Music Therapy

Rachel Darnley-Smith, Helen M Patey

• Publisher: SAGE Publications Ltd
• Year: 2003
• Print ISBN: 9780761957775, 9780761957768
• eBook ISBN: 9781446226018
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

`This book is a detailed introduction to music therapy, and should be of particular interest to intending students of the subject and those wishing to pursue a career within the profession. It should be of considerable use to all with a general interest in the subject as well those making a career on music therapy? - The Organ

`I found this a useful book in terms of its clarity and carefully thought out structure. It is a rich source of information and of ideas which are extremely important for the potential music therapy trainee to think about; it also makes valuable reading for more experienced therapists, bringing our minds back to some central questions about the nature of our work…. Whatever stage you may be at in your life as a music therapist, it will refresh your mind and your practice? - Eleanor Richards, Nordic Journal of Music Therapy

From the Foreword:

`Rachel Darnley-Smith and Helen M Patey have managed so well to tell their story of music therapy offering the framework of theory, training and professional practice, and the complimentary value of Analytical Music Therapy and Creative Music Therapy within improvization. The authors devote a whole chapter to promoting a wider understanding of improvisation, describing its value as a form of play, free association, with more or less structure depending on the form of intervention and the client?s needs. There is really a valuable resource of meaningful and relevant examples from their own clinical work. These examples clearly validate and illustrate the seminal theoretical concept of the first great pioneer of music therapy in the United Kingdom, Juliette Alvin, who taught us that music is a creation of people, and therefore we can see people in their music? - Professor Tony Wigram

Music Therapy is an introduction to contemporary training and practice. Written in a clear, jargon-free style, the book provides a lively source of information and ideas for all who are new to music therapy.

Written by highly experienced practitioners, the book examines improvization, the principal method for music therapy, and points to the underlying assumptions about music, which shape this way of working. Two of the main music therapy approaches - Analytic Music Therapy and Nordoff- Robbins Music Therapy - are also outlined.

Drawing on their own experience, the authors examine a range of clinical situations and give examples of working with children and adults with a range of needs, including autism, learning disabilities and mental health problems. They highlight the many issues which arise from day-to-day practice and explore other aspects of professional life, such as personal therapy and supervision.

For anyone training or thinking of training to be a music therapist, this book provides an ideal place to start. As a guide to contemporary music therapy, it also has much to offer those already in practice.

PART I

Getting Started

1

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IN THE BEGINNING

Ama, a woman in her twenties, sits down in a group of people she does not know and whose language she hardly speaks. There is an uncomfortable pause. John tells Paul to ‘Sing us a song’. Paul takes a breath and suddenly the German words of a song by Schubert ring out. The music finishes and most of the group members convey their appreciation. Someone then suggests that John ‘sings a song’. John explains to the group that he is from Ireland and immediately starts to sing a song in Gaelic, stamping his foot and accompanying himself on a small tambour. Many in the room tap their feet and some reach for percussion instruments to play with John’s strident beat. His song finishes and another group member asks Ama, in her own language, if she would like to join in. After a brief conversation, she starts to sing, long melodic lines in a very high register. The group sits listening in silence until she stops. There is another pause, but this time it feels more relaxed. The group leader, a music therapist, reaches for a drum and invites everyone to join her. Soon the whole group is playing, and although there are many individual sounds and rhythms, a new piece of music is jointly created, there and then.

Music therapy is a modern profession whose practice requires skill and theoretical knowledge. It is also a vocation, involving a deep commitment to music and the desire to use it as a medium to help others. Although music therapy has only been established as a profession relatively recently, the connection between music and therapy is not new. Writers and historians have repeatedly commented upon a human preoccupation with music as part of healing and medicine, and we can find this recorded and recounted in history, myth, legend and literature over the past 2000 years. As far as we can tell, music probably existed as a form of healing in the most primitive of societies (West, 2000: 51). Today it is practised throughout the world, its effectiveness being explained by knowledge systems as diverse as magic and science.

Why might this be so? It seems appropriate to begin by speculating why music might be a tool for healing worldwide and why ‘at various times and in various cultures over the past two and a half millennia – and probably still further back in time – music has been medicine’ (Horden, 2000: 1).

Contemporary research from child psychology and psychobiology has demonstrated the innate properties of musicality (Trevarthen and Malloch, 2000). Innate musicality has a vital function from the moment we are born, when we use sound as our earliest means of communication. The sounds an infant might make in any one moment have pitch, timbre, rhythm, intensity and melody. Furthermore, these sounds communicate feelings such as hunger, contentment, the need for sleep, and so on. The infant uses these sounds to interact, and, all being well, eventually learns to talk as developmental processes take place and the sounds are extended into speech. A parent also is able to communicate instinctively with the infant, employing elements which are familiar to us through music-making, for example, turn-taking, timing and regulating the pitch and timbre of the vocalisations. So, the musicality referred to here does not imply having perfect pitch or being able to play a musical instrument to a high standard. This intuitive manipulation of musical sound has been called ‘Communicative Musicality’ (Trevarthen and Malloch, 2000: 5–7), which refers to ‘those attributes of human communication, which are particularly exploited in music … [and which] is vital for companionable parent/infant communication’. Research has also demonstrated that a lack of opportunity for this early communication can have a profound effect upon the emotional and cognitive development of an infant (Malloch, 1999: 157).

But sound is not only used as a means of self-expression and relationship in the first few months of life. It is well known that musical sound is part of life in many different ways and for different purposes. As music therapists have frequently commented, humans are musical beings. Our hearts beat and we move ‘in time’. We speak and communicate in pitches, rhythms and timbre. Ethnomusicologist Gregory (1997) lists the main traditional uses of music which ‘are common to nearly all societies’: lullabies, the games of children, storytelling, work songs, dancing, music used in religious ceremonies, in festivals, in war, as a personal symbol, salesmanship, to promote ethnic or group identity, as communication within language itself, for personal enjoyment, in healing and in trance (1997: 123–37).

Music therapists are often asked to give lectures or workshops to colleagues, potential clients, students or the interested general public. In such situations it is always stimulating to invite the audience to contribute personal thoughts about their relationship to music. At these moments the energy in the room seems to surge, as people begin to share their experiences, finding that in talking about music there is much common ground between them. A mother may relate an anecdote of her unborn baby responding to music in the womb. Parents frequently relate the power of their non-verbal and essentially musical relationship with a new-born child. Others will speak of listening to music at the end of a stressful day or during a car journey. Many will talk about the importance of particular music that evokes either painful or joyful memories, from a time of being bereaved, or a time of being in love. As this shows, people do not need to be told about the therapeutic qualities of music – they have frequently already experienced them in their everyday lives.

So to return to the question, why is music as a healing phenomenon not restricted to time or place? We believe it is because the elements of music are fundamental to the human condition and have the potential to be used in the pursuit of common therapeutic goals, as self-expression (individually and collectively), in communication and to enhance physical, spiritual and emotional well-being.

Let us now look at a definition of music therapy to see how these elements of music are systematically employed in the modern discipline.

What is Music Therapy?

The World Federation of Music Therapy (WFMT) defines music therapy in the following way:

Music therapy is the use of music and/or musical elements (sound, rhythm, melody and harmony) by a qualified music therapist, with a client or group, in a process designed to facilitate and promote communication, relationships, learning, mobilization, expression, organization, and other relevant therapeutic objectives, in order to meet physical, emotional, mental, social and cognitive needs. Music therapy aims to develop potentials and/or restore functions of the individual so that he or she can achieve better intra- and interpersonal integration and consequently a better quality of life through prevention, rehabilitation or treatment. (1997: 1)

This definition is necessarily broad so that it can encompass the variety of different models and methods of practice which exist worldwide. In the international music therapy community, two distinct applications of music as therapy can be found:

• the use of music for its inherent restorative or healing qualities; and
• the use of music as a means of interaction and self-expression within a therapeutic relationship.

The Use of Music for its Inherent Restorative or Healing Qualities

Some forms of music therapy use the physical properties of music in treatment and as healing. The role of the relationship between client and therapist is in most cases secondary to the importance of the application of music as treatment. Here are some examples:

Vibroacoustic Therapy
The vibration of sounds or single tones has been used ‘in past civilisations and in different cultures … as a means of treating physical disabilities and pain … and psychosomatic disorders’ (Skille and Wigram 1995: 23–4). A modern version of this treatment, which makes use of the physiological effects of musical vibrations upon the body, has been developed, particularly in Scandinavia and Britain, since the 1960s. It was known in Norway initially as the ‘music bath’ and more recently as vibroacoustic therapy. Skille and Wigram write that:

The music bath is trying to create an environment whereby the body is ‘bathed’ in sound and vibration … The equipment (patented on a worldwide basis) consists of a bed/bench or chair with several built-in loud speakers. This is connected to a signal unit with six channels containing a cassette player which can run various tapes.
The process of vibroacoustic therapy involves lying a client on the bed so that the sound is being transferred by air directly to the body of the client. (1995: 25)

Examples of conditions which have responded well to the treatment include cerebral palsy, asthma, abdominal pain, constipation, insomnia, menstrual pain and sports injuries (Skille and Wigram, 1995: 38–40). Whilst essentially a receptive technique of music therapy, Hooper (2001: 75) discusses the interpersonal involvement required of the therapist, and also cites how vibroacoustic therapy can be used to encourage a therapeutic relationship and lead towards the client’s involvement in the more active methods of music therapy prevalent in the UK.

The Use of Music-making as a Direct Means of Cure in Mental or Physical Illness Music therapy researcher and historian Chava Sekeles describes how ancient techniques of music therapy are demonstrated today worldwide, for example by Navajo Indians, who use music as a direct means of cure. She writes ‘The tribal healer is still considered to be the best diagnostic, his advice and medicines are considered to be extremely powerful, while his extranatural and supernatural powers go totally unchallenged’ (1996: 6). The practice of medicine is accompanied by chants and song, over a traditional nine-day period, either performed by a specially trained singer or by the healer himself. ‘The Navajo believe that singing and incantation are the central means by which harmony can be restored to both the patient’s body and soul and to his surroundings’ (Sekeles, 1996: 6).

The Use of Recorded Music as Therapy Supplementary to the Cure of Physical Illness
In the United States methods of music therapy have been developed where recorded pieces of music are used in the relief of pain and the reduction of pain, anxiety or stress, so that patients require fewer drugs (Standley, 1995: 3–22). One procedure involves the patient listening to their chosen music on high-quality equipment, during or immediately before medical treatment. Wherever possible the patient retains control over the volume and the stopping and starting of the music. This type of music therapy takes place within a variety of medical settings, including surgery where it is used ‘pre-operatively to reduce anxiety and reduce the amount of anaesthesia required’ (Standley, 1995: 12). Clients include those on kidney dialysis, where music is used to reduce discomfort and serve as a distraction, and during childbirth. Other clients in Standley’s survey of passive music listening include those suffering from cancer, where music is used in the reduction of pain and to enhance the analgesic effects of medication. Passive music listening is also included in the treatment of premature or sick infants where it is used to promote weight gain and to reduce the length of hospitalisation (Standley, 1995: 12).

The Use of Music as a Means of Interaction and Self-expression Within a Therapeutic Relationship

The majority of music therapists across the world would acknowledge their use of music as a means of interaction and self-expression within a therapeutic relationship. There are, however, many different ways in which this is carried out, depending on factors such as the number of clients, the setting of the therapy, and the aims and theoretical underpinning of the work (Bruscia, 1998).

In this section we have chosen three models of treatment.

Community Music Therapy
Community Music Therapy is a psychosocial intervention, which aims to provide treatment within the community where the clients are living. The term has recently been used to describe the work undertaken by music therapists outside the boundaries of the oneto-one or small group therapy sessions. In particular, it is applied to situations where the music therapist is responding flexibly to the social and cultural context of the setting in which they work (Ansdell, 2002). This could be seen as following in the footsteps of the enlightened Victorian philanthropists who saw the importance of creating a musical community within the walls of the hospital or asylum through encouraging choirs, bands and concert performances (Tyler, 2000). In the same tradition we will see Mary Priestley’s broad interpretation of music therapy in St Bernard’s Hospital in the 1970s, which included open informal music sessions and performances by the therapists (see Chapter 2).

Ansdell has made a distinction between Community Music Therapy, which is undertaken by a trained State Registered Therapist, within a clinical discipline, and Community Music, which is often user-led and project orientated, although both take place within the community. Darnley-Smith, in a survey of her work in a Day Centre for people with physical disabilities, differentiated between therapeutic music-making and music therapy, although in this instance the same therapist facilitated both kinds of music. For example, playing Christmas Carols and running a classical music ‘listening group’ came under the heading ‘therapeutic music,’ while an ongoing improvisational ‘music and speech group’ for people with hearing loss was seen as music therapy (Darnley-Smith, 1989).

Although the term ‘Community Music Therapy’ is relatively new, the work it refers to has constantly been developed pragmatically by music therapists, addressing issues of culture, community and society together with needs that are personal, individual and private.

Guided Imagery and Music (GIM)
This ‘in-depth psychotherapeutic method’ (Goldberg, 1995: 128) of music therapy was originally devised during the 1970s by Helen Bonny, a music therapist at the Maryland Psychiatric Research Centre in the US. ‘In her research, Bonny found that when subjects listened to a carefully selected programme of [taped] classical music while in a relaxed state, powerful feelings and symbolic images were evoked, leading to significant insights into therapy issues’ (Goldberg, 1995: 112). For each session, the therapist chooses the programme of taped music, basing the choice upon the history of the client, a ‘formulation of the therapeutic issues’ and in support of the client’s current mood (Goldberg, 1995: 114–5). In GIM there is a standard procedure for sessions, as devised by Bonny (Goldberg, 1995: 114): ‘(1) The preliminary conversation, (2) the induction (relaxation and focus), (3) The music listening phase, and (4) the post-session integration.’ After the music has been played, the client is encouraged to share all ‘perceptions and experiences within the music’ with the therapist, who writes them down. The role of the therapist, who must be completely attuned to the client, is to ‘observe, listen and verbally reflect the process, serving to encourage, help and comfort as the client moves through the experience’ (Goldberg, 1995: 115). The method has been successfully applied to a variety of client groups, particularly those without specific clinical needs, who may use it as a means of self-exploration and fulfilment. Practising the method requires special training and supervision, after qualification as a music therapist.

Improvisational Music Therapy
In improvisational music therapy, live improvised music-making is used as a medium for communication between client and therapist as the focus of a ‘helping relationship’. The practice of music therapy in Britain today is largely based on the use of improvised music (Wigram, Odel...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgments
• Introduction
• PART I – GETTING STARTED
• PART II – CLINICAL MATTERS
• References
• Index