Music Therapy
	What is Music Therapy? Music Therapy is the clinical use of music in the accomplishment of therapeutic goals with service users of any age (early intervention to older adults). Music Therapy may address cognitive, social, emotional and / or behavioural needs. Seeking to create or develop an alternative means of interaction is one of the primary functions in music therapy. It provides a new and different means of expression and communication. This ability, for a person to make contact and be understood, has a profound value in satisfying emotional needs, and in building relationships (Wigram in Watson, 2007, p14). The Music Therapist The Music Therapist is a trained and qualified specialist who understands the ways in which music has beneficial effects and is specialised in the use of techniques to achieve certain goals. The MA in Music Therapy at the Irish World Academy of Music and Dance, University of Limerick is the only Masters’ degree in Ireland leading to a professional qualification in Music Therapy. In 54 countries of the world music therapy training courses have been training music therapists, and there are an estimated 12,000 practicing therapists all over the world. What does a music therapist do? Music therapists: Assess individuals to establish their needs in consultation with members of the team working with an individual or group. Plan and implement appropriate therapy programmes to address theses needs. Document and evaluate programs to assess their ongoing effectiveness. After assessment the music therapist selects and applies a range of techniques in order to achieve the program goals. Some examples of techniques adopted by music therapists to address the client’s needs include: Empathic Improvisation : The use of musical improvisation with a specific therapeutic purpose in an environment facilitating response and interaction. A musical relationship is gradually built through shared repertoire and exchange of musical expressions. Song writing: The process whereby a client can communicate and explore inner thoughts, feelings or externalize issues. Songs may also be written as a type of life review. Singing:           To vocalize words or sounds in musical tones. Songs may be used for memory recall and reminiscence. Music facilitated discussion: The use of songs as a catalyst for discussion of issues that are therapeutically relevant to the client. This involves song listening, analyses of lyrics and their meaning, and to examine the relevance of the lyrics to the client or the clients’ life. Educational/instructional songs: Concept comprehension songs are sung. Concepts may include, up/down, left/right, loud/soft, stop/go, colours, numbers etc. The Music Therapy Process Specific music therapy goals are determined by the MT through initial music therapy assessment and ongoing review of the client. In the case of special education, music therapy goals can be an integral component of progress toward attainment of educational goals as identified by the clients’ Individual Educational Plan (IEP) team and parents. In the case of adults with additional needs, music therapy can support goals suggested by their Person Centred Pan (PCP). Music therapy can therefore contribute to the quality of life of people with additional needs and their families. Here at St. Josephs Foundation service users attend music therapy through a referral system. Reasons for referral to music therapy include: Difficulties in making and maintaining relationships or meaningful interaction. Difficulties in relationships with others, such as repeated aggression or lack of self confidence. Difficulties related to communication. When the client is experiencing a period of difficult emotions (for example, are worried, upset or angry) and it is hard for these feelings to be communicated through usual ways of communicating such as talking or signing Specific issue’s, such as anger or a response to a life event. Difficulties related to sensory impairments. Multiple losses (for example, the death of a parent and a subsequent house move). Behaviour that challenges staff and services. (Watson, 2007). Results A range of empirical literature supports the effectiveness of music therapy in increasing the skills and abilities of people with special needs in the areas of (1) social and emotional behaviour, (2) motor skills, (3) communication skills, (4) language and vocal production, and (5) pre-academic and academic skills. The efficacy of these outcomes is enhanced by the power of music to arouse emotions that can be used to motivate and engage clients toward achievement of their therapeutic goals. Further reading Berger, D. (2002). Music therapy, sensory integration and the autistic child. Jessica Kingsley Publishers, London. Gold C., Wigram T & Elefant C (2006) Music therapy for autistic spectrum disorder (Cochrane Review), The Cochrane Library, Issue 2, 2006. Chichester, UK: John Wiley & Sons, Ltd. Davis, W., Gfellers, K., & Thaut, M. (1999). An introduction to music therapy: Theory and practice. McGraw-Hill College, U.S.A. Goodman, K.D. (2007). Music therapy groupwork with special needs children: the evolving process. Charles, C. Thomas Publisher Ltd, USA. Meadows, A. (2002). Approaches to music and movement for children with severe and profound multiple disabilities. Australian Journal of Music Therapy, 13, 17-27. Oldfield, A. (2006). Interactive music therapy – A positive approach: Music therapy at a child development centre. Jessica Kingsley Publisher, London. MUSIC THERAPY AND SEVERE/PROFOUND DISABILITIES Samuel and Pritchard list the characteristics of this client group as follows: Extremely delayed intellectual and social functioning Little or no apparent understanding of verbal language Physical and sensory disabilities Associated medical conditions Need for constant support and supervision (Samuel and Pritchard 2001, in Watson 2007). Seeking to create or develop an alternative means of interaction is one of the primary functions in music therapy. It provides a new and different means of expression and communication. This ability, for a person to make contact and be understood, has a profound value in satisfying emotional needs, and in building relationships. This is particularly true for those who have severe/profound intellectual disabilities (Wigram,1988, in Watson, 2007). In Music Therapy sessions many opportunities are provided for clients to interact and respond with the MT and peers.  Any sound or movement is treated as meaningful and communicative in order to encourage intentional interaction. Why Music? Music is Multisensory:  It provides auditory, visual, tactile, kinesthetic stimulation/vibroacoustic stimulation. The aims of the intervention with this client population include: To develop intentionality To tolerate the closeness of another person To initiate and maintain social interaction To develop and understand early communication, such as meaningful eye-contact, body language, facial expression, and anticipation and turn-taking exchanges. To develop sound production and vocal imitation skills. To explore and understand the given physical environment, including instruments and sound-making items. To develop an understanding of cause and effect, both socially (how their behaviour affects others) and physically (how their behaviour affects their environment). To develop physical imitation skills To develop extended ‘conversation’, using a combination of the above skills, together with any language the student may possess, meaningful or otherwise. To develop self-esteem from knowing that the person interacting with them is also enjoying the interaction, i.e. they want to be there. To express and develop a sense of their own feelings. (Adapted from Corke, 2002) A group run by a music therapist in UK with this population was developed: To encourage communication through the use of the musical medium To encourage an environment where fluency in communication is experienced through the musical medium To provide opportunities for group members to share and express aspects of their personalities and feelings To encourage interaction between group members and therapists To provide opportunities for group members to make choices To provide opportunities for group members to initiate and lead interactions To provide opportunities for group members to have control over events in the group To encourage liveliness and energy in musical interactions (Watson, 2007) Further reading: Watson, T. (2007).Music therapy with adults with learning disabilities. Routledge, London Skewes, K. & Thompson, G (1998). The use of musical interactions to develop social skills in early intervention. The Australian Journal of Music Therapy, 9, 35-44. Corke, M. (2002). Approaches to communication through music.  David Fulton Publuishers Ltd, London Lund, H. N. (1995). Music therapy with high-functioning autistic clients: a case study. In: Pedersen, I.N. and Bonde, L. Ole (eds.), Music therapy within multi-disciplinary teams: proceedings of the 3rd European music therapy conference, 1995. Aalborg: Aalborg University Press. Meadows, T. (1997). Music therapy for children with severe and profound multiple disabilities. Australian Journal of Music Therapy, 8, 3-17. Communication through Music Communication through Music is an Early Intervention Music Therapy and Speech and Language Therapy program for children who have additional needs. The group meets in the Speech and Language Dept at St. Joseph’s Foundation, Charleville, Co. Cork. Weekly (block) sessions allow families to participate in activities that assist children with communicative skills and provide parents with new and different ways to use music as a way of interacting, playing and enhancing communication with their children. What is music therapy? Music Therapy is the planned use of music to achieve therapeutic goals. In Communication through Music the goals include improving each child’s development by using age appropriate and stimulating activities. There is a focus on the child in relation to social, communication cognitive skill development: acquisition, maintenance and generalization. What happens at Communication through Music? A range of interactive, nurturing, stimulating and developmental music activities provide the framework for parents and facilitators to interact and play with the children, and promote child development. Known and new song material, singing, movement to music, imitation and action songs, relaxation and instrumental play are all incorporated into an established session plan. This allows consistency in implementation and evaluation, while providing freedom within each session structure to meet the individual needs of children attending. The session plan includes: Hello song: Greeting & social skills Action songs: Fine motor skills, gross motor skills. Small instruments and concept songs: concept comprehension. Dancing: Gross motor skills, body awareness. Large instruments: Sharing, turn-taking, peer interactions Quiet time: Relaxation, cuddling, bonding. Goodbye song: Closure & social skills. Further reading: Briggs, C. (1991). A model for understanding musical development. Music Therapy, 10(1),  1-21. Bronte-Tinkew, B & Magill, R. (2004) A dual-discipline approach to therapy: Music therapy and speech pathology. Retrieved April 9, 2004, from http://www.musictherapy.ca/content/postconf/magill. Cohen, N. S. (1994). Speech and song: Implications for therapy. Music Therapy Perspectives, 12,  8-14. Kennelly, J., Hamilton, L., & Cross, J. (2001). The interface of music therapy and speech pathology in the rehabilitation of children with acquired brain injury. Australian Journal of Music Therapy, 12, 13-20. Lowey, Joanne (2004). Integrating music, language, and the voice in music therapy. Voices: A World Forum for Music Therapy. Retrieved April 9, 2004, from http://www. voices.no/mainissues/mi40004000140.html Making music time a success: A guide for using music to engage families with young children. Playgroup Queensland 2008 Michel, D. E., & Jones, J. L. (1991). Music for developing speech and language skills in children. St. Louis, MO: MMB Music. Schwartz, E. (2008). Music therapy and early childhood: A developmental approach. Barcelona Publishers, U.S.A MUSIC THERAPY AND OLDER ADULTS Music Therapy is a professional health discipline that uses music as a therapeutic stimulus to achieve non-musical goals. Music therapy may address cognitive, social, emotional, physical and/or behavioural needs. Music therapy with clientele in retirement setting is defined as the specialized use of music with emphasis on the development or maintenance of each individual at the highest possible level of functioning. The Music Therapist at St. Josephs Foundation provides weekly group sessions at Hazelville Retirement Home. Individual sessions are provided if a resident is unable to attend the group setting secondary to health concerns. The intervention focuses on developing and increasing: Engagement and concentration levels Long and short term memory Decision making Verbal communication Interpersonal interaction Energy level (i.e affective state, arousal level) Emotional expression and status of mood With respect to the elderly population the sessions have been tailored to the specific cognitive levels of each client. Reminiscence (including associated emotional connections) Stimulative recall (incorporating associated environmental cues e.g. old photos, old recordings, weather) Active participation (singing & instrumental play) Reality orientation: Songs related to Mothers Day, St. Patrick's Day, Current Affairs etc. Themes: Emigration, Counties, Flowers, Love, Seasons Validation (recognition of emotions from an empathic attitude) Residents are encouraged to be active participants and each person receives individual attention within the group setting. The sessions are success oriented and intend to: Reduce isolation Increase confidence and autonomy Provide equality & shared experience Develop empowerment Develop friendships, empathy and altruism Provide space & opportunity Provide opportunities for the expression of grief and loss Seeking to create or develop an alternative means of interaction is one of the primary functions in music therapy. It provides a new and different means of expression and communication. This ability, for a person to make contact and be understood, has a profound value in satisfying emotional needs, and in building relationships. This is particularly true for those who have severe/profound intellectual disabilities or the final stage of a degenerative disease such as Alzheimer’s. Further reading: Aldridge, D. (2000). Music therapy in dementia care. Jessica Kingsley Publishers, London. Aldridge, D. (1998). Music therapy in palliative care. New Voices. Jessica Kingsley Publishers, London. Brotons, M., Koger, S. M., & Pickett-Cooper, P. (1997). Music and dementias: A review of literature. Journal of Music Therapy, 34(4), 204-245. Clair, A. (1996). Therapeutic uses of music with older adults.  Health Professions Press, USA. Davies, A &.Richards, E (eds).  (2002). ‘Group music therapy with elderly adults’ in Group work in music therapy. London: Jessica Kingsley Publishers. Short, A. (1992). Isoprinciple: The group approach. The Australian Journal of Music Therapy, 3, 57-62. Short, A. (1995). Insight-oriented music therapy with elderly residents. The Australian Journal of Music Therapy, 6, 4-18 Watson, T. (2007). Music therapy with adults with learning disabilities. Routledge, London. FOR FURTHER INFORMATION PLEASE CONTACT: Ms. Anne-Marie O’ Reilly, B.A (Mus)., M.A., RMT. Music Therapy Department. St. Josephs Foundation, Bakers Road, Charleville, Co. Cork E-mail: amoreilly@stjosephsfoundation.ie Tel: (063) 89252 or (063) 33317