What is Music Therapy and how does it work
by: Jaakko Erkkilä Professor of music therapy University of Jyvaskyla Finland
Modern music therapy consists of several models and methods where music and its effects are utilized in therapeutic work. Psychiatric music therapy, sometimes called music psychotherapy, is a traditional working area. In psychiatric music therapy basic principles are rather near those of psychotherapy. However, in music therapy the emphasis is in musical experiences as a tool of self-expression and interaction. Various psychological theories affect music therapy clinicians' work, psychodynamic approach probably being the most common.
Another traditional line is music therapy for developmental and neurological disorders. The spectrum of these disorders is large and thus there various music therapy methods and models exist. Psychiatric music therapy is often based on rather free and spontaneous working methods whereas music therapy for developmental and neurological disorders typically is more structured and method orientated. No wonder that behavioral theory, or learning theories, often works as framework in them.
What in music makes it a therapeutic tool?
Along with the rapid development of brain imaging techniques, researchers have been able to shed light to the specific qualities of music as a stimulus that activates the brain in a diverse manner. Music has been known to be in close connection to emotions as well as evoking emotions. Furthermore, researchers have found out that music listeners commonly utilize music for emotion regulation. Because majority of psychiatric disorders are emotional, or cause emotional disorders, it is no wonder that music has been found to be a powerful therapeutic agent. Emotions, images, associations and memories evoked by music offer a valuable view to one's mental processes thus reaching the experiences and qualities that are difficult to deal with, or reach verbally.
On the other hand, experiences with emotional loadings, and interaction in general become possible in music therapy even when verbal expression is not possible. This can be the case with children (even infants), clients with severe developmental disorders, people with dementia, or clients suffering from severe psychiatric disorders such as acute psychosis.
In addition to its mind related qualities, music, in particular playing, is active bodily functioning as well. Bodily coordination and motor functioning are often in the focus of music therapy with the clients with motor disabilities. In music therapy with children and adolescents bodily and action based functioning plays often an important role even if the primary emphasis of the therapy is in mental problems.
When using receptive techniques, the rule of thumb that the patient's preferred music usually works best. For instance, in the Finnish stroke study I briefly mentioned in my writing, only patients' preferred music was used. Researchers had to interview the patients, their relatives, and so on, in order to ensure that the music that they used really had a specific meaning to the client. The same piece of music can mean many different things to many different people, and thus, whatever music is used for therapeutic purposes needs to express a particular relationship between the client and the music. For some clients Mozart maybe the right choice, some prefer the Beatles, and so on. Music therapists are usually interested in the experiences (images, memories, etc.) that the patient associates with the music. The tendency is to find the most moving, personal, touching and important music as possible from the client's perspective.
Clinicians know that a piece of music from one's childhood can evoke incredibly strong memories or feelings: "This is the music that I used to listen to when I was very sad and I was again sitting in my room feeling loneliness and anger...I clearly remember the atmosphere then and whenever I listen to that song again I feel the same way..." In this example, music helps the client to really reach the emotional memories from his/her childhood, which was traumatic and that now is under investigation in therapy.
As you can see, it is often not only the music but the relationship between the patient and the therapist, which makes the therapy work. Music can be therapeutic as such on its own, but music therapists have specific techniques at their disposal that they can utilize to access the client's musical experiences in goal-orientated, therapeutic way.
Music is something that you have to concentrate on in a specific way for it to really touch you. Most often in our everyday life music comes and goes; it is everywhere, people don't really attach to it. At the same time, many of us are incredibly selective when it comes to music as well. When a radio station starts playing music that we don't like, we quickly switch to another station. Most often people are unconsciously seeking pleasurable music, music that enforces their mood, solace and so on. But there is also research evidence that some people listen to sad music in order to - probably unconsciously - meet their own sadness (maybe their personal losses, etc.) and deal with it. In this way music facilitates the person going through difficult things in their life.
Most people probably have the bulk of their personal musical experiences listening to his/her own favorite music alone and really concentrating on it. In brief, the music that we hear on the radio when we are focusing on something else seldom causes a negative effect because normal/healthy people have also normal and rather strong mental filters and defense mechanisms in use in their everyday life.
Of course, there are a lot of examples where music has been purposefully used as stimulator, or amplifier of a certain mood - in other words, the desired mood is already there but music is used to boost that mood. For instance, some school shooters are known to have boosted their killing mood by listening certain music before the event. During the recent massacre in Norway where 76 young people were killed, the shooter is said to have been wearing earphones and listening to music while doing this unbelievably brutal and merciless thing
Music therapy research is active
In many countries, music therapy training is located in University. In Europe and in North-America there are several University chairs in music therapy. Maybe due to close University connection music therapy is one of the most researched form of creative therapies and is doing well also when comparing it to psychotherapy research in general. Evidence based medicine, whose principles have been increasingly applied to therapy research, has become common in music therapy research as well. Several effectiveness studies as well as meta-analyses have been done on music therapy lately. To mention some, there are meta-analyses on music therapy in the treatment of schizophrenia, on psychopathology of children and adolescents, on autism, on severe mental disorders and on depression. In these meta-analyses (≈ common effect of several trials) music therapy has been found to be an effective form of treatment.
A recent Finnish study (published in the Stroke) showed that listening to the preferred music daily for a three months time period improved the clients with acute stroke in many areas such as in verbal memory and focused attention. They were also less confused and depressed than the control groups. Even though that study was music medicine study it shows authentically the power of music as such as therapeutic agent. Another recent Finnish study (published in the British Journal of Psychiatry) showed that music therapy is an effective form of treatment of depression. The participants in the music therapy group improved significantly better than the control group as being less depressed, less anxious and as having better general functioning.
Music therapy can be applied to various diagnostic groups. Music therapy can be divided to two main categories, receptive (music listening based) and active (music making). The latter refers to musical self-expression and interaction that often is spontaneous, free improvisation with instruments or voice. Contrary to common conception, music therapy does not presuppose musical skills or talent. In many countries, music therapy is most often applied to children and adolescents, and with people with developmental disorders. According to clinical experience and research, music therapy seems to be a relevant form of treatment also in the field of traditional psychotherapy – for instance in the treatment of adults' mental disorders.