Four years ago Richard Graham described the field of music therapy for COLLEGE MUSIC SYMPOSIUM readers, basing his article on the "official" definition of music therapy as given by the National Association for Music Therapy, Inc. (Graham, 1974). He elaborated on the definition, taking its elements of music, therapy, therapist, and the goals of music therapy to several interesting and illustrative ends. He also traced the history of music therapy, described the current job opportunities, and listed educational requirements for music therapists. Graham has just completed a two-year term as national president of NAMT and would need to make several changes to up-date his 1974 article. The writer served a term as national president seventeen years ago (1959-61) and from that perspective can note even greater changes in the development of the field. It will be the purpose of this article to attempt to give a current picture of the field from some perspectives in its development over the past 30 years, but the field is apparently developing at such a pace that this article may be out of date in some respects at the time of its publication! In an article written only two years ago, for example, there would be some necessary changes (Michel, 1977). At the time that article was written (in 1976, published in 1977) there were forty-four approved schools offering music therapy; today, there are fifty-five schools approved by NAMT/NASM (at last count, that is!).
If music therapy's time has not yet arrived, it would seem from this kind of development that it is well on its way. For one thing, there seems to be less need to explain what music therapy is . . . or at least, so it seems to the writer. Nevertheless, music therapy students in those fifty-five schools across the country (as well as in training programs in several other countries around the world) continue to be very enthusiastic about their chosen field. In some places they wear (and sell) t-shirts and buttons with such slogans as "Music Therapy—Healthy Vibrations." The latter is also the title of a song written by students and sung almost as a patriotic hymn at their club meetings. These students may still be encountering a lack of understanding about their field when they meet potential employers or friends, but they seem eager to explain. Perhaps this need to explain the field has been a positive factor in its development; i.e., if it still needs defining there may be a need to continue examining exactly what music therapy is, what it does, and how effective it is. Certainly the profession has developed a respectable bibliography of research and clinical reports which are published, not only in the NAMT's Journal of Music Therapy, but in many other respected professional journals. In 1976 Music Therapy celebrated the USA Bicentennial with the publication of its first comprehensive index (Music Therapy Index, Chas. T. Eagle, ed.) and plans are being realized to up-date this first index with an even more comprehensive coverage of research studies. Gradually, more books are being written and published in the field. All of this would seem to be indicative of the validity of the music therapy "movement." (But the writer seems to have fallen into justifying music therapy while claiming it needs less justification!)
For those who have not yet completely conceptualized just what music therapy is all about, it may be helpful to view it primarily as a type of activity therapy, similar in some ways to other activity therapies like Occupational Therapy, Therapeutic Recreation, Dance Therapy, and Art Therapy. Indeed, music therapy is sometimes grouped with the "Creative Arts Therapies," and while this grouping is welcomed by music therapists to some extent, there is also a feeling that music therapy is in a more advanced stage of professional development than are some in this group, and that it is unique from any other type of therapy—just as music is a unique activity of mankind. As an activity therapy, music therapy focuses on human behavior, and this places music therapists alongside many other types of behavior scientists. Such an identity extends our relationship to psychologists, special educators, and social workers. While therapy—any kind of therapy—is recognized as ultimately being an "art" in practice, this is a far cry from considering music therapy only an art because of the status of music as an art (Michel, 1976). It is primarily a behavior science. Thus, music therapists come from a quite different orientation and training than other music professionals, including music educators. They also come from a different orientation and training than any other therapist, activity or behavioral, in that they make use of the art of music.
Despite the fact that many more persons now understand more about what music therapy is, a brief look at some of the theory, research, and practice of music therapy seems in order. As stated before, music therapy is different from other music professions primarily because music is viewed not as an end in itself but as a means to other ends, mostly outside of music. These ends are the goals of all therapy or special education, i.e., directed toward alleviating the discomforts and pain of disease, disorders, and disabilities, and to providing new adaptations, new behaviors, and new attitudes for those who are being treated. Most of man's problems fall into some category of disease, disability, or disorder, and sometimes all three aspects are combined, as when we are disabled by influenza and our own adaptive behavior to everyday life becomes disordered. Music is applied by skilled therapists, as a means to therapy ends, sometimes even to such everyday problems as those caused by "the bug." (Although no research yet exists for this application, the writer has found relief from some of the discomforts of flu symptoms in listening to favorite music.) What music is used, and why?
For the most part, the effects of music which may be utilized by music therapists and their clients derive from the uses and effects of music applied in everyday life and in every culture on earth. More scientifically speaking, the effects of music may be viewed as providing two edges of a therapeutic sword: on one edge the uses and functions of music in everyday life, on the other edge, the effects of music as a source of sound. On the one edge, such activities as playing and performing music, individually and in groups, or listening to singing commercials on TV, represent functions which may be used by the professional music therapist. On the other edge, the music therapist is always aware of the basic effects of the sound of music upon the psychophysiological condition of human beings. Sometimes these effects are primary, as when the therapist attempts to arouse or to soothe his client; at other times, the structured activity effects are primary, as when the therapist assists a child in becoming socialized by encouraging participation in music group activity. In any case, the skilled therapist must be aware of both edges of his double-edged therapeutic sword, and apply it as scientifically and artistically as possible, if it is to be therapeutic.
Another way of conceptualizing music therapy is that developed by a group of music therapy educators in 1966 and synthesized by Sears (1968). This theory views music as a form of human experience (behavior). The potential value of music in therapy then derives from Music as Structured Experience, Music as Experience in Self-Organization, and Music as Experience in Relating to Others. As experience in structure, music is sound, structured not only by time but also by variations in pitch, rhythm, and loudness. (Rhythm, of course, is a part of the durational, or time, aspect of music.) The possibility of precision structuring within time frames is a very valuable aspect of music in therapy. As experience in self-organization, music functions for individuals in their development of physical coordination, their psychological orientation (such as self-image, self-esteem), and their basic motivation (music as a reward). As experience in relating to others, perhaps the most familiar use of music, music may help structure social relationships and enhance interpersonal interaction which is so important to therapy, whether for the crippled, cerebral palsied child or the behaviorally handicapped psychiatric patient.
How can music therapy apply to so many diverse client populations? For one thing, almost every person can respond to music in some way, even deaf persons. Music therapy does not depend upon developed talent or ability or skill to be useful as a tool in therapy. Music therapists work with the most elementary response to music. For example, a severely retarded child may be observed to respond to music by smiling or moving some part of his body to the rhythm; this response, as a pleasurable one for the child, can be used as a contingent reinforcer for other desired responses by the child, such as looking at the therapist, following instructions of learning, improving feeding habits, etc.
A second reason for the wide application of music therapy to all types of handicapped persons is the fact that many of man's problems are similar, even at widely different ages; language and speech problems, for example, may be found not only in cerebral palsied children, but also in older persons who have had strokes, or even in psychiatric patients who have developed problems in communication. The basic problem then is similar at different ages, and therapists may apply similar treatment if the disease, disability, or disorder of a person is viewed from the perspective of problems of adaptation, rather than primarily as a matter of "root causes." A large part of the treatment community today, including medical as well as psychological and special education, approaches disabled persons from this problem perspective. Thus, music therapists may apply their treatment skills using music in similar ways across age groups as well as across therapy problem areas. This view is further expressed in conceptualizing most of man's problems as falling within some six categories of skills which everyone develops in order to adapt to the world. Gross motor, sensory motor, perceptual motor, language, conceptual-cognitive, and social skills cover practically every area necessary for development of coping skills. Of course there are many sub-skills within these six categories, most of which have been developed through childhood, but many of which are increasingly recognized as continuing needs for development throughout life. In each one of us, undoubtedly, there are undeveloped skills which may be necessary for us to acquire under certain circumstances. An example might be that of a person being transferred by his company to another country and needing to develop language skills of that country.
Professional opportunities for music therapists continue to develop, fortunately in a fairly steady flow concomitant with the development of new training programs in schools around the country. Graham predicted that the job market for Registered Music Therapists would begin to tighten up, possibly by the early 1980s (Graham, 1974, p. 59). The development of opportunities, however, is still rather unpredictable. While there seem to be more persons and facilities in the therapy, rehabilitation, and special education fields willing to hire music therapists, there still are few if any guarantees in the form of allocated positions, designated places in tables of organization for treatment facilities, or the like. Music therapy graduates often seem to need to be able to "sell" themselves and their profession in new settings; perhaps it is fortunate they continue to gain and use skills in explaining just what music therapy is!
There are apparently many new chances for music therapy applications and jobs, however. The trend over the past twenty years in treatment of mental retardation and mental illness, as well as physical disabilities, has been to localize facilities, to put patients back into home communities, closer to caring families and relatives. There are still many institutions for care and treatment of many persons, and music therapists continue to be in demand in these, but the new opportunities for them in community-based centers also continue to grow. Often, as the locale of treatment changes, so does the overall concept of treatment. Many facilities recognize the need for creative arts, especially music, in treatment. The trend in change of locale is reflected in the latest federal legislation mandating the education of ALL children in the public schools. Public Law #94-142 is making it necessary for schools to provide more special education facilities and programs for handicapped children; and this federal legislation, backed up by federal funds to assist school districts, will provide for many new positions for music therapists as they relate their contributions to the needs of such children in the schools.
At the same time, the new law seems to imply that handicapped children are not only entitled to special education services such as provided by music therapists, but also to the same curricular offerings available to other children. This has inferences for college music curricula developers: ways must be found to equip future school music teachers to teach music, per se, to handicapped children. Here it seems obvious to this writer that there also is a new role for music therapists who will be working in the schools; they can and should operate as consultants or resource persons to their professional "cousins," music educators, as well as to classroom teachers and special educators working with the handicapped child. This consultant role is similar to that conducted by other specialists such as speech pathologists, psychologists, occupational therapists, physical therapists, etc. It is additional to, or may go along with, the music therapists' expected function in working directly with children, individually and in small groups.
Over the past few years there has been some confusion in the emerging roles of music therapists in the schools and the roles of music educators already working with handicapped children from special education classes. Some college music professors have advocated the establishment of a new curriculum to produce "special music educators." In considering how such persons might relate to music therapists in special education, the reasoning seems to become somewhat hazy. It appears to this writer that for those teachers who want to become therapists the best course is to return to school and become certified (registered) in music therapy . . . just as a classroom teacher might do if he wishes to become qualified as a special education teacher, or speech pathologist, etc. Many NAMT-approved schools, especially those offering graduate degree programs, are admitting increasingly larger numbers of such persons, i.e., music educators who want to become specialized in music therapy. Also, in some undergraduate programs, provisions are being made for students to acquire dual certification, in education and therapy, under what is usually a 5-year bachelor's degree program. This is being done in some instances because it facilitates (in some states) obtaining a position in the public schools which requires teacher certification. It is the writer's perception and prediction, however, that music therapists will be hired increasingly in schools without the requirement of teacher certification, with therapy certification being sufficient. Some students may still wish to obtain dual certification in order to increase job possibilities as well as job flexibility, i.e., being able to function as both a music educator and a music therapist through a divided time schedule.
How have all of these new developments in professional opportunities affected the music therapy curriculum? The courses in the core curriculum pertaining directly to the profession of music therapy still list a minimum of ten (10) semester hour credits, made up of at least 4 hours in the Psychology of Music, 4 hours, two courses in Music Therapy and the Influence of Music on Behavior, and 2 hours in introductory courses or clinical internship courses. This is a minimum, of course, and most of the fifty-five schools approved to offer the curriculum will have far more hours. At Texas Women's University, for example, there are 38 semester hours in the professional music therapy courses, with 24 of them being in clinical experience courses including the internship. (The remaining 14 hours at T.W.U. are 6 hours in Psychology of Music [2 courses], 6 hours in Influence of Music on Behavior and Music in Therapy [2 courses], and an introductory course, 2 hours credit.) Having clinical experience hours gain credit, of course, makes it possible to provide better faculty supervision for such experience. (At T.W.U. a second faculty person has been added, as is the case in several other schools around the country.)
The remainder of the core curriculum contains requirements in the behavioral sciences and special education (a total of 16 hours as a minimum requirement), and general education (total of 30 semester hours minimum), plus a requirement of 60 hours in music (usually amounting to about one half of the total hours). In the music hours, theory and history of music requirements are two years and one year, respectively (minimum), plus proficiency on a major instrument, study in guitar, study in piano and voice (especially class techniques), ensemble experience, methods courses for brasses, woodwinds, and strings, and at least one methods course in basic skills in social music, i.e., rhythm instruments, autoharps, etc., and group leadership skills.
Finally, a clinical internship, continuous for a six-month period (1040 hours) at approved centers, is a requirement for the bachelor's degree. Such internships are available in over 100 centers and vary from traditional hospital settings to public school special education programs and community mental health-mental retardation centers. They are under the supervision of music therapists who hold registration in the NAMT (RMT's), and who must have had minimum clinical experience of at least one year. The requirement for college music therapy instructors, incidentally, is registration in NAMT plus a master's degree, and a minimum of two years' clinical experience.
Graduate degree programs have been offered at the master's level since at least 1950, but at present there are still under ten schools in the country offering such programs. Many of these schools are experiencing increased interest in master's degree programs by applicants holding a first bachelor's degree in another area of music. A combination program is sometimes offered whereby the student may begin some parts of the graduate work while making up prerequisites leading to the minimum requirements for the certification (registration) program in music therapy. This type of program requires at least two years, plus whatever extra time may be needed for completion of clinical experience (internship) requirements and thesis for the master's degree. If the student already holds a bachelor's degree in music education and completes certification requirements in music therapy, there is thought to be some advantage in job flexibility, as noted before. At least three major universities now offer doctoral programs in music education where it is possible to complete master's degree level work in music therapy, but there is still no school offering a doctorate in music therapy itself. There is a high probability that such a program will be offered in the near future if the field continues to grow at its present pace, and if the demand continues for higher levels of training to develop college teachers in the field.
All of the foregoing seems to point to a bright future for music therapy. As with most health sciences, an ultimate goal is to develop preventive measures as well as treatment techniques. Has this yet been done in music therapy? Unfortunately, not much beyond the speculative and strong belief stage. Little or no research has appeared in the literature concerning the most healthful uses of music, except for that which shows that prolonged exposure to loud (usually rock and roll) music may result in permanent damage to a person's hearing. It would seem that we need to know more about how much and what kind of daily exposure to music and music activity can be considered healthy, and might act as a preventative for development of unhealthy conditions. This would seem most important for professional musicians to know, not to mention the average person who is seemingly exposed to increasing amounts of man-made sound daily. Music therapists today and in the near future must respond to the challenge of conducting such research. They will need to have the support and active cooperative help of other music colleagues as well as of behavioral and health science professionals.
Perhaps it is not too frivolous to fantasize about the music therapist of the twenty-first century in the role of the ecologist, i.e., relative to sound pollution and controlling the sound environment in which man lives so that healthful aspects are maximized, unhealthful ones minimized. Some Registered Music Therapists in 2003 may well be a type of Orkin man hired to analyze a home environment for its noise pollution ("infestation"), and to prescribe a treatment program for the prevention of further deterioration of the sound environment and the healthful use of sound and music. After proper scientific analysis of all factors, such as Junior's practicing on the trumpet, Sister's practicing on the drums, Mother's favorite TV programs listened to from rooms away from the TV, Dad's addiction to loud TV sports programs, and Grandma's addiction to loud rock music, the twenty-first century RMT may be able to come up with a program which can be put into the home computer, controlling and combining sounds and sound activities to their maximum health benefits, minimizing health-damaging effects for everyone concerned.
Whatever the future may hold for music therapy it would appear that it is here to stay for awhile, and its time may very well have arrived. As the clinical application and research arms of the music professions, music therapy may make an increasingly important contribution not only in therapy and special education but also in preventive medicine aspects of everyday uses of music. Hopefully, its contributions may also benefit the music performance and education professions, as well as reciprocally gain from them in the future. At this moment, music therapists and the field of music therapy welcome the interest of fellow music professionals. The National Association for Music Therapy, Inc., academic programs at the fifty-five universities around the country, and clinicians in practice stand ready to explain their profession and put it to use wherever possible.
Graham, Richard M. The Education of the Music Therapist. COLLEGE MUSIC SYMPOSIUM Vol. 14, 1974.
Michel, Donald E. Music Therapy as a Career. American Music Teacher Sept./Oct., 1977.
Michel, Donald E. Music Therapy: An Introduction to Therapy and Special Education Through Music. Springfield, Ill., Charles C. Thomas, 1976.
Music Therapy Index-I; edited by Charles T. Eagle, published by the National Association for Music Therapy, Lawrence, Kansas, 1976.
Sears, Wm. Processes in Music Therapy. In E.T. Gaston, Ed., Music in Therapy. New York, Macmillan Co., 1968.