Music Therapy and Language Barriers

Any form of therapy utilizes communication to assist in the flow of the sessions and help the clients reach their goals. Music therapy is unique because it can use music as communication, but can it still be effective through a language barrier? Language barrier refers to “music therapists who conduct music therapy sessions in a language that is not their native tongue” (Mori, 2021).

There are two main ways to facilitate music in music therapy: music in therapy and music as therapy. Music in therapy refers to when music is used as a tool to enhance existing treatment. Music as therapy refers to when the music has a direct impact on the client and is the primary tool for growth (Zanders, 2018). When a music therapist uses music as therapy, “music is the essential medium of communication and interaction to build a therapeutic relationship” (Mori, 2021). Four other methods of facilitating music therapy have been presented by Bruscia (2013). His methods are the receptive method, the re-creative method, the improvising method, and the compositional method. Mori (2021) describes these methods precisely as:

In the receptive method, clients listen to music and respond to it verbally or in different modalities. In the re-creative method, clients sing and play instruments through precomposed music or reproduce music forms. In the improvisational method, clients create a melody, rhythm, and instrumental piece with the therapists’ support. In the compositional method, the therapists assist clients in writing music and lyrics.

Nordoff-Robbins Music Therapy (NR-MT) is a prime example of music therapy that is effective in a language barrier due to its techniques of improvisational music making as the primary form of communication. An interview conducted by D. M. Kim (2010) revealed that therapists who worked through a language barrier preferred NR-MT over other music therapy methods. They appreciated NR-MT because it enabled both them and their clients to express themselves fully through music without the need for verbal communication (Towards musical individuation).

When practicing music therapy with a present language barrier, it is important to maintain a music as therapy model and rely on the music to communicate with the client. Research shows that the most important factors in building rapport in a second language include being honest, understanding facial expressions and body language, authenticity, and empathy (Mori, 2021). Mori’s (2021) study resulted in three significant findings: “English [for non-native English speakers] is not necessarily a language barrier; the respondents use music interventions depending on the clients’ goals; and the respondents are sensitive to the clients’ cues (e.g., body language, facial expressions), rather than depending only on verbal cues to facilitate the therapeutic process.”

-Janelle Lockney, Music Therapy Intern

References:

Kim, D. (2010). Towards musical individuation: Korean female music therapists’ experiences in the nordoff-robbins music therapy certification training. The Arts in Psychotherapy, 37, 353-362.

Mori, K. (2021). The influence of language barriers in music therapy (Publication No. 107) [Master’s thesis, Molloy College]. Lila D. Bunch Library.

Zanders, M. (2018). Music as therapy versus music in therapy. Journal of Neuroscience Nursing, 50(4), 218-219.

Humanism in Music Therapy

Humanistic music therapy is rooted in the belief that everybody can actualize their desires for their health and well-being and that conditions and states present opportunities for change. A humanistic music therapist does not need to limit themselves to only utilizing humanism in their practice. Humanistic music therapists can learn and practice techniques from other therapeutic approaches as long as they keep the core principles of humanism.

Bugental (1964) published five core principles of humanism in psychology. 

1. Humans are more than the sum of their parts and cannot be reduced to individual components.

2. Humans exist in a uniquely human context

3. Humans are conscious and aware of being conscious in the context of themselves and others

4. Humans have both choice and responsibility

5. Humans are intentional beings with goals, aware of how they play a role in future events and seek meaning, value, and creativity

These principles laid the foundation for humanism’s use in therapy. There are four foundations of humanistic music therapy and four humanistic constructs that exist outside of Bugental’s five principles. The four foundations of humanistic music therapy include clients, music, therapy goals, and the therapeutic process. The four core humanistic constructs include being, holism, agency, and relationship.

Humanistic music therapy is relational. It does not focus on the client’s response to interventions, but on how the treatment helps the client feel empowerment, meaning, and dignity. Relationships in humanistic music therapy are not just an aspect of the treatment but the therapy itself. Clients are regarded as beings. Being (in the context of humanism) is a way of existence centered on humanity and distinguishes each individual with a unique identity. This is typically contextualized most clearly as somebody’s name. Being is more concerned about the who rather than the what of the client's needs.

Humanism is practiced in music therapy through musicing. Musicing is the expression of a person’s aesthetic agency in action. Aesthetic agency is the capacity for an individual to control their musical experience. Goals in humanistic music therapy center around the “ongoing, evolving pursuit of self-actualization, or the maximal expression of human potential” (Wheeler et al., 2017). In the Humanistic music therapy intervention process, interventions are not isolated techniques accomplishing isolated goals but are understood by how they play a role within the context of the whole person.

-Janelle Lockney, Music Therapy Intern

References:

Wheeler, B. (2017). Music therapy handbook. The Guilford Press.

Music Therapy and Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition (Bergmann, 2016) defined by deficits in social communication and interactions paired with restricted, repetitive behaviors, activities, and interests (Velikonja, 2019; Andersson, 2020). Goals and objectives for adults with ASD seeking treatment can be addressed during music therapy sessions. Music therapy positively impacts adults with autism spectrum disorder by assisting in activities of daily living, social interaction, and cognitive function. Music therapy interacts with adults with ASD through improvisation, group music-making activities, and various other interventions to improve their quality of life. Symptoms and severity range in every person diagnosed with ASD, and how the condition progresses into adulthood is also unique to the individual and their level of care.

Activities of Daily Living [ADLs] are the everyday tasks (such as cooking, cleaning, and sustainability) that can be impacted by an individual’s diagnosis. Within ASD specifically, “Clinical characteristics… influence the relationship to the self, to other people, and to objects and thus include all areas of life” (Bergmann, 2016). Andersson (2021) released an article that studied positron emission and serotonin availability in adults with ASD and how this affects performance in cognition and functioning compared to neurotypical adults. They found that adults with ASD perform lower in social cognition, executive function, and central coherence (Andersson, 2021). The two most common goals for adults with ASD are understanding behavior and how it affects their lives and developing executive functioning skills.

Music therapy, as a treatment for ASD, can be rewarding and exciting for patients. Adults benefit from music therapy in the areas of “regulation/behavioral variability, imitation, disorders pertaining to different areas related with instinct, emotional disorders and interaction disorders” (Mateos-Moreno, 2013). The structure of music therapy can be comforting for adults with ASD because it can be uniquely tailored to their needs and wishes. A commonality amongst people with ASD is the comfort they receive in predictability and structure, and music therapy can provide that for its patients. Tony Wigram developed many improvisation techniques in music therapy that can be applied when working with adults with ASD. Improvisation is particularly effective in understanding emotions and emotional regulation. Portraying different emotions through piano or drumming can help a client connect with that particular emotion and how they can express it when it arises in their daily life. Group music-making allows adults with ASD to create joyful experiences and connections with their peers (Mateos-Moreno, 2013). An example of music therapy being used for adults with ASD was in 2013 when The Arts in Psychotherapy released an article discussing music and dance/movement therapy’s impact on adults with ASD. Their session started with everybody entering the room with soothing music and forming a circle. They then stated their names using a drum since the rhythm enhances the memory process. They continued the exercise by expressing their feelings by using the drum. After each client said their name and how they felt, the rest of the group chanted it back to them. This encouraged the participants to remember the details of their fellow peers and validate what the individual stated. Music therapy is a beneficial treatment option for adults with ASD because it is fun, safe, and inclusive and reaps real benefits for adults in the ASD community.

-Janelle Lockney, Music Therapy Intern

References:

American Music Therapy Association. (2005). What is Music Therapy? American Music Therapy Association. Retrieved 2022, from https://www.musictherapy.org/about/musictherapy/

Anderson, M. (2021). Serotonin transporter availability in adults with autism - a positron emission tomography study. Molecular Psychiatry. Vol.26(5), pp. 1647-1658

Bergmann, T. (2016) Music in diagnostics: Using musical interactional settings for diagnosing autism in adults with intellectual developmental disabilities. Nordic Journal of Music Therapy. Vol.25(4), pp.319-351

Buijsman, R. (2022). ‘Autistic man’ or ‘person with autism’?: Person-first language preference in Dutch adults with autism and parents. Autism: The International Journal of Research and Practice. Pp. 13623613221117914-13623613221117914

Mateos-Moreno, D. (2013). Effect of a combined dance/movement and music therapy on young adults diagnosed with severe autism. The Arts in Psychotherapy. Vol.40(5), pp. 465-472

Roberson, K. (2019). Goals of therapy for adults with autism spectrum disorder. Kenneth Roberson PhD. Retrieved July 2022, from https://kennethrobersonphd.com/goals-of-therapy-for-adults-with-aspergers/

Velikonja, T. (2019). Patterns of nonsocial and social cognitive functioning in adults with autism spectrum disorder: A systematic review and meta-analysis. JAMA Psychiatry, Vol.76 (2), p.135-151.

Final Farewells

Reflecting on my time here at Therabeat Inc., I have grown so much from when I first started. With the support of my supervisors, I created new music games, helped clients reach their goals, and built a library of materials. I learned how to go with the flow during co-treats and address the client’s needs such as needing a break or moving around.

I have learned many valuable lessons. For instance, I learned how to play the ukulele. Before this internship, I had never played the ukulele. Now, I can play and teach clients how to play the ukulele in sessions. I have learned how to think on my feet and think outside of the box. For instance, when a client requested more of the gong during her physical therapy session. I used the gong and her preferred music to cue her to cross midline to play it.

Other skills I have learned include how to look at a chord sheet and keep eye contact with the client and the importance of small talk during a session. I found that talking with the clients during the session created a positive client therapist bond and I learned more about the client. It helped to inform the way I plan to create more opportunities for clients to reach their goals. For instance, using their preferred music to write a song to work on goals such as answering questions and creating original ideas.   

One of the memories I look fondly on is seeing how well all my clients did at the recital. They all worked so hard to perform for their family and friends. For instance, one client successfully played and sang his song. The joy and pride he felt for his performance reminded me why I am a music therapist in the first place. Another fond memory I have with a client is a client diagnosed with autism. She was working on spelling and pronunciation words, so I brought visuals, a letter puzzle, and a song with an easy melody to remember. Within 2 weeks, she could spell and pronounce 3 words of the song. Not only did I help her develop her speech and academic skills, but it made me feel accomplished as a music therapist.

Thank you to Therabeat Inc. for giving me the confidence and skills that you have taught me. I will carry all the memories and lessons to my next adventure. I am not sure where I will be, but wherever I go I know I will be ready thanks to this internship. Farwell Therabeat Inc. You will always have a special place in my heart.

-Teresa Dominguez, Music Therapy Intern

Music therapy and Treating Children Who Experienced Abuse and Trauma

Trauma can occur at any age, however, children who experience trauma may experience effects on many parts of their development. Developmental trauma or reactive stress disorder is when a child is in a constant state of stress (Drevitch, 2018). A situation that can cause constant stress is abuse. The constant stress disrupts a child’s development (Drevitch, 2018). According to Drevitch, “Development of upper parts depends upon prior development of lower parts. In other words, the brain is meant to develop like a ladder, from the bottom up” (p. 1, 2018). If a child is raised in a healthy environment, the upper and lower parts of the brain have a good foundation to continue to develop and grow. However, for children who have experienced trauma such as abuse, that crucial part of their foundation during development is missing. These delays in development can manifest as sensory processing disorder, attention-deficit/hyperactivity disorder (ADHD), and speech delays (2018). Children who experience trauma need therapy to process their experiences and address their needs.

An assessment created by Bruce Perry called Neurosequential Model of Therapeutics (NMT) is used to assess the brain development of those who have developmental trauma (Drevitch, 2018). The areas of the brain that are assessed include sensory integration, self-regulation function, relational function, and cognition (Douglas, 2022). After the assessment is complete, the scores show the neuro-developmental needs of the child being assessed. Information collected in this assessment includes the history of the child’s past and present and 32 areas of the brain (Douglas, 2022). The assessment maps out the brain to show the child’s current functions, age development, and relational health (Douglas, 2022).  

How does music therapy address the needs of a child who experiences trauma? Music therapists use a variety of methods including re-creative, improvisation, compositional, and receptive music therapy techniques. For instance, a music therapist used improvisation with an 8-year-old girl named Kelly who experienced sexual abuse (Strehlow, 2009). The music therapist began by giving Kelly space to reenact of the trauma through music (Strehlow, 2009). Kelly would play the recorder by herself first, but once she was comfortable she allowed the music therapist to play along with her using the xylophone. After the music therapist had gained her trust, they reenacted the trauma through the instruments and role playing. The music therapist’s role was to support the child’s expression of the trauma and promote self-expression.

A music therapist using re-creative technique focusing on a child named Larna (3 years old) who experienced physical abuse (Pasiali, 2013). The music therapist used singing songs with instruments/props to address the child’s needs. The goal was to learn to play and explore (Pasiali, 2013). The songs used were age-appropriate songs, tunes with different modalities, and chants with instruments and props such as using a scarf to put over Larna’s head to pretend she was a princess while singing (Pasiali, 2013). Larna would sit on her mother’s lap and cuddle with her when singing songs. Other interventions included sitting on a parachute and playing games that involve singing short melodic phrases while touching another person at the end of each phrase pretending to “buzz” them (Pasiali, 2013).

Another music therapist who treated a child named Sally who experienced sexual abuse using a receptive technique. Sally went to music therapy from the age of 7 to 14. Music therapist worked on developing trust between Sally and the therapist (Robarts, 2006). The goal of each session included self-regulation and sensory integration (Robarts, 2006). The music therapist would play music and encourage her to play along. The music therapist would base the tempo and rhythm of the music on Sally’s mood and flashbacks during the session (Robarts, 2006). During the session, the music therapist was viewed as one of her abusers and the music therapist would address this by playing a steady rhythm and melody. The music would help to ground Sally and bring her back from her flashbacks (Robarts, 2006). It even inspired her to play with the music therapist (Robarts, 2006).

Another music therapist who treated a 5-year-old child named Leah who experienced sexual abuse, physical abuse, and neglect using a technique called compositional (Christenbury, 2015). The music therapist treating Leah used a compositional intervention called songwriting. The songs written during the session were based on Leah’s emotions such as being happy or sad (Christenbury, 2015). Emotions such as anger were more negative emotions and related to her trauma. Leah would draw pictures of what her emotions look like to her and the music therapist would work with her to create music to go along with her pictures. Leah would direct the music therapist to color with her using specific colors (Christenbury, 2015). All the pictures and lyrics were put into a book and the music therapist recorded all music for Leah to take with her. The pictures and music such as using minor keys for sad emotions reflect what Leah was feeling and process her feelings of sadness.

Music therapy supports children who have experienced trauma to process, self-regulate, cope, and build healthy relationships with others. For instance, in the case studies of Larna and Kelly the music helped them to build relationships with others by learning how to trust. In Sally’s case, she was able to entrain to the beat to bring her out of her flashbacks and prompted her to participate in making music (Robarts, 2006). Entraining to the beat helped Sally to learn how to self-regulate. Leah’s songwriting helped her to process current and past events (Christenbury, 2015). Music therapy supported these children in their journey to reach their goals and move past their trauma to trust and grow to be the best they can be.

-Teresa Dominguez, Music Therapy Intern

References:

Christenbury, R. K. (2015). I will follow you: The combined use of songwriting and art to promote healing in a child who has been traumatized. Music Therapy Perspectives, 35(1), 1 – 12. https://doi.org/10.1093/mtp/miv005

Douglas, A. C. Meeting children where they are: The neurosequential model of therapeutics. National Council For Adoption. (2022, March 15). ttps://adoptioncouncil.org/publications/meeting-children-where-they-are-the-neurosequential-model-of-therapeutics/

Drevitch, G. (2018). What is developmental trauma? Psychology Today. Sussex Publishers. https://www.psychologytoday.com/us/blog/expressive-trauma-integration/201808/what-is-developmental-trauma

Pasiali, V. (2013). A Clinical Case Study of Family-Based Music Therapy. Journal of Creativity in Mental Health. 8(3), 249 – 264. http://dx.doi.org/10.1080/15401383.2013.821925

Robarts, J. Z. (2006). Music Therapy with Sexually Abused Children. Clinical Child Psychology and Psychiatry.

Strehlow, G. (2009). The use of music therapy in treating sexually abused children. Nordic Journal of Music Therapy. 18(2), 167 – 183. https://doi.org/10.1080/08098130903062397