Music Therapy

An art beyond words

Leslie Bunt, Brynjulf Stige

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317815327
• Edition: 2
• Topic: Medien & darstellende Kunst
• Subtopic: Musik

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

Leslie Bunt and Brynjulf Stige document the historical evolution of music therapy and place the practice within seven current perspectives: medical, behavioural, psychoanalytical, humanistic, transpersonal, culture-centred and music-centred. No single perspective, individual or group approach is privileged, although the focus on the use of sounds and music within therapeutic relationships remains central. Four chapters relate to areas of contemporary practice across different stages of the lifespan: child health, adolescent health, adult health and older adult health. All include case narratives and detailed examples underpinned by selected theoretical and research perspectives. The final two chapters of the book reflect on the evolution of the profession as a community resource and the emergence 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 in music therapy and music education, those working in the psychological therapies, social work and other caring professions, and students at all levels.

1 The growth of music therapy

DOI: 10.4324/9781315817989-2

Introduction

Music has been used extensively throughout history as a healing force to alleviate illness and distress, but only in relatively recent times has music therapy begun to evolve as its own profession and discipline. What has evolved is a modern and research-based practice in the service of human health, together with new and inclusive ways of relating to music. This double identity of music therapy, as both a health profession and discipline and a music profession and discipline, contributes to the enormous diversity that characterises contemporary music therapy. This opening chapter will trace the emergence of music therapy, summarise some further historical and cultural reference points, explore some definitions, survey different areas of activity and practice, and reflect on the evolution of music therapy as a new professional discipline.

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

1 Mössler (2011).

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

Into the richly diverse world of music entered a mid- to late-twentieth-century phenomenon: the professional music therapist. There were historical antecedents for this emergence. William B. Davis has documented the activities of the Guild of St Cecilia, founded in 1891 by Canon Frederick K. Harford, himself an accomplished musician, to play music to a large number of patients in London hospitals. Groups of singers and instrumentalists playing muted violins and harp performed in rooms adjoining the patients’ wards. The musicians were encouraged not to see or talk to the patients. The Guild gained the support of leading reformers of the day, including Florence Nightingale, and received a great deal of attention. Grand plans were made, including providing groups of musicians for other provincial cities and experimenting with the use of sedative and stimulatory music and ways to relay live music to groups of hospital patients via the telephone. There was an exchange of correspondence in the Lancet and the British Medical Journal indicating some early apparent success stories, with patients reporting reduction of pain while the music was being played and staff commenting on the calming and stimulating effects.²

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 of classic articles). See also Tyler (2002) for discussion of Harford’s work.

In spite of these positive stories the Guild folded under the pressure of criticism from the musical and medical press, in particular relating to the temporary nature of 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 States during the early years of the twentieth century. These included the singer Eva Vescelius’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’s discordant vibrations to harmonious ones’.⁴

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).

In these early years of the twentieth century, music was used in hospitals mainly to boost morale, as a general aid to convalescence and as an entertaining diversion.⁵ Physicians invited musicians to play to large groups of patients, assuming that music might activate ‘metabolic functions’ and relieve mental stress.⁶ Listening to music could provide an aesthetic experience of quality and was regarded by many as a humane way of occupying patients’ time. Anecdotal accounts of music’s inherent worth abound in the early literature on music in medicine.⁷ Medical doctor Edward Podolsky cites, for example, the case of a schizophrenic musician being administered daily ‘doses’ of Chopin. Davis and Gfeller refer to the musician and nurse Isa Maud Ilsen prescribing Schubert’s Ave Maria for the treatment of insomnia.⁸ There seems to have been a general consensus that exposure to music could do nothing but good. As we will see when discussing contemporary practices, theories and research, this assumption is misguided. Music can be used for a variety of purposes, such as self-care and community-building, but also for self-harm and torture. This is one of the reasons why there is a need for professional knowledge and academic research on relationships between music and health.⁹

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 to music and did not include the full range of direct musical participation. 9 The claim that music participation and listening is innately helpful has been made even within the professional literature but has been scrutinised critically by several authors, for example Edwards (2011a), Gardstrom (2008) and McFerran and Saarikallio (in press).

The large influx into hospitals of Second World War veterans was significant for the development of music therapy as a modern discipline and profession. The medical authorities, in the United States in particular, wanted to develop services for these returning veterans. Musicians began to be employed regularly in hospital teams. But the medical and scientific communities were not so easily convinced by the early anecdotal stories of patients being reached by music when they responded to little else. Musicians were challenged to verify and systematise their work, to assess the influence of music and to examine the outcome and impact of any musical intervention in specific treatment plans. Physician and musician George W. Ainlay reports that until the 1940s and 1950s there appeared to be a general lack of understanding of music’s value, apart from its general aesthetic and cultural aspects, from both physicians and musicians.¹⁰ The musicians quite understandably lacked training in such assessment procedures and background medical and psychological knowledge.

10 Ainlay (1948: 322–51).

The scene was now set for the development of training courses for musicians wanting to develop their skills in this specific use of music. Some early key dates in 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

11 For further historical details, see Fleshman and Fryrear (1981), Gaston (1968), Goodman (2011) and Michel (1976).

The NAMT and AAMT united into a single body in 1998, renamed the American Music Therapy Association (AMTA).¹² The AMTA is committed to the advancement of education, training, professional standards, credentials and research in support of the music therapy profession. Professional competencies, proposed in 1999 by a commission set up by the AMTA, defined the basic levels of skills required to practise, the most recent revisions occurring in 2009.¹³

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

The history of any profession also links to the pioneering visions of key personalities. In the United States these included Ruth Boxberger, the first executive of the NAMT; Everett Thayer Gaston, director of the first music therapy training at Kansas University; and music therapists and writers Edith Boxill, William Sears and Florence Tyson. Recently some of the writings of these important pioneers have been brought together in edited volumes.¹⁴ In the United Kingdom the pioneers included the concert cellist and teacher Juliette Alvin and also the composer and pianist Paul Nordoff, who collaborated with the special education teacher Clive Robbins.¹⁵ Rachel Darnley-Smith and Helen Patey have positioned these developments in the United Kingdom within their historical context, referring to some exploratory work carried out in the 1940s in which musicians and medical personnel researched, for example, the effects of different genres of recorded music on patients.¹⁶ In the United Kingdom some early key dates were as follows:

14 See Boxill (1997), McGuire (2004; on the legacy of Tyson) and Sears (2007). For historical research on music therapy, see also Solomon (2005). 15 Nordoff and Robbins (1971, 2007). Paul Nordoff was American but Nordoff and Robbins developed their early pioneering work in the United Kingdom. 16 Darnley-Smith and Patey (2003: 13).

• 1958: Society for Music Therapy and Remedial Music formed by Alvin and renamed the British Society for Music Therapy (BSMT) in 1967;
• 1968: Guildhall School of Music and Drama, London: first full-time postgraduate course taught by Alvin;¹⁷
• 1974: Goldie Leigh Hospital, south London: first course taught by Nordoff and Robbins;¹⁸
• 1976: Association of Professional Music Therapists (APMT) formed, with Angela Fenwick as the first chair.¹⁹

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.

During the 1980s and 1990s new courses were set up, mostly by former students of Alvin and Nordoff and Robbins, and in other parts of the country.²⁰ In 1995 the Nordoff Robbins Centre began the first full-time taught Master’s-level music therapy training.²¹ From 2006 all music therapy trainings were required to be at Master’s level, and possibilities for studying for a PhD in music therapy have been increasing steadily. In 2008, plans began for the development of a new organisation uniting the BSMT and APMT, the charitable with the professional, and in 2011 a new organisation, the British Association for Music Therapy (BAMT), was formed.²²

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.

A further historical indicator is the growth of professional status and recognition. In April 1980 the issue of appropriate pay and conditions of service was addr...