorder’. For the purpose of thistext we define ‘illness’ as what people experience and ‘disease’ or ‘disorder’ aswhat healthcare professionals diagnose and treat. There is also a third dimension,namely the social role of not being in good health, as perceived by a community.These processes overlap, interact and separate in complex ways, as we will explainin more detail in Chapter 7. Music therapists also work with children and adultswith disabilities and with people and communities that are disadvantaged.

Given the range of practices and contexts in contemporary music therapy, we donot apply one generic term for the people benefiting from the services of musictherapists. In some texts the term ‘client’ is used, but it is not appropriate in allcontexts. We have therefore chosen to use ‘patient’ in medical contexts, ‘student’or ‘child’ in schools, ‘participant’ in more community-oriented practices, and soon. We use ‘patient/participant’ when the range of contexts is crucial, ‘player’when the creative musical interaction of music therapy is highlighted, or simply‘person’. Of course, the music therapist is participant and player too, and often

Introduction: formation and form 3

works not only with individual persons but also with groups and communities. Wehave tried to represent a broad international field of music therapy writers while atthe same time we are, of course, coloured by our own respective British andScandinavian backgrounds. We introduce music therapists with their full nameand thereafter by their surname. Writers from other disciplines are described bytheir profession where relevant.

Recapitulation: outline of the new edition

The first three chapters correspond to the first three chapters of the earlier edition:Chapter 1, ‘The growth of music therapy’; Chapter 2, ‘Music therapy examplesand perspectives’ (changed title); and Chapter 3, ‘Sound, music and musictherapy’. Chapters 4–7 have evolved from the earlier Chapters 4–6. Each of thesewill include a small number of selected case narratives from practice, somemaintained from the first edition and some new. These will be underpinned by aselection of revised theoretical and research-based reflections. The key areaschosen to represent current music therapy practice are as follows: Chapter 4,‘Music therapy and child health’; Chapter 5, ‘Music therapy and adolescent health’(a completely new chapter); Chapter 6, ‘Music therapy and adult health’; andChapter 7, ‘Music therapy and older adult health’ (another new chapter). Thesepractice-oriented chapters prepare the ground for the two final chapters on theprofession and discipline.

We make no apologies for being selective about which areas of practice todescribe and will attempt to point readers to other areas of practice not discussedin detail. Our vision for this introductory text is not to be comprehensive but toreveal the range of the discipline and profession and to instigate reflections onpossible future developments. The original Chapter 7, ‘Music therapy as a resourcefor the community’, maintains its emphasis on professional and community issuesand now becomes Chapter 8, ‘The profession of music therapy: a resource for thecommunity’. Some features of the earlier final chapter, ‘Music therapy as asynthesis of art and science: Orpheus as emblem’, have been maintained, with theemphasis now being on how music therapy is developing as a discipline. The newtitle of Chapter 9 is ‘The discipline of music therapy: towards an identity ofhybridity?’. Finally, our two voices will separate as we reflect on the journey takentogether in preparing and writing the book; in a brief Epilogue we will speculateon whether music therapy can be justifiably described as ‘an art beyond words’, thebook’s subtitle for both editions.

We hope that this new edition still upholds the introductory nature of theoriginal. We view practice as central, and present a range of as many case narra-tives as possible. Our intention is for all theoretical and research-based reflectionsto underpin practice, the imagined sounds of people making music never beingtoo far away from the page. Overall we hope that there will be something in thisintroductory text for all those who are interested in this rapidly developingprofession and discipline and all those who continue to be fascinated and affectedby this wonderful enigma we call music.

4 Introduction: formation and form

1 The growth of music therapy

Introduction

Music has been used extensively throughout history as a healing force to alleviateillness and distress, but only in relatively recent times has music therapy begun toevolve as its own profession and discipline. What has evolved is a modern andresearch-based practice in the service of human health, together with new andinclusive ways of relating to music. This double identity of music therapy, as botha health profession and discipline and a music profession and discipline, con-tributes to the enormous diversity that characterises contemporary music therapy.This opening chapter will trace the emergence of music therapy, summarise somefurther historical and cultural reference points, explore some definitions, surveydifferent areas of activity and practice, and reflect on the evolution of musictherapy as a new professional discipline.

The United States was the first country to develop music therapy as a modernprofession and discipline. There were early European initiatives such as theAustrian music therapy training established in Vienna in 19591 but we will beginwith developments in the United Kingdom and United States to illustrate some ofthe processes that made possible the establishment of music therapy as a modernprofession.

The emergence of music therapy in the United Kingdom andthe United States

Into the richly diverse world of music entered a mid- to late-twentieth-centuryphenomenon: the professional music therapist. There were historical antecedentsfor this emergence. William B. Davis has documented the activities of the Guild ofSt Cecilia, founded in 1891 by Canon Frederick K. Harford, himself an accom-plished musician, to play music to a large number of patients in London hospitals.Groups of singers and instrumentalists playing muted violins and harp performed

1 Mössler (2011).

in rooms adjoining the patients’ wards. The musicians were encouraged not to seeor talk to the patients. The Guild gained the support of leading reformers of theday, including Florence Nightingale, and received a great deal of attention. Grandplans were made, including providing groups of musicians for other provincialcities and experimenting with the use of sedative and stimulatory music and waysto relay live music to groups of hospital patients via the telephone. There was anexchange of correspondence in the Lancet and the British Medical Journalindicating some early apparent success stories, with patients reporting reduction ofpain while the music was being played and staff commenting on the calming andstimulating effects.2

In spite of these positive stories the Guild folded under the pressure of criticismfrom the musical and medical press, in particular relating to the temporary natureof any effects, lack of funds and Harford’s own ill health.3 Davis and Kate E.Gfeller have traced the development of similar associations in the United Statesduring the early years of the twentieth century. These included the singer EvaVescelius’s creation in 1903 of the National Therapeutic Society of New York,whose belief was ‘that the object of music therapy was to return the sick person’sdiscordant vibrations to harmonious ones’.4

In these early years of the twentieth century, music was used in hospitals mainlyto boost morale, as a general aid to convalescence and as an entertaining diver-sion.5 Physicians invited musicians to play to large groups of patients, assumingthat music might activate ‘metabolic functions’ and relieve mental stress.6

Listening to music could provide an aesthetic experience of quality and wasregarded by many as a humane way of occupying patients’ time. Anecdotalaccounts of music’s inherent worth abound in the early literature on music inmedicine.7 Medical doctor Edward Podolsky cites, for example, the case of aschizophrenic musician being administered daily ‘doses’ of Chopin. Davis andGfeller refer to the musician and nurse Isa Maud Ilsen prescribing Schubert’s AveMaria for the treatment of insomnia.8 There seems to have been a generalconsensus that exposure to music could do nothing but good. As we will see whendiscussing contemporary practices, theories and research, this assumption ismisguided. Music can be used for a variety of purposes, such as self-care andcommunity-building, but also for self-harm and torture. This is one of the reasons


2 See Harford (2002a, b, c) (one article from the Lancet and two from the British Medical Journal,originally published in 1891 and republished in the Nordic Journal of Music Therapy’s series ofclassic articles). See also Tyler (2002) for discussion of Harford’s work.

3 See Davis (1988) on music therapy in Victorian England and also Alvin (1975) and Edwards(2007).

4 Davis and Gfeller (2008: 27–8). See also Edwards (2007: 186).5 Blair (1964: 26).6 Feder and Feder (1981: 115).7 Note the interesting development in the titles of these books: Van de Wall, Music in Institutions

(1936); Licht, Music in Medicine (1946); Schullian and Schoen, Music and Medicine (1948);Podolsky, Music Therapy (1954).

8 Podolsky (1954: 18) and Davis and Gfeller (2008: 28). These early examples were of listening tomusic and did not include the full range of direct musical participation.

why there is a need for professional knowledge and academic research onrelationships between music and health.9

The large influx into hospitals of Second World War veterans was significant forthe development of music therapy as a modern discipline and profession. Themedical authorities, in the United States in particular, wanted to develop servicesfor these returning veterans. Musicians began to be employed regularly in hospitalteams. But the medical and scientific communities were not so easily convinced bythe early anecdotal stories of patients being reached by music when they respondedto little else. Musicians were challenged to verify and systematise their work, toassess the influence of music and to examine the outcome and impact of anymusical intervention in specific treatment plans. Physician and musician GeorgeW. Ainlay reports that until the 1940s and 1950s there appeared to be a generallack of understanding of music’s value, apart from its general aesthetic and culturalaspects, from both physicians and musicians.10 The musicians quite understand-ably lacked training in such assessment procedures and background medical andpsychological knowledge.

The scene was now set for the development of training courses for musicianswanting to develop their skills in this specific use of music. Some early key datesin the United States were as follows:

• 1944: Michigan State University: first curriculum established;• 1945: National Music Council formed a music therapy committee;• 1946: Kansas University: first full academic course taught;• 1950: National Association of Music Therapy (NAMT) formed;• 1971: American Association of Music Therapy (AAMT) formed.11

The NAMT and AAMT united into a single body in 1998, renamed the AmericanMusic Therapy Association (AMTA).12 The AMTA is committed to the advance-ment of education, training, professional standards, credentials and research insupport of the music therapy profession. Professional competencies, proposed in1999 by a commission set up by the AMTA, defined the basic levels of skillsrequired to practise, the most recent revisions occurring in 2009.13

The history of any profession also links to the pioneering visions of keypersonalities. In the United States these included Ruth Boxberger, the firstexecutive of the NAMT; Everett Thayer Gaston, director of the first music therapytraining at Kansas University; and music therapists and writers Edith Boxill,William Sears and Florence Tyson. Recently some of the writings of these

The growth of music therapy 7

9 The claim that music participation and listening is innately helpful has been made even within theprofessional literature but has been scrutinised critically by several authors, for example Edwards(2011a), Gardstrom (2008) and McFerran and Saarikallio (in press).

10 Ainlay (1948: 322–51).11 For further historical details, see Fleshman and Fryrear (1981), Gaston (1968), Goodman (2011)

and Michel (1976).12 www.musictherapy.org.13 Ibid.; Goodman (2011: 29).

www.musictherapy.org

important pioneers have been brought together in edited volumes.14 In the UnitedKingdom the pioneers included the concert cellist and teacher Juliette Alvin andalso the composer and pianist Paul Nordoff, who collaborated with the specialeducation teacher Clive Robbins.15 Rachel Darnley-Smith and Helen Patey havepositioned these developments in the United Kingdom within their historicalcontext, referring to some exploratory work carried out in the 1940s in whichmusicians and medical personnel researched, for example, the effects of differentgenres of recorded music on patients.16 In the United Kingdom some early keydates were as follows:

• 1958: Society for Music Therapy and Remedial Music formed by Alvin andrenamed the British Society for Music Therapy (BSMT) in 1967;

• 1968: Guildhall School of Music and Drama, London: first full-timepostgraduate course taught by Alvin;17

• 1974: Goldie Leigh Hospital, south London: first course taught by Nordoffand Robbins;18

• 1976: Association of Professional Music Therapists (APMT) formed, withAngela Fenwick as the first chair.19

During the 1980s and 1990s new courses were set up, mostly by former studentsof Alvin and Nordoff and Robbins, and in other parts of the country.20 In 1995 theNordoff Robbins Centre began the first full-time taught Master’s-level musictherapy training.21 From 2006 all music therapy trainings were required to be atMaster’s level, and possibilities for studying for a PhD in music therapy have beenincreasing steadily. In 2008, plans began for the development of a new organisa-tion uniting the BSMT and APMT, the charitable with the professional, and in2011 a new organisation, the British Association for Music Therapy (BAMT), wasformed.22

A further historical indicator is the growth of professional status and recog-nition. In April 1980 the issue of appropriate pay and conditions of service wasaddressed in the United Kingdom’s parliamentary House of Commons. This was


14 See Boxill (1997), McGuire (2004; on the legacy of Tyson) and Sears (2007). For historicalresearch on music therapy, see also Solomon (2005).

15 Nordoff and Robbins (1971, 2007). Paul Nordoff was American but Nordoff and Robbinsdeveloped their early pioneering work in the United Kingdom.

16 Darnley-Smith and Patey (2003: 13).17 The Guildhall course was set up originally in cooperation with the BSMT and is currently

validated by City University, London (www.gsmd.ac.uk).18 This course is currently based within the Nordoff Robbins Music Therapy Centre in North London

and since 1984 has been validated by City University (www.nordoff-robbins.org.uk).19 Other committee members included Mary Priestley, Esme Towse, Auriel Warwick and Tony

Wigram.20 For further details, see Darnley-Smith and Patey (2003: 15–23) and Wigram et al. (1993).21 Historical detail kindly verified by Pauline Etkin, who directed Nordoff Robbins Music Therapy

from 1991 to 2013.22 www.bamt.org.

www.gsmd.ac.ukwww.nordoff-robbins.org.ukwww.bamt.org

the result of growing pressure from the APMT and support from colleagues on theneed for a separate identity for the profession. A discussion paper had been incirculation that assumed music therapy could be subsumed under the umbrellaprofession of occupational therapy. While wishing to work alongside other alliedhealth professionals, music therapists felt strongly that their emerging professionneeded its own independent structure. The following question was put by the Hon.Ian Mikardo MP before the Rt Hon. Dr Gerard Vaughan MP, the then Secretary ofState for Social Services:

[I]s he aware that this relatively small group of professional workers, whomake an important contribution to therapeutic treatment, are the only publicservice employees who have no real negotiating machinery? Their wages arefixed unilaterally by their employers. Is it not time that this nineteenth-centuryDickensian anomaly was got rid of, and that we moved into the twentiethcentury?23

The ‘anomaly’ was eventually discarded in 1982 by the award of a career andgrading structure for music and art therapists by the Department of Health andSocial Security.24 This placed music therapists alongside speech therapists,physiotherapists and occupational therapists, for example, as recognised membersof a health and social care profession in the United Kingdom. The profession wasno longer to be regarded as an ad hoc group or to come under the structure foroccupational therapists. Since 1982 there have been further developments in theUnited Kingdom. The profession was awarded state registration in 1997 alongsideart and drama therapy. Initially the registration came from the Council forProfessions Supplementary to Medicine (CPSM) but since 2002 the HealthProfessions Council (HPC) has been the legislative body.25 In 2012 the Councilwas renamed the Health Care Professions Council (HCPC) and it maintains aregister of all therapists who have completed approved training courses and whomaintain their practice through continuous professional development. The HCPCprotects the public and gives legal protection to the registered title of musictherapist.26

In the United States, similar developmental stages can be observed. Musictherapy trainings have been established in about seventy universities, some atBachelor’s level and some at Master’s; PhD possibilities exist in several uni-versities through interdisciplinary collaboration. Temple University in Philadelphiahas established a strong specialised PhD education in music therapy.27 Since 1986the Certification Board for Music Therapists (CBMT) has been accredited by the


23 Hansard 29 April 1980: Art and Music Therapists (Pay): 6.24 DHSS Memorandum: PM (82) 6.25 www.hpc-uk.org.26 Bunt and Hoskyns (2002: 11–12).27 Other opportunities for PhD study in music therapy exist elsewhere, for example the international

programme at Aalborg University, Denmark.

www.hpc-uk.org

National Commission for Certifying Agencies. Currently the CBMT is the organ-isation responsible for certifying music therapists to practise.28

Paths of development in contemporary music therapy

In many countries around the world the 1960s and 1970s were pioneering decadesfor music therapy, while the 1980s and 1990s opened up a period for the pro-fessionalisation of services and the formalisation of education and research. After2000 there was an exponential development of music therapy research. Stige hasproposed that in order to understand the emergence of contemporary musictherapy, we need to take into account the modernisation of societies, includingprocesses such as differentiation and rationalisation. Differentiation here refers tohow aspects of life, such as health care, develop their own spheres of discourseand practice. Rationalisation refers to the way in which activities are organisedthrough formalised regulation, usually informed by reason and science.29

The growth of music therapy is based not only on the initiatives and hard workof visionary pioneers but also in conditions created by society. Hence, we shouldexpect the developments of music therapy in different countries to have somecommon characteristics due to shared processes of modernisation as well asdifferences due to idiosyncratic conditions. The emergence of music therapy in acountry such as Norway can exemplify this. There are similarities with the storiestold above about the development of music therapy in the United States and theUnited Kingdom. Music therapy emerged from initiatives in practice beforeassociations and training programmes were established and before furtherpossibilities for research and education at Master’s and PhD level were created.But there are also significant differences in relation to the socio-cultural aspectsof music therapy. As in many countries, early music therapy pioneers in Norwaywere often based in charitable endeavours and idealism. As music therapygradually became organised and professionalised, it developed in more sociallyengaged directions. In the 1960s the first pioneers of music therapy in Norwaystarted to organise meetings and seminars, welcoming inspiration from inter-national pioneers such as Nordoff and Robbins. In the 1970s, music therapyassociations were established and systematic work began to set up a training coursein Oslo. The first group of Norwegian students began their music therapyeducation in 1978, with Even Ruud, Unni Johns and Tom Næss as the three mainlecturers.30 This move towards professionalisation coincided with the ideologicalchanges just referred to. The vision was no longer charity in the service of ill-fatedindividuals but a welfare society in which the rights of people with disabilitieswere respected. Ruud’s early writings often described a vision of music therapycontributing to a more just society with equal access to music.31 These changes in


28 www.cbmt.org.29 Stige (2003/2012: 187–188).30 Stige and Rolvsjord (2009).31 See, for example, Ruud (1980).

www.cbmt.org

Norwegian music therapy in the 1970s were probably not unrelated to changes inNorwegian society, for example when it came to support of the arts. At this timethere was a shift in government policy, with more support for popular and folk-artactivities and more awareness about every person’s right to participate in cultureand society. This prepared the ground for the strong community music therapytradition that started to emerge in Norway, not least after the establishment in 1988of the music therapy training that is now located in Bergen.32

In short, compared to the early developments in the United States and UnitedKingdom, the growth of music therapy in Norway was much less based inresponses to the medical needs of those in hospital and much more on the culturalrights of everyone in society. The differences that we can see between the develop-ments of music therapy in different countries suggest that we should be careful inclaiming that there are given phases or patterns of development to a professionand discipline. The metaphor ‘paths of development’ seems to capture somethingsignificant: there may be some common elements but each nation’s ‘path’ towardsthe establishment of music therapy as profession and discipline is still in manyways unique.33

Music therapy is currently an international phenomenon. Developments inSouth America, Africa, Asia and Australia are as vital as those in the United Statesand Europe. The location of world congresses up to the time of writing goes someway to indicate the global evolution of music therapy. The first world congresstook place in Paris in 1974, with 400 attendees from twenty countries. Thelocations since have been Buenos Aires (1976), Puerto Rico (1981), Paris (1983,when there were two events), Genoa (1985), Rio de Janeiro (1990), Vitoria-Gasteiz (1993), Hamburg (1996), Washington, DC (1999), Oxford (2002),Brisbane (2005), Buenos Aires (2008) and Seoul (2011), where over 1,200 musictherapists, trainers, researchers and students from forty-six different countriespresented hundreds of papers in various formats.34 If we take into considerationthe growth of music therapy in countries such as India, China, Korea and Japan, wecan assume that in the future there will be more world congresses in Asia. Andwhen will we see the first world congress in Africa? The organisation of a worldcongress involves collaboration between a local organising committee, aninternational scientific committee and the World Federation of Music Therapy.35

In several parts of the world, countries have grouped together to form largerorganisations, for example the South American Music Therapy Confederation. In1990 the European Music Therapy Confederation was formed. One of its aims is


32 ‘Community music therapy encourages musical participation and social inclusion, equitableaccess to resources, and collaborative efforts for health and wellbeing in contemporary societies’;Stige and Aarø (2012: 5).

33 We borrow the metaphor from Aigen’s (1998) study of developmental processes in the Nordoff Robbins approach to music therapy.

34 See the interview series charting the history of the world congresses (www.voices.no) and onlineavailability of books of abstracts and/or congress proceedings from several of the eventsmentioned above.

35 www.wfmt.info.

www.voices.nowww.wfmt.info

for therapists trained in one country within the European Union to have theirqualifications recognised in another member state and potentially be able to workin a country other than the one in which they trained.36 Increased access to theinternet has been of enormous advantage to a profession at whose heart is thenotion of communication. Associations and groups have constructed websitesenabling the sharing of information (see, for example, the online open-accessjournal Voices).37

Further historical and cultural reference points

We begin here a brief excursion into further historical and cultural reference pointsby noting the ubiquitous and powerful influence of music. In his book The SingingNeanderthals, archaeologist Steven Mithen cannot imagine a time or culture whenpeople did not sing or dance, children play musical games, mothers hum to theirbabies or communal singing take place to commemorate important events. As heaptly notes, ‘Without music, the prehistoric past is just too quiet to be believed.’38

It is often pointed out that music is the oldest art form associated with helpingthe ill, not forgetting that the separation of various art forms such as dance, musicand drama to a large degree is a modern construction. Davis and Gfeller commentthat music was used in early nomadic hunter-gatherer communities to entreat thegods and ward off evil spirits. Here, they suggest, were the beginnings of a magicaland religious belief in the supernatural capacity for music used in healing rituals toinfluence physical and mental health.39 Many of the music therapy pioneers citedsuch uses of music in tribal medicine alongside mythological sources and biblicalreferences, an oft-quoted example being David playing his harp to the troubledSaul, to provide some historical perspective.40 More rational approaches to the useof music in healing emerged in different civilisations: Rolando Benenzon notedthat the use of music to influence the human body was first mentioned in writingin Egyptian medical papyri dating back to 1500 BCE.41

The historian Peregrine Horden argues that the written sources of the pre-classical civilisations of Mesopotamia and Egypt are too fragmented for any realinvestigation of beliefs and practices. He suggests that the historical study of musictherapy should start with the four major traditions of literate and learned medicine:Graeco-Roman, Arabian, Indian and Chinese. All of these literate traditionsinclude various notions of musical therapy.42 We will give some glimpses of theEuropean tradition.


36 www.emtc-eu.com.37 www.voices.no.38 Mithen (2006: 4).39 Davis and Gfeller (2008); Mithen (2006). For overviews of music and healing traditions, see Gouk

(2000) and Boyce-Tillman (2000).40 Soibelman (1948). See also Alvin (1975), Boyce-Tillman (2000), Licht (1946) and Schullian and

Schoen (1948).41 Benenzon (1981: 143).42 Horden (2000: 43).

www.emtc-eu.comwww.voices.no

An empirical stance to medicine informed the philosophers of ancient Greece,usually combined with colourful speculations grounded in specific schools ofthought. Here can be observed the development of rational concepts of order,proportion and harmony within music, coexisting with more metaphysical andspeculative descriptions. Pythagoras (born 569 BCE) laid the foundations for ourWestern understanding of musical proportions, pitch and interval relationshipswith his experimentations on the one-string monochord. As physician, Pythagorasis reported to have explored how various combinations of melodies played on thelyre, or sung, could influence a range of moods. These reports are placed along-side his more philosophical speculations linking these human vibrations andconnections to a mystical contemplation of universal resonances, planetarymovements and the ‘music of the spheres’.43 We can observe how rational andphilosophical explorations in the ancient world existed beside the more magical,unrestrained and purging aspects of the use of music in various healing rites toalleviate disorder.44

Other ancient ideas that have interested music therapy commentators includereference to vibrations of music being able to influence the healthy balance neededbetween the four ‘humours’ (blood, phlegm, yellow bile and black bile).Thistheory originated in Greek antiquity, becoming even more important in Europeduring the Middle Ages and retaining its influence even until the eighteenthcentury.45 Music took on a further secular role during the Renaissance. Thediscoveries of the anatomists were to promote a scientific and physiological basisto medicine. However, the older beliefs that evil was inherent in illness, especiallymental illness, could not be suppressed by these new developments. Of relevanceto the emergence of music therapy was the increased use of music as an individualand fundamentally human act of expression.

In an overview of the use of music in healing, historian Penelope Gouk notesthat tracing the origins of the discipline of music therapy to ancient Greece andthe European Renaissance is symptomatic of the historical moment when themusic therapy profession was beginning to gain ground but that such ‘ethnocentricand elitist assumptions are no longer tenable’.46 She made this comment in relationto Schullian and Schoen’s 1948 collection Music and Medicine, describing it asone that also gives pride of place to the Western medical model of care as opposedto other, more ‘traditional’ systems.47 In a similar way, Horden notes how somemusic therapy commentators have called on this European past to give validationto the present, taking it ‘as axiomatic that the past can be interpreted in much thesame light as the present’.48 Clearly, the ideas from antiquity were part of a


43 For a collection of some classical sources, see Godwin (1986), in particular Iamblichus ofChalcis’s summary of Pythagoras. And see Wigram et al. (2002: 17–28).

44 Feder and Feder (1981).45 Wigram et al. (2002: 24–5).46 Gouk (2000: 3).47 Schullian and Schoen (1948).48 Horden (2000: 21). See also Gouk (2000: 173–94).

cosmology and society that are different from the beliefs and conditions thatcharacterise most people’s lives today. These older ideas cannot be transplanteddirectly onto our times.

It is clear from the compilations by Gouk and Horden that there is less sense ofhistorical continuity than is often proposed and that music therapists can learnmuch by exploring the use of music in non-Western medical and healing traditions.Carolyn Kenny and Joseph Moreno have contributed to the increasing awarenesswithin music therapy about these traditions and the value of myths and rituals.49

When interpreting contemporary cultures different from our own, we cannot makecomparisons in any direct or unproblematic way, as similarly observed by Horden,because conditions, traditions and worldviews vary considerably.

These observations suggest that adequate learning from historical and culturalreference points requires critical examination of the assumptions that guide ourown practice and scholarly ideas. The forerunners and pioneers of modern musictherapy followed such paths only to a limited degree. They often turned to sciencefor what they considered a new and objective beginning in the history of musictherapy. The physiological and emotional effects of music began to be recorded.Davis and Gfeller cite the earliest reference to music therapy to appear in print in the United States when in 1789 an anonymous article, ‘Music physicallyconsidered’, was published in the Columbian Magazine.50 The author outlined theuse of music for influencing various ‘emotional conditions’, observing ‘that aperson’s mental state may affect physical health’.51 This article recommended thatspecialised training was necessary.

Jumping ahead, interest in the effects of music on health continued in Parisianmedical life in the mid-nineteenth century, as exemplified by a treatise of Dr Hector Chomet, ‘The influence of music on health and life’, which discussedthe preventive uses of music.52 However, the lack of sustained and rigorousexperimentation can be observed in many of the early uses of music in medicine.It was still apparent during the middle years of the twentieth century and led to awarning by the physician Sidney Licht that is still relevant today:

Musicians must be cautioned to consider that their sincere efforts may resultonly in discrediting music, as a therapeutic agent. As a result its acceptance onthe basis of such merits as it may possess may be undeservedly delayedbecause of antagonism aroused by extravagant claims made in its behalf.53

A body of physiologically based research measuring the effects of music onspecific patient groups played a large part in the emergence of modern musictherapy in the United States. Such research led to the possibilities of a medical


49 Kenny (1982/1988, 1989, 2006) and Moreno (1988).50 Davis and Gfeller (2008: 22).51 Ibid.52 Cited by Alvin (1975: 48).53 Licht (1946: 18).

model providing a reference point for the emerging discipline and profession.Many music therapists also turned to behaviour therapy and the direct observa-tion and documentation of external behaviours. This so-called ‘first force’ inpsychology contributed a great deal to the growing acceptance of music therapyfrom the 1950s to the 1970s, particularly in the United States. Psychoanalysis andthe work of Freud and Jung and their successors (the ‘second force’) providedanother major reference point.

During the latter part of the last century the ‘third force’ of an approach rootedin humanistic and existential philosophy began to wedge its way between the twopillars of behaviour therapy and psychoanalysis. Many music therapists wouldagree that their work embraces such humanistic goals as ‘helping individuals torealize their potentials’.54 Lars Ole Bonde notes that the work of the psychologistAbraham Maslow links the humanistic approach to that of the transpersonal, oftenregarded as the ‘fourth force’.55 The theorist Ken Wilber furthers our under-standing of the transpersonal, ‘focusing on the vast field of spiritual, non-ordinaryexperience and knowledge in Eastern and Western philosophy and psychology’.56

Kenneth Bruscia has argued that culture-centredness could be considered a ‘fifthforce’ in music therapy, a challenge to our uncontextualised generalisations aboutthe nature of music, therapy and music therapy.57 Several colleagues have similarlyargued that we need to develop more music-centred perspectives.58

There are both advantages and disadvantages in forming close relationships withexisting frames of reference, as we shall see in Chapter 2 when we explore thesedifferent ‘forces’ in relation to music therapy. But to escape any frame of referenceis hardly a possibility. Since the publication of the first edition in 1994 a series ofimportant publications has furthered the evolution of music therapy and placedthis emergent discipline and profession not only within prevailing psychologicaland therapeutic approaches but also within larger cultural, social and musicaldevelopments and patterns. This is in line with Gouk’s proposal for more con-sideration of cultural contexts and interdisciplinary approaches, and Horden’sinvitation to music therapists to explore wider social contexts for greater under-standing of practice.59

What is music therapy?

The question of what music therapy is, is one that seems to fascinate people but itis notoriously difficult to find a definition that will suit everyone. We can beginby describing how music therapy provides an opportunity for anybody to make arelationship with a trained music therapist through which his or her needs can be


54 Feder and Feder (1981: 43).55 Bonde (2001).56 Ibid.: 178–9.57 Bruscia (2002: xv).58 Aigen (2005, 2014); Ansdell (2013); Garred (2006); Lee (2003).59 Gouk (2000: 3); Horden (2000: 16).

addressed. The music is not an end in itself but is used as a means to an end. As theAmerican music therapy pioneer Don Michel points out, any definition of musictherapy is not self-evident; it is not as though music therapists are helping people’smusic, in the way that speech and language therapists aid speech and languagedevelopment.60 However, some argue strongly that music therapists are in facthelping people’s music; only if music is also an end can it be emotionally andaesthetically meaningful for the person and successfully appropriated for otherpurposes. Various music-centred and ecological perspectives on this have beendeveloped by, for example, Kenneth Aigen in the United States and Gary Ansdellin the United Kingdom.61

How we describe music therapy depends upon our intention and purpose in agiven situation. Music therapy students and musicians from all traditions may beinterested to learn more of how the music is adapted to suit the needs of differentpeople. Here discussion might focus on compositional and improvisationaltechniques and the range of music used, including the use of songwriting andreceptive (listening) techniques. Budget-holders within commissioning agenciesdebating whether to set up a music therapy post often need convincing evidence ofthe efficacy of music therapy. Is there any research evidence relating to the givencontext? Here discussion might be directed towards some of the therapeuticoutcomes or impact of the work, including any limitations or contraindications.

Music offers a versatile space for people to establish contact with each other.In music therapy we observe how people use the music and what might affect theflow of interactive communication. Pamela Steele reminds music therapists of theirmajor responsibility to listen: ‘Perhaps the most primary service which we offerour patients within the space and time of the therapeutic environment is ourwillingness and ability to listen.’62 She develops the notion of attendance,previously discussed by Kenny: ‘Attendance implies a mutual interchange, analert, resourceful, caring, vigilant patience and guidance. It represents an attitude,a way of being.’63

More formal definitions of music therapy have changed in emphasis over theyears as the emerging profession has adapted to different needs, contexts andcultural shifts in attitudes towards the nature of health. In the early development ofthe profession a standard definition in the United Kingdom was Alvin’s from 1975:‘Music therapy is the controlled use of music in the treatment, rehabilitation,education and training of children and adults suffering from physical, mental oremotional disorder.’64 The word ‘controlled’ implies that the music is used in aclear and focused manner but the definition as a whole makes for a somewhattherapist-centred approach, as if the therapy is ‘done to’ people. Terminology goesin and out of fashion, linked to the philosophical, ethical and moral perspectives of


60 Michel (1976: vii).61 Aigen (2005, 2014); Ansdell (2013).62 Steele (1988: 3).63 Kenny (1982/1988: 3).64 Alvin (1975: 4).

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