Music Therapy 1967202930
Music Therapy 1967202930
Music Therapy 1967202930
THERAPY
Karen D. Goodman
e-Book 2016 International Psychotherapy Institute
MUSIC THERAPY
Historical Use of Music in Healing
Music as a Tool
Performing Music
Bibliography
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MUSIC THERAPY
Karen D. Goodman
From ancient times music has played an essential role in the humane
scientific healing.
sounds in the environment (wind, rain, waves, trees, animals) gave primitive
man access to nonverbal communication with his “invisible world”—a
with the “spirits.” Eventually, ancient man moved from magical healing via
language with the supposed sources of disease rather than recognizing the
specific ability of music to affect man’s psyche and soma. As it was written in
the Bible: “Seek out a man who is a cunning player on a harp [David]: and it
shall come to pass, when the evil spirit of God is upon thee, that he shall play
created in their own image. Incantations, songs, and music were a standard
part of Greek and, later, of Christian ritual. Also available were environmental
healing treatments involving supplications for help from the gods. At some
At the same time, rational and scientific ideas about music and medicine
Aristotle recognized the cathartic power of music. Plato introduced the idea of
psychotherapy that affected the body through the median of the soul,” were
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not isolated phenomena. In scrutinizing the history of psychiatry, it is striking
to note that almost all of the humane treatment movements have included
institutions.
While this Arab and Judaic tradition had some impact on the Christian
overshadowed by the prevalent attitude that the mentally ill, labeled as evil,
actualization via the arts was recognized in that the patient was encouraged
to express himself through a musical experience. Obviously this experience
was still not fully understood in relation to the therapeutic growth of the
during the war, musicians had been encouraged to use their talents purely for
Many of the initial music therapists were music educators with training
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contributed to the field of music therapy. Continuing research cast doubts on
beliefs on which earlier clinical practice had been based. Several popular
turned to new ones. While the mainstream of music therapy in the fifties and
Florence Tyson and Mary Priestley began to translate these concepts into
clinical practice, embodying the analytic model suggested previously, as well
imagery was as valid as dream imagery was utilized in clinical practice by Dr.
Helen Bonny who opened the Institute for Music Consciousness and Research
centers and prisons), and outpatient and inpatient clinics for treatment of the
physically handicapped.
activities and points of view, carried out by a polyglot inclusive group whose
bond remains the use of music for the benefits of the sick and disabled.”
Music as a Tool
significant forms through the elements of melody, harmony, and color. Tones
or sounds occur in single line (melody) or multiple lines (harmony) and are
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sounded by voice(s) and instrument(s). Appreciation of or responsiveness to
musical sounds or harmonies is inherent in the concept of music.
man can and must be used to meet specific needs in clinical practice. With this
roles of the right and left hemispheres in music perception. The investigation
brain individuals who express themselves well through music. Music may
prove a means of transfer between left and right hemispheric functioning. Left
and right hemispheres are employed differently in the musical process. The
basis for the perceptual processes of the right hemisphere, which influences
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cardiovascular system, and galvanic skin response; lowering of the thresholds
of sensitivity to other forms of stimulation; and delay of the onset of muscular
fatigue. Why music has this power, what exactly it is about music that is
responsible for its effects, and how one can effectively tap music’s power to
As parts making up the whole, melody, rhythm, and harmony each have
the only instrument belonging to man, voice, able to produce both melody and
rhythm, best represents the “hidden person, his individuality, his uniqueness.”
Modes, the selection of tones within a scale, will vary from culture to culture.
Most common in this country are the major and minor scales. The timbre or
quality of sound offered to the child by the human voice may prove either
pacifying or disquieting.
consonance; the size of the intervals (small intervals, except for semitones
music develop.
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intervals assume physical postures and cathartic emotional value.
The information suggesting that rhythmicity is at least “hard wired” into the
circuits of our brains is well founded: witness the seasonal or monthly cycles
or even diurnal rhythms in depressives; the basic rhythm of the rapid eye
respiration, and brain wave activity; the various cries that change in rhythm
at different periods of life; the predictable rhythms of spontaneous neonatal
motor patterns; and the movement patterns and rhythms found in each
dynamically invested phase of development. These and related studies may be
potential diagnostic tools not only for music therapists but for the entire
medical profession.
Gaston said, “without rhythm, there would be no music, for its unique
interplay between basic beat (meter) and melodic rhythms, the stability and
consistency of basic beat, and the gradual evolution of tempi changes (much
faster or slower tempi can be tension laden) are all indicative of a need for
orientative Gestalt for the mind as well as the body: “the ultimate foundation
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As previously mentioned, music is fundamentally melodic, and so it is
presenting the dissonant. “Either too much tension or too much relaxation can
be fatal. Excessive consonances produce stagnation, while too many
music furnish an element of motion or progress, and keep the mind and the
imagination of the hearer aroused.” Initial contact with sound occurs at birth,
and hearing experiences may serve to master the outside world.” Thus, the
ego can function to re-experience early phenomena, as well as the present
experience of listening during a therapeutic situation. For some, the
In therapy, the music session is the ongoing context within which the
affective set of the listener, which is reinforced and/or prevailed upon by the
music (only when the listener’s affective state is very definite, strong, and in
sharp conflict with the prevailing mood of the music being presented, does it
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constitute a disturbing factor); (2) the flow of association and the arousal of
imagery usually based on the mood and emotions elicited by the music; and
(3) the visual stimulation provided by the musician. The intrinsic factors in
to intrinsic factors of listening are not controlled and usually exist on a level
that is apparently not conscious. Meyer attempted to clarify the role of mental
completion, and balance of tension and relief. The ability to recognize and
respond to these components of the intrinsic listening experience may prove
with a certain piece of music or the higher his musical training in general, the
more he will enjoy musical sequences of greater unexpectedness and
since there no longer exists any tension. How increased tension can become
Meyer, the ego-mastery is upset when control over the predicted resolution of
the music is temporarily or permanently lost. According to Miller, “Ego-
aggressive sounds), ego failures (complex and difficult sounds), and super-ego
become pleasurable when the listener realizes emotionally that the music is
only “make-believe” and not threatening to the self; the eventual regaining of
mastery over the music situation leads to decreased tension. “Ego mastery is
attained in music when sufficient defensive energy is invested to understand,
the listener in both positive and negative ways. The connection for these
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feelings may be the world of imagery and associations. In many cases, the
music and to its “meaning beyond itself,” may be viewed as the symbolic
expression of unconscious feelings and contents. As dreams are valuable
interpretative material for the analyst, so musical daydream, arising from the
Music (GIM), a process involving “listening to music in a relaxed state for the
purpose of allowing imagery, symbols and deep feelings to arise from the
superficially therapeutic “music to sooth the savage beast” notion does not at
longstanding value.
Performing Music
opportunity:
The voice represents the hidden person, his individuality, his uniqueness.
To be born means to become sounding, to have a voice means to be
something which has its own growth, its own development. . . . The
primitive or modern player has always identified himself with his
instrument, which is a prolongation of his body and transforms into sound
his psycho-motor impulses and liberates them. The manipulation of an
instrument demands also conscious control of movement in time and
space and obedience to certain laws of acoustics. The process has a well-
known therapeutic value, [pp. 19-20]
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According to the “Musical Communicativeness” evaluation scale of Nordoff
and Robbins, vocalization on a low level of response includes “fleeting
reflexive sounds that echo some parts of the music; brief sounds that have a
child” has yet to be formed but indicates some instinct for potential music
need of further elucidation and healthy integration. In the same way, the
experience and development can and must ultimately fit into an affective and
cognitive framework. In this way the relationship between musical
that musical development evolves through the same stages as other realms of
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stage (ages two to six) when sounds begin to acquire communally shared
meaning; a concrete operational stage (ages seven to eleven) when children
can voice to one another a set of organized patterns of sound; and a formal
operational period (age twelve and up) when they can reflect on how music
works, analyze a composition, and freely invent new patterns.
and in music therapy. Ewing seems to have translated into clinical practice the
even more specific stages of musical development in the first five years of life
important to remember that musical precocity and, at the very least, “normal”
ability are found quite frequently among children who are not intellectually
are stereotyped for their unusual musical capacities which, when developed
into communicative patterns, provide the first step in remediation of a serious
emotional illness.
development.
unconscious content in analogy with dreams, imagination, and humor; (3) the
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According to Noy, “The problem of defining the significance of forms by
relating it to the analysis of the content implied in those forms presents the
major challenge facing the analytical theory of art today.” This problem is
indeed a symbolic language even though its content may seem unfathomable
much of the time. Music lends expression to the world of feeling; it is a symbol
and its symbolized object is the emotional life.
The tonal structures we call “music” bear a close logical similarity to the
forms of human feeling— forms of growth and of attenuation, flowing and
stowing, conflict and resolution, speed, arrest, terrific excitement, calm or
subtle activation and dreamy lapses—not joy and sorrow perhaps, but the
poignancy of either and both—the greatness and brevity and eternal
passing of everything vitally felt.
Such is the pattern of logical form, of sentience; and the pattern of music is
that same form worked out in pure, measured sound and silence. Music is a
tonal analogue of emotive life. [p. 27]
difficult to fathom), then one can also accept the likelihood of perception of
level does the translation process of the unconscious content into tonal
structure take place? What is the nature of the motive or desire to find
The ego is served by music since organization and hence mastery of sound
impulses is achieved; music is, in this sense, a form of play. The superego is
served by music since an expression of rules to which one submits becomes a
under muscular tension in the tones of the human voice, also produces this
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effect; and harmony provides an additional and increased enjoyment since a
The key to the music therapy work, which calls itself analytic in
and the approach to the music experience must become conscious to the
extent that the client can achieve greater self-awareness. In some cases a
in this “pure” sense has been achieved most often with children. With adults,
particularly the neurotic, it has usually been necessary for the therapist and
client to verbally “process” the musical experience. The client is often guided
by the therapist to reflect back and clarify what pertinent dynamics the
means of approaching and integrating the musical experience into the self
become possible. This emotional awareness frequently effects extra-musical
change.
It is dangerous to extend any findings beyond the population (in our case,
Western) in which they have been established. As musicians, musicologists,
and psychologists have demonstrated, the music of one’s culture may be
(that is, musical mode), and different emphasis (for example, greater
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primitive societies, recognized the relevance of such findings to music therapy
practice. For example, the finding that unison instrumental folk music is more
common in societies whose political and social interaction patterns are simply
also been found that recorded contrapuntal musical textures are responded to
by some psychotic patients as though they were social interactions and that
patients’ acceptance or avoidance of contrapuntal music can provide clinical
structure and group musical performance not only within a given society but
within any social subculture.
Music has power to ease tension within the heart and to loosen the grip
of obscure emotions. The enthusiasm of the heart expresses itself in a burst of
song, in dance and rhythmic movements of the body. From immemorial times,
the inspiring effects of the invisible sound that moves all hearts and draws
them together has mystified mankind.
levels:
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potentialities
Depending on the training and orientation of the music therapist, the capacity
of the client to be involved in therapy, and the interdisciplinary goals set for
that client, the extent to which musical activity is developed to incorporate
Therapy”). In those cases where the client will undergo short-term therapy
and may be chronically ill and/or highly resistant to therapy, supportive
processing, music, perceived through the right hemisphere, can be a basis for
given musical situation. Through involvement with the musical process, one
can develop awareness of affectual states while maintaining the reality of the
Since music can be very much a formal art, the capacity for entry level
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music involvement will vary tremendously. Many clients may simply have an
emotional attachment to music and the desire (whether directly or indirectly
expressed) to become more involved. Others will have had previous amateur
and the client is able to initiate choices. A feeling of autonomy and self-respect
develops as the client identifies with the musical activity, incorporates more
and more of himself into it, and increases a sense of mutuality with the
therapist or group in the music-making experience.
communicating.
As has been implied all along, the relationship between client and
The loving feelings of the music therapy positive transference do not have
the same frustrating aim-inhibited quality as they do in analysis. To play
music together and, even partially, to relieve physical tensions in this way,
can be an unconscious symbolic equation for various basic impulses such
as feeding, making love or even killing. Music therapy transferences are
therefore deep but more manageable, both in their positive and negative
aspects, [p. 243]
therapist once again depends upon the orientation of the therapy as well as
reconstructive goals into therapy will provide as much structure and direction
as the client needs and will verbally support and “process” feelings evoked by
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Music therapy structure depends on the suitability of individual or small
The music therapist must communicate with the child at the level of the
idea of reinforcing the present mood of the client is based on the age old “Iso
as predictable music structures by which the child may “join” the therapist.
tonal instruments, such as reed horns, glockenspiels, claves, wood blocks, bird
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whistles, cymbals, adapted string instruments, autoharps, and zithers,
designed for developmental needs. The child able to engage in more abstract
contained some of his ‘old, uncomplicated’ music, engaged him and provoked
some vocal responses.” The ability to sing longer tonal phrases, the
(“What’s That?” “Roll Call Song,” “Goodbye Song”) while playing with the
therapist.
precomposed music should lead to the child’s eventual control of the musical
situation; in this regard the ability to perceive and play a regular beating
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The planning and implementation of musical involvement for the
The Neurotic
possible, verbally processed between client and therapist. “As the modern
analyst resolves the patient’s resistances to putting his thoughts and feelings
into words (the music therapist can) resolve resistances to putting them into
music. This process is begun by learning as much as possible about the client
and discovering with him what specific needs exist.” An ostensible “music
lesson” may really be a continuation of the learning process “with an
exploration of the many possibilities within the music and within the person
in terms of what he might want to say through his body and his own decoding
and simple melodic piano improvisations may help the client begin the
session. By his own selected musical modality and materials the client
provides the therapist with a self-portrait of his emotional and cognitive
may reflect on the patient’s emotional and cognitive styles outside of the
music session. Through the guidance of the music therapist, the client is
encouraged to process his feelings about musical experience in relation to
self. The client is encouraged to attempt alternate means of dealing with the
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may lead to new understanding and possible alternatives in behavior.
Often the highly verbal neurotic will gain more insight from the
emotionally-laden music experience than from incessant talking:
Priestley wrote that “as a reference point for working through the
of her painful emotions and makes it safe for her to talk about them and the
suggested: (1) “holding,” that is, a means of allowing the client fully to follow
disintegration under high emotional stress, thus giving the emotion the
chance to be expressed while expending enough bound energy to allow the
client to think more and feel less about the subject; and (2) “splitting-useful,”
that is, where the client has projected part of himself onto another character.
Therapist and client take on different roles and then switch musical feelings of
in conflict situations where all the energy is being held in maintaining the
status quo. After the client describes her feelings about both sides of the
conflict in word pictures, the music therapist starts off in the character of one
person or idea:
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out then she would have to be “Doormat.” Next I was “Doormat” but I left
spaces for her to answer back musically but she never did. Next I made a
long decrescendo (gradual lowering of volume) to see when she would
dare to reverse roles. At my “pp” (pianissimo—soft level of volume) she
was “ppp” (even softer) and then when I reached “ppp” suddenly, right at
the end, she did assert herself. Following this, she felt able to resist her
tutor’s efforts to make her take up work at a “suitable” school whose
principles she disbelieved in, and to risk looking for a position in which she
would feel happy and honest, [p. 125]
The Psychotic
With the psychotic in individual or small group therapy, basic goals (as
interaction. The need for more structure is necessary to bring the patient into
closer touch with external reality. Of paramount value for the psychotic is the
formation of an attachment, the expression of self within a structure, and the
moment that is relevant and real, the patient confirms his attachment within
Using his musical ear to pick out the notes on the keyboard, Arthur
[seventeen-year-old schizophrenic] very much wanted to recreate the musical
the melody. Since he had already learned the accompanying chords of the
while the therapist aided him. Given a meaningful structure within which to
work, it was easier for him to grasp the melodic meaning of the composition.
The rhythm had to be structured and modeled for Arthur by the therapist as
idea follows another as the scheme unfolds. The joy in taking apart the puzzle
and then putting it back together in a meaningful way helps give the client a
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The recognition of the psychotic client’s present capacity to participate
against stress, then their complete disorganization and need for structure in
music may “progress” into a defensive, literal, tightly structured musical
constricted ranges with even patter rhythms, and that this constriction of
range and lack of rhythmic differentiation were found to function defensively.
traits and remission of a psychotic thought process has also been observed.
The awareness that one can confront conflict and grow not only by
being one’s self but by participating with other selves may be achieved by
the individuals) and reacts. The need to channel cathartic and play activities is
psychic distance from threatening affect; the manner in which the person
expresses himself musically may represent his psychic constellation. The
acting out of feelings provides a possible basis for increased reality testing
when feelings, expressions, and mastery are overtly expressed within the
group: “The musical stimuli can act as a rehabilitative vector in revealing
can withdraw from . . . therefore ... it is a social force which unites people
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during therapy.” One example of this is the use of rhythm since it provides a
act with other individuals. Thus we can give in to rhythmic impulses and
can facilitate and sustain the group’s attention span and develop awareness of
other members’ sounds but also can be the basis for a group rhythmic sound.
Likewise, the creation of a group melody to which each member adds his pitch
group.”
duet, and trio vocalizing are helpful “to develop autonomy and to foster peer
support.” The nature of the song material as well as the nature of the music
experience (listening versus participation) can affect the cohesion of the
group. Mitchell and Zanker found that active singing of folk and traditional
cohesion during music group therapy. The group members who went from a
passive listening experience to active participation by singing these songs,
sessions to choose songs and recordings that appealed to them, found that it
acceptable to share the same feelings openly in a group.” During this group
understanding and control.” The authors did not cite any differences in
feelings toward the therapist. The selection of the song can also serve as a
“transitional object to gain autonomy within the group or from the leader.”
explore affectual responses within the group: “Depending upon the group’s
qualities as dynamics (loud and soft), tempo (fast and slow), and pitch (high
and low) in a socially appropriate way and can explore their control through
the use of percussion instruments.
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More active and more passive roles in the group are ongoing via musical
The intent of the group will vary. Ain suggested the creation of a music
therapy “work” group by structuring the beginning, middle, and ending of
person asks for another to sing a song with him, this could be an indication of
pairing in the group. If the patient randomly plays an instrument, this could
be a flight from the group’s task. If a person is silent, he has the opportunity to
dynamics will differ from group to group. Verbal interaction among members
of the group and the subsequent relationship between verbal interaction and
musical processes need further investigation. Ain studied two groups (each
The leader continues to provide order through sounds and rhythms that
have inherent relational patterns. Members unconsciously identify with
these structures and feel ordered experiences. From this stance, the group
gains courage to verbalize feelings and expression related to their intra-
psychic and interpersonal functioning. An example of this process is when
Yvonne [age 22, latent type schizophrenic] finishes singing and playing her
rhythmic patterns she then expresses she feels less self-hatred and hopes
to work in a satisfying job. [p. 104]
between group members and the therapist as well as the musical intervention
and structure of activities by the therapist.
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