People ask me regularly, “How does music therapy work?” I used to think they were asking about the psychological mechanisms that make music therapeutic. That’s a long conversation.
Instead what they usually want to know is how a session unfolds. What happens in the room? That conversation is not as long, but the answer is still complicated.
Music therapy sessions can be for individuals or groups. They happen in therapist’s offices, schools, hospitals, and any number of other locales. There may be lots of talking involved, or none at all.
The answer becomes more complicated because really we are talking about more than one single discipline. It’s more of a jamboree of approaches under a big tent called music therapy. And what happens under that tent may not even be what we would typically think of as psychotherapy. For example, neurologic music therapy is stunningly good at making it possible for people with Parkinson’s disease to walk.
And here’s another complication: Even in the area of the tent designated for psychotherapy, there is a tremendous amount of variety. In 1999, the World Congress of Music Therapy recognized five international models of practice. Four of them are well established in the United States. Here’s a taste of what they’re all about.
Behavioral Music Therapy
The modern profession of music therapy was born in the years after World War Two, a time when behavioral psychology was on the rise. In psychiatric hospitals, clinicians noticed how music calmed the nervous systems of people who had been traumatized. In this behaviorist model, which still persists as the default mode of music therapy in the minds of many Americans, music is used to lessen undesired behaviors, promote desired behaviors, and so on.
Then the 1970s brought a second wave of approaches. You could think of it as a humanistic backlash.
Paul Nordoff and Clive Robbins, working in special education schools, pioneered a music-centered branch of the human potential movement. Their approach has evolved to emphasize live music created together by clients and therapists with the goal of establishing a connection with the “music child”—the instinctive human response to music—in all of us. Nordoff-Robbins is often associated with individual or group therapy for autistic children, but its uses are broader.
Analytic Music Therapy (AMT)
AMT is aligned with classical psychoanalytic theory. Fundamental concepts identified by Freud figure strongly including: transference, which describes how a client directs emotions towards others onto the therapist, and countertransference, which is the same dynamic directed from therapist to client. A typical session blends musical improvisation and verbal processing for the purpose of interpreting unconscious motivations. One of the main proponents of AMT in the United States was Benedikte Barth Scheiby, active in the New York City area until her death in April of 2018.
Guided Imagery and Music (GIM)
GIM is a form of transpersonal psychology. In its original conception, the therapist curates a sequence of classical music recordings to bring on an altered state of consciousness. The client listens deeply to the music while going on a mental journey, with the therapist acting as a guide. GIM is heavily influenced by archetypes, which Carl Jung described as the universal myths and patterns that pervade all human cultures. The GIM journey is designed for the client to have a sensory experience that engages not only the mind but the entire body.
The 1999 World Congress recognized a fifth style of music therapy developed by a Brazilian psychiatrist and musician named Rolando Benenzon. It is practiced primarily to the south of the United States.
Community Music Therapy
In the past couple of decades a new concept of group music therapy has taken shape in Scandinavia and the United Kingdom—and is making inroads in the United States. One driving principle is that marginalized populations, say, in prisons or hospitals, should be entitled to have access to making music. Community Music Therapy tends to de-emphasize the hierarchy that separates therapists from clients.
Now I’m going to say something that may appear to fly in the face of everything I’ve written up to this point: I believe the particulars of this or that music therapy approach are of secondary importance. What matters most—and this is true for all forms of psychotherapy—is the relationship between therapist and client. It’s the factor with the most influence on whether the outcome is positive or negative.
Usually, after I’ve done my best to give people a concise overview of this sprawling collection of information, there is almost always a second question.
People generally ask, “Is music therapy just for musicians?”
My answer is mercifully brief: Absolutely not! Music therapy is for everyone. (Indeed, for people with dementia, it may be the only type of psychotherapy possible).
When I was in my early 20s and had been in therapy for about a year, my therapist actually said to me, “Great, we figured out why are you are the way you are. You’re done!”
I don’t remember what I said but I sure remember how I felt. What I wanted to say was, “Are you kidding me? This is where the hard work starts.”
That experience had a lot to do with why I became a therapist myself. I was not benefitting from psychotherapy, and I wanted to know why. Eventually I came to understand that my tendency to be cerebral was standing in the way of growth. Because I am verbally adept, I managed to talk myself out of getting better.
Music is extremely good at cutting through our defenses and putting us in touch with unconscious material. Instead of having a conversation about our emotions, music provides a safe container to experience them directly.
We all want to feel better. While there may be value in thinking about the things we want to stop doing, I believe the real possibility for change happens when we engage the imaginative self. There is no better way to create the person you want to be.
—Dean Olsher, LCAT, MT-BC