Bonny Method of Guided Imagery and Music

Music therapy is a great outlet to achieve goals such as cognitive and motor skills. But what about goals that address emotions, well-being, and mental health? There is a method called the Bonny method of Guided Imagery and Music (GIM) created by Helen Bonny. GIM method addresses goals in the socio-emotional domain. GIM is a music therapy method that uses pre-recorded music to put the client in a relaxed state to explore feelings, memories, and imagery in the subconscious. The philosophy behind GIM is that the music and therapist work together. Musical elements such as tension and melodic flow prompt a person’s journey into their subconscious (Knight et. al., 2018). Music therapists assist by guiding the person on their journey through the subconscious.

In 1969, Bonny was invited to help researchers to study the effects of LSD to expand consciousness. Bonny’s job was to research the effects of listening to music during an LSD experience (Knight et. al., 2018). During each session, she would use relaxation techniques with participants that took LSD. Next, Bonny tried the same relaxation techniques, but the participants did not take LSD (Knight et. al, 2018). The results of the study showed that the participants who did not take LSD had the same effects as the participants who did take LSD (Knight et. al., 2018). These findings paved the way for Bonny to create GIM. 

A GIM session uses recorded music from a pre-set classical list and has 5 steps (Knight et. al., 2018). The first step is to have a discussion with the client to see what is on their mind and what they would like to explore. The second step is to help the client relax using relaxation techniques. The music therapist will provide a bridge between the music and beginning the imagery (Knight et. al., 2018). The third step is listening to the music. The client describes the images they see while listening to the music and the music therapist guides them through those images. The fourth step the music therapist guides the client back to state of alertness. The music therapist may ask the client to draw a mandala or images of their experience (Knight et. al., 2018). The fifth step is where the music therapist and client will process what they saw and drew.

Guided Imagery and Music is a useful method that relaxes the client and brings thoughts/emotions from the subconscious to the conscious. It offers a way to then process these thoughts/emotions without the use of medication. Thanks to Helen Bonny, we have another way to address the emotional needs of the client.

-Teresa Dominguez, Music Therapy Intern

References

Knight, A. J., LaGasse, B., Clair, A. A., & Pasiali , V. (2018). Chapter 7: Approaches to  Music Therapy . In Music therapy: An introduction to   the profession (pp. 144–145). essay, American Music Therapy Association.

Short, A. E., & Heiderscheit, A. (2020, April 1). Directory of open access journals.  Approaches: An Interdisciplinary Journal of Music Therapy. Retrieved March 28, 2023, from https://doaj.org/article/edcf029c0e564b80bd650b5fa978690a

Music Therapy and Children with Dyslexia

Music therapists work with a variety of different clients, from those with disabilities to those with mental health diagnoses. However, an area that may be unfamiliar to the public is music therapy working with children with dyslexia. What is dyslexia? According to the Mayo Clinic (2017), dyslexia is a learning disability involving difficulties with reading stemming from problems identifying speech sounds and relating them to letters and words. Dyslexia affects the parts of the brain that process language and can be diagnosed at any age.

When children with dyslexia are in school, they can display symptoms such as below-average reading levels, issues processing and understanding what they hear, trouble finding the right words to form an answer to a question, problems remembering the sequence of things, difficulty seeing or hearing similarities and differences in letters and words, inability to sound out the pronunciation of an unfamiliar word, difficulty spelling, spending long periods of time with tasks that involve reading or writing, and avoiding tasks involving reading (Mayo Clinic, 2017).

Dyslexia has genetic and environmental causes. There are genetic links, such as a family history of dyslexia or other learning disabilities, that can cause a child to have difficulties processing language and reading skills (Mayo Clinic, 2017). Environmental aspects include exposure to nicotine, drugs, alcohol, or infections during pregnancy. It may change brain development in the fetus. Other causes that can alter the brain of the fetus include premature birth or low birth weight.

Where do music therapists work with children with dyslexia? Music therapists might encounter children with dyslexia in schools or private clinic and will address needs using a variety of methods, including re-creative, receptive, and compositional techniques. According to Hintz, “music therapy literature focuses on the use of re-creative methods for individuals with learning disabilities to address specific underlying cognitive, behavioral, and social functioning” (2013, p. 174).

Hintz (2013) describes re-creative methods used in music therapy such as musical play, adaptive lessons, and structured movement. Musical play methods include musical interventions using action songs, playing instruments with songs, instrumental songs, and musical games (2013). Adaptive music lessons are individual music lessons that address goals such as sequencing ability, self-awareness, and self-regulation (2013). The most common adaptive lessons include voice, piano, and guitar. Structured movement methods include using musical elements such as rhythm and tempo to address goals targeting cognitive and processing and motor coordination (2013).

A study done by Colwell and Murlless using a re-creative technique compares the effects of chanting vs. singing with elementary students diagnosed with learning disabilities, addressing reading accuracy and their behavior during music and non-musical activities (2002). During the study, the students were tested on a different word list each week for four weeks. In week one, the students were in a typical reading program. In the second week, the students were assigned to either chanting or singing (2002). The main focus of each group was to work on targeted words. During week three, the students switched groups and worked on new words. In the fourth week, the students went back to the reading program. After two weeks, the students were retested on all the words. The results of the study show that the students' reading accuracy improved, and they stayed on task more during the music intervention (2002).  

In 2013, Przybylski et al. conducted a study using a receptive method called external rhythmic auditory stimulation, which uses musical rhythm to address syntax processing. They used the rhythmic structure to see if it would improve syntax processing in children with dyslexia and specific language impairments (2013). The children in the study were prompted to either listen to regular or irregular musical prime sequences along with blocks of grammatically correct and incorrect sentences. For each auditory sentence, the children were required to display what they had learned (2013). The results showed that rhythmic structures have the potential to boost linguistic structure processing (2013). 

Compositional methods, such as songwriting, are used to address nonmusical goals (Hintz, 2013). Goals include improving behavior, attention, and working memory. Often, these goals are the basis of the lyrics. According to Hintz, “Composition arises out of the client-therapist’s musical interaction or musical themes from the session. At other times, the composition can arise out of a verbal discussion of interpersonal struggles or emotional difficulties” (2013, p. 182). Songwriting can give kids with learning disabilities such as dyslexia an outlet to express themselves and their experiences, in addition to the goals mentioned before. 

In conclusion, music therapy can address the needs of children with dyslexia. It addresses goals such as self-awareness, cognitive skills, reading accuracy, etc. Music can offer a fun and new way for a child with dyslexia to grow and reach their goals. Individualized music therapy sessions offer a way to address a child with dyslexia’s needs while building their confidence. For instance, re-creative methods using instruments or compositional methods using songwriting. Music therapy makes reaching a child with dyslexia goals fun and individualized to their specific needs.   

-Teresa Dominguez, Music Therapy Intern

References

Colwell, C. M., & Murlless, K. D. (2002). Music activities (singing vs chanting) as a vehicle for reading accuracy of children with learning disabilities: A pilot study. Music Therapy Perspectives, 20(1), 13–19. https://doi.org/10.1093/mtp/20.1.13

Hintz, Michelle R. (Ed.). (2013). Guidelines for music therapy practice in developmental  health. ProQuest Ebook Central. (p. 165 – 182)

Mayo Foundation for Medical Education and Research. (2017, July 22). Dyslexia. Mayo Clinic. Retrieved December 16, 2021, from https://www.mayoclinic.org/diseases-conditions/dyslexia/symptoms-causes/syc-20353552

Przybylski, L., Bedoin, N., Krifi-Papoz, S., Herbillon, V., Roch, D., Léculier, L., Kotz, S. 

A., &   Tillmann, B. (2013). Rhythmic auditory stimulation influences syntactic processing in children with developmental language disorders. Neuropsychology, 27(1), 121–131. https://doi.org/10.1037/a0031277

A Little Bit About Me

Hello! My name is Janelle Lockney, and I am so excited to be Therabeat, Inc.’s newest intern. I am currently enrolled at Belmont University in Nashville, Tennessee. My primary instrument at university was french horn, but I also enjoy playing piano, guitar, and singing. Before applying to college, I had never heard of music therapy. I always wanted a career in music, and my family encouraged me to find a career working with the special needs population because they saw how passionate I was about it. Discovering music therapy was the beautiful combination I had been looking for. Ever since my sister was diagnosed with autism spectrum disorder, I have been volunteering and working with the special needs community and have found a passion for helping those with diverse needs achieve their goals. Therabeat, Inc. came to me through recommendations from friends and professors who believed this internship would help me thrive and grow as a music therapist working with diverse populations. I fell in love with everything they offer and am very grateful I have been given the opportunity to intern with them.

My first week has flown by! I have absorbed so much while observing the talented therapists on staff and have greatly enjoyed learning more about the other disciplines here. I have always known music therapy can work in conjunction with other disciplines, but I never had the chance to see how. I am very excited to learn more about how music therapy can support other therapeutic disciplines and new methods of facilitating music therapy for a variety of kiddos.

-Janelle Lockney, Music Therapy Intern

The Effects of Child Abuse and How Music Therapy can Help

Each year, thousands of children are victims of some form of child abuse. Whether it be neglect, sexual abuse, emotional abuse, or physical abuse, the maltreatment of children has become a hidden epidemic. Music therapy is a proven tool to help children combat the emotional, physical, and social repercussions brought on by multiple forms of child abuse through the use of music interventions and the incorporation of other behavioral techniques.

When looking into the effects of child abuse, there are both immediate and long-term effects that can occur. These effects are present in a child’s physical, emotional, and behavioral well-being and can carry over into adulthood if left untreated. Some of the common effects reported in children and adults who have experienced abuse in their childhood are anxiety, depression, low self-esteem, aggression, social withdrawal, and PTSD. In severe cases, when child abuse has gone unnoticed or improperly addressed, children are at a higher risk for death.

Some of the aftereffects of child abuse might result in goal areas of increasing management of pain, self-esteem, and social skills, as well as decreasing outbursts of anger. Through music therapy, this can be accomplished with interventions such as music listening for sustained focus, music-assisted relaxation, music-guided imagery, and singing client-preferred songs (Bradt). The purpose of these interventions is to refocus attention away from the pain that the client is feeling. For example, music listening for sustained focus shifts the attention away from the pain and puts it on the music. The music therapist will play the client's chosen music usually accompanied by a guitar and observe the client as they listen to the music, making sure to take note of relaxed breathing or facial expressions as a sign of improvement.

Another area in which music therapy can be helpful is improving the low self-esteem caused by abuse. Oftentimes, children who have gone through physical, emotional, sexual abuse, or neglect will blame themselves for the maltreatment that they are receiving and go on to carry shame and self-contempt, leading to an overall low level of self-esteem. In this area, a multimodal treatment can be used, for example, the combined use of music therapy and cognitive behavioral therapy (CBT). CBT is an effective psychotherapy treatment that helps with identifying and changing current negative thoughts or behaviors.

In combination with music therapy (CBMT), it can prove to be beneficial in the treatment of abused children. Some possible CBMT interventions used for increasing self-esteem are songwriting, emotional identification and expression through instruments, musical dialogues, and lyric analysis. For example, in the treatment of a 6-year-old girl who experienced physical and sexual abuse, songwriting, along with the use of art, was used to increase the child’s self-esteem while also providing her with a safe emotional outlet (Christenbury). The music therapist begins by allowing the client to color a picture of an emotion of their choice, followed by the music therapist composing a song about the contents of the drawing.

Socialization with peers is a major part of a child’s developmental growth; however, that can be taken away due to abuse. Music therapy, often in the form of group treatment, can provide great ways to address social skills in children. In a group music therapy session, some interventions may include instrument turn-taking, collaborative instrumental play, drum circles, and collaborative songwriting. These interventions allow the participants to work on team-building and appropriate social behaviors. In instrument turn-taking, the music therapist begins with everyone playing their given instrument and singing along to a familiar song, followed by giving each child the opportunity to have a solo with either just their instrument, with singing, or with both. This allows the children to work on patience, impulse control, and building confidence amongst their peers.

Another effect commonly seen in children who have experienced child abuse is difficulty  managing anger or aggressive outbursts. With so much anger being projected onto a child through abuse, it is not a rare occurrence for that child to begin displaying similar acts or attitudes toward peers or authoritative figures. In music therapy, it can be helpful to address these issues with interventions such as drum dialogues, emotional expression through songwriting, and musical improvisation. One of the key factors in a lot of these interventions is the use of the Iso principle. This technique allows the client to release their current emotional state, whether that be anger, frustration, or sadness, and then, with the help of the music therapist, begin to find a way to gradually substitute in a desired emotion that is positive.

When looking at drum dialoguing, there are great opportunities for the child to engage in a non-verbal conversation with the music therapist. In doing so, they are working towards releasing their aggression and channeling it into a better form of coping. The music therapist can engage in a conversation through the drums or follow the lead of the child, providing support for the emotions that are being expressed. After this, the music therapist can bring the child back by asking open-ended questions about the feelings that they were experiencing while drumming. To end, the music therapist can give an example or prompt the child to show them a version of drumming opposite of what they just expressed.

To conclude, child abuse can have multiple immediate and long-term effects on a child’s life that can lead to complications throughout development. Through the use of music therapy along with cognitive behavioral techniques, children who have gone through abuse can receive treatment in a non-threatening way. The use of music interventions has been proven to be an effective treatment option for children who have experienced maltreatment because of the expressive outlet that provides the child with the opportunity to communicate their emotions and hurt in a fun and unique way.

-Beatriz Leal, Music Therapy Intern

References

Bradt, J. (2013). Guidelines for Music Therapy Practice in Pediatric Care. Barcelona Publishers.

Christenbury, K. R. (2017). 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.uiwtx.idm.oclc.org/10.1093/mtp/miv005

Goldbeck, L., & Ellerkamp, T. (2012). A Randomized Controlled Trial of Multimodal Music Therapy for Children with Anxiety Disorders. The Journal of Music Therapy, 49(4), 395-413. https://doi-org.uiwtx.idm.oclc.org/10.1093/jmt/49.4.395

Toth, S., & Manly, J. (2019). Developmental Consequences of Child Abuse and Neglect: Implications for Intervention. Child Development Perspectives, 13(1), 59-64. https://doi-org.uiwtx.idm.oclc.org/10.1111/cdep.12317.

Angelman Syndrome and the Potential for Management of Symptoms through Neurologic Music Therapy Techniques

Angelman Syndrome (AS) is a rare neuro-genetic disorder caused by a loss of function in the maternal UBE3A gene on chromosome 15 (Connor-Ahmad et al., 2023). Angelman syndrome causes significant impairment in developmental and behavioral areas as well as symptoms such as seizures, lack of verbal and expressive communication, sleep difficulties, poor fine and gross motor skills, and limited self-care abilities. With a prevalence of approximately 1 in 22,000 births, people with AS can live a long life, but not without continuous care. According to Sommese and Corrado (2021), around the age of six months, developmental delays are first noted, with clinical features not becoming noticeable until after the age of one. More than 80% of AS patients experience seizures with onset before the age of three. Mouthing objects, a happy demeanor, water attraction, hyperactivity, and a short attention span are all key characteristics of those diagnosed with AS.

Due to the severity of developmental delay, intellectual disability, and cognitive delay, it is highly recommended that individuals with AS seek early intervention services that target problematic symptoms (Ma et al., 2023). According to researchers, therapies such as physical therapy (PT), speech therapy (ST), occupational therapy (OT), and applied behavioral analysis (ABA) have all shown positive results in managing AS symptoms relating to development and behavior. 

Management of care and rehabilitation methods are the main focus of treatment for those with AS since there is currently no cure for this diagnosis (Sommese & Corrado, 2021). Because most who are diagnosed with AS have limited to no speech capabilities, researchers are still looking for the best communication method for these individuals. Speech therapy is one option that attempts to promote nonverbal communication methods through the use of alternative augmentative communication (AAC). In 2020, Roche and colleagues looked at three different types of AAC models and their effects on children with AS. The study found that enhanced natural gestures (ENG), picture exchange communication systems (PECS), and multi-modal ACC interventions all offered beneficial results in the development of communication methods for AS patients. It was suggested that other forms of therapy, identified by families of those with AS, have presented positive results in AS symptom management (Sommese & Corrado, 2021). These alternative therapies include hippotherapy, cranial osteopathy, aromatherapy, reflexology, hydrotherapy, and music therapy. However, current research supporting the effectiveness of these therapies with AS patients is extremely limited.

Within the field of music therapy, there are several neurologic music therapy (NMT) techniques that have explored targeting similar AS symptoms such as cognitive delay and lack of verbal speech and communication. Musical Sensory Orientation Training (MSOT), Auditory Perception Training (APT), and Musical Attention Control Training (MACT) are all NMT techniques that focus on cognitive goals (Thaut & Hoemberg, 2014). In the handbook of NMT, MSOT is used with developmental disorders to improve cognitive processing by using musical instruments to provide sensory stimulation and assistance in orienting a patient to time, place, and person (Myskja, 2014). Auditory perception training is integrated by having patients differentiate different components of sound, such as timbre, tempo, duration, pitch, and rhythmic patterns (Mertel, 2014). Musical Attention Control Training targets various kinds of attention, such as selective, divided, and sustained, by directing a patient with musical stimuli (Thaut & Hoemberg, 2014).

In one study focusing on the effectiveness of music therapy on individuals with Rett Syndrome, music therapy was shown to be beneficial in treating areas such as verbal and non-verbal communication, social skills, behavioral play, grip capabilities, eye contact, and epilepsy (Chou et al., 2019). The music therapist in this study used MSOT, APT, and MACT, as well as movement and music, in their treatment. The results of the study showed improvements in socialization and communication skills, as well as hand skills and eye gaze. Three out of the eleven participants with refractory epilepsy experienced a decrease in seizures, with two participants reducing by more than 50% and one participant being completely seizure-free during the 6-month follow-up.

While there is currently little research that tests the use of these specific neurologic music therapy interventions with AS, many individuals with a similar diagnosis have shown positive results in treating similar AS symptoms. More research is needed in this area; however, these results are a positive indication of another avenue of support for those living with Angelman syndrome.

-Beatriz Leal, Music Therapy Intern

References

Chou, M.-Y., Chang, N.-W., Chen, C., Lee, W.-T., Hsin, Y.-J., Siu, K.-K., Chen, C.-J., Wang, L.-J., & Hung, P.-L. (2019). The effectiveness of music therapy for individuals with Rett syndrome and their families. Journal of the Formosan Medical Association, 118(12), 1633–1643. https://doi.org/10.1016/j.jfma.2019.01.001

Connor-Ahmad, S., Tjeertes, J., Chladek, M., Newton, L., Symonds, T., Clinch, S., Vincenzi, B., & McDougall, F. (2023). Developing Angelman syndrome-specific clinician-reported and caregiver-reported measures to support holistic, patient-centered drug development. Orphanet Journal of Rare Diseases, 18(1), 156. https://doi.org/10.1186/s13023-023-02729-y

Ma, V. K., Mao, R., Toth, J. N., Fulmer, M. L., Egense, A. S., & Shankar, S. P. (2023). Prader-Willi and Angelman Syndromes: Mechanisms and Management. The Application of Clinical Genetics, 16, 41–52. https://doi.org/10.2147/TACG.S372708

Mertel, K. (2014). Auditory Perception Training (APT). In M. H. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 227–256). Oxford University Press.

Myskja, A. (2014). Musical Sensory Orientation Training (MSOT). In M. H. Thaut & V. Hoemberg (Eds.), Handbook of Neurologic Music Therapy (pp. 221-226). Oxford University Press.

Roche, L., Sigafoos, J., & Trembath, D. (2020). Augmentative and Alternative Communication Intervention for People With Angelman Syndrome: A Systematic Review. Current Developmental Disorders Reports, 7(1), 28–34. https://doi.org/10.1007/s40474-020-00187-w

Sommese, M., & Corrado, B. (2021). A Comprehensive Approach to Rehabilitation Interventions in Patients with Angelman Syndrome: A Systematic Review of the Literature. Neurology International, 13(3), Article 3. https://doi.org/10.3390/neurolint13030036

Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of Neurologic Music Therapy. Oxford University Press.