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Music Therapy Readings

Introduction to the Practice of Music Therapy (McMaster University)

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Music Therapy Readings

Pg. 167-180  Excerpts from: Music Therapy Treatment Process

Part 1: The clinical process

 Cohen & Gericke (1972)  cornerstone to develop responsible &
meaningful treatment-rehabilitation program is the accumulation &
synthesis of accurate & significant patient data
 After this info collected & analyzed  used to formulate treatment
goals, objectives & strategies
 Assessment of client needs also assists therapist in evaluating &
documenting clinical changes that occur during treatment
Client  Donna
 Donna, 68-years old, lower back pain, back injury tissue has healed,
still has pain, no interventions have worked, has changed her life,
recluse, stays inside, become depressed, negative impact on
relationship with husband, personal physician referred her to Backpain
Clinic at Roseville Rehab Centre for 4-week program to provide
intensive transdisciplinary approach to address physical, emotional &
social functioning

Referral 
o First step in treatment process = referral; facilitates access to
health care providers
o Requests for services may come from  physicians,
psychologists, OT’s, PT’s, SLP’s, teachers, parents, social
workers, clients themselves
o Hospital setting – referral for MT; by physician
o School setting – referral for MT; parents, school psychologist,
interdisciplinary team (IEP)
o Nursing home – referral for MT; staff member, physician, family
member, activity director
Donna cont’d 
 Physician administers medical exam to see if any tissue damage
 Psychologist conducts evaluation to identify psychological factors
(depression/personality traits)
 PT assesses functional movements
 OT reviews assessment of everyday activities
 Social worker interviews her to learn about lifestyle/interests prior to
onset of back pain
 Assessments identify  dance & music have had important role in
Donna’s life therefore music therapy is identified as important
treatment

Assessment 

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 Initial assessment  prior to start of treatment

 Provides overall view of client’s history and present condition
 AMTA standard of clinical practice  assessment should be included as
a general procedure prior to commencing services w/ a client
 Assessment=analysis of person’s abilities, needs, problems
 Assessment info. Can be acquired by interviews w/ client/family,
testing, observing, documenting how client does in cognitive, physical/
other tasks, viewing interactions w/ others, reviewing records
 Assessment data should be gathered in multiple ways
 Format & content of assessment tools vary – depend on age/type of
population served, policies of facility, state/federal requirements,
length of treatment, time available
 Three primary types of assessment currently used by music therapists

o 1. Initial assessment- completed at beginning of therapeutic
process to identify client strengths & weaknesses, help formulate
treatment goals
o 2. Comprehensive assessments – completed when a client is
referred for music therapy services only
o 3. Ongoing assessment – tracks functional levels and progress
through treatment process

Why is Assessment Important?

 The info learned from initial assessment helps determine nature &
scope of treatment; e.g., if client is suited for music therapy/what
treatment goals and techniques are appropriate
 Assessing client needs is to provide a reference against which progress
during treatment can be measured (ongoing assessment)
o Can’t tell how far we’ve come if we don’t know where we started
o Can moderate treatment plan
o Final evaluation at end of treatment – determines improvement
 Continued growth and development of music therapy profession is
dependent upon ability to assess, monitor, and evaluate treatment

Areas of assessment  to determine a treatment plan, the team will

assess strengths & needs of client in these areas;
1. Medical (past med. History, current health)
2. Physical (range of motion, gross & fine motor coordination, strength,
endurance)
3. Cognitive (comprehension, concentration, attention span, memory,
problem-solving skills)
4. Emotional (appropriateness of affect, emotional responses)
5. Social (self-expression, self-control, quality & quantity of interpersonal
interaction
6. Communication (expressive and receptive language skills)
7. Family (assess family relationships & needs)

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8. Vocational/education (adequacy of work skills/preparation for

workplace)
9. Leisure skills (awareness of recreational needs, interests, participation
in activities/community resources)

Donna Cont’d ; initial assessment

 Medical  record of dosage/frequency for pain & sleep medications, x-
rays, tests. No physiological abnormality found
 Physical  self-protective walk, fills out several pain scales
 Cognitive  normal intelligence, difficulty concentrating
 Emotional  MMPI, Beck Depression Inventory, medical outcomes
survey; sig. level of depression, resentment, anger, helplessness,
dependent
 Social withdrawn from activities, lonely
 Communication  NA
 Family  life revolves around back pain, relationship toll
 Vocational/education  OT met w/ donna to plan how to re-establish
capabilities
 Leisure skills  used to participate in activities, now home-bodies
 Music therapy assessment  questionnaire to determine fav music
styles, identify musical selections for relaxation sessions/exercise

Assessment Tools
 Good assessments = reliable and valid
 Reliability  consistency with which test measures
behaviour/behaviours
 Validity  how well a test measures what it is supposed to measure
 Music therapy assessments have been published for use with
variety of pops 
o Developmental disabilities
o Children in spec. ed.
o Behavioural-emotional disorders
o Hospitalized children
o Hospice patients
o Older adults
 Drawbacks 
o Reliability and validity have not been fully established

Treatment Plan
 Once initial assessment data is gathered & analyzed, next step =
establish treatment plan
 Multidisciplinary  each team member focuses on & reports in team
meetings on particular aspects of client’s needs closest to their
disciplinary scope of practice

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 Interdisciplinary approach  each team member takes primary

responsibility for particular treatment goals, with collaboration in
development of treatment goals & how they will be attained
 Transdisciplinary approach  several specialists collaborate on
particular goals & objectives

Therapeutic Goals & objectives

 Goal=broad statement of desired outcome of treatment
 Objectives= more specific and short-term
 Goal is broken down into series of short-term objectives
 Each objective describes an immediate goal; measurable
 Specific music therapy interventions can be used to help meet
objectives
o Music=excellent for exploring/expression emotions, strong social
component, effective for use in cognitive pain management,
promotes efficient movements & persistence in exercise
 Music as a stimulus to reduce discomfort
 Music to promote efficient movements & persistence
 Music in group therapy
 Music and leisure skills

Treatment goals for Donna 

 Reduce experience of pain (including psych components)
 Decrease/eliminate use of meds for pain
 Improve physical/lifestyle functioning
 Enhance social support

Documentation of Progress
 Monitoring progress through therapeutic process=most important
thing
 Objectives= what client needs to do to meet the treatment goal
 Baseline measure= important to maintain; indicates severity & is
reference point
 Organization must maintain accurate & complete records on diagnosis,
treatment, and care of clients (legal document)
 Submission of regular & accurate written reports is a fundamental
responsibility of ALL music therapists
o Contain: assessment data, goals, objectives, treatment plans,
progress notes, final report @ discharge
o Must be non-judgemental, objective terminology

Evaluation & Termination of Treatment

 When client has met treatment goals/when treatment team decides
client has achieved greatest benefit from therapy; treatment is
discontinued

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 @ time of discharge/discontinuation  MT writes an evaluation of

entire music therapy process (initial goals, progress made,
recommendations)

Pg. 1-8  Music Therapy: Historical Perspective

Music Therapy in Preliterate Cultures

 Preliterate societies: no system of written communication
 Members of preliterate cultures generally believe in the power of music
to affect mental and physical well-being
 Music often connected w/ supernatural forces
 Most instances  tribal musician/healer holds place of importance
within society
o They determine cause of disease, apply appropriate treatment to
drive spirit/demon from body
o Sometimes music functions as prelude to actual healing
ceremony
o Drums, rattles, chants, and songs – used in preliminary ritual &
throughout ceremony
o Musician/healer usually does not act alone

Music and healing in early civilizations

 Music played important part in “rationale” medicine during this time
(5000 and 6000 BC) as well in magical and religious healing
ceremonies

Use of music in antiquity: healing rituals

 Egyptian music healers enjoyed privileged existence, due to close
relationship with priests/government
 Egyptian-priest-physicians referred to music as medicine for the soul
and included chant therapies as part of medical practice

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 Babylonian culture  treatment of sick people consisted of religious

ceremonies, healing included music
 Music = special force over thought, emotion, and physical health in
ancient Greece
o Music prescribed for emotionally disturbed individuals
o People who subscribed to power of music  Aristotle, Plato,
Caelius Aurelianus
 Predominant explanation of health/disease became theory of 4 cardinal
humors  blood, phlegm, yellow bile, black bile (each had unique
quality)
o Good health = balance of the 4

Music and Healing in the Middle ages and Renaissance

 Christian beliefs influenced attitudes towards disease; practice of
medicine still based on theory of 4 humours
 This framework provided basis for role of music in treating illness
 Renaissance advances in anatomy, physiology and clinical medicine
= marked beginning of scientific approach to medicine
o Some integration of music, medicine, and art
o Music during renaissance was used as remedy for melancholy,
despair, madness, and prescribed by physicians as preventative
medicine
o Enhance emotional health
o Helped to maintain positive outlook on life
 Baroque period 
o Music continued to be linked with medical practice
o Theory of temperaments and affections by Kircher provided fresh
viewpoint on use of music in treatment of disease
o Kircher  believed that personality characteristics were coupled
with certain style of music
 E.g., depressed would Listen to melancholy music
 Thus, healer would choose correct style of music for
treatment
o Burton  Anatomy of Melancholy; supports use of music to treat
depression

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 Late 18th century  music still advocated by European physicians in

treatment of disease
o Increased emphasis on scientific medicine
o Use of music to soothe the gods= no longer consisted with views
on illness/healing
o Music was relegated to special cases, applied by only few
physicians who used holistic framework

Music Therapy in the United States

 MT as a profession became organized in 20th century

18th century writings on music therapy

 Earliest known reference to MT in USA  unsigned article in Columbian
Magazine in 1789;
o “Music Physically Considered” – basic principles of music therapy
still used today
o Influence and regulate emotional conditions
o Person’s mental state may affect physical health
o Music was a proven therapeutic agent
o Advised that the skilled use of music in treatment of disease
required properly trained practitioner
 Another article; “Remarkable Cure of a fever by music: an attested
fact” 1796 NY Weekly Magazine;
o French teacher with severe fever lasted 2 weeks, went to a
concert, symptoms disappeared during performance, returned
upon conclusion
o Music repeated; suspension of illness, 2 weeks later recovered
completely

Pg. 141-147  The Development of the Music Therapy Profession

 Traditionally – music’s role as a healing power has been assumed to be
the profession’s foundation
o Ignores 2 details 
 1. Music has historically served other purposes pertinent to
current music therapy practice
 While music has always had a healing role, was not until
1940s that music therapy evolved as distinct profession

The Roots of Music Therapy: Music’s Historical Roles

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 Music therapy mirrors this usage of music (various roles)

 Ancient societies; music fulfilled spiritual, religious, healing and social
roles
 Ancient preliterate societies; used music as means to connect to gods
o In palliative care, connection to higher being is made when
patients sing/meditate/etc.
 Ancient Greeks introduced concept that music is an integral part of the
cosmos, affect character development and health through “right” kind
of music and balancing one’s passions
 Ancient beliefs  music is essential to human development, can
influence health, character and relaxation – concepts integral to music
therapy approaches today
 Iso-principle  involves matching particular music to person’s mood
o Elements of music are gradually changed, altering client’s
emotions or energy levels
 Middle ages  development of music’s role in religion; emergence in
Renaissance and Baroque periods  de-emphasized music’s use as a
healing power
 Divisions found in various roles that music fulfills in life
o Ritual and ceremonial purposes
o Integral part of spiritual, religious, h
o ealing and social aspects of life
o Provides connection to that which is meaningful
o Affects behaviours and emotions
 These roles are all found in the music therapy practice

The Development of Modern-Day Music Therapy

 From ancient Greeks to modern times, physicians have written about
music as form of medical treatment
 Nearchus (Alexander the Great’s physician) used music as antidote
for viper and scorpion bites
 Roman Aulus Gellius believed music could relieve pain of gout
 Theophrastus thought music could relieve epilepsy
 1600s – physicians recommended music for treatment of melancholy
 Columbian magazine article  1789; earliest written reference to
music therapy
o Highlighted basic principles of music therapy still used today
o Document stems from writings of ancient Greeks; music and its
effect on regulation of emotions

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o Author asserted that music is proven therapeutic agent, requires

application by trained practitioner
 Doctorial thesis by Edwin Augustus; 1804 expanded these beliefs
 Next 100 years; number of articles referring to music therapy were
published sporadically in medical journals
 1832; US educational facilities such as Boston’s Perkin’s school for the
Blind; began to integrate music into curriculum to assist blind
population
 1880; 14 training schools had been established in US for people with
mental impairments; each school integrated music into curriculum (for
socialization and physical well-being)
 Late 1800’s and early 1900’s; number of individuals who worked to
establish music therapy as a profession
o Eva Vescelius, isa Maud Ilsen, Harriet Ayer Seymour
o Music should be used to facilitate health

The Development of Music Therapy in the United States

 Formation of the profession of music therapy is accepted as having
begun during World War 2 with the US Army’s establishment of music
programs for wounded servicemen
 Music had been used to entertain troops and support mental and
physical abilities
 Program developed during ww2; first to systematically implement and
evaluate music to boost morale and improve health outcomes
 Special Services Music Officer
 The success of the music recreation service led to development of US
Army’s Reconditioning Program
 Surgeon general of US requested a national survey be completed
looking at use of music in mental hospitals
 Program= based on belief that music is effective in bringing people
together, releasing emotions, and creating a feeling of community. 3
Programs:
o Active participation
 Play specific instrument/sing to heal that part of the body
o Passive participation
 Listening and discussing music, appreciate it
o Audio reception
 Listen without necessary response required, entertainment
 Army was VERY careful to avoid using term; music therapy
o Lack of supporting scientific evidence

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o This led to start of 3.5 year study looking at efficacy of Army’s

program
o Results 74% of patients within programs attained improved
health outcomes through involvement with music
 End of WW2; 122 veterans hospitals engaging with services of music
therapy personnel
o After war ended, led to development of numerous University
programs, and founding of national association for music therapy
in 1950
 Since then; developments in US include establishment of Registered
Music Therapist (RMT) qualification, institution of an examination
based certification process, degree programs and requirements,
journal of music therapy & music therapy perspectives, and the
gradual expansion of scope of practice to include various client pops.

The Development of Music Therapy in the United Kingdom and

Europe
 Music was used in WW2 in European hospitals like US, music therapy
did not formally develop in Europe until 1950s
 Juliette Alvin; being primary pioneer responsible for developing
music therapy in Britain
o Worked with autistic children, mentally impaired, and/or
physically impaired
o 1958; founded the society for music therapy and remedial
music therapy
 10 years later; founding the first training program at Guildhall school of
music and drama
 1976; field was officially recognized by British government with
formation of the Association of Professional Music Therapy
o 2005; 6 established training programs
 In UK; music therapy was largely based on improvised music and
existence of 2 primary theories:
o First considers music as a medium through which therapy occurs
o Second is based on psychodynamic theories and emphasizes
therapeutic relationship
 End of 1970’s; music therapy could be found in Netherlands, Norway,
Sweden, Denmark, Germany, Austria, France, Switzerland, Yugoslavia,
Belgium
 1989; formation of the European Music Therapy Confederation

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 2005; membership included countries listed above and Italy, Spain,

Cyprus, Estonia, Finland, Greece, Hungary, Israel, Lithuania, Malta,
Poland, Portugal, Switzerland, and Republic of San Marino

The Development of Music Therapy Worldwide

 Began in the US, soon spread across the globe
 Therapists trained in either US or England, then would return to home
country
 Music therapy approaches within each country depended on initial
pioneers whom therapists trained
 Specific country approaches; pg. 145-146
 In past 20 years; music therapy has gained a foothold in the Far East
 As music therapy grew around the world, the organization of an
international conference was inevitable
o First occurred in Buenos Aires in 1974
o American Association for Music Therapy began to publish an
international music therapy journal; music therapy international
report

Music Therapy Within the Context of Modern History

 Music therapy’s development in the US was clearly affected by 2
professions: medicine and music education
 Interactions between music education and music therapy began in
early 1800s
 Various schools incorporated music into curriculum w/ the belief that
students would benefit from the integration of music with studies
 National music council  conducted the survey upon which Army’s
program was based and sponsored committee that resulted in
formation of National Association for Music Therapy
 Before establishment of the association & regulatory qualification;
music therapists were often music educators/professional musicians
who worked with people w/ mental health needs
 Medical community influenced development of music therapy as
nurses also worked as music therapists in the early years
 First 10 years of profession, music therapy personnel were supervised
by physicians
 Two additional influences significantly affected the evolution of music
therapy as a profession
o Development of psychotherapy and occupational therapy; both
preceded establishment of music therapy

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Pg. 147-156  The Development of Psychotherapy and its Impact on Music

Therapy

 3 primary approaches to psychotherapy developed over first 50 years

of profession’s existence: psychodynamic therapy, behaviour therapy,
and humanistic-based therapy
 Psychodynamic therapy; Freud; 1890-1910
o Hidden motives/unconscious thoughts
o Said that most problems suffered in adulthood stem from painful
events/perceptions/feelings from childhood
o Job of psychodynamic psychotherapist= release the resultant
repressed emotions
 By 1950s; interaction btwn various schools of thought developed into
debate within area of psychodynamic psychotherapy
 Behaviour therapy was developed in 1950s, focusing on learned
behaviours vs. unobservable subjective mental experiences
o Wundt
o 3 recognized stages to history of behaviour therapy 
o 1. Watson; outlined principles of behaviour psychology,
dominated by classical conditioning
o 2. Began late 1920s; operant conditioning by Skinner
o 3. 1960-Present, integration of social learning theories (Maslow,
Bandura) into behaviour therapy
 Modeling, shaping
 Third major approach to psychotherapy, based on humanistic
philosophy, emerged in 1960s with Maslow & Carl Rogers
o Self-actualization
o 5 key values of this approach
 1. Belief in worth of persons and dedication to
development of human potential
 2. Understanding of life as a process
 3. Appreciation of the spiritual and intuitive
 4. Commitment to ecological integrity
 5. Recognition of profound problems affecting our world &
responsibility to hope & promote constructive change

 Frank (1974); various approaches have much in common, 4 common

features:

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o 1. Relationship where patient has confidence the therapist is

competent & cares for their welfare
o 2. Practice setting defined as place of healing
o 3. Rationale of “myth” that explains patient’s suffering and how
it can be overcome
o 4. Set of procedures that require active participation of patient &
therapist, restoring patient’s health

Multiculturalism
 Multiculturalism; inclusive term, addresses awareness and sensitivity
to one’s culture and issues of disability, feminism, gender constructs,
race and religion
 Survey conducted in 2000 by American Association of Music Therapy;
showed “our profession is not representative of the current racial,
ethnic, and gender demographic of our country”
o Dominated by white women
 1990; showed early indications of slow-growing awareness of cultural
differences
 Cultural awareness impacts music therapy on many levels, from that of
global interactions to training, to establishment of therapeutic
relationship
 Issues clinically; communication problems, ignorance, ethnocentric
attitudes, power dynamics, misunderstandings
 Multiculturalism is a difficult aspect to address in clinical practice
o Therapist must have clear comprehension of own culture, values
& beliefs and also develop understanding of client’s culture
o Therapist cannot know and understand every culture
encountered in clinical practice; challenge
 Additional area of concern; how music therapy spread and developed
around the world
o Western ideas were imported into non-Western countries; these
formed the basis on clinical work in those countries

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Theoretical Developments (Models of Practice)

Community Music Therapy

 Music therapy programs based in the community have been referred to
in literature as early as 1974; was not defined until early 2000s
 Community music therapy model is characterized by concern for
context and sociocultural factors
 Community music therapy is concerned with context; cultural and
social, in which people are actively engaged in making music for
purposes of supporting health, development, equity and social change
 model is participatory based; involves group music making and
acknowledging everyone’s own voices
 concern for an ecological perspective; relationships between
individuals, systems, organizations and networks are integral to the
process; the process is participatory (not expert directed); activism is
integral part of process; entire process is “ethics-driven”
 community music therapy stands in contradiction to traditional
standards of practice, which require confidentiality, closed sessional
work, and definitive session parameters with goals, objectives, and
evaluation
 NOT founded on psychological theory, FOUNDED on systems theory
and theories from anthropology, sociology and community psychology

Models of Practice
 Clinical work in music therapy & models of practice have evolved from
client needs, philosophical and theoretical environments,
governmental systems, economic demands, and societal pressures
 1984; Maranto identified over 100 models in use worldwide
 Clinical practice develops in response to client needs
 Economics have influenced which models of practice thrive
 Societal developments are another element that has implications for
developments of models of practice

Government Policy and Politics

 Music therapy profession in US grew out of government sanctioned
work within the Army
 Development has continued to be shaped by government policy

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 Move towards deinstitutionalization  closure of large institutions

resulted in loss of many professional healthcare jobs, while community
programs were created
 Deinstitutionalization policies forced health professionals to reconsider
clinical care

Economics
 Any music therapist who works in private practice is very aware of how
economics influence clinical work on a very pragmatic level
 Clear example of effect of economics on healthcare provision has been
the development of evidence-based practice
o Factors outside of healthcare (e.g., insurance companies) saw in
evidence-based practice a way to measure service effectiveness
and determine where and how to spend money
o Procter (2011) proposed the adoption of social capital theory as
a basis for music therapy – this theory allows for the full breadth
of music therapy practice to be seen as being economically
viable

Societal Changes
 Bunt & Stige (2014) – said that “areas of practice are shaped not only
by the possibilities of the profession but also by the needs and
structure of a society”
o Profession itself is shaped b society’s needs and by society itself
o Development of music therapy as a profession occurred due to
opportunities created by society as well as the social evolution of
concept of “professions”
o Music therapy’s growth has continued to mirror changes in
society
o US; prevalence of behavioural music therapy in 1960s and 70s is
reflective of the then dominance of behavioural psychology in
healthcare and education
 Social advancement that has influenced music therapy = the rise of
technology
o Affected both clinical work and research
o Neurological music therapy research uses technical apparatus
such as EEGS an fMRIs to understand how rhythm affects brain
and CNS

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 Twenty-first century scientific research, in the form of evidence based

practice, is another societal development that continues to exercise
strong influence on field
o Initial emphasis on wholeness and client-centred practice within
healthcare has now expanded to include respect for and
awareness of and responsiveness to cultural, render, race,
ethnic, and sexual orientation elements of the human condition
o Clinicians expected to integrate these concerns
 Growth of music-based healing work outside of the parameters of
music therapy, from nurses using music to modern-day “sound
healers”, to neuroscientists developing centers to study phenomenon
of music and developing their own interventions

Pg. 181-195 Approaches Developed within the Field of Music Therapy

 2 approaches that developed primarily within the field of music
therapy are
o Nordoff-Robbins Music therapy
o Bonny Method of Guided Imagery and Music
 These psychotherapeutic forms of music therapy use a combination of
spoken word and music to elicit changes in client behaviour
 These approaches to music therapy are intensely personal, frequently
conducted on an individual basis, with variety of people
 Goals; usually broad and aimed at personal growth, self-actualization,
and building self-worth in clients

Nordoff-Robbins music Therapy

 Developed from a unique partnership between Paul Nordoff (composer)
and Clive Robbins (special education teacher)
 Active music therapy; primarily uses improvisation to attain
therapeutic goals, founded on idea that all persons have inborn
musical ability and creativity
 Tapping into client’s innate musical ability leads to personal growth &
development
 Students take classes in 
o Improvisation
o Musicianship
o Assessment
o Theory of group music therapy

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 Participants engage in music making, playing high quality instruments

of various kinds, including pitched and percussion instruments
o Singing and movement can be incorporated into session to
enhance communication
 NR MT’s apply techniques to a wide range of adults and children,
including those w/ developmental disabilities or socioemotional
problems, older adults, and clients in medical settings
 NR MT emphasizes concept of self-actualization and meaningfulness
of human destiny
 Within every human being is a musical self / musical child
 No specific format or procedure for a session; improvisation is used to
begin musical dialogue between participant and therapist
 NR MT’s strive to build effective relationship between themselves and
clients with ultimate goal of helping person attain improved quality of
life
 Clinical goals & objectives aim to develop client’s individual potential
opposed to working toward cultural expectations of normality
 NR MT’s generally focus on long term therapeutic growth characterized
by 
o Expressive function
o Creativity
o Self-confidence
o Other human qualities association with self-actualization
 Assessment does NOT typically focus on specific target behaviours,
rather sessions are recorded and reviewed by clinicians, documented
in narrative style; “indexing the session”

The Bonny Method of Guided Imagery and Music (GIM)

 Helen Bonny; developed idea of using classical music to stimulate and
sustain a dynamic process through the imagination, facilitates self-
exploration and ‘peak-experiences’ (Maslow)
 Based on humanistic & transpersonal theories, GIM practitioners
subscribe to idea that combination of music and imagery can help
client expand self-awareness that leads to more healthy state of
being
 LSD era & self-actualization; Bonny proposed substituting music for the
drug
o Research showed that music, when properly applied, could
intensify and safely contain imagery, helping to uncover
detrimental thoughts, emotions and feelings

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 GIM therapists use classical music to evoke and catalyze images

(represent conscious and unconscious feelings from client’s past)
o Music plays throughout session, therapist facilitates ongoing
dialogue, individual experiences cathartic release of emotions,
leads to transformation in perception of past events, and ability
to view them from new perspective
o Cognitive reframing; lead them to positive behaviour change and
renewed sense of self-wort
o Therapeutic goals include 
 Creativity
 self-exploration
 spiritual insight
 cognitive reorganization
 this type of classical music & GIM; designed to challenge & expand
client’s comfort level while providing support to explore images that
arise during session
 MT chooses music that matches client’s affect, energy level, and issues
 Titles of music programs for GIM suggest themes;
o Positive affect
o Relationships
o Transitions
o Affect release
o Emotional expression
 NOTE: MT’s role in GIM is NOT to solve client’s problems but to
guide, support and serve as witness to individual’s process
towards self-understanding and change
 People most appropriate for GIM
o Those diagnosed with certain types of behaviour or emotional
disorders
o Those with chronic illness
o Those seeking a better understanding of self
 Those NOT appropriate for GIM 
o Individuals with psychosis
 Desired clinical outcomes 
o Improved interpersonal relationships and lives more manageable
and meaningful

Music Therapy Approaches Reflecting or Based upon Psychological

Philosophies, Theories or Models

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 Consistent with a biopsychosocial model of health care, treatment

should incorporate the psychological and social needs of the individual
 MT’s often work collaboratively with other health care providers
 MT’s often feel more comfortable with particular approaches, they may
need to select MT interventions congruent with
theories/models/adopted by client’s treatment team or facility’s
overarching mission
 Several prominent philosophies, theories, or models
associated with field of psychology, but have informed and
shaped music therapy 
o Behavioural therapy
o Cognitive behavioural therapy
o Psychodynamic therapy
 * Eclectic approach; use of techniques from several different
approaches

The behavioural approach to music therapy

 DEFINED AS; the use of music in association with the therapist to
change unhealthy patterns of socially important behaviour into more
appropriate skills
 Behaviour is changed through highly structured environment using
classical or operant conditioning principals (Skinner/Bandura)
 Behaviourism examines human behaviour through empirical
methods (measurable & observable) rather than focusing on
thoughts/internal emotional conflicts
 Behavioural psychology is the philosophical and theoretical basis for
understanding human behaviour
 Applied behaviour analysis (ABA) helps link research with clinical
practice
o Consists of variety of creative approaches that reflect
behavioural theories to influence behaviour change
 Procedures from behaviour therapy/ABA have been used to assess &
treat wide range of clinical entities including;
o Physical disabling conditions
o Behavioural emotional disorders
o Adults and children with ID’s
o ASD

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 Behaviour therapy can be used to modify maladaptive behaviours (SIB,

self-stimulating behaviours, anxiety/phobias, depression, eating
disorders, smoking, antisocial behaviours)
 Techniques common to behaviour therapy 
o Positive and negative reinforcement
o Punishment
o Extinction of undesirable behaviours
o Token economies (strengthen desirable behaviours)
o Shaping
 Techniques such as reinforcement/shaping; easily integrated into MT
sessions
o Praise, reward (stickers), other sorts of R+ to reinforce
appropriate behaviours
 Many research studies show that listening to/playing music can be a
very powerful reinforcement used to increase a target behaviour
 MT’s use shaping; help clients develop new and challenging skills
(shape/gradually guide client’s skills towards higher level)
 Pairing relaxing music with special relaxation techniques (progressive
relaxation or autogenic relaxation)
o Music becomes conditioned with relaxation

Cognitive-Behavioural Music Therapy

 Cognitive therapies are based upon the premise that what we think
about an event, object or person has an enormous influence on what
we feel/how we act
 Cognitive approaches emphasize importance of cognitive processes as
determinants of behaviour
 Cognitive behavioural therapy is designed to help clients replace
undesirable, irrational thinking with healthier cognitive patterns
 MT would use this approach with people who have emotional/social
problems;
o Anxiety disorders
o Substance abuse
o Eating disorders
o Mood disorders
o Also has treated chronic pain & sleep disorders
 CBT requires client be capable of insight and verbal communication;
therefor not good for people who are psychotic or have serious
intellectual deficits

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 MT helps client learn to adjust cognitive processes and associated

behaviours
 MT will use approaches such as 
o Role playing
o Rehearsal
o Modeling
 CMBT includes components of music and verbal processing
 MT’s use guided listening strategies including 
o Lyric analysis
o Song writing
o Relaxation experiences
 Pairing preferred relaxing music with an autogenic or progressive
relaxation script can help clients with pain management & focus
attention away from an unpleasant medical procedure
 Recent study by Silverman (2007); shows that music therapy
practitioners use cognitive-behavioural strategies more frequently than
other approaches with persons who have behavioural emotional
disturbances

The Psychodynamic Approach to Music Therapy

 This approach is related to psychodynamic theory of psychology
(Freud, Jung, etc.)
 Psychodynamic model is based upon the belief that human behaviour
is strongly influenced by unconscious psychological processes such as;
o Internal conflicts
o Impulses
o Desires
o Motives
o …….Things we are largely unaware of at the conscious level
 Psychodynamic therapies are all concerned with explaining motives
behind why people think, feel, and behave as they do
 Therapy is aimed at helping the individual gain insights/increased
awareness of unconscious conflicts to develop more
adaptive/satisfying behaviours and relationships
 Some music therapy approaches used by psychodynamic music
therapists include vocal and instrumental improvisation, song writing,
patient-selected music, music imagery, and the Bonny method of
Guided imagery and Music

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 Psychodynamically-based music therapy is used to help patients

develop insights into unconscious drives, motives, and conflicts that
negatively impact their functioning
 Relationship to therapist and client = fundamental to treatment
process
 Music and/or verbal interaction are the essential elements of
change
 Debate regarding role of music vs. role of patient-therapist relationship
in music psychotherapy
o Bruscia suggests 4 levels of engagement between patient and
therapist that fall on continuum from exclusively musical
interaction to predominantly verbal interactions

Music Therapy Approaches Reflecting Biomedical Models

 Core aspects of a biomedical perspective 
o The focus on the neurobiological foundations of the human
nervous system
o Strong emphasis on music perception and active music
participation as a form of stimulation that activates physiological
and neurophysiological processes in the body
o Belief that the unique structural and cultural properties of music
can be harnessed to access brain and behaviour functions to
facilitate and promote healing and rehabilitation
 Preliminary studies consistent with psychoneuroimmunology indicate
that stress-related hormones and neurotransmitters can suppress
immune functioning
 Music in conjunction with stress reduction and relaxation can reduce
levels of these hormones and neurotransmitters
 Therapeutic application of music have been associated with improved
neuromotor, speech/language, and cognitive functioning for people
with neurologically-based conditions such as;
o Stroke
o Parkinson’s disease
o Multiple sclerosis
o Traumatic brain injury
o Cerebral palsy

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Neurologic Music Therapy

 Study of neurobiological basis of music ability is inherently linked to
study of music’s influence on brain function
o When we study the biology of music in the brain, we recognize a
reciprocal relationship in musical behaviour: the brain that
engages in music is changed by engaging in music
 Rational Scientific Mediating Model (R-SMM) searches for the
therapeutic effect of music by studying if and how music stimulates
and engages parallel or shared brain functioning in following areas,
based on the psychological and physiological processes in music
perception:
o Cognition
o Speech and language
o Motor control
o Motion
 Since 1990; large body of research in neurosciences of music
 Neurologic Music Therapy (NMT) – has resulted in development of
clinical techniques
o 5 basic definitions articulate most important principles of
neurologic music therapy
 1. NMT is defined as the therapeutic application of music to
cognitive, sensory and motor dysfunctions due to
neurologic disease of the human nervous system
 2. NMT is based on a neuroscience model of music
perception and production, and the influence of music on
functional changes in non-musical brain and behaviour
functions
 3. Treatment techniques are evidence based
 4. Treatment techniques are standardized in terminology
and application & applied to therapy as therapeutic music
interventions (TMI) & are adaptable to patient’s functional
needs
 5. Practitioners are educated in areas of neuroanatomy
and physiology, brain pathologies, medical terminology,
and rehabilitation of cognitive, motor, speech and
language functions

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 Clinical applications of NMT are subdivided into 3 domains of

rehabilitation:
o 1. Sensorimotor rehabilitation
o 2. Speech and language rehabilitation
o 3. Cognitive rehabilitation
 In each domain, NMT can be applied to patient treatment within
different clinical fields and disciplines
 Therapeutic goals are directed towards functional rehabilitative,
developmental or adaptive goals
 2 additional concepts on NMT
o 1. Technique Standardization
 Current music therapy practice, lots of variety in how
therapy approaches are named, lack of standardization
makes communication among professionals difficult,
standardization provides foundation for establishing
treatment goals & intervention protocols
 NMT- 2 parameters of technique definition are introduced
to allow for standardized descriptions and applications.
First parameter is based on functional goals of therapeutic
music exercise, second parameter is based on mechanism
in music that facilitates the therapeutic change
 Techniques can be consistently defined
o 2. Assessment
 Complex process, NMT assessment evolves out of simple
question: what do music therapists assess that is unique to
their professional role in facilitating best treatment options
for patients?
 Assessment plays critical role in helping select treatment
for patient
 Can only be effectively applied when well-defined
standardized treatment techniques exist & evidence basis
 NMT- assessment is aided by standardization of goals and
interventions

Eclectic or Integrative Approach

 Elective/integrative approach to therapy means that therapists draw
freely on techniques from all types of therapy without necessarily
accepting the theoretical frameworks behind them
 Overall trend away from exclusiveness or narrowness of adhering to
particular system/theory, with goal of more efficient treatment

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 Eclecticism; no single theory is comprehensive enough to account for

complexities of human behaviours
 Accept that each theory has strengths and weaknesses, adopt an
integrative perspective, have the opportunity to more closely match
therapeutic interventions with needs and goals of clients
 An integrative approach to therapy should not be a random selection
of one’s personally favourite techniques
 Important for therapist to consider which theories provide best basis
for understanding cognitive, emotional, behavioural and biophysical
dimensions & reflect on therapeutic approaches best fit for client’s
problems, cultural background, and personality
 Integrated approach requires solid understanding of different therapy
approaches, characteristics, needs, and strengths of different types of
clients
 Survey of music therapists who work in psychiatric facilities –
Silverman 2007
o Largest proportion described themselves as having eclectic
philosophical orientation towards psychiatric treatment
 Cassidy and Cassidy (2006)
o Advocated for multimodal model of therapy for persons with
behavioural and emotional disorders

Pg. 25-34 Song-writing to Explore Identity Change and Sense of Self-Concept

Following Traumatic Brain Injury
 Rehabilitating physical, cognitive and communication functioning
following Traumatic Brain Injury (TMI) is an intensive, exhausting and
highly emotional task for people
 Over past 12 years- authors have employed song writing interventions
with children, adolescents and adult TBI clients to facilitate adjustment
process to help maintain motivation for therapy
 Therapeutic songwriting with TBI clients

Confronting and adjusting to change

 Clients with a TBI have to adjust to many losses: independence,
functioning, loss of control, loss of former body, financial status, future
hopes and dreams, ability to participate in activities, etc.
 Several theories have emerged about how and when adjustment
occurs and what variables influence the process

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 Wright (1960) viewed adjustment to disability in terms of reflecting

the interaction between a person’s value system, level of emotional
maturity and acceptance of self, and mental health status
 Olney and Kim (2001) suggest adjustment is a staged process which
includes:
o Response to initial impact
o Defence mobilization
o Initial realization
o Period of retaliation
o Reintegration & adjustment characterized by confidence,
contentment and satisfaction
 Adjustment involves the formation of an identity that integrates all
aspects of the self, and an understanding at multiple levels of
meanings and implications disability has on a person’s life
 Major themes arising from such processes
o How people describe their difficulties
o How they cope with specific limitations
o how they manage their identity and integrate their identity as a
person with a disability into a sense of self
 Simpson, Simons & McFadyen (2002)
o Propose major challenge after TBI is reaching an understanding
of how the injury affected their cognitive and psychosocial
abilities
 Two distinct periods within the recovery period when clients are most
vulnerable and confronting adjustment issues:
o Stage 1  occurs as they approach stage of rehabilitation where
progress starts to slow & growing realization that full recovery is
less likely
o Stage 2  occurs between 6-12 months after discharge. Initial
discharge=excitement about leaving hospital, then wears off and
reality of long-term life changes sets in, boredom and depression
may ensue
 Songwriting interventions = especially valuable at these two phases of
recovery from TBI
 Need to consider appropriate timing to encourage refection and
adjustment through songwriting
 MT has ethical duty to safeguard emotional well-being of clients, not
raising issues they are not yet aware/emotionally ready to deal with

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 When client recovery is active, full participation in rehabilitation is

essential
 More appropriate= inclusion of self-reflection through songwriting
when client’s rehabilitation is being hampered by negative emotional
responses

Exploration through song

 Coping and adjusting to trauma has been promoted within our therapy
programs by facilitating client exploration of thoughts, feelings, and
reactions to acquired brain injury through song writing
 82 songs written by clients with TBI  several themes emerged
o Distress and pain in hospitalization process, feelings of isolation,
dependency, helplessness, anger with current situation, body
image
o Positive experiences also included in songs  memories about
significant others

Communication Impairments: inhibitors of adjustment

 Language and communication impairments inhibit songwriting process
and therapeutic process
 Clients with TBI may demonstrate range of communication
impairments --.
o Aphasia: neurological damage, impairments in word-finding and
language, know what they want to say but cannot say it
o Dyspraxia and/or dysarthria: neurological damage, impairments
in articulating speech

Cognitive impairments: inhibitors of adjustment

 Adjustment to disability = understanding, exploring, responding and
working through range of loss and grief issues & forming new identity
 Wright 1960- the greater the cognitive impairment, the more difficult
process of adjustment is
 Poor insight= common problem in clients with TBI. Client may be
unaware of their impairments
 Short-term memory problems impact on the therapeutic songwriting
process.
 Process is further complicated by gaps in long-term memory where
clients have difficulty recalling details to include in songs they are
writing
 Additional cognitive problems found during adjustment phase:

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o Poor concentration
o Poor attention
o Limitations in planning & organizational skills
o Limitations in problem solving, initiation and abstract thinking
o Inability to learn new information
o Perseverative tendencies

Introducing songwriting as an intervention

 Many methods of approaching songwriting process when focusing on
emotional expression and adjustment issues for clients with TBI
 Often, clinician chooses most appropriate way to introduce songwriting
process for client, based on assessment of cognitive functioning
 For clients with more severe cognitive difficulties, clinician may be
more directive in process
 For clients with fewer cognitive difficulties, range of options for how to
begin song are presented and client can choose the approach
 potential therapeutic benefits of writing a song:
o identifying and externalizing emotions
o communicating to loved ones
o self-motivation and encouragement
o simply telling their story
 songwriting can create an alternative way to approach reality &
precipitate a change in thinking, encourages and promotes growth &
self-awareness
 many patients feel most comfortable starting with lyric creation,
clinician asks if they want to use music to a song they already
know/write new lyrics (song parody) or create completely new song
 providing opportunity for choice throughout songwriting process is
imperative, allows client to have as much control as possible
 empowerment= important for patients with TBI

When to introduce songwriting into therapy

 Songwriting process is rarely started in first music therapy session
when addressing emotional & adjustment issues for patients with TBI
 Rapport developed over time between client and therapist provides an
environment of trust and support
 For patient newly referred to music therapy to address emotional &
adjustment issues, first session = develop rapport, discuss musical
tastes, allow client to tell their story, build trust

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 For some clients, it IS appropriate to begin song in first session,

particularly with frontal lobe damage where memory problems/other
cognitive issues are present

Beginning a new song: lyric creation

 Most common way to start writing a new song = brainstorm ideas,
record them on paper
 Therapeutic lyric creation: Client talks about important/troubling
issues, then encouraged to select a topic/theme from the discussion
where ideas for lyrics might be generated
o Stage 1: generate range of topics to write about
o Stage 2: select topic for further exploration
o Stage 3: brainstorm ideas related to chosen topic
o Stage 4: identify principal idea/thought/emotion/concept within
topic
o Stage 5: develop ideas identified as central to topic
o Stage 6: group related points together
o Stage 7: discard irrelevant/least important points
o Stage 8: construct an outline of main themes within song
o Stage 9: construct lyrics for song

Fill in the blank and song parody techniques

 Fill-in-the-blank technique (FBT) using familiar song
o Song that client relates to may be used and adapted to make it
personally relevant
o Clients complete lyrics by including words/phrases that were
brainstormed earlier in the process
o This technique provides more structure for clients who have
difficulty expanding/organizing simple ideas
 Song parody technique (SPT)
o Uses music of pre-composed song where lyrics of original song
are completely replaced by client-generated lyrics
 Usually a combination of the 2 is employed
 SPT and FBT are often used with paediatric patients

Song collage technique

 Helpful for clients with difficulty identifying/articulating emotions

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 This technique involves client looking through music books or lyric

sheet within CD covers and selecting words or phrases from pre
composed songs that stand out

Use of Rhyme Technique (URT)

 Use of rhyming lyric patterns (termed use of rhyme technique) can be
employed to create structure in a song
 Therapist should make decision whether/not to introduce this option
based on client’s cognitive abilities
 If client can generate list of words that rhyme, this is a good technique
to expand/organize song ideas (sad, bad, glad, dad)

Music Composition
 Often the music is created after at least some of the lyric creation has
been completed
 At the start of the songwriting process, clients are given the option of
writing their own music or using music to a familiar song of their choice
to white their own lyrics (SPT)
 SPT= useful when clients feel daunted by idea of writing music for their
song

Musical Genre and style

 Good place to start the music creation is with the clients’ preference
for musical genre
 Once genre has been selected, different accompaniment styles can be
presented for client to choose between
o May be improvised on instrument by therapist
o Choice of instrumentation is often determined by genre
preference
 Most common method for melody composition  the therapist provide
melody options for client to listen to and choose between

Applications of the song post-recording

 A recording and written transcription of completed song is given to
client following completion of lyrics & music
 Recordings serve as a record of therapeutic songwriting process and
can be used by clients to validate their emotional journey
 Some songs may be used 

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o To communicate messages to loved ones

o To record positive past memories and experiences
o For self -motivation and encouragement during difficult times
o To affirm and encourage other clients who may be experiencing
similar difficulties

Case example: a filthy song – genre to match emotional intensity

 Sam, young man aged 19, referred to music therapy
 Had a severe TBI from train accident, possible attempted suicide
 Very physically disabled as result of his brain injury
 Speech was severely dysarthric and difficult to understand
 Legs were both broken, high muscle tone resulting from brain injury
that caused him lots of pain in physiotherapy
 Had severe cognitive and behavioural issues, affected his ability to
participate in rehabilitation
 He was angry, limited insight into his disabilities and need for
rehabilitation
 Therapy sessions often ended early due to non-compliance/aggression
 Was referred to music therapy for emotional expression and
communication needs
 Opportunity for self-reflection and expression through song-writing was
considered appropriate as Sam needed to work through these issues to
maintain motivation for continued therapy
 Songwriting process was introduced after Sam had been in music
therapy for some time and rapport was built
 Foundation of trust & openness allowed Sam to feel comfortable
talking about his feelings
 Music therapist introduced concept of songwriting to Sam as
potential vehicle he could express and capture emotions, Sam was
responsive to this idea, loved heavy metal genre
 First song was written over 3 sessions, phrases mostly consisted of
emotional intensity
 Chorus Lyrics express sadness and apathy, verses express anger and
frustration
 Sam wrote several songs in music therapy, became a medium to
document his adjustment process

Case example: ‘Wannabe’ like a Spice Girl – song parody and

musical identity

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 Sally, almost 12 when she was involved in car accident, multiple

traumas, severe head injury
 joint muscle therapy and speech pathology: focused on dysarthria and
language difficulties
 cognitive difficulties: memory impairment, psychomotor slowing,
impaired problem-solving, rigid thinking, impaired social judgement
 Sally was unmotivated to participate in most therapy sessions, referral
for music therapy to address emotional needs including self-expression
and adjustment to hospitalization
 Music therapy assessment revealed that Sally enjoyed listening to and
playing music
 Songwriting was offered to address need for self-expression, she chose
spice girls song ‘Wanna be’ to write her own lyrics (song parody)
 Sally had little difficulty creating ideas for lyrics, but her dysarthria
affected her ability to articulate her intended speech clearly
 Sally’s mom was at most sessions, able to understand her speech and
assist
 Sally chose to write about experiences in hospital
 Use of song parody provided necessary structure and predictability of
melody and rhythm to aid organization of ideas into lyrical format
 Song parody provided Sally with the opportunity to express a variety of
emotions, thoughts, feelings, which assisted her adjustment to hospital
and her return home

Conclusions
 Song parody, fill in the blank, song collage, use of rhyme 
appropriate strategies to manage cognitive deficits
 Can also be used to encourage creation of lyrics that express feelings
 use of samples, loops, and pre-programmed accompaniment styles
within music software programs and modern electric keyboards can be
used effectively to create genre-specific effects
 music therapists working in rehabilitation must be flexible, creative
and adaptive in their therapeutic approach to songwriting

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Pg. 35 - 46 Music Therapy with the Elderly

 US; cost of institutional care for patients with dementia is over $25
billion annually
 15% of those over 65 will have moderate to severe dementia with
projections to 45% by age 90
 20% - 30% of patients with Alzheimer’s will have an accompanying
depression

Clinical descriptions of dementia

 Acquired decline of cognitive function which is represented by memory
and language impairment
o Dementia of Alzheimer’s type (DAT)
o Multi-infarct dementia
 Alzheimer’s disease  progressive deterioration associated with
degenerative changes in the brain
o Aphasia= disorders of language
o Anomia= difficulty in finding the names of words
o Agnosia= the loss of the ability to interpret what is said, heard
and felt
o Apraxia= inability to carry out motor activities, such as
manipulating pen or toothbrush
 Cognitive test  Mini-Mental state examination; developed to
screen & monitor progression of Alzheimer’s disease
o Intended for clinician to assess functions of different areas of the
brain, based upon questions and activities
o Is widely used, well validated in practice, useful as predictive tool
for cognitive impairment and semantic memory
o Elderly patients scoring BELOW 24 points / 30 points are
considered as demented
o Criticism: 24 is not a very low cut off, education could play into
that
o Criticism: not sensitive enough to mild deficits
o Criticism: seriously underestimates cognitive impairment in
psychiatric patients
o Criticism: neglects intention/executive control, the ability of the
patient to persevere with a set task/ to reach a set goal/ change
tasks

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 The items which the MMSE fails to discriminate (minor language

deficits) or neglects to assess (fluency and intentionality) may be
elicited in playing of improvised music

Music and Dementia

 Individuals with Alzheimer’s disease  language deterioration is a
feature cognitive deficit, musical abilities are preserved
o Fundamentals of language are musical, prior to semantic and
lexical functions in language development
 Language processing=dominant in one hemisphere of the brain, music
production involves an understanding of interaction of both cerebral
hemispheres
 Evidence of the global strategy of music processing in the brain is
found in the clinical literature
 Syntactical functions may remain longer, it is the lexical and semantic
functions of naming and reference which begin to fail in the early
stages
 Phrasing and grammatical structures remain, giving an impression of
normal speech, yet content becomes increasingly incoherent
 These progressive failings appear to be located within the context of
semantic and episodic memory loss illustrated by the inability to
remember a simple story when tested

Musicality and singing

 Musicality and singing are rarely tested as features of cognitive
deterioration, yet preservation of these abilities in aphasics has been
linked to eventual recovery & could be indicators of hierarchical
changes in cognitive functioning
 Swartz and colleagues propose a series of perceptual levels at which
musical disorders take place:
o 1. The acoustico-psychological level, which includes changes in
intensity, pitch and timbre
o 2. The discriminatory level, which includes discrimination of
intervals and chords
o 3. The categorical level which includes the categorical
identification of rhythmic patterns and intervals
o 4. The configural level, which includes melody perception, the
recognition of motifs and themes, tonal changes, identification of
instruments, and rhythmic discrimination

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o 5. The level where musical form is recognized, including complex

perceptual and executive functions of harmonic, melodic, and
rhythmical transformations
 In Alzheimer’s patients, it would be expected that levels 1,2,3 remain
unaffected, the complexities of levels 4,5 when requiring no naming,
may be preserved but are susceptible to deterioration
 Rhythm is the key to the integrative process, underlying both musical
perception and physiological coherence

Music Therapy and the Elderly

 Much of the work on music therapy and the elderly is based on group
activity and is generally used to expand socialization and
communication skills with intention of reducing problems of social
isolation and withdrawal, and encourage participants to interact
purposefully with others, assist in expression and communicating
feelings and ideas, stimulate cognitive processes, sharpening problem
solving skills
 Clair  worked lots with this population, found that although group
members deteriorated quickly in cognitive, physical and social
capacities over 15 months, they continued to participate in music
activities
o Music therapy was the only time in the week they interacted with
others
 Wandering, confusion and agitation are linked problems common to
elderly patients / those with Alzheimer’s
 Music therapy sessions redirected a wandering patient, she sat double
that of a reading session
o MT also has calming effect during agitation
o MT also reduces disruptive vocalizations
 Groene  30 residences, 60-91 years old, of special Alzheimer’s unit,
were wanderers, randomly assigned to music attention or reading
attention groups. Those receiving music therapy remained seated
longer than those in reading sessions
 Central problem of elderly  loss of independence & self-esteem
o Palmer music therapy program at geriatric home designed to
rebuild self-concept
o 380 residents, marching and dancing increased ability of some
patients to walk, improved circulation, increased tolerance and
strength

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o Sing-along sessions used to encourage memory recall and

promote social interaction and appropriate social behaviour
 Music therapy has also been used to focus on memory recall for songs
and spoken word

Music therapy with an Alzheimer’s patient

 Nordoff-robbins music therapy is based upon the improvisation of
music between therapist and patient
 Music therapist plays piano, improvising with patient, who uses a range
of instruments
 Often begins with exploratory session using rhythmic instruments,
progressing to use of rhythmic/melodic instruments, developing into
work with melodic instruments and voice
 Case example  Edith, 55, sister died of Alzheimer’s, family
concerned she was repeating sister’s demise as memory was being
disturbed, memory problems, difficulty finding words when speaking,
depression?

Music Therapy as a Sensitive Tool for Assessment

 Alzheimer’s patients, despite aphasia and memory loss, continue to
sing old songs and dance to past tunes
 Music therapy appears to play important role in enhancing the ability
to take part actively in daily life
 Production and improvisation of music appear to fail in the same way
language fails
 Improvised music therapy appears to offer the opportunity to
supplement mental state examinations in areas where those
examinations are lacking
o Possible to ascertain fluency of musical production
o Intentionality, attention to, concentration on and perseverance
with task in hand are important features of producing musical
improvisations
o Episodic memory can be tested in ability to repeat short
rhythmic and melodic phrases
 If rhythmic structure is an overall context for musical production, and
the ground structure for perception, it can be hypothesized that it is
this overarching structure which begins to fail in Alzheimer’s patients
o Loss of rhythmical context would explain why patients are able
to produce and persevere with rhythmic and melodic playing
when offered an overall structure by the therapist

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o Such a hypothesis would tie in with musical hierarchy proposed

by Swartz & would suggest a global failing in cognition while
localized lower abilities are retained
 Music therapy appears to offer a sensitive assessment tool; it tests
those prosodic elements of speech production which are not lexically
dependent
o Can be used to assess those areas of functioning (receptive and
productive) not covered by other test instruments
 Fluency, perseverance in context, attention, concentration
and intentionality
o Provides form of therapy which may stimulate cognitive activities
such that areas subject to progressive failure are maintained
o Quality of life of Alzheimer’s patients is significantly improved
with music therapy accompanied by social benefits of
acceptance and sense of belonging gained by communicating
with others
 Prinsley- recommends music therapy for geriatric care as it reduces
individual prescription of tranquilizing medication, reduces use of
hypnotics, helps overall rehabilitation
o He recommends music therapy is based on treatment objectives:
social goals of interaction co-operation, psychological goals of
mood improvement and self-expression, intellectual goals of
stimulation of speech and organization of mental processes,
physical goals of sensory stimulation and motor integration

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