We have included music therapy as a separate category because it is appropriate in a wide range of settings in addition to schools.

What is music therapy?
What is the history of music therapy?
What are the benefits of music therapy?
In what contexts is music therapy used?
How does music therapy work?
What techniques/approaches are used in music therapy?

What is music therapy?

Used properly by a qualified therapist, music therapy can address a wide range of physical, emotional, cognitive and social needs. After assessing the strengths and needs of each client, the music therapist provides the indicated intervention – which can include creating, singing, moving to, and/or listening to music. Through musical involvement in a therapeutic context, clients' abilities are strengthened, and this can then be implemented to promote well being in their daily lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.

Music therapy has been proven effective by hundreds of scientific research studies and articles. Here are some links for further reading:

American Association of Music Therapy
Autism Research Institute
Internet Health Library
Irish Association of Creative Arts Therapies
Music Therapy MA Programme, University of Limerick
Music Therapy Online Journal
Music Therapy Research Resources
Northern Ireland Music Therapy Trust

What is the history of music therapy?

The idea of music as a healing influence that can have a positive effect on health and behaviour is as least as old as the writings of Aristotle and Plato. However, the discipline of music therapy began after World War I and World War II, when community musicians of all types, both amateur and professional, went to veterans hospitals in the US 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 proper training. The first music therapy degree programme started at Michigan State University in 1944, and there are now several hundred music therapy programmes in universities around the world.

What are the benefits of music therapy?

Music therapy is a powerful tool that can address a wide range of issues, including:

• Intellectual and learning disabilities (autism, Down Syndrome, Alzheimer’s, etc.)
• Physical disabilities (cerebral palsy, brain injury, acute and chronic pain, etc.)
• Emotional needs (depression, chronic stress, substance abuse problems, ADHD, etc.)

And the benefits are far-reaching:

• Promoting positive relationships in a supportive environment
• Promoting creativity and self confidence
• Promoting stress reduction and relaxation techniques
• Promoting communication and social interaction
• Promoting general health and well-being
• Providing opportunities for the individual to explore emotions and thought processes through music

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In what contexts is music therapy used?

Music therapy has been used successfully in a variety of health, social and special education settings, including:

1. Disability settings. Music therapy is appropriate for a wide range of disabilities, both physical and intellectual. Here are some specific areas that music therapy can address:
   • Intellectual disability. Music therapy can develop communication skills, develop self-confidence and strengthen feelings of identity through group play and song creation.
   • Learning difficulties. Music is an accessible medium that allows clients to feel comfortable expressing themselves and communicating thoughts and feelings.
   • Cerebral Palsy. Music provides a voice to those with none and helps with vocal work for those with limited speaking ability.
   • Autism. People with autism often have difficulties with social interaction and processing their emotions. Music therapy can address these areas by offering clients a supportive space in which to express, identify and deal with their emotions through shared musical play, vocalising and sensory stimulation.
2. Mental health settings. Music therapy helps to explore personal feelings, make positive changes in mood and emotional states, have a sense of control over life through successful experiences, practice problem solving and resolve conflicts leading to stronger family and peer relationships.
3. Hospital and rehabilitation settings. Music therapy helps to alleviate pain in conjunction with anaesthesia or pain medication, elevate patients' mood and counteract depression, promote movement for physical rehabilitation, counteract apprehension or fear and lessen muscle tension for the purpose of relaxation.
4. Nursing homes and care services for older adults. Music therapy helps to increase or maintain physical, mental and social/emotional functioning. The sensory and intellectual stimulation of music can help maintain a person's quality of life.
5. Palliative care settings and hospices for both adults and children. Music therapy benefits people at the end of life by promoting relaxation, pain control and a sense of well-being, as well as by acknowledging and celebrating life, stimulating meaningful memories, bringing loved ones together and supporting emotional and spiritual expression.
6. Schools.
   • Mainstream schools. Working with children with special needs in mainstream schools, individual music therapy can help address feelings of isolation by identifying emotions through improvised musical play, develop communication skills by talking/thinking about the music they improvise, improve physical co-ordination through instrument play and develop social interaction skills through group music therapy.
   • Special schools. In special schools, individual and group music therapy can address communication, social, emotional and physical needs. For example, a child who finds social interaction difficult may find it much easier when there is a ‘social buffer’ – such as music – provided, and communication and social skills are developed through shared musical play.

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How does music therapy work?

Music therapy can be done in both group and individual settings, and the process generally involves the following elements:

Referral. People are referred by their parent, carer, guardian, social worker, key worker, GP, teacher or psychologist. Sometimes a person may refer him/herself.

Assessment. Following referral, there are generally three assessment music therapy sessions. Although in all respects these are ‘normal’ sessions, they are also an opportunity for the therapist to assess client responses within a variety of contexts:

• Communication skills
• Social skills
• Emotional needs
• Psychological needs
• Physical ability

Goals and Objectives. Following assessment, a set of goals and objectives is drawn up for the period of music therapy. The goals state the overall goals for the therapy, and the objectives are the steps the music therapist and client will take in order to achieve these goals.

Report/Evaluation/Recommendations. Following the designated period of therapy, the music therapist will report on the developments made by the client, evaluate the therapy and recommend future possible interventions for the client and perhaps a further period of music therapy. Reports are given to the client, to the person who referred them and to other relevant parties. All reports are kept strictly confidential.

Here is an example (not a real case):

Background. Edward is a 27 year old man with a physical and mental disability. He leads a very full, independent life but has recently been feeling isolated, blocking out family and not attending social events. Edward is verbal but does not use his voice often, and this is something that needs to be focused on in therapy. As he has a great love of music, it was felt that music therapy may help him to address his social/communication issues.

Goals.

1. To use music therapy to re-connect Edward with himself and develop his self confidence through developing a concrete document of his musical preferences and exploring how he uses music in his daily life.
2. To increase Edward’s use of his voice through song-singing and lyric discussion
3. To maintain Edward’s hand function through instrument play (e.g. bodhran, maracas, bells)

Objectives.

1. Create a song list of Edward's twelve favourite songs.
2. Record Edward singing/playing these songs with guitar accompaniment and support from the music therapist.
3. Talk about each song chosen with Edward, including the reason(s) for his choice and what the song means to him.
4. Create a personal CD for Edward with these recordings.

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What techniques/approaches are used in music therapy?

Music therapists can use a range of techniques according to the needs and preferences of the individuals with whom they work. These techniques include, but are not limited to, the following:

Singing/Vocalising helps to develop articulation, rhythm and breath control. Singing/vocalising in a group setting can improve social skills and foster a greater awareness of others. For those with dementia, singing known songs can encourage reminiscence and discussions of the past, while reducing anxiety and fear. For individuals with compromised breathing, singing/vocalising can improve oxygen saturation rates. For individuals who have difficulty speaking following a stroke, music may stimulate the language centres in the brain. For non-verbal individuals, the therapist ‘supports’ the sounds the client makes with piano, guitar or singing, giving the client the sense that he/she is being listened to and helping to develop a sense of personal identity.

Rhythmic activities can be used to facilitate and improve an individual's range of motion, joint mobility/agility/strength, balance, coordination, gait consistency and relaxation. Rhythm and beat are important for the motor areas of the brain, in regulating autonomic processes such as breathing and heart rate and in maintaining motivation or activity level.

Playing instruments can improve gross and fine motor coordination in individuals with motor impairments or neurological trauma related to a stroke, head injury or a disease process. Instrumental ensembles can enhance cooperation, attention, and can provide opportunities for practicing various leadership-participant roles. Common instruments used by music therapists in a session are piano, guitar and percussion instruments. Common instruments used by clients are by their nature ‘accessible’ instruments that anyone can play and for which there is no previous musical training required (for example, xylophones, maracas, bells, bodhráns, ocean drums and tambourines).

Improvising offers a creative, nonverbal means of expressing thoughts and feelings. It is non-judgmental, easily approached and requires no previous musical training. As such, it helps the therapist to establish a three-way relationship among the client, themselves and the music. Where words fail or emotions are too hard to express, music can fill the void. Where trust and interaction with others has been comprised due to abuse or neglect, improvisation provides a safe opportunity for restoration of meaningful interpersonal contact.

Songwriting is used to facilitate the sharing of feelings, ideas and experiences. For example, with hospitalised children, it is a means of expressing and understanding fears. For people with a terminal illness, it is a vehicle for examining feelings about the meaning in life and death. It may also provide an opportunity for creating a legacy or a shared experience with a caregiver, child or loved one. Finally, lyric discussion and songwriting can help adolescents deal with painful memories, trauma, abuse, or to express feelings and thoughts that are normally socially unacceptable.

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