“Every disease is a musical problem; every cure has a musical solution.”
– W.H. Auden in conversation with Oliver Sacks.
When someone asks me, “What is Music Therapy?” the question is music to my ears, and often follows my having introduced myself as a board certified music therapist. It is a question I am asked a lot these days, as music therapy is not an established healthcare profession in Maine. My answer generally goes something like this:
Music Therapy is the meeting of science and art – a way of using music intentionally as part of treatment in a variety of clinical settings – medical, psychiatric, developmental disability, rehabilitation, aging, Hospice — as well as in wellness settings.
The American Music Therapy Association defines Music Therapy as:
“An established healthcare profession that uses music to address physical, emotional, cognitive, and social needs of individuals of all ages. Music therapy improves the quality of life for persons who are well and meets the needs of children and adults with disabilities or illnesses.”
www.americanmusictherapy.org
A favorite way of capturing the essence of Music Therapy is with the simple yet profound statement of Julie Zigo, a professor of music therapy at Berklee College of Music.
“Music Therapy is about connection, about relieving the isolation that various forms of illness and debilitation can bring.”
Indeed, the power of music therapy to illuminate dignity and ability in an individual whose life is more defined by disease and disability is real and can be profound. It is this very real function of music that, when applied with intention and skill by a trained music therapist, can truly make a major contribution to a client’s overall quality of life and to specific treatment goals. And so I find myself on a mission to establish music therapy in Northern New England as an element of Integrative Medicine and as a service in wellness settings.
My Journey to Music Therapy
My journey to enter the field is an example of what we are seeing and reading about these days as individuals easing toward retirement decide that there is one more thing to do – a calling of sorts – as a last chapter of one’s working life. There is often a “giving back” theme. There is often a connection back to something we love deeply. And so it is with me.
About 10 years ago I began working with a teenage girl I will call Jane, who had a moderate to severe case of cerebral palsy. She absolutely loved music! We knew each other via my role as artistic director of “Wassail By The Sea,” a community grass roots Christmas Revels production here in the Kennebunks in the early 90s. Knowing her connection to and aptitude for music, her parents asked me if I would work with her.
Jane became my first music therapy client, although I was not formally trained at the time. Guided by her musical preferences and my intuition, we learned songs, added rhythmic accompaniment and movement, and sang and played together for three years. I taught Jane how to play the piano, despite the fact that she had limited use of her hands and fingers. Her posture and ability to walk were compromised, and her speech was characterized by poor articulation, delays, stuttering and occasionally gasping for breath. But when the music began, she sang, mostly on pitch, moved in rhythm, and voiced the lyrics effortlessly. Her ability to learn the words and melody quickly was remarkable. We were even able to create simple harmony. Our time working together culminated in a joyful recital for family and a few close friends in my studio and remains one of the most moving moments of my life.
Two years later, I moved to Boston and entered Berklee’s music therapy training program, headed by Dr. Suzanne Hanser, who has been described by the Boston Globe as one of the top ten leaders and change agents in New England. An esteemed researcher, author and professor, Suzanne has spent years bringing her behaviorist, evidenced-based approach to the study and practice of music therapy. The department is thriving and growing. There are now full time music therapists at
Massachusetts General Hospital, Dana Farber, Children’s Hospital, University of Massachusetts Medical Center and at several Hospice organizations, as well as at many nursing homes, community health centers, V.A. Hospitals, rehabilitation facilities, public and special education schools and community music centers.
It was Suzanne who counseled me to become the first full time intern at Seasons Hospice in Boston. There I would be able to combine my interest in working with the psychiatric and aging populations and bring my spiritual self to work every day. She was absolutely right.
Music and Music Therapy
To understand what music therapy is, it is important to distinguish the profession from the use of music as entertainment and enrichment – both wonderful ways to experience music. Music therapy requires the practitioner to use her musicianship in the service of others. This means that two skill sets – those related to her ability as a musician and those related to her ability to build trusting therapeutic relationships with a clinical population are required. Skill in music improvisation is essential in meeting the patient from moment to moment. I like the Image of the triangle to frame the profession. There is the patient, the therapist, and the music, coming together in service of the non-musical treatment goals of the patient.
Music therapy goals in the clinical setting include improving cognitive function, promoting socialization, stimulating sensory and physical activity, facilitating emotional expression and contributing to the rehabilitation process. During a thorough music therapy assessment, the music therapist determines the client’s music experience and connection to music, if any, and observes the client’s response to a series of music activities.
The intention is always to engage the client and build on the capacity and ability that emerges. The degree of participation, engagement, energy level, focus, affect, physicality, capacity for leading and following and making choices, are among the behaviors the music therapist is observing and evaluating. Then, once a treatment plan is created and sessions begin, assessment and evaluation are ongoing.
Music therapists work in interdisciplinary teams in healthcare and wellness settings and in private practice on a contracting basis. The advantage of the former is that as team members, they can be more fully involved with the overall care of the patient and communicate and share progress notes with other team members.
What Does Music Therapy Look Like?
For me, it often means collapsing the back seats of my little car to make space for a bag of rhythm instruments – shakers, tambourine, hand drum, cow bell, chimes, clave — and a guitar and keyboard packed in soft gig bags. Sometimes it means bringing along my Mac laptop to record a song a client and I created together. Sometimes it means including a few art supplies for processing the musical experience. And sometimes it means sitting and breathing together in silence until one of us begins an improvisation, with a tap on the drum or a strum on the guitar or a single sung note. Sometimes there is a theme finding musical expression; sometimes it is simply free.
Music therapy happens on a one-to-one basis and in groups – again depending on the needs of the client. The same person may benefit from both individual and group sessions to address defined goals. A group music therapy session – for instance one in a nursing home setting — is a sure way to provide socialization and improve energy and mood among residents and staff, who will often participate on the side along with the residents they care for.
In my work with individuals in my studio, there are a number of instruments to choose from, including a baby grand piano and a midi keyboard. Vocal music therapy will find me at the piano with the client standing close by. The voice is an amazing muscle – full of emotional and physical energy that often longs to be expressed. Merita Gunter, one of my early voice teachers at the Roy Hart Theatre, described the voice as the “mirror and muscle of the soul.” Many people have a real disregard for their voices that can also signal unresolved issues and wounds. Working therapeutically with the voice, we bring breath, body and imagination together to rescue essential energy and facilitate profound healing.
Science Meets Art – How and Why Music Therapy Works
We all know from experience that music can be a healing balm for the soul. “Music hath charms to soothe a savage breast, to soften rocks, or bend a knotted oak.” (William Congreve, 1697.) It can relieve our anxiety, change or deepen an emotional state, energize or relax us physically, and guide us spiritually.
The expanding field of neuroscience tells us that music is processed along multiple neural pathways and, accordingly, is able to bypass a dysfunctional part of the brain and be processed in another. This explains the frequent phenomena of a patient who has lost verbal ability — both on the physiological and cognitive levels – and yet can sing lyrics to songs from his younger days with clear vocal quality, enhanced expression and renewed confidence. Or the stroke patient whose progress in relearning how to walk is quickened with rhythm based music therapy. Or the patient with Parkinson’s disease whose emotional and kinetic memory are stimulated by melody and rhythm. Amazing yes, and very predictable thanks to the neuroplasticity of the brain.
The distinguished neurologist, Oliver Sacks, author of the recent bestseller, Musicophillia and numerous other books, has been an advocate of music therapy for many years. In his work with aging patients with dementia he observes:
“For it is the inner life of music that can still make contact with their inner lives, with them; that can awaken the hidden, seemingly extinguished soul; and evoke a wholly personal response of memory, associations, feelings, images, a return of thought and sensibility, an answering identity. Familiar music acts as a sort of Proustian mnemonic, eliciting emotions and associations that had been long forgotten, giving the patient access once again to moods and memories, thoughts, and worlds that seemingly had been completely lost. One sees that there is not so much an actual loss of memories here, but a loss of access to these. Music, here, can provide a key for opening the door to the past, a door not only to specific moods and memories but also to the entire thought structure and personality of the past.”
– Oliver Sacks, in “Clinical Applications of Music in Neurologic Rehabilitation.”
It appears that Beethoven captured the essence of music as a healing modality when he described music as “the mediator between the life of the spirit and the life of the senses.” Music therapy is certainly anchored in this belief and in the ever-growing evidence that our health is dependent on the state of our mind and body. According to Suzanne Hanser and others, “to treat them separately is to treat less than the whole person.”
In my work as a music therapist, I witness the power of music therapy to connect the patient to him or herself and to relieve the isolation and confusion of a disordered world. I witness the presence of music bring physical and emotional comfort, decrease agitation, promote relaxation, and provide sensory stimulation. I witness music facilitate socialization, stimulate cognitive activity, encourage emotional expression and allow for a spiritual connection. In a wellness context, I witness the strengthening and integration of the self. Indeed, my role as a music therapist is a kind of ministry that invites the coming together of the physical and spiritual aspects of being human.
– Inner Tapestry, April-May 2012