2. Music Therapy
OUTLINE
Mediation with Music
 Introduction
 History of Music Therapy
 What IS Music Therapy?
 The Brain and Music Therapy
 NMT: Neurologic Music Therapy
 Children, Adolescents and Music Therapy
 Autism and Music Therapy
 Depression and Music Therapy
 Palliative Care and Music Therapy


3. History
Music Therapy
Ancient history
 1849 Report of the Commissioners, Beauport
Asylum, Quebec (music and dance)
 World War II (1945)

 Musicians went to Veterans hospitals
 Patients‟ physical and emotional responses
Columbia University offered the first music therapy
course
 1941 a National Foundation for Music Therapy was
established in the USA


4. History
Music Therapy
New training courses at Michigan State Uni. in
1944
 Kansas University in 1946
 National Association of Music Therapy (US)
 Related activities in UK

 E.G. Sydney Mitchell‟s orchestra of patients
 Role of recorded music on patients
 Live music in research on alcoholic and neurotic patients
 1950s the society for Music Therapy and Remedial
Music, later replaced by the British Association for Music
Therapy in 2011

5. History
Music Therapy
Difficult for MT to become recognized as an effective
treatment
 More than using as a recreational activity
 The National Association for Music Therapy (NAMT)
was founded in 1950
 Programs (1950s)

 Winter Veterans Administration Hospital in Kansas
 Other programs for children with disabilities; mental illness

Different organizations merged in 1998 and the result
was American Music Therapy Association (AMTA)

6. History

Music Therapy
In England: British Society of Music Therapy, founded in
1958 as the Society for Music Therapy and Remedial
Music, collaborated with the GSM to develop a one-year
post-graduate program
In Canada Alfred Rosé: first pilot projects (1952-61) at
Westminster Hospital in London, Ont
 1950s three prominent music therapists established
programs

 Norma Sharpe (St Thomas Psychiatric Hospital)
 Fran Herman (Bloorview Hospital)
 Thérèse Pageau (Hôpital Louis-Hippolyte Lafontaine)

7. History
Music Therapy
1974 Conference at St Thomas Psychiatric Hospital
Canadian Music Therapy Association
1974 Sharpe and Burnett published Canadian Music
Therapy Bulletin
 the CAMT Newsletter: the first official publication
 1979 the first 17 music therapists accredited by CAMT
 1991 the number of Music Therapists Accredited
(MTA) by the CAMT was 78


8. History
Music Therapy
Until the mid 70s most accredited music therapists
were training in England or USA.
 1976 - 1st MT training program in Canada founded at
Capilano College, North Vancouver

 Nancy McMaster & Carolyn Kenny
 two-year diploma program
 1990 - Changed in to a 3 year undergraduate
Graduates undergo supervised clinical internship of
1000 hours
 MTA


9. Music Therapy
Wilfrid Laurier University Curriculum

10. Music Therapy
Music therapy training in Canada
Wilfrid Laurier University - Ontario
 University of Windsor - Ontario
 Acadia University - Nova Scotia
 Capilano University - British Columbia
 Canadian Mennonite University - Manitoba
 Concordia University – Québec


11. Music Therapy
What Is Music Therapy

“music therapy is a systematic process of
intervention wherein the therapist helps the
client to achieve health, using musical
experiences and the relationships that
develop through them as dynamic forces of
change” (Bruscia 1995).

12. Music Therapy
What Is Music Therapy
Not about teaching/developing musical
skills
 Concept of change
 Social and Humanistic psychological roots
 Areas of change:
-communication, cognition, physical, social,
emotional, and neurological functioning
 All ages, groups, individual


13. Music Therapy
What is Music Therapy
 Diverse
settings:
specialized hospitals/treatment centers, preschools, schools, hospitals, residential homes,
centers for visual/hearing impairments,
hospices, probations/prison services, private
practice

14. What is Music Therapy

Music Therapy
WFMT (World federation of music therapy)
definition
 Use of music and musical elements by a qualified music
therapist with a client or group, in a process designed to
facilitate and promote communication, expression etc.
and other therapeutic objectives in order to meet physical,
emotional, mental, social and cognitive needs.
 MT aims to develop potentials or restore functions

Two applications of music therapy
 music for its inherent healing qualities
 mean for self expression, interaction within a therapeutic
relationship.

15. What is Music Therapy

Music Therapy
Use of music for its inherent healing qualities
 Focus on the physical properties of music as healing.
Client-therapist relationship is secondary
 E.G. Vibroacoustic therapy or Music Bath
 Use of recorded music as therapy supplementary to the
cure of physical illness
○ Surgery rooms
○ Clients on kidney dialysis
○ Cancer
○ premature or sick infants

16. What is Music Therapy
 Using
Music Therapy
music as a means for self expression,
interaction within a therapeutic relationship
 Community music therapy
 Guided imagery and Music (GIM)
 Improvisational Music Therapy

17. What is Music Therapy
Another definition
Music Therapy
“Music therapy is the use of sound and
music within an evolving relationship
between client and therapist to support and
encourage physical, mental and emotional
well-being”

18. Music Therapy
Role of the Therapist
Changes depending on the type of music
therapy used and needs of client
 Therapist is using music to bring about
change in client‟s behaviour or emotional
state
 Therapist must be open, and willing to listen
 Encourage client


19. Intervention Techniques
 Singing
 Playing
 Rhythmic
 Improvising
 Composing
 Imagery
 Listening
/ Songwriting
Music Therapy

20. Music Therapy
Goals of Music Therapy
Music as a means to an end
 Maintain and develop physical skills,
cognitive potential, motivation, speech,
language, non-verbal expression, social
skills
 Bring about individual changes in mood,
releasing tension, expression of feelings,
social interaction, development of selfesteem


21. Music Therapy
Clips – sex drug rock

Levitin 1st clip

22. The power of music
Music Therapy
 Is
there a biological basis for the experiences
that people talk about?
 heart rate increases, breathing deepens their muscle
tension increases
 Human body fall into synchronism with a rhythmic
phenomenon
 What about hormones
○ adrenaline, cortisol, and ACTH
○ Study: surgery, cortisol level and music‟s impact

23. The power of music
Music Therapy
 Sex,
drugs and rock and roll right there in the
brain?
 Listening to music releases neurochemicals such
as
 Prolactin
 Oxytocin
 Dopamine
 But
why are music and sex and drug act so
similar?
 Study by Robert Zattore

24. The power of music
Music Therapy
 Specific
parts of the brain are involved in
perceiving different musical elements.
 Pitch, harmony, melody, loudness, rhythm
 E.G. specific neurons in the auditory cortex are tuned
to perceive specific pitches

Some of the areas involved: auditory cortex, motor
cortex prefrontal cortex, sensory cortex, the visual
cortex, nucleus accumbens and amygdala,
hippocampus and so on.

25. Music Therapy
 Hearing
music
 auditory cortex
○ Core: pitch and volume
○ Surrounding: timbre, melody and rhythm
 Imagining
music
 Auditory cortex to a lesser magnitude
 Inferior frontal gyrus (retrieving memories)
 Dorsolateral frontal cortex (working memory)

26. Music Therapy
 Playing
music
 auditory cortex (feedback system)
 visual cortex (reading a score)
 parietal lobe ( e.g. computation of finger position)
 motor cortex
 sensory cortex
 frontal lobe
 cerebellum

27. Music Therapy
 Emotional
reaction to music
 Reward structures such as ventral tegmental area (when
you get chills!)
 Same areas that get activated while:
○ Eating
○ Sex
○ Using drugs
 Pleasing song  Inhibition of amygdala

28. Music Therapy
Oliver Sacks

Clip 2 – How brain reacts to music
?

29. Music Therapy
Neurologic Music Therapy
Center for Biomedical Research in Music at
Colorado State University
 Brain imaging, brain wave analysis, kinematic
motion analysis, technological shift early 90s
 Finding: central nervous system involved in
creating, perceiving, understanding, producing
 Improvement in 3 areas: sensorimotor
functioning, speech and language functioning,
cognitive functioning


30. Music Therapy
Rhythmic Auditory Stimulation (RAS)
for sensorimotor functioning
Who uses RAS?
 Stroke patients, Parkinson‟s patients showed
improvements
 Spinal cord injured patients, traumatic brain
injured patients


31. Music Therapy
Rhythmic Auditory Stimulation (RAS)
for sensorimotor functioning
Applies auditory sounds to movement
(walking, stepping) 2/2, 2/4
 Therapist gradually increases to form a
pattern
 Rhythmic entrainment, priming of auditorymotor pathway, cueing of movement
 Rhythm has physiological function to
stimulate movement


32. Music Therapy
(RAS)
Auditory system detects patterns
 No large effort required
 Stimuli activates motor neurons via
reticulospinal pathways – “priming of the
auditory-motor pathway”
 Rhythm offers cues for movement: when to
place foot down, creating a pattern
 Limit cycle: optimal movement frequency


33. Music Therapy
Vocal Intonation Therapy (VIT) or
Melodic Intonation Therapy (MIT)
Structured singing and voice exercises:
pitch, timber, breath control, volume,
phonation, resonance, intonation
 Technique: relaxing head, neck, upper body,
warming up the diaphragm breath using
scales and singing
 Therapist may resemble a voice coach, yet
they customize the therapy to patients‟
needs: Speech therapist or Music Therapists


34. Music Therapy
(VIT)(MIT)
Helps for: pitch disorder, hoarseness, respiratory
control, trouble with phonation, emphysema,
dysarthria (communication disorder – Parkinson's
patients develop dysarthria), aphasia
 Technique: posture/breath exercises, vocal
warming up, echo singing
 Improvements: speech intelligibility, voice
control, vocal intensity


35. Music Therapy
(VIT)(MIT)
Works closely with language therapy
 many different levels and techniques music
 Therapist modifies to meet clients‟ needs


36. Music Therapy
MT Neurological disorders
 Melodic
Intonation Therapy
 Aphasia
 “Rhythm
in disguise: why singing may
not hold the key to recovery from
aphasia”

37. Music Therapy
Musical Neglect Training (MNT)
or Patterned Sensory Enhancement
(PSE)
Patients play musical instruments in spatial
configuration (left-right, right-left)
 Temporal, spatial cues
 focus attention on area of brain that is
damaged, visual neglect due to injury, stroke
(hemispheric lesions)
 How: music can activate neurons!


38. Music Therapy
Goals of NMT

CASE STUDY: “Mrs. S”
MT helps the individual as a “whole”
 Being in MT helps: verbal/non-verbal
communication, social-interaction, motor
functioning, cognitive functioning, helps
psychological and emotional adjustment to
disability
 Environment becomes more relaxed; music has
emotional and physiological effects


39. Music Therapy
…Goals
COMMUNICATION!
 Patients may not have language – MT can
help to asses and help provide info
 MT a medium for interaction
 Music abilities may be preserved when
language is not (TBI)
 MT can asses: (non verbal) imitation,
development, turn-taking, eye contact, nonverbal gestures


40. Music Therapy
…Goals

Help patients foster a rewarding and
enjoyable environment
COGNITION!
 Playing instruments and singing – initiation,
attention, concentration, short/long-term
memory, motor planning, sequencing,
switching between tasks, behavioural
control motivation, fluency in thinking


41. Music Therapy
…Goals
MT a vehicle for brain responses – pulse,
rhythm, tempo, melody, phrasing, melodic
contour, harmonic direction
 Therapists can use music and customize
activities to what patients‟ cognitive
disabilities are


42. Music Therapy
…Goals
PHYSICAL FUNCTIONING!
 Being part of MT requires patients to be
physically active – playing an instrument
 Uni/bilateral hand grasps, arm extension,
trunk alignment, leg stretching
 Wind instrument: breath control and
coordination, face muscles, voice production
 Improves walking gait
 relaxation


43. Music Therapy
…Goals







EMOTIONAL FUNCTIONING!
TBI patients dealing with trauma, loss of
independence, fatigue, relationship change, anxiety
MT allows an outlet for emotions to be expressed
when verbal expression is unavailable
Shared musical interactions allow can help self
esteem, well being, confidence
Challenge their abilities through creative means
From grief to joy
Reduce anxiety

44. Music Therapy
…Goals
SOCIAL FUNCTIONING!
 Music for social gathering, celebrations
 Patients with TBI may benefit from
interaction with others
 Enhance relationships, relate to each other,
express together,
 Decreasing anger, agression


45. Music Therapy
Group Jam Session

46. Music Therapy
Children & Music therapy
Bonding and attachment in traumatized kids
Building a secure relationship; Music therapists have
resources for supporting this
 Early trauma affects right-hemisphere brain
development
 Parent-Infant MT: using musical and music-like
interactions for developing a relationship with a
caregiver/dyad

 E.G. vocal improvisation and lullabies to help mutual co-
regulation
 practised in groups

47. Music Therapy
Music Therapy for children (0-3)

The musical parent
 Infant has the capacity to recognize the emotional
intention of vocal timbres
 “infant-directed communication”
○ Not present in depressed mothers

Finding the pulse
 Exposure to crisis  children display distress
 Repeated negative experience builds mistrust; Music
therapy as an environment to explore positive and
creative connections
 Words may be experienced as threatening by some
adopted children

48. Music Therapy
Music Therapy for children (0-3)

The role of music therapy in supporting parent–
child bonding
 Parent–infant communication is intrinsically musical
 MT may „permit regression to early, infantile modes of
feeling, thinking and meaning‟
 Relearn how to engage in social exchanges

49. Music Therapy
Music Therapy for children (0-3)
The challenge of separation: Sam and May
Sam adopted by Richard and May, appeared wellbonded to adopted parents
 After 6 months, became very clingy with May
 Also stopped crying
 Attended MT for security and self-confidence
 In his first MT session Sam remained physically
attached to May
 Gradually began to explore some of the instruments


50. Music Therapy
Music Therapy for children (0-3)
The challenge of separation: Sam and May (Cont‟d)
 fascinated by drum; first significant separation
Little by little he waited longer before jumping
 Lack of toleration for May‟s absence
 Music indicated that something still „existed‟ rather
than Sam being left with the void created by silence
 Appearance of smile as her mom reappeared
reappearance from behind a drum


51. Music Therapy
Music Therapy for children (0-3)
The challenge of separation: Sam and May (Cont‟d)
Session 7 introduced the idea of mother being
absent from the music therapy room
 His little smile on being „found‟ began to
reassure the presence
 Sam became able to stay in the room for whole
sessions without May present; May always
joined us for the „Goodbye‟ song
 May described Sam as „chatty‟


52. Music Therapy
Clip: Children and music therapy

53. Music Therapy
Music Therapy and Children

“Emotional, motivational and interpersonal
responsiveness of children with autism”

54. MT and Emotional Behavioural
Disorders (EBD) children
Music Therapy
WHO? Physical, sexual verbal assault victims,
accident victims, death of family, loss of limbs,
spinal cord injuries, paralysis, trauma
 Children are limited in ways they can express
themselves and emotions; behaviour is affected,
pressure from parents, teachers peers
 Stress and anxiety can lead to withdrawal from
peers, low academic performance, enjoyment
levels decrease, risky behaviours, irritability,
depression, suicide
 “talk-therapy” can intimidate with figures of
authority; forced into by parents


55. Music Therapy
MT and EBD




Breakdown in MT assessment
Interviews with family about musical history
Assessment tools: Natural response choice,
Musical Preference, Musical responsiveness,
Verbal Associations, Non-verbal reactions and
Client/Therapist Interaction
Music used as tool to build trusting relationship
between therapist and child/adolescent
Case Studies…

56. Music Therapy
Clip: Dr. Levitin on emotions

57. Music Therapy
Music Therapy and Emotion

Depression

“The effectiveness of music listening in
reducing depressive symptoms”

“Effects of music therapy on depression
compared with psychotherapy”

58. Music Therapy
3 clips of music and emotional
responses
 Clip
1
 Clip 2
 Clip 3

59. Music Therapy
MT and Palliative Care






Palliative care has grown so has MT in
palliative centres
Therapists may use song writing, musical
improvisation
Oncology, HIV/Aids, multiple sclerosis, cystic
fibrosis, other degenerative diseases
In home MT or institutions
All members of hospital staff may refer patients
to MT
Adult family members may refer child

60. Music Therapy
..MT and Palliative Care




Patients may also self-refer themselves, includes
adults, adolescents and children
Depending on the diagnosis, the music therapist
creates and implements programs for longer term or
acute care
MT Palliative GOALS and OUTCOMES:
helps with coping, pain management, reduction of
anxiety, enhance relationships, provide selfexpression, feelings of support and validation,
improves self-worth and dignity, allows for
interaction in “non-patient” way, feelings of choice
and control, hospital environment becomes more
pleasurable, assist with grieving

61. Music Therapy
...MT and Palliative Care

Study done with Health professionals:
Art therapist, Chaplain, Clinical Nurse, Day-Care
Nurse, Medical Director, Occupational Therapist,
Physiotherapist, Social Workers
1) General Attitudes towards Music Therapy?
- Nurses: too intrusive? affect the wrong “spots?”
2) Perceived Scope of Music Therapy?
- emotional, physical, social, environmental,
spiritual

62. Music Therapy
…Study MT in Palliative Care
3) Holism and Music therapy
4) Integration of Music therapy and palliative
care

63. Music Therapy
Music therapy and dementia
Study: Music therapy-induced changes in behavioral
evaluations, and saliva chromogranin A and
immunoglobulin A concentrations in elderly patients
with senile dementia
 Aim: to clarify music therapy-induced changes in
behavioral evaluations, and saliva chromogranin A
and immunoglobulin A concentrations in elderly
patients with dementia.


64. Music Therapy
Music therapy and dementia
 Methods:
 8 patients with dementia
 25 1h sessions of MT twice weekly for 3 months
 Scales: Gottfries–Brane–Steen Scale (GBS) and
Behavioral Pathology in Alzheimer‟s Disease
Rating Scale
 Saliva chromogranin A and immunoglobulin A
measured

65. Music Therapy
Music therapy and dementia

Evaluation
 Mini-Mental State (MMSE)
 Gottfries–Brane–Steen Scale (GBS)
 Behavior Pathology in Alzheimer’s Disease Rating Scale
(BEHAVE-AD)
 Salivary chromogranin A
 Secretory immunoglobulin A

Results:
 Improvement on MMSE after 1 month showed significant
improvement (MT group)

66. Music Therapy
Music therapy and dementia

Results (Cond’d):
 In the MT group, significant improvement on a GBS
subscale (symptoms common in dementia); disappeared
after 1 month
 On the “paranoid/delusional ideation” subscale the MT
group significantly improved; more significant after 1
month
 “motor-function” = “inability to control bladder and
bowel” MT demonstrated significant improvement
 level of salivary CgA was significantly decreased after the
last therapy session; impact disappeared after 1 month

67. Music Therapy
Music therapy approaches

Analytically oriented music therapy (AOM)
 Mary Priestly
 roots in psychoanalysis
 Example a person might be frustrated by her intruding
mother
 Title for improvisation in order to access the unconscious
 Real case example: rape victim

68. Music Therapy
Music therapy approaches
 Nordoff-Robbins Music Therapy
 Philosophy: every human being has an innate






responsiveness to music
Power of music enables self expression and
communication
Requires a skilled musician as the therapist, trained to
improvise music
making is the primary focus of the sessions
The therapist provides a musical frame
Nordoff and Robbins‟s account of the therapy session
Also to work with adults in areas of neurology, psychiatry
and terminal illness

69. END?