Music Therapy Defined
The term, "Music Therapy," refers to the prescribed use of music and music-related activities under the supervision of qualified personnel to assist a client (patient or student) to achieve a definite therapeutic goal.1 The crucial words in this definition are "prescription," "music," "client" (patient or student), "qualified personnel," and "therapeutic goal." A brief discussion of each of these terms will assist in defining the profession.
The Prescription. Music therapists frequently work directly with physicians and other members of medical teams. When such is the case, it is necessary for the music therapist and the other health specialists to administer their services according to previously agreed upon specifications so that all concerned are working in support of each other for the client's good. When music therapy is practiced in medical settings, prescriptions should be written and signed by the physician in charge. There are other occasions where the prescription or treatment plan is arrived at by consensus and not formally written. This procedure is not uncommon in special education and other settings which are primarily nonmedical.
Music Activity. The primary means of therapy in music therapy is, obviously, through music. Almost any situation developed around music and musical ideas can be used as therapy. The music therapist is aware that he is not a psychotherapist and, consequently, attempts not to involve the client in extended conversations of any type. The purpose of the music therapy session is to assist the patient to feel and to behave better through the learning and expressive experiences of performing, composing, listening, discussion, and movement to music.
The Client. The recipient of music therapy can be a patient, client, or student receiving services in any sort of helping-services setting. These settings vary from special education classrooms to state mental hospitals and from pediatrics wards to homes or wards for geriatric patients. It is because music can be employed in so many ways that it is as effective as it is in therapy. There is some form of music which can be effective in eliciting positive responses from practically every human being. It is the job of qualified personnel to plan and develop the most beneficial kind of music experience for each of his clients.
Qualified Personnel. The qualified personnel mentioned in the music therapy definition are music therapists whose training and experience have earned them a place in the national registry maintained by the National Association for Music Therapy, Inc. The procedures for becoming registered shall be discussed later in this article.
The Therapeutic Goal. Just what is to be done for the client through music is usually determined by a staff of health specialists. The goal almost always has something to do with better or more sociable behavior. The therapeutic goal of the music therapist for the client is not unlike the goal of the other health professionals. The difference lies in the music therapist's use of music to obtain this goal.
How he uses music reflects the prevailing attitude toward disability in which the music therapist finds himself. Disabilities in psychiatric settings are viewed differently from disabilities in rehabilitation centers or in special education classrooms. Whatever the setting, the music therapist—now and historically—has used music in a manner consistent with civilization's attitudes towards disability and disease. The following brief treatment of music and medicine from primitive times will help to explain how contemporary music therapy finds itself compatible with today's scientific approach to dealing with human disabilities.
A Brief History of Music and Medicine
A study of contemporary primordial cultures reveals a combination of music and medicine in the treatment of disease. Anthropologists inform us that this use of music and medicine in combination to treat the ill probably dates from the earliest tribes of Homo sapiens.
These studies reveal that from the time of the earliest man through the Hellenic Greeks, music was considered to be an expression of harmony in the universe. The sick tribesman was treated by the tribal shaman's healing songs and dances performed to restore the ill to harmony with nature by exorcising evil spirits or by calling upon beneficent ones. In ancient Greece, music was held essential in the child's education to develop a harmonious character. Music also served as a means of bringing about catharsis, the purging release of emotions. Pythagoras was the first to organize the Greek beliefs about the curative powers of music into a philosophic system. Music and diet were his means of cleansing the soul to maintain its harmony and health of mind and body.
The close association of music and medicine is exemplified in Rome in 430 B.C. when the first of its many temples to Apollo was built. In this single godhead were embodied the power to cure (Apollo Iatromantis) and the power of music (Apollo musagetes). The palliative effect of music was also recognized by the Etruscans, who flogged their slaves to the sound of flutes to soften the pain. In the great days of Arabic medicine, the music of flutes combined with the sound of tinkling fountains was joined to medical treatment in the care of the sick.
In Christian Europe, music and medicine were linked when the Church took over the care of the sick and used the chanting of prayers as a means of therapy. During the 9th and 10th Centuries both a secular music and a secular medicine began to germinate outside the Church. While a program for training physicians was being started at Salerno, people started making their own music, dancing to lively rhythms, and singing ballads.
In the 13th century, these new voices in both music and medicine drew together in the characteristic music of the Middle Ages: in the burgeoning university medical schools, physician-teachers began to approach medicine as science rather than a mystery, making the first efforts at investigation and dissection; in the marketplace, the people were turning simple songs into canons; in the feudal courts, the troubadours and minstrels were developing new musical elaborations of epic tale and love lyric. When a great personage of the day was purged, bled or treated for disease, the court musician composed a song in commemoration of the event.
Even as the simple canon evolved into the beginnings of polyphony, music remained an anonymous, collective art. Disease was also collective: people shared the common terror, pain, and death of successive epidemics. Music and medicine were thrown closely together in the wake of the Black Death of 1348, when hordes of people roamed through town and countryside in the grip of flagellation and dancing manias; when the dance mania broke out in a town, not the physicians but the musicians were called, in the belief that only dancing could cure the illness.
During the Renaissance, musicians and physicians revived the Greek concept of medical and musical theory as being linked to the four humors of Hippocrates and the four elements of the cosmos. It was generally agreed that both good health and good music depended on the right balance of these elements. The Greek philosophers' theories of the power of music were also revived. The well known military surgeon, Ambroise Paré, recommended music for spider bites, sciatica, and gout. Against the pestilences of the time, the enjoyment of music was medically recommended as a remedy for the "accidents of the soul" such as anger, sorrow, worry, excessive cogitation that would open the way to disease.
Music as a relief from Melancholy. The English author, Robert Burton (1577-1640) prescribed music to exhilarate a patient in depression:
. . . Musick is a roaring meg against melancholy, to rear and revive the languishing soul, affecting not only the ears, but the very arteries, the vital and animal spirits; it erects the mind, and makes it nimble.
Music as a cure for a spider's bite. A 17th-century cure for a spider's bite was reported by a German scholar, Athanasius Kircher (1601-80):
. . . He who is bitten by this tarantula spider can only be cured by music and dancing. Melancholic people or those who have been bitten by a tarantula, filled with an especially great amount of poison, are cured by loud and sounding drums and tympani or other similar instruments rather than by more subtle ones. . . . Choleric and bilious people and those rich in blood, are more easily cured by cytharas, violins, lutes, harpsichords and other sweetly sounding instruments. . . .2
England and America. An early advocate of music therapy was the English Physician, Richard Brocklesby (1722-97). He makes reference to Cato's belief that luxated joints were eased by the harmony of sounds.
In the United States the well-known pianist-composer Louis Gottschalk (1829-69) began to include performing in insane asylums in his concert schedule. He, like others of his times in America and Europe, believed in the tranquilizing effect of music upon the mentally ill.
It was not until 1878 that the long-held idea that music functioned as a tranquilizer was first tested medically when a half hour of piano music was played to 1400 psychotic patients in a New York City asylum. The results of the experiment were inconclusive but unquestionably led to a more receptive attitude toward the use of music in therapy and to the organization of music therapists in the greater New York area at the turn of the century.
Through the 18th century there was a close affinity between music and medicine, and it was not until shortly after this point in history that the two disciplines became clearly separated. Medicine moved more in the direction of science, while music became more identified as an art. From this time to the present, there has never been a total divergence in the two disciplines; however, music was relegated to more specific kinds of treatment rather than as common practice in medicine.
Contemporary Music Therapy. Other organizations concerned with music therapy were formed mainly in the eastern part of the United States. Some individuals stand out as being instrumental in the growth of music therapy through the 1920's and 1930's. Isa Maud Ilsen saw a need for organization and formed the National Association for Music in Hospitals in 1926. Harriet Ayer Seymour founded the National Foundation for Music Therapy in 1941. Previous to that time, Mrs. Seymour was able to make significant contributions to the field of music therapy in her capacity as Chairman of the Hospital Music Committee of the State Charities Aid Association. Apparently, this organization received some funding through the Federal Music Project of the WPA. In her leadership capacity, she was directly responsible for bringing live music to many patients in hospitals in the New York area.
The most influential figure between the two world wars in the field of music therapy was Willem Van de Wall, who at one time had a professional music career that included membership in the Metropolitan Opera House Orchestra, the New York Symphony, and the Marine Band during World War I. As a result of his efforts, the first comprehensive music therapy program was established at the Allentown State Hospital for Mental Diseases. This program became a prototype for State Hospital music therapy programs throughout the United States. Van de Wall lectured in music therapy between 1925 and 1932 at Teachers College, Columbia University.
Degree Programs for Music Therapists. Although courses in music therapy had been taught at Columbia University, the first degree program was introduced at Michigan State College in 1944 under the direction of professor Roy Underwood. In 1946, Professor E. Thayer Gaston of the University of Kansas introduced a graduate program in "functional music" to prepare music therapists on the Master's Degree level. By the year 1950 there was a total of five college programs in music therapy offering undergraduate and graduate study.
A problem with all of the early curricular programs was in determining what should be taught and, more specifically, what a graduate from a music therapy program should know. There was very little agreement among the first five universities and colleges offering degree programs.
There was perhaps even less agreement between the professors and clinicians as to how a music therapist should function. In an effort to establish better communication between clinics and colleges and among colleges, interested individuals from academic and clinical settings arranged a series of conferences and meetings to discuss music therapy. In 1948, the Conference on Functional Music was held in Boston. The next year, 1949, saw a similar meeting held in Chicago. The information assimilated in these early meetings provided a basis for much that was taught in the first music therapy courses. The need for more information still existed, however, and in June of 1950, the Committee on Music Therapy of the Music Teachers National Association reorganized itself under the name of The National Association for Music Therapy (NAMT). Since that time, it has been the purpose of this organization to organize information, structure curricula, encourage research, and to exert general leadership in the profession.
The Core Curriculum. The Education Committee of NAMT presented a core curriculum to the membership of the organization on November 1, 1952. The Approved Curriculum was designed to reflect "the ideal program" rather than following any curriculum in existence at that time. The required courses for a baccalaureate degree in music therapy were presented as follows:
|MUSIC THERAPY||a minimum of 10 sem. hrs.|
|Psychology of Music||4|
|Influence of Music on Behavior/Music in Therapy||4-6|
|Therapy Orientation (course and/or clinical)||0-2|
|Internship in Music Therapy (credit or no credit)|
|PSYCHOLOGY OR EDUCATIONAL PSYCHOLOGY||10-12 sem. hrs.|
|The following courses must be taken:|
|Selections from the following are recommended:|
|Psychology of Exceptional Children|
|Survey of Special Education|
|SOCIOLOGY AND ANTHROPOLOGY||6-8 sem. hrs.|
|At least one course in Sociology or Anthropology. Other courses to be selected with assistance of the advisor. Selections from the following are recommended:|
|Delinquent and Normal Behavior|
|Culture and Personality|
|Culturally Learned Behavior of American Minority Groups|
|MUSIC||60 sem. hrs.|
|Basic Theory. Two years, to include Rhythmic and Melodic Dictation, Sight Singing, Keyboard Harmony, and Harmony.|
|Music Literature. History of Music, one year.|
|Applied Music. Proficiency in voice or instrument of student's specialty is highly recommended.|
|Piano. Great stress is placed on sight playing, accompanying, transposition, improvising and playing by ear.|
|Voice. Preferably class voice, which should include vocal methods.|
|Orchestral and Band Instruments. Instruction and experience in the various families of instruments—Brass, Woodwinds, Strings, and Percussion—recommended.|
|Conducting. Vocal and/or instrumental ensembles.|
|Arranging. Basic work in arranging and adapting for small groups of instruments and vocal combinations.|
|Recreational Music. Guitar and other non-symphonic instruments; rhythm instruments both for children and for adults.|
|Ensembles. Two years recommended.|
|GENERAL EDUCATION||30 sem. hrs.|
|This allows for specific requirements of various institutions in Liberal Arts and Sciences. Examples of courses generally included in this group are:|
|English and Speech (activities in Drama strongly recommended)|
|Natural Sciences and Mathematics (Biology, Anatomy, Physiology recommended)|
|Physical Education (some emphasis on dance through credit or noncredit courses recommended.)|
|GENERAL ELECTIVES||6 sem. hrs.|
|Total (approximately)||128 sem. hrs.|
Clinical Experience. When the core curriculum was adopted by NAMT, there was still considerable disagreement as to the kind and amount of internships that a music therapy student should have. In 1957 a committee was assigned to study the problem and in 1960 the association adopted the idea of a six-month internship to be accomplished in certain hospitals to be approved by NAMT. Upon completion of a four-year music therapy curriculum (or its equivalent) and a six-month internship, a graduate in music therapy could apply for entry into the national registry established by NAMT in January of 1960.3 When admitted to the national registry the individual received the designation, Registered Music Therapist (R.M.T.) and may be accorded special classification within NAMT.
Differing Views on the Music Therapy Curriculum. The adoption of a uniform curriculum was a great step toward unification and development of the discipline of music therapy. Most music therapists who complete degree programs in the twenty-six universities now offering baccalaureate programs in music therapy have read the same books and articles and have had similar laboratory and field experiences. Since neither the practice nor the study of music therapy comprises a coherent discipline, one still finds considerable disagreement from college to college and from clinic to clinic as to how music therapy should be taught and practiced. This disagreement stems from the relative newness of music therapy as a modern treatment modality and from differing philosophical persuasions held by professors and practitioners. The relative newness of the field has caused difficulty in establishing the identity of the music therapist over the past two decades. Robert F. Unkefer refers to this difficulty in the following:
. . . music therapy has passed through three periods or stages in the past twenty-five years: First much emphasis was placed on music without recognizing the important role of the therapist. Second, the therapist tended to disregard music in favor of developing a one-to-one relationship with the patient. Third, a position between these two extremes has been adopted. The therapist uses his specialty to focus the relationship with the patient and moves in the desired direction at the most suitable rate in both the activity and the relationship.4
The existing music therapy education programs are still divided upon whether emphasis should be placed upon preparing the individual as a therapist more or less than as a musician. A view against extended concentration upon "applied performance and prestige musicianship" seems to have been held by Madsen in favor of developing the researcher-therapist.5 There are a significant number of professors and clinicians who share this thinking. Others tend to take the view that the better the musician (as performer, conductor, and arranger), the greater his potential for becoming an effective music therapist.6 The latter is probably the older but not necessarily the more commonly held view.
Behavioral Objectives of the Music Therapy Curriculum
Although music therapy curricula in the various colleges and universities do differ, there is a general consensus about certain minimum competencies of the graduates of any of these curricula. It should be understood that many, if not all, of the schools might exceed these levels in one or all areas.
The graduate of an NAMT-approved baccalaureate program should be able to:
1) show at least college junior-level proficiency in some area of musical performance;
2) play piano accompaniments to singing or playing groups performing folk music or marches;
3) use the singing voice effectively in solo or ensemble singing;
4) direct vocal and instrumental ensembles in music of medium difficulty;
5) demonstrate facility in the use and teaching of social or classroom instruments;
6) demonstrate advanced accompaniment techniques on the guitar and other fretted instruments;
7) arrange music for a variety of instrumental, vocal, or mixed performance groups;
8) demonstrate familiarity with the traditional and current literature of his performance area;
9) give evidence of some knowledge of the history and function of music in a variety of subcultures in Western society, particularly in the U.S.;
10) translate medical, psychological, or educational prescriptions for any individual or group of clients into musical experiences;
11) design musical experiences to bring about improved behavior consistent with medical, psychological, or educational goals;
12) use medical, psychological, or educational terminology (whichever is appropriate) to report any behavior changes brought about through music therapy;
13) participate in basic research in music therapy.
It is also highly desirable but less critical than the above that the graduate of a music therapy program be able to:
14) function as a music leader in recreational music activities;
15) organize and lead dance therapy sessions;
16) plan, organize and carry out research in music therapy;
17) function as a therapist in other primarily non-music services.
It should be repeated that the above are minimal standards for those having completed baccalaureate programs including a six-month internship in music therapy. These standards are frequently exceeded by schools offering the music therapy major.
Graduate programs differ considerably in their course offerings and expectations of students. Generally, there is a greater concentration upon research and a tendency to concentrate upon study in music therapy for one or two areas of exceptionality rather than the entire field of possibilities.
There are music therapists employed in every state in the union and in foreign countries. Most of these are not registered music therapists (NAMT lists some 2000 members approximately half of whom are registered). Presently, there is no universally accepted standard for music therapists, although NAMT is dedicated to bringing such standards about. Because there are no universal standards, many music therapists are employed as recreation leaders, occupational therapists, bandmasters, and under other titles. These music therapists usually do not have benefit of four-year music therapy training programs but ordinarily do have some sort of a music degree. One of the goals of NAMT is to establish job descriptions and standards for conduct of music therapists which, when adopted by the various states, would in the near future lead to the employment of only registered music therapists.
Currently, music therapists are found in a great variety of medical, educational, and social service agencies. The greatest number of music therapists are found in mental retardation and mental illness settings. Others are found working with the hearing impaired, the visually impaired, the crippled, the learning disabled, and the geriatric. Many music therapists are employed to work in nursing homes, special education classrooms, camps, recreation centers, and churches. There are a few music therapists in private practice who work with patients on referral from physicians.
Availability of Music Therapy Positions. There are presently more music therapy positions in the United States than there are music therapists. The trend has been for more positions to materialize whenever a college or university begins to prepare music therapists in a geographic area which has not previously seen music therapists. Consequently, as more and more universities begin to offer the music therapy major, the helping service agencies in the general vicinity of the university begin to create music therapy positions where none existed previously. This pattern has been repeated time and time again in various parts of the country. The agencies which create music therapy positions usually also provide positions for the music therapy internship required as part of the baccalaureate experience.
The job market for music therapists will become tighter in the not too distant future, perhaps in the early 1980's. For now, however, there is still a growing need for qualified (registered) music therapists in all parts of the country.
1L.C. Muskatevc, "The Role of Music Therapy in the Clinical Setting," Music Therapy (Lawrence, Kansas, 1961), p. 42.
2Paul Nettl, ed., The Book of Musical Documents (New York, 1948), pp. 67-68.
3Music Therapists who had been practicing prior to 1960 could qualify for registration by NAMT if they met certain experimental requirements. This means of "special registration" was again made available for certain outstanding music therapists between October, 1971, and March, 1974. At this time one must complete a course of study in an NAMT approved college or university as well as an approved internship in order to qualify for registration by NAMT.
4"Introduction," Music in Therapy, ed. by E. Thayer (New York, 1968), pp. 3-4.
5Clifford K. Madson, "A New Music Therapy Curriculum," Journal of Music Therapy, II, 3 (Sept. 1965), p. 83.
6R.M. Graham, "Guest Editorial," Journal of Music Therapy X, 4 (Winter, 1973), pp. i-ii.