Midterm Flashcards
What is Music Therapy?
1960 - National Association for Music Therapy (NAMT) defined music therapy as the “scientific application of the art of music to accomplish therapeutic aims. It is the use of music and the therapist’s self to influence changes in behavior”
American definition of music therapy was based on changing behavior
Current Day – American Music Therapy Association (AMTA) defines music therapy with these additions:
Music therapy involves the clinical and evidence-based use of music interventions to accomplish individualized goals
Research in music therapy indicates its effectiveness in overall physical rehabilitation and facilitating movement, increasing people’s motivation to become engaged in their treatment and providing emotional support for clients and their families.
Music Is
Music is a universal phenomenon
People of all ages and backgrounds can listen, perform, create, and enjoy it
Music is a flexible therapeutic medium
Many different styles
Variety of ways to get involved (composing, performing, listening etc.)
Music therapists use music and musical activities to facilitate therapeutic/health care goals
Therapy refers to assisting or helping a person
Musical improvising
Creating something with your voice/an instrument that has never been created before
Benefit: this can never be done incorrectly
MTAs facilitate improvising
Build confidence
Piano example: “you play only the black keys and I’ll play the white keys”
Why is Music Therapy effective?
Universality Flexibility Brain activation The ONLY thing that can activate all the areas of the brain Recognition Emotion Speech Cognition Memory
Music as a tool
Use within music therapy in order to achieve a variety of healthcare goals
Music has been found to alter mood/elicit relaxation responses
Can distract from physical pain
Evokes memories
Dementia – memories can be accessed through music even in individuals who struggle with accessing memories
Culture of music
Music therapy means different things to different people, shaped by cultural backgrounds, philosophy, values, training, clinical setting etc. - MTAs can refer to other MTAs that can better relate to certain cultures and backgrounds, this can be beneficial to the client (must recognize if this would beneficial based on cultural needs)
Music Therapy is NOT:
Special music education
Exclusively for people with musical backgrounds
Music lessons
Entertainment
Entertainers are not MTAs
While there is therapeutic value, the entertainer is not forming a relationship w/ the client and/or actively engaging the client in the music
The purpose is not for healthcare goals even if there is therapeutic value
Canadian Association of Music Therapists (CAMT)
CAMT is a federally-incorporated, self-regulated non-profit professional organization
It aims to create strong certified MTAs (Music Therapists) and to raise awareness surrounding professional music therapy services throughout Canada
Canadian definition: the use of music by an accredited music therapist to achieve health care goals
CAMT wants to encourage the practice of music therapy in clinical, educational, and community settings.
Boston Children’s Hospital
Allowing children to gain control over something again
Loud/quiet sounds
Choice of instrument
Singing
Empowering
Building confidence
Also to impact the family/parents
Watching their child engage in something they enjoy again
Encouraging healthy development (music is part of natural development) (rehabilitation)
Process to receive music therapy:
- Referral
You DO NOT refer someone to MT because they have autism/cancer/ABI/dementia, these are diagnoses.
Clients are referred for specific healthcare goals (social skills, speech, communication, self-expression, gross motor skills/fine motor skills) - Assessment
purpose: to tell you what the clients goals and objectives are, to inform the treatment plan - Goals
Based on observations/assessments - Treatment plan (interventions)
- Reports & re-assessments
Framework of Music therapy session:
Hello Song
Interventions
Closing Song
Interventions
Pre Composed Music Singing Listening Instrument Playing Improvising Composing Lyric Analysis
Pre-composed music
can help with people with AD- may still have remember music from their past (able to remember lyrics)
sense of familiarity and safety
therapist must comprehend their knowledge of the client’s pre-composed music
Singing
Improves articulation, rhythm, and breath control
Improves intake of oxygen
Encourages reminiscence and discussions of the past, while reducing anxiety
Brain injuries such as ABI/aphasia - people can still sing even if they can’t speak
Once the brain is primed through singing, the patients are also able to answer questions – short term increase in speech fluency
Rehabilitation
Listening
Cognitive skills, attention span, memory
Opportunity for insight with client recordings
Instrument playing
Facilitates and improves range of motion, joint mobility/agility/strength, balance, coordination, gait consistency and relaxation
Rhythm and beat are important in priming the motor areas of the brain, in regulating breathing and heart rate, and maintaining motivation or activity level
Motor areas of the brain
Strong beats and catchy rhythms have been found to facilitate the initiation of movement with Parkinson’s patients
Improvising
Offers a creative, nonverbal means of expressing thoughts and feelings
Non-judgmental, easy to approach, and requires no previous musical training
Improvising can lead to expression of emotion – ex. “I don’t know how I’m feeling today…” After playing music, the client may be able to better articulate their feelings based on how they felt while playing the music or what they chose to play
Where words fail to communicate emotions, music can feel that void
Provides a safe opportunity to interact with feelings associated with trauma
Musical expression from client followed by musical response by MTA – I heard you, I’m here, I’m listening
Composing
For people with terminal illness, it is a vehicle of examining feelings surrounding feelings towards life/death and the meaning of life and death
Provides an opportunity to create a legacy/shared experience to caregiver/child/loved one prior to death
Familiar melody – you are my sunshine example
Lyric analysis
Lyric discussion can facilitate discussion surrounding trauma/abuse
With whom does a music therapist work?
In Canada, the majority of MTAs are working within long-term care with the elderly population, as the largest client-base is within the elderly population group + funding is available within long-term care facilities
Children with autism – funding is accessed for children with disabilities through passport funding
Children and elderly people have others advocating for them (their parents or their adult children)
Schools/school groups
Prisons
Mental health programs
Rehabilitation
Private practice
What are the personal qualifications of a music therapist?
Musician
Excellent functional musical skills
Broad knowledge of different musical styles
Uses music flexibly, creatively and in an aesthetically satisfying manner
Piano requirement for programs
Usually guitar as well
Therapist
Good physical and emotional stability
Sincere interest in helping others
Patience, tact and understanding
Reliable, genuine, ethical
Clinical objectivity
Learning to be a musician but ALSO a therapist, using music in a therapeutic way
As a pianist, you may excel at classical music but an MTA requires musical flexibility to be therapeutic
Educational preparation of a music therapist
University
1000-hour supervised internship
Certified board of music therapists (CBMT) exam
MTA certification
Continuing education – MTA must maintain their credential every 5 years through CAMT continuing education process
Piaget’s Developmental stages:
Sensorimotor (0-2)
Preoperational (2-7)
Concrete operational (7-11)
Formal operational (11+)
Sensorimotor (0-2)
Learning about their immediate environment through senses and motor activity
Although hearing is still developing, newborns are active listeners and can identify sound source
Newborns and infants are attracted it infant-directed speech, their mother’s voice and songs that contain characteristics of ID-speech
Following beat is innate to humans
Preoperational (2-7)
Rapid language and conceptual growth
Increased vocalization
The child (ages 2-3) may be able to improvise short, melodic patterns (old McDonald – E-I-E-I-O)
2-4 years – the child may show brief moments of brief synchrony to rhythmic music – but being able to maintain steady beat (beat competency) would require greater physical maturation
Rehab/ABI/Post-stroke
3-4: walking, galloping, jumping in musical games
4-5: the child does more accurate imitation of pitch patterns with greater vocal control
4-6: before this, parallel play is primary; at this bracket, children are more willing to share and cooperate
Concrete operational (7-11)
Think systematically and mentally solve problems related to immediate reality
Playing rules for music therapy improv (ex. Play only the black keys)
Music is used to foster social interactions, group interaction and motor functioning
Formal operational (11+)
Children develop abstract thinking skills
Religion, politics, fantasy, gaming
Metacognition (awareness of one’s own thought process)
*How can I make an impact on change? What is within my control, what is not?
The Musical Adolescent
Music is normal/natural – teens may participate in formal music organizations (band/choir) and informal (rock bands) or watch music videos and listen to recordings
Music is an outlet for feelings of rebellion and confusion that come with adolescence. As such, music therapy is a powerful therapeutic intervention for individuals of this age bracket
Musical Diversity
Style and cultural heritage
With such diversity, people can identify with at least one style
Music is a universal phenomenon, music itself can be found across the globe
BUT, music is NOT a universal language, as the same type of music does not communicate the same way across the globe
MTAs take into account which instrument to use – ex. Playing the same song, “You are my sunshine” is different on a piano vs. Guitar vs. Clarinet vs. Flute
Personal preferences of client
Benefits/health-care goals that can be achieved
Functions of Music
Auditory and tactile simulation of music can be helpful in evoking initial or more adaptive responses from nonresponsive individuals at a verbal level
Music serves as an effective mnemonic device
Communication
Emotions
Culture and society
congruity
is a phenomenon wherein a particular music selection or style is paired with a specific event. E.g. tearing up after hearing a song on the radio that was played at a funeral of a loved one
Isomorphism
refers to the use of music to convey human emotions and movements
Music in preliterate cultures
Members believe that music affects mental and physical well-being
“medicine men” used music in religious/healing rites to appease the gods
Healing choruses (a group effort)
Early Civilizations
The advent of agriculture 8,000-10,000 years ago led to civilization
Music played an important role
Ancient Egypt (c. 5000 BC):
Magical, religious and rational components of medicine coexisted
Priest-physicians often included chant therapies in their medical practice because they believed that music was the medicine for the soul
Hieroglyphics depict playing instruments
Music was considered emotional catharsis
Four cardinal humors
- Blood
- Phlegm
- Yellow bile
- Black bile
These four cardinal humors influenced medicine for the next 2,000 years and was particularly important in the middle ages
Middle Ages and Renaissance
Still based on four humors
Hymns were considered effective against certain unspecified respiratory diseases
During the renaissance, physicians prescribed music as a preventative medicine
Reactive healthcare VERSUS proactive healthcare
Baroque Period: Kircher suggested that certain personality characteristics were associated with certain styles of music
e.g. depressed people responded better to melancholy music
Today, MTAs recognize the preferences of the individual rather than prescribing music – there is no musical prescription!
The healer now had to consider which style of music to use for treatment
By the late 18th century, emphasis was placed on scientific explanations
At this time, music was relegated to special cases and only applied by physicians who views treatment with a holistic framework
History/Development of MT
The earliest reference to Music Therapy as a profession in the US was in 1789
As early as the 1830s, MT was used in schools for the blind
Early 20th Century Music Therapy
Hospital stays were longer (average of 13 days in 1923 to about 4 days today) and patients with intellectual or mental disabilities could be hospitalized for life
Cases for MT were presented in academic papers
1950
MT became regulated in the US (AMTA today)
Today (in Canada), the majority of MTAs work with the elderly/people with Alzheimer’s but the foundation of MT started with working with children and mentally ill individuals CRPO - College of Registered Psychotherapists of Ontario
Music Therapists using the act of psychotherapy need to become a member of the CRPO (ONLY if using the act of psychotherapy)
Music therapy involves
Developing identity
Self-expression
Qualities of music: Using rhythm, pitch, and form to support all individuals
Accessibility and inclusivity; support all individuals
Improvised music
Core of therapy - the therapeutic relationship
Individual relationship with music
Therapeutic relationship between client and MTA
MT Enhances
Communication skills Confidence Self-awareness Cognition Memory
Neuroscience model of MT
NMT uses the functional perception of all properties of music to retain brain behaviour function
Therapeutic application of music to cognitive, sensory, and motor functions
Psychodynamic
Involves: Sensorimotor, speech and language, cognition
Music and functional changes in the brain
NMT can be effective for:
Stroke TBI Parkinson's disease Minimizing symptoms including tremors Multiple sclerosis Looking at the autoimmune disease and working to minimize symptoms Dementia and Alzheimer's disease Functional memory Cognition Emotional state Daily activities (eating, dressing, medicating) Cerebral palsy Autism spectrum disorder Social communication Behavioural management Repetitive behaviour
Sensorimotor Skills
Patterned sensory enhancement - ex. Jenn pacing arm music to the music
Movement to the cue of music
Spatial
Pitch
Dynamic
Therapeutic instrumental music performance - ex. pacing hitting the drum to music
Client is actually playing an instrument to the music/beat
Rhythmic auditory stimulation - gait training video example
Rhythmic cues for gait training (walking)
Melodic intonation therapy
Beating to and humming the prosody of speech/phrase - I want coffee example
Used commonly by SLPs - Vocal intonation therapy
Speech and Language
Musical speech stimulation
Rhythmic speech cueing
Oral motor and respiratory exercises
Vocal intonation therapy
Therapeutic singing
Singing songs you enjoy while combining the techniques of accessing language and oral motor function
Tying together all the vocal
Developmental speech and language training through music
Symbolic communication training through music
Cognition
Auditory perception
Emotion
Sensory function
Music in Psychosocial Training and Counseling
Using social situations and group therapy
Group cohesion process
Using MPC as a warm-up to group therapy
Mood factoring
Drum example (musical wave)
More reflective than Associative Mood and Memory training
Associative Mood and Memory training
Facilitate memory recall
Dementia and TBI memory loss
Associating mood with music to access memory
Live or recorded music
Henry example - excited about music, lighting up to his favourite songs and singing/remembering his old favourites
The goal here is to access the memory not the emotion
3 domains
Sensorimotor Pattern sensory enhancement Rhythmic auditory situation Speech and language Melodic intonation therapy Therapeutic singing Cognition/dalcros Associated mood and memory training Music and psychological training and counseling
Method
Certain organized and systematic way for conducting therapy
Philosophy
Beliefs and basic attitudes
Theory
Scientific explanation for behaviours
Model
Relationship between music and behaviour/healthcare goals
Trends that have influenced the development of Music Therapy Approaches
Advances in scientific knowledge regarding health and illness
Biopsychosocial model of health and illness
Societal changes
Short-term health care
Multiculturalism
Research and clinical initiatives in the MT field
Continues to develop by researchers and clinicians
Factors that influence Clinical choices
Developmental Age vs Chronological
Personal Attitudes and Values
Orff-Schulwerk - elemental music
Holistic approach Hearing before learning Call and response Chants "hello" song, eye contact
Dalcroze Eurhythmics
Using movement to enhance range of motion, motor skills etc.
Kodaly Approach
Developmental in approach
Communication, socialization, fine and gross motor
Nordoff-Robbins
Form of active music therapy
Music-centered
Conceptually and by definition using music as the primary method of therapy
The work is done within the music, no dialogue/verbal discussion, all music
Belief: music exists within everybody
Accessing Innate music ability
Finding the music child within
Two MTAs in the room, 1 on the piano continuously holding the musical space, the second works with the client to engage in music on another instrument or vocally
Music making, playing instruments, singing etc.
Techniques applicable to wide range of clients including those with developmental disabilities
Cont.
Self-actualization and the meaningfulness of human destiny
Within every human being is a musical self aka “musical child”, working to access that
Long-term engagement in music therapy
Improvisation is used often at the beginning
Index the session/indexing: document in a narrative style with attention to the client’s significant musical and non-musical responses, changes, musical relationships and teamwork (transcribing/recording minutes/seconds) documenting sessions
Apply separately to a Nordoff-Robbins MT degree, cannot become accredited additionally like NMT
Bonny Method of Guided Imagery and Music
Can gain accreditation following MT accreditation/other field in addition
Guided imagery and music (GIM)
Bringing self-awareness by associating music with imagery
Therapeutic goals include:
Creativity
Self-exploration
Spiritual insight
Cognitive reorganization
Tapping in to the unconscious through imagery
Aiding in uncovering and working through negative thoughts, emotions and feelings
MTA is not meant to solve, but to help guide the client through the emotions/feelings
Behavioural approach
Classical or operant conditioning
Example: Pavlov’s conditioning with the dogs and the bells
Behaviorism
Behavioral psychology
Applied behavioural analysis (ABA)
Purpose: to modify behaviors (through reinforcements or punishment)
MT example: client who hits his head on the ground, guiding him to redirect and hit a drum with his hands instead - more cathartic and safe for him
Reinforcing positive behaviour by offering the reward of drumming/cathartic experience
Cognitive-Behavioural Music Therapy
Replacing undesirable, irrational thinking with healthier cognitive patterns
Can help people with emotional/social problems including anxiety, substance abuse, eating disorders, mood disorders, chronic pain and sleeping disorders
Example: I’m afraid of water
Reframing water to associate with life, with drinking water (necessity)
Psychodynamic approach
Based on the belief that human behaviour is influenced by unconscious psychological processes (internal conflicts, impulses, desires, motives) which are largely unaware consciously
Reflection of Biomedical models
How music impacts the release of hormones and neurotransmitters surrounding pain/feeling pain
Using MT to relax and reduce stress, reducing pain hormones and neurotransmitters
Music therapy and relationship with hormones
Eclectic or Integrative Approach
Therapists use techniques from all types of therapy without necessarily accepting the theoretical frameworks involved
NO SINGLE THEORY is comprehensive enough to account for the complexities of human behaviours
Accepting that each theory has its strength and weaknesses, therapists that use an integrative approach have the opportunity to more closely match the needs and goals of individual clients
Biopsychosocial Mode
Biological aspects (physical) Psychological aspects (cognitive, emotions) Social aspects (values, culture, family, community) How all three work together and interact to impact your health
Transference
Unconscious redirection of feelings from one person to another
Countertransference
Initially something to get rid of
The emotional reaction of the therapist
Primacy of Countertransference
“wounded healers” - extremely empathetic/sensitive therapists who can fall victim to countertransference
Therapist’s hook
The area of wounded-ness that allows the therapist to get caught in the client’s material
Musical hook
The moment when the music and or lyrics intersect with the therapist’s issues and trigger associations
Sharing countertransference - relates to disclosing countertransference feelings
Level of disclosure depends on each individual client
Reason for disclosure, therapeutic alliance, length and stage of treatment In VP, the transference can be heard in the voices (with or without)
Psychological theories behind Vocal Psychotherapy:
Carl Yung's theories influence Collective unconscious Interpersonal relations Object relations theory Relationship with play and developing one's true self Vocal improvisation Vocal holding Vocal improvisation in a safe environment can help clients find comfort in the environment Trauma theory Intersubjectivity
Trauma theory
Three stages of healing
Safety
Remember, reminisce, mourn
Integration
Attachment trauma - the mother infant bond (or lack of) can set the stage for other forms of trauma
VP offers therapeutic regression and positive integration
Natural sounds
Humming/toning/chanting can stimulate the Vagus nerve which encourages the release of neurotransmitter Nitric Oxide (NO)
Parasympathetic nervous system can be thought of as the “stress eraser” - putting us back in a state of balance
The power of the voice to affect physiology
Toning
The conscious use of sustained vowel sounds for the purpose of restoring the body’s balance
Vocal Holding
The intentional use of two chords in combination with the therapist’s voice in order to create a consistent and stable musical environment that facilitates improvised singing within the client-therapist relationship
Promote therapeutic regression
Helps clients who are afraid or not used to improvising
Relinquish some of the mind’s control to allow spontaneous singing and trance-like altered state and easier access to the world of the unconscious
Vocal holding interventions
Unison singing
Therapist matches the client’s improvised notes
Harmony
Singing with client at the same rhythm but different notes (hopefully complimentary)
Harmony is ideally below the client’s singing in order to contain/support
Mirroring
Mirroring what the client just improvised
Grounding
The therapist sings a note below what the client is singing
These techniques can all be experienced differently for the client based on their experiences
Not necessarily feelings that we should avoid as they provide insight for reparative experience
Free Associative Singing
Words enter the vocal holding process
Piano accompaniment (2 chords or more)
Based on Freud’s technique of free association
But the MTA is also singing
Lyric creation
Guiding free brainstorming (example) Freud and Jung Freud : picking a word and seeing what word comes after and after, may not have any connection Jung : specific word, relate it to another and then to the original and then another Guiding original lyrics and music Facilitating original lyrics Selecting words from a list Client self generates words Client writes a poem Open ended or direct questions
Song writing techniques
FBT (fill in the blanks) Song parody Changing all the words rather than just certain ones like FBT Song collage Mashup of songs and changing lyrics Pre-existing lyrics Keeping lyrics of a song but changing melody Once upon a time… Age appropriate for children Storytelling/predictability
Techniques of music creation:
Improvisation Instrumental sound effects Using whole/parts pre-composed music Improvised melody over the chord pattern Client directed key/mood/etc.
Song writing with TBI:
Motivation Adjustment - identity establishment Loss/depression Coping with changes Memory - melody Concentration/attention
Themes of song writing within TBI MTA:
Isolation Dependency Helplessness Anger Body image Positive memories of relationships with significant others Uncertainty
No definitive answer about aging
There are stages of child development, broad but existent
There are not designated stages to aging
Stages for adolescence, lines of stages blur as older adulthood is approached
Different types of ages:
Chronological age (number of years one has been alive) Biological age (aging of the body physically) Bone density, muscle strength Change in weight Stamina (loss of..) Cellular, molecular, organ functions become less efficient with age Psychological age Ability to adapt New situations, environment Emotions Learning Recognizing that client may require consistent sessions, predictability, routine etc. Psychosocial age Cultural view and expectations Negative portrayal (western culture) High regard/wisdom (non-western) Booming cosmetic industry
Common Diagnosis:
Depression Dementia Alzheimer's disease (type of dementia) Parkinson's disease Post-stroke Aphasia ABI Symptoms can be similar --> MTA healthcare goals can be similar Speech Orienting to environment
Reasons for referral:
Decrease pacing, agitation, vocalizations (non-speech/non-communicative noise)
Increase eye contact, meaningful moments
Increase alertness, movement
Evoke positive memories, orientation to the “here and now”
Transition to facility, lessen confusion, decrease anxiety
Having dementia? No, that is a diagnosis, not a healthcare goal
Music is validating
Sense of accomplishment for elderly people with memory loss
Remembering lyrics
Remembering melody
Pre-composed music
Why pre-composed? Familiarity/predictability (ABA) Verse/chorus/verse/chorus/verse/chorus etc. The way pre-composed songs are designed - predictability, security Security Empowering Reassurance Confidence (acknowledge ability) Memory evoking Stimulate dialogue/relationships Why is it a powerful tool? (listening exercise) Music timeline
Dementia and Pre-composed music
Acquired decline of cognitive function Memory and language impairment Music abilities preserved - uses both hemispheres of the brain Alzheimer's Mini mental state exam and music therapy MMSE asking questions through song? Listening to story vs. music Attempting music playing can highlight deterioration
