Professional Documents
Culture Documents
Croatian Musicological Society Is Collaborating With JSTOR To Digitize, Preserve and Extend Access To International Review of The Aesthetics and Sociology of Music
Croatian Musicological Society Is Collaborating With JSTOR To Digitize, Preserve and Extend Access To International Review of The Aesthetics and Sociology of Music
Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at
http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless
you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you
may use content in the JSTOR archive only for your personal, non-commercial use.
Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at
http://www.jstor.org/action/showPublisher?publisherCode=croat.
Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed
page of such transmission.
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of
content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact [email protected].
Croatian Musicological Society is collaborating with JSTOR to digitize, preserve and extend access to
International Review of the Aesthetics and Sociology of Music.
http://www.jstor.org
D. DEGMECIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 287
MUSIC AS THERAPY
Abstract- Resume
The article focuses on music as a thera- cally to address physical, psychological, cogni-
peutic option in psychiatry. In the first part of tive, behavioural and social functioning. The
the article the authors have given a review of music therapy experience is related to art and
various comprehensions and definitions of everyday experiences in many different ways.
music itself, as well as the effect of music on In other parts of the article, the authors have tried
the mind. The idea of music as a healing influ- to show the importance of rhythm through life,
ence which could influence health and behav- as well as to show the functions of music
iour is at least as old as the writings of Aristotle therapy, and the favourable experiences that
and Plato. Today, music therapy is a well-estab- they have had with their patients who had mu-
lished allied segment of the health profession, sic therapy as a therapeutic option.
similar to occupational therapy and physical Key Words: music therapy; music and
therapy. It consists of using music therapeuti- art; rhythm in life; functions of music therapy
An old Chinese proverb says: ,Music comes from the heart of the human
being. When emotions are born, they are expressed by sounds and when sounds
are born they give birth to music. Actually this old proverb speaks of the essence
288 D. DEGMEDIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300
1S. LANGER (1953), Feeling and Form. New York: Charles Scribner's Sons.
2 S.LANGER (1967), Mind. Baltimore: John Hopkins Press.
3 L. BROWER (1984), The Cuba's Composer Virtuoso Leo Brouwer. Guitar Player, 19, 79-85.
4 C. LEICHTER(1984), Musiikki taidemuotona. Synteesi, 3, 1-2, 42-43.
5 E. TARASTI (1983), Tulemisen aika. Synteesi, 2 (3-4) 50-64.
6 M. PROUST (1970), Kadonnuttaaika etsimassa.Helsinki: Ottawa.
D. DEGME(I( ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 289
7K. LEHTONEN (1987), Creativity, the Symbolic Process and Object Relationships. CreativeChild
and Adult Quarterly, 12, 259-270.
8 I. STRAVINSKI (1973), Musiikin poetiikka.Helsinki: Ottawa.
9 D. STERN (1985), The InterpersonalWorldof the Infant. A View from Psychoanalysis and Develop-
mental Psychology. New York: Basic Books.
10K. LEHTONEN (1991), Music as a Language of Possible Worlds: Music as Psychotherapy. Crea-
tive Child and Adult Quarterly.XVI/3, 133-163.
" E. RECHARDT (1987), Experiencing Music. Psychoanal.Study Child, 42, 11-30.
290 D. DEGME(I1 ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300
without content in music actually represent the similar structures of archaic bod-
ily comprehension.
The relationship between music and the unconscious is extremely interesting,
since it seems to show up clearly during clinical music therapy processes.12 The
psychical state during performing or listening to music seems to be in close con-
tact with the symbolic process of the individual. Music seems to promote or speed
up the psychic work and symbolic process of the individual. Music therapy proc-
esses activate the unconscious mind of the therapist and his/her patient and brings
into the light such unconscious material (e.g. in the form of music, fantasy or
mental pictures), which could not be raised to consciousness otherwise. Especially
the temporal creative, but, at the same time, well-controlled regressive state dur-
ing the intensive music therapy process seems to reach back to even the earliest
phases of development. The symbolic material presented during the sessions of
intensive music therapy is in close relationship with dream work and dream pic-
tures, because they have similar unconscious structures; condensation of thoughts,
mirror images, crab movements, pictures instead of thought, and so on.13'14 Analo-
gous to the remark made by the founder of psychoanalysis, Sigmund Freud,'5that
dreams are the royal road to the unconscious may justifiably be completed by
adding music to the definition, because the forms of both dream work and musi-
cal thinking are largely similar ways of approaching and understanding the hu-
man unconscious, which is largely dominated by symbolic processes.
The idea of music as a healing influence, which could have an effect on health
and behaviour, is at least as old as the writings of Aristotle and Plato.'6 The 20th
century discipline began after World War I and World War II, when community
musicians of all types, both amateur and professional, travelled around to hospi-
tals in different countries to play for the thousands of veterans suffering both physi-
cal and emotional trauma from the wars. The patients' noticeable physical and
emotional responses to music led the doctors and nurses to request the hiring of
musicians by the hospitals. It was soon evident that the hospital musicians needed
some prior training before entering the facility and so the demand grew for a col-
lege curriculum. The first music therapy degree program in the world was founded
at Michigan State University in 1944. The American Music Therapy Association
was founded in 1998.17,18 In Norway, music therapy grew as a more or less politi-
cally correct anti-elitist counter-culture.17 An attempt to summarise the values
emphasised in this counter-culture follows:
Definition
other words, music therapy is the structured use of music to assist people of all
ages in times of need.30Music in music therapy is not used mechanically, as some
kind of medicine, it is more a medium for contact, communication and experience.
It seems to me that one should neither neglect the relationship between music
therapy and art, nor promote music therapy as a new art form. The music therapy
experience is related to art and everyday experiences in many different ways .31,32
The concept of 'aesthetic practice' thus probably does not help us to answer
many questions related to aesthetics in music therapy. It could rather help us in
developing better questions, and in avoiding unhelpful answers. For instance, we
are not guided to look for universal aesthetic qualities, but for communicative proc-
esses on values and value related to specific contexts and forms of life. Aesthetic
practices in music therapy include negotiations on values and value.33'34It will not
always be helpful to the client if this serves to promote the values of the therapist
on behalf of his/her values. Therefore, an important aspect of a therapist's compe-
tency is to be able to reflect upon his/her own aesthetic values, judgements and
choices. Thus, he/she should be focusing upon i) the preparation of the music
therapy room, ii) the negotiation on values and value through the musical dia-
logues in the therapy sessions and, iii) the process of framing and interpreting the
music. When preparing the physical environment, the music therapist is already
25 M. BROTONS - P. MARTI, Music Therapy with Alzheimer's Patients and Their Family
Caregivers: A Pilot Project, Journalof Music Therapy2003, 40(2):138-150.
26M. J. SILVERMAN, Music Therapy and Clients Who are Chemically Dependent: A Review of
Literature and Pilot Study, Arts in Psychotherapy2003, 30(5):273-281.
27A. TURRY- D. MARCUS, Using the Nordoff-Robbins Approach to Music Therapy with Adults
Diagnosed with Autism. In: Wiener DJ - Oxford LK, Action Therapywith Families and Groups:Using
CreativeArts Improvisationin Clinical Practice2003, 197-228.
28D. ALDRIDGE (1996), Music TherapyResearchand Practicein Medicine.FromOut of Silence.Jessica
Kingsley, London.
29 P. NORDOFF - C. ROBBINS (1971/1992), Therapyin Music for HandicappedChildren.Victor
Gollancz Ltd., London.
30 B.E. HOGAN, Soul Music in the Twilight Years - Music Therapy and the Dying Process, Topics
in GeriatricRehabilitation2003,19(4):275-281.
31K. AIGEN (1995), An Aesthetic Foundation of Clinical Theory: An Underlying Basis of Creative
Music Therapy. In: C. Kenny (ed.), Listening, Playing, Creating.Essays on the Power of Sound. State Uni-
versity of New York Press, Albany. Cf. Also footnote No. 30.
32J. DEWEY (1934), Art as Experience.G. Putnam's Sons, New York.
33S. FELD (1994), Aesthetics as Iconicity of Style (uptown title); or, (downtown title) Lift-up-
over Soundings: Getting into the Kaluli Groove. In: Ch. Keil - S. Feld: Music Grooves.The University of
Chicago Press, Chicago/London.
34 G. L. HAGBERG (1995), Art as Language. Wittgenstein,Meaning and Aesthetic Theory. Cornell
University Press, Ithaca/London.
D. DEGMEIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 293
making many choices: on acoustics, lighting, pictures and room decor, arrange-
ment of instruments and equipment, etc. The physical environment is an impor-
tant context for the moods and communications developed in therapy, and pro-
vides conditions for the activities, roles and relationships of the music therapy
process. Is the therapist preparing the room for contemplation by providing chairs
as the focal point in the room, or is he preparing it for movement by having a lot of
free space and few things to disturb movement? What kind of musical genres and
activities does the choice and arrangement of instruments suggest? Does the room
provide the client with both the space and the boundaries he/she needs? How
well suited is the room for making (easy) changes in activities and roles? These
choices are of course clinical, but they are integrated with values and aesthetic
choices. The questions to ask are: to what degree do I make these choices accord-
ing to my own aesthetic preferences and to what degree do I (and should I) rear-
range the room according to the client's preferences? To what degree do I (and
should I) discuss these aesthetic choices with the client?
To express yourself you need competence and knowledge, as clarified in
Wittgenstein's35 discussion of language and meaning (to learn a language is to
learn a technique). To detach music from genres known by the client therefore
might be to reduce his/her possibilities to express him/herself. Of course genres
could also be used by the client as a defence in the therapy process, just as, for
instance, intellectualisation might be used in verbal therapy. However, this does
not change my argument. Defence is an essential element in the therapy process,
and should be dealt with according to our understanding of the client and the
therapy process. Music made in therapy is always framed in some way or another;
through use of body language (smiles, grimaces, posture, etc.), verbal discussions
and also other media. We might remind ourselves that framing is a major part of
any aesthetic practice.34By framing an object or a phenomenon in a specific way,
we give value to it. Famous examples are John Cage's 4:33 and Duchamp's Fontaine.
Silence and a urinal; a phenomenon and an object that people usually do not de-
fine as art were framed as such by these artists. What happens is that you might
discover new aspects and values in the object or phenomenon. Provided you are
open to it, a process of reflection upon and redefinition of your own values might
start. I therefore think that framing is a very important aesthetic practice in music
therapy.
It seems to me more helpful to adapt some of Bakhtin's ideas about polyphonic
dialogues.36'37 It is no disaster if the client and the therapist have different values and
aesthetic perspectives. In many ways this can make the interpersonal communica-
tion richer and more colourful. To be able to stimulate such polyphonic dialogues, by
sharing one's own values and showing respect and interest for those of the client,
must therefore be an important element of the therapist's competence.
If you think there is too much beauty in this conclusion, I think I agree. Poly-
phonic dialogues are hard to establish because power relations tend to make them
monological, and therapy is certainly not automatically a context free from power
relations.
Beebe's research42shows that mother and infant track and influence each oth-
er's rhythms, anticipating certain points of mutual synchrony, in both activity (vo-
calisation) and non-activity (silence). Proprioceptive cues, providing information
about an individual's own body states, also contribute to auto-regulation, provid-
ing additional feedback. When bodies are touching as they often are in mother/
infant interaction, the feelings of limb and body acement are part of the communi-
cation - dance with song.
Co-ordinated interpersonal timing is robust in the mother/infant relationship.
A cross-site replication study by Feldstein et. al46found that significant co-ordinated
interpersonal timing occurred at both sites for 90% of comparisons. Co-ordinated
interpersonal timing was also redictive regarding developmental outcomes of in-
dividual infants for up to one year. Infants are able to predict patterns in rhythmi-
cally structured behaviour, and to synchronise the expression of their own behav-
iours with the rhythms of an adult.
The infant is indeed actively seeking out rhythms that it can use to interact
with adults and generate organised sequences of joint action. In further analysis of
such interactions, 'simultaneous improvisation' around a rhythmical structure, that
is, synchronised behaviour in which both mother and infant are 'playing' in uni-
son and not taking turns, is observed to make up a much greater proportion of
mother/infant interaction as compared to polite adult conversation.
While studies such as the above have described important commonalties in
the temporal interaction of infants with their caregivers, 'protoconversations' also
represent highly stylised instances of communication, in which both the mother
and the infant act as individuals, bringing their own personal characteristics out in
the interaction. The detailed patterns of rhythmical behaviour in mother/infant
interaction are a function of the individuals involved. Individual factors are ro-
bust, with personalisation of certain rhythmical patterns evident in the range of
rhythms used by individual infants in later speech patterns. Fridman14reports that
this is most marked in the personalised pronunciation of words. Acceptance of the
principle that infants and mothers already show individuality of expression in
'protoconversations' indicates that the relationship that they are creating together
is a personal one from the start. The studies of mother/infant interaction demon-
strate that the musical qualities of such interactions are robust features, and in the
case of co-ordinated timing they can prove to be predictive of a child's abilities in
co-ordinating its behaviour with that of others in later development. Music psy-
chology has suggested that the further study of musicians and the skills they em-
ploy would provide a greater insight into all forms of human communication.47
Music therapy is an efficacious and valid treatment for persons who have
psychosocial, affective, cognitive and communicative needs.50 Research results
and clinical experiences attest to the viability of music therapy even in those who
are resistive to other treatment approaches. Music is a form of sensory stimulation
that provokes responses due to the familiarity, predictability and feelings of secu-
rity associated with it.
Music therapy intervention provides opportunities to:
- explore personal feelings and therapeutic issues such as self-esteem or
personal insight;
- make positive changes in mood and emotional states;
- have a sense of control over life through successful experiences;
- enhance awareness of the self and the environment;
- express oneself both verbally and non-verbally;
- develop coping and relaxation skills;
- support healthy feelings and thoughts;
- improve reality testing and problem-solving skills;
- interact socially with others;
- develop independence and decision-making skills;
- improve concentration and attention span;
- adopt positive forms of behaviour;
- resolve conflicts leading to stronger family and peer relationships.
48 K. LEHTONEN (1987), Creativity, the Symbolic Process and Object Relationships. Creative
Child and Adult Quarterly, 12, 259-270.
49E. RECHARDT (1987), Experiencing music. Psychoanal.Study Child, 42, 11-30.
"'E. YORK, A Comprehensive Guide to Music Therapy. Journalof Music Therapy2003, 40(2):171-
175. Cf. also footnote No. 19.
298 D. DEGMEIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300
The work of the American Music Therapy Association - New York City Mu-
sic Therapy Relief Project, combined with over fifty years of practice and research
in music therapy, has demonstrated the impact of music therapy as 'second-wave'
relief in helping to cope with events surrounding a crisis and its aftermath. The
directed use of music and music therapy is highly effective in developing coping
strategies, including understanding and expressing feelings of anxiety and help-
lessness, supporting feelings of self-confidence and security, and providing a safe
or neutral environment for relaxation. Research results and clinical experiences
attest to the viability of music therapy even in situations outside of traditional
therapeutic settings.19
Music therapists assess emotional well-being, physical health, social function-
ing, communication abilities and cognitive skills through musical responses; de-
sign music sessions for individuals and groups based on patient needs using mu-
sic improvisation, receptive music listening, song writing, lyric discussion, music
and imagery, music performance, and learning through music; and, participate in
interdisciplinary treatment planning, ongoing evaluation, and follow up.5'
Children, adolescents, adults and the elderly with mental health needs, de-
velopmental and learning disabilities, Alzheimer's disease and other aging-related
conditions, substance abuse problems, brain injuries, physical disabilities, and acute
and chronic pain, including mothers in labour, can benefit from music therapy.52,53
Patients don't have to have some particular music ability to benefit from mu-
sic therapy. All styles of music can be useful in effecting change in a patient's life.
The individual's preferences, circumstances and need for treatment, and the pa-
tient's goals help to determine the types of music a music therapist may use. Music
therapy sessions are designed and music selected based on the individual patient's
treatment plan.54
Our experiences with music therapy have been very good. Patients at our
clinic are able to choose music repertoire in their treatment plan which gives them
chance to feel they are partners in the therapeutic process. Music therapy sessions
are held once a week with patients who fulfil different diagnostic categories (anxi-
ety disorders, depressive disorders, psychotic disorders, etc.).
Healthy individuals can use music for stress reduction via active music-mak-
ing, such as playing piano or drums, as well as passive listening for relaxation.
Music is often a vital support in physical exercise.55
51 W. SEARS (1968/1996), Processes in Music Therapy. Nordic Journalof Music Therapy,5 (1).
52 C. KORB, Music Therapy and Group Work: Sound Company, Arts in Psychotherapy 2003,
30(3):177-178.
53M. VALENCIA - MoL.RASCON - H. QUIROGA, Research Contributions to Psychosocial
and Familial Treatment of Schizophrenic Patients, Salud Mental 2003, 26(5):1-18.
54 S. ROBB, An Introduction to Music Therapy Theory and Practice, 2nd ed., CollegeMusic Sympo-
sium 2002, 42:155-158. Cf. also footnote No. 50.
55C. KENNY (1989), TheFieldof Play. A Guidefor the Theoryand Practiceof Music Therapy.Ridgeview
Publishing Company, Atascadero.
D. DEGMECI( ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 299
Conclusion
Music is the special form of flexible abstract thinking, which enables us to use
all kinds of configurations and schemes in our various developmental stages in
the creative and integrative purposes. We must keep in mind that, according to
this theory, the musical integration and working through processes also comple-
ment the psychic integration and working through processes. There is every rea-
son to believe that expressive therapies may be curative. As described by Frank,56'57
there are the same general therapeutic relational and ritual elements. It may there-
fore not be necessary to understand in detail what music is, how music influences
the patient, or how the psyche develops. If it works, it works. This simple pragma-
tism is adopted in many forms of healing activities. On the other hand, the motiva-
tion to choose music therapy must emerge from the music therapist's professional
judgement that it is more effective than mere positive social interaction with any
other randomly assigned activity.58'59
The future of music therapy is promising because state-of-the-art of music
therapy research in physical rehabilitation, Alzheimer's disease and psycho-
neuroimmunology is documenting the effectivevess of music therapy in terms that
are important in the context of a biological medical model.
56 C. JONES - F. BAKER - T. DAY, From Healing Rituals to Music Therapy: Bridging the
Cultural Divide between Therapist and Young Sudanese Refugees, Arts in Psychotherapy 2004,
31(2):89-100.
57J. D. FRANK (1989), Non-specific Aspects of Treatment: The View of a Psychotherapist. In: M.
Shepherd - N. Sartorius (eds.), Non-SpecificAspects of Treatment.Hans Huber Publishers, Toronto.
58E. RUUD (1998), Music Therapy:Improvisation,Communicationand Culture.Barcelona publishers,
Gilsum, N. H.
59 E. RUUD (1980), Music Therapyand its Relationshipto Current TreatmentTheories.Magnamusic-
Baton, St.Louis, MO.
300 D. DEGME(IC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300
Safetak
Stara kineska poslovica ka2e: 'Glazba potjece iz srca ljudskih bica. Kada su emocije
rodene, izraZavaju se zvukovima, a zvukovi radaju glazbu.' Prema Leichteru, konaCni cilj
izvodenja, izrazavanja ili razumijevanja glazbe leZi u psihickoj relaksaciji. Avangardni
skladatelj John Cage u jednom od svojih brojnih intervjua navodi da je konacan cilj njegova
skladanja odnosno glazbenih aktivnosti postizanje mentalnog mira. Glazba djeluje izravno
na naS autonomni Zivcani sustav, dovodeCi do razlicitih autonomnih tjelesnih reakcija.Dakle,
za razumijevanje glazbe na tjelesnoj razini nije potrebna inteligencija. Glazba na isti nacin
dopire do teSko mentalno retardiranog bolesnika kao i do visoko obrazovanog profesora
filozofije.
Glazbeno iskustvo u svojoj osnovi ima mnogo slicnosti s arhaicnim nainom razmisljanja.
Glazba je oblik tjelesnog izricaja, posebna vrsta tjelesnog procesa kojim se daje znacenje
stvarima te u kojem nesvjesna tjelesna iskustva dobivaju svoje znacenje kroz simbole i
apstraktnu formu. Posebno je zanimljiv odnos izmedu glazbe i ljudskog nesvjesnog sto se
jasno vidi tijekom seansa muzikoterapije. Jos su davno Aristotel i Platon u svojim spisima
prikazali ideju da glazba ima ljeeidbeni ucinak. Muzikoterapija je sliena okupacijskoj terapiji,
u njojse koristi glazba u svrhu poboljSanjatjelesnog, psiholoskog, kognitivnog, bihevioralnog
i socijalnog funkcioniranja. Brojnestudije pokazale su sposobnost prepoznavanja temporalno
organiziranih obrazaca ponasanja te posljedieno sinkroniziranje pojedineeva ponasanja u
skladu s ritmickim mjerama. Studije radene na novorodencadi pokazuju da se radamo sa
prirodnom orijentacijom prema ritmicki koordiniranim interpersonalnim interakcijama,
preko kojih komuniciramo sa svojom okolinom.
Muzikoterapija je efikasan nacin lijeCenja osoba s psihosocijalnim, afektivnim,
kognitivnim i komunikacijskim problemima. Rezultati klinickih iskustava pokazuju
vrijednost muzikoterapije cak i u onih bolesnika koji su bili rezistentni na ostale pristupe u
lijecenju. Glazba stimulacijom osjeta navodi na pozitivan odgovor zahvaljujuCi bliskosti,
predvidljivosti i osjeeaju sigurnosti. Bolesnici ne moraju imati posebne glazbene sposobnosti
da bi im glazba koristila, svi glazbeni stilovi kroz muzikoterapiju mogu dovesti do pozitivnih
promjena u bolesnikovu ivotu, premda bolesnikove preferencije, okolnosti i potreba za
lijecenjem kao i postavljeni cilj odreduju vrstu glazbe koju ee muzikoterapeut koristiti u
terapijskom procesu. Seanse muzikoterapije te izabrana glazba temelje se na individualnom
bolesnikovu planu lijeenja.
MoZemo zakljuditida je budunost muzikoterapije obeCavajuCas obzirom na istraZivanja
koja pokazuju njezinu udinkovitost u tjelesnoj rehabilitaciji, Alzheimerovoj bolesti i
psihoneuroimunologiji u kontekstu bioloskog medicinskog modela.