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Music Therapy for Children and Adults

Webinar Series March Topic: Music Therapy for Children & Adults

On March 20th, Crista Orefice, MA, MT-BC, board-certified music therapist, hosted a webinar on music therapy, in celebration of Music Therapy Awareness Month.

This post provides a breakdown of the information discussed during the webinar and is intended for mental health professionals and as a resource to educate the public about this alternative therapy option. We’ll discuss music therapy practices for children and adults and how this alternative therapy can be beneficial in treating and overcoming mental health and/or addiction issues. Skip down to read that information or watch the webinar recording below.

Watch the Recording

An Introduction to Music Therapy

“Music acts like a magic key, to which the most tightly closed heart.”
-Maria August von Trapp

What is Music Therapy?

First, here are some things to clarify (misconceptions about music therapy):

  • One does not need to be a musician in order to partake in music therapy as a client.
  • Music therapy is not designed to improve one’s musical abilities
  • The music is not the end itself but is rather a means to a non-musical end.
  • There is no “ONE SIZE FITS ALL” approach.
  • Each session is tailored to meet the individual’s needs.

There is not one particular style of music that is more therapeutic than the rest, or one type of music that used for a certain disorder or issue (i.e., there is no “ONE SIZE FITS ALL” approach). A variety of musical styles of music can be effective in treatment for patients.

The types of music a music therapist may use in treatment are based upon such factors as an individual’s preferences, circumstances and need for treatment, as well as the client or patient’s determined goals. Each session is tailored to meet the client’s needs.

So Then…What is Music Therapy?

“Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

The AMTA is an organization which represents over 5,000 music therapists in the United States. They are committed to the advancement of education, training, professional standards, credentials, and research in support of the music therapy profession.

Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives.”

–The American Music Therapy Association

As mentioned, Music Therapy is a clinical treatment.

Interventions can be designed to:

  • Promote wellness
  • Manage stress
  • Alleviate pain
  • Express feelings
  • Enhance memory
  • Improve communication
  • Promote physical rehabilitation

Brief History of Music Therapy

  • Ancient Cultures (e.g., Egyptians, Babylonians, Greeks)
  • Viewed music to hold healing properties.
  • Considered music to be a special force over mental, emotional and physical health.
  • Believed that music was able to cure mental disorders.
  • Believed that music was able to bring about emotional catharsis.
  • Believed that music was medicine for the soul.

Since the beginning of recorded time, music has served as a means of communication as well as a healing tool for indigenous cultures. Within the medical practices of these ancient peoples, songs, chants, drums, flutes, rattles, gongs, and whistles were utilized as a means of disease prevention and health restoration. Ancient Greek philosophers made frequent mention in their writings of music’s beneficial healing abilities on certain diseases. Pythagoras, Plato, and Aristotle believed, for example, that music held therapeutic benefits, and that it had the power to influence health positively by restoring harmony to body, mind, and souls via certain musical modes, rhythms, and instruments.

An Ancient Greek text states, “Men have song as a physician for pain.” Legend has it that Alexander the Great has his ‘sanity’ restored from music played on the lyre.

Bible tells the story of David playing the lyre to cure Saul of his affliction.

Middle Ages (c. 476-1450 A.D.) & Renaissance Period (c. 1300’s -1600’s)

Music was used…

  • as a curative power
  • as a remedy for melancholy, despair & madness
  • as preventative medicine

People of the Middle Ages believed that the singing of monks and clergy during worship had the ability to produce sudden and dramatic cures: the music entered the ear as a healing spiritual balm that could hasten results beyond the reach of any contemporary physician.

Writers such as Shakespeare included music as a therapeutic agent in his plays and poems (e.g., “If music be the food of love, play on.” – Twelfth Night).

Baroque Period (1580-1750)

Certain styles of music were used to treat disease by being paired with particular personality characteristics.

Late 18th Century

1789 – Earliest known reference to music therapy in the United States (“Music Physically Considered” – anonymous author).

  • Music viewed as a regulator of the body.
  • Tarantella for “Tarantism”: Fast-paced music was played to help cure the victim of mania.
  • “Music Physically Considered” discussed using music to influence and regulate emotional conditions. The author also advised that a properly trained practitioner should be the one to skillfully use music in the treatment of disease.

19th Century

The use of music to treat mental and physical illness continued to be written about in music journals, medical journals, psychiatric, periodicals and medical dissertations.

20th Century

Mid -1940’s – Used with WWII veterans to boost morale, and in the rehabilitation of leisure skills, socialization, and physical & emotional functioning. “Music therapists” at this time were volunteers under the supervision of medical staff.

Research & publications showed continued support for music therapy

It was used regularly in hospitals and other institutions.

The return of World War II veterans traumatized by their horrific war experiences, and their remarkable responses to music, there was a growing interest in the therapeutic and rehabilitative value of music – both live and recorded (thanks to Edison’s invention of the phonograph in 1877). At the same time, an increasing number of publications were presenting the case for music therapy and for training music therapists who were able to use specific music skills in the assessment and treatment of patients of all ages and presenting a wide range of disabilities.

Important Dates in Music Therapy History

  • 1944 –Michigan State University: First curriculum designed
  • 1950 – National Association of Music Therapy (NAMT) is formed.
  • 1971 – American Association of Music Therapy (AAMT) is formed.
  • 1998 – NAMT & AAMT merged to form the American Music Therapy Association (AMTA)

“NAMT succeeded where previous music therapy associations previously failed by creating a constitution and bylaws, developing standards for university-level educational and clinical training requirements, making research and clinical training a priority, creating a registry and, later, board-certification requirements, and publishing research and clinical journals. NAMT operated from 1950-1997 and saw the creation of a board-certification program (1985).

The American Music Therapy Association (AMTA) was formed in 1998 as a merger between the National Association for Music Therapy (NAMT) and the American Association for Music Therapy (AAMT). AMTA united the music therapy profession for the first time since 1971. Currently, AMTA is the intellectual home for, and it serves member music therapists, students, graduate students, and other supporters. AMTA’s mission is to advocate and educate for the music therapy profession as a whole.”

– The American Music Therapy Association

AMTA publishes two research journals as well as a line of publications, serves as an advocate for music therapy on the state and federal levels, promotes music therapy through social media streams, and provides research bibliographies, podcasts, scholarships, and newsletters to its members.

Music Therapy Training

Training programs for Music Therapy must be approved by the American Association of Music Therapy.
Music Therapy Training Breakdown (approximate):

  • 45-50% – Focuses on the study of music;
  • 20-30% – Focuses on music therapy and related behavioral/health sciences;
  • 20-25%- Focuses on general required college courses;
  • 5%- Various electives
  • 1200 hours of supervised clinical training

MT-BC: Music Therapist-Board Certified Credential

  • Credential requires renewal every 5 years.
  • Maintenance and renewal of the national Board Certification issued by the CBMT requires 100 educational credits accrued over a 5-year period (e.g., taking courses, teaching courses, lectures, conference attendance, additional degrees, etc.).

The Certification Board for Music Therapists (CBMT) is the designated organization providing Board Certification to Music Therapists, upon completion of training and internship. There is currently no licensure for MT in NJ, but local task forces are on it to help it move in that direction.

A sit-down board examination, consisting of 150 questions, is required to be passed in order to obtain the MT-B credential.

Where Do Music Therapists Work?

  • Psychiatric hospitals
  • Rehabilitative facilities
  • Medical hospitals
  • Outpatient clinics
  • Daycare treatment centers
  • Schools
  • Agencies serving intellectually and developmentally disabled persons
  • Drugs & alcohol programs
  • Senior centers
  • Nursing homes
  • Hospice programs
  • Correctional facilities
  • Halfway houses
  • Community mental health centers
  • Private practice

The Music Therapy Treatment Process

  • Referral – Music therapy services may be recommended by physicians, psychologists, occupational therapists, physical therapists, speech and language pathologists, teachers, parents, social workers and clients themselves. Explain that at Carrier, music therapy is included in the group programming.
  • Assessment – An overview of a person’s history as well as their present level of functioning, strengths, weaknesses and needs; helps to determine the nature and scope of treatment as well as a reference point against which to measure progress.
  • Treatment Plan –Based on set goals (broad, long-term) & objectives (specific, short-term), determined by the assessment that the client works towards by way of specific musical experiences/musical interventions.
  • Data Collection/Progress Evaluation – The music therapist tracks, monitors and records a client’s responses and progress within and throughout the course of treatment. This helps to determine if any adjustments or modifications need to be to the treatment plan.
  • Discharge/Termination – Once a client has met their treatment goals, and/or the therapist decides that the client has derived the greatest benefit they could from the treatment, it is then terminated. A full evaluation by the therapist discusses the process and what the overall results were in treatment. Recommendations for other services or treatment may be included.

Music Therapy Interventions

  • Re-creation/Performance – Clients reproduce pre-composed music or a structured musical form through performance. Performances can be instrumental or vocal in nature.
  • Improvisation – Clients creatively invent and make up music with their voices, instruments, body parts, or other materials. The music therapist helps to guide the experience by providing structure (if needed) and/or improvising along with the client.
  • Songwriting – Clients write songs, lyrics and/or instrumental pieces with the assistance of the music therapist; piggyback songs (existing melody – change lyrics).
  • Listening – Clients receptively listen to music in order to elicit a response or behavior in some way (verbally, mentally, physically, emotionally).
  • 7 elements of music – Melody, Harmony, Tempo, Rhythm, Timbre, Dynamics, and form. The combination or isolation of how these elements are utilized can yield various responses.

Benefits of Music Therapy

  • Encourages active participation
  • Facilitates communication of thoughts, feelings, etc.
  • Manages stress and helps to cope with anxiety
  • Increases positive outlook/mood regulation
  • Improves awareness of self and environment
  • Increases attention/concentration
  • Increases ability to follow direction or redirection
  • Taps into and mobilizes personal strengths, potential, and inner resources
  • Enhances memory recall
  • Enhances perception
  • Nurtures communal interests
  • Enhances sensory integration (auditory, visual, tactile)
  • Improves gross and fine motor skills
  • Diminishes pain/discomfort
  • Increases adaptive behavior
  • Offers gratifying opportunities for success and achievement

Mental illness often involves feelings of low self-esteem and low self-worth.

There is evidence that music therapy can help to improve the mental health of people with depression and schizophrenia.

Symptoms seen are usually confusion, psychosis, low energy, emotional flatness, feeling alienated & isolated, lack of appropriate boundaries, learned helplessness.

Stigma – feeling worthless and marginalized from society; difficulty making connections with others; need for reconnecting with self and others, to be listened to, to feel valued, to access their personal resources, and to identify and strengthen the positive aspects of themselves.

Music and the Brain

There is growing evidence demonstrating that both making music or listening to music activates a multitude of brain structures involved in cognitive, sensorimotor, and emotional processing. Neural correlates of music-evoked emotions affect the autonomic, endocrinological, and immunological systems and point to the many beneficial effects of music on psychological and physiological health.

“The mounting evidence that music improves health and well-being through the engagement of neurochemical systems for (i) reward, motivation and pleasure; (ii) stress and arousal; (iii) immunity; and (iv) social affiliation strengthen the potential use of music in therapy.

Dysfunctions and structural abnormalities in, e.g., the amygdala, hippocampus, thalamus, nucleus accumbens, caudate, and cingulate cortex are characteristic in psychiatric and neurological disorders, such as depression, anxiety, stress disorder, Parkinson’s disease, schizophrenia, and neurodegenerative diseases.”

-Hans-Eckhardt Schaefer, Music-Evoked Emotions—Current Studies

There have been findings that music can change the activity in these structures, and this will hopefully encourage more studies of the neural correlates of the therapeutic effects of music in order to provide further research to support this evidence.

The neurochemical Dopamine (important for emotional and cognitive functioning) has been found to increases when listening to pleasurable music, creating a reward/motivation response. Deficits in dopamine have been associated with conditions like Depression.

In Summary

Music Therapy is “a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change.” -Kenneth Bruscia (1998)

“May all that has been reduced to noise in you, become music again.”

References

American Music Therapy Association. www.musictherapy.org.

Davis, W.B., Gfeller, K.E., & Thaut, M.H. (1992). An introduction to music therapy: theory and practice. New York: McGraw Hill.

Berger, D. (2009). Presented at the Creative Arts Therapy Conference, Petro Mohyla Mykolaev Black Sea University, Mykolaev, Ukraine, May, 2009.

Eyre, L. (2013). Adult groups in the inpatient setting. In. L. Eyre (ed.), Guidelines for music therapy practice in mental health (pp. 71-114).Gilsum, NH: Barcelona Publishers.

Jackson, N.A. (2013). Adults with depression and/or anxiety. In. L. Eyre (ed.), Guidelines for music therapy practice in mental health (pp. 339-375).Gilsum, NH: Barcelona Publishers.

Iliya, P.J., & Lewis, M.B. (2011). Singing for healing and hope: Music therapy models that use the voice with individuals who are homeless and mentally ill. Music Therapy Perspectives, 29(1), 14-22.

Maratos, A., Crawford, M.J., & Procter, S. (2011). Music therapy for depression: it seems to work, but how? The British Journal of Psychiatry, 199(2), 92-93.

Schaefer H-E (2017) Music-Evoked Emotions—Current Studies. Front. Neurosci. 11:600. doi: 10.3389/fnins.2017.0060

Silverman, J. (2011). Effects of music therapy on psychiatric patients’ proactive coping skills: Two pilot studies. The Arts in Psychotherapy, 38, 125-129.

Wheeler, B.L., Shulits, C.L., & Polen, D.W. (2005).Clinical training guide for the student music therapist. Gilsum, NH: Barcelona Publishers.