What Instruments Do Music Therapists Play?

InstrumentCollage“How many instruments do you play??”

That’s a question I hear on a regular basis, usually from a shocked healthcare provider or family member after I break out my oboe or mini-marimba in a music therapy session.

The fact is, being a music therapist requires a high level of musicianship, in both breadth and depth. Music therapists have to play a lot of instruments and have to play at least one instrument extremely well.

All music therapists must sing and play guitar, piano, and percussion.

To be a board-certified music therapist, you must complete an academic program approved by the American Music Therapy Association as well as clinical training through undergraduate practica and an approved internship. Through the academic and clinical training process, prospective music therapists must demonstrate competence on multiple instruments: voice, guitar, piano and percussion. Over years of clinical practice, most music therapists eventually use some instruments more than others – I favor guitar over piano for its portability and reliability, for example – but we all have to demonstrate competency on these instruments before we can become music therapists.

All music therapists have a primary instrument, too.

On top of learning those four core instruments, music therapy students also have to have a primary instrument. Also known as our “major instrument,” this is the one we play in university ensembles, in private lessons, and ultimately for a senior recital. Some music therapy students have voice, piano, guitar or percussion as their primary instruments, but others have an instrument that you would typically find in a band or orchestra as their primary instrument – flute, trumpet, violin, cello, or bassoon, for example. My primary instrument is the oboe, and while I don’t play it in every session, it does make an appearance on a regular basis.

Many music therapists keep learning new instruments over years of practice.

The thing about music therapists is that we all really love playing music, and we just can’t stop developing as musicians. Lots of music therapists are performers as well, and many of us become much more skilled on our instruments than might be apparent in a clinical setting. Many music therapists learn new instruments, too. I joined the ukelele craze a few months ago, and learning to play the harp is on my list for the future.

What does this mean for you?

All of this means that you should expect your music therapist to be a highly skilled musician, who can sing well and play multiple instruments across different types of music. Music is the medium through which we serve clients, so you’d better expect us to play music well.

 

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How Does Music Therapy Help In Hospice?

Hospices provide comprehensive palliative care to people at the end of life. At a time when comfort and quality of life become more important than curing a disease, people on hospice services receive help from from professionals across several disciplines, including medical doctors, nurses, home health aides, social workers, chaplains, and volunteers. Increasingly, music therapists are also part of this interdisciplinary team.

Music therapy is a clinical service provided by credentialed music therapists (MT-BCs in the United States). Because of their unique training and experience at the intersection of music and human health, music therapists are uniquely qualified to work with patients through music at a deep, therapeutic level.

It is the depth and breadth of clinical music therapy practice that distinguishes it from other applications of music in hospice care. While an approach like harp therapy is limited musically (to harp music), a music therapist can provide a wide variety of music on several different instruments. A music therapist is also knowledgeable and experienced in manipulating the various elements of music to address the various clinical needs that emerge in the shared music experience. (I wrote much more on that topic here.)

Old young holding hands seatedMusic therapists help in many ways, and exactly what we do and why changes from session to session, depending on the patient’s needs and desires on any given day.

Here are three big ways that music therapy helps people in hospice care:

1. Music therapy helps loved ones connect.

Several disease processes and symptoms that occur frequently for people in hospice care can make it difficult for loved ones to connect with each other, just when those loving relationships are most important. Whether the cause is dementia, confusion due to end stage cancer, or disorientation or lethargy related to high levels of pain medications, this disconnection can be very painful for the person on hospice care and for their loved ones. Music can be a bridge for people, because of its central place in human experience and because of how music is processed in the brain. Music therapists know how to introduce and facilitate music experiences that help loved ones connect and communicate their love, despite dementia, confusion, or disorientation getting in the way.

2. Music therapy provides relief from pain and anxiety.

Music can help people relax on a physical level and on an emotional level. Music therapists are uniquely skilled in helping people find the right music for the moment as well as the techniques or images that work for them. For people who need another approach to pain management in addition to the medical interventions offered by the hospice team, music therapy can be just the right answer.

3. Music therapy can help people say the un-sayable.

Just as the symptoms attending the dying process can make communication difficult, so can the emotional burden of facing life and death. For people approaching the end of life, coming to terms with regrets, fears, and other intense feelings can at the same time be incredibly important and tremendously challenging. Music can provide a container for difficult emotions, allowing people to feel those intense feelings that are impossible to put into words. Music can also be a vehicle for sharing messages that are too difficult to say.

Why choose a music therapist for hospice care?

Two huge advantages to having board-certified music therapists working in hospice care are that

  1. They can be flexible in adapting their approaches to meet patients’ needs on any given day
  2. They have a depth of clinical knowledge that allows them to work effectively with people who are dealing with serious physical, emotional, social, and spiritual needs.

But still, you might be asking this question:

Are music therapists the only people who use music in hospice care?

No, we certainly aren’t! Other hospice professionals can use music within their own scope of practice, and musician volunteers are called upon frequently to visit patients to provide entertainment and companionship. Ideally, hospice organizations will call upon music therapists to provide direct clinical services to those patients who are most in need, and to train and consult with other team members and volunteers on how best to use music in their own work. In this way, people receiving hospice care will have music touching and healing them through the very end of life.

Song Spotlight: “Don’t It Make My Brown Eyes Blue”

I work in eldercare settings, but that doesn’t mean all of my clients love Frank Sinatra and Hank Williams. In fact recently, I’ve been learning a bunch of of songs from the 1970s, so I can have new ways to connect musically with people in their 50s and 60s, who might be caring for loved ones in their 80s and 90s or on hospice or long-term care services themselves.

One tool I’m using is The Grammy Awards Song of The Year 1970-1979. As the title suggests, this songbook includes all of the songs nominated for the Song of the Year during the 1970s. Does that mean these are the best songs to use in music therapy for people who were young in the 1970s? No. But it’s an excellent place to start an exploration.

The song that has struck me recently was a 1977 hit for Crystal Gayle: Don’t It Make My Brown Eyes Blue. Written by Richard Leigh, this song has a jazzy piano line that probably helped it to become Gayle’s first and biggest crossover hit. This song reached #1 on the country charts and #2 on the Billboard Hot 100, and it won Gayle a 1978 Grammy Award for Best Female Country Vocal Performance.

Uneasy senior woman praying for sick manThere are a few things about this song that work really well for clinical and caregiving situations:

Sing-ability. Another fun fact? This song was recognized by ASCAP in 1999 as being one of the ten most-performed songs of the twentieth century. That means a lot of people are doing live cover versions of this song, and I bet that’s because its narrow range makes this song pretty easy to sing.

Honest feelings and unanswered questions. This song is about someone leaving and the person being left not quite understanding why. One thing is clear: the singer is sad and lonely and trying to cope with it all. Beyond that, though, there is plenty of room for interpretation about the details of what happened. The listener can put a lot of their own feelings and experiences into this song.

Simple, repetitive lyrics. When you’re dealing with difficult feelings, sometimes all you can do is say how bad it feels. The repetition of the line “don’t it make my brown eyes blue” underscores the sadness and loneliness, while making the song more singable, too.

That crossover appeal. Because this song was popular with country and pop music audiences, chances are a lot of people will be familiar with this song. That makes it a good one for opening a discussion about love and loss, or starting a deeper musical exploration.

Try This: Songwriting Experience

This song also works quite nicely for a simple fill-in-the-blank songwriting experience.

Especially for family caregivers, this song could be a great container for some of the difficulties you’re experiencing in your caregiving work. Try adding your own words to this framework:

I don’t know when I’ve been so blue

Don’t know what’s come over you

You’ve __________________

And don’t it make my brown eyes blue

I’ll be _______________ when you’re gone

I’ll just ____________ all night long

Say it isn’t true

And don’t it make my brown eyes blue

Tell me ________________ and tell me ___________

Give me ________________, give me _____________

Tell me you love me and don’t let me cry

Say _____________ but don’t say ________________

I didn’t mean ____________________

I didn’t know ____________________

But honey ______________________

And don’t it make my brown eyes

Don’t it make my brown eyes

Don’t it make my brown eyes blue

Some of those phrases sound just like what I’ve heard from people who are caring for loved ones with Alzheimer’s Disease or other forms of dementia:

I don’t know what’s come over you.

Tell me…

… you love me.

… you know my name.

… I’m doing the right thing.

I didn’t mean…

… to make you upset.

… to leave you alone.

… to get so angry.

I didn’t know…

…it would be this hard.

…it would end like this.

…how scared I’d feel.

I think there is comfort in having our deepest thoughts and feelings expressed through music. Perhaps using the framework of this song can give you some comfort in expressing your own experience.

What do you think of this song? What lyrics would you fill in the blanks? Leave a comment below, and let us all know.

This post is part of an occasional series on special songs to share with your clients and loved ones. For more song spotlights, click here.

Music Therapists Do It Differently: Supporting Movement

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part ten of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Our bodies have a natural tendency to move with music. In fact, classical music concerts are kind of weird for the expectation that people are to sit quietly in assigned seats. The truth is music and dance have almost always gone hand in hand, in cultures around the world. It just feels natural – and really darned good – to move in time with music. You could even say that moving to music is musical all by itself.

"Methinks it's time for a conga line."

“Methinks it’s time for a conga line.”

Still, dancing and moving to music are not that common in the live music situations you might encounter in an eldercare community. Most often, I see folks listening quietly to entertainers, applauding quietly at the end of each song. When it gets a little jazzy, you might spy a few people tapping their toes, or clapping to the music if the performer tells them to. If you’re lucky, some brave soul may stand up and start dancing to the music, and for a brief but brilliant second, you think maybe a dance party is going to get going. On the other hand, if the poor entertainer is performing during a party while people are being served refreshments, her audience will be too busy with conversations and snacking to get into dancing.

I’m not sure why this is. Do we expect our elders to be polite and sedate? Are they just tired or hurting to the point that moving doesn’t feel good? Or are our seniors embarrassed to be seen moving the way they do now, rather than how they did decades ago?

In any case, I know two things to be true:

  1. Most people should be moving more. Research has demonstrated that regular physical activity can lead to improved mobility and strength,  better sleep, preserved cognitive functioning, decreased depression, and stronger feelings of self-efficacy and personal control. Yet adults over the age of sixty-five are the most sedentary age group.
  2. Moving your body as a form of musical expression feels great. People have always known this on a human level, but now neurological research is starting to show us why movement and music go together so well, too.

This is why I deliberately encourage movement to music when I am doing live music with older adults. Rather than just hoping for people to “get into the music” and move spontaneously, as you might do in an entertainment-oriented program, I view movement as an important form of musical communication and consciously facilitate movement to music. This is one more way that music therapists do live music differently.

#10. Supporting Movement

Sometimes music therapists are very direct in facilitating movement to music with verbal, visual, or tactile cues; and sometimes music therapists focus on reflecting and amplifying the movement that arises spontaneously for people that are doing music with us.

Let me share some examples of how this works.

Directing Movement

Imagine Janet’s music therapy group in a memory care community. One song fitting into her “weather” theme is “Over the Rainbow.” Knowing that the wide range of this song makes it difficult for many of her clients to sing, Janet plans to integrate movement with this song. She demonstrates expressive arm movements to match specific lyrics (e.g. reaching one arm over the head to draw a rainbow shape for “somewhere over the rainbow”), then leads the group by singing a cappella and demonstrating the movements visually. When participants have the arm movements learned well, Janet adds a guitar accompaniment, for an even more layered musical creation.

Planned movement experiences could work in a one-on-one session, too. For example, maybe Jennifer knows that her hospice patient Maude craves touch. Rather than playing guitar, Jennifer often holds Maude’s hands and sings a cappella. When Maude seems to have the energy, Jennifer says, “will you dance with me?” and sways Maude’s hands gently while singing, “My Bonnie Lies Over The Ocean.” If Maude resists this movement or feels tense, Jennifer stops dancing with her, but on some days, Maude seems to take over moving to the beat. Jennifer notices that Maude is more likely to make eye contact and smile on these occasions.

Reflecting and Amplifying Spontaneous Movement

Of course, those planned experiences aren’t the only ones that get participants moving to the music. Perhaps Janet is playing “Singin’ in the Rain” as several residents sing along, and she notices that Glenda, who is usually pretty withdrawn, looking up in her direction and kind of waving her fingers to the beat. Janet says, “you’ve got the beat, Glenda!” and taps her guitar in imitation of Glenda’s movement. In this case, Janet is supporting movement in a different way: reflecting and amplifying Glenda’s movement.

Again, the same thing can happen in one-on-one sessions, too. Perhaps Jennifer notices Joe nodding his head slightly to her rendition of “Hound Dog.” Jennifer mirrors his rhythm, swaying to the beat while continuing to sing and play guitar. Seeing Joe’s movements get even bigger and more deliberate, Jennifer abruptly mutes her guitar on the line “you never caught a rabbit,” then points at Joe and sings, “and you ain’t no friend of mine.” He smiles broadly and points back at her, while Jennifer strums an appropriately rock-n-roll beat to end the song. Here, Jennifer was amplifying Joe’s movement and showing him where to add an accented movement, too. Now Jennifer and Joe are collaborating in the music on a new, deeper level.

Helping music therapy clients move to music means that they can shift from passive listening to more active engagement in the music-making. What’s more, music therapists see participants’ movement as being an essential part of the music itself.

Facilitating movement to music is one more way that music therapists do live music differently.

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Music Therapists Do It Differently: Adding Instruments

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part nine of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

If you’ve been keeping up with this series, I’m sure you’re getting the point now:

Music therapists don’t just stand up, strum, and sing.

When we do live music in clinical sessions, we aim to relate to and interact with our clients through the music, based on their needs and goals in that moment. Sometimes, our clients are mostly listening, in what we call receptive music experiences. But other times, clients become more active participants in the music-making:

#9. Adding Instruments

One key way that people can become more actively involved in musicking together is by playing instruments. As do most music therapists, I carry around bags of rhythm instruments in my car, and I always have a drum or shaker or two with me when I see a client. I don’t always use instruments, however, and this aspect of live music is not as simple as handing out the instruments and asking folks to play.

It takes clinical skill to choose when and how to invite people to play instruments.

"Nice drums!"

“Nice drums!”

Here are some questions I ask myself:

1. Is this respectful and age-appropriate?

For some clients, playing an instrument may be a rewarding way to contribute to the music, but for others, it may feel childish. Much of this has to do with the instruments we use and how we frame the music experience.

In my practice, I use the highest-quality, most ethnically-appropriate instruments I can. So, I might bring in tambourines and frame drums with mallets, then support participants musically as they find the beat to an Elvis Presley song.

By contrast, if you hand someone a cheap plastic maraca and urge them in a high-pitched, preschool-teacher voice to “shake it, Mary, shake it!” – that may feel demeaning or childish. Then again, pairing cheap plastic maracas with virgin maracas at your Cinco de Mayo party may be just the right kind of fun. (See – these decisions take forethought!)

2. Is this musically-enhancing or distracting?

Sometimes, playing an instrument enhances a client’s engagement in the music, allowing them to play an important role in the music even if they can’t or don’t want to sing along. But sometimes the instrument causes a distraction.

Having too many instruments, or participants who struggle with finding the beat, can turn the whole session into more noise than music. Or, someone may be engaged by playing a drum for a song or two, but then feel too tired to keep playing. The music therapist may decide to use fewer or different instruments, to have fewer people play at one time, or to give people permission to listen for a while rather than play.

3. How can I support their music-making best?

Beyond deciding when and with whom to use instruments, the music therapist also has to determine how best to support a client’s music-making experience. Are we going for exploration of various instruments? Syncing rhythms across a group? Playing in parts, like a small ensemble? Targeting particular physical needs? Pointing back to a verbal discussion? (P.S. These musical decisions can point back to creative, social, cognitive, physical, and emotional goals, respectively.)

Always considering what the client’s needs or goals happen to be, music therapists are deliberate in choosing when and how to use instruments in live music-making experiences with clients.

That’s another way music therapists do live music differently.

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We Are Music Therapists

SM Advocacy Badge 2012_250x250Music therapists offer something very different from what other healthcare professionals offer. The difference? We work in and through music.

For a society and a world that is used to seeing music primarily as entertainment, thinking of music as a measure of health and a medium for healing may seem a little bizarre. So, we often rely on metaphors and analogies to explain what we do.

The thing is, the analogies aren’t sufficient. We aren’t just like OTs or PTs or psychotherapists who happen to use music as a tool in our work. We aren’t simply talented musicians who happen to have a lot of empathy and enjoy working with special populations. Rather, we music therapists have a unique therapeutic approach and set of skills based on the high level of clinical musicianship we reach through our education and training as music therapists.

January is Social Media Advocacy Month in the music therapy world. If you haven’t done so already, I encourage you to read the post below from Judy Simpson, AMTA’s Director of Government Relations. The time has come for us to stand firmly in the knowledge that what we offer is unique and valuable.

There is no comparison.

—————————

We Are… Music Therapists!

By Judy Simpson, MT-BC – Director of Government Relations, American Music Therapy Association

When I started my career as a music therapist in 1983, it was not uncommon for me to describe my profession by comparing it to other professions which were more well-known. If people gave me a puzzled look after I proudly stated, “I use music to change behaviors,” I would add, “Music therapy is like physical therapy and occupational therapy, but we use music as the tool to help our patients.” Over the years as I gained more knowledge and experience, I obviously made changes and improvements to my response when asked, “What is music therapy?” My enhanced explanations took into consideration not only the audience but also growth of the profession and progress made in a variety of research and clinical practice areas.

The best revisions to my description of music therapy, however, have grown out of government relations and advocacy work. The need to clearly define the profession for state legislators and state agency officials as part of the AMTA and CBMT State Recognition Operational Plan has forced a serious review of the language we use to describe music therapy. The process of seeking legislative and regulatory recognition of the profession and national credential provides an exceptional opportunity to finally be specific about who we are and what we do as music therapists.

For far too long we have tried to fit music therapy into a pre-existing description of professions that address similar treatment needs. What we need to do is provide a clear, distinct, and very specific narrative of music therapy so that all stakeholders and decision-makers “get it.” Included below are a few initial examples that support our efforts in defining music therapy separate from our peers that work in other healthcare and education professions.

  • Music therapist’s qualifications are unique due to the requirements to be a professionally trained musician in addition to training and clinical experience in practical applications of biology, anatomy, psychology, and the social and behavioral sciences.
  • Music therapists actively create, apply, and manipulate various music elements through live, improvised, adapted, individualized, or recorded music to address physical, emotional, cognitive, and social needs of individuals of all ages.
  • Music therapists structure the use of both instrumental and vocal music strategies to facilitate change and to assist clients achieve functional outcomes related to health and education needs.
  • In contrast, when OTs, Audiologists, and SLPs report using music as a part of treatment, it involves specific, isolated techniques within a pre-determined protocol, using one pre-arranged aspect of music to address specific and limited issues. This differs from music therapists’ qualifications to provide interventions that utilize all music elements in real-time to address issues across multiple developmental domains concurrently.

As we “celebrate” 2014’s Social Media Advocacy Month, I invite you to join us in the acknowledgement of music therapy as a unique profession. Focused on the ultimate goal of improved state recognition with increased awareness of benefits and increased access to services, we have an exciting adventure ahead of us. Please join us on this advocacy journey as we proudly declare, “We are Music Therapists!”

About the Author: Judy Simpson is the Director of Government Relations for the American Music Therapy Association. She can be reached at simpson@musictherapy.org

Music Therapists Do It Differently: Verbal Interaction

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part eight of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Music therapists talk a lot.

At least, we don’t spend ALL our time playing music, at least not usually. Verbal interaction is a crucial part of what happens in music therapy sessions. And, music therapists do verbal interaction differently from other professionals.

#8. Verbal Interaction

Consider two of our sister professions:

For performing musicians, the music is the point of their professional work. They may use speech as banter, as a bolster to the entertainment value of their show, but it’s probably considered to be ancillary to the music itself. This is especially clear in a classical concert, where you’ll hear very little speech. The conductor comes out, the orchestra plays, the conductor bows and everyone leaves. No jokes, no history lessons – just music.

"What are they talking about?"

“What are they talking about?”

On the flip side, for therapists who primarily work verbally – psychotherapists, social workers, counselors, and others – the verbal discussion is the point. They may use music as an added element in their sessions, but it is likely that the intention is to have that music start a meaningful discussion. Communicating through the music itself is not the intention.

For music therapists, though, music and verbal interaction are both integral parts of the therapeutic process. In fact, one of the major strengths of our medium of therapeutic interaction is that we can move back and forth between non-verbal (musical) communication and verbal communication as appropriate. And, as usual, these decisions are based on the needs and goals of the clients.

How do music therapists do verbal interaction differently?

Imagine a hospice music therapy session. The music therapist, Karen, is talking with Pat, a woman in her 80s who loves the gospel music of her rural Baptist church. In one session at Pat’s bedside, singing “How Great Thou Art” leads to a conversation about Pat singing in the church choir, which leads to her and Karen singing “Just A Closer Walk With Thee” and “Precious Lord, Take My Hand.” The session flows easily from music to conversation and back.

On another day, though, Pat is not chatty at all. Karen offers to sing “Precious Lord, Take My Hand,” and Pat agrees, but she doesn’t sing along, and her eyes glisten. At the end of the song, Karen pauses, waiting for Pat. After a few moments, Karen prompts Pat gently, saying, “what’s on your mind?” Pat responds that she’s just feeling tired today, that she’s “ready to be with Jesus.” Then, Pat closes her eyes and turns her head away.

What is Karen thinking about during these sessions?

1. Deciding When To Talk

Of course, the first decisions are whether to communicate verbally or musically, and whether to talk or to listen. In Karen’s first session with Pat, the conversation and music were feeding into each other easily. Here, the goals may have been assessment, establishing rapport, or facilitating reminiscence. Karen was likely mindful of gathering information about Pat that could be important in future sessions – her musical background and preferences, her spiritual background – as well as communicating an unconditional positive regard while engaging in music together.

Deciding whether to talk would have been trickier in the second session, when Pat was quieter and the session had more frequent silent moments. At the end of “Precious Lord, Take My Hand,” should Karen have started in on another song? What comes next – music? Silence? Talking? The end of the session? All of these are questions that the music therapist would have to consider in the moment, while thinking about the client’s needs and goals at that time.

2. Choosing What To Say

Beyond deciding whether to talk or not, the music therapist must consider the content of what she says carefully. For instance, after that silent moment with Pat, Karen could have said a number of things. She could have made a cheerful comment about how pretty the song was. She could have chided Pat for not singing that day. She could have suggested another gospel song, to get back into singing as quickly as possible. Or, as she did, she could have given Pat an opening for verbal interaction on another level.

The same choices applied after Pat made her statement about being ready to go to Jesus. Karen could have encouraged more verbal interaction. She could have let the silence stand longer. She could have chosen a song that validated Pat’s statements, to communicate empathy and acknowledge Pat’s spiritual beliefs, like “Peace in the Valley.” Or she might have jumped back into singing something to shift the mood, maybe something more upbeat.

What would have been the “correct” decision? It’s impossible to say, without being in that session at that time. In any case, Karen would decide what to say based on Pat’s needs in that moment.

3. Refining How We Say It

Deciding on verbal interaction vs. music vs. silence, then deciding what words to say – that’s tricky enough. But another level of nuance comes with how we say what we say. Doing music therapy can never be as simple as following a decision tree or a strict protocol, saying, “if Client says x, then MT sings y. Then MT says z with great empathy while patting Client’s left hand.” Rather, all of the music therapist’s experience and training and intuition come into play as he/she decides what to say or sing or do, and how to sing/say/do it.

This is frustratingly difficult to describe. So, here is where I find it especially helpful to think of music therapy sessions as being MUSICAL from start to finish, regardless of the level of silence or verbal interaction involved. As any musician knows, beautiful music is made of more than playing the correct notes and rhythms or singing the correct words. So it goes for music therapy sessions – the value of the whole music therapy session is more than the sum of the words we say and the songs we sing.

Verbal interaction is one important piece of the entire picture of the therapeutic relationship in music therapy.

That’s how music therapists do verbal interaction differently.

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Music Therapists Do It Differently: Sound and Silence

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part seven of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

In a music therapy session, you should not expect to hear a wall of sound from start to finish. In fact, you may be surprised at how much “non-music” time happens during the session.

Contrast a typical entertainment event at a nursing home with a music therapy session.

"Why did she stop playing? Isn't she still on the clock?"

“Why did she stop playing? Isn’t she still on the clock?”

Say you hire a pianist for your nursing home’s holiday party. You likely expect that person to show up early enough to start playing at the 2:00 party time and to continue playing until the party ends at 4:00. Yes, it’d be nice to see the performer tell jokes or share fun facts from the stage, but you probably don’t expect them to chat with the residents individually, and you might be a little irked if they stepped away from the piano for more than a couple of minutes. The entertainer is there to provide music, and that’s what you want to see. Plus, you probably expect the audience members to chat with each other as they enjoy their hot toddies.

Music therapists work differently. Sure, we provide music, but our main concern is developing the therapeutic relationship through music. And, as anyone knows, a one-way conversation does not a relationship make. Plus, music therapists are conscious of working with folks who might get over-stimulated by music more easily than the general population. Thus, another way that music therapists do live music differently:

#7. Sound and Silence

Music therapists make judicious use of sound and silence in their work. These are two reasons why:

1. Music therapists focus on building an interactive relationship in the music.

Silence becomes an important tool in this effort. Here are just some of the ways we can use silence in our music-making with clients:

  • Stopping a musical phrase early to cue participants to “fill in the blank”
  • Waiting for silence before beginning a song so that everyone starts together
  • Silencing the therapist’s voice or instrument to allow a client plenty of room to lead the music
  • Leaving silence at the end of a song rather than jumping into a conversation or verbal discussion
  • Allowing quiet moments between chords or musical passages to leave room to breathe in music for relaxation

Using these tweaks and techniques can help to cultivate an interactive client-therapist relationship in the music itself, even without considering verbal interaction. (More on that one in the next post.) Breaking that wall of sound and allowing silence can become an essential part of the music therapist’s work.

2. Music therapists aim to avoid over-stimulation.

There are times when our planned music experiences are too much for a given session. That is when in-the-moment adaptations come into play, and the music therapist dials down the planned experiences to be less overwhelming, either by thinning the texture or stopping the music altogether. In fact, sometimes sitting in silence together is the best – and most musical – gift a music therapist can give a client. Insisting on filling our whole hour with songs can sometimes be counterproductive.

Music is made of sound and silence.

All musicians must be aware of how these pieces fit together to make a beautiful musical whole. For music therapists, though, sound and silence are first of all considerations in building the therapeutic relationship and meeting clients’ needs.

That’s another way we do live music differently.

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Music Therapists Do It Differently: Texture

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part five of a ten-part series. You can find an introduction and links to all ten posts here.

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#5. Texture

Musical texture refers to the way that melody, harmony, and rhythm are combined to create a particular musical sound. There are formal terms for musical texture (including monophonic, homophonic, polyphonic), but for our purposes, we can think in terms of how thick or thin the musical sound is.

What is thick or thin texture in music?

For a thin or light texture, think about the solo violinist playing on a stage, before the full orchestra comes in. Or imagine an open mic night, with one guy singing while strumming his guitar. The sound is simpler, with fewer musical lines crossing over each other. You could hear every single note if you wanted.

By contrast, for a thick texture, imagine the moment the full orchestra swells behind that solo violinist, carrying the concerto through to the finale. Or imagine a rock band pumping out a power ballad, with guitars and drums and backup singers. Now you’re hearing a bigger sound, something closer to a wall of sound. Many musical lines are happening at once, and it might be difficult to hear individual parts.

In terms of musical entertainment, composers, arrangers, and producers are generally the folks who determine the texture of the music, by deciding which instruments or voices to include in the composition, or how many layers to add to a recording or live performance. Performers have some control, too, by adjusting the complexity of their arrangements or adding more instrumentalists or singers to their performance. (Of course, the latter often becomes a matter of logistics, too – how many performers will fit in the venue? How many can we afford to pay?)

For me as a music therapist, though, musical texture is on my mind frequently for clinical reasons.

Musical texture plays an important role in clinical music-making.

Music therapists do a lot of in-the-moment arranging of music to meet the demands of a given clinical situation, in both group and one-on-one sessions.

How do music therapists use musical texture in groups?

"How does she choose what strum patterns to use?"

“How does she choose what strum patterns to use?”

Take the example of Janet leading a group in “Singing in the Rain.” In the scenario described here, Janet was facilitating music with a very thick texture, with every group member playing an instrument. The aim was to have everyone in the group making music together at once. But what if the sound of Edith playing the rain stick was getting lost in this thick musical sound? Janet could have everyone stop playing except for Edith, highlighting the rain stick solo.

This change could facilitate a few goals for group members – shifting attention to one instrument, encouraging the group to support Edith and allowing Edith to feel that group support, bringing down the volume level to decrease the potential for agitation due to noise or discomfort for those with hearing aids, or bringing attention back to the session theme of weather, providing a natural shift back to a group discussion. The music therapist facilitated shift from a thicker texture to a thinner texture to meet a clinical purpose.

Music therapists pay attention to texture in one-on-one sessions as well.

When facilitating music for entrainment with a hospice patient, for example, a music therapist might start with a strummed guitar accompaniment, then taper down to a finger-style pattern, before ending with a cappella singing. Here, the shift from a thicker texture to a thinner texture is meant to facilitate relaxation. Or, a music therapist might shift from finger-style playing to a thicker, strummed guitar accompaniment to support someone in playing an instrument. Here, the shift to a thicker texture provides a stronger musical support for someone trying out an instrument.

In any case, just as music therapists pay attention to tempo, key, range, and session structure, they consider musical texture for the purpose of meeting clinical needs.

This is yet another way that music therapists do live music differently.

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Music Therapists Do It Differently: Tempo

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part four of a ten-part series. You can find an introduction and links to all ten posts here.

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#4. Tempo

One incredible advantage that live musicians have over recorded music is the ability to adjust tempo. That is, we can play slower or faster depending on what is happening in the room. Any skilled musician may make some of these choices:

  • Bumping up the tempo to raise the energy level, or slowing it down a bit so people can keep up dancing
  • Matching the tempo of a famous recording or the composer’s specifications, or choosing to play much faster or slower for an intended musical effect
  • Adjusting tempo for our fellow musicians (e.g. slowing down to the new drummer’s pace.)

Musical decisions about tempo have to do with sounding great as performers with mindfulness towards the audience we’re trying to reach.

Music therapists take this a step further, choosing and modifying tempo to address clinical concerns.

Let’s start with an example from a group session. Using the same scenario as in an earlier post, imagine music therapist Janet leading a group playing rhythm instruments along with the song “Singing in the Rain.” A common goal for this kind of experience involves bringing everyone into the music-making experience at their own level, to promote environmental awareness, group cohesion, and socialization.

"How did she get Robert to play in time with everyone else? He's usually just making noise, not music!"

“How did she get that Robert to play in time with everyone else? He’s usually just making noise, not music!”

Janet might have one tempo in mind when she starts singing, but she notices one resident – Robert – playing his drum with a steady beat slightly ahead of her tempo. Janet could try to get Robert to match her beat. In fact, she would have to do this if she were using recorded music. Instead, she just speeds up a bit to match Robert and help the group meet at one tempo.

The result is more musically pleasing, increasing everyone’s satisfaction with the music they’ve created together, and Janet has helped someone be in the music with others who might have struggled otherwise.

Tempo choices are also important in one-to-one sessions. In fact, one technique I use often in hospice care is all about tempo. We call it entrainment or using the iso principle, and it involves starting music at a higher tempo, matching the client’s energy, anxiety, or pain level, then gradually decreasing the tempo. Because our bodies want to match the dominant rhythm in the environment, this helps the client to relax, in body and mind. (Read more about using the principle of entrainment for yourself here.)

As you can see from these examples, playing music live allows for tempo adjustments much more easily than using recorded music. Add to that music therapists’ extensive training and practice in making tempo and other musical choices according to clinical needs, and you can see why music therapists can make such a difference.

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