The Trouble with Music Therapy

What is Music Therapy?

The American Music Therapy Association, of which I'm an associate member, defines Music Therapy as "the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program." 

There's much more information on the AMTA website here, including quotes by noted musicians, physicians and researchers, music industry notables, politicians and individuals who've had insight into the power of music.

It's important to be specific about Music Therapy, but there's a problem with this definition. By narrowing the scope of the practice to "clinical and evidence-based use of music" it isolates Music Therapy (and potentially Music Therapists) from much of the "real" world...the world where music is having a huge impact on everyone.

So What's The Problem?

"Spiritual" Music

A minister I correspond with was laughing during one of our email discussions about how, when he plays guitar and sings for his congregation, he's technically practicing music therapy without a board certification. I suppose a church isn't really a "clinical" setting, but people do go to church to deal with stuff, to heal, to find a sense of peace.

I've just finished reading a very cool book by Alan Light: The Holy or the Broken: Leonard Cohen, Jeff Buckley, and the Unlikely Ascent of "Hallelujah". Light chronicles the life span Cohen's "Hallelujah" including interview excerpts from many of the top artists who've covered it. You may remember k.d. lang's performance at the 2010 Olympics. About "Hallelujah," Light writes, quoting lang, that it

"...grew out of Cohen's sense of 'the irony of being a human being and looking for the religion in sex' -- a concise summary of the dichotomy at the heart of the song, and central to much of Cohen's work." (p 128)

Light then includes this fascinating k.d. lang quote:

"I think spirituality in general in our society has been diffused into some sort of relationship between the pop culture and our own personal pillars that we create for ourselves. As culture moved forward, we were counting on God less, and people settled into some sort of spirituality that they created for themselves, and a lot of it has to do with incorporating their own human desire. We're greatly craving some sort of spirituality in music....We're mulling over a lot, we're not being rammed with somebody else's doctrine down our throat, we're coming up with our own. It's less structured, less guided, and more individual, more personal." (p 129)

The point here is that lang joins the power of "Hallelujah" with our society's need for a more personal spirituality, and that Cohen's song makes that connection for so many of us.

Is singing in church or listening to "Hallelujah" music therapy? For many people, even though it certainly falls outside the clinical definition, the effects of listening to this amazing song are quite profound, perhaps religious, sometimes spiritual, maybe even palliative. If that's not healing through music, I wouldn't know how else to describe it.

"Nostalgic" or "Re-Membering" Music

Oliver Sacks has a wonderful YouTube video of the effects of music on an elderly man in nursing home. The elderly man is shown before the "music intervention" takes place, during the intervention and afterward. The change in his entire demeanor is obvious. (Since the nursing home is a "clinical" environment, I use the technical term "music intervention" purposefully.) Although we are not shown anything in the video that indicates a "therapeutic relationship" with a "credentialed professional" Music Therapist, it is obvious that the elderly man's response to music is powerful and transformative, at least for a time. The music brings him from being lethargic to animated, alert and active -- being alive. In a sense, listening to the music he loves brings this elderly gentleman back to remembering -- to the life he has loved.

Do you know anyone who responds like that to the music they love? My kids and my wife do, as do I! Do you?

More importantly, when we respond positively like that, are we giving ourselves Music Therapy? Not technically...but I'm sure you see my point.

Provocative Music

Even more to the point: provocative music gives you a visceral response. Hearing music that absolutely makes you wretch or cringe. Jumping to your feet at a baseball game when the organist plays "Charge!" or singing along to "Take Me Out to the Ball Game" at the 7th-inning stretch. Being moved to tears by the solitary trumpet at a military funeral playing "Taps." Any sexy music that turns you on. This is what I call "provocative" music.

Provocative music can have a "good" or "bad" effect, depending on whether or not you happen to like it, but all provocative music causes you to respond strongly, physically or emotionally. Since everyone responds to music differently, it's possible that a song which provokes you might have little impact on me. For example, I've found, generally, that playing recordings of rap or hip hop for an elderly audience can be provocative. On the other hand, playing Classical music by composers of the Romantic era to a middle-school audience can also provoke strong responses, ranging from vulgarity to instant ennui.

One would hope that a "credentialed professional" wouldn't purposefully provoke a patient, right? Not so: plenty of therapists do precisely that in order to move treatment forward. Ask a psychologist about the techniques used for treating post-traumatic stress disorder (PTSD) for example, and you may hear about "guided imagery," which is a somewhat benign way of recalling and re-inventing a significant personal experience. "Regression therapy" is a practice that purposefully prompts patients to recall and re-experience a moment of trauma, and there are sophisticated 3-D simulators in use to treat military post-traumatic stress by re-creating traumatic experiences.

So, if I intentionally listen to music that provokes a strong response with the goal of processing some feeling more fully, am I giving myself music therapy? Music Therapists might argue that I shouldn't do that for myself -- that I ought to have professional guidance to prevent having a poor response or perhaps to mold any response I might have in a healing direction, or that I ought to have evidence which could predict the outcome of my "intervention" before attempting it.

By that same logic, perhaps a Music Therapist ought to be present whenever anyone who wants to feel sexy puts on music before taking off their clothes....

So What's the Trouble with Music Therapy?

A powerful book, written in 2009 by Dr Diane Austin, summarizes her  years of using music as a practicing psychotherapist. Austin's doctoral degree is in Music Therapy. Her book is called "The Theory and Practice of Vocal Psychotherapy -- Songs of the Self." I believe it is a harbinger of the future of Music Therapy, since its focus is how to actually use music as a functional tool in general psychological clinical practice. Having clients improvise vocally -- actually sing their therapy sessions -- may seem foreign at first, but think about the access music gives to your psyche and you will begin to see the power in Dr Austin's approach.

(Clearly, music is used in clinical practice by Music Therapists in a variety of settings. Significant advances -- and solid evidence -- for music as a tool in treating Autism, stroke, chronic pain, traumatic brain injury and post-traumatic stress are well-documented and well known. Music Therapists continue to make solid cases for music as primary and/or adjunct treatment for many clinical conditions.)

The trouble with Music Therapy, as Austin's book illustrates, is that the variety of ways to apply music as an intervention are as varied as the number of people who listen to music multiplied by the variety of songs available. While there are some common practices evolving out of the music therapy literature and evidence-based studies, Austin demonstrates that successful treatment in "vocal psychotherapy" rests with the skill of the therapist. That is, just being a credentialed professional music therapist means about as much as being a credentialed healer in any of the other professions: it is still all about one's skills as a practitioner.

Or is it?

What about the people who are using music for "intervention" and getting results -- in church, in a nursing home, on the highway or the dance floor or in bed? Are they "practicing music therapy without a license?"

The trouble with Music Therapy is that it draws a line around what turns out to be a very general skill set (therapeutic uses of music), then forces folks who want to help others using their musical skills into a very narrow set of credentials prior to permitting them a paid profession -- and a paid profession at the very bottom of the pay scale for professional healers at that. A very active working Music Therapist for whom I have great respect has measured his income potential against the other healing professions and, based on the fact that he actually sees his patients an average of only 1.3 times ever, has made a choice to use his skills to better effect outside the realm of Music Therapy.

Could it be that ministers, physicians, musicians, songwriters -- anyone who has some working knowledge of the power of music -- are best serving as our advocates for its wider use...not as entertainment, but as self-intervention?

Imagine a Music Therapist who encourages clients to use music on their own? Sacrilegious! Sort of like the doctor saying "take two aspirin and call me in the morning." But don't we have plenty of "anecdotal" evidence for the power of doing just this?

Are we as a society so stuck on having evidence-based studies of successful music interventions that we're not willing to simply try listening to music as a transformative tool for for ourselves? Yes: some parts of society are stuck on the traditional model of treatment, and responsible Music Therapists working in that paradigm are doing great things to help many people. And no: some people are willing to try anything, especially things where other folks have had good results.

Lastly, what about the whole universe of non-clinical applications for music? Does it take a Music Therapist to properly choose the music you use to work out with? Does it take a Music Therapist to program a sound track for a movie? What about choosing the music you need to help boost your memory, retention and recall, as is done in university exam rooms in some parts of the world? Those are a few simple examples of how the power of music is used functionally on a regular basis and to great effect by folks who have skills outside the clinical arena.

So What's the Answer?

I believe that responsible Music Therapists and others in the healing professions have the vision to want to encourage people to explore the potential for music as a transformative tool, even if that's outside of the clinical treatment environment. Given the widespread nature of debilitating stress and the high cost of care for its symptoms, humanity is being forced to do what? Take better care of itself. One great way to do that -- a way that's free, safe and effective -- is to use music as a tool. Dr Sacks is right to point out the obvious: this stuff works.

Whether your question is for better health, deeper meaning, lasting love or simply a quick "fix" that gets you through a stressful moment, if you haven't given music a chance, I encourage you to do so the very next time you find yourself sick, stuck, lonely or stressed. While you could consult a professional for your care, you can jump-start that care on your own, right now, using music.