Musicians and fans know the power music plays in one's life. An art form that speaks to soul, music has the ability to connect with people in ways far beyond our understanding. It has the power to heal and repair.
Music therapy is one way music is being used to heal and repair. According to the American Music Therapy Association (AMTA), the earliest known reference of music therapy was listed in a 1789 magazine titled Columbian Magazine in the article "Music Physically Considered".
I had the opportunity to interview three music therapists on the specialties they practice in, what they have seen in their experience and what music can do to heal the mind and body. The second installment of this series welcomes Laurie Farnan, a music therapist who works with autism spectrum, developmentally disabled, and neurologically impaired people from ages 20-64.
One of the things Laurie stressed to me during our interview was in categorizing music as having healing powers. It's a very delicate issue, because there isn't supportive scientific evidence that shows music has healing powers. But, music therapy can be a very important part of a treatment team. When used in healthcare settings to teach life skills and independence, music becomes a positive way for people to learn these valuable necessities.
J: What can you tell me about your experiences as a music therapist?
L: I worked in group settings with other staff. I would see four to six individuals with one or two other staff assisting. In our program, we primarily used live music emphasis. We composed music based upon the life skill needs of the people in the group.
People will developmental disabilities often have a delay in processing time. For example, if I would say 'hello' to a person with developmental disabilities, it might be ten to thirty seconds before they will say hello back to me. With the compositional aspects of music, we could compensate for that delay in processing time. By that I mean, we might start the group in a familiar way such as an opening song that would include the person's name and hello like, <sung> "It's time for music, hello David. It's time for music, come on let's play. It's time for music, hello David. We're gonna to have a musical day."
There's repetition within the music and by the time David hears it and gets it all processed through all that neurology it might be the fourth time I'm singing it, but we have compensated for that delay and he's in synchronicity with what's happening in real time within that moment. That is something that is inherent in the qualities of music that we can link lyrics with the scope and shape of the melodic line to try recruit other neuropathways to elicit a positive outcome.
Another example is many of the people I worked with needed to have range of motion for their upper extremities. We would write range of motion songs and have the melody go up if we were trying to inspire someone to reach up, <sung> "Reach up and higher and higher and hold. Reach down and lower and lower and hold."
The shape of the melodic line and length of time on the pitch was another method of communication, so that through the music itself we could help the person understand what was supposed to be happening. In our group sessions we would follow a standard format depending on the focus of the life skills of the people in the group.
The treatment team would create goal areas and a treatment plan for each person. As a music therapist, I can work on making choices, communication of choices, and self-expression. I worked with people who were non-verbal and they weren't going to say, "I would like the tambourine please." They would look in the direction of something they might prefer. What we would say as music therapists was, <sung> "Pick a bell or pick a maraca. Pick which one you wanna play. Look at the bell (ring the bell). Look at the maraca (shake the maraca). Look at what you wanna play today."
The person would look at the bell or the maraca or reach for the bell or maraca shaping their ability to communicate to other people what they want. And, that would have carryover to the rest of the treatment team in that, whomever was getting David getting ready for his day. The person would hold up two different shirts for example, and say, "David, look at the shirt you want to wear today."
Then David would look at one of the shirts. The person working with him would respond with an affirmative remark about the shirt he looked at to confirm he wanted to wear it. That's how music therapists work on non-musical goals like functional life skills such as communication, self-determination, moving of upper extremities, etc.
J: Each one of the people you worked with then, you geared the therapy toward what they needed to work on?
L: Yes, it's what we in the business call person-centered and individualized for each person. That said, some people might share areas of need, which was why we could see people in groups. We could follow each person's plan of care that the team had identified they needed. And, the goals were measurable. Each person would have at least one individualized goal that would go back to their treatment plan. We would have to report on every quarter and annually. We would take data after every session. We would report the data systematically back to the rest of the team.
J: What specifics and complexities can you tell me about music therapy? There is much more to it than just playing music.
L: Well, you may have already come across this on the AMTA website, but, there's a standard practice where music therapists are expected to complete a thorough assessment of the person's level of functioning, which includes reading the reports of other professional who have assessed them. Then the therapist would develop and tie into the goals of the treatment team. They would identify the goal areas that can be implemented in the music therapy session. And, finally they would collect data and report back to the treatment team on how the person is doing.
Those standards of practice are very important to music therapists and there is also a code of ethics we must follow, too.
To be a music therapist, it's a college degree program with a required clinical training internship in an approved facility that the student must finish, which have to be approved by AMTA. After the internship, the students sit for a national board examination to be a music therapist-board certified. And, the certification board is part of the national council of certifying organizations for other healthcare related professions. Music therapy is clearly defined by a music therapist...a credentialed music therapist.
Musicians playing in healthcare places is a practice that has been around a long time and it is enjoying a resurgence with orchestras doing community outreach. That's a good thing. It's a wonderful thing. And, people may feel good after attending an event, but it's not music therapy. It's not music therapy, because it hasn't had an assessment, a goal, implementation and data collected behind it.
J: What have been your experiences with using music therapy to aid in the healing process with patients and the receptiveness of those in the medical community?
L: Where I worked it was very well supported and accepted. We had three music therapists on our staff. We enjoyed support from our other colleagues: physicians, nurses, physical therapists, occupational therapist, social workers, case managers, etc. Many of those disciplines would help bring clients to the group. They could participate in the group process and see that Danny lifts his head up, which is a big deal for Danny, after we do a movement experience. We can explain that all by the neurology of what's going on in the brain and the rhythmic movement that moves the cerebral spinal fluid around.
As really good example is for most people who can walk around and move on their own, their cerebral spinal fluid renews itself every four hours. So, if they have been sedentary or sat for a long time and then stand up, they would feel like they need to clear their head. And, they really do, because the cerebral spinal fluid has been collecting waste all that time. It needs to get it out of their system and have fresh cerebral spinal fluid in there. When people go for walks to clear their head, they really are going out to clear their head. And, that's supported by really good research.
For people who do not move around independently or are very limited in their independent movement, when we provide a very prescriptive movements whether it would be going in a circle or forward and back, we're really helping their cerebral spinal fluid to renew itself; to clear all that metabolic waste. It's particularly effective when done to music, because there's a rhythm that drives the movement. And, rhythm is the organizer-energizer of music. We all respond to rhythm below the level of consciousness.
You can see it all the time in traffic. I have often said when I give talks that the steering wheel is the most played instrument in the United States. Nobody decides to do that. It's not a conscious decision. They're listening to something and they have a psycho-motor movement output. If it's warm out they tap outside the car. They're not aware the rhythm is coming into their nervous system and being processed by their neurology with a motor output coming out the other side. They will move in some way.
Music therapists try to very carefully design interventions that utilize that power of rhythm to help someone move. And, it's a non-verbal prompt from the environment. Maybe they'll take a deep breath or tap their toe. It tells us that the rhythm is getting in, being processed and people are moving. It's a really neat thing.
J: I think one of the positive things I enjoyed hearing from talking to you is that everybody around the person is working together to see the success of the individual.
L: Yes, exactly. And, it's not that they learn to play the drum. It's that they picked up the drum mallet and played on the drum, because of the rhythm going on. But, the movement of reaching out picking up the drum mallet, going up and down, are the same movements that person needs to be able to reach out, pick up their spoon and eat independently rather than have someone feed them.
While we're using rhythm and materials of music, the real prize is independence and life skills. So, what we think about are the movements to play a maraca, ring a bell, beat a drum. We think about whether a person should use a mallet or their open hand on the drum. We analyze the instrument and the motor demands to play that instrument. Then we determine if the instrument is the best match for the person's needs.
J: How and why did you get into music therapy?
L: Someone suggested it to me <chuckles>. I'm a guitarist and I was playing out at places. Someone who was in the show I was in said they were going to be there next year because they were going to school for music therapy. I don't know why, but when I was eleven years old I told my family I wanted to play guitar. Now, nobody else in my family plays guitar. I wish could explain why those things happen to people. I don't know why people have that desire to pick up a guitar and have to learn it. Or there are people who are singers that have to go out and sing. Then there are others who hate singing. Do we come wired that why? You look at something and make a connection.
I was lucky enough in my career to love what I do. I love figuring out what it is about music that is going to improve someone else's life. It's very challenging. It's intellectually stimulating and esthetically stimulating. <asks the question> How can this be the most musical product we have and yet have the greatest affect on functional skills? The music is more than making a CD. We can do better than that. we can do live music that includes vibrations from the instruments for people to feel. We want to have as esthetically pleasing of music as we can while still getting to a life skill.
J: Are there any success stories you could tell me about?
L: I'll frame it in a little different way. I would do, on average, at least four sessions every day Monday through Friday. In those sessions, there would be five or six clients in each session. I would take data after every session for each person. Pretty much after every session I saw something wonderful occur with at least half the group or all the group. I knew we had evidence that we had made a connection and that everyone in the group was better for it.
We had interns and typically trained 121 interns in our work. One of the interns played a clarinet. I was working with a young women who often had her head down and when the intern started playing the clarinet, she picked up her head and turned it exactly towards the clarinet. I had the intern stop playing. The client puts her head down. I had the intern play the clarinet again. The client raises her head back up and looks at it again. We can say we think the person likes sound of the clarinet. So, we can work the clarinet or the things they like into the interventions.
I seen people smile and reach out towards instruments when we didn't know if they would be interested in them or not. I've seen people take deep breaths in response to rhythmic music. I've seen people try and vocalize. Now, remember, I was working with people who were non-verbal, non-ambulatory and in need of pervasive supports. So, if someone could take a deep breath on their own...that was a big deal.
To try and produce an 'ah' sound, we would do a closing song with a 'la' in it. It would have all the repetition again. The ending word was goodbye. And, every time we would do it someone would vocalize on that ending sound. Now that is the power of music: to communicate and invite participation.
I wasn't standing there telling them to complete the sentence when I get done singing. I played it on the guitar, sang and would wait using a chord that has tension inherent in it <the 5-7 chord>. And, generally, someone in the group, whether it would be the word 'my' or a neutral syllable. Phenomenal things happened.
Music therapy is not about a secret power to heal, but utilizing music to help people achieve life skills and independence. Our internal processes connect with the rhythm of music and produce movement. These movements are essential aspects when designing measurable goals for those who have autism, developmental disabilities or are neurologically impaired. While music may not have a mythical, otherworldly power to heal, it does have the connective ability to assist people in positive ways.
© 2013 Jenna Cornell, All rights reserved. No part of this article may be reproduced without prior permissions from the author or Clarity Digital Group LLC d/b/a Examiner.com. Virtual Music Cafe, Heroes in Music, Coffeehouse Confessions and Stepping into the Twilight Zone are property of Jenna Cornell.
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