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Other Re-creative Methods 57
Elefant et al. (2012) explored the use of group music therapy sessions that
included singing with Parkinson’s patients. They found that the majority of
patients who participated in the 60-minute group music therapy sessions each
week for a period of 20 weeks experienced significant improvement in singing
quality and voice range and demonstrated an absence of any decline in the
quality of their speech. This indicates that they were able to help patients to not
only maintain their quality of speech, but also avoid any loss over this 20-week
time frame as well.
Loewy (2015) reported that providing parents with training and support in
identifying their song of kin and assisting them in singing that song to their infant
facilitated their expression of hope and instilled a sense of safety and security.
Song of kin is a song that is culturally based, parent-selected, and personalized.
All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.
It can become a resource that can be utilized at home following discharge from
the hospital, supporting the infant’s growth and transitional moments.
The research on the re-creative method variation of singing indicates wide
applicability for a variety of patient needs. While the body of research on re-
creative method variations is largely limited to one particular variation, this is not
representative of the use of the other variations in clinical practice. It is also
important to recognize that in music therapy research, multiple method variations
may be incorporated into a music therapy session, resulting in research that is
not isolating the use of method variations. There are case studies that provide a
more in-depth perspective regarding the use of re-creative methods. These cases
have been cited in the benefits of re-creative method variations and are further
illustrated in the additional case examples that follow.
Supplemental Cases
Case examples are included in this section to illustrate more variations of the re-
creative method. These cases come directly from each music therapist’s clinical
practice. You will discover in each case how a re-creative method variation was
implemented and, in some of the cases, how the use of a re-creative method
variation led to the use of another method. This illustrates the fluid process of
therapy and how different method variations can be utilized to address the
emerging needs of clients.
Case A5 – Familiar Song for the Development of

Attachment in a Hospitalized Newborn
Helen Shoemark, PhD, RMT
Copyright 2018. Barcelona Publishers.
Tadisha sat quietly by Deon’s tiny bed, thinking about the three weeks she’d
watched him struggle into life. He was now down to just nasal continuous
positive air pressure (CPAP) to help him get enough oxygen. She loved the
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58 Introduction to Music Therapy Practice
moment when the nurse would get his feed ready to put down the tube and
he’d flutter his eyes open, as if he were hungry for it. Tadisha would tuck her
finger into his hand and whisper, “I love you, Bubba, Mommy is here.”
When the music therapist (Fiona) introduced herself, Tadisha was curious
but worried. Surely, she didn’t expect Tadisha to sing to Deon in front of the
nurses? But Fiona just asked Tadisha about her own experiences of music and
singing in her family. Tadisha remembered that her own mom would sing to
her and her brother in the car and in bed at night. Fiona explained how
Tadisha’s voice was an important experience that Deon was waiting for, and
that it would give him a chance to really know that his mom was there loving
him. She said that talking was enough, but that singing was also great
because you could repeat it over and over. They decided together on singing
a song that Tadisha’s mom had sung every night. Fiona knew that she could
help Tadisha to find her voice for Deon, but even better, she knew that if she
could connect Tadisha to the memory of her own mom’s singing, then it would
help her to reconnect to singing as a safe place. Fiona expected that Tadisha
might be nervous about letting her voice out, so she suggested that Tadisha
hum for a little bit to warm up her voice. Fiona put down the railing on Deon’s
bed and suggested that Tadisha put her finger in as she’d done before. Fiona
stood really close to but just behind Tadisha, and as they both started to hum,
she carefully watched Tadisha and Deon. Deon’s eyes fluttered open, and
Tadisha smiled and began to sing while Fiona kept humming very quietly.
Deon looked toward his mom, his eyebrows up and then relaxing. As they
repeated the verse, Deon gently drifted back to sleep. When they finished the
song, Fiona knew that Tadisha was gently crying, so she leaned in and asked,
“You okay?” Tadisha smiled, and knowing it was true, said, “Somehow, now I
really feel like his mom.”
Fiona had seen it many times before. She knew that while she easily could
have sung to Deon herself, supporting Tadisha to use her own voice to sing to
Deon returned the pivotal role of nurturer to Tadisha. In the hospital,
experiences for attachment may need to be constructed rather than occurring
naturally. Deon’s response to Tadisha’s voice would create an experience of each
other which is fundamental to the creation of attachment. By establishing
Tadisha as the provider of music, Fiona ensured that Deon would have access
to attuned interaction many times a day rather than just when she could be at
the bedside. This meant that in addition to building attachment, Deon would
have experiences necessary for his neurodevelopment. Fiona would continue
to work with Tadisha and Deon until Tadisha felt totally at ease in reading Deon’s
cues and comfortable with a range of singing for settling and play times.
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Case A6 – Re-creative Music in Memory Care

Elisabeth Swanson, MMT, MT-BC
Barbara, diagnosed with dementia, has been a resident on a memory care unit
for six and a half years. She is 95 years old and has poor mobility and trunk
support and severe kyphosis and spends most of her day in her reclining
wheelchair. Her short-term memory is poor, but she seems to have some intact
long-term memory. She was a schoolteacher for many years and can still be
observed yelling “You kids be quiet!” or “Stop that right now!” in response to
noise on the unit. She is frequently agitated and may display anger, swatting, or
scolding behaviors, as if she were still managing active children in a classroom.
More recently, she can be heard chanting, “Daddy, Daddy” in a rhythmic chant,
often quite loudly. For Barbara, familiar music can be helpful in engaging her with
others and decreasing her agitation.
Clients like Barbara, who are diagnosed with dementia and unable to use
language purposefully to communicate, are often still able to sing along with
familiar songs. Songs that were popular during their late teens and early 20s are
typically the songs that a client like Barbara can recognize and access most easily
from memory. Barbara can be easily redirected from agitated chanting to singing
familiar hymns or folk or patriotic songs, starting with a rhythmic pattern similar
to her chant. She knows multiple verses to many songs. Recently, she engaged
with the music therapist in singing “Glory, glory, hallelujah!” from the chorus of
the “Battle Hymn of the Republic.” Together they sang several verses followed by
this chorus. By the end of the song, Barbara was content, much calmer, and
smiling at the music therapist.
In the process of using these familiar songs with Barbara, the music
therapist watches for signs of recognition and connection with the music. These
include Barbara singing along, looking up at the music therapist, smiling, and
humming. The music therapist reproduces familiar music as closely as possible
to the client’s experience of the song, using familiar instruments/timbre,
harmonization, motifs, tempo, and style. This is an effective way to tap into client
memories of the music and elicit a greater response. Re-creating the music in
sessions allows the music therapist to emphasize aspects in the music that may
be familiar to the client and adjust tempos to allow the client to participate. The
music therapist can also leave pauses or breaks to prompt the client to fill in
information, such as at the end of a familiar phrase.
Familiar songs help to engage Barbara for longer periods of time, sustaining
her attention throughout the song. Her favorite songs encourage her to make and
hold eye contact with the therapist, as well as to engage her in singing along with
these songs. For clients like Barbara who are diagnosed with dementia,
understanding their unique music preferences allows the music therapist to select
and utilize music that is meaningful. Re-creating music can draw on past
experiences with this music and engage the client, while providing structure for
interpersonal connections. The music therapist must be flexible and responsive
to clients in the moment and be prepared to change levels of stimulation or song
choices to support a client’s engagement and participation.
Case A7 – Performing for Family in a

Mental Health Group Home
Nancy Jackson, PhD, MT-BC
For people who have chronic mental illness (CMI), group homes can provide a
safe, supervised living situation that allows as much freedom as possible.
Residents in this particular group home have lived together for some time, a good
number of them for years. They are a cohesive group, but because of the
symptoms of their CMI they do not always spontaneously interact with one
another as you might expect a family or a group of friends to do. The impact of
the medications that some of them take also contributes to the inability to make
meaningful social interactions throughout the day and leaves them drowsy and
with flat affect.
The music therapy student and I have a weekly group with the residents
with the objective of increasing their emotional expressiveness and their
spontaneous social interactions with one another. We engage the group in
singing, dancing, improvising on instruments, and receptive experiences that
incorporate other creative arts, like drawing and poetry. Each fall, the group starts
preparing for a large holiday party at the house, to which their family and friends
are invited. It is a real celebration for the residents, as they have the opportunity
to show off all of the wonderful things about their home. Music therapy assists
with this by preparing the residents to give a short musical performance as a gift
for their guests.
While the preparation for this performance might normally be just another
activity, we engage the residents in the decision-making for everything related to
the performance, as well as in the process of preparing the songs. Within that
process, they must make decisions about what songs they will learn, how they
want to perform those songs, if they want to have props, and so on. This provides
an opportunity to address treatment objectives related to self-expression and
social interaction. Additionally, it is an empowering process in which the residents
can experience using their own resources and skills to provide enjoyment for
others. This helps to build feelings of self-efficacy and self-esteem, as well as build
a true sense of community as they plan, prepare, and perform together.
This year, the residents decided that they would like to perform “Up on the
Housetop,” “Silent Night,” and “We Wish You a Merry Christmas.” These
selections were chosen by a process of elimination. The residents first made a
full list of songs that each of them especially liked. Then, together, they started
eliminating the songs that might be too difficult and those that not enough of
the group liked. When they were down to a short list, the group voted on the
final three selections.
As the group began practicing the songs, they made decisions about how
to embellish their performance. They added costumes to “Up on the Housetop”
(reindeer antler headbands and winter scarves) and instruments to the other two
songs. One resident plays the guitar, and the group decided that he should
accompany them on “Silent Night.” They also wanted to add choir chimes to
“Silent Night,” so the music therapy student prepared an adaptive notation chart
that enabled the group to play an additional chime accompaniment. They chose
to add jingle bells to “We Wish You a Merry Christmas.” Rehearsing had its
challenges because individuals in the group sometimes have days during which
their CMI symptoms become worse, and this can disrupt the session. But those
are also the days when the group can practice tolerance of and respect for one
another because they all understand the difficulty of living with CMI.
Finally, the performance day arrived, and the group was so excited to be
performing for their guests. Having their friends and loved ones as audience
members led to expressiveness that this group usually doesn’t exhibit. They were
smiling and chatting with the guests and with one another. During the
performance, they sang out like they rarely do and recovered quickly from little
errors. The gestures that they had added at the last minute to “We Wish You a
Merry Christmas” became high drama, drawing laughs and applause from their
audience. There were some tears in the audience from family members, who
seldom get to see the residents being so interactive and having such fun. The
pride of the group was evident on their faces, and afterward they enjoyed the
party with their guests as though they hadn’t a care in the world.
Case A8 – Re-creative Music Therapy with a

Young Adult with Cerebral Palsy
Peggy Farlow, MAE, MT-BC
Casey was a 20-year-old male with cerebral palsy (CP) who had recently
graduated from high school when he first began receiving music therapy
services. His CP affected him from the waist up, but his entire body was involved.
He had no functional use of his hands and arms and used his feet for all tasks. In
addition to CP, Casey had a vision impairment and needed to use large-print
material whenever possible. Casey also had bilateral hearing loss and wore
hearing aids in both ears. Casey was able to read lips and use the SEE Method
for communication. He was able to speak, but his speech was very difficult to
understand, so he also used a communication devise called a Lightwriter to
communicate with others. He was able to type on a computer using an enlarged
keyboard on the floor, which enabled him to communicate and connect with
friends. Casey had a cheerful personality and was able to learn and remember
new skills without difficulty.
Casey was referred for music therapy services by his Medicaid waiver case
manager. Motor skills and communication were identified on Casey’s Individual
Service Plan (ISP) as possible target areas for music therapy. During the
assessment sessions, the music therapist introduced Casey to the electric piano
keyboard. The keyboard was placed on the floor, and Casey was shown how to
use his feet to turn it on, use the voice and chordal rhythm style settings, and
play the white and black keys. After some experimentation, the best position for
the keyboard was found to be with the back of the keyboard slightly elevated so
that the keyboard was angled with the keys down toward the floor. Due to his
hearing impairment, Casey and the music therapist learned how to communicate
with each other by having the music therapist use gestures and physical touch
and Casey use his Lightwriter or the SEE method to spell his thoughts to music
therapist on the floor with the big toe of his right foot. Casey was able to play a
one-note melody by using the big toe on his right foot and to change chords by
using the big toe on his left foot, with music therapist pointing to the keys. Casey
was motivated to learn how to use the functions on the keyboard and to learn to
play precomposed songs. In his music therapy sessions, Casey worked on his
motor skills by using the electric keyboard to improve his ability to use his toes
and feet independently and in coordination.
The song “Happy Feet” was introduced to Casey, and by following adapted
notation with enlarged print, he was able to play the melody of the song by using
his right foot and to change chords by using the chordal rhythm function with the
big toe of his left foot. He was able to play the entire piece (48 measures) slowly,
with assistance from the music therapist. While he was able to play the correct
notes, he was not able to play with a consistent beat or with accurate rhythm.
Several other songs were also introduced to Casey at this time, and he chose to
work on songs that had fewer measures with easier rhythms. Over the next year
and a half, Casey worked on learning to play several songs in order to perform
his first recital. Two years after starting music therapy, Casey performed the
following songs in his recital.
Over the next 10 years, the music therapist continued to reintroduce the
“Happy Feet” song to Casey. Each time it was reintroduced, Casey learned a little
more of the song and became a little more fluid with his rhythm. However, each
time, he ultimately decided to work on other songs for future recitals. Each new
song that Casey learned helped him to improve his ability to use his toes and feet
in an independent and coordinated manner, which allowed his music to become
more fluid. Here are the songs Casey played in other recitals:
Table 4.1 Songs Learned in Therapy Sessions
RECITAL DATE: SEPTEMBER 2010

SONG TITLE # of MEASURES HOW CASEY PLAYED THE SONGS
“Halloween Drum 8 (repeated) R foot played the melody line; L foot played a
Song” two-beat
rhythmic response after each melodic phrase
“Guantanamera” 28 R foot played the melody line; L foot, using a
chordal rhythm, changed chords following a four-
chord repeated pattern (using his big and little
toe)
“Joe Turner Blues” 12 R foot played the melody line; L foot, using a
chordal rhythm, changed one-note chords
Table 4.2 Recital Performances

SEPTEMBER 2011
“Banuwa” 24 R & L feet played a melody, with harmony
following the same rhythm in time to a rhythmic
beat
“Blue Danube” 33 R & L feet worked together to play a one-line
melody
SEPTEMBER 2013
Theme from 27 R & L foot worked together to play a one-line
Star Wars melody
SEPTEMBER 2014
“Riders on 30 R foot played the melody line; L foot, using a
the Storm” chordal rhythm, changed one-note chords
“Joy to the World” 20 PLAYED CHORUS BELLS: R & L feet worked
together to play a one-line melody
SEPTEMBER 2015
“Chopsticks” 36 (repeated) PLAYED CHORUS BELLS: R & L feet played
together to play two-part harmony. MT
accompanied on electric keyboard.
FEBRUARY 2017
Theme from Star 38 R foot played the melody line; L foot played a
Trek, the Motion one-note accompaniment following chord names
Picture
When the music therapist reintroduced “Happy Feet” to Casey in February

2017, he agreed to work on it to prepare it for the next recital. He continued to
work on this piece in music therapy sessions for the next year and was able to
perform it in the Music Therapy Client recital. This time, he was able to play
through the entire piece with a more consistent beat and more rhythmic accuracy.
Table 4.3 Casey’s Final Recital

FEBRUARY 2018
“Happy Feet” 48 R foot played the melody line; L foot played an
independent accompaniment line written in bass
clef
The music therapy intervention used with Casey was re-creative and
involved learning to play precomposed music. By utilizing his good memory
ability, good cognitive abilities, and interest in learning new skills, Casey was able
to learn to play the electric keyboard, which helped him to improve his ability to
use his toes and feet both independently and in coordination.
Case A9 – Re-creating Music with a Group of

Adults Who Are Visually Impaired
Paige Robbins Elwafi, MMT, MT-BC
The adult music group met for an hour every other week, at the end of the workday,
at a nonprofit agency. All group members but two had been blind from birth. Group
members ranged in age from 23 to 85 years old, and there were approximately six
to eight group members at each session. Most of the clients had very little
functional vision, if any. The group was co-led by two music therapists, one of
whom was blind. The primary goal was to re-create music together.
During group sessions, clients would share their preferred music and artists.
We would work together to choose several songs to learn. The music therapists
would then lead the group to re-create the music by collaborating and creating
their own arrangement of the song. Many group members specialized in an
instrument and several preferred singing. One group member played piano;
another, the snare drum and cymbal; two others, also percussion; and two others,
guitar. We re-created songs such as “Country Roads,” “Back Home Again,” and “I
Believe in Music.” As the group continued to make music together, my co-
therapist and I discovered more therapeutic opportunities, such as developing
and improving coping skills and fostering emotional expression. The structure of
the group provided the perfect opportunity to explore social interaction and
improve communication skills. While the initial goal of the group had been to
make music as a group, we were happy to take the opportunity to go a little

deeper with them.
The music therapists introduced songwriting to the group by playing a blues
progression on the guitar and brainstorming ideas for lyrics. Ideas emerged
organically with the group on the topic of challenges that they encountered in
the world because of their blindness. One of the music therapists played a blues
progression on guitar continuously to support the musical creativity, to create a
nonthreatening environment, and to encourage sharing within the group. In the
process of writing their song, group members talked about their struggles with
being blind and became more excited about the song. They shared many stories
throughout the lyric-writing process, stories that were both happy and sad. The
lyrics that they wrote encompassed many of their fears, losses, and attempts to
cope with the hardships of blindness. To facilitate the process, the co-therapists
wrote down the lyrics. The lyrics were repeated back to the group as we worked
together to finalize them. Each verse represented the ideas or personal hopes of
each one of the group members.
The group proudly presented “Blindness Is a Nuisance” at our annual music
recital. The safe space that was created by the music therapists and the music
allowed the clients to write a song of which they could be proud. It was a song to
which each of them had contributed in his or her own way, and it communicated
their experiences of how they have felt treated by society as people who are blind
and visually impaired. The song lyrics are included below:
“Blindness Is a Nuisance”
Verse One: Blindness is a nuisance, it’s such a pain to me. If it weren’t for
blindness, I know where I would be. I’d be drivin’ a big old truck right on
through your town. And if you act real nice, I’ll give you a ride around.
Chorus: Blindness is a nuisance: If you could only see all the things I’m thinkin’,
you’d think more of me.
Verse Two: Blindness is a nuisance, it’s such a pain to me. If it weren’t for
blindness, I know where I would be. I’d be flying a big jet plane high up in the
sky. But I take off with my pilot dog, don’t have to worry about my eyes.
Verse Three: Blindness is a nuisance, but I can see through my mind’s eye more
than you will ever know, looking through your eyes. If you wore a blindfold and
followed my cane around, then you’d know what it is like how to see with
sound.
Verse Four: Blindness is a nuisance, it’s hard to read my mail. Can’t easily go
where I want to go; everything’s not in Braille. I can read with my talking book
player, my scanner, a friend or my phone. Take a bus or a cab or go for a walk
with my dog and I’m never alone.
Verse Five: Blindness is a nuisance, I’ve dealt with it, you see. I’d like to help
you understand what it’s like to be me. I learn new things through touch and
hearing as I travel from place to place. I can learn about who you are and I
don’t need to see your face.
Chorus: Yes, blindness is a nuisance: If you could only see all the things I’m
thinkin’, you’d think more of me. Yes, blindness is a nuisance: If you could only
see all the things I’m thinkin’, you’d think more of me.
Case A10 – Re-creative Music Therapy in the

Midst of a Bone Marrow Transplant (BMT)
Debbie Bates, MMT, MT-BC
Martina is a 50-year-old woman with acute myeloid leukemia, admitted to the

blood and marrow transplant (BMT) unit to undergo an allogeneic hematopoietic
stem cell transplant. Her brother served as her blood and marrow donor. She is
married; she and her husband each have three adult children from previous
marriages, all of whom live within an hour of her. She also has 12 grandchildren,
with whom she is quite close. Her family is involved and supportive. Martina lives
two hours away from the hospital, so her family’s availability to visit is limited
by distance and work schedules. Martina worked outside the home prior to her
diagnosis, which was two years prior to the scheduled transplant. Her anticipated
length of stay is four to six weeks. Martina plays many stringed instruments and
brought a mandolin with her to the hospital. She was referred to music therapy
by her social worker for coping skills. All music therapy sessions took place in
Martina’s room, as patients admitted to the BMT unit are not allowed to leave the
hospital floor.
Martina’s bone marrow preparation regimen consisted of six days of high-
dose chemotherapy, which she completed during her first week of hospitalization.
The music therapist met Martina on her transplant day and, despite receiving
Ativan and Benadryl, Martina reported feeling alert and eager to participate in
music therapy. She reported no side effects from the chemotherapy, such as
mucositis or nausea, and had no complaints of pain or anxiety, but she described
her mood as “so-so.” In the initial session, Martina chose to engage in active
music-making with the music therapist. Using songs from her own songbook,
Martina played her mandolin while the music therapist played the guitar and both
sang. Between songs, Martina talked about her diagnosis and her supportive,
musical family. She shared that she especially enjoyed making music with her
son, whom she described as very talented. At the end of this session, Martina
noted an improvement in her mood.
The second session took place four days after the initial session. Martina’s
only physical complaints were fatigue and minor mucositis pain. This session
began similarly to the first, with Martina and the music therapist making music
together. Based on a song that Martina chose in this session, the music
therapist asked whether Martina would be interested in rewriting the lyrics to
reflect Martina’s hospital experience and observations. Martina was
enthusiastic about this, immediately began brainstorming ideas, and worked
with the music therapist to draft an initial verse. At the end of this session, the
music therapist invited Martina to continue working on the lyrics in her ample
free time.
When the music therapist returned for the third session a few days later,
Martina had complaints only of fatigue. She had completed lyrics for the song
but worked with the music therapist to refine them. The lyrics reflected the
monotony and predictability of hospitalization, as well as her emotional
experiences, including challenges of a lengthy hospitalization; gratitude for
good medical care; and recognition of the support that she received from all
parts of the interdisciplinary team. After she and the music therapist sang the
song together, Martina talked more about the difficulties associated with
treatment, which especially included waiting for the hematopoietic stem cell
transplant to take effect. The music therapist listened and supported Martina as
she processed her experience and also observed that she had become more
energized as the session progressed. Martina and the music therapist explored
options for her song, including making a recording or sharing it with the
hospital staff. With musical support from the music therapist, Martina opted to
share the song with the staff toward the end of her hospitalization in
appreciation of their care.
Case A11 – Re-creating Music in

Pediatric End-of-Life Care
Kathryn Lindenfelser, MMus, MT-BC
Anger, pain, disbelief, and trauma are some of the words that capture what the
music therapist was walking into when entering a family home on a crisp fall
day. The music therapy referral requested a visit to a family whose six-year-old
son Billy had been diagnosed with leukemia and was nearing the end of life.
When the hospice nurse called the music therapist, she asked, “How soon can
you see them? There doesn’t seem to be anything else that we can do to help,
and we think that music therapy will be the key to addressing the pain and anger
that this family is experiencing.” Billy had been sent home from the hospital
following his unsuccessful final treatment for leukemia. The high doses of pain
medication that he needed to help manage his pain left him lethargic, but when
he did wake up, it was with a vengeance from the pain and fear.
Music therapy turned out to be the key to opening up the emotions for most
of the family on that fall day. Billy had two older brothers who were frightened
for what might happen next, as they watched their brother suffer. In addition to
Billy’s struggle, his parents were in the midst of a difficult divorce. The stress and
strain that this was creating in the family was evident in Billy’s behaviors. For
example, the words out of his mouth often included profanity, and he would
throw whatever was within his reach. He often hit and swatted at his loved ones
as a way to communicate his anger, pain, and frustration. Music therapy gave
them all an opportunity to express themselves in a new and different way.
When the music therapist arrived that day, Billy was about to wake up from
a nap on the living room couch. The hospice volunteer warned the music
therapist, “Be careful—he wakes up unhappy.” Cautiously, the music therapist
sat next to him on the couch as he slept. She began finger-picking on her guitar
and humming and then singing new words to “Baby Beluga” —something like,
“Billy is swimming in the deep blue sea.” When Billy woke up, he enthusiastically
said, “I know that song and I can play guitar. This indicated his interest in
jumping right into the music. Slowly, Billy’s two brothers came into the living
room to join him, coming closer to the couch each time that Billy strummed the
guitar. As Billy and the music therapist continued singing familiar songs, the
brothers joined in. The music therapist, Billy, and his brothers continued to make
music and also began playing the drums. What initially had begun as a
competition to determine which brother could play the drum the loudest and
fastest turned into a steady and comforting improvisation. The boys’ mother
arrived with tears in her eyes from seeing them engaged in making music
together. She then joined them in making music, and her engagement in the
music made them all giggle. The improvisation continued, with the boys adding
words about what made them laugh, what made them cry, their worries and
fears, and words that described their real and tender love.
Re-creating words to a familiar song brought Billy comfort and an
opportunity to express himself in a new and different way. Re-creating music
provided a foundation that brought Billy a sense of safety and security, a space
in which the brothers could connect and engage as a family. Re-creating music
served as a building block for moving in a new musical direction and fostering
new experiences for Billy and his family.
Case A12 – Re-creative Music Therapy with a

Five-Year-Old Girl with Autism
Peggy Farlow, MAE, MT-BC
Alexa was a five-year-old girl with autism. She had good gross and fine motor
skills and was able to recognize letters, words, colors, and numbers appropriate
for her age. She was verbal, and her enunciation was clear and understandable.
She was able to give an appropriate one- or two-word response to a direct
question but did not use speech to communicate with others and did not initiate
any type of communication with either peers or adults. She often repeated words
that she had just heard spoken and would frequently talk to herself. Alexa also
had a short attention span, but when involved with singing activities, she was
able to maintain attention for longer periods of time. When she heard someone
sing a familiar song, Alexa often sang along and was able to continue singing the
words even when the other person stopped singing.
Based on information gained from Alexa’s initial assessment, her goals in
music therapy treatment were identified as (1) to improve her ability to work with
a peer/adult in a give-and-take setting, and (2) to respond verbally to adult
requests with/without prompting.
The music therapist planned singing interventions using songs with familiar
tunes and recurring phrases to prompt Alexa to give specific verbal responses.
One song that was particularly effective was “What Do You Do?,” written by
Kathleen Coleman, MMT, MT-BC. This song involved echoing, singing questions
and answers, and speaking using complete sentences. The music therapist began
the song with a guitar introduction and then sang the words:
What do you do, what do you do, what do you do when you’re feeling hungry?
I eat ________, I eat ___________, that’s what I do when I’m feeling hungry.
Alexa soon began to recognize the tune and started singing along. At first,
she sang both the question and the answer. After she became familiar with the
song, the music therapist stopped singing when it was time for the answer but
kept the guitar accompaniment going in order to cue Alexa to sing the answer
by herself. Once Alexa became good at this, the music therapist taught her other
possible responses to the questions. So, in response to the question “What do
you do when you’re feeling hungry?,” possible responses could have been “I eat
French fries,” “I eat apples,” “I eat popcorn,” and so forth.
Now, when the music therapist stopped singing after the question, Alexa
had to choose an answer. The music therapist repeated this process with other
“What” questions, such as “What do you do when you’re sleepy?” (go to bed,
take a nap, etc.), and later expanded this to “When” and “Where” questions. Once
Alexa became good at answering these questions, the music therapist began the
song by playing the familiar guitar introduction, singing the first few words, and
then pausing and not completing the question but continuing to play the guitar
accompaniment in order to prompt Alexa to complete the question.
After some practice, Alexa began to realize that she was supposed to sing a
question. Once she sang a question, the music therapist immediately sang an
appropriate response. At first, Alexa also sang her own answer, so the music
therapist used gestural prompts to cue Alexa to stop singing and allow the music
therapist to give the answer. After practice, Alexa became very good at interacting
with the music therapist and taking turns in singing questions and answers.
Alexa’s mom often observed the music therapy sessions and learned the
“What Do You Do?” song. One morning, 10 months after Alexa had begun her
music therapy sessions, her mom began singing questions to her, to which Alexa
sang an appropriate response. Alexa also began to sing questions to her mom.
After a while, they both stopped singing but continued asking and answering
questions with each other. With tears in her eyes, Alexa’s mom later told the music
therapist that they had kept this verbal interaction going for two hours and that
it had been the first time that she had ever had a conversation with her daughter.
The music therapy intervention used with Alexa was re-creative and
involved utilizing familiar music. By using a familiar tune with familiar words and
Alexa’s strengths of echoing and singing, she was able to learn how to take turns
in asking and answering questions and to initiate her own verbal responses.
Summary
Re-creative methods allow clients to address therapeutic issues and goals
through the process of learning, singing, playing, and performing music. The use
of precomposed music gives the music therapist the opportunity to select music
that is preferred by the client. The difficulty and complexity of the music can be
adapted to the ability, skill level, and needs of the client. Additionally, the level of
complexity can be adapted over time as a client’s skill level changes, in order to
support the client in achieving their highest potential. The flexibility and
adaptability in the process also allow for a wide range of treatment goals and
objectives to be addressed. Re-creative variations may lead to a performance,
such as a concert or musical production. This culminating event may be
videotaped and recorded, providing a reminder or artifact of the client’s
therapeutic achievements. This recording can also be reviewed for further
therapeutic exploration.
Re-creative experiences vary from other methods because the clients are
engaged in reproducing music but not creating it. In clinical practice, music
therapists commonly implement a method and may transition to another
method. For example, a group may listen to a song that is representative of their
experiences and decide that they would like to play and sing the song to deepen
their exploration of its meaning and to foster their own expression on these

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IntroToMTv2_Layout 1 16/07/2018 14:48 Page 57

Other Re-creative Methods 57

Case A5 – Familiar Song for the Development of

58 Introduction to Music Therapy Practice

Other Re-creative Methods 59

Case A6 – Re-creative Music in Memory Care

60 Introduction to Music Therapy Practice

Case A7 – Performing for Family in a

Other Re-creative Methods 61

Case A8 – Re-creative Music Therapy with a

62 Introduction to Music Therapy Practice

Other Re-creative Methods 63

Table 4.1 Songs Learned in Therapy Sessions

RECITAL DATE: SEPTEMBER 2010

Table 4.2 Recital Performances

SONG TITLE # of MEASURES HOW CASEY PLAYED THE SONGS

64 Introduction to Music Therapy Practice

When the music therapist reintroduced “Happy Feet” to Casey in February

Table 4.3 Casey’s Final Recital

SONG TITLE # of MEASURES HOW CASEY PLAYED THE SONGS

Case A9 – Re-creating Music with a Group of

Other Re-creative Methods 65

make music as a group, we were happy to take the opportunity to go a little

66 Introduction to Music Therapy Practice

Case A10 – Re-creative Music Therapy in the

Martina is a 50-year-old woman with acute myeloid leukemia, admitted to the

Other Re-creative Methods 67

Case A11 – Re-creating Music in

68 Introduction to Music Therapy Practice

Other Re-creative Methods 69

Case A12 – Re-creative Music Therapy with a

70 Introduction to Music Therapy Practice

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