Music therapy is defined as "the prescribed use of music by a qualified person to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems" (American Music Therapy Association, 2003). While music therapy is closely aligned with the behavioral sciences, it is distinct in that it bridges art with science. Two publications by Elio Frattaroli, M.D., (2002, 2001) illustrate the dilemma faced by modern psychiatry in trying to understand mental illness, not only in the science of neurological processes but also in the art of skillful healing relationships.
Music therapists are skillful practitioners who orchestrate their talents to help soothe a wide variety of painful human conditions. While many psychiatrists are aware of the uses of music therapy for the treatment of autism, substance abuse, Alzheimer's disease and pain, far fewer are aware of the exciting work that's being done with children who have serious emotional disturbances.
Children with such disturbances have diagnosable mental health disorders and extreme functional impairment that limit or interfere with the ability to function in the family, school and/or community (Stroul and Friedman, 1994). Conservative estimates from epidemiological studies suggest that 8% to 12% of students ages 6 to 21 suffer from a significant disability, and approximately 8%, roughly 470,000 of this population, are identified through their schools as being emotionally disturbed (U.S. Department of Education, 2001).
A review of the music therapy literature delineates at least three broad domains of functioning where music therapy has been successfully utilized in the treatment of emotionally disturbed children: affect regulation, communication and social/behavioral dysfunction. Assessment and intervention in each of these domains requires strong grounding in developmental theory, a key component in the training of music therapists. Early on, music therapy was identified as an intervention to treat impairments in affective functioning, including reducing levels of anxiety (Cooke, 1969), and as a tool to improve emotional responsiveness (Wasserman, 1972). Music therapy has been well-suited to help improve communication deficits and stimulate nonverbal communication. Numerous positive outcomes in improving social functioning, social awareness and cooperation (Werbner, 1966), and decreasing disruptive behaviors (Hong et al., 1998) have been reported. One of the major contemporary applications for music therapy is working with children who have serious emotional disturbances and high degrees of impulsivity and limited ability to self-regulate (Layman et al., 2002).
Some of the modalities and techniques used in the treatment of emotionally disturbed children include live music production (e.g., playing instruments and/or singing), improvisation, guided imagery (e.g., pairing of visualization with music), creative songwriting and lyric analysis. After a careful assessment of the child's needs and capabilities, music therapists formulate individualized treatment plans that include goals and measurable objectives. Music therapists reinforce and shape targeted behaviors, while dynamically exploring underlying feelings and issues. Music therapists who work on multidisciplinary treatment teams often concentrate on a specific subset of treatment goals or objectives most appropriate for music therapy intervention. These techniques are applied in a variety of community treatment settings, as well as in hospitals, residential treatment centers and partial hospitalization programs. Therapy sessions with children typically last from 30 to 60 minutes and may be structured to include individual, family and group formats.
An advantage of music therapy is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to address more complex issues such as grief, abandonment or deeply conflicted emotions. As a medium, music therapy has enormous range and scope in targeting multiple clinical needs across the gamut of childhood developmental stages. It can set the occasion for a child to establish a meaningful relationship with an adult through musical play and interaction. Music therapy can also facilitate the development of prosocial skills, trust and feelings of positive attachment. Developmentally, almost all children respond to music. This greatly assists in laying a strong foundation for engaging in deeper therapeutic work. Children's natural interest in music is enhanced by the fact that they are occupied in stimulating motor and auditory activities more associated with play or fun than work or therapy. The careful and repetitious orchestration of such multisensory experiences, in the context of a skillful and nurturing relationship, has a remarkable range of clinical benefits.
Music Therapy Applications
The mental health care and child welfare fields are searching for effective therapies that can be utilized with victimized children, especially those who have comorbid disorders. The most heavily researched psychiatric sequelae of victimization is posttraumatic stress disorder, and its most frequently studied treatment is cognitive-behavioral therapy. A concerning gap in the treatment literature is that many emotionally disturbed children suffer from cognitive deficits and developmental disabilities. Research indicates that the average IQ of child welfare populations undergoing intensive mental health treatment is in the low- to mid-80s (Hussey and Guo, 2002). Such intellectual and information-processing deficits render cognitive and verbal therapies less effective for these children than for children with higher IQs.
American Music Therapy Association (2003). Available at: www.musictherapy.org. Accessed Jan. 22.
Cooke RM (1969), The use of music in play therapy. J Music Ther 6(fall):66-75.
Frattaroli E (2001), Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World. New York: Viking.
Frattaroli E (2002), Healing the Soul in the Age of the Brain: Why Medication Isn't Enough. New York: Viking.
Hong M, Hussey D, Heng M (1998), Music therapy with severely emotionally disturbed children in a residential treatment setting. Music Therapy Perspectives 16(2):61-66.
Hussey D, Guo S (2002), Profile characteristics and behavioral change trajectories of young residential children. Journal of Child and Family Studies 11(4):401-410.
Layman D, Hussey D, Laing S (2002), Foster care trends in the United States: ramifications for music therapists. Music Therapy Perspectives 20(1):38-46.
Montello L (1999), A psychoanalytic music therapy approach to treating adults traumatized as children. Music Therapy Perspectives 17(2):74-81.
Robb SL (1999), Piaget, Erikson, and coping styles: implications for music therapy and the hospitalized preschool child. Music Therapy Perspectives 17(1):14-19.
Stroul BA, Friedman RM (1994), A system ofcare for children and youth with severeemotional disturbances. Available at:http://rtckids.fmhi.usf.edu/publications.html. Accessed April 1, 2003.
U.S. Department of Education (2001), Twenty-third Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act. Washington, D.C.: U.S. Government Printing Office.
Wasserman N (1972), Music therapy for the emotionally disturbed in a private hospital. J Music Ther 9(2):99-104.
Werbner N (1966), The practice of music therapy with psychotic children. J Music Ther 3(1):25-31.