What is Music Therapy

What is Music Therapy?

Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music. Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives.

 Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words. Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings.

History of Music Therapy

The idea of music as a healing influence which could affect health and behavior is as least as old as the writings of Aristotle and Plato and in some cultures, long before that. The 20th century profession formally began after World War I and World War II when community musicians of all types, both amateur and professional, went to Veterans hospitals around the country to play for the thousands of veterans suffering both physical and emotional trauma from the wars. The patients' notable physical and emotional responses to music led the doctors and nurses to request the hiring of musicians by the hospitals. It was soon evident that the hospital musicians needed some prior training before entering the facility and so the demand grew for a college curriculum. A very brief historical glimpse of this fascinating profession follows, below.

 

Earliest references

The earliest known reference to music therapy appeared in 1789 in an unsigned article in Columbian Magazine titled "Music Physically Considered." In the early 1800s, writings on the therapeutic value of music appeared in two medical dissertations, the first published by Edwin Atlee (1804) and the second by Samuel Mathews (1806). Atlee and Mathews were both students of Dr. Benjamin Rush, a physician and psychiatrist who was a strong proponent of using music to treat medical diseases. The 1800s also saw the first recorded music therapy intervention in an institutional setting (Blackwell’s Island in New York) as well as the first recorded systematic experiment in music therapy (Corning’s use of music to alter dream states during psychotherapy).

Early Associations

Interest in music therapy continued to gain support during the early 1900s leading to the formation of several short-lived associations. In 1903, Eva Augusta Vescelius founded the National Society of Musical Therapeutics. In 1926, Isa Maud Ilsen founded the National Association for Music in Hospitals. And in 1941, Harriet Ayer Seymour founded the National Foundation of Music Therapy. Although these organizations contributed the first journals, books, and educational courses on music therapy, they unfortunately were not able to develop an organized clinical profession.

Early Educational Programs and Advocates

In the 1940s, three persons began to emerge as innovators and key players in the development of music therapy as an organized clinical profession. Psychiatrist and music therapist Ira Altshuler, MD promoted music therapy in Michigan for three decades. Willem van de Wall pioneered the use of music therapy in state-funded facilities and wrote the first "how to" music therapy text, Music in Institutions (1936). E. Thayer Gaston, known as the "father of music therapy," was instrumental in moving the profession forward in terms of an organizational and educational standpoint. The first music therapy college training programs were also created in the 1940s. Michigan State University established the first academic program in music therapy (1944) and other universities followed suit, including the University of Kansas, Chicago Musical College, College of the Pacific, and Alverno College.

American Music Therapy Association

The American Music Therapy Association (AMTA) was formed in 1998 as a merger between the National Association for Music Therapy (NAMT) and the American Association for Music Therapy (AAMT). AMTA united the music therapy profession for the first time since 1971. Currently, AMTA is the intellectual home for, and it serves member music therapists, students, graduate students and other supporters. AMTA's mission is to advocate and educate for the music therapy profession as a whole.  AMTA publishes two research journals as well as a line of publications, serves as an advocate for music therapy on the state and federal levels, promotes music therapy through social media streams, and provides research bibliographies, podcasts, scholarships, and newsletters to its members.

AMTA is the single largest music therapy association in the United States, representing music therapists in the United States and in over 30 countries around the globe.

The mission of the American Music Therapy Association is to advance public knowledge of the benefits of music therapy and to increase access to quality music therapy services in a rapidly changing world.

Certification Board for Music Therapists

The Certification Board for Music Therapists (CBMT) is a separate and distinct organization from AMTA, which was incorporated in 1983 to strengthen the credibility of the music therapy profession by assuring the competency of credentialed music therapists. The first music therapy board examination was administered two years later. CBMT has been fully-accredited by the National Commission for Certifying Agencies since 1986 and is committed to maintaining certification and recertification requirements that reflect current music therapy practice. To date, there are over 8,000 certificants who hold the credential Music Therapist-Board Certified (MT-BC). Though CBMT and AMTA are separate, independent organizations, they often work together to achieve recognition for the music therapy profession and the MT-BC credential.

National Association for Music Therapy

The National Association for Music Therapy (NAMT) was founded at a meeting in New York City on June 2, 1950. NAMT succeeded where previous music therapy associations previously failed by creating a constitution and bylaws, developing standards for university-level educational and clinical training requirements, making research and clinical training a priority, creating a registry and, later, board-certification requirements, and publishing research and clinical journals. NAMT operated from 1950-1997 and saw the creation of a board-certification program (1985), a critically-acclaimed Senate Hearing on Aging (1991), and the growth of music therapy from a few dozen practitioners to thousands. *photo of Hospital Music Newsletter courtesy of National Music Council.

American Association for Music Therapy

Originally called the Urban Federation of Music Therapists, the American Association for Music Therapy (AAMT) was established in 1971. Many of the purposes of AAMT were similar to those of NAMT, but there were differences in philosophy, education and approach. Starting in 1980, AAMT published its own research and clinical journal, Music Therapy and by 1997, AAMT had grown to 700 members.

Group Therapy

Group therapy is a form of psychotherapy that involves one or more therapists working with several people at the same time. This types of therapy  is widely available at a variety of locations including private therapeutic practices, hospitals, mental health clinics, and community centers.

Group therapy is sometimes used alone, but it is also commonly integrated into a comprehensive treatment plan that also includes individual therapy and medication.

Principles of Group Therapy

In The Theory and Practice of Group Psychotherapy, Irvin D. Yalom outlines the key therapeutic principles that have been derived from self-reports from individuals who have been involved in the group therapy process:

1. Instills hope: The group contains members at different stages of the treatment process. Seeing people who are coping or recovering gives hope to those at the beginning of the process.
2. Universality: Being part of a group of people who have the same experiences helps people see that what they are going through is universal and that they are not alone.
3. Imparting information: Group members can help each other by sharing information.
4. Altruism: Group members can share their strengths and help others in the group, which can boost self-esteem and confidence.
5. The corrective recapitulation of the primary family group: The therapy group is much like a family in some ways. Within the group, each member can explore how childhood experiences contributed to personality and behaviors. They can also learn to avoid behaviors that are destructive or unhelpful in real life.
6. Development of socialization techniques: The group setting is a great place to practice new behaviors. The setting is safe and supportive, allowing group members to experiment without the fear of failure.
7. Imitative behavior: Individuals can model the behavior of other members of the group or observe and imitate the behavior of the therapist.
8. Interpersonal learning: By interacting with other people and receiving feedback from the group and the therapist, members of the group can gain a greater understanding of themselves.
9. Group cohesiveness: Because the group is united in a common goal, members gain a sense of belonging and acceptance.
10. Catharsis: Sharing feelings and experiences with a group of people can help relieve pain, guilt, or stress.
11. Existential factors: While working within a group offers support and guidance, group therapy helps members realize that they are responsible for their own lives, actions, and choices.

12. How It Works

    Groups can be as small as three or four people, but group therapy sessions often involve around eight to twelve individuals (although it is possible to have more participants). The group typically meets once or twice each week, or more, for an hour or two.
    According to author Oded Manor in The Handbook of Psychotherapy, the minimum number of group therapy sessions is usually around six but a full year of sessions is more common. Manor also notes that these meetings may either be open or closed. In open sessions, new participants are welcome to join at any time. In a closed group, only a core group of members are invited to participate.

13. Effectiveness

    Group therapy can be effective for depression. In a study published in 2014, researchers analyzed what happened when individuals with depression received group cognitive behavioral therapy. They found that 44% of the patients reported significant improvements. The drop rate for group treatment was high, however, as almost 1 in 5 patients quit treatment.
    An article published in the American Psychological Association's Monitor on Psychology suggests that group therapy also meets efficacy standards established by the Society of Clinical Psychology (Division 12 of the APA) for panic disorder, bipolar disorder, obsessive-compulsive disorder, social phobia, and substance use.

14. Benefits

    The principal advantages of group therapy include:Group therapy allows people to receive the support and encouragement of the other members of the group. People participating in the group can see that others are going through the same thing, which can help them feel less alone.
    • Group members can serve as role models for other members of the group. By observing someone successfully coping with a problem, other members of the group can see that there is hope for recovery. As each person progresses, they can, in turn, serve as a role model and support figure for others. This can help foster feelings of success and accomplishment.
    • Group therapy is often very affordable. Instead of focusing on just one client at a time, the therapist can devote his or her time to a much larger group of people.
    • Group therapy offers a safe haven. The setting allows people to practice behaviors and actions within the safety and security of the group.
    • By working in a group, the therapist can see first-hand how each person responds to other people and behaves in social situations. Using this information, the therapist can provide valuable feedback to each client.

Cognitive Behavioural Therapy

This leaflet is for anyone who wants to know more about Cognitive Behavioural Therapy (CBT). It discusses how it works, why it is used, its effects, its side-effects, and alternative treatments. If you can't find what you want here, there are sources of further information at the end of this leaflet.

What is CBT?

It is a way of talking about:

• how you think about yourself, the world and other people
• how what you do affects your thoughts and feelings.

CBT can help you to change how you think ('Cognitive') and what you do ('Behaviour'). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

When does CBT help?

CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.

How does it work?

CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:

• A Situation - a problem, event or difficult situation. From this can follow:
• Thoughts
• Emotions
• Physical feelings
• Actions

Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally.

All these areas of life can connect like this: 5 Areas

What happens in one of these areas can affect all the others.

There are helpful and unhelpful ways of reacting to most situations, depending on how you think about it. The way you think can be helpful - or unhelpful.

An example:

The Situation

You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. This starts a cascade of:

	Unhelpful	Helpful
Thoughts:	He/she ignored me - they don't like me	He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?
Emotional: Feelings	Low, sad and rejected	Concerned for the other person, positive
Physical:	Stomach cramps, low energy, feel sick	None - feel comfortable
Action:	Go home and avoid them	Get in touch to make sure they're OK

The same situation has led to two very different results, depending on how you thought about the situation.

How you think has affected how you felt and what you did. In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:

• having a number of uncomfortable feelings
• behaving in a way that makes you feel worse.

If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself.

If you avoid the other person, you won't be able to correct any misunderstandings about what they think of you - and you will probably feel worse.

This 'vicious circle' can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.

CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can 'do it yourself', and work out your own ways of tackling these problems.

What does CBT involve?

The sessions
You can do CBT individually or with a group of people, or even a self-help book or computer programme.

In England and Wales, two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks; Beating the Blues is for people with mild to moderate depression.

If you have individual therapy:

• You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly sessions. Each session will last between 30 and 60 minutes.
• In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
• The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
• You decide what you want to deal with in the short, medium and long term.
• You and the therapist will usually start by agreeing on what to discuss that day.

The work

• With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
• Together you will look at your thoughts, feelings and behaviours to work out:
• if they are unrealistic or unhelpful
•  how they affect each other, and you.
• The therapist will then help you to work out how to change unhelpful thoughts and behaviours.
• It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend 'homework' - you practise these changes in your everyday life. Depending on the situation, you might start to:

• question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT

• recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.

• At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping.
• They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.

How effective is CBT?

• It is one of the most effective treatments for conditions where anxiety or depression is the main problem.
• It is the most effective psychological treatment for moderate and severe depression.
• It is as effective as antidepressants for many types of depression.

Behavioral Therapy

Behaviorism see psychological disorders as the result of maladaptive learning, as people are born tabula rasa (a blank slate). They do not assume that sets of symptoms reflect single underlying causes.

Behaviorism assumes that all behavior is learnt from the environment and symptoms are acquired through classical conditioning and operant conditioning.

Classical conditioning involves learning by association and is usually the cause of most phobias. Operant conditioning involves learning by reinforcement (e.g. rewards) and punishment, and can explain abnormal behavior should as eating disorders.

Consequently, if a behavior is learnt, it can also be unlearned.

Therapies

Behavioral therapies are based on the theory of classical conditioning.  The premise is that all behavior is learned; faulty learning (i.e. conditioning) is the cause of abnormal behavior. Therefore the individual has to learn the correct or acceptable behavior.

An important feature of behavioral therapy is its focus on current problems and behavior, and on attempts to remove behavior the patient finds troublesome. This contrasts greatly with psychodynamic therapy (re: Freud), where the focus is much more on trying to uncover unresolved conflicts from childhood (i.e. the cause of abnormal behavior).  Examples of behavior therapy include:

o          Systematic Desensitization

o          Aversion Therapy

o          Flooding

The theory of classical conditioning suggests a response is learned and repeated through immediate association.  behavioral therapies based on classical conditioning aim to break the association between stimulus and undesired response (e.g. phobia, additional etc.).

Aversion Therapy

Aversion therapy is used when there are stimulus situations and associated behavior patterns that are attractive to the client, but which the therapist and the client both regard as undesirable. For example, alcoholics enjoy going to pubs and consuming large amounts of alcohol

Aversion therapy involves associating such stimuli and behavior with a very unpleasant unconditioned stimulus, such as an electric shock.

The client thus learns to associate the undesirable behavior with the electric shock, and a link is formed between the undesirable behavior and the reflex response to an electric shock.

In the case of alcoholism, what is often done is to require the client to take a sip of alcohol while under the effect of a nausea-inducing drug.  Sipping the drink is followed almost at once by vomiting. In future the smell of alcohol produces a memory of vomiting and should stop the patient wanting a drink.

More controversially, aversion therapy has been used to "cure" homosexuals by electrocuting them if they become aroused to specific stimuli.

Critical Evaluation

Apart from ethical considerations, there are two other issues relating to the use of aversion therapy.

First, it is not very clear how the shocks or drugs have their effects.  It may be that they make the previously attractive stimulus (e.g. sight/smell/taste of alcohol) aversive, or it may be that they inhibit (i.e. reduce) the behavior of drinking.

Second, there are doubts about the long-term effectiveness of aversion therapy.  It can have dramatic effects in the therapist’s office.  However, it is often much less effective in the outside world, where no nausea-inducing drug has been taken and it is obvious that no shocks will be given.

Also, relapse rates are very high – the success of the therapy depends of whether the patient can avoid the stimulus they have been conditioned against.

Flooding

Flooding (also known as implosion therapy) works by exposing the patient directly to their worst fears. (S)he is thrown in at the deep end. For example a claustrophobic will be locked in a closet for 4 hours or an individual with a fear of flying will be sent up in a light aircraft.

What flooding aims to do is expose the sufferer to the phobic object or situation for an extended period of time in a safe and controlled environment. Unlike systematic desensitisation which might use in vitro or virtual exposure, flooding generally involves vivo exposure.

Fear is a time limited response. At first the person is in a state of extreme anxiety, perhaps even panic, but eventually exhaustion sets in and the anxiety level begins to go down. Of course normally the person would do everything they can to avoid such a situation. Now they have no choice but confront their fears and when the panic subsides and they find they have come to no harm. The fear (which to a large degree was anticipatory) is extinguished.

Prolonged intense exposure eventually creates a new association between the feared object and something positive (e.g. a sense of calm and lack of anxiety). It also prevents reinforcement of phobia through escape or avoidance behaviours.

Critical Evaluation

Flooding is rarely used and if you are not careful it can be dangerous. It is not an appropriate treatment for every phobia. It should be used with caution as some people can actually increase their fear after therapy, and it is not possible to predict when this will occur. Wolpe (1969) reported the case of a client whose anxiety intensified to such as degree that flooding therapy resulted in her being hospitalized.

Also, some people will not be able to tolerate the high levels of anxiety induced by the therapy, and are therefore at risk of exiting the therapy before they are calm and relaxed. This is a problem, as existing treatment before completion is likely to strengthen rather than weaken the phobia.

However one application is with people who have a fear of water (they are forced to swim out of their depth). It is also sometimes used with agoraphobia. In general flooding produces results as effective (sometimes even more so) as systematic desensitisation. The success of the method confirms the hypothesis that phobias are so persistent because the object is avoided in real life and is therefore not extinguished by the discovery that it is harmless.

For example, Wolpe (1960) forced an adolescent girl with a fear of cars into the back of a car and drove her around continuously for four hours: her fear reached hysterical heights but then receded and, by the end of the journey, had completely disappeared.

References

Wolpe, J. (1969). Basic principles and practices of behavior therapy of neuroses. American Journal of Psychiatry, 125(9), 1242-1247.

Narrative therapy

Narrative therapy is a form of psychotherapy that seeks to help people identify their values and the skills and knowledge they have to live these values, so they can effectively confront whatever problems they face. The therapist seeks to help the person co-author a new narrative about themselves by investigating the history of those qualities. Narrative therapy claims to be a social justice approach to therapeutic conversations, seeking to challenge dominant discourses that it claims shape people's lives in destructive ways. The approach was developed during the 1970s and 1980s, largely by Australian social worker Michael White and David Epston of New Zealand.

Michael White