CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH

Taking Music Therapy : Shaping The FutureForward

Volume : III Issue : I June 2014

the HARMoNYBulletin

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EDITOR’S DESK

The focus of the current issue of "The Harmony" is on clearing common myths and misconceptions that

clouds the field of music therapy in India. Though music therapy is an established academic discipline and

an insurance reimbursable allied health care profession in many western countries, the field is yet to

develop fully in India. CMTER is a pioneering initiative from Sri Balaji Vidyapeeth dedicated to promote

music therapy in the areas of clinical practice, research and professional training. The goal of the bulletin is

to share information on the activities of the center to expand professional music therapy knowledge by

reporting empirical studies, clinical cases, patient stories, photo stories and many interesting music

therapy information to benefit practitioners from diverse specialties. In this issue, the featured article

“Understanding Music Therapy: Clearing Misconceptions by Dr. Sumathy Sundar clarifies all the myths,

distinguish between healing and music therapy, discusses various methods and procedures adopted during

the music therapy process and also clearly explains the distinction between music medicine and music

therapy approaches. Also, often, the clinicians wonder as to what are the appropriate referral areas for

which they could recommend music therapy services and so a chart of referral areas for various clinical

specialties is provided in this issue. But, this chart is only illustrative and not exhaustive. The clinicians are

encouraged to use this chart for recommending music therapy services to CMTER. The CMTER team which

comprises of trained music therapists who not only work with patients who come for OPD services but also

go to bed-side and support patients who experience emotional difficulties, have Quality of Life issues and

communication deficits and also be part of adjunct non-pharmacological pain management services all

offered as a part of integrative care in Mahatma Gandhi Medical College and Research Institute.

Editorial

Featured article

Music therapy information

Photo stories

Global music therapy events

Referral areas for music therapy services

Recent publications from CMTER

Inside this issue

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UNDERSTANDING MUSIC THERAPY : CLEARING MISCONCEPTIONS

Dr. Sumathy Sundar, Head, Center for Music Therapy Education and Research, Sri Balaji Vidyapeeth

Introduction

What is Music Therapy?

While there is a growing interest in the field ofmusic therapy among medical professionals, alliedhealth care and mental health professionals andstudents in India, there is also a deep rootedmisconception and lack of clarity around this field.It is a matter of concern that though there is a lot ofinterest shown by these people in learning abouthow to offer clinical music therapy services, theirknowledge is limited to the existence of musichealing practices across Indian history and cultureand they struggle to integrate these practices inclinical services. The confusion is about identifyingwhat is healing and what is music therapy andunderstanding the difference that exists betweenhealing and music therapy. Also there is a strongbelief that there are ready made generalprescriptions of music available for curing variousdiseases. There is also an enigma around musicmedicine (music being used as therapy by medicalprofessionals) and music therapy in which music isbeing used in therapy. The practices are based onbelief systems using history as a tool. The variousmusic therapy techniques apart from the receptivelistening experiences are not still known due to lackof training. This article attempts to clear all thesemisconceptions and also explain what is musictherapy, the theoretical background and thetherapeutic processes involved in clinical musictherapy sessions.

According to World Federation of Music Therapy,the definition of music therapy is as follows. Musictherapy is the professional use of music and itselements as an intervention in medical, educationaland everyday environments with individuals,

groups, families or communities who seek tooptimize their quality of life and improve theirphysical, social, communicative, emotional,intellectual, and spiritual health and well being.Research, practice, education and clinical trainingin music therapy are based on professionalstandards according to cultural, social and politicalcontexts.1 Another definition of music therapy isthat music therapy is an interpersonal process inwhich the therapist uses music and all of its facets-physical, emotional, mental, social, aesthetic, andspiritual-to help clients to improve or maintain theirhealth. In some instances, the client's needs areaddressed directly through music; in others theyare addressed through the relationships thatdevelop between the client and therapist.

What is a healing practice? Healing is deepenedand inherited not so much with words but by"feeling in one's body, heart and soul" and "belief“.and music therapy is something observable andmeasurable. It is an evidence based practice asindicated by many Cochrane reviews. In somecultures “the drive for theory is not so intense.Things are just known. Explanations are not alwaysrequired for practices to be accepted.Understandings are transferred across thegenerations through action. Indeed, in somesocieties in which traditional healing practices aremaintained, healing is contingent on notquestioning the how's, why's, what's, when's,where's of the experience. In these societies, thevalue is on belief more than description orexplanation.” This situation holds true for Indiansituations. The local resources by way of healingpractices like Raga Chikitsa, Vedic Chanting and

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Healing and Music Therapy

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Chakra activation exist as a strong belief system asa curative solution and the last decade ofdevelopment in the music therapy field was basedonly on this premise. Now, new horizons haveemerged. The unquestionable is being questioned.There is a shift from using the static-history as atool for explaining the practice of art of healing tothe dynamic music therapy workings which explainhow music, therapy, cultural, spiritual and socialcontext work in a clinical set up are rationalized.Further, we can question now how traditionalpractices located in a past that has its own validitycan be transposed in time to the present.However, there is another understanding thatmusic therapy in general is arational science as well as anart with irrational aspectsand anthropological, culturaland personal dispositionsplaying an important role inreception of musicc o m p l i c a t e s t h edevelopment further. Byculture, we mean beliefsystems, philosophicalorientations, tradit ion,religion, art, values andsocietal norms for behavior. In a country like Indiawhere there is a rich tradition and culture andphilosophy of life is linked strongly to religion andspirituality, during the therapy process, when wewant to connect to the client, the musicalexperiences which are closer to these aspects playa more important role than the drive for theory. Thelocal healing resources which are availablethroughout the history cannot be ignoredcompletely as they strongly form the basis for theclients' actual needs. The principle function ofmusic in these healing practices is at times healing,at times spiritual, at times religious, and sometimesa combination of these three elements. Hence,

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ways and means to integrate these resourcesbecome primarily important in practice, educationand research. The unquestionable is questioned,also at the same time keeping in mind that the localresources should be transferred wherever possiblewith a need for explaining the processes involved.

Also, the musical experiences that the therapistsuse in the music therapy sessions range widelyfrom the methods of passive listening to theactive re-creative experiences, song writing,improvisation, playing of musical instruments andengaging in verbal discussion methods.

Sometimes, the therapist singsand at other times, theclients sing. The therapistplay both tuned and un-tuned musical instrumentsand also engage the clientswith baseline, prompted,c o l l a b o r a t i v e a n dindependent musical tasksin singing, moving, rhythmicand p la y in g mus i c a linstruments activities. Themusical responses for

engagement, pleasure, self confidence andcreativity levels are recorded during initialassessment to find out the musical profile of theclient and for planning the therapy protocol. Thetherapist selects musical experiences depending onthe needs of the clients and also the goals set fortherapy. Playing instruments can help physicallydisabled clients to develop gross and fine motorcoordination.1

The responses range from developing sensorimotorskills, learn adaptive behaviours, developspontaneity, creativity and freedom of expressionand also develop communication and interpersonalskills. Individual singing Exercises can help

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Methods and Responses

Do you know that Music Therapy isnot.............

Taking Music Lessons

Learning to Play a Musical Instrument

Appreciating Music

Performing Ragas

Promoting Classical Music

A Cure for Diseases

Just Listen To Music Through Headphones

Prescribing CDs And Cassettes as Cure for

Specific Diseases

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individuals who have speech impairments to helpimprove their articulation or fluency and groupsinging builds reality orientation in elderlyindividuals, or help mentally retarded peopledevelop adaptive behavior, or build cohesiveness ina dysfunctional family or group. Playinginstruments can help physically disabled clients todevelop gross and fine motor coordination. 1

The different stages of music therapy, a systematicprocess of intervention are 1) Referral, 2) A firstsession: Building Rapport, 3) Assessment, 4.Setting up Goals, Objectives and Targets, 5)Observation, 6) Music Therapy Strategies, 7) MTTreatment plan, 8) Implementation 9) Evaluationand 10)Termination8 During these stages thetherapist works on modulating either the client's

Music Therapy Process and Outcome

communication or the behavior, emotions,attention or cognition. The neuro biologicaloutcome of the therapeutic musical dialogingdepends on 1) the therapist recognizing the needsof the client and the client recognizing the intentionof the therapist to help him 2) the therapist's abilityto get into emotional resonance with the client 3)engaging in musical activities that result in sharedattention between the therapist and the client 4)the therapist understanding the motivation and theintention of the client and 5) the cooperative actionbetween the therapist and the client.9 The mind, aproduct of the brain, influences physical healththrough three brain-body information transfersystems namely the autonomic nervous system(ANS), neuroendocr ine pathways andneuroimmune pathways and the health behaviorpathways.10

BRAIN MIND/ MENTAL HEALTH (Emotions, stress etc.)

Information transfer system/ pathways

ANSPathway

EndocrinePathway

ImmunePathway

HealthBehaviorPathway

PHYSICAL HEALTH

Music therapy being a mind body medicine, thetherapeutic musical dialoguing outcome during themusic therapy process depend on how the braintransfers the information to the ANS, Endocrineand Immune pathways and the Health Behaviourpathway influencing the physical health.Researchers have indicated that there are many

major computational centres for processing musicin the brain which get influenced by appropriatemusical inputs to transfer positive information tothe ANS, Endocrine and Immune pathways toachieve physical health.

Music as Medicine Versus Music Therapy

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Use of recorded music by medical professionalswho may not be skilled musicians or musictherapists in order to achieve desired biologicaleffects is a regulatory approach called musicmedicine approach. This approach depends on theinherent quality of music to reach the desired goal.Music therapy is both a regulatory and a relational

approach which has an interpersonal componentworking as a dynamic force within the therapeuticprocess between the therapist and the client. Thefollowing table indicates the difference and theresearch designs between music in medicine andmusic therapy approaches. 11

Table 1. Therapeutic Concepts and their Research Designs

Music Medicine

Biomedical Concept

Symptom Orientation

Music as Medicine

Positivistic Scientific Tradition

Music has Therapeutic Potential by Itself

Starting - Point : Illness

Desired Biological Effects

Music therapy in medicine

Relational-medical concept

Health orientation

Artistic-creative activity

Hermeneutic scientific tradition

Emphasis on relation: therapist-client; music-client

Starting-point: health (resources)

Improved quality of life through creative expression of self

Conclusion

Music therapy is both an art and science of healingand an evidenced based practice. The scientificaspect of this field is yet to be established firmly inIndia due to lack of adequate training facilitiesacross the country and pioneering efforts havebeen taken by medical universities like Sri BalajiVidyapeeth to launch professional trainingprograms and introduce music therapy as amedical discipline not only to create awareness onthe field but also to integrate music therapy clinicalpractice based on education and research. TheCentre for Music Therapy Education and Research,a unit of Mahatma Gandhi Medical College andResearch Institute, Sri Balaji Vidyapeeth hascommenced a one year Post Graduate DiplomaProgram on March 25, 2014. This initiative is surelyan important milestone in India for the

development of music therapy as a profession andan academic discipline

Global Music Therapy Events

World Congress of Music Therapy

Theme :

Venue :

III International Conference on Musicand Medicine

Theme :

July 8 – 12 2014

Cultural Diversity in Music TherapyPractice, Research and Education

IMC University of Applied Sciences,Krems, Austria

Music Medicine through the LIfespan

June 24-27 2014

University of TorontoVenue :

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References

1. Bruscia, K E (1993). Music Therapy Brief. Barcelona Publishers. Available fromwww.temple.edu/musictherapy/home/program/faq/htm

2. Definition of music therapy. Available at www.musictherapyworld.net/WFMT/About_WFMT.html

3. Kenny, C. B. (2001). Review of: Constructing Musical Healing: The Wounds That Sing, by June Boyce-Tilman. The Arts in Psychotherapy, 28, 265- 269.

4. Sundar, S. (2012). Music Therapy Training in India: New Horizons. Proceedings of InternationalSeminar on Current Trends in Music Therapy Practices: Methodology, Techniques and Implementation.Benares Hindu University. Page 57-58

5. Sundar, S. (2014). In press. (Ed) Goodman, KD. Music Therapy Education in India: DevelopmentalPerspectives in International Perspectives in Music Therapy Education and Training: Adapting to aChanging World. Charles C Thomas Ltd. Illinois. US.

6. Aldridge, D. (2006) Performative Health - a commentary on Traditional Oriental Music Therapy. MusicTherapy Today (Online) Vol.VII (1) 65-69. available at http://musictherapyworld.net

7. Tucek et al. (2006). The revival of Traditional Oriental Music Therapy discussed by cross culturalreflections and a pilot scheme of a quantitative EEG-analysis for patients in Minimally ResponsiveState. Music Therapy Today (online) Vol. VII (1), (March) 39-64. available athttp://musictherapyworld.net.

8. Hanser SB. (2000). The New Music Therapist's Hand book. Berkeley Press. US.

9. Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach.Music Therapy Today (Online 1st October) Vol.VII (3) 623-647.

10. Sivaprakash, B. (2014). (Ed) Mind & Medicine. Newsletter. Department of Psychiatry. Mahatma GandhiMedical College. Pondicherry. Volume 1 Issue 1 July-Sep 2013

11. Krautschick (2003) Relationship between music in medicine and music therapy in medicine.http://www.hisf.no/sts/Musikkterapi/hovudfag/semv01_Krautschick.html

What is Evidence-Based Music Therapy

Practice?

“Evidence-based music therapy practice

integrates the best available research, the

music therapists' expertise, and the needs,

values and preferences of the individual(s)

served”

Source: American Music Therapy Association

(2010)

MetaAnalysis

RandomizedControl Trial

Controlled TrialsNo Randomization

Cohort or Case Control

Case Series and Case Report

Qualitative

Expert Opinion

Levels of Evidence in Music Therapy Practice

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Photo story

31 01 2014

The new premise for CMTER was inaugurated by the Vice Chancellor. A Drum Circle was conducted forburnout among doctors of MGMC &RI. All the doctors present were screened for Burnout and participatedin the Drum Circle. Dr. sumathy Sundar highlighted the benefits of participating in a Drum Circle whichincluded de-stressing, alleviating anxiety, enhancing mood and relaxation, increasing performance andteam spirit

16 02 2014

CMTER organized a stress management program for hospital staff. The program trained the participants torelax and engaged them musically for about an hour by making them play a variety of melodic and rhythmicmusical instruments.

25 03 2014

The first Post Graduate Diploma in Music Therapy as a medical course in India was introduced by CMTER.This is an important mile stone in the development of music therapy as a clinical profession and academicdiscipline in the country. SBV is the first university to have introduced this innovative course as there areonly a few courses available right now through private institutions.

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Referral Areas For Music Therapy Services In Hospitals For Various Clinical Specialities

Pre-Procedural Anxiety and Stress

Cooperation Level During Procedures

Post-Operative Pain

Provide a Positive Means for Coping

Induce Sleeping

Elevate Mood

Provide Emotional Support

Dentistry

Reduce of Stress and Anxiety

Reduce Symptoms of Depression

Improve Sleep Quality

Improve Attention and Focus

Emotional Support

Anger Management

Provide a Positive means to Coping

Enhance Self Expression

Psychiatry

Expressive and Receptive communication

Cognitive and Sensory Stimulation

Increasing Motor Activity, strength and Endurance

Improving Range of Motion

Increasing Reorientation

Normalizing Hospital Environment

Emotional Support

Neurology

Antenatal Anxiety

Intrapartum Cooperation

Postpartum Depression

Menopausal Depression

Emotional Support

Providing a Positive Means to Coping

Obstetrics and Gynaecology

Pre-Operative Stress

Peri-Operative Anxiety

Eliminating Sedation During Minor Procedures

Post Operative Pain

Normalizing Sterile Operating Environment

Providing a Positive Means for Coping

Anaesthesiology

Optimize Breathing

Improve Peak Expiratory Flow Rates

Improve Voice Intensity

Alleviate Anxiety

Psychological Distress in COPD

Support Stress Management

Enhance Quality of Life

Pulmonary Rehabilitation

Reduce distress levels (Child and Mother)

Fear of Needle

Reduce Pain Perception

Reduction of Crying Spells

Normalizing Hospital Environment

Provide a Positive means for Coping

Paediatrics

Pre-Operative Anxiety

Reduce Restlessness

Cooperation Level During Painful Diagnostic procedures

Post-Operative Pain

Normalize Hospital Environment

Induce Sleep

Reduced demand for Post Operative Analgesics

Surgery

Pre-operative Anxiety and Stress

Reduce Systolic and Diastolic Blood Pressure

Reduce Heart Rate

Cooperation Level During Diagnostic Procedures

Post-operative Pain

Induce Sleep

Reduced Demand for Post Operative Analgesics

Cardiology

Dermatology

Pre Procedural Aanxiety

Cooperation Levels During the Procedure

Anxiety and Stress Reduction

Providing a Positive Means for Coping

Decreasing Symptoms of Depression

Elevate Mood

Normalize Hospital Environment

Radiology and imagery

Reduce Symptoms of Depression in Chronic Patients

Pre Procedural Anxiety

Improve Cooperation Levels during the Procedures

Anxiety and Stress Reduction

Provide a Positive means for Coping

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Editorial Board

Patrons

Shri. M.. Rajagopalan, Chairman

Prof. Dr. Rajaram Pagadala, Chancellor

Advisory Board

Prof. Dr. K.R. SethuramanProf. Dr. N. Ananthakrishnan

Prof. Dr. S. Krishnan

Editor in Chief : Dr. Sumathy Sundar

Prof. Dr. A.R. SrinivasanProf. Dr. B. Sivaprakash

Mrs. A.N. Uma

Executive Editors

Members

Dr. S. SrirangarajDr. V.R. Hemanth Kumar

Dr. Sobana JaiganeshMrs. Asha Suresh Babu

Ms. Vijay Chitra

Taking Music Therapy : Shaping The FutureForward

CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH