Parallels and Divergence Between Neuroscience and
Humanism: Considerations for the Music Therapist
KIMBERLY SENA MOORE, PhD, MT-BC
A. BLYTHE LAGASSE, PhD, MT-BC
ABSTRACT  A neuroscience-informed approach to music ther-
apy may not appear to have many similarities to a humanistic one.
However, a closer look at both reveals some commonalities, as well
as some divergences, particularly in the conceptualization of com-
mon aspects to music therapy practice. Thus, the purpose of this
article is to explore such similarities and differences and examine
how ideas inherent in humanistic-leaning music therapy practice may
inform and strengthen neuroscience-informed music therapy prac-
tice. After describing characteristics of the neuroscience-informed
music therapy approach, we review current publications from this
area of practice to see where humanistic principles are suggested.
We then outline where standards of selfhood, agency, relationality,
and aestheticality in particular can be infused in the clinical practice
and research of the neuroscience-informed music therapist as a way
to enhance client outcomes by allowing them input in realizing their
own health and wellness.
Keywords:  music therapy; neuroscience; humanism; clinical
practice; research
A neuroscience-informed approach to music therapy may
not appear to have many, if any, similarities to a humanistic
approach. However, a closer look at both reveals some com-
monalities. One example is in the use of the word entrain-
ment. From a neuroscience approach, this word is often used to
describe a physiological mechanism of synchronization where
an internal oscillator (i.e., gait) is coupled with an external cue-
ing stimulus (i.e., metronome) (Thaut, 2013). In humanistic lit-
erature, entrainment is similarly used to describe a pull from one
object to another; however, Dimaio (2010) used entrainment as
a musical pull from the experience of pain into the experience
of healing, a concept based on Dileo and Bradt’s (1999) Music
Therapy Entrainment technique where the client and therapist
are together in the client’s experience (e.g., pain) and the thera-
pist may “pull” the client into another experience (e.g., healing).
Although in the above instance the neuroscience-informed
and humanistic writings refer to entrainment as a mechanism
used in the therapeutic interaction, the conceptualization of
entrainment is quite different. This type of divergence between
the two approaches can be found in other areas, such as in
Kimberly Sena Moore is Assistant Professor of Professional Practice in the Frost
School of Music. Her research focuses on emotion regulation development and
professional work on advocacy, policy, and social media communications. E-mail:
ksenamoore@miami.edu A. Blythe LaGasse, PhD, MT-BC, is Associate Professor
of Music Therapy at Colorado State University and has more than 15  years’
experience as a clinician using a neuroscience-informed approach.
Address correspondence concerning this article to Kimberly Sena Moore, PhD,
MT-BC.
© American Music Therapy Association 2018. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com
doi:10.1093/mtp/miy011
Advance Access publication June 16, 2018
Music Therapy Perspectives, 36(2), 2018, 144–151
144
University of Miami
Colorado State University
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the conceptualizations of common aspects of music therapy
practice. For example, in neuroscience-informed practice,
therapeutic treatment goals are non-musical and focus on
improving skills related to specific functional deficits a client
exhibits. This seems in contrast to the humanistic approaches,
which focus on addressing a client’s self-actualized goals that
themselves are based on a more holistic understanding of the
client, inclusive of the context in which they exist and not nec-
essarily based on an existing symptom (Abrams, 2015). In this
example, even the process of shaping the treatment purpose
differs, with the neuroscience-informed purpose focused on
specific functional deficits and the humanistic approach on
the whole person. Even the framework for understanding the
primary treatment modality differs between these approaches.
In the neuroscience-informed approach, music is a stimulus
that can be used to strengthen, shape, or re-train parts of the
human brain (O’Kelly, 2016; M. Thaut, 2014). In contrast, for
music therapists practicing from a humanistic perspective,
music is a way of being, not an object for use (Abrams, 2015).
These types of similarities and differences can be found
throughout the neuroscience and humanistic literature, creat-
ing both a platform for shared understanding and a differing
approach in the utilization of music therapy. Thus, the purpose
of this article is to explore such similarities and differences
and examine how ideas inherent in humanistic-leaning music
therapy practice may inform and strengthen neuroscience-
informed music therapy practice. After outlining character-
istics associated with the neuroscience-informed approach,
we review the extant literature to see where humanistic ele-
ments are currently embedded, then end by outlining ways in
which the clinical practice and research of the neuroscience-
informed music therapist may be enhanced through a more
intentional integration of humanistic principles.
Neuroscience-Informed Approach
Neuroscience-informed music therapy is composed of
numerous writings, research studies, and ideas about how
music impacts the brain and the importance of translating this
knowledge to inform music therapy practice. Music therapy
scholars have contributed numerous theoretical and educa-
tional papers on neuroscience in music therapy (LaGasse &
Thaut, 2013; O’Kelly, 2016; Stegemöller, 2014; Tomaino,
2015). Furthermore, music therapists have written about a
neuroscience perspective for specific populations, includ-
ing for persons with emotional regulation difficulties (Sena
Moore, 2013), autism spectrum disorder (LaGasse, Hardy,
Anderson, & Rabon, 2018), disorders of consciousness
(O’Kelly & Magee, 2013), early childhood (Geist & Geist,
Parallels and Divergence Between Neuroscience and Humanism
2012), rehabilitation (Thaut, McIntosh, & Hoemberg, 2014),
and mental health (Hunt & Legge, 2015). Collectively, these
writings demonstrate over 20 years of ideas related to a neu-
roscience-informed approach with considerations in develop-
ment, mental health, and rehabilitation.
Neuroscience-informed music therapy is based on an under-
standing of (a) the neuroscience of human brain and behav-
ior function and how disease and disability impacts them; (b)
the neurological aspects of music perception and production
(O’Kelly & Magee, 2013); and (c) the study of how music engage-
ment can change the brain—in particular how the specific appli-
cation of music therapy protocols may change behavior and
facilitate development of functional neural networks (LaGasse
& Thaut, 2013). The music therapist is making clinical decisions
based on the current information in three areas: the neurosci-
ence of human functions, the neuroscience of music perception
and production, and music-elicited brain activation patterns that
can facilitate therapeutic outcomes. The specific outcomes tar-
geted in this approach are functional, non-musical therapeutic
goals in domains including sensory, motor, communication, and
affective/emotional (O’Kelly & Magee, 2013; Thaut et al., 2014).
Identifying neurological differences in persons with disease
and disabilities can help the clinician better understand the
origin of a particular behavior or symptom (Tomaino, 2015),
which can be used to make informed choices about how the
behavior or symptom may be addressed. For example, know-
ing about the particular area of the brain impacted by cerebral
vascular accident can help the music therapy professional
understand why a client is able to complete some tasks, while
they are unable to complete others. For example, Stegemöller
(2017) illustrated how individuals with a cerebral vascular acci-
dent affecting the left inferior frontal gyrus would demonstrate
impaired speech ability due to the lateralization of speech to
this area of the brain, yet a person with a comparable insult on
the right side of the brain would likely have unimpaired speech
abilities. Similarly, a lesion more posteriorly in the left side of
the brain would impact the individual’s ability to understand
language; however, they would likely retain all motor speech
ability. In this way, knowledge of basic locations in the brain
and their function helps the music therapy clinician determine
why a client is presenting with certain clinical characteristics.
Information about neurological functioning may also help
the music therapist challenge assumptions made about certain
populations. For example, autism spectrum disorder has long
been considered a social functioning disorder, with diagnostic
criteria centered on social communication and restricted and
repetitive behaviors (American Psychiatric Association, 2013).
However, recent studies have indicated neurological differ-
ences underlying motor and sensory systems (Torres et  al.,
2013). Thus, although a child with autism spectrum disorder
may present as having social deficits, the underlying neurologi-
cal disruption could be one of sensory difficulties combined
with motor planning and sequencing (Hardy & LaGasse, 2013;
Torres et al., 2013). This information would change the thera-
peutic approach to provide motor and sensory support for the
affected systems that are impacting social skills, a shift in focus
from the more traditional approach to focusing on social com-
munication and behavioral goals (see Hardy & LaGasse, 2013).
Knowledge of music processing in the brain provides a
unique insight as to how music may impact neural functioning
145
and neuroplasticity in a range of domains. According to
O’Kelly (2016), in a neuroscience approach the music ther-
apist is attempting to understand how “musical activity and
experiences operate at a neural level integrating diverse corti-
cal activity, shaping neuroplasticity, and wide ranging neuro-
hormonal activity” (para. 1). Similarly, Michael Thaut (2014)
explained that following the development of neuroimaging
techniques, a complex picture of neurological processes in
music engagement has emerged, providing evidence that
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music can be a tool to rehabilitate the brain. According to
Thaut and colleagues (2014), these changes reach beyond a
general concept of well-being to the use of specific musical
stimuli to reach therapeutic outcomes. In this way the music
therapist practicing from the neuroscience-informed approach
may use music engagement—or may isolate a specific ele-
ment of music—for therapeutic application (e.g., the use of
rhythm to cue gait). These music experiences exist within a
therapeutic relationship; however, Thaut and colleagues focus
on the music as the central working mechanism. Therefore, it
is the music stimuli or protocol, as implemented by the music
therapist, that invokes the change in the client. In order to
implement effective music therapy interventions, the music
therapist must have an excellent working knowledge of the
neuroscience of music perception and production.
Identifying how music affects the brain and human behav-
ior drives another aspect of the neuroscience approach—
research. Researchers in a neuroscience-informed approach
undergo empirical testing of clinical protocols in order to
drive knowledge of music in the brain, refine clinical pro-
tocols, and further inquiry. Protocols in the neuroscience-
informed approach are specifically developed from research
on music processing in the brain (Thaut et  al., 2014). In at
least one neuroscience-informed approach, there is even
an epistemological model for engaging with and develop-
ing research, the Rational-Scientific Mediating Model (Thaut
et al., 2014). Overall, though, the role of research in a neuro-
science approach is to identify neurological processes asso-
ciated with music engagement and determine the impact of
treatment protocols.
The neuroscience-informed approach incorporates what is
known about music in the brain, along with basic principles of
music perception and production, to inform how music may
be most effectively used in a therapeutic context. For example,
knowing that rhythm can provide a precise temporal cue for
motor movement, including oral-motor movement, the music
therapist would ensure that the rhythmic stimulus helps with
the anticipation and execution of a motor-based task, such as
a speech sequence or an upper-extremity movement pattern.
In consideration of neuroplasticity, the music therapist would
know to provide multiple opportunities for successful comple-
tion of these tasks. Integral to this process is the music therapy
clinician, who reads the research, learns about current neuro-
science information, and creates or uses protocols to address
functional needs.
Humanism in Current Neuroscience-Informed Music
Therapy Literature: A Brief Review
Whereas neuroscience-informed music therapy is built on
an understanding of how music influences brain and behav-
ior functioning, humanistic approaches are grounded in the
146
belief that as humans, we have an innate ability to conceive
and realize our own health and wellness (Abrams, 2015).
Although they emerged from different traditions, there are ele-
ments of humanism implied in the writings of music therapy
authors who have incorporated neuroscience research in their
work, in particular selfhood (having an identity), relationality
(being aware of and understanding that one exists with others
and in the world), agency (having choice and control over
one’s life), ethicality (holding oneself responsible for them-
selves and their actions), and aestheticality (understanding
one’s meaning and value in relation to beauty and balance).
These principles are at times suggested through the context
under which the authors understand music therapy treatment,
implied through describing specific music interventions and
how they are facilitated, or embodied when outlining future
directions in music therapy clinical practice and research. The
music therapy texts and journal articles included in this brief
review can all be considered neuroscience-informed, and
the authors imply, even minimally, at least one of these five
humanistic principles.
One of the earlier neuroscience-informed music therapy
texts is Tomaino’s (1998) Clinical applications of music in neu-
rologic rehabilitation, a compilation of papers based on a con-
ference sponsored by Beth Abraham Health Services in March
1993. Whether consciously or not, most of the music therapists
who contributed to this text—Drs. Concetta Tomaino, Alicia
Ann Clair, and Joseph Nagler—embedded humanistic princi-
ples in their chapters, most notably in their clinical vignettes.
Tomaino, who incorporated multiple clinical examples in her
chapter, made statements such as:
• “She needed the music to organize and to call to her as a
person” (p. 23);
• “As the sessions progressed, he became more inventive in
his movements” (p. 25); and
• “Within a few months, she was able to sit down and be
part of the music therapy session of the duration of the
group” (p. 23).
When interpreting these statements through a humanistic
lens, the first two arguably imply selfhood, as they speak to
clients having a unique identity, and the last statement to rela-
tionality, as it implies the client understands they are with oth-
ers in that moment. Whereas Clair, too, references relationality
(she writes that group music therapy sessions for caregivers of
persons with dementia provided opportunities for couples to
interact both socially and purposefully), Nagler’s case study
about Willie, an adolescent African American with cerebral
palsy and a mild intellectual disability, integrates selfhood,
agency, and aestheticality. He opens by writing that “The case
is reported as an illustration of the power of music and music
therapy exacting a change in a person’s way of being. Willie,
the participant profiled, is a truly distinctive person” (p. 45),
an arguably explicit statement acknowledging selfhood. This,
along with agency and aestheticality, can also be found in
Nagler’s discussion of this case (statements in italics added
for emphasis):
Willie used the music as an enabler that assisted him in
creating his own identity through both the metaphorical
and tangible process of music making (selfhood). Willie
has grown from a passive listener of music to an active,
Music Therapy Perspectives (2018), Vol. 36
creative participant in his own process of rehabilitation
(agency, aestheticality)…Willie has found the means to
express his innate musicality (aestheticality). (pp. 47–48)
Humanistic principles can also be found in other clinician-
focused, neuroscience-informed music therapy texts. In the
introduction to their clinician’s manual on music therapy in
neurorehabilitation, Baker and Tamplin (2006) remind the
reader that although the focus of the manual is on redevelop-
ing functional skills, this does not mean they do not consider
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the whole person during treatment. This implied concept of
selfhood is found elsewhere in their book. For example, in a
chapter outlining emotional adjustments related to a neuro-
logical insult, they note that these types of injuries may lead
to a loss of independence and the subsequent need to form
an identity that “integrates all aspects of the self” (p.  197).
Selfhood is also suggested in some of the music interventions
they describe, such as song discussion for self-exploration
and self-understanding, songwriting for self-expression, and
music improvisation as a way for clients who are nonverbal to
express themselves.
In addition to selfhood, Baker and Tamplin (2006) also
implicitly reference the humanistic principles of relational-
ity and agency. The former concept is incorporated in both
the understanding of the impact a neurological injury has on
how one exists in their personal and professional worlds (i.e.,
the clinician must recognize that the client is processing the
impact the loss has on their professional status and personal
relationships), as well as through some of the music inter-
ventions described, such as singing as a way to interact with
others and songwriting to share emotional experiences with
others. The latter concept—agency—is first presented in Baker
and Tamplin’s introduction, when they write that “patients pre-
sent with what often appears to be an almost innate drive to
attain health and well-being” (p. 13). This motivation can be
understood as the client making the conscious, independent
choice to improve their condition. Agency is further implied
through the authors’ suggestion that music therapists incor-
porate the client’s musical choice and preference during the
treatment process.
The final clinical-focused, neuroscience-informed music
therapy text included in this review that implied at least in
part humanistic principles is Thaut and Hoemberg’s (2014)
Handbook of Neurologic Music Therapy, a manual outlin-
ing the theory and interventions specific to Neurologic Music
Therapy (NMT). Throughout this text there is an emphasis
on providing music therapy experiences that are guided by
musical logic. In other words, several chapter authors empha-
size that the music experiences and how they are facilitated
should adhere to aesthetic and artistic principles. This idea
aligns partially with the humanistic concept of aestheticality,
which involves the client understanding their value through
aesthetic experiences. This seems a partial consideration in
the NMT handbook, as it is not the client who is independ-
ently seeking out aestheticality, but the music therapist who
is responsible for creating an experience that allows for the
understanding. This type of support may be needed based
on the extent of the client’s brain injury. The NMT tech-
nique of TS (Therapeutic Singing) takes this further, as author
Sarah Johnson (2014) writes that “it is the perceptive musical
choices, implemented with esthetic facilitation of the singing
Parallels and Divergence Between Neuroscience and Humanism
opportunity, that elevate therapeutic singing above the ‘sing-
along’ and into an extremely effective therapeutic technique”
(p. 194). In other words, in addition to aestheticality, there is
an element of client choice (agency) involved.
Finally, in addition to aestheticality and agency, some of the
specific NMT techniques support relationality and selfhood.
The former is implied with the techniques SYCOM (Symbolic
Communication Training through Music) and MPC (Music
in Psychosocial Training and Counseling). In both instances,
the techniques are intended to allow clients to relearn and
practice skills that will allow them to be aware of and inter-
act with others, with SYCOM focusing on strengthening
nonverbal communication exchanges (C. Thaut, 2014) and
MPC on developing social competence and self-awareness
(Wheeler, 2014). MPC also has connections to the human-
istic principle of selfhood, as does AMMT (Associative Mood
and Memory Training) (de l’Etoile, 2014). Both are intended
in part to develop or become reacquainted with one’s identity
and sense of self, either through an awareness and expression
of felt emotions (MPC) or through a music-evoked process of
remembering one’s life story (AMMT).
The implicit connections to humanistic principles extend
beyond neuroscience-based music therapy textbooks to
include journal articles as well. For example, Stegemöller
(2014) and O’Kelly (2016) published articles fully grounded
in a neuroscience-informed practice, yet they imply human-
istic principles of agency (Stegemöller) and relationality
(both). For example, when describing how neuroplasticity
can help explain why music experiences work to help the cli-
ent increase interactions (relationality), Stegemöller empha-
sizes the importance of incorporating client-preferred music
(agency; aestheticality). O’Kelly also implies relationality at
multiple points in his 2016 article exploring neuroscience-
informed music therapy practice and research. He addresses
the connection between music and relationship, highlight-
ing the prevalence of social musical activities between peo-
ple and the live, dynamic process inherent to clinical music
therapy work. Furthermore, he encourages music therapists
to utilize developments from the social neuroscience field to
explore the neural mechanisms implicated in social processes
and behaviors. Finally, O’Kelly acknowledges the limitations
of current neuroscience research in explaining music therapy
practice. While reflecting on an experience when a client who
was unable to communicate verbally due to aphasia, yet was
able to sing a favorite song, O’Kelly mused:
(W)ould this effect have happened without the therapeutic
relationship I  had developed prior to the landmark ses-
sion, and how could this be captured with neuroscience
methods? Was it just repetition and neuroplasticity that
supported his recovery, or was the instillation of hope
brought from the event equally important? And how could
neuroscience capture the ripple effect of working with
him later on in the more social environment of the day
hospice lounge, where other staff and patients described
being inspired by his transformation? (p. 9)
Though not explicitly stated, these questions imply the
humanistic principles of relationality, and possibly agency
as well.
Whereas the writings reviewed thus far imply humanistic
principles, authors are beginning to explore more explicit
147
integrations between neuroscience- and humanistic-informed
approaches (Hunt, 2015; Lichtensztejn, Macchi, & Lischinsky,
2014). Lichtensztejn and colleagues explored the use of music
improvisation as a way to help differentiate when a client is
in a vegetative or minimally conscious state, both Disorders
of Consciousness (DoC). Through their literature review and
case report example, they highlight humanistic principles of
selfhood and relationality, and imply several others. For exam-
ple, early in the article the authors acknowledge that a core
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issue is to determine whether or not a client with DoC exhib-
its awareness of their surroundings. The ability to be aware
of one’s surroundings is foundational to being aware of and
understanding oneself (selfhood) and one’s choices in their life
(agency, ethicality, aestheticality), as well as being aware of
others (relationality). In addition, the authors focus on clini-
cal music improvisation as a way to utilize what they term
“communicative musicality” to stimulate the client’s ability
to communicate, writing that “clinical improvisation creates
a space in which the client and therapist can interact in the
music” (p.  48). In other words, this particular type of music
experience allows the client to be aware of existing with
another (relationality). Selfhood and relationality are further
emphasized when the authors review Herkenrath’s work with
patients in a persistent vegetative state, as he focuses on the
importance of the client-therapist relationship (relationality)
and the role music can have in helping a client in this state
to direct their attention to parts of their body (i.e., begin to
become aware of one’s self again).
Outside the clinical space, Hunt (2015) outlines current and
emerging trends in neuroscience research methods as they
relate to music therapy research. In her opening paragraph,
Hunt writes that “(d)econstructing music…merely addresses
the neural processing of music perception and action, ignoring
the holistic experience of music, which unfolds over time and
is embedded in personal and situational context” (p. 1). The
acknowledgment of the importance of understanding context
seems to highlight the spirit of humanistic principles. Hunt
also expresses several times the need to be aware of the cli-
ent-therapist relationship, the intersubjective nature of music,
and the social and environmental context when designing
and interpreting music therapy research—and, in this case,
neuroscience-informed music therapy research. To do other-
wise would lessen the ecological and sociological validity of
the work, and limit understanding of music therapy practice,
sentiments seemingly informed by principles of selfhood and
relationality. The emerging trends Hunt reviews are particu-
larly intriguing in this conversation, as they seem to integrate
humanistic components. For example, hyperscanning meth-
ods, during which imaging data is collected between two indi-
viduals simultaneously in order to explore neural synchrony
during shared experiences, may allow for the exploration of
the client-therapist exchanges when interacting musically,
as well as allowing for the investigation of a broader range
from music experiences, including improvisation and live
music-making. These types of advancements in neuroscience
research reflect the importance of understanding human inter-
actions (relationality).
Although a non-exhaustive review, these findings indicate
that the spirit of humanistic principles seems at least implied
in music therapy publications grounded in a neuroscience
148
approach. Of particular note is when these principles seem
to appear more frequently—through case example descrip-
tions. In other words, when authors such as Nagler (as cited
in Tomaino, 1998), Tomaino (1998), and O’Kelly (2016) share
clinical vignettes, their descriptions of clients and the inter-
actions they have with their clients demonstrate an implicit
embodiment of humanistic principles, especially relationality.
The concept of relationality is further emphasized through the
acknowledgment many authors make as to the importance of
the client-therapist relationship, as well as the engagement
and interactions that occur through shared musical experi-
ences. Finally, many of the music interventions outlined incor-
porate elements of agency, in particular through incorporating
client musical preference and choice, as well as aestheticality,
through offering clients a meaningful way to musically engage.
A Proposed Integration of Humanistic Principles in a
Neuroscience Music Therapy Approach
The overall aim of music therapy seems similar regardless of
whether the music therapist approaches their work from a pri-
marily humanistic or neuroscientific lens; that is, for the client
to achieve an improved state of health and wellness. However,
a difference lies in the way this aim is conceptualized, with
neuroscience focused largely on improving or strengthening
an identified deficit resulting from a neurological difference or
insult, and humanism through a belief that we have an innate
ability to conceive and realize our own health. Stated differ-
ently, through a neuroscience perspective the music therapist
is working to help the client develop skills that will allow them
to have choice, responsibility, and be able to seek meaning in
their lives, whereas for the humanistic music therapist these
abilities of choice, responsibility, and meaning-seeking are
innate and ever-existing.
Despite this fundamental difference, there is arguably
enough commonality between these two approaches—not
only in overall purpose of therapy, but also in realizing the
extent to which humanistic principles are implied in current
neuroscience-informed music therapy publications—to war-
rant exploring how they can be further integrated. We recog-
nize that though there is much to gain from understanding how
music engagement can change the brain and from utilizing
this knowledge to drive the intentional application of music
interventions, there are limitations. More specifically, the neu-
roscience approach is limited by current knowledge and tech-
nology available in studying the brain (outlined in detail by
O’Kelly, 2016), as well as by the inherent reductionistic sys-
tem. Neither of these can fully capture or explain all aspects
of human functioning or musical engagement, characteristics
that seem of particular relevance to humanistic principles.
Thus, here we propose ways in which a neuroscience-informed
music therapy approach may be enhanced through a more
intentional embedding of humanistic principles.
The Process of Assessment and Establishing Goals and
Objectives
In the neuroscience-informed approach, the music therapy
assessment is a formalized effort to identify specific func-
tional deficits a client exhibits through the use of standard-
ized assessments, when possible. This type of system makes
sense when considering the origins of the approach, which
Music Therapy Perspectives (2018), Vol. 36
primarily grew out of neurorehabilitation. This area of practice
aims to strengthen losses incurred as the result of a neurologi-
cal insult or disorder such as a cerebral vascular accident or
Parkinson’s disease. Though a neuroscience perspective has
been proposed about work with clinical populations who do
not have an acquired neurological injury (e.g., autism spec-
trum disorder), the process of utilizing a more formal assess-
ment as a way to identify functional skills to target in therapy
remains the same.
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The assessment process culminates in the establishment
of treatment goals and objectives, which in the neuroscience
approach are non-musical and focused on functional skills.
Here, goals and objectives targeted in music therapy are often
the same goals and objectives being targeted in other thera-
pies, including physical therapy, occupational therapy, and
speech therapy. Unified goals across therapies ensures that the
interprofessional team is working together to support the same
goals from different angles, in order to better facilitate treat-
ment outcomes (M. Thaut, 2014). Goals are therefore focused
on measuring progress toward functional outcomes with the
intent of helping the individual gain or regain skills. However,
treatment goal selection and writing measurable goals is a task
completed by the music therapist.
Here we propose that music therapists who approach their
work through a neuroscientific lens consider more closely the
humanistic principle of agency, particularly in terms of incor-
porating the client’s voice throughout these processes. Do we
consistently ask the client about themselves? Seek their input
on their own strengths and deficit areas? Perhaps because
neuroscience is grounded in medicine, a field in which the
medical professional is considered the “expert,” the neurosci-
ence-informed music therapist may be viewed (and may view
themselves) as the expert in the clinical space. As outlined in
current writings, it is the music therapist who conducts the
assessment and identifies the deficits exhibited by the client.
In a similar fashion, the music therapist practicing from the
neuroscience approach could make an intentional effort to
ensure that the client’s personal goals are central to the pro-
cess of determining treatment goals as well. Although these
goals may vary from their stated team treatment plan, pro-
viding an avenue for autonomy may strengthen the client’s
resolve across all therapies. For example, the treatment team
may identify that an individual with Parkinson’s has been los-
ing vocal volume, making them difficult to hear. The client’s
goal may be to increase vocal volume in order to be heard
by their grandchild via Skype. The information about the cli-
ent’s goal helps provide context, outline a direction in the
therapeutic approach, and may also help the therapist iden-
tify supports to help meet the goal. This may include utilizing
music-based techniques to increase vocal volume, as well as
downloading a decibel meter on the client’s iPhone so they
can visually see when they are within an audible speaking
range. Furthermore, the music therapist may put together a
DVD of vocal exercises the client can complete prior to call-
ing their grandchild on Skype. In this way, consideration of
not just the therapeutic outcome (i.e., sustaining speech at a
certain decibel level), but its functional use as identified by
the client, may help bridge any gap between gains made in
therapy and those made for real-world application. This may
also help the therapist better identify what the client and their
Parallels and Divergence Between Neuroscience and Humanism
support system view as the most important part of their devel-
opment or recovery, decreasing the potential for the therapist
to impose their bias via their authority.
This incorporation of agency can be applied across several
clinical scenarios. For example, clients across the age spec-
trum can have a voice in identifying their personal therapy
goals. Music therapists who work in pediatric rehabilitation
may consider asking their clients, even as children, what skill
or set of skills they want to improve upon. In addition, ther-
apeutic progress is influenced by the support of the client’s
immediate social network, which is most often the family unit.
Thus, it may behoove the music therapist to inquire about the
family dynamics and family relationship as part of the assess-
ment process. Here it could be considered an incorporation of
the voice of the entire family—the family’s agency. Although
incorporating the voice of the family and/or asking children
about their goals may not be a strict interpretation of human-
istic principles, it seems to follow in their spirit. Thus, though
it could be that in practice the neuroscience-informed music
therapy clinician inherently incorporates this humanistic ele-
ment to the assessment process, it may not be as intentionally
done as it is in the humanistic tradition. There is potential,
then, for improvement by allowing the client a voice in deter-
mining what they want to strengthen or improve in order to
actualize their concept of their own health and wellness.
Regarding treatment goals and objectives specifically, the
neuroscience-informed music therapist may also examine
the inclusion of musical goals. Although not a novel concept
in other approaches to music therapy practice (e.g., music-
centered music therapy; Aigen, 2005), it is novel to the neu-
roscience approach, where a musical skill is often considered
in terms of the non-musical skills required. For example, if an
individual recovering from stroke who had difficulties with fine
motor control were to request learning how to play the piano as
a leisure skill, the music therapist in the neuroscience approach
would likely construct a goal focused on improving fine motor
control of the affected hand. Although a goal written for motor
outcomes could be addressed via piano playing, this discounts
the client’s request and imposes the therapist’s ideas of how
music may help with motor dysfunction. Writing the goal in
terms of the client’s personal goal (to establish musical skills)
would allow for self-actualization and autonomy, with a sec-
ondary outcome of a meaningful way to work on motor control.
Another consideration regarding musical goals is that
musical skills are a typical part of development. Music and
neuroscience literature have long shown an overlap in the
neural processing of music and non-musical skills, such as
in the brain regions implicated in speech production and
language development (Knight & Rabon, 2017; Patel, 2011).
Researchers have also demonstrated that experience in music
can impact cognitive skills (Sachs, Kaplan, Der Sarkissian, &
Habibi, 2017), language skills (Flaugnacco et al., 2015), and
social skills (Trainor & Cirelli, 2015). Therefore, supporting
music development is supporting child development. One
concern could be that other professionals may not view music
therapy as essential if goals are based in music; however, from
the humanistic perspective the view of the other professionals
should not be put above the expressed needs and desires of
the individual. Furthermore, one could argue that inclusion
of musical goals provides a space for music therapy to be dif-
ferentiated from other disciplines in how music is supporting
149
the individual, an idea expressed by others as well (Abrams,
2011; Aigen, 2005). Although the physical therapist may help
with fine motor control, they would not have the training or
knowledge to design a piano program of preferred music that
is attainable given motor restrictions. Thus, the music therapist
has a unique knowledge of music that can yield different goals
and objectives to meet clients’ musical needs.
The Therapeutic Process in Music Therapy
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The therapeutic process in a neuroscience-informed
approach includes the use of music-based protocols and tech-
niques to address non-musical client goals (M. Thaut, 2014)
in order to be reintegrated into their premorbid lifestyle and
community (Baker, 2011). This approach is heavily based on
using therapeutic techniques to habilitate or rehabilitate skills
that are dysfunctional or underdeveloped due to disease or
disability. Techniques are selected based on available research
and the likelihood of therapeutic outcomes. For example, a cli-
ent demonstrating expressive aphasia may be offered Melodic
Intonation Therapy as a possible treatment technique for elicit-
ing verbal communication (Baker, 2011; M. Thaut, 2014). From
a humanistic approach this could be seen as authoritarian, with
the music therapist deciding on a treatment technique based
on the client’s presenting disease and disability, thus removing
the client’s agency. However, as discussed previously in this
paper, writings from the neuroscience perspective clearly con-
sider the person in this process, though not written as a primary
consideration in the development of a treatment plan.
Baker’s (2011) case study of music therapy for neuroreha-
bilitation provides an example of the therapeutic process in the
neuroscience approach. Baker worked with a woman who sus-
tained a brain injury and employed singing to help the woman
with expressive communication deficits. Baker recommended
this approach due to the treatment team’s observation that the
client could sing words to popular songs despite difficulties in
producing speech, even after four weeks of speech therapy. The
purpose of this singing-based intervention was to provide the
client an opportunity to be successful while strengthening her
speech skills. This focus on providing an opportunity for client
success speaks to supporting selfhood, whereas slow progress
in a rehabilitation program could negatively impact selfhood.
The music therapist, using their experience and extensive
knowledge of music, may therefore select interventions or pro-
tocols for the client with the goal of strengthening selfhood.
One concern from a humanistic perspective may be that
seemingly prescribed music protocols reduce the human con-
nection necessary for a therapeutic relationship. The word proto-
col is defined by Merriam-Webster (n.d.) as “a detailed plan of a
scientific or medical experiment, treatment, or procedure”. This
“detailed plan” is often carried out in a similar fashion with each
implementation in order to facilitate predictable outcomes. For
example, the music therapist may begin by referencing a basic
gait training protocol with an external stimulus, following the
protocol steps outlined by a text or training manual. The music
therapist might incorporate an isolated musical element, such as
rhythm, in the protocol to facilitate the outcome. Here, although
the protocol’s steps guide the interaction, it is adaptable. The
music therapist could use additional musical cueing to better
facilitate the gait cycle (e.g., dynamic cues), may add a client-
preferred song within the protocol to help with motivation, or
may walk backward facing the client to provide a visual target
150
and feedback. Also essential is the therapeutic interaction within
the facilitation of the protocol. The clinician communicates with
the client throughout the process, assessing their current state,
explaining the exercise, checking with the client as they engage,
and reflecting on the experience. All of these points provide an
opportunity to build a connection with the client (relationality),
while honoring the client’s selfhood and agency.
Just as there are some overlaps in the therapeutic pro-
cess between the neuroscience-informed and humanistic
approaches, there are clear (and fundamental) differences as
well. In the neuroscience approach the music therapist may be
concerned with offering the client research-based protocols to
improve specific outcomes. There is a clear tie here between
the protocol and the intended outcome. However, according to
Abrams (2015), in the humanistic perspective the musical inter-
action and therapeutic relationship are central to the therapeutic
process and outcomes are experienced through expression of
musical potential. In this way musical and therapeutic inter-
action supports ways of being in order to promote self-actualiza-
tion. Although specified techniques may be used in humanistic
music therapy, they are not used to invoke predetermined out-
comes that may be predicted based on presenting disease or
disability. Rather, techniques or interventions are understood as
opportunities for the client to self-actualize though their own
agency. Further, from the humanistic perspective techniques are
not used to gain isolated outcomes; rather, they are considered
in the larger context of being (Abrams, 2015).
These points from humanism are worthy of consideration for
the music therapist practicing from a neuroscience-informed
approach. For example, clinicians could make a conscientious
effort to consider how music therapy techniques or protocols
may best support the client in actualizing their agency. In other
words, rather than considering treatment as a cause-and-effect
relationship, consider how music therapy helps the client miti-
gate their social and/or environmental contexts in an effort
toward self-actualization (Abrams, 2015). This more holistic
and humanistic consideration of the client may help advance
the use of specific techniques as the status quo into the use of
techniques to make an individualized, lasting difference. For
example, working with a child on the autism spectrum who
lacks verbal communication and social interaction may lead
the neuroscience-informed music therapist to use rhythm and
structure to facilitate specific speech utterances within a scripted
social interaction. Although the client may increase speech
production, they may lack agency and flexibility within these
interactions, which could lead them to only use the practiced
speech in this specific interaction. Looking at the client from
a humanistic lens may lead a music therapist to focus more
on their relationship and engagement in the music experience,
where speech production may be a secondary outcome derived
from the client’s agency in the interaction itself as opposed to
the result of instruction. A hybrid of these two approaches may
provide a platform for learning that supports self-actualization,
where the music therapist utilizes music experiences to support
the client’s goal areas, but allows them to naturally explore their
skills in a flexible and supportive environment.
The Role of Music
In the neuroscience perspective, music functions as the
working mechanism that drives neural activation and, by
extension, therapeutic outcomes. This approach is based on an
Music Therapy Perspectives (2018), Vol. 36
understanding of the neurological impact of music perception
and production and how to translate this understanding toward
developing music interventions designed to target functional
goals. In this way, the historical understanding of the role of
music in the neuroscience-informed approach is largely reduc-
tionistic. This approach to understanding music perception and
production can be beneficial, particularly in developing con-
sistently effective clinical protocols. However, there is also a
potential to shift into a more informed practice built on the
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commonalities between neuroscience and humanism.
One such commonality involves a focus on aesthetics. The
neuroscience-informed music therapy writings clearly address
the importance of aesthetics in clinical practice, a view that
seems shared with the humanistic perspective. However, much
like there is a conceptual difference in the neuroscientific and
humanistic understanding of entrainment, there seems to be a
similar difference in the conceptualization of aesthetics. For
example, Thaut and Hoemberg (2014) emphasize that music
experiences and how they are facilitated should themselves
adhere to aesthetic principles, and that the music therapist
is responsible for shaping an experience that allows for aes-
thetic meaning. In addition, several authors from the neurosci-
ence tradition speak to the importance of incorporating client
musical preference during music therapy treatment (e.g.,
Baker & Tamplin, 2006). This seems in contrast to the human-
istic concept of aestheticality, which is grounded more in the
innate human quality to seek meaning through beauty and
balance. As with other similarities and differences outlined
thus far, the neuroscience perspective focuses more on the
music-therapist-as-expert facilitating an experience that fol-
lows established aesthetic principles, whereas the humanistic
perspective focuses more on the innate ability and motivation
of clients to engage in a creative, meaningful experience.
Where, then, might the neuroscience-informed music ther-
apist do better? One way is through the recognition of the
value of facilitating music experiences that are engaging for
the client, as opposed to simply focusing on the role of music
as a working mechanism. This focus on engagement through
music can integrate several potential humanistic principles.
For example, if a client is musically engaged with the therap-
ist, by extension that means the client is aware of others and
of their existence in the world (relationality). Perhaps there is a
way to still hold a focus on improving functional goals while
providing clients with these opportunities to connect and
interact with those around them through musical engagement.
Another avenue through which the neuroscience-informed
music therapist can promote musically engaging experiences for
clients is through allowing client choice (agency) in determining
the musical experience to have and the style in which they occur
(i.e., through musical preference). Through having a voice in their
own music therapy experience, there is potential for the client
to be more engaged in their own therapeutic change. The music
therapist is then charged with developing a therapeutic experience
that intentionally embeds the client’s input. Thus, the possibility
exists to add the client’s voice by incorporating their preference
without sacrificing the working mechanism of the music.
Finally, it is worth noting that this focus on valuing client
engagement in the music therapy experience has a connec-
tion to our understanding of the neuroscience of engagement.
Clinically, though clients can be intrinsically motivated to
engage in treatment (e.g., adults in rehabilitation, as described
Parallels and Divergence Between Neuroscience and Humanism
by Baker and Tamplin, 2006), they may also require extrinsic
motivation to participate. This is in part where music therapy
can be of value, as engagement in a music experience may serve
as an extrinsic way to stimulate (motivate) a client to participate
in a therapeutic task. Here the neurotransmitter dopamine is
implicated as a link between musically facilitated engagement
and therapeutic change. Dopamine not only underlies motiva-
tion and reward-seeking behaviors (e.g., through engaging in
music), but it is also involved in driving neuroplasticity, the neu-
ral mechanism of therapeutic change (Stegemöller, 2014).
Conclusions
On the surface it may seem as though the neuroscience-
informed and humanistic approaches are vastly different.
However, on closer inspection there are similarities, primar-
ily in descriptions of clinical interactions in publications
grounded in a neuroscience approach, where the spirit of
humanistic principles seems at least implied. That said, there
is room for improvement. Here we propose areas in which
the neuroscience-informed music therapy approach may be
enhanced through a more intentional embedding of human-
istic principles, particularly the concepts of agency, selfhood,
relationality, and aestheticality. Allowing for the consideration
of the human and human elements in this way may serve to
enhance client outcomes by providing space for client auton-
omy and input as they realize their own health and wellness.
References
Abrams, B. (2011). Understanding music as a temporal-aesthetic way of being:
Implications for a general theory of music therapy. The Arts in Psychotherapy,
38, 114–119. doi:10.1016/j.aip.2011.02.001
Abrams, B. (2015). Humanistic approaches. In B. L. Wheeler (Ed.), Music therapy
handbook (pp. 148–160). New York: Guilford Press.
Aigen, K. (2005). Music-centered music therapy. Gilsum, NH: Barcelona.
American Psychiatric Association. (2013). Diagnostic and statistical manual of men-
tal disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Baker, F. (2011). Facilitating neurological reorganization through music therapy: A
case example of modified melodic intonation therapy in the treatment of a per-
son with aphasia. In T. Meadows (Ed.), Developments in music therapy practice:
Case study perspectives (pp. 280–296). Gilsum, NH: Barcelona Publishers.
Baker, F., & Tamplin, J. (2006). Music therapy methods in neurorehabilitation: A clini-
cian’s manual. London: Jessica Kingsley Publishers.
de l’Etoile, S. K. (2014). Associative mood and memory training (AMMT). In M.
H. Thaut & V. Hoemberg (Eds.), Handbook of neurologic music therapy (pp.
314–330). New York: Oxford University Press.
Dileo, C., & Bradt, J. (1999). Entrainment, resonance, and pain-related suffer-
ing. In C. Dileo (Ed.), Music therapy and medicine: Theoretical and clini-
cal applications (pp. 181–188). Silver Springs, MD: American Music Therapy
Association.
Dimaio, L. (2010). Music therapy entrainment: A humanistic music therapist’s per-
spective of using music therapy entrainment with hospice clients experiencing
pain, Music Therapy Perspectives, 28, 106–115. doi:10.1093/mtp/28.2.106
Flaugnacco, E., Lopez, L., Terribili, C., Montico, M., Zoia, S., & Schön, D. (2015).
Music training increases phonological awareness and reading skills in devel-
opmental dyslexia: A  randomized control trial. PLOS One, 10, e0138715.
doi:10.1371/journal.pone.0138715
Geist, K., & Geist, E. A. (2012). Bridging music neuroscience evidence to music
therapy best practice in the early childhood classroom: Implications for using
rhythm to increase attention and learning. Music Therapy Perspectives, 30,
141–144. doi:10.1093/mtp/30.2.141
Hardy, M. W., & Lagasse, A. B. (2013). Rhythm, movement, and autism: Using
rhythmic rehabilitation research as a model for autism. Frontiers in Integrative
Neuroscience, 7, 19. doi:10.3389/fnint.2013.00019
151
Hunt, A. M. (2015). Boundaries and potentials of traditional and alternative neu-
roscience research methods in music therapy research. Frontiers in Human
Neuroscience, 9, 342. doi:10.3389/fnhum.2015.00342
Hunt, A. M., & Legge, A. W. (2015). Neurological research on music therapy for
mental health: A  summary of imaging and research methods. Music Therapy
Perspectives, 33, 142–161. doi:10.1093/mtp/miv024
Johnson, S. B. (2014). Therapeutic singing (TS). In M. H. Thaut & V. Hoemberg,
(Eds.), Handbook of neurologic music therapy (pp. 185–195). New York: Oxford
University Press.
Knight, A. K., & Rabon, P. (2017). Music for speech and language development
in early childhood populations. Music Therapy Perspectives, 35, 124–130.
Downloaded from https://academic.oup.com/mtp/article/36/2/144/5039159 by University of Melbourne user on 08 December 2021
doi:10.1093/mtp/mix014
LaGasse, A. B., Hardy, M., Anderson, J., & Rabon, P. (2018). Rhythm and movement
for autism spectrum disorder: A neurodevelopmental perspective. In E. Torres
& C. Whyatt (Eds.), Autism: The movement sensing perspective (pp. 229–242).
Boca Raton, FL: Taylor & Francis.
LaGasse, A. B., & Thaut, M. H. (2013). The neurobiological foundation of neurologic
music therapy. Music and Medicine, 5, 228–233. doi:10.1177/1943862113502547
Lichtensztejn, M., Macchi, P., & Lischinsky, A. (2014). Music therapy and disorders
of consciousness: Providing clinical data for differential diagnosis between veg-
etative state and minimally conscious state from music-centered music ther-
apy and neuroscience perspectives. Music Therapy Perspectives, 32, 47–55.
doi:10.1093/mtp/miu001
O’Kelly, J. (2016). Music therapy and neuroscience: Opportunities and chal-
lenges. Voices, 16. Retrieved from https://voices.no/index.php/voices/rt/
printerFriendly/872/720
O’Kelly, J., & Magee, W. L. (2013). Music therapy with disorders of consciousness
and neuroscience: The need for dialogue. Nordic Journal of Music Therapy, 22,
93–106. doi:10.1080/08098131.2012.709269
Patel, A. D. (2011). Why would musical training benefit the neural encoding of speech? The
OPERA hypothesis. Frontiers in Psychology, 2, 142. doi:10.3389/fpsyg.2011.00142
Protocol. (n.d.) In Merriam-Webster’s collegiate dictionary. Retrieved from https://
www.merriam-webster.com/dictionary/protocol
Sachs, M., Kaplan, J., Der Sarkissian, A., & Habibi, A. (2017). Increased engagement of
the cognitive control network associated with music training in children during an
fMRI Stroop task. PLOS One, 12, e0187254. doi:10.1371/journal.pone.0187254
Sena Moore, K. (2013). A systematic review on the neural effects of music on
emotion regulation: Implications for music therapy practice. Journal of Music
Therapy, 50, 198–242. doi:10.1093/jmt/50.3.198
Stegemöller, E. L. (2014). Exploring a neuroplasticity model of music therapy. Journal
of Music Therapy, 51, 211–227. doi:10.1093/jmt/thu023
Stegemöller, E. L. (2017). The neuroscience of speech and language. Music Therapy
Perspectives, 35, 107–112. doi:10.1093/mtp/mix007
Thaut, C. (2014). Symbolic communication training through music (SYCOM). In M.
H. Thaut, & V. Hoemberg, (Eds.), Handbook of neurologic music therapy (pp.
217–220). New York: Oxford University Press.
Thaut, M., & Hoemberg, V. (Eds.) (2014). Handbook of neurologic music therapy.
New York: Oxford University Press.
Thaut, M. H. (2013). Entrainment and the motor system. Music Therapy Perspectives,
31, 31–34. doi:10.1093/mtp/31.1.31
Thaut, M. H. (2014). Assessment and the transformational design model. In M. H.
Thaut & V. Hoemberg, (Eds.), Handbook of neurologic music therapy (pp. 60–
68). New York: Oxford University Press.
Thaut, M. H., McIntosh, G. C., & Hoemberg, V. (2014). Neurologic music therapy: From
social science to neuroscience. In M. H. Thaut, V. Hoemberg (Eds.), Handbook of
neurologic music therapy (pp. 1–6). New York: Oxford University Press.
Tomaino, C. M. (1998). Clinical applications of music in neurologic rehabilitation. St.
Louis, MO: MMB Music.
Tomaino, C. M. (2015). Music therapy and the brain. In B. L. Wheeler (Ed.), Music
therapy handbook (pp. 40–50). New York: Guilford Press.
Torres, E. B., Brincker, M., Isenhower, R. W., Yanovich, P., Stigler, K. A., Nurnberger,
J. I.,…Jose, J. V. (2013). Autism: The micro-movement perspective. Frontiers in
Integrative Neuroscience, 7, 32. doi:10.3389/fnint.2013.00032
Trainor, L. J., & Cirelli, L. (2015). Rhythm and interpersonal synchrony in early social
development. Annals of the New York Academy of Sciences, 1337, 45–52.
doi:10.1111/nyas.12649
Wheeler, B. (2014). Music in psychosocial training and counseling (MPC). In M.
H. Thaut & V. Hoemberg, (Eds.), Handbook of neurologic music therapy (pp.
331–360). New York: Oxford University Press.