MUSIC 2MT3 Lecture 4: Lecture 3 & 4
18 Jun 2018
School
Department
Course
Professor
Intro
Not all music therapists practice in the same way.
-
The may practice differently depending on your client, some approaches might
be more appropriate.
-
And depending on the music therapist's strengths.
-
Model vs approach:
Will be used interchangeably throughout the class.
○
Don't get hung up on it.
○
-
Humanistic vs Behavioural
Humanistic = client/person-centred
Therapist follows the lead of the client.
§
Most music therapy approaches are humanistic.
§
○
Behavioural = outcome based
Therapists stays on the course of the treatment plan and tries to
keep the client on task.
§
○
-
Creative Music Therapy
Nordoff-Robbins
Music therapy training
There isn't any specific Nordoff-Robbins training programs in Canada, but
Laurier is influenced by Nordoff-Robbins.
○
In NY or England, for example, there are Nordoff-Robbins training
programs where you would graduate as a Nordoff-Robbins therapists.
○
-
In true form, uses 2 therapists with 1 client.
1 at the piano supporting the music relationship and creating the music
space, the other physically supporting the client.
○
Some therapists have adapted this model to perform as a solo therapist
because it's difficult logistically and financially to have 2 music therapists.
○
-
Creative music therapy because you are being creative in the music space.
-
The idea is at all humans posses a "Music Child" which remains intact and
accessible, no matter the diagnosis, physical problems, etc.
Idea of N-R is to create a safe music space where the "music child" can
come out, self-express.
○
-
Humanistic approach
Developed with children - the therapist follows the child's lead.
○
Now applied to all age groups.
○
-
Music centred.
Very little verbal expression.
○
They believe the magic happens within the music - no need for music
because the music does the communicating.
○
-
Video:
In 1959, American composer and pianist Paul Nordoff and special
education teacher Clive Robbins developed a new form of collaborative
music-making to engage vulnerable and isolated children, which they
termed "therapy in music."
○
They began researching, publishing and teaching all over the world.
○
Led by Sybil Beresford-Pierse, the first music therapy service was
established in South London in 1970.
○
This was soon followed by the first Nordoff Robbins training program in
1974 which was essential as it gave Nordoff and Robbins the opportunity
to pass on the vital skills they had been developing for years.
○
In the video, we see Nordoff and Robbins following the child's lead.
They're so in sync with the child, it's hard to tell who is following
who.
§
○
-
Biomedical Model
Hospital/medical setting.
-
Working towards a medical goal (e.g., pain management post-surgery)
-
Or it could be that the therapist is working in this model to tackle psychological
symptoms post-surgery.
-
They may incorporate other approaches (e.g., verbal therapy).
-
Biopsychosocial Model:
We are physiological, psychological and social beings.
Each contributes to our identities.
§
○
This approach looks at …
Managing biological/physiological goals.
§
Managing psychological goals
§
And managing social goals (e.g., "what is my place in the world
now?")
§
○
Biopsychosocial vs Nordoff-Robbins
Nordoff-Robbins is not Biomedical or Biopsychosocial because
they're not necessarily working on a physiological goal - sometimes
they do.
§
They never use verbal treatments, however, so there's not as much
direct engagement with psychological goals.
§
○
Neurologic Music Therapy
An example of Biomedical
○
Requires Post-Music Therapy training.
○
Looks at neurological rehabilitation.
E.g., post-stroke issues, gait, Parkinson's
§
○
Example: George's stroke
George had difficulty walking post-stroke.
§
Began RAS (a standardized intervention of neurological music
therapy)
§
George was able to speed up his walking using RAS.
§
Gait was improved.
§
○
Neurologic music therapy uses standardized interventions (i.e., RAS,
metronome use, therapeutic singing).
Goals are rehabilitation based.
§
Not going to typically talk about emotions/expression.
§
Extremely effective.
§
Don't need CRPO if you're not using psychotherapy and neurologic
music therapists don’t need it.
Need CAMT recognition and NMT training.□
§
○
Evidence-Based
Quantitative, measurable data because neurologic music therapy
uses standardized methods.
§
Difficult in regular music therapy because it is more flexible by
nature, but in the case of rehab, we have standardized methods.
§
○
Example: Speech after Stroke
Used therapeutic singing to help improve speech abilities after
stroke.
§
You can see the improvement over time.
§
○
Aesthetic Music Therapy
Dr. Colin Lee, WLU
Developed aesthetic music therapy.
○
At Laurier, the program is heavily based in aesthetic music therapy and
psychotherapy.
○
If you go to Laurier, it doesn't require more education.
○
-
Humanistic
But the music must remain aesthetic.
○
-
Music Centred
-
Around the aesthetics of the music created in the therapy session.
Important that the music had form and sounds like real music.
○
Very different from other approaches which find the outcomes to be
nothing compared to the process.
○
Client still doesn't need a music background - it's the music therapist's job
to maintain the aesthetic.
○
-
Who/what determines the appropriate aesthetic?
Cultural rules, unconscious.
○
The therapist decides what aesthetic is, but it's important to recognize
their client's cultural background.
○
-
Client is not supposed to verbally process what's happening in the music.
Therefore, it doesn't fit with everyone's needs.
○
E.g., Might be good for non-verbal people, more so than people with
emotional issues.
○
-
Goals
Building self-confidence, autonomy.
○
"Despite my limitations, I can create this beautiful music"
○
-
Research with Penderecki String Quartet
Quartet aesthetically improvised.
○
Then worked with psychodynamic music therapists.
○
They had dynamic struggles when improvising aesthetically even though
they were completely competent musicians.
○
After verbally working through the problems (psychodynamically) the
music became the evidence of their cohesiveness and cooperation.
○
-
Behavioural Model
Prominent model in the U.S.; developed there.
-
Result/outcome driven as opposed to client centred.
-
The use of music as a contingent reinforcement or stimulus cue to increase or
modify maladaptive behaviours.
-
When to use?
E.g., young child on the autism spectrum and they often perform unsafe
behaviours (i.e., exit behaviours)
○
Music therapy can work to modify those behaviours and to engage them
for longer periods of time.
○
-
Music is used as a stimulus.
-
Video: music therapy reinforces the lessons of unacceptable behaviour and
apology.
Goal is to bring awareness to these behaviours and eventually modify
them.
○
-
Behavioural approach is not specific to music therapy - adopted by music
therapists.
-
Cognitive Behavioural Music Therapy
Point is to become aware of irrational thinking.
Actions are the result of irrational thinking.
§
○
Start to put rational thought processes in place to promote appropriate,
safe behaviours.
○
Guided Imagery Method
Requires post-Music Therapy training
3 years (training + practice hours)
○
-
Developed by Helen Bonny
She created a collection of classically informed instrumentals organized by
specific beats per minute.
○
-
Uses pre-recorded music to bring emotions to the forefront
-
Client talks about the goal
Guided Imagery Music Therapist plays the music, the client discusses the
images evoked and later they talk through them.
○
-
Client music be neurotypical
Typically, they need to be able to verbally process and cognitively engage.
○
E.g., individuals with PTSD, anxiety, depression, those in end of life care,
etc. benefit from this therapy.
○
-
Performance anxiety
Therapist can facilitate understanding of performance anxiety through
guided imagery.
○
-
Psychodynamic Music Therapy
Analytically Oriented Music Therapy ("The Priestly Model")
Founder: Mary Priestly (1970s, violinist, music therapist)
-
Main way of engaging is through improvising/song writing, not aesthetically
influenced.
-
Developed to now include theories of psychology and psychosocial theories
-
Verbal processing supports uncovering the unconscious.
-
Music is used as a tool to explore a client's inner life - to provide a way forward
for growth and greater self knowledge.
-
Therapeutic relationship and awareness of transference imperative in this
model so the client will engage.
-
Freud and Jung - Songwriting example
Freud and Jung both used "free association"
Freud - used continuous connections
§
Jung - comes back to one main word
§
○
We use this to create goals and to gain an understanding of what's on the
client's mind.
○
We then can use free association to come up with a song.
Gives form to self-reflection.
§
○
-
Free-Improvisation
The Alvin Model
Juliette Alvin (developed model 1950-1980), Cellist
Founded the British Society for Music Therapy (1959) and Post-grad music
therapy program (1968) at Guild Hall (London, UK)
○
-
"Music is a human creation and therefore, each person can see him/herself in
self-created music."
-
The idea is that you cannot hide when improvising - you're completely
vulnerable and exposed.
-
Eclectic Model
A mix of approaches depending on the client's healthcare goals.
-
Also depends on the music therapist's goals and strengths.
-
What is Developmental age vs Chronological age?
Someone might be 40 years of age, but from a developmental approach they
might be 8.
-
Important to use music in a way that is chronological age appropriate and
developmental age appropriate.
-
Use of Improve
As an approach vs as an intervention
-
Ways to facilitate are important because improve can be daunting, intimidating.
Playing Rules1.
E.g., "just play the black keys on the piano" - choices become less and
permission is given to play them all
○
We thrive on permissions, so we tend to feel more confident when there
are rules.
○
We can make the rules less and less restrictive as the client becomes
more confident.
○
Mirroring and Matching2.
Mirroring:
Client plays something and therapist plays it back to them.
§
Therapist has to be careful so as to not look like they're making fun.
§
Idea is to say "I have heard you"
§
Clients on the autism spectrum love this mirroring
§
○
Matching:
Matching is similar, but it happens at the same time.
§
Client and therapist play in sync.
§
Re: Nordoff-Robbins video where you couldn't tell that the client
was leading the therapist because they looked so in sync.
§
○
Use of Empathy/Reflecting3.
Picking up on the other person's feeling.
○
Important part of improv because you can hear things very differently
when you're being empathetic.
○
Using awareness of emptions is important to reflect on the improv.
○
Grounding, Holding, and Containing4.
When the client is playing very chaotically the therapist grounds them.
○
E.g., on the keyboard, the therapist can play an octave apart to create
something strong and predictable so thy are reminded that the therapist
is there while they're exploring musically and that the therapist isn't
scared or intimidated.
○
Provides a container for the individual's emotions.
○
Dialoguing (musically)5.
-
Songwriting In Music Therapy
Provides a tangible product, something we use to communicate.
-
Safe way to self-explore, externalize or identify emotions.
-
Telling one's own story.
-
Reflection - self-motivation and encouragement.
-
Client groups?
Depressed, anxious, adjusting to new life after injury, accident, loss, end
of life, etc.
○
-
Reason for referral?
Build confidence, empowerment, self-expression, coping.
○
-
Traumatic Brain Injury (TBI) and Songwriting
Individuals with TBI are going through:
Loss
○
Emotional crisis
○
Adjustment
○
Rehabilitation
○
Identity confusion
○
-
Individuals with TBI benefit from songwriting (evidence-based)
-
An analysis of 82 songs by individuals with TBI revealed the following common
themes:
Isolation
○
Dependency
○
Helplessness
○
Anger
○
Body image
○
-
Common TBI speech problems:
Aphasia: cognitively aware of what one wants to say, but cannot find the
words to communicate.
Can be extremely frustrating
§
○
Dyspraxia: difficulty articulating speech.
○
-
When to introduce songwriting?
Can be intimidating
○
Therapeutic relationship is important before songwriting can be
attempted.
○
Not the same for everyone, it's important to take the client's lead.
○
-
Songwriting Techniques
Brainstorming1.
Starts with an idea, ask "what would that idea sound like?"
-
Client develops the message they want to say.
-
Fill in the Blank2.
Might use a familiar song and then change out some of the words.
-
Personalize the song.
-
Facilitates self-expression, makes it more about the client.
-
Baby step towards writing a song on your own.
-
Song Parody3.
All of the words to a song are changed, melody remains roughly the same.
-
Even though the client did not write the original song themselves, they can still
make it their own.
-
Song Collage4.
Look at the lyrics and titles of different songs and pull from those to create a
new song.
-
Provides examples and inspirations.
-
Rhyming5.
Starting with words that have meaning and brainstorming through rhyming.
-
Only possible with people who are cognitively able.
-
Examples from the Readings
19 year old man who had an accident on a train:
Both legs broken, TBI, bound to a wheelchair
○
Cognitively impaired - lacked insight.
○
Struggled with rehab exercises and was in a lot of pain.
○
Referred to MT because he couldn’t participate in rehab.
Engaging in music doesn't label you as being "sick" or "injured" so
he was less resistant.
§
It brings an element of normalcy because tool (music) is not specific
to being unwell.
§
○
He started to self-express.
Said he was lonely, missed his friends/family/home.
§
○
He became receptive to songwriting.
○
Wrote "Filthy Song" - provided a way for him to share his experience and
for the staff to see him in a different, more open way.
○
-
12 year old girl who was struck by a car
She was very empowered by the idea of writing a song like the Spice Girls.
○
She wrote a parody to the song "Wannabe" by the Spice Girls.
○
She was able to participate in rehab as a result of her engagement in
music.
○
-
Lecture 3 & 4:
Wednesday, May 16, 2018
1:01 PM
Intro
Not all music therapists practice in the same way.
-
The may practice differently depending on your client, some approaches might
be more appropriate.
-
And depending on the music therapist's strengths.
-
Model vs approach:
Will be used interchangeably throughout the class.
○
Don't get hung up on it.
○
-
Humanistic vs Behavioural
Humanistic = client/person-centred
Therapist follows the lead of the client.
§
Most music therapy approaches are humanistic.
§
○
Behavioural = outcome based
Therapists stays on the course of the treatment plan and tries to
keep the client on task.
§
○
-
Creative Music Therapy
Nordoff-Robbins
Music therapy training
There isn't any specific Nordoff-Robbins training programs in Canada, but
Laurier is influenced by Nordoff-Robbins.
○
In NY or England, for example, there are Nordoff-Robbins training
programs where you would graduate as a Nordoff-Robbins therapists.
○
-
In true form, uses 2 therapists with 1 client.
1 at the piano supporting the music relationship and creating the music
space, the other physically supporting the client.
○
Some therapists have adapted this model to perform as a solo therapist
because it's difficult logistically and financially to have 2 music therapists.
○
-
Creative music therapy because you are being creative in the music space.
-
The idea is at all humans posses a "Music Child" which remains intact and
accessible, no matter the diagnosis, physical problems, etc.
Idea of N-R is to create a safe music space where the "music child" can
come out, self-express.
○
-
Humanistic approach
Developed with children - the therapist follows the child's lead.
○
Now applied to all age groups.
○
-
Music centred.
Very little verbal expression.
○
They believe the magic happens within the music - no need for music
because the music does the communicating.
○
-
Video:
In 1959, American composer and pianist Paul Nordoff and special
education teacher Clive Robbins developed a new form of collaborative
music-making to engage vulnerable and isolated children, which they
termed "therapy in music."
○
They began researching, publishing and teaching all over the world.
○
Led by Sybil Beresford-Pierse, the first music therapy service was
established in South London in 1970.
○
This was soon followed by the first Nordoff Robbins training program in
1974 which was essential as it gave Nordoff and Robbins the opportunity
to pass on the vital skills they had been developing for years.
○
In the video, we see Nordoff and Robbins following the child's lead.
They're so in sync with the child, it's hard to tell who is following
who.
§
○
-
Biomedical Model
Hospital/medical setting.
-
Working towards a medical goal (e.g., pain management post-surgery)
-
Or it could be that the therapist is working in this model to tackle psychological
symptoms post-surgery.
-
They may incorporate other approaches (e.g., verbal therapy).
-
Biopsychosocial Model:
We are physiological, psychological and social beings.
Each contributes to our identities.
§
○
This approach looks at …
Managing biological/physiological goals.
§
Managing psychological goals
§
And managing social goals (e.g., "what is my place in the world
now?")
§
○
Biopsychosocial vs Nordoff-Robbins
Nordoff-Robbins is not Biomedical or Biopsychosocial because
they're not necessarily working on a physiological goal - sometimes
they do.
§
They never use verbal treatments, however, so there's not as much
direct engagement with psychological goals.
§
○
Neurologic Music Therapy
An example of Biomedical
○
Requires Post-Music Therapy training.
○
Looks at neurological rehabilitation.
E.g., post-stroke issues, gait, Parkinson's
§
○
Example: George's stroke
George had difficulty walking post-stroke.
§
Began RAS (a standardized intervention of neurological music
therapy)
§
George was able to speed up his walking using RAS.
§
Gait was improved.
§
○
Neurologic music therapy uses standardized interventions (i.e., RAS,
metronome use, therapeutic singing).
Goals are rehabilitation based.
§
Not going to typically talk about emotions/expression.
§
Extremely effective.
§
Don't need CRPO if you're not using psychotherapy and neurologic
music therapists don’t need it.
Need CAMT recognition and NMT training.□
§
○
Evidence-Based
Quantitative, measurable data because neurologic music therapy
uses standardized methods.
§
Difficult in regular music therapy because it is more flexible by
nature, but in the case of rehab, we have standardized methods.
§
○
Example: Speech after Stroke
Used therapeutic singing to help improve speech abilities after
stroke.
§
You can see the improvement over time.
§
○
Aesthetic Music Therapy
Dr. Colin Lee, WLU
Developed aesthetic music therapy.
○
At Laurier, the program is heavily based in aesthetic music therapy and
psychotherapy.
○
If you go to Laurier, it doesn't require more education.
○
-
Humanistic
But the music must remain aesthetic.
○
-
Music Centred
-
Around the aesthetics of the music created in the therapy session.
Important that the music had form and sounds like real music.
○
Very different from other approaches which find the outcomes to be
nothing compared to the process.
○
Client still doesn't need a music background - it's the music therapist's job
to maintain the aesthetic.
○
-
Who/what determines the appropriate aesthetic?
Cultural rules, unconscious.
○
The therapist decides what aesthetic is, but it's important to recognize
their client's cultural background.
○
-
Client is not supposed to verbally process what's happening in the music.
Therefore, it doesn't fit with everyone's needs.
○
E.g., Might be good for non-verbal people, more so than people with
emotional issues.
○
-
Goals
Building self-confidence, autonomy.
○
"Despite my limitations, I can create this beautiful music"
○
-
Research with Penderecki String Quartet
Quartet aesthetically improvised.
○
Then worked with psychodynamic music therapists.
○
They had dynamic struggles when improvising aesthetically even though
they were completely competent musicians.
○
After verbally working through the problems (psychodynamically) the
music became the evidence of their cohesiveness and cooperation.
○
-
Behavioural Model
Prominent model in the U.S.; developed there.
-
Result/outcome driven as opposed to client centred.
-
The use of music as a contingent reinforcement or stimulus cue to increase or
modify maladaptive behaviours.
-
When to use?
E.g., young child on the autism spectrum and they often perform unsafe
behaviours (i.e., exit behaviours)
○
Music therapy can work to modify those behaviours and to engage them
for longer periods of time.
○
-
Music is used as a stimulus.
-
Video: music therapy reinforces the lessons of unacceptable behaviour and
apology.
Goal is to bring awareness to these behaviours and eventually modify
them.
○
-
Behavioural approach is not specific to music therapy - adopted by music
therapists.
-
Cognitive Behavioural Music Therapy
Point is to become aware of irrational thinking.
Actions are the result of irrational thinking.
§
○
Start to put rational thought processes in place to promote appropriate,
safe behaviours.
○
Guided Imagery Method
Requires post-Music Therapy training
3 years (training + practice hours)
○
-
Developed by Helen Bonny
She created a collection of classically informed instrumentals organized by
specific beats per minute.
○
-
Uses pre-recorded music to bring emotions to the forefront
-
Client talks about the goal
Guided Imagery Music Therapist plays the music, the client discusses the
images evoked and later they talk through them.
○
-
Client music be neurotypical
Typically, they need to be able to verbally process and cognitively engage.
○
E.g., individuals with PTSD, anxiety, depression, those in end of life care,
etc. benefit from this therapy.
○
-
Performance anxiety
Therapist can facilitate understanding of performance anxiety through
guided imagery.
○
-
Psychodynamic Music Therapy
Analytically Oriented Music Therapy ("The Priestly Model")
Founder: Mary Priestly (1970s, violinist, music therapist)
-
Main way of engaging is through improvising/song writing, not aesthetically
influenced.
-
Developed to now include theories of psychology and psychosocial theories
-
Verbal processing supports uncovering the unconscious.
-
Music is used as a tool to explore a client's inner life - to provide a way forward
for growth and greater self knowledge.
-
Therapeutic relationship and awareness of transference imperative in this
model so the client will engage.
-
Freud and Jung - Songwriting example
Freud and Jung both used "free association"
Freud - used continuous connections
§
Jung - comes back to one main word
§
○
We use this to create goals and to gain an understanding of what's on the
client's mind.
○
We then can use free association to come up with a song.
Gives form to self-reflection.
§
○
-
Free-Improvisation
The Alvin Model
Juliette Alvin (developed model 1950-1980), Cellist
Founded the British Society for Music Therapy (1959) and Post-grad music
therapy program (1968) at Guild Hall (London, UK)
○
-
"Music is a human creation and therefore, each person can see him/herself in
self-created music."
-
The idea is that you cannot hide when improvising - you're completely
vulnerable and exposed.
-
Eclectic Model
A mix of approaches depending on the client's healthcare goals.
-
Also depends on the music therapist's goals and strengths.
-
What is Developmental age vs Chronological age?
Someone might be 40 years of age, but from a developmental approach they
might be 8.
-
Important to use music in a way that is chronological age appropriate and
developmental age appropriate.
-
Use of Improve
As an approach vs as an intervention
-
Ways to facilitate are important because improve can be daunting, intimidating.
Playing Rules1.
E.g., "just play the black keys on the piano" - choices become less and
permission is given to play them all
○
We thrive on permissions, so we tend to feel more confident when there
are rules.
○
We can make the rules less and less restrictive as the client becomes
more confident.
○
Mirroring and Matching2.
Mirroring:
Client plays something and therapist plays it back to them.
§
Therapist has to be careful so as to not look like they're making fun.
§
Idea is to say "I have heard you"
§
Clients on the autism spectrum love this mirroring
§
○
Matching:
Matching is similar, but it happens at the same time.
§
Client and therapist play in sync.
§
Re: Nordoff-Robbins video where you couldn't tell that the client
was leading the therapist because they looked so in sync.
§
○
Use of Empathy/Reflecting3.
Picking up on the other person's feeling.
○
Important part of improv because you can hear things very differently
when you're being empathetic.
○
Using awareness of emptions is important to reflect on the improv.
○
Grounding, Holding, and Containing4.
When the client is playing very chaotically the therapist grounds them.
○
E.g., on the keyboard, the therapist can play an octave apart to create
something strong and predictable so thy are reminded that the therapist
is there while they're exploring musically and that the therapist isn't
scared or intimidated.
○
Provides a container for the individual's emotions.
○
Dialoguing (musically)5.
-
Songwriting In Music Therapy
Provides a tangible product, something we use to communicate.
-
Safe way to self-explore, externalize or identify emotions.
-
Telling one's own story.
-
Reflection - self-motivation and encouragement.
-
Client groups?
Depressed, anxious, adjusting to new life after injury, accident, loss, end
of life, etc.
○
-
Reason for referral?
Build confidence, empowerment, self-expression, coping.
○
-
Traumatic Brain Injury (TBI) and Songwriting
Individuals with TBI are going through:
Loss
○
Emotional crisis
○
Adjustment
○
Rehabilitation
○
Identity confusion
○
-
Individuals with TBI benefit from songwriting (evidence-based)
-
An analysis of 82 songs by individuals with TBI revealed the following common
themes:
Isolation
○
Dependency
○
Helplessness
○
Anger
○
Body image
○
-
Common TBI speech problems:
Aphasia: cognitively aware of what one wants to say, but cannot find the
words to communicate.
Can be extremely frustrating
§
○
Dyspraxia: difficulty articulating speech.
○
-
When to introduce songwriting?
Can be intimidating
○
Therapeutic relationship is important before songwriting can be
attempted.
○
Not the same for everyone, it's important to take the client's lead.
○
-
Songwriting Techniques
Brainstorming1.
Starts with an idea, ask "what would that idea sound like?"
-
Client develops the message they want to say.
-
Fill in the Blank2.
Might use a familiar song and then change out some of the words.
-
Personalize the song.
-
Facilitates self-expression, makes it more about the client.
-
Baby step towards writing a song on your own.
-
Song Parody3.
All of the words to a song are changed, melody remains roughly the same.
-
Even though the client did not write the original song themselves, they can still
make it their own.
-
Song Collage4.
Look at the lyrics and titles of different songs and pull from those to create a
new song.
-
Provides examples and inspirations.
-
Rhyming5.
Starting with words that have meaning and brainstorming through rhyming.
-
Only possible with people who are cognitively able.
-
Examples from the Readings
19 year old man who had an accident on a train:
Both legs broken, TBI, bound to a wheelchair
○
Cognitively impaired - lacked insight.
○
Struggled with rehab exercises and was in a lot of pain.
○
Referred to MT because he couldn’t participate in rehab.
Engaging in music doesn't label you as being "sick" or "injured" so
he was less resistant.
§
It brings an element of normalcy because tool (music) is not specific
to being unwell.
§
○
He started to self-express.
Said he was lonely, missed his friends/family/home.
§
○
He became receptive to songwriting.
○
Wrote "Filthy Song" - provided a way for him to share his experience and
for the staff to see him in a different, more open way.
○
-
12 year old girl who was struck by a car
She was very empowered by the idea of writing a song like the Spice Girls.
○
She wrote a parody to the song "Wannabe" by the Spice Girls.
○
She was able to participate in rehab as a result of her engagement in
music.
○
-
Lecture 3 & 4:
Wednesday, May 16, 2018 1:01 PM
Intro
Not all music therapists practice in the same way.
-
The may practice differently depending on your client, some approaches might
be more appropriate.
-
And depending on the music therapist's strengths.
-
Model vs approach:
Will be used interchangeably throughout the class.
○
Don't get hung up on it.
○
-
Humanistic vs Behavioural
Humanistic = client/person-centred
Therapist follows the lead of the client.
§
Most music therapy approaches are humanistic.
§
○
Behavioural = outcome based
Therapists stays on the course of the treatment plan and tries to
keep the client on task.
§
○
-
Creative Music Therapy
Nordoff-Robbins
Music therapy training
There isn't any specific Nordoff-Robbins training programs in Canada, but
Laurier is influenced by Nordoff-Robbins.
○
In NY or England, for example, there are Nordoff-Robbins training
programs where you would graduate as a Nordoff-Robbins therapists.
○
-
In true form, uses 2 therapists with 1 client.
1 at the piano supporting the music relationship and creating the music
space, the other physically supporting the client.
○
Some therapists have adapted this model to perform as a solo therapist
because it's difficult logistically and financially to have 2 music therapists.
○
-
Creative music therapy because you are being creative in the music space.
-
The idea is at all humans posses a "Music Child" which remains intact and
accessible, no matter the diagnosis, physical problems, etc.
Idea of N-R is to create a safe music space where the "music child" can
come out, self-express.
○
-
Humanistic approach
Developed with children - the therapist follows the child's lead.
○
Now applied to all age groups.
○
-
Music centred.
Very little verbal expression.
○
They believe the magic happens within the music - no need for music
because the music does the communicating.
○
-
Video:
In 1959, American composer and pianist Paul Nordoff and special
education teacher Clive Robbins developed a new form of collaborative
music-making to engage vulnerable and isolated children, which they
termed "therapy in music."
○
They began researching, publishing and teaching all over the world.
○
Led by Sybil Beresford-Pierse, the first music therapy service was
established in South London in 1970.
○
This was soon followed by the first Nordoff Robbins training program in
1974 which was essential as it gave Nordoff and Robbins the opportunity
to pass on the vital skills they had been developing for years.
○
In the video, we see Nordoff and Robbins following the child's lead.
They're so in sync with the child, it's hard to tell who is following
who.
§
○
-
Biomedical Model
Hospital/medical setting.
-
Working towards a medical goal (e.g., pain management post-surgery)
-
Or it could be that the therapist is working in this model to tackle psychological
symptoms post-surgery.
-
They may incorporate other approaches (e.g., verbal therapy).
-
Biopsychosocial Model:
We are physiological, psychological and social beings.
Each contributes to our identities.
§
○
This approach looks at …
Managing biological/physiological goals.
§
Managing psychological goals
§
And managing social goals (e.g., "what is my place in the world
now?")
§
○
Biopsychosocial vs Nordoff-Robbins
Nordoff-Robbins is not Biomedical or Biopsychosocial because
they're not necessarily working on a physiological goal - sometimes
they do.
§
They never use verbal treatments, however, so there's not as much
direct engagement with psychological goals.
§
○
Neurologic Music Therapy
An example of Biomedical
○
Requires Post-Music Therapy training.
○
Looks at neurological rehabilitation.
E.g., post-stroke issues, gait, Parkinson's
§
○
Example: George's stroke
George had difficulty walking post-stroke.
§
Began RAS (a standardized intervention of neurological music
therapy)
§
George was able to speed up his walking using RAS.
§
Gait was improved.
§
○
Neurologic music therapy uses standardized interventions (i.e., RAS,
metronome use, therapeutic singing).
Goals are rehabilitation based.
§
Not going to typically talk about emotions/expression.
§
Extremely effective.
§
Don't need CRPO if you're not using psychotherapy and neurologic
music therapists don’t need it.
Need CAMT recognition and NMT training.
□
§
○
Evidence-Based
Quantitative, measurable data because neurologic music therapy
uses standardized methods.
§
Difficult in regular music therapy because it is more flexible by
nature, but in the case of rehab, we have standardized methods.
§
○
Example: Speech after Stroke
Used therapeutic singing to help improve speech abilities after
stroke.
§
You can see the improvement over time.
§
○
Aesthetic Music Therapy
Dr. Colin Lee, WLU
Developed aesthetic music therapy.
○
At Laurier, the program is heavily based in aesthetic music therapy and
psychotherapy.
○
If you go to Laurier, it doesn't require more education.
○
-
Humanistic
But the music must remain aesthetic.
○
-
Music Centred
-
Around the aesthetics of the music created in the therapy session.
Important that the music had form and sounds like real music.
○
Very different from other approaches which find the outcomes to be
nothing compared to the process.
○
Client still doesn't need a music background - it's the music therapist's job
to maintain the aesthetic.
○
-
Who/what determines the appropriate aesthetic?
Cultural rules, unconscious.
○
The therapist decides what aesthetic is, but it's important to recognize
their client's cultural background.
○
-
Client is not supposed to verbally process what's happening in the music.
Therefore, it doesn't fit with everyone's needs.
○
E.g., Might be good for non-verbal people, more so than people with
emotional issues.
○
-
Goals
Building self-confidence, autonomy.
○
"Despite my limitations, I can create this beautiful music"
○
-
Research with Penderecki String Quartet
Quartet aesthetically improvised.
○
Then worked with psychodynamic music therapists.
○
They had dynamic struggles when improvising aesthetically even though
they were completely competent musicians.
○
After verbally working through the problems (psychodynamically) the
music became the evidence of their cohesiveness and cooperation.
○
-
Behavioural Model
Prominent model in the U.S.; developed there.
-
Result/outcome driven as opposed to client centred.
-
The use of music as a contingent reinforcement or stimulus cue to increase or
modify maladaptive behaviours.
-
When to use?
E.g., young child on the autism spectrum and they often perform unsafe
behaviours (i.e., exit behaviours)
○
Music therapy can work to modify those behaviours and to engage them
for longer periods of time.
○
-
Music is used as a stimulus.
-
Video: music therapy reinforces the lessons of unacceptable behaviour and
apology.
Goal is to bring awareness to these behaviours and eventually modify
them.
○
-
Behavioural approach is not specific to music therapy - adopted by music
therapists.
-
Cognitive Behavioural Music Therapy
Point is to become aware of irrational thinking.
Actions are the result of irrational thinking.
§
○
Start to put rational thought processes in place to promote appropriate,
safe behaviours.
○
Guided Imagery Method
Requires post-Music Therapy training
3 years (training + practice hours)
○
-
Developed by Helen Bonny
She created a collection of classically informed instrumentals organized by
specific beats per minute.
○
-
Uses pre-recorded music to bring emotions to the forefront
-
Client talks about the goal
Guided Imagery Music Therapist plays the music, the client discusses the
images evoked and later they talk through them.
○
-
Client music be neurotypical
Typically, they need to be able to verbally process and cognitively engage.
○
E.g., individuals with PTSD, anxiety, depression, those in end of life care,
etc. benefit from this therapy.
○
-
Performance anxiety
Therapist can facilitate understanding of performance anxiety through
guided imagery.
○
-
Psychodynamic Music Therapy
Analytically Oriented Music Therapy ("The Priestly Model")
Founder: Mary Priestly (1970s, violinist, music therapist)
-
Main way of engaging is through improvising/song writing, not aesthetically
influenced.
-
Developed to now include theories of psychology and psychosocial theories
-
Verbal processing supports uncovering the unconscious.
-
Music is used as a tool to explore a client's inner life - to provide a way forward
for growth and greater self knowledge.
-
Therapeutic relationship and awareness of transference imperative in this
model so the client will engage.
-
Freud and Jung - Songwriting example
Freud and Jung both used "free association"
Freud - used continuous connections
§
Jung - comes back to one main word
§
○
We use this to create goals and to gain an understanding of what's on the
client's mind.
○
We then can use free association to come up with a song.
Gives form to self-reflection.
§
○
-
Free-Improvisation
The Alvin Model
Juliette Alvin (developed model 1950-1980), Cellist
Founded the British Society for Music Therapy (1959) and Post-grad music
therapy program (1968) at Guild Hall (London, UK)
○
-
"Music is a human creation and therefore, each person can see him/herself in
self-created music."
-
The idea is that you cannot hide when improvising - you're completely
vulnerable and exposed.
-
Eclectic Model
A mix of approaches depending on the client's healthcare goals.
-
Also depends on the music therapist's goals and strengths.
-
What is Developmental age vs Chronological age?
Someone might be 40 years of age, but from a developmental approach they
might be 8.
-
Important to use music in a way that is chronological age appropriate and
developmental age appropriate.
-
Use of Improve
As an approach vs as an intervention
-
Ways to facilitate are important because improve can be daunting, intimidating.
Playing Rules1.
E.g., "just play the black keys on the piano" - choices become less and
permission is given to play them all
○
We thrive on permissions, so we tend to feel more confident when there
are rules.
○
We can make the rules less and less restrictive as the client becomes
more confident.
○
Mirroring and Matching2.
Mirroring:
Client plays something and therapist plays it back to them.
§
Therapist has to be careful so as to not look like they're making fun.
§
Idea is to say "I have heard you"
§
Clients on the autism spectrum love this mirroring
§
○
Matching:
Matching is similar, but it happens at the same time.
§
Client and therapist play in sync.
§
Re: Nordoff-Robbins video where you couldn't tell that the client
was leading the therapist because they looked so in sync.
§
○
Use of Empathy/Reflecting3.
Picking up on the other person's feeling.
○
Important part of improv because you can hear things very differently
when you're being empathetic.
○
Using awareness of emptions is important to reflect on the improv.
○
Grounding, Holding, and Containing4.
When the client is playing very chaotically the therapist grounds them.
○
E.g., on the keyboard, the therapist can play an octave apart to create
something strong and predictable so thy are reminded that the therapist
is there while they're exploring musically and that the therapist isn't
scared or intimidated.
○
Provides a container for the individual's emotions.
○
Dialoguing (musically)5.
-
Songwriting In Music Therapy
Provides a tangible product, something we use to communicate.
-
Safe way to self-explore, externalize or identify emotions.
-
Telling one's own story.
-
Reflection - self-motivation and encouragement.
-
Client groups?
Depressed, anxious, adjusting to new life after injury, accident, loss, end
of life, etc.
○
-
Reason for referral?
Build confidence, empowerment, self-expression, coping.
○
-
Traumatic Brain Injury (TBI) and Songwriting
Individuals with TBI are going through:
Loss
○
Emotional crisis
○
Adjustment
○
Rehabilitation
○
Identity confusion
○
-
Individuals with TBI benefit from songwriting (evidence-based)
-
An analysis of 82 songs by individuals with TBI revealed the following common
themes:
Isolation
○
Dependency
○
Helplessness
○
Anger
○
Body image
○
-
Common TBI speech problems:
Aphasia: cognitively aware of what one wants to say, but cannot find the
words to communicate.
Can be extremely frustrating
§
○
Dyspraxia: difficulty articulating speech.
○
-
When to introduce songwriting?
Can be intimidating
○
Therapeutic relationship is important before songwriting can be
attempted.
○
Not the same for everyone, it's important to take the client's lead.
○
-
Songwriting Techniques
Brainstorming1.
Starts with an idea, ask "what would that idea sound like?"
-
Client develops the message they want to say.
-
Fill in the Blank2.
Might use a familiar song and then change out some of the words.
-
Personalize the song.
-
Facilitates self-expression, makes it more about the client.
-
Baby step towards writing a song on your own.
-
Song Parody3.
All of the words to a song are changed, melody remains roughly the same.
-
Even though the client did not write the original song themselves, they can still
make it their own.
-
Song Collage4.
Look at the lyrics and titles of different songs and pull from those to create a
new song.
-
Provides examples and inspirations.
-
Rhyming5.
Starting with words that have meaning and brainstorming through rhyming.
-
Only possible with people who are cognitively able.
-
Examples from the Readings
19 year old man who had an accident on a train:
Both legs broken, TBI, bound to a wheelchair
○
Cognitively impaired - lacked insight.
○
Struggled with rehab exercises and was in a lot of pain.
○
Referred to MT because he couldn’t participate in rehab.
Engaging in music doesn't label you as being "sick" or "injured" so
he was less resistant.
§
It brings an element of normalcy because tool (music) is not specific
to being unwell.
§
○
He started to self-express.
Said he was lonely, missed his friends/family/home.
§
○
He became receptive to songwriting.
○
Wrote "Filthy Song" - provided a way for him to share his experience and
for the staff to see him in a different, more open way.
○
-
12 year old girl who was struck by a car
She was very empowered by the idea of writing a song like the Spice Girls.
○
She wrote a parody to the song "Wannabe" by the Spice Girls.
○
She was able to participate in rehab as a result of her engagement in
music.
○
-
Lecture 3 & 4:
Wednesday, May 16, 2018 1:01 PM
