Music therapy

Rebecca Hughes explains music therapy, and how it is more than listening to music to make you feel good

An 8 year old girl stands rocking and staring into space. The few words she utters are obscene and random. She can be violent and spends most of her time alone. But six months later she interacts with other children in a group and vocalises appropriately. What made the difference? She has been working with a music therapist.

Music therapy builds a relationship between the patient and the therapist through musical improvisation. The patient can communicate without needing to use words. The therapist responds musically and provides support; the patient has the space to develop a sense of self. In this girl's case, the connection that was built through music with her therapist allowed her to show her true potential and to begin to learn basic social skills.

Music therapy is a rapidly growing discipline, which recently became a state registered profession in the United Kingdom. The Association of Professional Music Therapists had 490 practising members at the end of 2000 and, with seven postgraduate training courses in the UK the number is rising steadily.1 Most music therapists work, in close collaboration with the wider clinical team, in the NHS, local education authorities, and some are self employed.2

Music therapy is an interactive and primarily non-verbal intervention. It provides a process through which clients can express themselves, become aware of their feelings and interact more easily.

Music therapists work with a wide range of patients; for example, adults and children with autism, learning difficulties, or emotional and behavioural problems. Music therapy departments exist in areas as diverse as mental health, neurology, forensic psychiatry, and palliative care. The body of research into music therapy in these and other areas is growing.3

A music therapist is a highly skilled musician and many are trained to use aspects of psychological and psychodynamic theory in their clinical work. Training in music therapy is only available at postgraduate level, and trainees are usually 25 or older. Most trainees have a music degree, but some may have studied related subjects or practised in areas such as nursing, social work, or teaching. All music therapists must have the necessary musical skills.

The fundamental components of music form the basis of social communication; this is evident from the earliest stages of child development. From birth, babies use a range of sounds to communicate with their mothers. Music therapists work with patients who may have lost or never acquired the skills of interaction by drawing on this innate musicality. Clients need no musical expertise or experience but use instruments, mainly percussion, to spontaneously create a musical interaction with the therapist.

According to Oliver Sacks, "Music has been the profoundest non-chemical medication for our patients,"4 and as doctors you may find yourselves working in a multidisciplinary team with a music therapist. How can you benefit from their work?

A music therapist's contribution is becoming increasingly valued for example, in the field of forensic psychiatry. Although patients are treated medically, music therapists can help to rebuild the skills patients have lost in their illness - skills such as coping with intimacy and understanding the consequences of their actions.

Ann Sloboda, head of the arts therapy department in a regional secure unit, wrote, "The act of making sounds on musical instruments gives the patient a medium for expression. It can also give even the most inarticulate person a means of relating directly to another person, thereby serving as a link between the inner and outer world of the patient, and between the patient and the therapist."5

Mr B, 30, was diagnosed as having paranoid schizophrenia in a psychiatric unit. He was violent and had been in prison, but at this time he claimed to be well. Initially Mr B's piano playing was obsessive, disorganised, and confused. He played to himself, seeming oblivious to the therapist's music.

In three years, a relationship developed between Mr B and the therapist through making music. Mr B was gradually able to use music to express his emotions and his playing became more responsive and interactive with the therapist's. Later Mr B was able to gain insight into the way he related to other people. His growing confidence and awareness enabled him to talk about his remaining paranoid ideas.6

In many settings, group work is used to encourage respect for peers, social skills such as taking turns, increased social interaction, and self confidence. This can be an ideal opportunity for people with emotional and behavioural problems to learn to accept and relate to others. The music could be free improvisation or a more structured approach, depending on the level of interaction and needs of the client.

Five adolescent boys from a school for pupils with emotional and behavioural difficulties were referred for music therapy. The boys were extremely aggressive towards each other, and the school found them exceptionally hard to manage. A therapist worked with the boys once a week. To begin with the therapist gave them the opportunity to express their complex feelings of anger, grief, guilt, hatred, rejection, and sadness. Structured activities with clear boundaries created a safe environment to explore these emotions. The boys were encouraged to channel their emotional energy into playing music, which was often loud and chaotic. In time, they began to use the activities to interact positively with each other. Occasional fights still broke out, but they were able to discuss the cause, understand their feelings, and translate these feelings into music. Staff at the school reported a decrease in aggression both in and out of the classroom.7 Music therapy had enabled the boys to understand what was driving them to act in a particular way and to express themselves more clearly.

The late Professor David Baum, one time president of the College of Paediatricians, was a dedicated supporter of music therapy. He stated, "We hope to bring music as a serious therapeutic tool into the medical community... We would like to be associated with work which shows it is good in a specific sense and is not something "fringey and out there" but is something which should be prescribable and used as a serious therapeutic tool in serious clinical work."8

Rebecca Hughes, music therapy student, Guildhall School of Music and Drama, London
Email: beccaboohughes@yahoo.com


studentBMJ 2003;11:43-86 March ISSN 0966-6494

1. APMT survey of membership 2000
2. Bunt L, Hoskyns S, eds. The handbook of music therapy. London: Brunner-Routledge, 2002:13.
3. Wheeler BL, ed. Music therapy research: quantitative and qualitative perspectives. Barcelona: Publisher, 1995.
4. Sacks O. Awakenings. London: Pan, 1991.
5. Sloboda A. Music therapy and psychotic violence. In Welldon E, Van Velsen C, eds. A practical guide to forensic psychotherapy. London: Jessica Kingsley, 1996.
6. Association of Professional Music Therapists and British Society for Music Therapy. How can music therapy help adults with mental health problems? East Barnet, Glastonbury: APMT and BSMT.
7. Association of Professional Music Therapists and British Society for Music Therapy. How does music therapy help children with special needs? East Barnet, Glastonbury: APMT and BSMT.
8. Presentation video for the MusicSpace Trust 1991. In Bunt L, Hoskyns S, eds. The handbook of music therapy. London: Brunner-Routledge, 2002: 15.