Evidence-Based Practice: Music Therapy

Evidence-Based practice-Music Therapy

Music therapy is defined as “a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change.” (Bruscia). Wilber’s quadrants breaks down major psychological theories and music therapy models into four quadrants (Abrams). These areas are the individual interior, individual exterior, collective interior, and the collective exterior (Abrams). The individual internal focuses on the therapeutic goals and the inner psychological process of the client (Dr. A. Meadows, personal communication, Sept 2014). The individual exterior focuses on skills and behaviors where the goals

are educational and learning based (Dr. A. Meadows, personal communication, Sept 2014). The collective interior is the collective belief and values of groups of people typically community based (Dr. A. Meadows, personal communication, Sept 2014). The collective exterior is systems oriented where the focus is on the human body as well as behaviors as they apply to all people.

In the middle is aesthetic and spiritual which incorporates traits from each quadrant (Dr. A. Meadows, personal communication, Sept 2014). Evidence-based practice (EBP) of music therapy covers many perspectives depending on which the practice is based, either biomedical, cognitive-behavioral, psychodynamic, music-centered, and holistic oriented (Abrams). Music therapy has a multitude of uses, it provides emotional support, promotes relaxation, improves mood, reduces anxiety, and provides support for medical procedures. Two important areas in music therapy are the ISO principle and entrainment. The ISO principle is when the therapist attempts to match the emotional state or feelings of the client or patient (topangamusictherapy.wordpress.com). This is done through using various percussion instruments, piano, guitar, or improvised vocalization (topangamusictherapy.wordpress.com). By meeting the client or patient is still able to feel what they are currently feeling, but it becomes possible to redirect them into a more productive directive (topangamusictherapy.wordpress.com). Entrainment occurs when two objects that resonate at similar

frequency sync and vibrate at the same frequency (Harer). In music therapy entrainment can be used to help facilitate a state of relaxation, cue Parkinson’s patients to take steps, and help motor control in individuals with autism (Clayton). It is important that the music be at or below resting heart rate (< 80 beats per minute), have predictable dynamics, rhythms without sudden changes, fluid melodic movement, and have a pleasing harmony (Harer).
Music Therapy and Autism
Music therapy is a valuable tool in addressing language and communication skills, cognitive skills, and behavior skills in children with autism (music in sped book). Through music, a child with ASD can be provided structure, sensory input, and is able to be engaged in ways that might not be reachable in other modalities. A session can include the child listening, singing, playing, moving, and provide opportunities for them to respond both verbally and nonverbally (music in sped book). Some children can be more responsive to a music stimuli, music is flexible and can be a highly motivating medium (intro to MT book). Specific goals, such as motor skills, attention, communication skills, and social skills, can be addressed in songs, playing instruments, and being in a group setting. With children with ASD, music therapy addresses these non-music goals using music-based interventions (autismspeaks.org). ASD prevents the processing and understanding of language and issues with detecting emotions, because music is processed in different parts of the brain the child can processes their emotions through the music and not spoken words (allpsychologycareers.com).
Music Therapy and Mental Health
The use of music therapy in a mental health setting provides structured support with interactions, helps manage symptoms, and express their feelings (Edwards).

Interventions used in the treatment of mental disorder are divided into 3 levels and meet the various needs of the patient (MT and mental health book ch 3). The first level being supportive, activity oriented music therapy, the therapeutic focus is on the here and now, reactions, behaviors, skills, and is generally success-oriented and structured (MT and mental health book ch 4). Interventions would typically be small group ensembles, group singing, and drum circles. The second level is insight music therapy with re-educative goals, here the music is used to stimulate verbalization while gaining insight through discussion (MT and mental health book ch 5). Interventions at this level would include, lyric analysis or song discussion. The third level is insight music therapy with re-constructive goals, the experiences are used to uncover, relieve, or resolve conflicts at the subconscious level (MT and mental health book ch 6). Interventions used would be visualization to music, Guided Imagery and Music (GIM), and analytical music therapy. A session can have elements from each level, starting with an opening drumming activity/drum circle, transitioning into a lyric analysis/song discussion, visualizing of negative and positive feeling, and finally closing with another drumming activity. The questions used in the

song discussion are open ended which requires the patient to respond with more than just a yes or no. Music therapy in this setting provides patients a space where they are able to express themselves, that is safe, free from judgement, and requiring minimal verbal communication (Halligan).
Analysis
In some ways the thinking behind each session, either children with autism or adult inpatient mental health, is similar to that of the universal design for learning (UDL). Sessions with 3-4 year olds with autism is usually didactic in nature, and lends well to the guidelines of the UDL. When planning a session for children with autism, activities are chosen to allow the most opportunities for engagement, and are structured to have the client be as successful as possible. Visuals and manipulative are valuable tool to utilize in sessions. The client is able to reach out and choose the leaf that corresponds to the color in the song, flip the pages or point out certain animals in a book, or play a shaker egg or drum when cued. When using live music over recorded music, the tempo, rhythm, and dynamics can be altered. This makes it possible to easily modify the activity to match the energy of the child, or create spaces for a response.
Music therapy sessions with adult inpatient mental health still contains the basic idea of the UDL. In sessions, interventions are planned with specific goals in mind to most benefit the patient. Since some if not most patients are medicated, getting them to actively play as soon as possible with limited verbal explanation is one of the best was to get them engaged in the music. Again altering tempo, rhythms, and dynamics, increases awareness, attention, and provides variations in the session. Sessions are typically structured in either a bell curve, or reverse bell curve depending on where the group currently is and where we want them to be heading. During each intervention the group is giving multiple ways to respond, either verbally, though solos in the music, and even by writing/drawing. Having them write/draw their answers still lets them participate, and afterwards they have the option to share if they would like.
Autism and mental health sessions do share similarities with each other but are also vastly different. The theory behind each session is the same and they follow the same general structure. However, the internal structure differs and is tailored to the specific population. They both include activities/interventions that focus on certain goals, and follow the bell curve structure. The type of music used is individualized based on age, ability, and general need at that time. With the ASD group, there are objectives that are measured based off the goals, and with the mental health group there are no objectives. Activities with the children are kept short, simple, and are repetitious so the group can be as successful as possible. Interventions with the adults are reflective, touch on challenging topics, and requires the facilitator to also get into the same emotional space as the group.
Moving forward to future work, the theories of the UDL could be relevant.