3.3 Analytically Oriented Music Therapy (AOM) : Inge Nygaard Pedersen A Historical Outline and Definitions

3.
3 Analytically Oriented
Music Therapy (AOM)
Inge Nygaard Pedersen
A historical outline and definitions

Active music therapy
Analytically oriented music therapy (AOM) is the term now used in Europe for a newer
development of Mary Priestley’s analytical music therapy (AM), and it has, along with
the Nordoff-Robbins music therapy tradition, been the most widely used active music
therapy approach in many European countries. Today, AOM represents a solid basis for
many different clinical methods and approaches to music therapy. As these approaches,
further developed from AOM, include many other methods, the common term in
Europe is now simply: music therapy.
Clients participate actively in clinically prepared musical activities, the most
common activity being musical improvisation. Improvisation can be tonal or atonal,
and the client’s own musical expression is the basis for the music created. Composed
music and/or composition of songs/music can also be a part of therapy. In all cases,
the focus is on the client’s development, and not on the aesthetic quality of the
musical product.
Analytical music therapy (AM)

Analytical music therapy (originally AMT, here referred to as AM) was originally
established at the beginning of the 1970s by the English professional musician,
violinist Mary Priestley, who, through her many years of psychoanalytic training, tried
to combine a psychotherapeutic understanding of the therapist–patient relationship
with musical, artistic expression in improvisation. In a biographical study, Hadley
Copyright © 2019. Jessica Kingsley Publishers. All rights reserved.
presents the close relationship between Priestley’s life history and the therapeutic
approach she developed (Hadley 1998).
Priestley established AM as an innovative complementary training module
for other music therapy educational programmes, because she felt her own music
therapy education at the Guildhall School of Music and Drama in London had not
given her knowledge of and a focus on transference relationships and of the effect of
the music therapist’s way of being present in the clinical setting. She had not found
this kind of training in other music therapy programmes in the 1970s either. The
complementary module consisted primarily of comprehensive experiential training
of music therapists with music as the therapeutic medium (see Part 6). Priestley
defines AM, in short, as follows:
167
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168 A COMPREHENSIVE GUIDE TO MUSIC THERAPY
Analytical Music Therapy is the name that has prevailed for the analytically-informed
symbolic use of improvised music by the music therapist and client. It is used as a
creative tool with which to explore the client’s inner life so as to provide the way
forward for growth and greater self-knowledge. (Priestley 1994, p.3)
Mary Priestley developed AM primarily in her work with psychiatric clients
and in personal growth work with private clients. She considered uncovering
and re-experiencing traumatic experiences from early childhood as important
curative factors. She further developed, as a psychotherapeutic method, the use
of musical improvisation as a stage for re-enactment of the earliest relationship
experiences. Today, this method is applied with a broad range of clients. The
symbolic use of music (often combined with fairytales or other stories) can also
be used in therapy with children and adolescents with weak egos, where it can
offer an indirect movement towards better integration and a stronger self-image.
In the more recently developed versions of the method, however, identification and
transformation of rigid patterns in the here-and-now relationship are considered
to be the most important curative factors.
Based on her clinical experiences, Priestley developed a theory of empathy and
countertransference as important clinical tools in music therapy. She was inspired
by Racker (1968), and she classified countertransference reactions as 1) classical (the
therapist’s own subconscious and not-contained emotions), 2) empathic (the therapist
resonates with the client’s emotions, which are still subconscious or preconscious
for the client) and 3) complementary (the therapist takes a position that resembles
that of a person in the patient’s life – a person with whom the patient has had a
difficult relationship). Priestley (1994, 2012) described numerous clinical examples
of how these countertransference reactions can be played out and made conscious
through musical improvisation. Priestley was a pioneer in the sense that she never
used transference interpretation alone without at the same time consciously ensuring
that there was a warm alliance and a deep sympathy for the patient’s conflicts. Today,
identification and re-enactment of early relationship experiences are no longer
seen as the primary curative factors in music therapy. Identification and gradual
transformation of repetitive and often rigid or obsessive relationship patterns in the

present are considered just as important curative factors for the patient’s problems
and wishes for change.
Experiential training of music therapists, as introduced by Priestley in the form
of a complementary module for other music therapy training programmes, was later
integrated into longer music therapy educational programmes. This was first done in
Herdecke, Germany (headed by Johannes Th. Eschen), later at Aalborg University,
and was then gradually introduced – in a modified form – to German, British,
Austrian, Belgian, Dutch and Scandinavian educational programmes.
As an example, all music therapists with a master’s degree from Aalborg
University go through experiential training based on analytically oriented music
Selected Music Therapy Models and Interventions 169
therapy (see below and Part 6). This training is an integrated part of the five-year
bachelor/master’s programme in music therapy (see Part 6), and it qualifies the
students to work with complex psychological issues using music as a therapeutic
instrument (Lindvang 2007, 2010, 2011, 2013, 2015; Lindvang and Bonde 2012). The
basic idea is that the music therapist must develop a high degree of sensitivity, so that
they can act as a ‘resonator’: in clinical situations, the music therapist must be able
to use their own senses and emotional sensitivity to perceive and understand what
is happening in the interaction with the client (Langenberg, Aigen and Frommer
1996). The training also gives music therapists tools to orientate themselves during
musical improvisations. In work with complex psychological problems, this training
has a primary significance for building alliances and trust in music therapy. In
music therapy with other client groups, for example with developmentally disabled
individuals without verbal language, the training gives an underlying understanding
of actions and interventions (Kowski 2002). Analytical music therapy in its original
form is primarily conducted in the United States, first and foremost by Benedikte B.
Scheiby, who (just as Priestley did) offers further AM training for students who have
undertaken other music therapy programmes.
Analytically oriented music therapy (AOM)

In several European countries, including Denmark, the term analytical music
therapy (AM) is no longer used. Experiential training of music therapists, which
functions as a platform of some longer educational programmes, is now based on
analytically oriented music therapy (AOM), which indicates that the approach is
not only based on theories of psychoanalytic or analytical psychology, but also on
theories regarding communication, interaction, developmental psychology and
the psychosocial elements of personality. This is also the case in Germany at the
University of the Arts (Berlin), Institut für Musiktherapie der Hochschule für Musik
und Theater (Hamburg) and Westfälische Wilhelms-Universität (Münster) (Cohen
2018). Similarly, some music therapists use the term ‘analytically oriented’ when
describing their practice, even when they have not been trained by Priestley or in
AM (e.g. Austin 2008), and the term ‘analytical’ is also used when describing the
Jungian psychotherapy tradition. AOM is not based on the technical rules defined in
psychoanalysis (see Chapter 2.3.1). However, there are well-defined clinical terms in
analytical music therapy (see Chapter 2.3.1) that are also meaningful for analytically
oriented music therapy and for the more general term ‘music therapy’, which is the
term commonly used in Denmark and other European countries.
In all three definitions, an analysis of three components – music therapist,
music, client – is emphasised when describing progression. For example, Bruscia’s
Improvisational Assessment Profiles (Bruscia 1987) can be used to focus on certain
aspects or phases of development in musical improvisation, but it is also important
to analyse the music as a whole. The meaning of the music lies not only in the client’s
music itself, but also in how this music affects the therapist’s music. In other words,
there is a great degree of focus on the relationship and on transference relationships.
Many research projects have tried to describe (based on Priestley’s original definition
of analytical music therapy in which the symbolic use of improvised music expresses
the inner life of the actors) how intra-psychological processes as well as interpersonal
processes and psychological growth are made audible and can be understood from
the sounding musical material.
The session: procedure and techniques

In AOM with clients who can verbalise, a session often starts with the therapist
and client meeting in a verbal conversation, through which they find a focus or
theme for the musical improvisation. This theme is explored through the music,
and the music therapist can be musically supportive of or creative in regard to
the client’s music, or the therapist can assume a role that is agreed on before the
improvisation. The music can start tonally or atonally and move in many directions.
Often the act of improvising will give rise to a slightly altered state of consciousness
for the client as well as the music therapist, showing new ways of musical expression
as well as new insights regarding the theme or problem. Sometimes the music
will also give rise to strong emotions, and here it is extremely important that the
music therapist contains these emotions in the shared musical expression while
the emotions are lived through. Sometimes the client wishes to play alone and
‘be listened to’, or wishes that the music therapist plays for the client, who listens
actively, either to familiar pre-composed music or improvised ‘comforting music’.
Comfort is an important part of AOM, but tough emotional confrontations
can also be a part of the musical improvisation, if there is enough trust in the
relationship. Typically, some clients will find it less risky to play out their anger on
the drum set or piano, as they fear they may hurt others by showing their anger
elsewhere. In the music, they can allow themselves to feel the energy and strength
in their anger, without hurting others. In other words, a musical projection of
the anger is possible. This can be a very important turning point in working with
accumulated anger or anxiety.
It is important in AOM that there is a verbal reflection after the musical
improvisation (when possible), so that the inner movements that the music provoked
can be made conscious for the client and contained emotionally and cognitively.
Classical psychoanalytical interpretations based on Freud’s theories are not used;
in this way, the method differs from AM. Usually the session ends with a final
improvisation where the focus of the session is processed as much as possible.
Philosophically, AOM can be defined as music in therapy, as the music is used
to symbolically express inner moods, emotions and associations. However, often the
music will ‘take over’ and start to live a life of its own during an improvisation, so
that new and unexpected sounds, notes and rhythms emerge that move the client and
therapist in a different direction to that they had intended. AOM is thus often both
music in therapy and music as therapy.
It is important that the music therapist has a flexible approach to playing piano and
percussion instruments, but other instruments such as string and wind instruments
can also be useful. Priestley has described different techniques for structuring the
music in relation to the theme.
In this connection, university classes such as clinical use of main instrument
and piano have shown to be very useful in music therapy programmes. In Aalborg,
Professor Tony Wigram developed musical skills classes to support clinical work
within different music therapy approaches, among these AOM (see Chapter 3.9.1 and
Part 6). These classes are an important part of training to create the freely improvised
music that is a part of the N-R model, the Alvin model, AM and AOM.
Play rules
Finding a focus or theme for musical improvisation is called (creating) play rules.
Many different categories of play rules can be used, depending on the nature of the
problem. In short-term AOM, there is often a general playing rule (a theme) for the
course of therapy, as well as more specific playing rules for each individual session.
The aim of the playing rule is for the client to express musically a specific emotion,
fantasy, dream, bodily experience, memory or situation. A playing rule can also be
directly associated with the music or instruments, so that certain notes, chords,
instruments or musical rules can structure, mirror or symbolise the psychological
focus. The playing rule serves as an inspiration and an anchor for the inner imagery
and emotional and sensory experiences that emerge during improvisation.
One could say that the more the musical improvisation is connected to a
playing rule, the more the clinical situation will be directed towards a particular
goal. The playing rule is defined by the music therapist or by the client and the
music therapist together.
At the same time, it is the nature of improvisation to be unpredictable. Even if the
client starts playing with a conscious intention of what they want to express, music
can surprise and transform what is being expressed, so that this transformation in
itself becomes a part of the treatment. Treatment in AOM takes place on two levels;
on the non-verbal, pre-conscious level while improvising, and on a more conscious
level during verbal reflection.
Examples
An example of a playing rule that focuses on a specific emotion can be: ‘I am playing
my feelings towards my father’ (if, for example, the client expresses being afraid of
her father or doesn’t feel she can live up to her father’s expectations).
An example of a playing rule that focuses on a specific bodily experience can be:
‘I’m playing what I feel in my stomach right now’ (if, for example, the client expresses
nervousness or tension or a feeling of having a knot in his stomach).
Often the client will be prepared for improvising from a playing rule by doing
centring exercises. In the last example, where the focus is on a bodily experience, the
client can be asked to sit with his eyes closed and allow himself to feel sensations, to
be aware of what is happening in his body and specifically his stomach here and now,
and then to let these sensations be expressed in the music.
Monological and dialogical form

AOM sessions can take the form of a monologue, where the client plays and the
music therapist listens, and then they both reflect on the music verbally. Or a
dialogical form can be used, where the music therapist and client play together and
reflect on their joint improvisation afterwards. In the first approach, the problem
addressed will often be intra-psychological, while in the dialogue form, social
relations to others will often be addressed. Intra-psychological issues can, however,
also be addressed here, where the music therapist matches or amplifies the client’s
music. Where the role of the music therapist in the monologue approach is primarily
listening, affirming and clarifying, their role in the dialogue approach can differ
– the music therapist can support, amplify, contrast, centre, confront or mirror.
AOM as resource-focused music therapy

As in most other music therapy approaches, AOM focuses on the client’s innate
self-healing abilities and psychological resources. These are strengthened through
unconditional acceptance of and often confrontation with unfamiliar or unaccepted
parts of the client’s inner life. There is a focus on negative symptoms and psychological
inhibitions, as well as self-healing resources, from an understanding that these are
dynamically related (Pedersen 2014). The aim is to work with integration, insight
and transformation of psychological problems and issues, to expand the client’s

possibilities to act, and to improve relationship competencies as well as quality of life.
When working with the most severely disabled clients and clients with no verbal
language, AOM can be used to achieve rapport and communication on a very basic
level (Kowski 2002). This emphasises a demand on the therapist’s ability to be a
resonator. The meaning of rapport and communication in these cases must be defined
very broadly, and development processes and goals must be defined according to the
client’s realistic possibilities for growth. In recent years, AOM has been developed
also in music and medicine (Scheiby 2010, 2013b).
Clinical experience with AOM shows clearly the importance of a non-verbal
and playful active approach to the client. This approach, where improvisation is an
active process in the clinical setting, is one of the reasons that AOM is applicable as
complementary psychotherapy and milieu therapy in a comprehensive treatment
plan in clinical settings – in psychiatry as well as other clinical areas.
Documentation and research

AM in its original form has been maintained and further refined in the United States,
where Scheiby has introduced a supplemental training module, inspired by Priestley,
and documented her own AM work with students and with patients in neurological
rehabilitation (Scheiby 2010, 2013b). At Temple University in Philadelphia, there is
a Priestley archive, where historical material describing the method can be studied.
There is extensive literature describing practice and theory based on AM, which is
not defined as research on AM or AOM. Priestley described AM using many clinical
examples (1975/2012, 1994), and Eschen (2002) edited an anthology covering many
different aspects of AM and AOM. Scheiby documents the basic ideas of AM in
Wheeler’s Music Therapy Handbook (Scheiby 2015), and Cohen has documented
AM in her book Advanced Methods of Music Therapy Practice (Cohen 2018). From
the doctoral programme in music therapy at Aalborg University, the following PhD
dissertations rooted in AM/AOM can be mentioned: Mahns (1998), Hannibal (2001),
De Backer (2005), Pedersen (2007a), Lindvang (2010), Storm (2013). Research on
AOM is primarily qualitative, as, for example, Langenberg et al. (1996) and Lindvang
(2013). A comparative analysis of Nordoff-Robbins music therapy (creative music
therapy) and analytical music therapy, and an analysis of the relationship between
the creator of a method and the method itself, was done by Hadley (1998, 2001) with
a focus on the relationship between the creators’ lives and the development of their
methods, their views on transference and the philosophical premises underlying the
two approaches.
Clinical research in the method focuses on symbolic musical improvisation as
the source of transformative changes for the client as well as music therapist (Mahns
2002; Pedersen 2002a; Purdon 2002; Scheiby 2002). Extensive clinical documentation
of the beneficial effects of treatment (mostly in the form of case studies) is found in
papers by Langenberg (1988), Bruscia (1998), Wigram and De Backer (1999a, 1999b),
Hannibal (2001), Eschen (2002), Mahns (2002), Pedersen (1998, 1999, 2002a, 2002b,
2002c, 2007a, 2007b, 2013a, 2013b, 2013c, 2014) and Scheiby (1999, 2002, 2005,
2013a), among others. A series of articles about AOM is included in The Music in Music
Therapy. Psychodynamic Music Therapy in Europe: Clinical, Theoretical and Research
Approaches (De Backer and Sutton 2014). Elements from training such as intertherapy
and supervision are thoroughly documented by Aigen (2005), Scheiby (2013a) and
Pedersen (2002b). Pedersen and Scheiby have documented the development of the
intertherapy model (Pedersen and Scheiby 1999), and Pedersen has documented an
evaluation form for this experiential training method (Pedersen 2014).
Categorisation
In Bruscia’s systematic account of music therapy models (Bruscia 1998), AOM
is placed as ‘Insight Music Therapy’ at the intensive level (p.219), when it has re-
educative goals (behaviour change, goal modification, self-actualisation), and at
the primary level when it has reconstructive goals (in-depth changes in the client’s
personality structure). This classification is still valid today (Cohen 2018).
3.4 Nordoff-Robbins Music Therapy
Lars Ole Bonde and Gro Trondalen

The Nordoff-Robbins (N-R) approach is one of the most famous improvisational
models of music therapy developed since the 1950s. Paul Nordoff, an American
composer and pianist, and Clive Robbins, a British-trained special educator,
collaborated to pioneer the model, which is known worldwide and has been taught
in a variety of countries across the world. Nowadays, the model is called Nordoff-
Robbins, but is also known in some countries and in some of the literature as
‘Creative Music Therapy’ (Nordoff and Robbins 2007). In the beginning, it was aimed
at children with learning disabilities, from the mild end of the spectrum to the severe
(Aigen 1998). Paul Nordoff died in 1977, and Clive Robbins further expanded the
work together with his second wife, Carol Robbins, and other colleagues, including a
new focus on children with hearing impairment (Robbins and Robbins 1998). Music
therapists trained in the N-R model in the US, in the UK and in Germany have
expanded the clinical spectrum to encompass adult clients in areas such as neuro-
rehabilitation, psychiatry and somatic and palliative care.
In the early years of developing their model, Nordoff and Robbins were influenced
by the ideas of Rudolf Steiner and the anthroposophic movement in humanistic
psychology (Lee and Houde 2011, p.46f.; Robbins 2005). However, their use of drums
and percussion was controversial within such a framework. They developed the idea
that within every human being there is an innate responsiveness to music, and within
every personality one can reach a ‘music child’ or a ‘music person’. The idea was
vital in their approach to the disabled population, as they believed in the potentially
natural responsiveness to music and the power of music to enable self-expression
and communication, in spite of severe degrees of learning and physical disabilities.
Robbins (2007) writes about the music-centred core of the model:

The motivation that generated this work was fundamentally musical. The work came
about from a love of musical creation, musical expression, and musical experience. It
arose from Nordoff ’s natural enthusiasm for music making, from his intuitive feeling
for the powers of spontaneous communication in musical participation, and from
the considerable extent of his musical knowledge, skill and experience. Robbins’s
empathetic recognition of the healing immediacy of Nordoff ’s clinical innovations
supported the birth of the therapy and adaptively nurtured its development in all the
directions it took. The work did not originate in Steiner’s teaching. (p.65)
175
Later Nordoff and Robbins related their therapeutic goals to the humanistic concepts
of Abraham Maslow, including in their framework the aspiration towards self-
actualisation, peak experiences (Maslow 1962) and developing special creative talents.
The relationship with the client is built on a warm, friendly approach (accepting the
child as they are, recognising, reflecting and respecting the child’s feelings, allowing
the child to make choices), and a non-directive approach to give the child autonomy,
and the therapist the role of following and facilitating. At the same time, the child’s
(sometimes rigid) patterns of behaviour and attachment can be confronted and
challenged within the musical relationship. This is a dominating feature in early
documented examples of N-R therapy (Aigen 1998). Based on a non-directive
attitude, the child’s development is stimulated towards autonomy, and the primary
role of the therapist is to follow, support and stimulate the child in developing new
patterns – unless there is a situated need for a more challenging approach and thus
also a more directive therapist role. In all situations, the core of the N-R model is the
belief in music itself as a medium of growth and development – together with the
axiom that every human being, no matter what disability, illness, trauma or mental
health problem is at hand, has an ability to respond to music and thus the access to
enhancing quality of life and promoting healing in their life (Etkin 1999).

The Nordoff-Robbins working style is unique and often easily recognisable. From the
very beginning, the music is placed at the centre of the experience, and the client’s
musical reponse is the primary material for the therapists’ work in the session and later
in the analysis and interpretation of the video recording. The therapists are usually
highly skilled musicians because the rich flexibility and variability of a harmony
instrument are central to their working style. During training, the music therapists
develop a sophisticated use of piano and/or guitar in improvised music-making.
In individual therapy, clients were traditionally offered a limited channel for their
musical material, mainly the cymbal and drum, together with strong encouragement
to use their voice. Today, and especially in group work, other instruments are
involved – pitched instruments, reed horns, wind instruments and various string
instruments – because they are fairly easy to play and produce great sound.
In much of the individual work, Nordoff-Robbins therapists (where possible)
traditionally worked in a pair. One person established a musical relationship from the
piano, while the other therapist facilitated the child’s responses and engagement. This
working model originated in the early years of the Nordoff-Robbins collaboration
where Paul Nordoff was the pianist-therapist and Clive Robbins the supporting
therapist. Today, most N-R music therapists work individually (Tsiris, personal
communication 2018). Another pillar in the musical style of this model is Paul
Nordoff ’s own tonally founded compositions. Nordoff developed a unique style of
improvisation that was transformed into two volumes of Playsongs for Children (now
available in several languages). Contemporary N-R therapists improvise creatively

in this style and create a living musical atmosphere in the therapy room, from
the moment the client enters until they leave. Examples can be heard on the CD
accompanying Gary Ansdell’s Music for Life (Ansdell 1995).
In N-R music therapy, the approach comes within the conceptual framework
of music as therapy, where the music provides the therapeutic catalyst through
which change will take place. The relationship itself is formed in the music.
The therapists work through different phases in their therapy: ‘Meet the child
musically… Evoke musical response…develop musical skills, expressive freedom,
and interresponsiveness’ (Bruscia 1987, p.45).
Within this model, a model of analysis has been developed to facilitate description
and characterisation of what goes on in therapy, and to enable assessment of eventual
progress. The model includes a number of rating scales:
• 13 response categories
• the client/therapist relationship
• musical communication
• musical response scales: instrumental/rhythmical and vocal response.
Clinical application
Nordoff and Robbins offered a significant perspective on how music can be used
in music therapy, from the use of musical play songs (e.g. Nordoff and Robbins
1966, 1969 – with texts translated to many languages) to pure improvisation.
Examples include: the improvisational style of music must be free from musical
conventions, and flexible; intervals are considered important and represent different
feelings, when used in melody; triads and chords can be used in special ways; and
improvised music should also include ‘musical archetypes’, such as organum, exotic
scales (Japanese, Middle Eastern), Spanish idioms and modal frameworks (Robbins
and Robbins 1998).

The therapist often provides a musical frame, frequently establishing clear
rhythm and pulse, and particularly, singing about what the client is doing while
it is happening, in order to bring into focus the experience that is occurring. Any
musical expression produced by the client, vocal or instrumental, is incorporated
into a frame, and encouraged.
The clinical application of Creative Music Therapy has been introduced in
wide-ranging and in diverse ways. The graduates of the courses in the Nordoff-
Robbins model, particularly in New York, London, Sydney and Witten/Herdecke
in Germany, have diversified the approach to work with adult patients in the areas
of neuro-rehabilitation, psychiatry and terminal illness. The model has been greatly
developed through research and extension of application (Aigen 1991, 1996, 1998,
2005, 2014; Ansdell 1995, 1996, 1997, 2014; Brown 1999; Guerrero et al. 2014; Lee
1996, 2000; Neugebauer and Aldridge 1998; Næss and Ruud 2008; Pavlicevic 1995,
1997; Pavlicevic and Trevarthen 1994; Schmid 2005; Spiro, Tsiris and Pavlicevic
2014; Tsiris 2013; Tsiris, Spiro and Pavlicevic 2017). A special issue of Music Therapy
Perspectives (2014, 1) was devoted to recent developments in N-R therapy. Streeter
(1999b) offers a critique of the model.
Documentation
This model of music therapy has also developed methods of analysing what is
going on and how therapy is progressing. As mentioned above, a number of rating
scales have been generated, including: 13 categories of response, child–therapist
relationship, musical communicativeness, musical response scales (instrumental
rhythmic responses, singing responses).
So far, case studies are the most typical way in which therapists working in
the Nordoff-Robbins tradition document their work (e.g. Aigen 2002, 2005; Etkin
1999; Howat 1995). A number of early N-R cases are documented and discussed
by Aigen (1998). The material is often presented as a ‘story’, a narrative description
of the process and progress of therapy. Howat (1995) presented a lengthy and
detailed account of individual work with a young 10-year-old girl with autism called
Elizabeth, documenting more than 100 sessions over a five-year period. The narrative
descriptions, sometimes brief and sometimes more detailed, mainly focused on her
musical behaviour in the sessions, explaining how she played with many examples
and interpretations of the emotional expression present in her playing. Life events
were also included in order to provide a context for the musical process in the therapy.
Etkin (1999) described a period of therapy with an emotionally, physically and
socially abused and deprived child called Danu. She described the way that Danu
played during the initial assessment session, and then set out the case study in the
stages of therapy: early work – emergence of songs and stories – disclosure – endings.
A method of improvisation called ‘singspiel’ or ‘sprechgesang’ featured strongly in
the therapy sessions, and there was significantly more verbal material than is typical
in other case studies from this tradition. From this example, it is clear that while
the original conceptual model of Nordoff-Robbins provides the basis for a strong
and grounded training, individual therapists develop methods and techniques out
of their primary approach. Piano-based improvisation still forms the foundation,
but guitar-based improvisation developed by Dan Gormley in the US, jazz and
blues improvisation styles more culturally effective with some populations in New
York developed by Alan Turry, and Aesthetic Music Therapy defined by Colin Lee
in Canada (Lee 2003), among others, have emerged from the initial foundations of
N-R music therapy.
One of the most famous early cases in the N-R tradition is that of ‘Edward’, a fine
illustration of the dynamic span of the model. The dramatic meeting between Edward
and the two therapists in the very first session was the topic of a series of analyses
in the Nordic Journal of Music Therapy (1998–99). Music therapists and researchers
with different backgrounds discussed how this fascinating case could be understood
and explored from many perspectives.
Nordoff and Robbins also taught in Denmark and in Norway, and therapists in
both countries followed their style of work while others incorporated their concepts
at a more general level with certain clinical populations. Among them are the Danish
music therapist Claus Bang,3 who worked with hearing-impaired children, and the
Norwegian music therapist Tom Næss, who used to work mainly with people with
developmental disabilities (Næss 1989; Stensæth and Næss 2013).
Nordoff-Robbins music therapy has stood the test of time. This is visible in
the increasing number of music therapists using this approach and the extensive
publications of case studies based on N-R music therapy. Some very important
writings are published by Paul Nordoff and Clive and Carol Robbins (Nordoff and
Robbins 1971, 1971/83, 1977; Robbins and Robbins 1980, 1998). There is also an
extensive literature on case studies in books (see, for example, Aigen 1996; Ansdell
1995; Bruscia 1991; Pavlicevic 1997; Wigram and De Backer 1999a).
Categorisation
In Bruscia’s systematic account of music therapy models (Bruscia 1998), Nordoff-
Robbins music therapy is placed as either ‘Developmental Music Therapy’ or ‘Music
Therapy in Healing’ or ‘Transformative Music Psychotherapy’ at the intensive level
(pp.189, 210, 219), because the therapeutic goal is transformation of personality
through the musical process itself.
3 www.clausbang.com
3.5 Benenzon Music Therapy
Lars Ole Bonde and Gro Trondalen

Psychiatrist, musician and composer Rolando Benenzon founded the first music
therapy training programme in Buenos Aires, Argentina, in 1966. Over the next
decades, Benenzon participated in the development of training programmes and
professional associations in several countries, not only in South America, but also in
southern Europe (Wagner 2007). Benenzon’s model is mainly known and practised in
South American countries and in Spain and Italy. Theoretically, it is an eclectic model
inspired by many different psychological and psychotherapeutic theories, including
psychoanalysis and psychodrama. Some of Benenzon’s texts are available in English
(Benenzon 1982, 1997, 2007). A recent definition of the model can be found in the
last reference given:
The aim of this model of music therapy is to enable clients to direct their creative
energies into opening channels of communication between people, a process that
is dependent upon the ability to establish relationships and connections. In music
therapy, these connections are developed within the non-verbal context. (Benenzon
2007, p.149)
The key concept is ‘Musical Sound Identity’ (ISO). The ISO principle was originally
defined by Altschuler (1948/2001) as a cross-modal similarity between internal
psychological states and external sound expressions. Benenzon understands ISO
as the infinite set of sound energy, acoustics and movement that belongs to an
individual and characterises them – they comprise the person’s identity. ‘The mental
time of the patient must coincide with the sound and musical time executed by the
therapist’ (Benenzon 1981, p.33). Four sub-concepts describe different aspects of
this individual energy field that can be activated by music: universal ISO, cultural
ISO, complementary or group ISO, and gestalt ISO. Fundamental for the person,
patient as well as therapist is the gestalt ISO, the dynamic mosaic of sound features
characterising the individual. The complementary ISO is ‘the momentary fluctuation
of the Gestalt ISO induced by specific circumstances’, for example in the music
therapy session. The group ISO needs time to be established within the social system
of the group, be it a therapy group or a musical ensemble. In a music therapy group,
it is a dynamic synthesis of each patient’s identity. The group ISO is always part of
and influenced by the cultural ISO, defined by Grebe as ‘the sound identity proper
to a community of relative cultural homogeneity’, in a dynamic interchange with
subcultures or groups. From his work with psychotic children, Benenzon developed
the concept of a universal ISO – the ‘sound identity that characterizes or identifies all
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human beings […] including the specific characteristics of the heartbeat, the sound of
inhaling and exhaling, the mother’s voice during birth, and the first days of the infant’
(Grebe in Benenzon 1981, p.36). There are interesting similarities and differences
between this concept and Nordoff-Robbins’ concept of ‘the music child’.
From psychoanalysis and psychodrama, Benenzon imports two other important
theoretical concepts: the intermediary object and the integrating object. Music
instruments and sounds can have the function of intermediary objects, but unlike,
say, puppets, they have a life of their own, and the music therapist can explore together
with the patient(s) what instruments and sounds resonate best with the gestalt ISO
and thus may have an integrative function. Musical instruments can be more or less
dominating, thus enabling leading instruments in a group to link distinct gestalt ISOs
to both group and cultural ISO.

In Benenzon’s Music Therapy Manual three session stages are described: 1) Warming
up and catharsis, 2) Perception and observation, 3) Sonorous dialogue. In the first
stage, the aim is to discharge stress (for Benenzon this is equivalent to ‘catharsis’),
and this is primarily done through rhythmic playing on selected instruments. The
second stage is ‘limited to the moments when the therapist discovers or elaborates
a hypothesis about the patient’s complementary ISO’ (ibid., p.70). Based on the
therapist’s personal ISO reflection, a communication channel is opened, and the third
stage unfolds. Benenzon makes it clear that the duration of each stage is unpredictable,
and that there is no guarantee for a sound dialogue to occur.
From the very beginning, Benenzon concentrated on specific clinical areas: autism
(defined as early childhood psychosis), vegetative states (coma) and states dominated
by hypertension. The major problem of the autistic person according to Benenzon
is the isolation (‘like a fetal psychic system living outside the womb’ (1981, p.88)).
As an intermediary object, music may enable communication between that autistic
person and the therapist who primarily uses the ISO principle to engage the patient
in dyadic work.
Documentation
Benenzon has published mostly in Spanish, but his books on music therapy for
children within the autism spectrum are translated into English, Portuguese and
Italian. The Benenzon model is described in the Italian edition of Wigram, Pedersen
and Bonde (2002) by Di Franco.
Categorisation
In Bruscia’s systematic account of music therapy models (Bruscia 1998), Benenzon
music therapy is not listed. Benenzon himself describes his model as psychotherapy
that can be used as a model on its own (i.e. complementary or advanced) or as an
adjunct to medical treatment (i.e. supportive).
3.6 Cognitive-Behavioural Music Therapy
Lars Ole Bonde, Gro Trondalen and Tony Wigram

From the very beginning, modern music therapy was closely related to behavioural
theory (Ruud 1980). The therapeutic work with American veterans of the Second
World War was based on behavioural principles, and behavioural music therapy
(BMT) has probably been the most influential theoretical reference of American
music therapy education (Bunt 1994). The model is defined as: ‘the use of music as
contingent reinforcement or stimulus to increase or modify adaptive behaviours and
extinguish maladaptive behaviours’ (Bruscia 1998; see also Standley and Whipple
2003, pp.106–107).
One of the pioneers in behavioural music therapy was Clifford Madsen. As early
as 1966 he wrote an article with Vance Cotter, describing BMT as cognitive-behaviour
modification assisted by applied behavioural analysis. In 1981, he published a book
called Music Therapy: A Behavioral Guide for the Mentally Retarded, and he has
subsequently contributed to the literature (Madsen, Madsen and Madsen 2009).
Another researcher from the tradition of natural science who has contributed to the
understanding of music therapy as a modern, cognitive-behavioural science-based
treatment model is Michael Thaut (Davis, Gfeller and Thaut 1999; Leins, Spintge and
Thaut 2010; Thaut 1990, 2005; Thaut and Hoemberg 2014).
Madsen, Cotter and Madsen (1966) described BMT as a form of cognitive-
behaviour modification using music 1) as a cue, 2) as a time structure and body
movement structure, 3) as a focus of attention and 4) as a reward. Music is used
to modify behaviour through conditioning, and the results can be measured by
applied behaviour analysis. The therapeutic process is based on a stimulus-response
paradigm, and as a dependent variable the music must be controlled. This explains
why specific music, often recorded, is preferred to, for example, improvisation in the
treatment of patients.

Many types of behaviours are manipulated in BMT: physiological, motor,
psychological, social, emotional, cognitive, perceptual and autonomic. A patient-
preferred music stimulus can be given or withdrawn as related to the patient’s target
behaviour, for example increase of attention span.
Music-assisted reinforcement in its purest form is used in Standley’s research
with premature infants (Standley 1995). Music was used to stimulate sucking, and
when the infant stopped sucking, music was withdrawn. Standley documented
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a positive effect of music stimulation on sucking time, weight gain and health
of the infants.
The session format depends on the cognitive or behaviour modification goals,
but it always has a firm structure and strict protocol. Predictability and control of
the musical stimulus is necessary. When participation in musical activities is used
as a stimulus, there is a given relationship between the activity, for example singing,
playing or dancing, as a means, and non-musical goals and objectives, such as
enhanced social engagement, increased physical activity, improved communication,
development of cognitive processing, increased attention and concentration,
enjoyment and self-expression, and reduction or elimination of anti-social or self-
damaging behaviour.
BMT is a good example of music in therapy, because the music acts as a
reinforcing stimulus of non-musical behaviour. Music and musical activities are a
means to achieve cognitive and behavioural changes.
Cognitive-behavioural music therapy is used with a wide variety of clinical
populations, including children and adolescents with developmental disability,
geriatric populations and psychiatric patients; however, most often patients have
physiological problems and belong to a somatic patient group. Premature infants have
been mentioned as an example, and people with Parkinson’s disease and autism are
other typical patient groups. Hilliard (2001) suggested cognitive-behavioural music
therapy as an appropriate treatment of patients with an eating disorder. Moe (2011)
combined group music and imagery with cognitive therapy for psychiatry inpatients
with substance abuse disorders, while Hakvoort and colleagues (2015) used cognitive
principles in an anger management programme for patients in forensic psychiatry.
Neurological rehabilitation is a major field in current music therapy, and Michael
Thaut has developed specific training in ‘neurological music therapy’, based on the
principles of cognitive-behavioural music therapy (Thaut and Hoemberg 2014).
Documentation
BMT was from the beginning based on the rigorous standards and procedures of
natural science, ensuring the possibilities of replication and standardisation and thus
leading to recognition in the scientific community. Research has been used to define
what types of music will promote specific therapeutic and treatment objectives.
Thaut has shown that pulsed, rhythmical music can promote good walking patterns
in patients with Parkinson’s disease. In fact, the rhythm in itself can be more effective
in gait training, and a metronome can be sufficient to produce the right stimulation
(Thaut and Abiru 2010). Music with a slower tempo is used when older adults are
prompted to move or dance.
Applied behaviour analysis allows the BMT therapist or researcher to measure the
effect over time of the music medicine or music therapy intervention. It can measure,
for example, the number of defined asocial behaviours targeted during periods with
or without music therapy, utilising the patient’s preferred music or activity. Using
reversal designs and multiple baselines, the researcher can evaluate the efficacy of
the music intervention over time when compared with periods of non-intervention.
Research in cognitive-behavioural music therapy meets the traditional
standards of natural science, and Michael Thaut, its most prominent contemporary
representative, considers this type of music therapy the only truly scientific therapy
(Thaut 2000, 2005).
Categorisation
In Bruscia’s systematic account of music therapy models (Bruscia 1998, p.184),
BMT is placed as a ‘Didactic Practice’ at the augmentative level, because this model
works with limits and goals that specifically address symptoms and (maladaptive or
inappropriate) behaviours, and, to a lesser degree, with the client’s personality
or general development.
3.7 Community Music Therapy
Gro Trondalen and Lars Ole Bonde

The term community music (therapy) has been used in American literature since
1960 and there have been community-oriented practices for decades. However,
today’s community music therapy is something more than and different from music
therapy in community settings (Stige 2010). Initial traces of the recent emergence of
community music therapy are found in some early publications of Even Ruud, where
he does not only relate music therapy to different treatment theories (Ruud 1980),
but also emphasises, for example, disabled people’s right to music (our italics) (Ruud
1990). Such a culturally and socially engaged practice – music as a situated activity
within a context – is theoretically elaborated on in depth by Stige (2002, 2003; Stige
and Aarø 2012).
An international scholarly discourse on community music therapy is a relatively
new phenomenon involving theories from fields such as systems theory, anthropology,
sociology, community psychology and musicology (e.g. Ansdell 1997, 2001; DeNora
2000; Small 1998). The movement of community music therapy addresses mechanisms
of exclusion and inclusion in a broader context and requires a more socially engaged
practice, as is the case in a setting of a more traditional clinical practice within clinical/
professional or institutionalised settings (Ruud 2004; Stige 2010). Community music
therapy (post 2000) ‘goes beyond conceptions of music therapy in community settings
to also embrace music therapy as community and music therapy for community
development’ (Stige et al. 2010, p.10). It aims to engage directly with the problems
and possibilities of music and health in society – towards a psychosocio-cultural
model concerned with the musical cultivation of personal and social wellbeing
(empowerment). Accordingly, it concerns how music may afford and appropriate
therapeutic experiences and processes of change, through collaborative musicking, to

mobilise resources (Rolvsjord 2010) for the benefit of individuals and communities.
There is no common definition of community music therapy. Ansdell suggested
community music therapy to be a ‘paradigm shift’ (Ansdell 2002, paragraph 1).
Stige suggests community music therapy may operate as a ‘cultural critique’
informed by socio-cultural processes of change both in society at large and in
the academic discourse on music, and suggests that we discuss music therapy as
a discipline, a profession and a practice (Stige 2003, p.11). During a continuous
discussion (Ansdell 2002; Garred 2004; Kenny and Stige 2002; Stige 2002), Ruud
suggested, ‘Community Music Therapy is the reflexive use of performance based
music therapy within a systemic perspective’ (Ruud 2004, p.33). While Stige took a
broader position:
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Community Music Therapy as an arena of professional practice is situated health

musicking in community, as a planned process of collaboration between client and
therapist with a special focus upon promotion of sociocultural and communal change
through a participatory approach where music as ecology of performed relationships
is used in non-clinical and inclusive settings. (Stige 2003, p.454)
However, definitions of community music therapy are still a topic of debate (Ansdell
and Stige 2016; Stige et al. 2010; Stige and Aarø 2012). Stige and Aarø created the
acronym PREPARE to sample core qualities in community music therapy, which are:
Participatory – Resource-oriented – Ecological – Performative – Activist – Reflective
– Ethics-driven (Ansdell and Stige 2016).
Community music therapy encourages musical participation and social inclusion,
equitable access to resources, and collaborative efforts for health and wellbeing in
contemporary societies (Stige and Aarø 2012).
The current community music therapy movement is included in what Bruscia
(1998, 2014) has defined as ‘ecological’ music therapy. A similar view is also at the
forefront of Aasgaard’s ‘milieu’ music therapy (Aasgaard 2002, 2004).

There are no common established procedures or techniques in community music
therapy, and this is actually an important point – and the reason why Aigen (2014)
calls community music therapy an orientation, not a model: community music
therapy sessions are related to specific, ordinary everyday contexts and practices,
where people engage in music regularly. Therefore, every single setting requires a
procedure adapted to the context, either at an individual, group or community level,
where music can reveal its transforming power. This means that a community
music therapist often works in ways similar to those of a community musician,
accompanying participants and promoting community singing or playing (DeNora
2000; Stige and Aarø 2012; Stige et al. 2010). The main difference is that the
community music therapist has the needs and potentials of participants with health
problems as a point of departure. Ruud (2012) discusses similarities and differences

between community musicians, community music therapists and ‘health musicians’.
Some of what Stuart Wood (2006) calls the ‘formats’ are shared between these agents;
however, only the music therapist will be able to cover them all: individual music
therapy; group music therapy; workshops; concert trips by ensembles (choirs, bands);
performance projects’ tuition; music for special occasions (Ansdell and Stige 2016).
Community music therapy is always seen in relation to health, human development
and social change and coherence in some way or another, and may offer its potential
to marginalised individuals of groups, or to communities at a more general level,

aiming at creating a cultural and social link between music therapy and music (and
health) in everyday life. Populations can be clinical or non-clinical, or a mix of both,
for example users of mental health services (Ansdell and DeNora 2016), prisoners
– in jail as well as when they are set free (Tuastad and O’Grady 2013; Tuastad and
Stige 2014), children and adolescents with risk behaviour (McFerran and Rickson
2014), and people with mental and physical handicaps (Kleive and Stige 1988). In
the mental health context, community music therapy is often closely related to the
recovery model in theory and practice (Solli 2014, 2015; Solli and Rolvsjord 2015;
Solli, Rolvsjord and Borg 2013).
Documentation
There is an extensive literature on community music therapy practices. One early
example is a project on community integration in and through music in the mid‑1980s
in Norway (Kleive and Stige 1988). During the last decade, however, there has been
extensive publication of a variety of examples of community music therapy. Examples
include female adults recreating their identity from criminal band members to music
band members (e.g. Nielsen 1996); Music for Life, a project with young men in a
South African context, exploring music therapy as social activism (Pavlicevic 2010);
and the ‘triptych’ or three-panelled work by Ansdell and DeNora on ‘how music
helps’ people with mental health problems in the Chelsea Community Music Therapy
Project from 2005 onwards (the SMART project) (Ansdell 2014; Ansdell and DeNora
2016; DeNora 2013; Stige et al. 2010). Several national contexts have been explored,
discussed and published in a wide range of theoretical orientations; however, these
always focus on health musicking (Stige 2002; see Chapter 3.13), as it is concerned
with the relationship between individual experiences and the possible creation of a
musical community (Aigen 2005, 2014; Ansdell, DeNora and Wilson 2016; Kenny
and Stige 2002; Pavlicevic and Ansdell 2004; Stige 2002; Stige et al. 2010).
Categorisation
In Bruscia’s systematic account of music therapy models (Bruscia 2014a), community
music therapy is labelled as an ‘ecological practice’ and suggested at the intensive level,
as this level incorporates ecological aims and values into the client’s music therapy,
or combines a traditional form of therapy with community work. Such an approach
may also lead to significant and enduring changes in the individual or community,
when the goals and processes extend across several areas of practice (Bruscia 2014a).
3.8 Free Improvisation Therapy
– The Alvin Model
Tony Wigram

Juliette Alvin was a pioneer of music therapy and developed a foundation model for
improvisational music therapy between 1950 and 1980. She was an internationally
famous concert cellist, studying with Pablo Casals, and she strongly believed in
the effect of music as a therapeutic medium. Her own definition of music therapy
was: ‘The controlled use of music in the treatment, rehabilitation, education and
training of adults and children suffering from physical, mental or emotional
disorders’ (1975, p.15).
In 1959, Alvin founded the British Society for Music Therapy, and subsequently
founded the post-graduate course of music therapy at the Guildhall School of
Music and Drama in London in 1968. During her extensive travels in Europe, the
USA and Japan, she was invited to start a course in music therapy at university
level, but she firmly believed in the importance of highly trained and experienced
musicians as potential music therapists, so she chose to begin her course at a music
conservatoire, where the emphasis was on musical training and skill, rather than
academic knowledge. The programme at the Guildhall School of Music is still
running (now in collaboration with the University of York, which validates it), and
graduates from her courses, including Tony Wigram (Denmark), Leslie Bunt (UK)
and Helen Odell-Miller (UK), have furthered her methods in other training courses.
Mary Priestley (UK) also trained with Juliette Alvin, and went on to found analytical
music therapy (see Chapter 3.3). Many therapists and teachers of music therapy have
been influenced by her methods, and her model of free improvisation therapy is still
taught and used in clinical practice (Alvin 1975, 1976, 1978).
Alvin worked in psychiatry, and also focused her work on children, including
those who are autistic and mentally and physically disabled. She argued that the
analytical concepts of Freud underpin the development of music therapy, as music
has the power to reveal aspects of the unconscious. While not requiring one to
be ‘Freudian’ to believe in this important concept, Alvin’s theory was built on the
primary statement: ‘Music is a creation of man, and therefore man can see himself in
the music he creates.’ This idea was developed alongside Alvin’s perception of music
as a potential space for free expression. She cited Stravinsky as one of the single most
important influences on music in the 20th century, because his compositions broke
the ‘musical rules’ in terms of harmony, melody, rhythm and form, and allowed us
189
to make and experience a range of dissonant and atonal sounds that had previously
been taboo. This opened the door for her development of free improvisation therapy,
where clients and therapists can improvise without musical rules, and where the
music can be an expression of the person’s character and personality through which
therapeutic issues can be addressed.
Alvin died in 1982, as music therapy in the UK was becoming a regulated
profession within the health and social system. Her contribution both at a theoretical
and clinical level was foundational in promoting the value of music therapy, and in
beginning a course in the UK that placed music skill and competence at the centre
of music therapy training and clinical practice. Alvin holds a place in history as one
of the earliest and perhaps most eclectic and inspirational pioneers.

Alvin’s method is musical and based on the following principles:
• All the client’s therapeutic work centres around listening to or making music.
• Every conceivable kind of musical activity can be used.
• Improvisation is used in a totally free way, using sounds or music that are not
composed or written beforehand.
• By sounding the instruments in different ways, or by using unorganised vocal
sounds, inventing musical themes allows great freedom.
• Free improvisation requires no musical ability or training, and is not
evaluated according to musical criteria.
• The therapist imposes no musical rules, restrictions, directions or guidelines
when improvising, unless requested by the client. The client is free to establish,
or not establish, a pulse, metre, rhythmic pattern, scale, tonal centre, melodic
theme or harmonic frame.
These were revolutionary concepts for music therapy in the 1960s, as the main
schools in the USA used conventional, pre-composed music in more behaviourally
orientated therapy. Only Paul Nordoff and Clive Robbins’ model (see Chapter 3.4)
came close to this, although their music was more conventional and structured, and
analytical theory was not inherent in their method.
Alvin taught about the importance of developing the client’s relationship
with music. In her work with people with autism and developmental disability in
particular, she proposed that the client’s relationship with the instrument was the
primary and initial therapeutic relationship. The musical instrument, according
to Alvin, can be the container of the negative feelings projected by the client,
and represents a ‘safe intermediary object’. After this, clients become attracted
to, and form relationships with, the instrument of the therapist, centring their
feelings in the music created together. It is after going through this process that the
development of a relationship directly between client and therapist occurs. So her
concepts relating to the objectives of the therapy, the process of the therapy and
the successful outcome of the therapy start and develop in the musical relationship.
This was a seminal and unique contribution to the theory and understanding of
music therapy from a psychotherapeutic point of reference in the 1950s and 1960s
and was picked up and developed by leading figures in music therapy all over
the world.
From a psychotherapeutic and theoretical point of view, Alvin worked within
the concept of an ‘equal term relationship’ where the therapist and client share
musical experiences at the same level, and have equal control over the musical
situation. This is very significant as a concept, and explains much about the
remarkable effect of her therapeutic approach, and her success in drawing out the
potentials and strengths of clients with whom she worked. Autistic, maladjusted
and physically disabled children responded eagerly to her approach, when offered
an empathic and sensitive musical frame.
Alvin proposed the potential to use different approaches in different situations,
and this ‘eclectic model’ has caused some controversy. She mainly worked from a
humanistic and developmental point of view, often describing in her many cases
changes in the clients’ behaviour that represented underlying changes in their
capacities. When working in the field of psychiatry, she approached clients from a
more analytical perspective.
Alvin believed the therapist’s instrument was their primary means of
communication and interaction. She herself employed a method of ‘empathic
improvisation’ when she used her cello. This involved gaining an insight and
understanding about a client’s way of being, mood and personality, and then
reflecting it back through improvised playing on her cello. This was ‘playing for the
client’ and therefore receptive in style. Therapists can also, through this method,
introduce themselves to the client in a safe and non-threatening way, adjusting their
playing to the listening responses of the client.
Documentation
Alvin wrote extensively about her concepts and ideas of music therapy in her main
books and many clinical articles. Her books were: Music Therapy (1975), Music
Therapy for the Handicapped Child (1976), and Music Therapy for the Autistic Child
(1978). Probably the most useful overview of Alvin’s theory, method, clinical approach
and methods of assessment and evaluation can be found in Unit 3 (Chapter 3)
of Bruscia’s Improvisational Models of Music Therapy (1987). As well as what we know

and understand about the psychotherapeutic functions of music in music therapy,
Alvin placed emphasis on the importance of understanding the physiological effects.
She said one needs to link the psychological effect of music with the physical effect,
and used the examples of shamans and witch doctors from primitive cultures to
illustrate this idea.
Music therapists need to understand human physiology and the way the body
reacts to music and sound to fully grasp the influence of music within music therapy.
Alvin defined some important concepts for our understanding of music therapy within
free improvisation therapy:
• analytical concepts of music
• psychological functions of music
• physiological functions of music
• functions of music in group music therapy.
She formulated a descriptive approach to evaluating the effects of music and music
therapy, including evaluating listening responses, instrumental responses and vocal
responses.
Categorisation
Alvin’s method is not included in Bruscia’s overview; however, her concept of the role
of the music therapist places the level of therapy at either augmentative or primary. In
her own clinical work, Alvin worked as part of multidisciplinary teams in hospitals
and units, but also with individual clients in private practice – as a primary therapist.
3.9 Methods in Music Therapy
Stine Lindahl Jacobsen and Lars Ole Bonde
Music therapists use and apply the properties of music in many different ways
in clinical practice. Often the approach or method is chosen in relation to aims
of treatment and to the individual, personal and clinical needs of the client. It
is not uncommon to use several methods within the same course of treatment
because there are more aspects and factors to consider simultaneously. Several
method-based teaching materials and books have been published independently of
music therapy models, including both specific methods and characteristics across
countries and models. In the following chapters, we zoom in on primary active
methods including improvisation, songwriting and therapeutic voice work, as well
as selected receptive methods.
3.9.1 Improvisation-Based Methods

Improvisation-based methods within music therapy have developed in different forms
and independently from countries and music therapy models. In particular, Nordoff-
Robbins (Chapter 3.4), analytically oriented music therapy (Chapter 3.3) and Alvin’s
free improvisation method (Chapter 3.8) have all markedly affected our history.
Likewise, Bruscia (1987, 2015b) has also contributed to the basic understanding
of improvisation within music therapy. Lee and Houde (2011) have thoroughly
described genre-oriented improvisation practice relevant both in music therapy and
music education. Lee et al. (2011) intend to provide music therapists with innovative
ideas for creating music in a therapy setting looking at compositions, improvising
with orchestral instruments, themes in world styles, themes in contemporary styles,
receptive themes, levels of interaction, and interval explorations. Common to these

forms and applications is the focus on the here-and-now interaction with the client
and the individual needs, characteristics, personal history and values playing an
active role in the interaction.
In 2004, Tony Wigram published the first method-focused book on improvisation
techniques independent of music therapy models and focusing on both musical
and clinical improvisation techniques. With its detailed technical explanations and
illustrative audio examples, it is unique within music therapy literature even though
it primarily addresses improvisation techniques using the piano in contrast to later
publications looking at other instruments and settings (Gardstrom 2007; Oldfield
et al. 2015). However, the techniques are thoroughly described by Wigram (2004),
which does enable transfer of the techniques to other instruments. The first part
193
3.9 Methods in Music Therapy
Stine Lindahl Jacobsen and Lars Ole Bonde
Music therapists use and apply the properties of music in many different ways
in clinical practice. Often the approach or method is chosen in relation to aims
of treatment and to the individual, personal and clinical needs of the client. It
is not uncommon to use several methods within the same course of treatment
because there are more aspects and factors to consider simultaneously. Several
method-based teaching materials and books have been published independently of
music therapy models, including both specific methods and characteristics across
countries and models. In the following chapters, we zoom in on primary active
methods including improvisation, songwriting and therapeutic voice work, as well
as selected receptive methods.
3.9.1 Improvisation-Based Methods

Improvisation-based methods within music therapy have developed in different forms
and independently from countries and music therapy models. In particular, Nordoff-
Robbins (Chapter 3.4), analytically oriented music therapy (Chapter 3.3) and Alvin’s
free improvisation method (Chapter 3.8) have all markedly affected our history.
Likewise, Bruscia (1987, 2015b) has also contributed to the basic understanding
of improvisation within music therapy. Lee and Houde (2011) have thoroughly
described genre-oriented improvisation practice relevant both in music therapy and
music education. Lee et al. (2011) intend to provide music therapists with innovative
ideas for creating music in a therapy setting looking at compositions, improvising
with orchestral instruments, themes in world styles, themes in contemporary styles,
receptive themes, levels of interaction, and interval explorations. Common to these

forms and applications is the focus on the here-and-now interaction with the client
and the individual needs, characteristics, personal history and values playing an
active role in the interaction.
In 2004, Tony Wigram published the first method-focused book on improvisation
techniques independent of music therapy models and focusing on both musical
and clinical improvisation techniques. With its detailed technical explanations and
illustrative audio examples, it is unique within music therapy literature even though
it primarily addresses improvisation techniques using the piano in contrast to later
publications looking at other instruments and settings (Gardstrom 2007; Oldfield
et al. 2015). However, the techniques are thoroughly described by Wigram (2004),
which does enable transfer of the techniques to other instruments. The first part
193
of the book introduces the reader to musical improvisation without a focus on the
clinical application. There is emphasis on letting go of conventional ways of playing
music but still using well-known genres and styles in new, creative and flexible ways.
The last half of the book focuses in on clinical methods and interventions, and this
is further divided into basic and advanced methods.
Basic clinical techniques

Most of the basic improvisation techniques applied in clinical settings centre around
emphatic support and acknowledgement of the client and the music of the client. This
can either be done through mirroring, imitation or copying all of the client’s music.
The music therapist often chooses the supportive intervention when there is a need to
clearly affirm and acknowledge the client in an almost symbiotic musical relation or
interaction. The client can experience this as quite confronting and even unpleasant
or condescending, and therefore the techniques must be applied with caution,
constantly evaluating the appropriateness of the intervention.
Another more flexible way to offer support and acknowledgement to the client
is musically to match all of or parts of the client’s music, where the music of the
therapist has the same form, style or quality as the client’s music. In matching, it
has to be possible to differentiate between the music of the client and the music
of the therapist, and the client is offered unconditional positive attention. The
music therapist can move even further away from the client’s music but still offers
acknowledgement and support without inviting the client to change the expression
in the music by being emotionally reflected in the improvisation. Here the focus
is not on musical parameters or elements but more on moods and atmospheres.
The music of the therapist can be quite different as the mood or state of the client
here is acknowledged or understood by the music therapist and is reflected back to
the client in a new expression. Sometimes the client’s expression is very chaotic or
unstructured, making it almost impossible to match or even imitate for the therapist.
Here the music therapist often applies techniques that are more containing and that
can offer the needed grounding elements.

As a basic technique, improvisation can be applied in trying to form a conversation
or a dialogue with the client. This can either be through clear turn-taking and turn-
giving or in more free-floating dialogues developed naturally or initiated by the music
therapist through musical invitations, cues or signals such as clear musical endings
and clear pauses where the client is invited to fill out the gaps.
Advanced clinical techniques

The purpose of many advanced improvisation techniques is often to invite the client
into increased creativity or into the change and development of the client’s music.
Often therapy centres around finding alternative ways of dealing with or relating
to the surrounding world, with people or life in general, regardless of the specific
problem or challenge at hand. The basic idea behind improvisation techniques in
music therapy is to offer a safe way to explore, find, create and evaluate alternative
ways to interact with the world. Sometimes the client seems to be quite fixed or
locked within one specific expression or maybe even a specific song or phrase. To
unlock the expression, the music therapist often uses techniques that expand the
client’s expressions by first matching and then slowly expanding and changing the
music, thereby ‘seducing’ or inviting the client into trying out other ways of expressing
themselves.
It can be quite effective to create a musical frame around the client’s music
either in the form of clear genres and styles or just using a steady pulse, which the
client can lean on and use to develop their play. Many music therapists also use
accompaniment techniques, especially when the client has found a new independent
expression or when the client actually can cope or do without the clear support and
creative invitations of the music therapist. Quite consciously, the music therapist uses
transitions when there is need for a shift or a change in the client’s music or in the
musical interaction between client and therapist. The transitions can be seductive and
discrete but they can also consist of new elements overlapping old or already known
elements in the music, or the music being brought to a halt from where anything can
happen afterwards – a so-called limbo transition (Wigram 2004).
Group improvisation
When the music therapist plays together with more clients, the focus is to combine
basic and advanced improvisation techniques often simultaneously. The group
needs support and acknowledgement, but help to get assembled or connected
through musical frames and dialogue invitations is also needed. The focus of group
improvisation can be on developing social skills, and often playing rules are applied
to meet this focus either in clear turn-taking activities or through collaboration
exercises. Here the group members have to listen and be attentive to each other in
order to solve or complete simple play rules or tasks such as play soft, play loud
or play soft together. There are many different playing rules adequate and relevant
for both group and individual music therapy treatment and for both social and/or
emotional purposes. Actually, only the therapist’s imagination is a limitation.
Daniel Stern (2010a) talks specifically about Wigram’s (2004) concept of matching
and describes it as a form of affect attunement, which ‘is at the base of so much of
the relationship and the transmission and communication between therapist and
child’ (p.94). Stern connects matching to parent–child interaction and describes the
techniques as essential in emotional communication (Stern 2010a, p.94): ‘Music is
fabulous at it [affect attunement].’ Stern points out that this form of intersubjectivity is
the simple most necessary aspect in successful therapy because it is a form of contact
of which two people can expand (Stern 2010a). In his later publication (Stern 2010b),
Stern calls this moments of meeting, where relationships change and move towards
a deeper form of intersubjectivity. The variation of themes in affect attunement
is important in order to be able to match the emotional quality of the client or
child’s state, and here the parent or music therapist uses different affect attunement
mechanisms and vitality forms such as movement, power, space, direction and time
(Stern 2010b). The possible compliance between Wigram’s techniques and Stern’s
terms is presented in Table 3.9.1.1.
Table 3.9.1.1: Clinical improvisation techniques categorised by clinical purpose

Clinical improvisation Clinical purpose
techniques
Matching To support and acknowledge the client
Grounding To offer the client grounding
Holding To contain the musical and emotional expression of the client
Framing To invite creativity and expression
Accompaniment To support the independent musical expression of the client
Transition To invite the client to vary and expand the expression
3.9.2 Songwriting
Music therapists have always applied well-known songs, framed songs and
songwriting as more or less usual or permanent parts of therapy. In 2005, Felicity
Baker and Tony Wigram published the first method and technique book independent
of specific music therapy models and approaches on songwriting. This book contains
11 different techniques presented by individual music therapists, while the last
chapter written by the editors attempts to look across differences and similarities in
approaches, variations and perspectives within songwriting techniques.
In a later publication, Baker (2015) provides a comprehensive examination of

contemporary methods and models of songwriting as used for therapeutic purposes,
looking at how songwriting is understood and practised within different psychological
and wellbeing orientations, including both environmental sociocultural individual
and group settings. Aasgaard and Ærø (2016) give an overview of songwriting
techniques in clinical practice, with guidelines and many examples.
Songs can offer a feeling of safety and support, and can both stimulate and calm
clients. Songs can assist clients to reflect on their life, connect with unconscious or
unexplored thoughts, and transfer emotions into the music. The structural properties
of songs can help clients strengthen cognitive, physical and communication skills,
and in group settings songs can help clients build community, trust and a sense of
belonging. Songs can also aid and strengthen the relationship between clients or
between therapist and client.
Songwriting is about writing songs together with clients in a process where
the psychological, physiological, emotional, social, spiritual or communication
needs of the client can be met. The therapeutic value consists of the client creating,
performing and/or recording their own song. The music therapist is a facilitator
of this process and is there to help the client find expressions that more or less
reflect the thoughts and emotions of the client. Thus, the focus is both on process
and product, where the product in itself can have therapeutic value, for instance
in the sense of increased self-confidence caused by an authentic self-expression
made accessible for others. There are many ways to apply songwriting in a music
therapy setting, but primarily the techniques can be divided into creation of lyrics
and creation of melody or composition.
Creating lyrics
Some clients produce lyrics spontaneously in the form of poems or short narratives,
but most clients need support in finding the right focus or the right words. The
therapist might suggest a brainstorm on possible themes or suggest words related to
the challenges or narratives of the client. It is also possible to choose words from a list
or use parts of lyrics from known songs. Sometimes the lyrics can emerge by a client
spontaneously singing, rapping or talking over a more or less known musical frame
made by the music therapist. Often the professional skills of the music therapist are
put to use when the fragmented words and the themes have to be merged together
into meaningful song lyrics. Song lyrics do not have to rhyme and you can also let the
client create lyrics at home. Another technique often used is song parody, the use of
well-known lyrics as a rhythmical-metric base for new lyrics – as one might do when
creating personal songs for larger family events such as birthdays and weddings.
Composition – creating melody

The music in the songs can be an existing melody or be produced by the client,
but often the music therapist has to offer assistance in this part of the process.
The melodies and the harmonies can be either partly or completely improvised
by the client and/or the therapist. Perhaps the music therapist creates a harmonic
frame over which the client can improvise, or the music therapist suggests both
melodic phrases and possible chords that can be accepted by the client or not.
Clients need different degrees of structure and support to create lyrics and music,
and even though songwriting techniques can easily be compared across music
therapy models and methods, no two songwriting processes are alike.
Felicity Baker has developed a technique where people with acquired brain
injuries and limited communication skills can express themselves through their
own songs and at the same time train psychological and physiological skills.
The songwriting technique centres round the music therapist offering different
statements that the client then can approve or dismiss with gestures or possibly
verbal responses. Often the text is done first, but it is important to create short songs
that are easy to remember. Likewise, the music is simple and contains repetitions as
the concentration span of the client is often challenged. Baker points out that one
should not underestimate the appealing character of a simple song. The songs of the
clients can also be used to evaluate change and improvement in their competences by
looking at meaningful and consistent content of the songs, repetition, development
of new ideas and improvement of the vocabulary of the client (Baker 2005).
A more unconventional method, also developed by Baker, is writing songs online.
Studies have shown that adolescents with mild autism are more engaged and active
in writing songs with a music therapist online than a music therapist sitting in the
room next to them. Baker points out that this may be due to their familiarity with
and confidence in the internet as a means of communication, and they may favour
the distance also typical of web communication (Baker et al. 2009).
Randi Rolvsjord has also applied songwriting in her resource-oriented approach
within adult mental health and psychiatric challenges. The focus here is working
with the strengths of the client for them to recognise and use their competences and
musical resources and generally use the resources of the music in therapy. Rolvsjord
sees songwriting as a way to express and communicate emotions, work with
emotions, gain new insights and strengthen identity and self-confidence. The client
can feel acknowledged and understood by the music therapist through the song, and
sometimes it is easier for this group of clients to communicate through songs rather
than verbal conversations (Rolvsjord 2001, 2013).
In his many years of clinical practice at paediatric units in Norway, Trygve
Aasgaard has developed different songwriting techniques and he underlines the
importance of flexibility and adaptation to the needs of the individual client and
the demands of the hospital setting. It can be completely different approaches that
will motivate hospitalised children into creating and singing their own songs. Some
might get interested in a certain rhythm, while others focus on strengthening their
autonomy and making all the decisions. Some children want to create happy songs
of hope, while others want to create sad songs of loss, and the music therapist has
to be able to adjust to these needs and make an effort to understand and decode the
child’s feelings. Aasgaard prefers to include the hospital setting in the songwriting
process and especially in performing the songs. The children are encouraged to sing
their songs in front of other children and parents to strengthen their self-confidence,
build unity between children and families and create a culture of enjoyment of life in
the hospital unit that otherwise can be burdened with feelings of sadness, pain and
sorrow. Recording the songs can keep them alive as they can, for instance, be used to
communicate with friends outside the hospital – friends that can choose to respond
with a song of their own (Aasgaard 2002, 2004; Aasgaard and Ærø 2011).
3.9.3 Therapeutic Voice Work

The human voice is the most personal and private instrument we have available,
and both clinical practitioners and researchers seem to agree that the voice is
closely connected with the self or who we are as humans. As with songwriting or
improvisation techniques, using the voice can also be applied to meet different client
needs and therapeutic purpose across all age groups. Diane Austin, an American
pioneer within therapeutic voice work, bases her work on psychoanalytical and
analytical theories (Austin 2008). Felicity Baker and Sylka Uhlig (2011) have divided
therapeutic voice work into two main directions consisting of a psychodynamic
approach focusing on giving inner depths a resonating outer expression and a
medical approach focusing on training, rehabilitating and maintaining the
functionality of the voice and other mental and physical processes. Techniques used
in therapeutic voice work are wide ranging, including different degrees of structure,
from singing freely, singing specific aspects of oneself and singing pre-composed
lyrical phrases. It can either be the music therapist or the client singing alone, and
all constellations can be with or without accompanying instruments. However,
certain common characteristics in relation to the role of the music therapist, the
role of the music therapist’s voice and the voice of the client seem to be present.
It can be quite challenging for the client to use their voice, and the therapist often
has to make an effort to create a feeling of safety for the client to be brave enough
to dive into voice work activities. One way of creating trust is to be a role model
and show the client how the voice can be used or to offer musical support through
instruments and musical frames. The music therapist can also focus on choosing
songs and voice exercises that gently can expand the vocal expressions of the client.
The therapist also facilitates the possibility to verbally process voice expressions, and
this can promote insights, development and positive change.
The voice of the music therapist can be supportive to the client by applying
imitating, grounding, matching or containing improvisation techniques (see Chapter
3.9.1). A possible psychological parallel to early non-verbal interaction between
parent and infant may be a factor in this intervention form, often being quite effective
and nourishing to the client. Simultaneously, the music therapist can engage the
client and invite them into dialogues by adjusting to the voice expressions of the client
and, when appropriate, gradually guiding the client into new directions (again this is
comparable to improvisational transition techniques – see Chapter 3.9.1). Through
vocal expressions, the client can express repressed emotions such as frustration and
aggression by screaming, babbling or sighing. Often the voice functions as a link
between the self and the self-expression, but therapists also focus on (re)building or
maintaining the functionality of the voice (or both).
Active music therapy intervention methods such as improvisation, songwriting
and therapeutic voice work all rest on the same cornerstone and the same basic
idea. In a here-and-now interaction between the music therapist and client, the
self‑expression of the client or the way of relating in the client is activated, and it
becomes possible for the client through the musical interaction and through the
support of the music therapist to try out alternatives, develop expressions, and
experience or realise personal possibilities, limits and potentials.
In her psychodynamic voice work approach Sanne Storm (2013, 2017)
describes how focused voice work can help free fixed energy, create new insights
and foster personal development. According to Storm, the voice includes all
the different vocal sounds a human can create, but the voice is not only one
element. If the client can focus on vocal sounds instead of the meaning of the
words, an independent individual expression emerges which can inform about the
psychological state of the client. The timbre, rhythm and melody of speech and the
volume of the voice are all active parameters when we unconsciously decode the
psychological state of humans in conversations in everyday life. In working with
people with depression, Storm focuses on the vocal sound of the voice, on the body
and psychodynamic movements, and on listening to both voice and body with
specific listening attitudes. Together with the music therapist, the client listens to
their own voice, how it feels in the body, and afterwards reflects on the emerging
sensations, emotions and thoughts. The method includes specific techniques such
as grounding, breathing and voice exercises, including glissando movements,
singing a core tone and free vocal improvisations. These techniques are also part
of a voice assessment tool developed by Storm where simple exercises are analysed
looking at timbre, rhythm, melody and volume to assess the state of the client
(Storm 2018; see also Chapter 5.2).
3.9.4 Receptive Methods

Listening to music has been applied for therapeutic purposes since ancient times
(see Chapter 1.1). Listening to music is one of the most common practices in the
world, and there is no right or wrong way to listen but many different approaches
(Bonde 2011b). Chapter 3.2 focuses on guided imagery and music (GIM), one of
the most widespread and advanced models of receptive music therapy, but music
listening can be applied in many different ways in order to meet different client needs
and therapeutic purposes across age groups, diagnoses and theoretical backgrounds.
Denise Grocke and Tony Wigram (2007) published a comprehensive method book
presenting a range of different techniques and interventions. The book is structured
in the following sections, all including descriptions of settings, procedures and
repertoire suggestions:
• relaxation and music listening for children and adolescents (somatic and
psychiatric hospitals, palliative care and schools)
• receptive methods and inductions for adults (hospitals and palliative care)
• music, visualisations and imagery (group/individual – guided/unguided)

• song lyric discussion, reminiscence and life review
• perceptual listening and music appreciation (individual/group, intellectual
disability)
• receptive music therapy and art media (drawing and narrative)
• vibroacoustic therapy and receptive music therapy
• music and movement.
Clearly there are many ways to work with music listening in music therapy in relation
to the individual needs of clients, but often music therapists also work in smaller or
larger groups.
Listening groups
Listening groups are applied within many different didactic and therapeutic contexts.
When working with groups of refugees, the participants can, for instance, in turn
bring recordings of music from their home country, play the music for the group and
explain the traditions, history and emotions connected with the music. The purpose
can be to strengthen language skills, supporting integration into the current or new
country, but such an activity can also be used as a way to focus on healthy parts of
the participant in a constructive and resource-oriented manner. Deep respect for the
individual choice of music and its connected history will often develop in a music
listening group (see Chapter 4.6.1).
Within adolescent and adult mental health, listening groups are offered to
patients in open or closed settings. Participants listen and talk about music chosen
by the participants or the music therapist (Lund and Fønsbo 2011). Here the purpose
can be, for instance, to verbalise emotional experiences, to work with the identity-
promoting potential of music and to strengthen the feelings of unity and togetherness
in the group. Work with multimodal imagery can also be part of the activities in a
listening group, as described by Torben Moe in his work with substance abuse in
psychiatric units (Moe 2007).
Lund and Fønsbo (2011) have studied types of receptive group music therapy
applied in psychiatry in Denmark and identified elements that in different
combinations form specific types including (1) listening to music (chosen by the
patient or the therapist), (2) verbal dialogue, (3) relaxation, (4) artwork, (5) imagery
and (6) improvisation.
Lisa Summer (2002) differentiates more generally between listening groups
with or without interaction between group members. Groups without interaction
are not actually group therapy but can be understood as ‘individual work in a
group setting’. Dynamic group work is when members of the group interact and
activate powerful group dynamics that can be used for therapeutic purposes.
Based on a psychotherapeutic classification of levels (Wolberg 1977), Summer
(2002) describes the development of an interactive group format, ‘group music
and imagery’ (GrpMI) (Grocke and Wigram 2007, p.139; see also Grocke and
Moe 2015). Here, the needs of the individual participants and the specific clinical
context are organised in one of the following three levels: 1) Supportive; 2) Re-
educative; 3) Re-constructive. The three levels, briefly described below, have
different requirements in relation to the participants, the therapist, the setting and
the choice of music.
1. Supportive level: The participant’s sense of feeling safe in relation to the
therapist, each other, the music and the imagery is essential. Trust is necessary,
especially for vulnerable and ego-weak clients to engage in the music and
to dare to share the experience. The intervention is meant to engage the
participants in positive experiences that can strengthen self-confidence and
a sense of belonging. This can happen through positive aesthetic experiences
stimulated and supported by short, simple and structured music based on
different musical genres and styles. (Examples can be found in Bonde and
Pedersen 2015; Grocke and Moe 2015; Pedersen and Bonde 2013; Summer
2002.) The therapist must ‘hold’ the group and facilitate and enhance the
positive experiences that can promote ego-development.
2. Re-educative level: On this level, the participants have a more consolidated
and developed ego, and the purpose of group music therapy here is to
support change through new insight and enhanced self-awareness. Trust is
still a precondition for development and change; however, on this level the
focus can include resources of as well as challenges for the client – such as less
appropriate, troublesome patterns and emotional reactions. A safer group
enables more focus on conflict material. The music applied is still simple
and with aesthetic appeal, but it can be longer and contain more variation
(see the taxonomy categories in Chapter 2.5.3; other examples can be found
in Grocke and Moe 2015; Summer 2002). An important task of the therapist
is to help the participant understand the link between imagery and conflict
material, which can happen when participants comment and give feedback
on each other’s experiences.
3. Re-constructive level: This level is rarely possible when working in somatic or
psychiatric hospital units as it requires a strong ego in the participants and a
readiness to be challenged. The purpose is personal change and growth and
eventually transpersonal change. Therefore, the setting often has an explicit
focus on change and self-development. There is a potentially high level of
acceptance regarding challenges from the therapist, the group and the music,
and there is a high degree of interaction. Music on this level can be more
complex and varied, and often classical music of 10–12 minutes’ duration is
used, such as symphonic music by Brahms and Mahler (taxonomy category
2 in Chapter 2.5.3).
The three levels are discussed and exemplified in a Danish context by Bonde and
Pedersen (Bonde 2011b; Bonde and Pedersen 2015; Pedersen and Bonde 2013) as
GrpMI with psychiatric outpatients.
3.10 Physiological Reactions to Music
Tony Wigram and Lars Ole Bonde
‘If music be the food of love, play on’ – a well-known line from Shakespeare tells us
of the place music holds in the emotional lives of people, particularly in its subtle
and powerful psychological effect. We can also see in music therapy the frame music
provides for reaching to a deep psychological level. However, Juliette Alvin, one of
the foremost pioneers of music therapy, once said that we should never ignore the
physical effect of music. She felt it was necessary to study physiology, to understand
how music can affect the body, and that this aspect was often ignored because it was
not ‘romantic’, and did not seem to relate to the more important psychological and
psychotherapeutic processes in music therapy. Yet one cannot have the emotional
effect of music without a corresponding physical effect, and all physical effects of
sound inevitably provoke a psychological reaction. A good example is what John
Sloboda (2005), a leading music psychologist in Great Britain, referred to as the
‘DTPOTA’ effect (‘Darling, They’re Playing Our Tune Again’) in provoking physical
‘goosebump’ responses through association, and the effect of music to recall memories
and associations is very powerful.
Earlier, the study of how music affects us physiologically fascinated
psychologists and physicians more than music therapists. Many extensive
investigations and quite detailed studies have been undertaken. More recently,
music therapists have engaged in the question of how the brain perceives and
processes music, and how music influences the human being physiologically.
Whether it is psychologists, music therapists or doctors looking at the physical
effect of music and sound, interesting results from the research studies have
included the way music influences:
• heart rate
• blood pressure
• respiration
• skin temperature
• electrodermal activity (arousal levels)
• brain waves (electroencephalography).
Even if a music experience is predominantly individual, it makes sense in the study of
the physiological effects of music listening to make a distinction between ‘stimulating
music’ and ‘relaxing music’.
204
Stimulating music tends to enhance body energy, induces bodily action and
increases heart rate and blood pressure, while sedative or relaxing music can reduce
heart rate and blood pressure, reduce arousal levels and generally calm individuals.
Some researchers have tried to establish links between heart rate, blood pressure and
anxiety, but there are many reasons why heart rate and blood pressure will change,
and individual differences make it difficult to establish that any specific piece of music
will universally reduce or increase these parameters, even if the change may be linked
to raising or decreasing anxiety.
An example is a classical study by Landreth and Landreth (1974), who recorded
changes in heart rate in 22 members of a college-level music appreciation society while
listening to the first movement of Beethoven’s Fifth Symphony. Taking measurements
over a six-week period, before, during and after the experiments with listening to
this music, they found significant changes (tachycardia and bradycardia) in different
parts of the music. However, there was not a consistently reliable effect on listeners’
heart rates.
Individual likes and dislikes in music mean that the effect will vary. For example,
when using biofeedback methods to develop a music-based, individualised relaxation
training (MBIRT), Saperston (1989) found that a patient who identified with the
hippy subculture of the 1960s was more likely to relax to rock music, whereas another
patient relaxed to Indian sitar music.
In considering the physical effects of music, it is therefore more important to
look at the elements in the music that might affect stimulation or relaxation. Wigram
(2001; Grocke and Wigram 2007) defined the parameters that influence whether
a piece of music has such effects in terms of predictability within the music. If the
musical elements are stable and predictable, then subjects will tend to relax, whereas
if the elements in the music vary significantly over time, and are subject to sudden
and unpredictable change, then the subject will maintain a higher level of arousal
and stimulation.
Potential elements in stimulating music are:
• unpredictable changes in tempo

• unpredictable or sudden changes in volume, rhythm, timbre, pitch, harmony
• wide variations in texture in the music
• unexpected dissonance
• unexpected accents
• harsh timbres
• loose structure and unclear form in the music
• sudden accelerandos, ritardandos, crescendos and diminuendos
• unexpected breaks in the music.
Potential elements in relaxing music are:

• stable tempo
• stability or only gradual changes in volume, rhythm, timbre, pitch, harmony
• consistent texture
• predictable harmonic modulation
• appropriate cadences
• predictable melodic lines
• repetition of material
• simple structure and clear form
• gentle timbre
• few accents.
In developing musical skills to be used in clinical improvisation, music therapy
students and qualified practitioners learn how these elements can be balanced and
used in a very sensitive and subtle way to engage and help patients. Some clients
need the stability and safety of predictable music, for example people with psychotic
disturbance, whose world is chaotic and disconnected. Others, for example patients
with autism, learning disabilities or anxiety neuroses, need to develop abilities to
cope with an unpredictable world, and this can begin in developing adaptability to
unpredictable musical experiences. So these elements of music that can determine
the effect in receptive music therapy also play an important role in active music-
making with clients.
Many recent research studies investigate how music influences the body, but in the
present context we can mention only a few. Some of the leading music neuroscientists
have published review articles. Altenmüller and Schlaug (2012) present a summary of
the biological foundations of music’s potential health effects. Koelsch and Stegemann
(2012) focus on how music influences the immune system and how musicking is
related to health-promoting social functions. Koelsch (2013) identified seven specific
social functions of music, the ‘7 Cs’: individuals have contact with other individuals
when playing together, they engage in social cognition, participate in co-pathy (the
social function of empathy), they communicate and coordinate their actions, and
cooperate with each other, and this leads to increased social cohesion. Kreutz and
colleagues (2012) reviewed studies of the influence of music on the bio-markers that
drive stress and wellbeing physiologically. West and Ironson (2008) describe research
methods and designs used to study the influence of music on health and wellbeing,
and they present a number of (‘music-body-mind’) theories suited to connect basic
research with the clinical practice of music therapy in a broad cultural perspective.
The meta-theory of Clark, Baker and Taylor (2014) is founded on a review and
comparison of research-based theories on the influence of music on movement,
training and physical activity – and the relevance of these theories for music therapy in
neuro-rehabilitation, in sports training contexts and in the study of motoric processing
of auditory stimuli. They identified two consistent themes in the reviewed theories:
1) music’s ability to evoke physiological arousal, combined with 2) positive subjective
experiences. In other words, if the music is experienced as relevant and pleasant, it can
stimulate and support increased physical activity such as more intensive training and
performance, more engaged participation and more precise patterns of movement. This
meta-theory is especially relevant for music therapists who work within a cognitive-
behavioural paradigm. Clark, Baker and Taylor have published several studies of how
music can stimulate physical activity in different client groups.
The Swedish physician, musician and public health researcher Töres Theorell
has published a book entitled Psychological Health Effects of Musical Experiences:
Theories, Studies and Reflections in Music Health Science (Theorell 2014). Based
on reviews of a great number of studies, including his own, he covers themes like
‘Stress and music’, ‘Physiological effects of listening to music’, ‘What happens in the
body during singing’ and ‘The musicians’ health’. In a recent article, Theorell (2018)
explains how music translates itself biologically, and how knowledge of this can be
used to inform not only music therapy but also public health initiatives.
Vibroacoustic and vibrotactile therapy

One of the areas where music has been used specifically as a physical treatment is
the ‘vibroacoustic’ form of therapy. Music is played through speakers built into a
chair, mattress or bed on which the patient is sitting or lying. The patient therefore
experiences directly the vibrations created by the music. This is a receptive form
of music therapy, which nevertheless still involves a client–therapist relationship.
In Europe, the main pioneers of vibroacoustic therapy were Olav Skille in Norway,
Petri Lehikoinen in Finland and Tony Wigram in Denmark and England. Many
vibroacoustic and vibrotactile devices have been developed in the USA and Japan.
However, in England, the treatment has involved the use of pulsed, sinusoidal low-
frequency tones between 30 Hz and 70 Hz combined with appropriate and relaxing
music. (See Lehikoinen 1988, 1989; Skille 1982a, 1982b, 1989a, 1989b, 1992; Skille
and Wigram 1995; Skille, Wigram and Weekes 1989; Wigram 1991a, 1992a, 1993,
1996b, 1997a, 1997b, 1997c, 1997d, 1997e.) Wigram and Dileo (1997) is a collection
of vibroacoustic studies.
Anecdotal results accrued over many years of experimentation and treatment
sessions can be looked at as helpful and guiding rather than statistically significant.
There has been a certain amount of objective research into vibroacoustic therapy,
including two doctoral dissertations (Chesky 1992; Wigram 1996b), although very
few studies undertaken have been replicated. However, there has been a wide clinical
application of this ‘treatment’, and many results have been positive.
Collated reports fall into five main clinical/pathological areas:
• pain disorders
• muscular conditions
• pulmonary disorders
• general physical ailments
• psychological disorders.
An overview of vibroacoustic treatment within these five clinical areas can be found
in the first edition of this book (Wigram, Pedersen and Bonde 2002).
In Jyväskylä, Finland, a Nordic centre for training, treatment and research in
vibroacoustic therapy opened in 2013, named after two of the pioneers: The Skille-
Lehikoinen Centre for Vibroacoustic Therapy and Research (VIBRAC). Two of the
researchers have published an overview article on the development and present
situation of vibroacoustic therapy (Punkanen and Ala-Ruona 2012). The journal
Music and Medicine published a special issue on vibroacoustics in 2017.
3.11 Music Medicine and Music Therapy
.
Lars Ole Bonde
Music medicine – sometimes also called ‘music in medicine’ or ‘musicmedicine’ – is

the use of pre-recorded or live music by medical professionals to improve patient
status and medical care. Music medicine is employed in a variety of settings within
somatic or psychiatric hospitals directed towards many medical conditions and
procedures – for example, needle interventions or electroconvulsive therapy (ECT)
– to enhance or facilitate the treatment and to assist rehabilitation. Music is used
to influence the patient’s physical, mental or emotional states before, during or
after medical, dental or paramedical treatment (Bruscia 1998; Dileo 1999; Schou
2007). The music is played via sound systems, ordinary or specially constructed
loudspeakers, headphones, ‘music pillows’ or Bluetooth devices driven by mp3
players, special applications (apps) or smartphones. Patients can listen in the wards
or in the individual hospital bedroom (Lund, Bonde and Bertelsen 2016). There is
usually no therapeutic relationship established through music involved in such a
procedure. From a paradigmatic point of view, music medicine might be seen as
a cognitive-behaviourally oriented intervention model.
The fundamental difference between music medicine and music therapy is
that while music medicine is based on a stimulus-response paradigm, the latter is
relational and always involves the triad of music, patient and therapist. Such a music
therapeutic relationship also includes assessment, treatment and evaluation. Music
medicine is most often administered by a nurse or other member of the medical staff.
The music used may have been chosen or developed by a music therapist, but this
is most often not the case. Most music medicine protocols have been developed by
medical doctors, nurses or music psychologists, and often the music is composed by
musicians or composers who may or may not have medical or therapeutic training.
The music experience in music therapy is always embedded in the therapeutic

relationships that are both interpersonal and intermusical. The difference between
the two practices is illustrated in Figure 3.11.1.
209
MUSIC THE RAPY

Interpersonal relationship
Patient Therapist
Receptive: Listening
Expressive: Playing,
singing, improvising
Intramusical Intramusical
relationship relationship
Music
Intermusical relationship
MUSIC ME DICINE
Selection Intramusical relationship
Therapist Patient Music
Feedback
Figure 3.11.1: Elements and relationships in music therapy and music medicine
Music medicine is quite well established in North American hospital treatment

and care, but only on its way in other continents. Apart from palliative care, music
therapy is much less included in somatic care worldwide; however, there is evidence
that both practices are effective. Dileo and Bradt (2005) examined the therapeutic
effects of the two practices in 11 medical areas, based on 183 controlled studies.
Their conclusion was 1) that both practices had a significant effect in 10 of the 11
areas, and 2) that the effect of music therapy in most areas was almost double the
effect of music medicine (effect size measured as Cohen’s d). In a recent Cochrane
review of music interventions (Bradt and Dileo 2014) it was not possible to compare
the two intervention types, so the main conclusion is that both music medicine and
music therapy are effective and can serve as complementary practices in somatic
care. The same conclusion can be found in a large Japanese review including 16
Cochrane reviews and five other meta-reviews of controlled studies of the effects
of music therapy and music medicine interventions (Kamioka et al. 2014, p.727):
This comprehensive summary of systematic reviews demonstrated that MT
treatment improved the following: global and social functioning in schizophrenia
and/or serious mental disorders, gait and related activities in Parkinson’s disease,
depressive symptoms, and sleep quality. MT may have the potential for improving
other diseases, but there is not enough evidence at present. Most importantly, no
adverse effect or harmful phenomenon occurred in any of the studies, and MT was
well tolerated by almost all patients.
In this quote, ‘MT’ covers music therapy as well as music medicine, and it will probably
take some years before there is enough evidence to study their effectiveness separately
within a range of somatic areas. Bro and colleagues recently published a systematic
review and meta-analysis of music interventions (in most cases music medicine)
in cancer care (Bro et al. 2017). Their conclusion is quite typical for meta-reviews
these years: ‘Music may be a tool in reducing anxiety, pain and improving mood
among cancer patients in active treatment. However, methodological limitations in
the studies carried out so far prevent firm conclusions.’
The application of music in the field of medicine has become more defined and
precise in recent years. There are two international organisations: the older is the
International Society of Music in Medicine (ISMM), founded in 1982 and including
mainly medical practitioners, but also nurses, psychologists and music therapists. The
younger is the International Association for Music and Medicine (IAMM), founded
in 2008 and since 2009 responsible for the interdisciplinary scientific journal Music
and Medicine. The editors are the German pioneer Ralph Spintge, who was also one
of the founders of ISMM, and Joanne Loewy, leader of a model music therapy clinic
at Mount Sinai Beth Israel Hospital in New York.
Music therapy may relate to the medical treatment of the patient in a variety
of ways:
• Supportive to medical treatment (e.g. the use of music listening during
kidney dialysis).
• As an equal partner to medical treatment (e.g. the use of singing in
conjunction with medication as a treatment for respiratory disorders).
• As a primary intervention for a medical condition (e.g. the use of music
listening to directly suppress pain). (Dileo 1999; Maranto 1993)
These three levels correspond to Bruscia’s ‘levels of practice’ (Chapter 3.1). Within
the medical field, Bruscia (2014a) makes a distinction between ‘Music therapy in
medicine’, which is a short-term supportive intervention focusing on anxiety and
pain reduction, and ‘Medical music therapy’ at the complementary level, offering a
holistic treatment over a longer time and with broader aims.
Medical and dental practitioners use pre-recorded, in some cases specially
composed, music as a background relaxant, for example in waiting rooms, but this
must be clearly differentiated from the specific application of music in a treatment
process. This is important when considering the use of recorded music in a variety
of situations where it may or may not have a therapeutic purpose. Additionally, it
may or may not have a therapeutic effect, something that the institution or unit using
music in this way may or may not have intended, and of which they may or may not
be aware.
It has become common practice for surgeons (especially in the USA) to have
background music in the operating theatre during operations. The music can provide
a relaxing and conducive atmosphere for the operating team, and is not intended
for the anaesthetised patient. However, there is some research on the use of music
in surgical procedures, particularly in operations where the patient is conscious and
under spinal anaesthesia (Spintge 2012; Spintge and Droh 1992). Spintge describes
the use of ‘anxioalgolytic music’ in medical and surgical procedures to reduce the
distress, anxiety and pain suffered by patients. From a psychological point of view,
Spintge’s studies reported significantly reduced anxiety and improved compliance,
particularly during the preparation phase before a surgical procedure. From
physiological measurements, he reported a significantly reduced need for medication
during surgery, especially during procedures where the mode of anaesthesia was
other than a general anaesthetic.
Spintge looked at the musical elements he was using, in order to define differences
in music he would describe as ‘relaxing music’ and the elements in the music he
would describe as ‘anxioalgolytic music’. In order to select appropriate music that he
expected would have the effect of reducing anxiety, Spintge suggested some specific
parameters for ‘anxioalgolytic music’ that differentiated it from relaxing music (see
Table 3.11.1).
Table 3.11.1: Musical parameters of relaxing music compared with anxioalgolytic music
Music elements Relaxing music Anxioalgolytic music
Frequency 600–900 Hz 20–10,000 Hz
Dynamics Little change in dynamics Little change in dynamics
Melody Regular, continuous Regular, continuous
Tempo 60–80 beats/min 50–70 beats/min
Rhythm Constant: little contrast Floating: no contrast
In Chapter 3.10 there is a related comparison of relaxing versus stimulating music.

Grocke and Wigram (2007, p.46) describe in detail how variations of musical
elements can have a relaxing, calming effect – or stimulate movement or imagery.
All musical parameters can be varied: tempo, volume, dynamics, timbre, harmony,
melody, rhythm and form. If these parameters are stable, repetitive and predictable,
they may influence the autonomous nervous system and physiological processes
such as pulse, breathing, heart rate and brain waves: arousal can be regulated down.
However, the patient’s personal musical preferences are important; they must find
the music accessible and relevant. If the music creates physical or psychological
discomfort, for example because the style is unfamiliar or unattractive, it cannot
have a relaxing effect. This means that playlists/applications created for relaxation or
down-regulation of arousal must include different musical styles while all selections
still meet the demands identified by Spintge, Grocke and Wigram (Lund, Bonde and
Bertelsen 2016).
Many examples of music medicine and research studies were presented in the
first edition of this book (Wigram et al. 2002, pp.145–147). ISMM published three
conference reports entitled Music and Medicine (1992, 1996, 2000), including a
number of pioneering studies. Since 2009, the IAMM journal Music and Medicine
has published a large number of articles, often by interdisciplinary teams. The journal
homepage lists the following topics covered in the journal:
Analgesia and Music Sedation – Brain Music Approaches – Cancer Care: Active and
Receptive Music Approaches – Cardiology and Rhythm – Clinical Improvisation in
Health and Disease – Dementia, Stroke and Music Memory – Environmental ICU
Music – Infant Stimulation – Integrative Music Medicine – Medical Conditions and
Treatment of Musicians – Medical Ethnomusicology – Medical Music Psychotherapy
– Mood Disorders and Music Psychology – Music and Culture in Medicine – Music
Health and Wellbeing – Music in Transition: NICU, Hospice to End of Life – Music in
Surgery: Pre-op to Post-op – Music in Traumatic Response and Injury – Neurologic
Music Approaches – Pain and Palliative Medical Music Strategies – Psychosocial
Music Interventions – Respiratory Music Advances: Asthma, CF, COPD – Song,
Sound and Resonance in Mind-Body Medicine – Stress Response and Music
Relaxation – Vibration and Toning in Medicine
A neurologist and a music therapist (Schneck and Berger 2006) have formulated a
theory of analogies (isomorphy) between musical and bodily elements and processes,
for example rhythm as a periodical organisation of (musical or physiological)
progress in time. Such a theory can help explain the effect of music interventions in
medical contexts. A music therapist and a medical doctor (West and Ironson 2008)
have collaborated on a review of research (variables and designs) into the effects of
music on health and wellbeing. A special feature of this article is that the question
of music’s effect is seen in a larger, cultural context: music medicine is not a neutral
concept of music’s universal potential as a healing agent; the specific culture and its
understanding of music and health always plays an important role.
The nurse Ulrica Nilsson is a Swedish pioneer in music medicine research
and she has published a number of controlled studies documenting the relaxing
effect of music listening applied to different medical procedures (for an overview,
see Nilsson 2008). In Denmark, the composer Niels Eje worked together with the
physiologist Lars Heslet to create a specific music concept for hospitals: MusiCure.
It was originally aimed at creating a beneficial sound milieu in recovery rooms for
patients after operations (Schou 2007; Thorgaard et al. 2005); however, MusiCure
has been documented as effective in many other contexts, for example sleep support
and relaxation for veterans and patients with mental health problems. Samples of
MusiCure have also been used as a playlist among others in relaxation studies, for
example Karin Schou’s study of guided relaxation with music (GRM) for heart surgery
patients (Schou 2007, 2008; see Chapter 4.5.2). Schou offered participants a choice
between four styles, and the tendency was clear: 1) Easy listening (60%), 2) Classical
music (25%), 3) MusiCure (13%), and 4) Jazz (2%). Lund, Bonde and Bertelsen
(2016) report on the development of the special app The Music Star, designed to
help psychiatric inpatients to find music that can help them calm down and relax.
MusiCure is included in the series of playlists in different styles, all created to follow
the taxonomy of supportive music presented in Chapter 2.5.3.
The use of specially developed playlists – as an alternative to 1) the patient’s
own or preferred music and 2) expert-chosen or specially composed music (such
as MusiCure) – is a fairly new trend in music medicine. Short and Ahern (2008)
described the use of playlists (again including MusiCure) with patients in an
emergency department in an Australian hospital. They present professional and
ethical arguments for the use of playlists to give patients an informed choice, based
on personal preferences as well as expert knowledge of taxonomies and the complex
interplay of musical parameters.
There is a need to clarify practices and competences in music medicine, because
in many studies no distinction is made between music medicine and music therapy,
and this can create inappropriate confusion (Bonde and Robinson 2017; Gold et al.
2011). Many agents use music in hospitals – medical staff, music therapists and
musicians – and all have important contributions to make. Dileo (2013) proposed a
model for identifying practices within music medicine, developed from her earlier
classification with three categories (Dileo 1999): music therapy, music medicine
and performing arts medicine. Based on a content analysis of articles in Music
and Medicine (2009–2013), she suggested a revised classification system with four
categories characterising the interface of music and medicine:
1. Treatment of musicians (a. by medical personnel; b. by music therapists).
2. Music in medical and health education (a. in medical humanities; b. in
medical education; c. in health education).

3. Music practices for medical patients and staff:
3a. by musicians (a1. environmental music practices; a2. diversional music
practices)
3b. by medical personnel (b1. music medicine; b2. music performance for
patients; b3. personal use during medical procedures)
3c. by music therapists: music therapy with medical patients.
4. Foundational research (e.g. music neuroscience, physiological responses to
music).
Dileo expects that practices will develop further and new categories may be necessary
to reflect the growth of research and practices in the area.
Summary
There is an international increase in the acknowledgement and implementation of
music interventions in somatic as well as psychiatric hospitals. This is based on a
large number of studies documenting the effect of music listening in many different
medical contexts. Music interventions to reduce anxiety and pain have been in focus,
and music can also be used systematically also to evoke other beneficial physiological
or psychological effects in hospitalised patients. When music therapy is implemented
in hospitals, it also enables special, individualised treatment of patients with special
needs and unusual high levels of anxiety or arousal. This may be the explanation of
why music therapy in some meta-analyses has a larger effect than music medicine
(Dileo and Bradt 2005).
In music medicine, research is very focused on specific variables and the
predominant design is experimental, often in randomised controlled trials. Evidence
is based on a systematic and controlled collection of data and objective analyses, often
with advanced statistical procedures. Basically, music therapy and music medicine
belong to different paradigms, but interdisciplinary collaboration is becoming
mainstream. Music therapists develop playlists and music listening procedures and
train hospital, staff in using them in daily routines; they work individually with
hospital patients who have special needs, and as milieu therapists they can fill hospital
areas with sound, music, tears and laughter.
3.12 Music and Healing
Lars Ole Bonde
Music has been used for healing purposes since the dawn of civilisation. There is a
direct line from classical Greek music philosophy (see Chapter 1.1) to many current
healing practices based on sound vibration, or music healing. The crucial difference
between music healing and music therapy is ontological. It becomes obvious when
answering the question: Where does the healing power of music come from? What
is it that promotes (healing) change?
In the different models and methods of music therapy described earlier in
this section of the book, therapeutic change is promoted by the dynamic ‘triad’:
client–therapist–music (experience). In healing practices, the changing agent is ‘the
universal forms of energy in music, and their elements – sounds and vibrations’
(Bruscia 2014a, p.226). For the same reason, music healing is often connected with
an inclination towards spiritual practices, rituals or procedures with a background
in religion or nature worship. The basic idea is that everything in the universe is
vibration. Some vibrations can be felt in the body, some can be seen or heard, while
others can only be perceived in altered states of consciousness. The vibrations of a
living body can be in or out of harmonic balance, and with sound and music the
disturbed inner balance of a human being (or the balance between the individual
and the universal) can be restored.
Bruscia makes a distinction between sound healing (which is considered a form
of music therapy, when music plays an important role) and music healing. He writes:
Sound healing is the use of vibrational frequencies or sound forms combined with
music or the elements of music (e.g. rhythm, melody, harmony) to promote healing.
The use of sound alone, without music, is called Sound vibrational healing, while
Musical sound healing is the use of music experiences and the inherent universal
energy forms in music to heal body, mind and spirit. (Bruscia 2014a, p.564)
In other words, the difference is a matter of the understanding of the aesthetic
dimension of music and of music as a means of interpersonal communication. It is
obvious that it is difficult to distinguish clearly between physiological methods like
vibroacoustic and vibrotactile therapy (Chapter 3.10) and sound healing on one side,
and between music healing and music therapy for self-development and spiritual
purposes, like guided imagery and music (Chapters 3.2 and 4.7), on the other. The
common denominator of the traditions is that music is used as therapy or as an
agent of healing. The differences lie mainly in the understanding of the human being
and of music, in the understanding of the potentials of the therapeutic relationship
216
(client–therapist–music), and above all in the understanding of the healing potentials

of the music experience: whether it is the work of the individual client (the potential
of self-healing) and the therapeutic relation – or the work of universal, collective,
possibly divine powers that are externally channelled into therapy.
There are many different procedures, variations and techniques within vibration,
sound and music healing (see Campbell 1991, 1997; Gardner-Gordon 1993; Halpern
1985; Hamel 1979; McClellan 1988; an overview is given in Bruscia 2014a). We shall
only mention a few practices that are internationally common (after Bruscia 1998,
Chapter 20). For a critical discussion of music healing theory and practice, as found
in the ‘new age’ literature, see Summer (1996).
Procedures within sound healing

Body and voice work
These procedures include the use of breathing, body and voice exercises and
techniques to set the voice of the individual client free, in a process aimed at the
elimination of muscle tensions, energy blocks and limitations in body, mind and
spirit. Examples: the voice-building principles of the Roy Hart Theatre (Storm
2007, 2013), and the ‘therapeutic voicework’ of the British therapist Paul Newham
(Newham 1993, 1998).
Healing with sound bowls, gongs and overtones

This concept covers the use of the voice and ancient Eastern ‘instruments’, their
fundamentals, vibrations and rich spectra of overtones to promote resonance and
balance in the listener. The ancient instruments are often used in combination with
meditation, Gregorian chant and overtone chanting. Examples: Michael Vetter, David
Hykes and the Harmonic Choir, Igor Reznikoff (see also Moreno 1988).
Toning
This is a technique utilising the conscious sustaining of sounds and tones produced
by the voice of the client and/or the therapist, directed inwards, to the body, or
outwards. It may be a question of finding, sustaining and exploring a specific tone
(frequency and sound quality) by using, for example, different vocals, consonants,
rhythms or mouth positions, but without text or melody. The purpose may be that the
client finds their own ‘personal tone’ or ‘fundamental’, cell changes in body tissues,
pain reduction or the activation of energy centres or chakras. In group work, toning
can be a powerful technique to achieve attunement of group dynamics and energies
(see Gardner-Gordon 1993; Garfield 1987; Myskja 1999).
The use of the monochord or other ancient healing procedures

In Chapter 1.1 the monochord was described as the instrument used in Pythagoras’
experiments. Today, the monochord is used in different versions where the strings
are tuned in octaves and fifths and mounted on sound bodies that can be shaped
as beds or chairs or as mobile devices (‘body tamburas’) that can be placed directly
on the client’s body (chest or back). The sounds (that can be accompanied by voice
improvisations) are experienced with the body as well as with the ear. The effects of
this sound massage have been studied scientifically in different clinical contexts (Teut
et al. 2014; Tucek 2005, 2007).
Crowe and Scovel (1996, in a special issue of Music Therapy Perspectives) divided
the field of sound healing into six areas:
• Self-generated sound (toning, overtone chant, chakra sounds).
• Projection of sounds into the body (Cymatic therapy, radionics, tuning
forks).
• Sounding the body (the ‘Sirene technique’, projection of overtones, resonant
kinesiology, bioacoustic systems, low frequency sounds).
• Listening technologies (for the improvement of hearing and sound
perception, e.g. the Tomatis model).
• Healing compositions (healing songs, instrumental pieces and special ethnic
music); ‘therapeutic voice work’ (Newham); music in Pythagorean tuning;
‘drumming’ (Flatischler 1992; Hart 1990); ‘entrainment’ (Clayton, Sager and
Will 2005; Rider 1997; Saperston 1995); HemiSync; special instruments, such
as singing bowls and gongs; specially composed healing music (e.g. Halpern,
Kay Gardner).
• Sound environments/vibrotactile apparatus (‘ambient music’, ‘sound
environment’, the Somatron, many types of vibrotactile equipment (Chesky
and Michel 1991; Standley 1991; Wigram and Dileo 1997)).
Crowe and Scovel suggest that music therapy and sound healing are considered two
poles of a continuum covering all forms of healing with sound and music.
Techniques within music healing

Music rituals
The use of music rituals often belongs to a given community (religious, social, cultural)
and is specially designed for healing purposes. The ritual(s) may already exist – or they
can be created and developed for the specific group purpose (Kenny 1982).
Shamanistic music travels

This ancient healing tradition has survived in remote parts of all continents, and it
has seen a contemporary revival, modified to meet the needs and problems of people
living in modern Western cultures (Harner 1990). The shaman (the ‘music therapist’)
uses drums and rattles, songs and hymns to bring himself and the client into an altered
state of consciousness, enabling access to healing powers and spirits. The relationship
between shamanism and music therapy has been studied by several music therapists
(Cissoko 1995; Gattino 2008; Kenny 1982; Kovach 1985). Many music therapists have a
solid anthropological knowledge of the use of music for healing in ancient cultures, and
they know the potentials of ritual for the modern human being, whose life is poor in
rituals, especially in Western societies. This knowledge of the potentials of shamanism
and rituals is used consciously when the music therapist creates and develops the
therapeutic field of play and interaction (Aigen 2014; Kenny 1982, 1989, 2006; Moreno
1988; Winn, Crowe and Moreno 1989).
Altered states of consciousness

In shamanism as well as in guided imagery and music (Chapter 3.2), altered states
of consciousness (ASC) play an important role. Sound and music can facilitate,
promote, enhance and deepen ASC; this is also well known from meditative states
and processes (with or without music). The healing and transformation potential of
music-supported ASC has been acknowledged in non-Western health philosophy
since antiquity, but it has only been accepted (more or less) in Western health care
in recent years (Brummel-Smith 2008). Aldridge and Fachner (2006) edited a cross-
cultural book with chapters describing and explaining the use of music and ASC in
music therapy and other types of music healing.
Many of the books on music and self-development are based on or refer
to especially Eastern traditions of music healing, and often the chakra system (a
vibrational system uniting man’s body and mind) is used as a basis for the classification
of different types of music and exercises (Gardner-Gordon 1993; Hamel 1979; Perrett
1999). Also, Western spiritual influences on the understanding of the transforming

potential of music and sound can be found (Pontvik 1996; Steiner 1983; Tame 1984).
Music healing and music therapy

Many music therapy scholars have discussed the relationship between sound or
music healing and music therapy (Aigen 2014; Bruscia 2014a; Kenny 1982, 2006;
Stige 2002; Summer 1996). Summer (1996) was an early critic of the ‘new age’ culture
and its often romantic and non-scientific ideas of music’s healing powers. She wrote:
These practitioners, best described as New Age Music healers, have created amongst
themselves a philosophy which lacks clarity and logic. It has grown out of myths and
legends, converted into ‘facts’ in a parody of how science progresses. The foundations
and axioms of New Age music healing are based upon wishes and fantasies which
the practitioners in the field have agreed, perhaps unwittingly, to believe are facts.
This agreement is protected by the apparent good intention of the healers. (Summer
1996, p.7)
The Danish music ethnologist Lind (2008) studied healing milieus in Copenhagen,
including the role of music in Reiki healing. This type of research belongs to a cross-
disciplinary field of research called medical ethnomusicology (Koen et al. 2008). In this
field, described below in more detail, the relationship between consciousness, music
and medicine are studied in their complex cultural contexts. A critical as well as a
culturally sensitive approach is necessary: on the one hand, it is obvious that music
healing with its roots in ancient, mono- or multicultural magic-mystical traditions is
fundamentally different from modern, scientific and evidence-based music therapy.
On the other hand, music therapists in non-Western cultures must relate and respond
to healing cultures in their own national or regional contexts, and music therapists
in the Western world must respond to other paradigms concerning the interplay
of music, therapy and health when they work with clients or patients from non-
Western cultures, such as refugees and immigrants (see Chapter 4.6.1). Some of the
concepts originating in and relating to ancient healing cultures are relevant also in
contemporary music therapy theory and practice, for example ‘ritual’, ‘liminality’ and
‘communitas’, described below.
The music therapy journal Voices published until 2012 an article series called
Country of the Month where music therapists from all continents described traditions
as they had developed in their specific countries. In these articles, it became clear
that music therapy in Eastern as well as African countries necessarily would relate
and respond to – and possibly integrate – traditional music healing practices and
assumptions. Good examples are the reports from Mongolia (Chamberlain 2009)
and Nigeria (Olayinka 2012).
Joseph Moreno (1988, 1999), the founder of music psychodrama, points at healing
cultures as living and relevant sources of inspiration for music therapy practice and
advocates music healing as a specific cross-disciplinary field. Carolyn Kenny (2006)
was probably the first music therapy scholar to develop a theoretical understanding
of the discipline including (and to a certain degree transforming) myths and rituals
from traditional cultures. Aigen (2014) presents a comprehensive discussion of the
relationship between contemporary music therapy and traditional forms of music
healing, and he also points at common traits and the potential of acknowledging
them in modern practice.
Kenny (1982, 2006) developed the idea of music therapy as a ritual quite early. In
Western cultures where rituals have become sparse, it is helpful for many clients if the
music therapy sessions have marked ritual elements, such as standardised openings and
closings (e.g. with specific songs) or marked transitions, almost like phases in a ritual
or a liturgy. As Kenny says, many clients resist change, and this is one of the greatest
problems in psychotherapy. It is difficult, but necessary, for the client to surrender to
the process and let go of old, originally comforting but no longer appropriate patterns of
attachment or communication. Such a process is almost a death-rebirth ritual. Another
common ritual element in music therapy is the hero/heroine’s journey. One session (for
example a GIM session (Chapter 3.2) with a music programme designed to facilitate
this specific ritual experience), or a complete therapy process, can be experienced as a
ritual transformation by the client. The concept of transformation can actually be used
as a neutral denominator of related processes in healing and therapy.
Liminality is another common concept used to describe and explain processes
of transition and transformation. In a transition ritual, the protagonist spends a lot
of time in an in-between phase, between states of being or states of consciousness
(Ruud 1998). It is a condition for change that the protagonist (the adolescent or the
client) can endure this intense liminal state where old and safe patterns are dissolved,
and it is often very helpful to share this experience with other people, for example
members of a peer group, or a therapist.
Ruud (1998) refers to anthropologist Victor Turner’s concept of communitas as
a relevant term to characterise the intense experience of community and belonging
which is at the core of (transition) rituals that can be facilitated or amplified by music.
The concept is also used to describe processes in group music therapy, especially in
community music therapy (see Chapter 3.7).
Aigen (2014) concludes that music therapy and music healing are not necessarily
polarities; however, it is very demanding for the therapist to integrate the traditions:
Accepting that the forces of myth and ritual can be accessed in music therapy and
used for establishing liminality and communitas provides a connection to earlier,
more archaic uses of music – such as in shamanism – in a way that does not require
the abandoning of a modern worldview. (Aigen 2014, p.144)
Medical ethnomusicology (Berman 2015; Koen et al. 2008) is a new cross-disciplinary

discipline developed by researchers and practitioners within neuroscience, historical
and systematical musicology, ethnomusicology, music psychology and therapy.
Ethnomusicologists (e.g. Blacking 1973) have long since described and explained
how music in non-Western cultures is not an independent, aesthetic phenomenon
but rather an element in a larger cultural complex involving social exchange, religious
ceremonies, and healing:
Nearly a century of ethnomusicological research into music and healing shows
not only how culturally diverse practices of specialized music function as tools for
therapy, but that music is most often practiced as a means of healing or cure – a
way for a person to transform from illness or disease to health and homeostasis.
Such specialized music almost always emerges from a spiritual or religious ontology
and from ritual or ceremonial practice. (Koen et al. 2008, p.6)
The Bantu word ngoma is a fine example of musicking as an integrated part of a
larger whole (what Wilber calls holon) – drumming, dance, song and instrumental
performance create an arena of communitas or physiological and psychological
healing. The Swahili word kucheza has the same basic meaning.
The ontological problem that music healing is understood as a gift from
the gods or a process related to supernatural powers and processes is discussed
thoroughly in medical ethnomusicology. Scientific, medical, sociological and
humanistic perspectives are used in an attempt to understand how music healing
works. Quantum physics may be used to understand music practices as phenomena
of resonance in a wider sense (see Part 1). Medical and humanistic theories of the
placebo (and nocebo) effects may work as a psycho-social-cultural foundation for a
theory of music healing.
Roseman (2008) formulates two guiding research questions: 1) Can music
(combined with other ritually applied sensory stimuli) evoke a transformation
from illness to health? 2) How is such a transformation experienced by the persons
involved, and how can it be understood within cultural, ethnographical and
biomedical paradigms? Roseman presents a model case of music healing from the
Temiar people in the Indonesian rainforest: a man is treated for losing his voice
and severe breathing problems related to mourning over his late brother. Roseman
suggests a research procedure involving four perspectives to describe and understand
the case: a musical (focusing on musical vibrations and structures); a sociocultural
(focusing on the meaning of the ritual in the culture); a performative (focusing on
the physical-bodily arrangement and performance of the healing ritual); and finally a
biomedical (focusing on actual and measurable physiological transformation effects).
Similar perspectives could be adopted by contemporary (Western) music therapy – a
multidisciplinary dialogue is warranted.
3.13 Health Musicking – Music and
Health: A Final Discussion
Lars Ole Bonde
Music therapy theories and models are closely related to the development of
psychological theories and paradigms, as stated early by Ruud (1980). The
behavioural ‘wave’ in psychology was the theoretical foundation of the first clinical
models of music therapy in modern times (Madsen, Cotter and Madsen 1966), and
this tradition has developed into a modern cognitive-behavioural model leaning
heavily on neuroscientific evidence of ‘the music effect’ (Hallam 2015; Schneck and
Berger 2006; Thaut 2010; see also Chapter 3.6). Psychoanalysis had, from the early
20th century, a tradition of exploring music and music experiences as part of ‘the
talking cure’ (Bonde 2009; Nass 1971), and also the Jungian tradition of analytical
psychology had some affinity with music and music therapy (Lawes 2017; Marshman
2003; Short, Gibb and Holmes 2011; Ward 2002; Wärja 1994).
However, an analytical tradition in music therapy developed quite late (from the
1970s), with Mary Priestley in particular as a contributor. It is also possible to place
Benenzon as a pioneer quite closely related to psychodynamic thinking. Priestley’s
analytical music therapy has been developed into a more eclectic dynamic tradition,
focusing on the therapeutic relationship as the primary agent of change, slowly
emerging during the last 35 years. This is reflected in the label ‘analytically oriented
music therapy’ (see Chapter 3.3). Alvin’s free improvisation therapy (Chapter 3.8)
was also influenced by analytical thinking.
The third wave in psychology – the humanistic-existential – is reflected in both
Nordoff-Robbins music therapy and the Bonny method of guided imagery and music
(GIM), the latter also influenced by the fourth: the transpersonal wave (see Chapters
3.2 and 3.4). GIM has evolved towards an integrative foundation (often referring
to Wilber’s use of the concept ‘integral’), while the Nordoff-Robbins tradition has
influenced also the newest ‘model’, community music therapy (CMT), strongly.
The influence of positive psychology, recovery theory and new musicology on CMT
is obvious (see Chapter 3.7).
In other words, all the international models of music therapy presented here had
some affinity with the development (‘waves’) of academic psychology. They are all still
alive and developing in order to meet the health needs of people in the 21st century.
However, music therapy – all these models and many others as well – can also be
considered special traditions and procedures within a much broader field: ‘music and
health’ (Bonde 2011a; DeNora 2007; Stige 2003, 2012).
223
Theoretical framework: health musicking

The field of ‘music and health’ covers a broad spectrum of activities and experiences,
from lay therapeutic use of music in everyday life (DeNora 2000) to the highly
specialised procedures of music medicine and music therapy presented earlier. Bonde
(2011a) developed a ‘map’ of the field, inspired by the concept of health musicking that
especially Stige has developed theoretically (Stige 2002, 2003, 2012; Stige and Aarø
2012). Stige was inspired by Small’s concept of musicking (‘Any activity involving
or related to music performance, such as performing, listening, rehearsing, or
composing’ (Small 1998, p.9)), and Stige defined health musicking as ‘the appraisal
and appropriation of the health affordances of the arena, agenda, agent, activities, and
artefacts of a music practice’ (2012, p.192).
According to Batt-Rawden, Trythall and DeNora (2007), health musicking
contributes to and promotes resilience, coping and recovery, while Bonde (2011a)
relates it to four main objectives: 1) the formation and development of identity, 2)
the development of communities and values, 3) the lay and professional use of music
and sound to support and help individuals, 4) the sharing and creation of musically
designed environments. This is reflected in a quadrant model, inspired by Ken Wilber
(see Chapter 2.4.2), where different arenas, agendas, agents, activities and artefacts
are related to the four objectives (Figure 3.13.1).
Bonde (2011a) presents a number of empirical examples within each of the
quadrants. Most of the existing evidence – outside the specific field of clinical music
therapy, including case studies as well as randomised controlled trials (Koelsch
2013, 2015; Theorell 2014) – addresses the health benefits of choral singing. Clift
and Hancox (2010) identified four specific factors to explain these benefits: 1) the
experience of positive emotions, 2) focused attention, 3) deep breathing, 4) social
support. Balsnes (2018) summarises recent studies of choral singing as health
promotion. Broader epidemiological studies give a more general insight into
associations between participation in cultural activities and health (Theorell and
Kreutz 2012). For example, Konlaan (2001) conducted a cohort study (ULF) in
Sweden, where 10,609 men and women aged 25–74 were interviewed about their
health as related to attendance of cultural activities. Participants were followed over

14 years (1982–1996) with regard to survival. The researchers found that there was
a higher mortality risk for those informants who never or rarely visited the cinema,
concerts, museums or art exhibitions compared with those visiting them more often.
Regular visits to concerts significantly predicted survival per se, but no advantage of
regular music-making was found. A similar pattern was observed in the Norwegian
HUNT Study with more than 50,000 informants (Cuypers et al. 2012; Løkken et al.
2018). Statistically significant, gender-specific associations were found between
several receptive and creative cultural activities and self-rated health, depression,
anxiety and satisfaction with life. Again, active participation was not found to be
more beneficial than receptive experiences.
INDIVIDUAL
The formation The
and PROFESSIONAL
Music as a Medical music therapy
development of USE of
‘technology of the self’
IDENTITY Playlists and special music music/musicking
through and sound to
Humanistic-existential AFFORDANCES Music medicine
musicking music therapy AND help individuals
Vibroacoustics
APPROPRIATIONS
Psychodynamic music therapy Music for the hearing impaired
Affirmative and
corrective bodily,
MIND MEANING emotional and relational REGULATION BODY
experiences through
Community music therapy musicking
Soundscapes
Community music EMPOWERMENT Noise-reduction systems
The development Choirs, orchestras, AND Psychoacoustics
of bands RECOVERY The SHAPING
Sound healing
COMMUNITIES Festivals and SHARING
AND VALUES of musical
through environments
musicking
SOCIAL
Figure 3.13.1: Health musicking – a descriptive model

The model is inspired by Ansdell (2001) and Wilber (see Chapter 2.4.2). Most of the music therapy models
presented in this chapter are located in the upper left quadrant; however, community music therapy is
situated in the lower left quadrant. Music medicine and vibroacoustics are placed in the upper right quadrant.
The positive association between cultural attendance and self-reported health

was confirmed in a biennial longitudinal Polish household panel study with adult
participants in four waves over six years (Węziak-Białowolska and Białowolski 2016).
However, a positive, causative relationship could not be confirmed, and no evidence
was found to corroborate a positive impact from cultural attendance on physical
health. Therefore, the authors conclude that ‘future research should investigate the
causative influence of active participation in creative activities on health outcomes
as, in contrast to passive attendance, it may be influential’ (p.1). The Danish study
described below is cross-sectional and therefore it can only establish associational
connections between music and health; however, it does look more closely into active
musicking, not only passive and receptive attendance.
A Danish study of music and public health

In 2013, eight questions about music behaviour and beliefs in everyday life were
included in the Danish Health and Morbidity Survey. This survey has been carried
out regularly by the National Institute of Public Health (University of Southern
Denmark) since 1987 with the aim of describing status and trends in health and
morbidity in the adult Danish population, and the factors that influence health status
(e.g. health behaviour, social relations and environmental and occupational health
risks). A random sample of 25,000 Danish adults was drawn from the Danish Civil
Registration System, and thus, background information was obtained for all invited
individuals. A postal questionnaire and a letter of introduction were sent to each
invited participant, briefly describing the purpose and content of the survey; 14,265
individuals (participation rate: 57%) completed the questionnaire.
All respondents were asked if they had voluntarily sung in a choir or sung or
played a musical instrument in a band, orchestra or a musical ensemble – as an
amateur or professional. Based on the answers, five respondent groups were created:
active professional musicians; non-active professional musicians; active amateur
musicians; non-active amateur musicians; non-musicians. The respondents were also
asked if they used music for one or several of the following purposes in everyday life:
for relaxation; to gain energy; to get into a certain mood or change mood; to express
or explore feelings; to get to know yourself as a person; as a means of concentration;
not using music for anything special in everyday life. The questionnaire also included
the question ‘How often do you attend live musical performances?’, and respondents
were asked if they believed that music activities and music experiences could help
them to stay healthy. A question about music in childhood was also included. In the
statistical analysis, answers to the music questions were correlated with information
from the register (background variables) and with self-reported health behaviours,
symptoms, pain or complaints during the last two weeks, for example alcohol intake,
smoking (including cannabis).
It is not possible to present the results of the study in detail here (they can be
found in Eckholm and Bonde 2018; Ekholm, Juel and Bonde 2015, 2016); however,
some results relevant in the context of this chapter can be presented.
• The study indicates that a majority of the informants used music in their
daily life – for many different purposes, with relaxation and mood/energy
regulation as the most prominent (Table 3.13.1).
Table 3.13.1: The use of music in everyday life according to age (percentages)
16–24 y. 25–44 y. 45–64 y. 65–79 y. ≥80 y. All
For relaxation 85.2 69.6 62.1 52.5 41.5 65.2
To gain energy (e.g.
to improve exercise 72.2 55.4 30.3 18.4 11.6 41.2
performance)
To get into a certain mood
74.1 60.4 42.0 31.6 24.8 49.8
or to change mood
To express or explore
40.0 22.7 14.2 9.8 5.6 19.4
feelings
To get to know yourself as

19.0 10.8 7.3 6.4 5.6 9.9
a person
As a means of
46.1 26.3 15.3 10.1 7.2 21.9
concentration
Not using music for
anything special in 3.6 12.7 23.9 31.6 43.3 19.7
everyday life
• A majority of informants attended at least one live concert per year and the
prevalence decreased with age (Figure 3.13.2).
100%
13.5 8.5
17.8 14.9 14.8
15.1
80%
27.7
38.8
60% 42.1 45.0
40% 76.4
58.8
20% 46.4
40.1 40.2
0%
16–24 y. 25–44 y. 45–64 y. 65–79 y. ≥80 y.
Never/rarely 1–3 times a year More than 3 times a year

Figure 3.13.2: Frequency of going to live musical performances according to age (percentages)
A significant association was documented between attending live concerts

and reporting good health. Additionally, a majority of the informants,
including those who never or rarely attended live concerts, believed in music
as a health resource (Figure 3.13.3).
100%
23.0
80% 34.5
53.5
60%
44.4
40% 49.0
9.2 38.3
20%
4.7
23.4
2.2
11.8 6.0
0%
Never/rarely 1–3 times a year More than 3 times a year
Don't know No Yes, to some extent Yes, definitely

Figure 3.13.3: Believed that music activities and music experiences can help to stay healthy
according to frequency of attending live musical performances (age-adjusted percentages)
These results are in line with the epidemiological studies of the influence of
cultural participation on health mentioned earlier, for example the Swedish
ULF study and the Norwegian HUNT study. However, the Danish study
took – for the first time in Denmark and probably internationally – a closer
look at associations between active musicking and health. This was done by
dividing informants into the five groups mentioned above, based on their
relationship with music: non-musicians (65.5%), active versus non-active
amateur musicians (3.6/28.0%) and active versus non-active professional
musicians (1.5/1.5%).
• The study documented that active professional musicians suffer more from
various health problems and discomforts (e.g. sleeping problems, tinnitus)
than non-musicians. In addition, active professional musicians were more
likely to report a number of health risk behaviours (e.g. binge drinking,

cannabis use). Paradoxically, active professional musicians reported that
they had excellent, very good or good self-rated health, even if they were at
the same time more likely to have high perceived stress than non-musicians.
The data were not detailed enough to allow interpretations of the influence
of musical style or type of music activity on health behaviour or self-rated
health (e.g. singing in a classical choir or playing in a rock band). However,
in earlier American studies certain specific musical genres and styles (rock,
metal, electronic, hip-hop, rap) have been identified as predictors of increased
mortality (Bellis et al. 2012; Kenny and Asher 2016).
All four types of musicians indicated that they had better self-reported
health than non-musicians, and active amateur musicians tended to have
more healthy behaviours than all other groups in all variables – except
cannabis use. Non-active amateur musicians seemed to maintain some
of the health benefits. However, they were more likely to be obese than
non‑musicians.
• The study also documented an association between music in childhood/
parental support and a later interest in music as a hobby or profession
(Bonde, Ekholm and Juel 2018). This association could be taken as a point of
departure (agenda) for music education initiatives in preschool institutions,
public schools and music schools. Teaching children about music as a health
resource must start early and be designed in an age-specific way (Hallam
2010, 2015).
These results somewhat contradicted cultural participation studies
that found no extra benefit of active participation in cultural activities. The
findings pointed towards a specific health potential of active musicking –
especially for amateurs – and on this background the researchers formulated
a number of recommendations for public health initiatives (Ekholm and
Bonde 2018). Preventive and rehabilitative music activities and experiences
(active as well as receptive, from small listening groups to community choirs)
can fairly easily and with low costs be designed for special target groups, for
example men over 45 and, more generally, citizens over 65.
Concluding remarks
In Part 3 of this book we have covered some of the major international music
therapy orientations and models, their theoretical foundations, and a number of
practical approaches to the broader field of music and health or health musicking.
Music therapy is often defined as an intervention where a trained therapist helps a
client to promote health, using music experiences and the relationships developing
through them. Some approaches use music for health-related goals in ways that do
not qualify as music therapy but are described as music medicine. The very essence
of music therapy is the therapeutic relationship, which is established through music,

and it is interactive in nature. The relational context – the interplay of (expressive as
well as receptive) music experiences (musicking), the therapeutic or broader social
relationship and the specific participants in their environment – is discussed and
compared between the models.
In summary, expressive and receptive musicking allows for experiences in
different contexts and at different levels through a present aesthetic participation
within a multilayered frame of interpretation. Such a musical relationship, based
on attunement and empowerment, supports affirmative, corrective, emotional and
relational experiences through musicking. Music therapy is defined as a specific health-
promoting practice within the larger field of music and health or health musicking.

3.3 Analytically Oriented Music Therapy (AOM) : Inge Nygaard Pedersen A Historical Outline and Definitions

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3.

A historical outline and definitions

Analytical music therapy (AM)

transformation of repetitive and often rigid or obsessive relationship patterns in the

Analytically oriented music therapy (AOM)

The session: procedure and techniques

Monological and dialogical form

AOM as resource-focused music therapy

and transformation of psychological problems and issues, to expand the client’s

Documentation and research

A historical outline and definitions

Robbins (2007) writes about the music-centred core of the model:

The session: procedure and techniques

available in several languages). Contemporary N-R therapists improvise creatively

and Robbins 1998).

A historical outline and definitions

The session: procedure and techniques

A historical outline and definitions

The session: procedure and techniques

A historical outline and definitions

therapeutic experiences and processes of change, through collaborative musicking, to

Community Music Therapy as an arena of professional practice is situated health

The session: procedure and techniques

problems as a point of departure. Ruud (2012) discusses similarities and differences

to marginalised individuals of groups, or to communities at a more general level,

A historical outline and definitions

The session: procedure and techniques

of Bruscia’s Improvisational Models of Music Therapy (1987). As well as what we know

3.9.1 Improvisation-Based Methods

receptive themes, levels of interaction, and interval explorations. Common to these

3.9.1 Improvisation-Based Methods

receptive themes, levels of interaction, and interval explorations. Common to these

Basic clinical techniques

can offer the needed grounding elements.

Advanced clinical techniques

Table 3.9.1.1: Clinical improvisation techniques categorised by clinical purpose

In a later publication, Baker (2015) provides a comprehensive examination of

Composition – creating melody

3.9.3 Therapeutic Voice Work

3.9.4 Receptive Methods

• music, visualisations and imagery (group/individual – guided/unguided)

• unpredictable changes in tempo

Potential elements in relaxing music are:

Vibroacoustic and vibrotactile therapy

Lars Ole Bonde

Music medicine – sometimes also called ‘music in medicine’ or ‘musicmedicine’ – is

The music experience in music therapy is always embedded in the therapeutic

MUSIC THE RAPY

Therapist Patient Music

Music medicine is quite well established in North American hospital treatment

Rhythm Constant: little contrast Floating: no contrast

In Chapter 3.10 there is a related comparison of relaxing versus stimulating music.

medical education; c. in health education).

(client–therapist–music), and above all in the understanding of the healing potentials

Procedures within sound healing

Healing with sound bowls, gongs and overtones

The use of the monochord or other ancient healing procedures

Techniques within music healing

Shamanistic music travels

Altered states of consciousness

1999). Also, Western spiritual influences on the understanding of the transforming

Music healing and music therapy

Medical ethnomusicology (Berman 2015; Koen et al. 2008) is a new cross-disciplinary