Therapy of real note

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How music can make a major difference to troubled lives

I have worked as a music therapist for the past 30 years, using music as a means towards a non-musical end. In the early 1980s, I was one of only around 70 music therapists in the country; now, music therapy is a registered profession within the Health Professions Council with an established career structure. There are around 700 music therapists working in all areas of learning disabilities and psychiatry, as well as in neurological hospitals, with the elderly, in hospices and in prisons. The main employers of music therapists are NHS trusts, local education authorities and charities.

There are seven different two-year postgraduate music therapy courses in the country. The majority of students are music graduates, but people from a wide variety of backgrounds and with a range of experience can become music therapists, if they have sufficient music expertise and have some clinical experience.

In this article, I will try to demonstrate, by looking at specific cases, what music therapy involves, why it works and which conditions it is most useful for.

What is music therapy?

Let me begin with an example. I could be working with a primary school aged girl with severe learning difficulties who is passive and withdrawn. We would sit together at the piano with a large drum next to her. I might gently lift one of her hands and let it fall on the drum. I would then pick up that beat with a chord on the piano, and then repeat the procedure, responding with a different chord. The girl may develop an interest in the sounds I am making and then be motivated to tap the drum on her own, perhaps anticipating my response on the piano.

Music therapy can help children become more communicative.The aim here is to engage the young girl and draw her out of her isolation. The means is a basic improvised exchange between the piano and the drum. In my work with children I work in an active way, allowing myself to be inspired by what the children do. I use mainly live, improvised music, inviting the children to take part on a wide range of simple percussion, string and wind instruments. I respond to their music-making, joining in with the children, singing or playing the piano, the guitar or the clarinet.

A specific case is that of three-year-old Lenny (not his real name) who walks into the music therapy room tentatively, having checked that his mother is following him in. He then spontaneously sits down on a special small chair next to his mum. She looks at me and smiles; this is the first time since he started coming to see me for weekly sessions six weeks ago that he has anticipated the music-making through sitting down.

Lenny has a diagnosis of autistic spectrum disorder (ASD). He often appears to be in his own world and sometimes wanders around going over a set path in a repetitive way. He understands language quite well and uses a few words. He doesn’t like being directed and can get very upset by small changes in routine.

I sit down opposite Lenny and his mum with my guitar and sing the “Hello” song. Lenny looks at me and smiles, recognising the song he has heard every week. Then he joins in by strumming himself. I accompany his strumming by moving into an improvised pentatonic vocalisation to match the open strings of the guitar. To maintain his interest I insert a vocal descending glissando (gliding from one note to a lower note) accompanied by a downwards hand movement. This turns into a game where we try to catch each other’s hand as it taps the body of the guitar. Lenny giggles and holds out his hand to his mum. His mum tickles his hand and sings “Incy Wincy Spider” with him, which I accompany on the guitar.

Later in the session, I offer Lenny and his mum reed horns. He marches around the room playing short staccato notes. When he stops to take a breath, I match both his style of playing and movements by playing the clarinet and marching with him. The next time Lenny stops playing, he looks up at me expecting a response. I answer on my clarinet and we have a short reed horn and clarinet turn-taking exchange which Lenny’s mum joins in with.

After the music therapy session is over, Lenny plays with some toys while his mum and I review the session. We are both excited about how much more communicative and confident Lenny has become. We discuss how the predictable structure of the session, as well as particular musical phrases, seem to have reassured him and enabled him to trust me. His mum is also particularly pleased that he will now approach her at home and indicate that she should sing him various action songs.

The following week I show a group of university music therapy students DVD excerpts of this session with Lenny. We reflect on how, with many children with ASD, the music-making initially motivates children to become engaged. The music therapist then has to strike just the right balance between following the child and initiating his/her own musical material.

The act of teaching students means that I have to be clear about how and why I work in the ways that I do, and my clinical work continuously inspires my teaching.

Group working

On another occasion, I work with a group of five children between the ages of seven and 12. A psychiatric nurse and a music therapy student also take part in the session. The children have a variety of complex difficulties, including Asperger’s syndrome, attention deficit disorder, mild learning disabilities, anorexia, obsessive compulsive disorder and post-traumatic stress disorder.

I lead a group improvisation from the piano. After we have played together a little, I try to pick up on individual children’s style of playing by encouraging them to have solos which I support from the piano while the other children listen. The non-verbal aspects of the musical exchanges, as well as the fact that adults and children have equal roles, seem particularly important here. I often observe strengths in the music therapy groups which the children have not shown on other parts of the programme.

As we have seen, the role of the music therapist is necessarily very varied, but whatever techniques are employed, the aim is usually the same: to draw children and young people out of their locked-in worlds and to help them communicate in ways which can ultimately enhance their development and improve their wellbeing.

Further information

Dr Amelia Oldfield works as a clinical music therapist at the Croft Unit for Child and Family Psychiatry in Cambridge and is Senior Lecturer in Music Therapy at Anglia Ruskin University:
www.anglia.ac.uk/music

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