Music as a Form of Therapy:
Changing Lives One Note at a Time
David Ervast, MT-BC, NICU-MT, Board Certified Music Therapist
Music is a universal language. You have probably heard that statement before, and it is true; music can communicate meaning, emotion, intention, and state of mind. Music is also a powerful tool; it can empower, intimidate, encourage, and validate. Music can do all of these things because of the connection that we, as people, have to music regardless of our favorite genre or our musical skill.
However, a music therapist will tell you that music can also structure, reinforce, and validate behavior, provide smoother transitions in sessions, and facilitate discussion of a topic. A music therapist will also tell you that music can be used therapeutically to facilitate positive changes that have nothing to do with music or with musical skill. If you are now asking yourself, “Who are music therapists and what do they do?” then you have come to the right place to find out.
My first exposure to the field of Music Therapy was during my freshman orientation at Florida State University. Having been accepted into the University and the College of Music, I was still at a bit of a loss as to what exactly I wanted to major in. Vocal Performance was the least likely option for me, and I was told I had to really feel the passion beforehand if I wanted to go into Music Education.
So, in my advising meeting at orientation, I mentioned I was also interested in psychology and my advisor immediately suggested music therapy. Music and therapy together? After looking into it and doing some research, I found that music therapy is a pretty cool field in which practitioners integrate and utilize concepts from music, psychology, medicine, and counseling to reach non-music-related goals in various clinical, educational, and community settings.
The American Music Therapy Association defines music therapy as “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.” A credentialed professional is someone with at least a Bachelor’s degree in Music Therapy (including a 1,200-hour clinical internship) and who has passed the national board certification exam. A music therapist, as a fully qualified musician and a fully qualified therapist, has the training and experience to effectively utilize music interventions with singing, movement, instrument playing, and listening to meet the non-musical needs of the specific individual or group that he or she is working with. Further, the music interventions implemented by the trained music therapist are supported both by past experiences (clinical) and research (evidence-based). Music therapists utilize accurate assessment, appropriate goal-setting, and evaluation of outcomes throughout the treatment process.
Along with the definition of music therapy, it is also important to specify what music therapy is not. There are musicians out there with good intentions to share the gift of music with people who are sick, disabled, or less fortunate. Often, musicians will volunteer their time to these individuals by sharing music, teaching lessons, performing, or otherwise. Despite being a valuable service or ministry, these activities are not considered music therapy because: 1) they are not goal-directed; volunteer musicians are not trained to meet non-musical goals utilizing evidence-based interventions while considering the safety and comfort of the client, 2) they are solely about the music; volunteer musicians work solely to provide a musical performance, and while performance has its own value, it is very different from therapy, and 3) they are often designed to be fun for the audience or individual; while music therapy inherently includes an element of fun for many populations, the purposes of therapeutic musical interventions are to facilitate positive change in the physical, psychological, emotional, behavioral, and/or social domains (having fun can be considered a positive “side effect”). Additionally, music therapy is an established profession recognized by the healthcare industry and increasingly by state governments; music therapists in many states are working toward professional licensure at the state level.
In practice, applications of music therapy are highly varied. Music therapy can be appropriate for people of all ages, all levels of ability, and all backgrounds, and musical skill or talent is not a prerequisite for participation. In the following paragraphs, I will share interactions I have had with patients and clients in neonatal, pediatric, hospice, and wellness settings.
Neonatal Intensive Care Unit
When a baby is born prematurely, he or she often stays in the neonatal intensive care unit (NICU) for a period of time. I had one patient that was about 6 months old when she first started receiving music therapy. She was born premature and had some resulting respiratory issues that required an extended hospitalization. She also had a tendency to lean her head to the left, and was referred to music therapy to provide developmental stimulation due to not receiving developmental play elsewhere. In music therapy, she was provided with developmental stimulation, play, and music that incorporates developmental milestones as well as medical goals (for example, looking to the right more). I facilitated this by staying on her right side (so she had to look right to see me), and using visual stimulation (with songs like Itsy Bitsy Spider and Wheels on the Bus) to provide something interesting to look at. After a few months, this patient was looking to the right more (allowing her to use the full range of motion of her head) as well as receiving some of the developmental play and stimulation that she needed.
In pediatric units and hospitals, music therapy can facilitate many goals having to do with developmental stimulation, quality of life, normalization, mood, and education regarding treatment and academic concepts. One patient I worked with for a few months was a child receiving chemotherapy. This particular patient was Spanish, had Down syndrome, and was non-verbal, however he did make sounds and vocalizations. Often, the general goals addressed with children receiving chemotherapy in the inpatient setting include mood elevation, normalization, autonomy and control, and self-expression. Addressing these goals, I started this particular session with the theme song from Spongebob (he loved Spongebob, so I always began with this song) and went from there to more popular music that he enjoyed. This session consisted of providing music that lent itself to active engagement with me, the music, the instruments, and his parents. I facilitated the goals by providing many instrument choices, imitating him when he played instruments a certain way, being engaging with affect and musical choices within songs, and sticking to music that he knows. He played with all of the instruments presented, played in creative ways (played the bongo drums with a fruit shaker as a drum stick, for example), took turns with everyone involved, and vocalized with the music. Having gotten a chance to play and make music with some novel instruments and opportunities, he remained happy and smiling at the conclusion of the session.
Hospice care is a growing area for music therapy, and can be provided in the medical or private practice settings. One patient I worked with was receiving hospice care in the hospital. This patient presented asleep and did not arouse or respond when I entered their room and announced myself. I planned to do fifteen minutes of continuous, patient-preferred music to promote comfort and quality of life; I had seen this patient with her family before and knew that she enjoyed gospel music and hymns (her family was not present during this session). I did the fifteen minutes of continuous music, and the patient ended up waking up during the last song. After she woke up, I talked to her a little bit; she was able to tell me the title of a very favorite hymn, so I sang that hymn while maintaining appropriate non-verbal engagement and interaction. Even though she was disoriented, she was able to tell me the title of one favorite song and give positive responses (a head nod, a small smile) to music. She thanked me at the end of the session and passed away shortly after this interaction.
Wellness is an area of music therapy that is a great example of how you don’t need to have something “wrong” in order to benefit from it. Most of my experience with music therapy and wellness comes from teaching music play classes with typically developing children and their parents. Music play classes can benefit all areas of development for children starting at about six months of age. In music play classes with children, I address physical, social, emotional, cognitive, and communicative development by utilizing music activities that target these areas of development. I usually begin a music play class with a “Hello” song that introduces the names of each child in the class and encourages positive social behaviors like waving, smiling, and saying “hello.” Then, I lead a “sign language” or a “gestures” song (like Itsy Bitsy Spider or Wheels on the Bus) to promote language development and communication. Following this are music activities that incorporate dancing and movement to promote physical development, drums and instruments that incorporate directional principles such as “high/low” and “loud/soft,” songs that introduce and reinforce emotions such as “If You’re Happy and You Know It,” and numerous other activities that facilitate visual tracking, the learning of colors with colorful scarves, and appropriate social interactions for family and friends, all while being fun and engaging for the children. These classes always end with a “Goodbye” song that incorporates sign language and reinforces appropriate social interactions.
The patient and client interactions shared here barely scratch the surface of the numerous uses and benefits of music therapy. Music therapy is also commonly applied with veterans, patients in psychiatric hospitals, adults and children in physical rehabilitation, families, individuals with emotional and/or behavioral disturbances, individuals with autism or other developmental and intellectual disabilities, individuals with physical disabilities, and in schools, among others.
Before I entered the field of music therapy, and as I was starting school, I thought music therapy sounded like a pretty cool thing. Now, as a practicing music therapist, I am humbled and honored to facilitate positive change in peoples’ lives, contribute to the growing evidence base, and advocate for the recognition of music therapy as an allied health profession. As music therapy services are increasingly covered under health insurance plans, and as the music therapy profession is increasingly recognized at the local, state, and federal levels, it is my hope that through the education of other professionals and through the sharing of experiences, we will continue to bring music therapy to the forefront of the allied health professions.
For more information about music therapy, please visit:
The American Music Therapy Association website – musictherapy.org
The Certification Board for Music Therapists website – cbmt.org
Florida Music Therapy Government Relations Facebook page – facebook.com/FLMTGovRel (also like and share!)
David Ervast, MT-BC, NICU-MT is a Board Certified Music Therapist living and working in Tallahassee, Florida. Working primarily in the medical setting, David has clinical experience with people of all ages in a variety of settings including medical, psychiatric, pediatric, private practice, speech-language, and community-based settings. He will graduate from Florida State University with his Master’s degree in Music Therapy in May of 2017. You can contact David at email@example.com
Laughter is the Best Medicine
Jillian Heilman, PhD: Rehabilitation Sciences, Founder:The Halle Grace Foundation
For our first quartley professional article, I have chosen to post a piece I wrote a few years back. Many things have changed since then, namely the loss of Halle Grace, but despite her passing I still find these words to be true.
Being the mother of three children with chronic medical issues offers me the opportunity to experience hospitals, pharmacies, therapy centers, doctors’ offices and the like on numerous occasions. I have been given handfuls of prescriptions for my kids’ chronic ear aches, sinus infections, or bouts of pneumonia. I have been given strict courses of action to take when emergencies arise and been provided detailed treatment plans to aide my child in learning to eat, to practice her ability to walk or to continue to develop his speech. With one pediatrician, two speech therapists, an occupational therapist, a physical therapist, an aquatic therapist, a respiratory therapist, and upwards of ten specialists, I have found one of the best treatments for my children and our family is not found in a bottle at the pharmacy, but rather a little closer to home. The best medicine I have found for us has been laughter.
Yes I said laughter! Between my three children, our family has been through more than 30 surgeries, 100s of hours of therapy, monthly and weekly infusions and thousands of doctors’ appointments. This life with chronic illness in three children could send us over the edge, but we have chosen to hang a rope from that edge, tie a tire to it and take turns swinging.
We all have life struggles, my children’s may be very different from yours or maybe you have walked in similar shoes. Regardless, we all have those days with our children that we want to break down and cry, and some days we do! But we can also choose to find the joy in our struggles. Here are a few things I have used to change those bumps in the road into a bumper car game:
1. Celebrate the little things in life.
This may be anything from your child’s good grade to a great hair day for yourself. Nothing is too small to celebrate. I have been known to bake cupcakes for my kids just because it is a half day at school – yes there are several of those this year in our county…but what child gets tired of baking cupcakes after class? We have also been known to host premier parties for Disney Channel movies, just a little way to add some fun to the day. We can each find a reason to celebrate during a difficult time.
2. Focus on the good.
Sometimes it helps to write down the blessings in your life. I was not born an optimist, it takes work for me to be positive and I have found putting pen to paper helps me find those positive things in my daily life. Being specific is key, try writing down five things that have been good in your day. Some days you may find it more difficult to find the good. In fact, here’s one entry from my own journals: “Okay, let’s see, five things I am thankful for today: 1) I didn’t pull my hair out; 2) My kids are asleep now; 3) Tomorrow is a new day; 4) I get to go to bed soon; and 5) I am stocked up on diet coke so I can face tomorrow.” As I said, some days you may have to work at finding the good – but remember it is in there!
3. Laugh out loud.
Laughter has been proven to relax your body; boost your immune system; release endorphins and actually promotes heart health*. So get out there and laugh, even if its fake to begin with, you will find that laughter turns to real joy in no time. Find some joke books to share with your kids, look at the funny things your own children do day to day, rent a comedy to watch or have a girls’ night out with some friends…you are bound to find some things to make you laugh! Laughter is also contagious. Once you start, it is easy to keep on going. We all need to remember to take time out for ourselves and enjoy the moment.
So as they say, when life hands you lemons, make lemonade, well okay not in my family at least because I am allergic to lemons. But I could cut one lemon slice, peel out the inside, cut slices in the rind, flip the white inside part out, slip it in my mouth and have a crazy set of lemon teeth! So on those days when I just want to either laugh or cry – I choose laughter! How about you?
Jillian Heilman, PhD in Rehabilitation Sciences, Certified People Map Trainer and Optimist in Training
* Smith, M., Kemp, G., & Segal, J., (2010). Laughter is the Best Medicine: the Health Benefits of Humor and Laughter. http://helpguide.org/life/humor_laughter_health.htm, downloaded January, 26, 2011.