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 1

INrnouucrroN ro Mastc THnnqpY AND MrotctNs:

DnrnvrrroNs, TgnnoRETrcAr OnreNTATroNs
AND Lnvnr,s oF PnacrrcB

Cheryl Dileo, PhD, MT-BC

Mnnrcu, Arpr.rclrroNs oF Musrc

T EVENTUALLY HAPPENS to every one of us and everyone we love. People get sick,
need medical tests, need medical treatment, need to be hospitalized, have accidents, etc.
When illness happens, it can cause a crisis and a host of physical, psychological, cognitive,
social, and spiritual challenges. Illness or the threat of illness calls upon most or all of the
individual's resources for coping. Being sick implies change and adjustment, anxiety, fear, pain,
loss, disempowerment,lowered self-esteem, and existential and spiritual questioning.
Many things can help; music is one of them. Knowledge of this fact is growing rapidly in
terms ofresearch and clinical information. @ileo, 1997a; Dileo-Maranto,1993a,l993b,1996a).
We already know that music can help patients with a wide variety of medical conditions, or those
who are undergoing a wide variety of medical procedures. Some medical specialty areas in which
music therapy is used are shown in Figure l.
We know that music helps ease the anxiety and fear associated with these conditions and
procedures. We know that music can help the patient undergo procedures more successfully. We
know that music can reducqthe perception of pain and help reduce the amount of medicine
needed. We know that music can help calm the body's autonomic reactivity and enhance immune
response. We know that music can soothe and comfort the individual and reduce the threat of the
medical environment. We know that music can help people regain physical functioning better. We
know that music provides stimulation within the medical environment and can enhance
development. We know that music can help people cope better on many levels. We know that
music enhances mood, motivation, and self-expression, and addresses spiritual needs. We know
that music can provide an educational tool for health, facilitate decision-making, and increase
patient compliance to treatment. We know that music helps create, maintain and enrich sociat
connectedness. We know that music helps people recover from illness betteq perhaps wen
 Dileo

Neonatology* Pediatrics* Physical Rehabilitation*

General Medicine* Radiology Pulmonology*
Surgery* Anesthesiology* Pain Management*
Intensive Care* Cardiology* Obstetrics
Gynecology Dentistry Oncology*
Endocrinology Prevention*

*included in the current

book

Figure,I. Medical specialty Areas in which Music Therapy is used.

contributing to earlier discharges from the hospital. We are beginning

to know that music can help
prevent illness. And most importantly, we are striving to knori
how-music can help patients more
effectively and why. Wc are seeking to know the clinical approaches
ured,'as well as the
underlying theories to these approaches. This is the purpose of this
book.

Muslc TuTrupy AND MUSIC MEDICINE

Two complementary yet somewhat different, approaches to the uses of music

in medical
settings are currently in practice: music therapy and music medicine. Both
of these approaches
are represented in this book. Both music therapy and music medicine rely
on the inherent
therapeutic possibilities of music to relieve stress and pain and promote
well-being, yet each has
essential distinguishing features.
Music medicine is typically used by medical personnel (nonmusic therapists,
such as
physicians, nurses, dentists and allied health professionals)
as an adjunct to various medical
treatments or situations. It often represents an attempt to providl
a nonpharmacological
intervention for stress, anxiety, and/or pain for the medicai patient.
Examples oimusic medicine
interventions include background music in waiting rooms or other
areas of the hospitaUtreatment
environment, musical programs available to the pitient prior to surgery
or other procedures, and
vibroacoustic treatment. Music medicine intlrventions rely primarily
upon receptive music
experiences involving prerecorded music (preselected by med-icat
statror selected by the patient
from available programs) (Dileo-Maranto, 1995); ,rri. stimuli may include a wide range of
music in a variety of genres and styles, low frequency sounds,
specially composed music (e.g.,
womb sounds), or combinations thereof. Sometimes specialized equipment,
as in vibroacoustic
thtt"py, is required for administration ofthe music. The applications of music medicine are indeed
broad, and research has supported their effectiveness.'Chapters in
this book by Schwartz and
Ritchie and by Butler provide excelrent examples of music medicine.
Music therapy (also refered to in this volume as medical music
therapy), on the other hand,
in its approach to medical patients always involves a therapeutic
process, a .usic therapist, and
a relationship that develops through the music and procesrioil.o,
1997a, lggIb, t997c,l9g7d,
Introduction 5

1997e,1998; Dileo-Maranto, 1991, 1992, 1993a, 1993b, 1994, 1995, 1996a, 1996b, 1996c;
Wigram & Dileo, 1997).In music medicine, there may certainly be a therapeutic relationship
between the patient and the medical staffmember(s) involved; however, this relationship does not
develop through the music, nor is there a definable process that occurs in relationship to the
music.
In music therapy, the gamut of experiences within music are utilized (receptivg improvisation,
recreation, activities, combined arts, composition). The focus of music therapy may be broader,
involving the whole of the patient on many levels, rather than just the presenting medical
condition or reactions to the medical procedure. In music therapy, both the music and therapeutic
relationship serve as healing components in treatment. In spite of the fact that tlrere may be
emphasis on one, the otheq or both during treatment, both are always present @ileo-Maranto,
lggl, 1992). In additioq music therapy may serve as a primary mode of intervention with regard
to medical treatment, may be considered supportive to medical treatment, or may work in an
equal partnership with medical treatment (Dileo-Maranto, 1991,1992) (Table l).
Chapters by Justice and Kasayka, Saperstoq Edwards, Aldridge and Aldridge, Scheiby, Rider,
Tomaino, Ramsey, Griggs-Drane, Reuer and Roskam, Dileo, Turry and Turry, Dileo and Bradt,
and Loewy, in the present volume, provide examples of medical music therapy. Further, these
chapters are organized in the text according to the type of music experiences used: receptive,
improvisational, re-creative, songs, or combined approaches.
Both music medicine and music therapy approaches are considered important and necessary
for the medical patient, and collaborative approaches between medical personnel and music
therapists often provide valuable and rich opportunities for research and clinical practice.

PrRronvrrNc ARTS Mrorcrxr

As music therapy and music medicine represent two subfields in the broad interface between
music and medicine, a third possibility is included in this volume: performing arts medicine. This
subfield refers to the study and treatment of the performance-related medical and psychological
problems ofmusicians (as well as other performing artists) @ileo-Maranto, 1991, 1992,1994).
Music therapy is emerging as one possibility for treatment of the problems of musicians,
particularly those related to performance-anxiety (Dileo-Maranto, 1994; Habboushe & Dileo-
Maranto, 1991). In this book, Reitman provides an excellent description of a music therapy
process with this population.

THNONNUCAL ORIENTATIONS WITHIN MEDICAL MUSIC TTTNnIPY

An important purpose of this book is to illuminate the various theoretical approaches that may
underlie clinical practice in music therapy with medical patients. As seen in Figure 1, music
therapists employed in medical settings often work with a wide range of clinical problems and
patient needs. It is not surprising, therefore, that they base what they do upon different theoretical
models, and often upon several theoretical models. What is surprising, however, is the breadth
of these models. Figure 2 provides an overview and a rather loose classification of the various
theoretical models described in this book. It can be accurately assumed that this classification
 6

Table 1

Music Therapy and Music Medicine

Characteristics

Music Therapy Music Medicine

Music
Yes Yes
Self-selected/Pre-selected Music
Not Usually Yes
RelationshipThrough Music
Yes No
Music Therapist
Yes No
Assessment process
Yes Sometimes
Evaluation
Yes Sometimes
Goals
Yes Not Usually
Process
Yes No
Self-help
No Sometimes
Types of Music Experiences
- Receptive
.Improvisation Yes Yes
. Recreative Yes No
.Composition Yes No
Yes No
'Activity
.Combined Arts Yes No
Yes No

does notfully embrace all of the orientations that

are currently being used in practice
one cannot consider this list as all-inclusiye and, thus,
11 aaaition, new theoretical
in medicine are cu,entlv being a.r.rod,'ur'p..r"nt"d
models for the role of
[T:rff:TJ by Rider and by Ardridge
Although various psychological theories
may employed, the distinction between
music therapy practice and music psychotherapy !e medical
is int"ntiorutty not made for several
current research points to the prlrlourly artificial reasons.
environment, and spirit, emphasizing
aiuirl*, between mind, body, the social
the intlrrelut.an.r, ;i;h.r" parts
assessment' and treatment' Because of the person in etiorogy,
of this, it is not p;r;ibr" to isolate ttre
any ofthese areas' For example,. erecis of therapy in
music psychothempy undertaken with a medical patient
to improve his psvchologicaf adjustmeni, ";;;
tut it ir b;;;;increasingly crear that this
will influence his or her medical condition. may and
The reverse is also-true. It may
primary and secondal be possibre to derineate
sgals of therapy, for exampl", *-l"ing primarily psychological
secondarily physical, but it is not po*i6i. and
to say rrrui'*.'music therapy strategy
physical needs' whereas another addresses
udd..rr., psychorogi cal, and/or spiritual
individual cannot be compartmentalized, -sociai, needs. The
and neither can prevention or treatment.
 Introduction 7

Medical Daelopmental psychologicot

Butler & Lehikoinen Loeuy Edwards (stress)
Griggs-Drane Schwartz& Ritchie
Schwartz & Ritchie

BehavioraUCogrtfive Gestalt psychoanolytic

. Saperston Loewy Scheiby
Reitman Loewy

Behavioral Medicine Transpersonal/ Existential

(Mind-BotlyMdcq Spiritual
Aldridge & Aldridge Aldridge & Aldridge Aldridge & Aldridge
Justice & Kasayka Justice & Kasayka Dileo
Loewy Turry & Turry
Reuer & Roskam Dileo
Dileo & Bradt
Dileo

Humanistic Anthroposophic communicafion Theory

Tomaino Turry & Turry Ramsey
Turry & Turry
Dileo

Neurological Physics Wellness

Tomaino Rider Reuer & Roskam
Dileo & Bradt
Butler & Lehikoinen

Homeodynaiic
Rider

Figure 2. Theoretical Orientations in Medical Music Therapy.

Luvrr,s oF MEDIcAL Muslc THnupy pnlctrcr

When one examines the breadth of theoretical orientations and approaches to medical music
therapy clinical practice, as well as the variety of clinical needs addressed in patients, various
levels of practice become apparent. Organizing them into some coherent frame of reference is
another issue! Realizing that it is not possible to construct a "levels" framework upon wlrici all
fu
practitioners would ?g@, it is nevertheless necessary to begin the process as a starting pofutr
further discussion.
Criteria for designating various levels of practice may and should include the fotlowfurg:
 Dileo
. clinical needs of patient;
' level of training, experience, and qualifications of the therapist and autonomy in
designating and implementing therapeutic goals;
. depth of intended goal of music therapy intervention,
' the function of music therapy with regard to medical treatment (supportive, primary
equal).

With these criteria in mind, a levels model is presented for a specific therapeutic goal,
e.g.,
pain management. This model can be either refined or generalized
to include various other clinical
goals.
Three levels of
music therapy work are defined: (l) supportive, (2) specific, and
(3) comprehensive @ileo-Maranto, 1993c, 1993d). Criteria for this classincation, as
well as
examples of music therapy interventions, are shown for each level in Figure
3.

1. Suppottive Level

Needs of Client: Temporary relief from pain

Level of Therapist: Beginning, intermediate
Depth: Distraction, provision of coping skills
Function: Supportive of medical intervention
Common Music Therapy Interventions: Music and biofeedback, music-based rela:ration
strategies, vibroacoustic therapy, re-creative
techniques

2. Specific Level

Needs of Client: Understanding of pain

Level of Therapist: Intermediate, experienced, graduate studies
Depth: Dialogue with or confrontation of pain
Function: Equalwith medical intervention
Common Music Therapy Interventions: Improvisation, music and imagery techniques

3. Comprehensive Level

Needs of Client: Resolution of pain

Level of Therapist: Advanced, experienced, graduatdspecialized
training
Depth: Resonance by therapist with pain
Function: primary
Common Music Therapy Interventions: Entrainment, guided imagery and music

Figure 3. Levels of Music Therapy practice in pain Management.

 Introduction

Coxcr,usroxs

It is hoped that this brief introduction to medical music therapy, music medicine, and
performing arts medicine *ill help the reader identi$ these various approaches in clinical practice.
It is also hoped that the emphasis on theory and practice in this book will ultimately enrich the
practice of medical music therapy. Each reader will evaluate what has been written, agreeing or
disagreeing with various orientations and clinical styles. This process is considered veryimportant
in formulating and refining one's own beliefs, perspectives, theoretical orientations,-and unique
way of working.
Medical music therapy is certainly coming of age, and the present volume is only one
testament to all that is possible. As said in the beginning of the chapter, illness will eventually
cause a crisis in all ofour lives. Music therapy can help.

RrreRnxcrs

Dileo, C. (1997a). Receptive strategies in music therqy.Paper presented at the Polymedia Music
as a Tool forWell-Being and Preventive Health Care Mini-symposium, Hamburg, Germany.
Dileo, C. (1997b). Reflections on medical music therapy: Biopsychosocial perspeitives of the
treatment process. In J. Loewy (Ed.), Music therapy and pediatric pain. Cherry Hill, NJ:
Jeffrey Books.
Dileo, C. (1997c). The process of medical music therapy. Paper presented at the annual
conference of the National Association for Music Therapy, Los Angeles.
Dileo, C. (1997d). The context of music and medicine. In T. Wgram and C. Dileo (Eds.), Music
vibration and health. Cherry Hill, NJ: Jeffrey Books.
Dileo, C. (1997e). El proceso musical en Pacientes Medicos. In P. del Campo (Ed.), La musical
como proceso humano. Salamanca: Amaru Ediciones.
Dileo, C. (1998). The process of medical music therapy. Paper presented at the Mid-Atlantic
Regional Conference of the American Music Therapy Association, Cherry Hill, NJ.
Dileo-Maranto, C. ('1991). A classification model for music and medicine. In C. Dileo-Maranto
(Ed.), Applications of music in medicine. Washington, DC: National Association for Music
Therapy.
Dileo-Maranto, C. (1992). A comprehensive definition of music therapy with an integrative model
for music medicine. In R. Spintge & R. Droh (Eds.), Musicmedicine. St. Louis: MMB.
Dileo-lvlaranto, C. (1993a). Music therapy and stress management. In P. Lehrer and R. Woolfolk
@ds.), Principles andpractice of stress marngement New york: Guilford.
Dileo-Maranto, C. (1993b). Applications ofmusic in medicine. In M. Heal and T. Wgram
@ds.),
Music therapy in health and education.London: Jessica Kingsrey.
Dileo-Maranto, C. (1993c). Music therapy clinical practice: A global perspective and
classification system. In C. Dileo-Maranto, Music therapy: International perspecfives
Pipersville, PA: Jeffrey Books.
Dileo-Maranto, C. (1993d). Music therapy in the United States of America. In C. Dileo-Maranto
(Ed.), Music therapy: International perspectives. Pipersville, PA: Jeffrey Books.
Dileo-Maranto, C. (1994). The professionalization of musicmedicine and music therqlt Paper
presented at the V International MusicMedicine Symposium, San Antonio, TX.
 9
Introduction
Coxcr'usroxs

music therapy, music medicine' and

It is hoped that this brief introduction to medical
these various approaches in clinical
practice'
unr r"airi* will help th" r;;;i;t"S
performing
It is also hoped that the emphasis ", th;;;
J iractice in this u*t *itt ultimatelyagreeing
enrich the
or
witten'
practice of medical *rri" it!r.py. Each ,.ud", will evaluate what has been very important
*a tfi"itd styles' This process is considered
disagreeing *itfr r"riou, ori"nt"iion
own b;li.fb, peispectives' theoretical orientations' and unique
in formulating and refining one's
-",J1il:f;ff;sic and the present -volume is onlv one
therapy is certainly coming of age,
illness will eventually
As said in tt ri"ginning of the chapteq
testament to all that is possible.
can help'
;;; crisis in all of our lives' Music therapy

REFERENCES

the Polymedia Music

in music therW'faner presented at
Dileo, C. (1997a). Receptive strai:gtes
and PreveliJg n*1ttt ftli"ifSymposium' Hamburg' Germany'
as aTool forWell-Being 9it" perspectives of the
medical music therapy: nioisychosocial
Dileo, c. (lgg7b). Reflections on Hill' NJ:
p-".rr. l" J. Loewy (Ed.t Music theripy and pediatric pain' Cherry
treatment

The process of .medicat music

therapv. Paper presented at the annual
Los Angeles ..
"rJ;:;1',r"r"fi
conference orit Nutional Association for Music Therapy' Music
"
ii" *r"" or.uri" medicine. In T. Wigram and c' Dileo @ds')'
Dileo, c. (lgg7d). "na
vibrationandhealth.CherryHill,NJ:JeffreyBooks.
pua*,.s Medicos. In p. del campo (Ed.), Lamusical
Dileo, c. (1997e). El proceso musical "n
Amaru Ediciones'
como proce,o himano' Salamanca: the Mid-Atlantic
music rherapy' Paper presented at
Dileo, c. (1998). The process of medical Hill' NJ'
Music Therapy Asiociation' Cherry
Regional Conference of the American
(1991). A classifi'.,i",,"aelfor music and medicine. In C. Dileo.Maranto
Dileo-Maranto, C.
National Association for Music
(Ed.), Applications of music in midirinr. washington, Dc:

therapy with-anintegrative model

,c. (rggz).A comprehensive definition of music
R. broh @ds.), Musicmedicine' St' Louis: MMB'
"rJiffi%
for music medicine. In R. Spintg;& and R' woolfolk
Dileo-Maranto, c. (1993a). Music
and stress
therapy
'nun"g"ttnt ltll:o
-In-P Guilford'
and o!it'e" managemeni Nt* York:
(Eds.), Principles ryact1c" (Eds')'
(1993b). ApplicatiJnr-oi*uric irimedicine. In M' Heal and T' Wgram
Dileo-Maranto, C.
London: Jessica Kingsley.
Music *rropy'in nriin ira education.
c. (1993c). rrruri.--ti.rapy clinigr fru.tir.l slobal perspective and
I
Dileo-Maranto, pileo-Marant o, Music therapy: International perspectives
classification system. In c.
PiPersville, PA: JeffreY Books'- In c. Dileo-Maranto
therapy in the united States of America.
Dileo-Maranto, c. (1gg3d). Music PA: Jeffrey Books'
(Ed.), t tusii irrapyi tntr*r,tioniiprrspectives.Pipersville,
of misicmediicine and music therqy'
Paper
Dileo-Maranto, c. (1gg4 ). Th" profrss;iinalimtion
San Antonio' TX'
presented u,-,rr. v International MusicMedicinasymposium,
 l0 Dileo
Dileo-Maranto, C. (1995). Music and the mind-bdy connection. paper
presented at the
Centennial Conference of the University of Melbourne, Melbourne,
Australia.
Dileo-Maranto, C. (1996a). Research in music and medicine: The
state of the art. In M. A.
Froelrlich (Ed.), Mulic therqyfor hospitalizedchil*en: A
creative ar* cni4-nqe
Cherry Hill, NJ: Jeffrey Books. ";p;;;;.
Dileo-Maranto, C. (1996b). New directions and research in music
therapy and medicine. paper
presented at the world congress of Music Therapy,
Hamburg ce#any
Dileo-Maranto, C. (I996c)' Music medicinefor patients undergoint
cotonoscopy procedures and
music therapy for oncology patients: Clinical descriptions-and
distinctions in practice. paper
presented at the M International MusicMedicine
Symposiurq San Antonio, TX
Habboushg F., & Dileo-lVlaranto, C. (1991). An overview oimedical
and psychotlgical problems
of musicians- In C. Dileo-Maranto @d.), Applications of masic in medicini.
washingtorl
DC: National Association for Music Therapy.
Wgram, T., & Dileo, C. (1997). Clinical and ethical considerations.
In T. Wgram and C. Dileo
(Eds.), Music vibration and health. cherry Hill, NJ: Jeffrey
Books.