I first learned of the profession of Music Therapy whilst studying a degree in Music at Manchester University, UK.More specifically, it was during one clarinet lesson where my teacher, a professional orchestral musician, declared with a curious tone that she had recently been “looking into Music Therapy,” and announced, “It may be just your thing.” Despite my love of musical performance and my expressive capabilities as a clarinettist, we both knew that I was not technically cut out to be an orchestral performer – and neither did I want to be, if I were truly honest. Somehow the musicians seemed too far away from the people in the audience, the people who were nonetheless being incredibly moved, lulled, aroused, calmed and energised by all manner of emotional evocations, simply from sitting, listening to a concert. In his book Music Therapy: An Art Beyond Words, Bunt (1999) suggests why we as a species have evolved to be so concerned with the acts of listening to and making music:

“At the root of all these reasons lies the fact that music links with our innermost emotional, spiritual and most private selves. Music makes us feel more human. It brings us into very close and immediate contact with the people around us and at the same time connects us both with images from the past and predictions of the immediate future.”

Music Therapy is a professional discipline practised by Registered Music Therapists – musicians clinically trained to employ music in the assessment, implementation and evaluation of personalised music therapy programmes. The aims or goals of music therapy are therapeutic, not musical; although musical sensitivities and skills may be acquired during the process of engagement in a music therapy programme, these are secondary to the pre-determined therapeutic objectives. The following aims that can be addressed within music therapy is not an exclusive list:

• Development of communication, social skills, self esteem and confidence
• Promotion of self acceptance and self expression
• Providing emotional support during healing processes following trauma and illness and help processing life changes
• Aiding development of body coordination and physical rehabilitation
• Exploration of personal identity
• Enhancement of social bonds and sense of community.
• Aiming high-exploring motivation to reach and play (tambourine)

Music therapists use their therapeutic skills to generate a safe, accepting and creative environment, and their musical skills to forge a creative musical relationship that facilitates growth and positive change in their clients.The therapist’s skilled use of music, in response to the client’s qualities of sound, movement or words, fosters a therapeutic rapport – the therapist invites the client to explore with them a world of sound and musical relationships through which they can communicate, express, find joy and solace, physical or social empowerment and experience new or enriched ways of being and relating.

Music therapists work both with individuals and small groups of all ages, and with all manner of abilities and personal needs.

Therapists therefore work in a variety of different settings and commonly liase with other professionals, and also with the client’s family where appropriate. A music therapy session may involve one or more of the following uses of music; listening and reflecting upon recorded or live music, co-creating music through improvisation, writing music or songs, and playing or singing pre- composed songs.

Given that I am a wind player by formal training, you may be thinking how do I utilise flute and clarinet with clients? The answer is perhaps no surprise: I use it as an extension of my voice, to respond to and expand a client’s gestures, and also to explore emotional states and sometimes transport them to an imaginary place they otherwise may not have ever entered alone.

The vast pitch range and various timbres of the clarinet registers can play melodies at pitches and with character that my voice cannot convey. The flute, I find, matches the vocal timbre of children’s voices well and is useful for soothing a distressed client. Both instruments evoke curiosity and thus can serve as significant instruments to create connections, and to arouse and enliven lethargic individuals. I use these, and recorders, most commonly with less physically active clients – for example, my clients with cerebral palsy who are wheelchair users and are frequently severely limited in their freedom of physical/sensory exploration and self-expression. For some of my more able-bodied, active clients I choose not to use my wind instruments, as they may not understand why they cannot have access to these instruments and also, for the safety of the instrument and myself, it could be dangerous to have an instrument in my mouth.

The following case study outlines how I have used flute and clarinet in music therapy for two clients who have been receiving music therapy in a pair for over a year. (Their names have been altered for reasons of confidentiality):

Amy and Reuven are adolescents who have been attending weekly music therapy sessions in a pair for five terms. Both students have complex medical needs and severely limited physical and communicative abilities. Neither client is able to use verbal language, although it is felt that they understand a great deal of what is said to them. For both clients, vocal expression requires considerable time and effort to process the therapist’s expectation, consider a response, and engage the relevant muscles etc to deliver such.

One aim of therapy with Amy and Reuven is to encourage greater vocal expression. The session begins with a greeting song, accompanied on guitar. Here, each client is invited to vocalise, to express their presence and feeling state, in familiar pauses in the music. After this, I play a recognised melody to each in turn: on the flute and clarinet respectively. The melodies have been chosen especially to reflect something of each client’s individual characteristics or musical preferences. Amy’s melody is a bright, joyful, dance played on the flute, and Reuven’s melody is more rhythmic and is played with the low, resonant tones of the clarinet.

I play the original melody close to the client after preparing them for the sound by showing them the instrument and reminding them of how they can engage with the music. I then proceed to play the melody again, or phrases of it, and leave a deliberate pause or silence. Here it is expected that Amy or Reuven will vocalise to request further music. Each time I play the theme I adapt it slightly (rhythmically or modally) in order to expand their musical experience and often in response to the shape of the vocal gesture they have been able to express.

Both clients are intrigued by the sounds of these instruments and sometimes smile when they are introduced during the session. Amy and Reuven’s ability to respond through sound varies from week to week, and when even the smallest sound seems too difficult to produce, I acknowledge Amy’s fluttering eyelids and Reuven’s tongue movements as indications that they are signalling for ‘more’, and I duly play again.

I am careful to match my perseverance in waiting for a sound or subtle movement gesture with Amy and Reuven’s perseverance in seeking to give one. One of the skills a therapist possesses is the ability to listen actively with patience, whilst holding the expectation of some form of reciprocal communicative gesture. Sometimes the wait can be painfully long; at these times, I reflect on just how painful this struggle may be for them. Sometimes I will outwardly acknowledge such feelings by verbally commenting words like: “Gosh, it seems to be just too hard to muster the effort to sing today, but I can see that you are listening and watching intensely.”

Many countries now have one or more institutions offering music therapy training courses, and each course will differ in philosophical and theoretical emphasis; this is especially so in different countries where health is defined in a diversity of ways and different emphasis may be placed on the role of music within music therapy. As the profession has reached a certain maturity and research from fields such as neuroscience supports music therapy theory and practice, many courses now offer increasingly eclectic training. If you are interested in exploring a potential career in music therapy, I suggest contacting the national organisation/association of music therapy for the country in which you are interested in studying for more information and addresses for training courses.Entrance requirements and pre-requisites differ from course to course, however most expect a high degree of musical competence (often with a speciality in one or more instruments) and some evidence of working with populations of need within the community.

Bibliography

Bunt, L. (1999) Music Therapy – An Art Beyond Words. London; Routledge, p1

Recommended Reading – Music Therapy

Alvin, J. (1966) Music Therapy. London; Stainer and Bell
Bruscia, K. (1998) Defining Music Therapy (2nd Edition). Gilsum; Barcelona Publishers
Bunt, L. (1999) Music Therapy – An Art Beyond Words. London; Routledge
Wigram, T., Pedersen, I.N., Bonde, L.O. (2002) A Comprehensive guide to Music Therapy – Theory, Clinical Practice, Research and Training. London; Jessica Kingsley Publishers

Music Therapy Web Links

A world forum for Music Therapy, www.voices.no/
www.musictherapyworld.net
www.musictherapy.org.nz (NZ)
www.musictherapy.org (USA)
www.musictherapy.org (AU)
www.apmt.org (UK)

Recommended Reading-Related Interest

Sacks, O. (2007) Musicophilia – Tales of Music and the Brain. London; Picador
Storr, A. (1992) Music and the Mind. London; HarperCollins

Marie completed a Bachelors degree in Music (Hons), and a Post Graduate Diploma in Music Therapy in the UK, and worked with children and young people with special needs, before moving to New Zealand to take up a full-time music therapy position for the Raukatauri Music Therapy Trust. Marie is a Registered Music Therapist (RMTh) in New Zealand, a member of Music Therapy New Zealand’s (MThNZ) Music Therapists’ Forum., and represents music therapists within the Council of MThNZ.