Positive Health Online

As I started to write this article I came across a concert programme the front of which proclaims ‘ Music is Power, music is healing’. ( Joyce DiDonato). So lets consider that statement:

Music affects everyone’s lives, whether it be piped music in shops, banks, hairdressers, work places, underground stations or exercise classes to name just a few.

We are bombarded with sounds and the general uses of music, which may or may not be music to our ears.  This is why music therapy has become both an art and a science.

There are multiple sensory aspects that are activated during music listening. Compton Dickinson & Hakvoort (2017 Ch.7 p.186) state that there are no hard and fast rules about music listening together with patients.  Music can stimulate mood, memory, physical reactions, chemical reactions, movement and dance as well as psychological aspects. Individuals listen to music for entertainment, but also to influence mood (for revival, to discharge emotions, for solace and for sensation seeking), to divert or distract, or to aid concentration or cognitive awareness. (Laiho 2004; Saarikallio 2007; Saarikallio and Erkkilä 2007)

Music regulates the pulse rate to promote either relaxation or energizing activity. Music does not just affect the brain but also the body at a vibrational level. Hence music can elevate the mood and inspire. This is why when listening to a great performance, one may get a spine or scalp tingling sensation.

Music listening can be used to improve physical fitness, for example in a Zumba class, in which our bodies can entrain to the rhythm. By this I mean that that our motor functions and the music synchronize as the central nervous system receives the musical stimulus through the ears.

Music Therapy is a Health and Care Professions Council (HCPC) registered profession that involves Masters degree training. Therefore, defining the boundaries between different therapeutic specialisms requires some consideration. 

The British Association of Music Therapy acknowledge that

“music plays an important role in our everyday lives. It can be exciting or calming, joyful or poignant, can stir memories and powerfully resonate with our feelings, helping us to express them and to communicate with others.  Music therapists support the client’s communications with a bespoke combination of improvised or pre-composed instrumental music and voice, either sung or spoken”’

They continue by clarifying:

“Music therapy uses these qualities and the musical components of rhythm, melody and tonality to provide a means of relating within a therapeutic relationship. In music therapy, people work with a wide range of accessible instruments and their voices to create a musical language, which reflects their emotional and physical condition; this enables them to build connections with their inner selves and with others around them. Individual and group sessions are provided in many settings such as hospitals, schools, hospices and care homes, and the therapist’s approach is informed by different theoretical frameworks, depending on their training and the health needs which are to be met.”

Yet music should not be considered the personal domain only of the music therapist.

Clinicians and therapists of many disciplines can support patients to use their music constructively. My co-author Laurien Hakvoort and I in The Clinicians Guide to Forensic Music Therapy suggest three general purposes that all staff can use with patients as music listening for wellbeing:

1. To Influence mood and memory.

2. For private and personal solace.

3. To promote cognitive awareness of specific issues.

Influencing Mood and Memory

Depending on the treatment environment and patient needs, music listening requires a clear understanding of the clinically agreed goals of each patient, with consideration of how the role of music may help towards achieving that goal.

Counter-therapeutic effects may occur if a therapist were to create an ambience through their personal choice of music, this can be an unwanted imposition, which can have a disagreeable and negatively distracting effect; paradoxically, if the patient brings his own choice, then others may feel controlled by him. Clear group rules and negotiations are required for passive listening. When listening to music with a group of patients, everyone will have their own issues to bring to the group; they will not all feel the same. If patients are invited to bring their own choice of music, for example, to an occupational therapy group, there is a potential for crossing professional boundaries. Therefore, for hospital based multi-disciplinary work this requires interdisciplinary negotiation. 

Excellent results and mutual learning can be achieved when working collaboratively across therapeutic disciplines through the cross-fertilization of ideas. For example, by developing a healthy co-working relationship between an occupational therapist and a music therapist, or between a speech therapist and a music therapist.

Jeffcotte and Watson (2004) describe how an art therapist and a music therapist co-ran a group over twelve sessions. The music therapist led the process in making music for six sessions and then the art therapist led the sessions in doing artwork for six sessions. There was a one- week break in the middle in which the whole group had a community outing and visited an art gallery together. This could just as easily be planned as a visit to a concert. This sort of event can help to mark the transition between which therapist takes the lead role, and can provide an experience of listening to new genres of music.

Listening in Music Therapy

Creating improvised music together in music therapy begins with discovering new ways of listening. Learning to create a musical dialogue involves the ability to listen and to wait and then to discover how to respond in a way that is attuned within the relationship to the music therapist.  Ultimately, the listening skills of those attending music therapy develop so that they can relate better to other people without interruption or intrusion. This however can be a long and complex process that begins non-verbally in musical interaction and develops into a greater sense of finding an authentic voice in which each individual, perhaps for the first time in his or her life, can feel understood.

Recovery through hospital treatment is generally a combination of biological, psychological and social factors that lead to recovery rather than one single intervention. Musical improvisation is central to music therapy in the United Kingdom and can be harmful unless skillfully delivered.

Music for Private and Personal Solace 

Staff members may advise patients to listen to music to provide solace. It can be useful for staff members to discuss the choice of music that the patient may enjoy to facilitate their emotional regulation or other purposes. Music that elicits sadness may allow the patient private time in which to mourn a loss, but this requires sensitivity, as there are risks to consider if the patient has insufficient relational support, otherwise depressive symptoms and suicidal thoughts may be strengthened rather than reduced. The main thing is that nurses and therapists can support each other in their different and equally important roles.

Cognitive Awareness of Specific Issues

Psychotherapists and music therapists use music listening to support patients to discuss lyrics or the content of songs (e.g. Elligan 2004, 2012). Elligan used the content of rap songs in verbal psychotherapy to discuss difficult subjects that included anger, drug abuse and idolisation of violence and fear of failure. He invited patients to bring music with an important meaning to them. Most often they chose music with lyrics that conveyed an important personal message. This might initiate new material for cognitive awareness or analysis.  

Skemperi, (p.183 in Compton Dickinson and Hakvoort 2017) integrated the patient’s choice of heavy metal music into his course of cognitive analytic therapy, by which the patient, a medic, described how he identified with the lyrics of songs by ‘Metallica’. He was able to find his own voice and reflect on his progress and move from having a mixed diagnosis of anxiety and depression to accessing his own feelings rather than remaining ‘locked in’ within himself. From the place of feeling like the victim he became able to express and release his anger safely.

Crimmins (2012) found that lyric analysis of live or recorded music belonged to the top ten most common approaches among music therapists in forensic psychiatrics in the USA. There are published manuals for techniques in the effective use of lyric analysis available by Elligan (2004) and Hadley and Yancy (2012). These are referred to in  Grocke, Bloch and Castle 2009; O’Callaghan and Grocke 2009; Silverman 2007,2009).

Potential Contra-Indications

When providing music in secure hospitals or prisons, low staffing levels, inadequate management, observation or resources may trigger antisocial behaviours, coercion, threats and opportunistic or dangerous behaviours. Additionally, certain songs might be associated with drug abuse and therefore these could trigger cravings (Horesh 2003; Van de Ree and Hakvoort 2014). Rehearsal time may be used subversively to collect information, deal in illegal substances or settle scores; therefore rigorous risk procedures have to be followed.

‘Too Many Cooks Risk Spoil the Broth’

The ability to work as part of a team work is mandatory when treating severely mentally ill or learning impaired patients. If a music therapist is working in a secure hospital setting, the multi-disciplinary team must agree her input. The music therapist contributes to that process by following the overall treatment goals and working within a recognized psychological framework. This can sometimes be disturbed if a patient is then invited to an extra curricular activity of musical recreation in which he may indulge in narcissistic aspects of gratification and admiration that go against the overall need for him to self-reflect on his wrong - doing and to move towards the potential of feeling remorse. The most important aspect in maintaining a patient -centred approach is good communication within the treatment team.

Music as an Emotional Outlet and Container in Prisons

Bensimon, Einat and Gilboa (2013) compared the effects on a prison unit with no music with the effects of relaxation music on a prison ward. Relaxation music consisted of volume of 50–60 dB, a tempo of 60–80 bpm and was culturally sensitive. The self-reported anxiety and anger of the prisoners diminished significantly.

To Conclude

Dr Celia Taylor, Head of Forensic Services in East London NHS Foundation Trust spoke about the power of music in secure treatment settings at our recent book launch where she said:

“ I’ve never met a prisoner who didn’t use music as a vehicle for the expression of their most unbearable feelings – most often, intense shame, loneliness and regret.  Music can express something for these individuals, for which no words have yet been found.  In my experience, love of music and the need to listen to music – and I use the word “need” deliberately – is universal for these people.  The philosopher Roger Scruton wrote, “Music shines a light of meaning on ordinary life, and through it we are able to confront the things that trouble us, and to find consolation and peace.

“The idea of music as a healing influence which could affect health and behaviour is as least as old as the writings of Aristotle and Plato.  The 20^th century profession formally began after the Second World War, when musicians of all types, both amateur and professional, went to hospitals around the country to play for the thousands of returning, wounded soldiers, who were suffering both physical and emotional trauma.  These patients’ remarkable physical and emotional responses to music led the doctors and nurses to request the hiring of musicians by the hospitals.  It was soon evident that the hospital musicians needed some prior training before entering the facility, and so the demand grew for a college curriculum -  and from there the profession grew into the highly trained and expert clinicians we know today.” 

Dr Taylor continued by expressing the current need for evidence-based forms of music therapy, which can contribute towards helping patients to self-reflect on their offences.

Music listening can be used subversively to disturb, music can be a powerful tool, which must be used ethically and sensitively. The sound of Trumpets and Horns preceded by ominous silent marching round the walls of Jericho brought down the walls. This form of psychological warfare waged against the besieged population within suggests that maybe we can add to Joyce DiDonato’s statement that Music can be a weapon of destruction and of victory, because Music is power, music is healing.

References

Bensimon, M., Einat, T. and Gilboa, A. ‘The impact of relaxing music on prisoners’ levels of anxiety and anger.’ International Journal of Offender Therapy and Comparative Criminology 59, 4, 406–423. 2013.

British Association of Music Therapy  accessed on 20.08.17 at https://www.bamt.org/music-therapy.html  2017.

Compton Dickinson SJ., and Hakvoort, L. The Clinicians Guide to Forensic Music Therapy: treatment manuals for Group Cognitive Analytic Music Therapy and Music Therapy Anger Management. 2017.

Compton Dickinson, SJ. and Benn. ‘Discovering Harmony: Music Therapy in Forensic Settings.’ In A.Aiyegbusi and G. Kelly (eds) Professional and Therapeutic Boundaries in Forensic Mental Health Practice. London: Jessica Kingsley Publishers. 2012.

Crimmins, A. Identifying and Quantifying Music Therapy Services within a Forensic Psychiatric Setting Serving Residents with Aggressive and Criminal Behaviour. Charleston, SC: ProQuest, UMI Dissertation Publishing. Davies, A., Richards, E. and Barwick, N. (2014) Group. 2012.

Elligan, D.  Rap Therapy; A Practical Guide for Communicating with Youth and Young Adults Through Rap Music. New York: Kingston Publishing Corp. 2004.

Elligan, D. ‘Contextualizing Rap Music as a Means of

Incorporating into Psychotherapy.’ In S. Hadley and G. Yancy (eds) Therapeutic Uses of Rap and Hip-Hop. New York/London: Routledge. 2012.

Grocke, D., Bloch, S. and Castle, D.  ‘The effect of group music therapy on quality of life for participants living with a severe and enduring mental illness.’ Journal of Music Therapy 46, 2, 90–104. 2009.

Gilligan, J.  (2009) Shame Guilt and Violence  accessed on 20.08.18  at http://internationalpsychoanalysis.net/wpcontent/uploads/2009/02/shamegilligan.pdf

Hadley, S. and Yancy, G.  Therapeutic Uses of Rap and Hip-Hop. New York/London: Routledge. 2012.

Horesh, T. ‘Dangerous Music – Working with the Destructive and Healing Powers of Popular Music in the Treatment of Substance Abusers.’ In D. Aldridge and J. Fachner (eds) e-book. Music Therapy Today, IV(3). Accessed on 12/12/04 at www.wfmt.info/ Musictherapyworld. 2003.

Jeffcote, N and Watson, T. Working Therapeutically with Women in Secure Mental Health Settings. Jessica Kingsley Publishers. London. 2004.

Laiho, S. ‘The psychological functions of music in adolescence.’ Nordic Journal of Music Therapy 13, 47–63. O’Callaghan, C. and Grocke, D. (2009) ‘Lyric analysis research in music therapy: rationales, methods and representations.’ The Arts in Psychotherapy 36, 5, 320–328. 2004.

Saarikallio, S. (2007) Music as Mood Regulation in Adolescence. Accessed on 03/09/16 at https://jyx.jyu.fi/dspace/bitstream/handle/123456789/13403/9789513927318.pdf  

Saarikallio, S. and Erkkilä, J.  ‘The role of music in adolescents’ mood regulation.’ Psychology of Music 35, 1,88–109. 2007.

Scruton, R.  The Aesthetics of Music. Oxford University Press. Oxford United Kingdom. 1999.

Silverman, M.J.  ‘evaluating current trends in psychiatric music therapy: a descriptive analysis.’ Journal of Music Therapy 44, 4, 388–414. 2007.

Silverman, M.J. ‘The effect of lyric analysis on treatment eagerness and working alliance in consumers who are in detoxification: a randomized clinical effectiveness study.’ Music Therapy Perspectives 27, 2, 115–121. 2009.

Van de Ree, M. and Hakvoort, L. ‘Muziekluistergedrag van jongeren met verslaving: steun en risico.’ [Music listening behavior of youngsters suffering from addiction: support and risks]. Verslaving 10, 4, 22–31. 2014.

Acknowledgement Citation

Please note this article uses some material from the latest publication by the Author Stella Compton Dickinson and Laurien Hakvoort. Consent obtained from the Publisher Jessica Kingsley Publishers.