MUSIC AS ALTERNATIVE THERAPY

VICTOR EMANUEL GALVÃO DOS SANTOS

Master’s Program Final Term Paper

UPTIME – Communication in English

Itaúna

Minas Gerais

June, 2023
 This paper explores the effects of music on the brain and its therapeutic potential.
It begins by discussing the increasing popularity of psychotherapy, especially in the wake of
the COVID-19 pandemic. Various types of psychotherapy, such as Cognitive Behavioral
Therapy and Psychoanalysis, are briefly described. The focus then shifts to the relationship
between music and the brain, highlighting the brain structures involved in sound perception
and the impact of music on neural activity. The paper discusses the influence of music on
memory, brain structure, and the differences between musicians and non-musicians. It also
examines the concept of music therapy, which uses music as a therapeutic tool to address
physical, emotional, mental, social, and cognitive needs. The paper explains different music
therapy interventions, including active and receptive approaches, and emphasizes the
importance of the therapist-patient relationship. Lastly, the Nordoff-Robbins approach, known
as Creative Music Therapy, is introduced, highlighting its emphasis on creativity, clinical
responsibility, and the identification of the patient's clinical theme. Overall, the paper provides
an overview of the effects of music on the brain and demonstrates the potential of music
therapy as a valuable therapeutic intervention.
 CONTENTS

1. Introduction .................................................................................................................... 4
2. Music and the brain......................................................................................................... 5
3. Music as therapy ............................................................................................................. 7
3.1. Music therapy .......................................................................................................... 8
3.2. Active Intervention .................................................................................................. 8
3.3. Receptive Intervention ............................................................................................. 9
4. Music Therapy Methods ................................................................................................. 9
4.1. Nordoff-Robbins Approach - Creative Music Therapy ........................................... 10
4.2. The Bonny Method of Guided Imagery and Music (GIM) ...................................... 10
4.3. Musical Esperience of Bruscia ............................................................................... 11
5. Conclusion .................................................................................................................... 12
Bibliography ........................................................................................................................ 14
 4

1. Introduction

Today the practice of psychotherapy has become part of many people’s lives,
especially after the COVID-19, pandemic years. In 2021, a study showed that 60% of
respondents who go to psychologists started therapy after the beginning of the pandemic
(FBSpesquisa, 2021). It shows that psychological treatments greatly impact our lives, thus
being important for self-understanding and how to deal with the issues presented.

According to the American Psychological Association, psychotherapy is a

collaborative treatment based on the relationship between an individual and a psychologist.
This kind of therapy presents some elements as the need for emotional trust with the therapist
and the patient’s belief that the process will help. There are several types of treatment and the
choice of which one you take depends on the objective and resources that will be used. The
frequency of sessions and the duration of treatment are examples of it.

Some of the options are Cognitive Behavioral Therapy, which focuses on the
relationship among thoughts, feelings, and behavior, it emphasizes how changes in any of them
can improve functioning in the other (APA, 2017). The way that a person interprets the events
is the cause of the effects of discomfort. Psychoanalysis is a therapy that seeks to bring about
basic modifications in an individual’s personality by investigating his or her transference with
the analyst (APA, XXXX) and the Analytical Psychology, to achieve a creative balance among
the ego, the personal unconscious, the collective unconscious and dynamic polarities (APA,
XXXX).

Psychotherapy is a compelling psychological intervention for many psychological,

behavioral, and somatic problems, symptoms, and disorders (Prince et al., 2007; Goldfried,
2013). As a consequence, therapy shows some benefits such as self-knowledge and resilience.
And its main objective is to influence the patient, helping him/her to modify emotional,
cognitive, and behavioral problems (Osório et al. 4).

In another way, there are people who choose a different treatment for their
problems, an option, for example, is music therapy, which is characterized as a non-traditional
treatment. American Music Therapy Association defines music therapy as a clinical and
evidence-based use of music interventions to accomplish individualized goals within a
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therapeutic relationship in order to meet physical, emotional, mental, social, and cognitive
needs.

Besides, this method of treatment studies human beings, their sound manifestations,
and the phenomena that result from the interaction between people and music, sound, and its
elements: timbre, pitch, intensity, and duration (Cunha, and Volpi 86). In practice, it seeks the
relationship between the participants, music, and the music therapist in a way that creates
possibilities to interact with the surrounding environment.

This paper tries to explain what are the effects of music in the brain, and how it can
influence our body, describing the mechanisms and the way that it happens based on
neuroscientific optics (Rocha, Boggio 132). In addition, it is important to emphasize what are
the fundamentals of music therapy and how this practice began, followed by how music therapy
can benefit human life.

2. Music and the brain

The process of sound perception involves a series of brain structures (OVERY;

MOLNAR-SZACKACS, 2009): the prefrontal cortex, premotor cortex, motor cortex,
somatosensory cortex, temporal lobes, parietal cortex, occipital cortex, cerebellum and areas of
the limbic system, including the amygdala and thalamus. Some of these areas are directly linked
with the regulation of body temperature and coordination of neural and endocrine systems.

At this point, the perception of rhythms requires several neural structures,

demanding a high level of activity from the brain and working it almost completely. As a
consequence, the greater the number of information to be processed, the greater the brain
activities.

The frequency emitted by the sounds has a correlation with the ciliary cells (these
are the true sensory cells of the cochlea, they are arranged in a single row on the inner side of
the internal tunnel (of Corti), they are contacted with almost all type 1 neurons whose axons
constitute 95% of the auditory nerve (Rémy Pujol, 2016)), and the intensity of the sound is
related to the number of fibers that are part of the action.

The first stage, in the musical field, can be seen in the projection areas in the
temporal lobe (auditory cortex) which is responsible for decoding musical characteristics:
 6

timbre, contour and rhythm. This part of the brain connects with the others in round trip circuits,
these being the memory area such as the hippocampus, thus recognizing the familiarity of the
elements; the cerebellum and the amygdala that establish emotional value to what is being
listened to; and a small nucleus of gray matter that is related to the sense of pleasure and reward
(Muszkat, 2019).

That is why it is common the feeling of remembrance, sometimes related to a

specific place, a person, a moment, etc. This happens because during this process the brain tries
to associate the sound with something visible or touchable, through this, it contextualizes new
sounds and creates memory links.

While this is happening, other areas of the brain are engaged in other activities, such
as decoding the structure and temporal order of sounds. The right side of the brain has a
specialty for dealing with the melodic contour (an abstraction of pitches, musical notes, in time
(Sampaio, 2012)), and the emotional content generated by music and timbres. On the other
hand, the left side works with rhythm, metrics and sound discrimination, it also analyzes aspects
related to pitch, interacting directly with musical syntax.

This type of art triggers different areas of the human brain, and can even induce
acts, thoughts, and feelings, as occurs with religious, romantic, or more agitated music
(Octaviano, 116). With the evolution of science and neuroscience studies, the process of
correlation between music and the nervous system has been better understood.

With these technologies, some studies have been advanced, but the use of music as
a mnemonic resource brings some doubts. There are some people whit insanity that can forget
about some facts, but they are able to remember and sing childhood songs. For this reason, if
not special, the memory of music is at least different from the memory of everyday facts and
images (Rocha, and Boggio 2013). In spite of it, healthy people demonstrate the same easiness
to keep their memories regardless of context.

Music is recurrently used as a mnemonic resource, but there are few studies that
justify the functioning of this practice, thus leaving an open field for future studies and further
research in the area.

Another point to be analyzed is the effects of music on the brain of a musician.

There are some studies based on analyzing the difference between the brains of musicians and
 7

non-musicians. Some of these differences are related to the increased volume in the auditory
cortex and greater concentration of gray matter in the motor cortex (Rocha, and Boggio 2013).

Long exposure to music and intense music learning increases the production of
neurotrophins, substances that are produced when the brain is in a state of challenge,
determining the survival rate of neurons, moreover, influencing the change in connectivity
patterns. People without musical training preferentially process melodies in the right cerebral
hemisphere, while in musicians there is a transfer to the left cerebral hemisphere (Muszkat,
2019). taking this into account, it is understood that the music experience can modify the brain
structure. This constant contact with music influences the greater number of synapses-contacts
in different areas of the brain, such as the corpus callosum, cerebellum and motor cortex.

In this case, music stimulates different neural circuits, taking into account that its
practice involves diverse skills ranging from the perception of simultaneous stimuli to the
integration of cognitive functions. Furthermore, it is possible that there is a critical period
related to these changes, indicating a possible correlation between the age at which one began
to study music and brain structural changes (Rocha, and Boggio 2013), but this remains
unknown.

3. Music as therapy

Music is considered a source of pleasure for almost every human being and it is
present in our lives since the beginning. It was understood that songs, in general, can contribute
with other benefits like bringing therapeutic effects and being a way to stimulate brain areas,
because music has the ability to influence the physiological reactions that connect the emotional
brain and the executive brain

Plato, in The Republic, comments on the impression of moral concepts present in

people from the musical experience, for him some specific parts of music had the ability to
transmit different characteristics. Based on this, it becomes understandable that there is a
capacity to set up emotions, consequently helping the individual to face and recognize them.

When observed in the context of evolution, it is noticeable that song may have
participated in the process of expressing emotions among the first humans and it may have also
contributed to the better coexistence in groups of the first humans, through its characteristics
that favor social interaction (MITHEN, 2009).
 8

Some studies believe that music arouses emotions considered common like joy,
sadness, fear, and anger indicating that music would recruit limbic and paralimbic system
structures and not just cortical areas of the brain (KOELSCH, 2010). That way, the fact of
listening to pleasant songs involves the process of the brain's reward system, and this can be
related to the effects that drugs cause on us.
3.1. Music therapy
The practice of music therapy summarizes treating people with the use of music, in
a way that addresses health using different strategies than the common one. This scheme is
based on the effects that song cause in our brain, and as a consequence, in our body. It can be
defined as a transdisciplinary hybrid around two main fields: Music and Therapy (CHAGAS,
2008).
Based on Bruscia's words, music therapy works with a therapeutic process where
other manifestations are triggered through musical experiences. relate to this, a kind of tripod
is established, based on the music, the therapist, and the patient.

“Music therapy is a systematic process of intervention in which the

therapist helps the client to promote health using musical experiences and the
relationships that develop through them as dynamic forces of change”
(BRUSCIA 2000, p.22)

The therapy will work in processes where the patient will be under the action of the
music and in others of the therapist. This balance will guide the session, creating a possibility
for the therapist to understand which are the best methods to be used and how he/she will give
continues the procedure. Based on it, the treatment is based on the issue of alternating the main
agents (music and therapist) during the process.
There are different ways to use this practice because the strategy depends on the
patient’s necessities. But according to the music therapy literature, music therapy interventions
can be divided into two parameters: active and receptive interventions (Bruscia,2014;
Wheeler,2015).
3.2. Active Intervention
The active intervention is related when the patient makes music during the therapy
sessions. This approach is based on the principle of encouraging he/she to demonstrate him/her
emotions and develop social, cognitive, and motor skills. Next to it, the professional can analyze
all the context, and use activities that will be directly linked with the patient. These interventions
 9

can be categorized into a number of subcategories, and for each one, there are a series of
characteristics related to therapeutic goals, the musical instrument that will be used, etc.
One of these types is the improvisation-based interventions, in this case, the
therapists agreed that this method it was one of the most useful. It is distinguished from the
others by the level of structure, the improvisation techniques that are used and the used musical
instruments. So, the way that the therapist will guide the process will be defined during the
section.
Besides improvisation, there are the performing existing songs, which is
characterized by singing and playing of an existing song. This method tries to work by releasing
tension and stimulating self-expression and has a focus on an increase of the music tempo, and
a clear rhythmic structure.
As a last example, there are songwriting and composing, this active intervention is
used when the therapist wants to stimulate exposure to stress-causing situations and help the
patient how to face this situation.
3.3. Receptive Intervention
On the other hand, a receptive intervention was applied in an individualized way,
adopting a specific procedure involving the following points. The musical stimulus - where the
songs are focused on cultural movements, such as Renaissance, Baroque, Romanticism, and
others. Sensation - is where the patient experiences the sensations provoked by the stage of the
musical stimulus. Situation - the process of relating those sensations to everyday feelings
occurs. Reflection - the patient reflects on the sensations experienced and tries to understand
why they are related to everyday life. And behavior change - is related to changes in life habits,
expected over weeks or months.
It is associated with attentive listening to music as a means of achieving specific
therapeutic goals. In this case, the therapist plays the song and the patient has just to pay
attention. As a result, having a greater focus on controlling emotions.

4. Music Therapy Methods

The scientific method is based on a set of rules and procedures, those

responsible for guiding towards an established purpose. A therapeutic method is a particular
type of musical experience in which the client engages for therapeutic purposes, that is, it
aims to change the client through the music (Bruscia, 2000).
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4.1. Nordoff-Robbins Approach - Creative Music Therapy

The Nordoff-Robbins approach seeks to use creative experience, originality,

and personal areas not yet explored. For this process to occur, the participation of the music
therapist becomes important, because he/she is the one who should help in the process of
seeking clinical musicality. “The music therapist works with people’s musicality”
(CUNHA et., 2010), so the music therapist is responsible for analyzing the individual's
musical behavior and their reactions to musical stimuli.
This process is characterized by clinical responsibility, where the therapist
shows interest in human beings, performs work involving ethics as a primordial factor and
understands that this process goes beyond the four walls. The musical construction, requires
the therapist to be familiar with the elements of music (harmony, musical analysis,
melodies), as it is through them that the work is developed. Creative freedom boils down to
breaking a rigid structure of procedures and carrying out work according to the identified
needs. And finally, clinical spontaneity, which the Nordoff-Robbins theory defines as the
sound-musical life experience through inspiration.
Another important topic within this approach is the definition of "Clinical
Theme", which is the identification of the musical context in which the patient demonstrates
particular reactions. Because after identifying the clinical theme, the therapist is able to
apply tools to deeper into the patient's sound identity.
Based on it and in the idea that every human being has an innate musicality, two
basic concepts emerge, the Music Child, which is characterized as an area of abilities and
sensibilities, and the Conditional Child, which is characterized by individual limitation.
These concepts confront each other within the process, in such a way, interventions such as
clinical-sound and clinical-musical, based on the clinical theme, come into action to break
the presented limitation and access the Music child. As a result, it comes up a new person,
"(...) It arises not only because it proposes a way of understanding the music therapy
phenomenon, but also because it is part of someone's system of life values."(Aingen,1996).

4.2. The Bonny Method of Guided Imagery and Music (GIM)

The method of Guided Imagery and Music (GIM) is a specialization of music

psychotherapy, which uses classical music to create a reading of experiences contained by
patients. Music, in this case, is responsible to make easier the continuous dialogue with the
unconscious, in which the ego holds its own reality while allowing the unconscious to do
 11

the same (Hanks, 1985). In this method, the therapist's objective is to encourage and induce
some reaction, which can be, emotions, sensory images, physical sensations, memories, etc.
Music and therapist will work together, supporting and facilitating the creative process.
The theory behind this is that listening to classical music while relaxed state,
provoking a charge of emotions and symbolic images, can give a better understanding of
therapy issues. This idea to imagine to music is common, many people create mental images
while in this situation. The initial purpose was to create something focused on provoking a
therapeutic experience similar to the effects provoked by the ones that use a hallucinogenic
drug, but without using it.
In general, GIM searches for access the language of the unconscious from
mental images. Therefore, based on an anamnesis sheet about the client, these images will
guide the patient to solutions for the difficulties they face in their daily lives. This process
happens in some steps. The first one is preparation, a moment when the therapist and the
patient will create intimacy and trust, furthermore, it is dedicated to establishing objectives
and approaches. The second part is to choose the song that will be used. It is based on the
patient’s information. Previously the part of induction, which is characterized by the
moment when the patient will get relaxed. Afterward comes the “musical journey”, a
moment dedicated to the therapist guiding the patient through an imaginative journey, it can
include instruction to view scenes, emotions, etc. After this starts the process to understand
lived experiences and exploring the personal insights and meanings that emerged during the
session. Finally, the closure of the session and a conversation about the points raised.

4.3. Musical Experience of Bruscia

Bruscia's Musical Experiences approach is founded on the question that music

can be an important tool to promote emotional expression and growth. They are based on
fundamental principles of music therapy, such as improvisation, re-creation, composition,
and receptive experience.
The improvisation process is characterized by an interaction between therapist
and patient, where the patient has complete freedom to use musical tools to express himself.
This approach requires the therapist to have a good interpretation of the musical domain,
analyzing sound elements such as rhythm, interval, timbre, and harmony, and through these
points that the understanding of what the patient is expressing comes. The first part of this
 12

method is music improvisation, this approach focuses on musical improvisation as a form

of expression. At this time, patients are encouraged to create as spontaneously as possible
Then there is creative expression, where the patient can explore the most different styles,
rhythms, melodies, etc. Bruscia’s method values the authenticity of the patient, with this
comes the process of emotional authenticity, which is a moment where music is used as a
means of exploring deep emotions, thus allowing an intense connection with the most
intrinsic topics.
On the other hand, the recreation process focuses on making the patient perform
and interpret actions from an existing musical model. The actions on which this method is
based may involve playing or learning a musical instrument and vocalizing or singing
existing songs. These sessions are usually based on musical cards that will guide attendance.
Musical composition is related to the creation of songs using the same musical cards
mentioned above. In this process, the patient can create a 100% authorial composition or
choose the path of parody. the purpose of this method is to assess issues related to planning
and organization and the ability to solve problems creatively. And finally, there is sound
and musical hearing, which boils down to listening to the sounds and notes emitted by
various means, whether by musical instruments or recorded music. This step focuses on
analyzing the capacity for attention and receptivity, improving listening and memorizing
information.
In addition to these characteristics, an important point of this approach is that
the therapist has full control of the sessions and must always guide them towards a path of
results, choosing the safest paths and encouraging the patient.

5. Conclusion

Music therapy emerges as a powerful therapeutic approach, capable of

promoting healing and well-being through music. In this text, we explore the benefits of
music therapy, highlighting its ability to stimulate positive emotions, improve
communication, relieve stress and promote creative expression.

Music has the power to reach deep into our mind and body, activating areas of
the brain related to emotions and memory. Through music therapy, individuals of all ages
and health conditions can find relief, solace and personal growth.
 13

Integrating musical elements into therapeutic sessions, music therapists are able
to adapt activities to each client's individual needs and abilities. Whether through musical
improvisation, active listening, or the use of instruments, music therapy offers a safe and
inclusive space for emotional exploration and the promotion of well-being.

It is fundamental to recognize the importance of music therapy as a valuable

complement to conventional treatments. It has been successfully applied in a wide range of
settings, including hospitals, schools, mental health clinics, and rehabilitation centers. The
benefits of music therapy are evident not only in individuals with mental disorders or
medical conditions but also in those who wish to explore their creativity and seek greater
emotional balance.
 14

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