International Journal of Disability, Development and Education Vol. 57, No.

3, September 2010, 335340

REVIEW ESSAY

Music Therapy: Diversity, challenge and impact

Lynne M. Baker*
School of Education, The University of Queensland, Brisbane, Qld 4072, Australia
International 10.1080/1034912X.2010.501254 CIJD_A_501254.sgm 1034-912X Review Taylor 2010 0 3 57 jjandryn@powerup.com.au LynneBaker 00000September & and Essay Francis Francis (print)/1465-346X Journal 2010 Ltd of Disability, (online) Development and Education

Music Therapy Groupwork with Special Needs Children: The evolving process, edited by K. D. Goodman, 2007, Springfield, IL, Charles C. Thomas, 302 pp. + index, US$49.95 (paperback), ISBN 978-0-39-807739-6
Music has charms to sooth a savage breast, To soften rocks, or bend a knotted oak. (William Congreve)

Throughout the centuries, music in its many forms has been utilised in various celebrations, rites and rituals, war and victory, grief and mourning, and general community life (Best & Huttar, 1975; Cox, 1969; MacIntosh, 2003; Madvig, 1992; Olson, 1981). Music is also recorded as the means by which King Saul was able to find peace and rest as David, the young shepherd, played his harp (Avers, Mathur, & Kamat, 2007; Purkiser, 1965; Youngblood, 1992). The popularity of relaxation music depicting sounds of nature, the rainforest or the ocean might also indicate the continuing benefits of music in todays very active and often stress-filled society. The therapeutic value of music cannot be underestimated. From my very early teens, for approximately 20 years, I frequently performed in a variety of concerts held at a wide range of venues, including homes for the elderly and institutions for people with intellectual and/or physical disabilities. As a young person it was sometimes difficult to deal with the life situations I witnessed in those places, but I will never forget the way in which the faces, and particularly the eyes, of the elderly would light up as I began to sing the old familiar songs. Those whose memory had faded frequently remembered the music that connected them with happier times, and would often sing along, rarely forgetting the words. On another occasion in my early twenties, the mother of a teenage girl with significant intellectual and physical disabilities came to me after a concert and spoke the most incredibly moving words, Thank you. Thats the first time Ive seen my daughter smile. This paper will highlight a selection of themes in relation to music therapy, its potential, and varied role across a number of life circumstances. Themes include: music as a therapeutic intervention; its role in illness, hospitalisation and death; its possible relevance to counselling and psychotherapy with a particular focus on victims of trauma; considerations for the classroom and students with special needs; and the advantages of combining a music therapy approach with other therapeutic options.

*Email: jjandryn@powerup.com.au
ISSN 1034-912X print/ISSN 1465-346X online 2010 Taylor & Francis DOI: 10.1080/1034912X.2010.501254 http://www.informaworld.com

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Music as a Therapy Many people enjoy music and are often able to relax while listening to music or engaging in musical activity in some form. While the benefits associated with such activity cannot be denied, the simple interaction with music should not be considered music therapy, in the same way that talking through a problem with a friend or work colleague cannot be considered counselling (Baker, 2009). Music therapy is usually conducted by a qualified music therapist who carefully assesses the specific needs of the client as part of the pre-treatment process. During the initial assessment, consideration will be given to health, current medical treatment, cognitive functioning, psychological and emotional needs, family and social networks, and the musical background of the client in an effort to devise a comprehensive and individualised treatment plan (Maue-Johnson & Tanguay, 2006). In Music Therapy Groupwork with Special Needs Children, Goodman considers many of these issues specifically in relation to children with special needs and their placement within a particular group. Treatment options can vary considerably depending on the age of the client, the setting, and the goals to be achieved. For example, while music therapy has the potential to impact positively upon a variety of situations (Bright, 2006), the goals and type of music therapy utilised in an educational environment could be quite different from the options available in a palliative care facility. Music and Illness It is probably safe to say that hospitalisation, although necessary at times, is not the most enjoyable experience, particularly if the stay is a lengthy one or involves extensive treatment. Regardless of age, illness and subsequent hospitalisation can take their toll on individuals as a result of pain, prolonged treatment, and separation from family or friends. Such conditions can contribute significantly to high levels of anxiety for the patient (Longhi & Pickett, 2008), and music therapy can offer a means through which patients are better able to cope with the difficulties confronting them (Avers et al., 2007). A number of studies have indicated a range of positive outcomes associated with music therapy. For example, Longhi and Pickett found that the oxygen levels in the blood increased significantly (2008, p. 247) as a result of music-based interventions. Music therapy has been found to reduce both blood pressure and heart rate while contributing to relaxed muscle tension (Brunges & Avigne, 2003, p. 818); and decreases in chronic pain, levels of depression and degree of disability were also found to be associated with patients involved in a music programme (Siedliecki & Good, 2006). Similar results regarding chronic pain and levels of depression were also found during an investigation involving the effects of listening to music (Mitchell, MacDonald, Knussen, & Serpell, 2007). This study further highlights an improvement in the quality of life enjoyed by the individual, together with an increase in general energy levels and the ability to perform different tasks or activities. Those who work within the field of palliative care are often required to assist both individuals and their families through the pain, anxiety and even fear associated with impending death (Horne-Thompson & Grocke, 2008). Although in this situation, pain and ongoing fatigue can prove debilitating, music therapy with a focus on the holistic needs of the patient (OKelly & Koffman, 2007) can still be utilised in an effort to decrease levels of anxiety and restlessness, increase coping and relaxation skills, and assist the client to more effectively express his/her feelings and associated emotions (Maue-Johnson & Tanguay, 2006). One might also consider the role of the therapist. Within this field, in particular, the challenges can be quite notable and can prove somewhat stressful for the

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therapist. Contributing factors include a close, and often ongoing, association with issues surrounding death and related grief (Salmon, 2003), and the rapidly changing physical and emotional needs of the patient, combined with an uncertainty regarding the length of treatment and thus the duration of the relationship (Hilliard, 2003; Maue-Johnson & Tanguay, 2006). Nevertheless, the music therapist embraces his or her role with commitment and consideration for the client and others perhaps less directly involved in the treatment process. Music and Counselling Music therapy can be used in conjunction with counselling or psychotherapy. It offers the option of a non-invasive approach and can be valuable in working with a variety of client situations. For example, Bensimon, Amir, and Wolf (2008) describe using only the simple instrument of a drum when facilitating sessions for soldiers suffering from post-traumatic stress disorder. Conducted in an environment where the participants were able to feel safe, group drumming was found to create feelings of openness, togetherness, sharing, closeness, connectedness and intimacy (Bensimon et al., 2008, p. 38). It also provided participants with the opportunity to release rage in an expressive, effective, yet acceptable manner. Music therapy has also been found to provide a helpful alternative for women recovering from domestic violence (Teague, Hahna, & McKinney, 2006). Once again, decreases in depression and anxiety were apparent, and the suggestion is offered that music-based interventions could be utilised to help alleviate some of the psychological difficulties for women in domestic violence situations. In a study by Baker (2006), some women who identified themselves as victims of domestic violence also identified music and song as a part of their coping response to living in an environment of ongoing abuse. In a similar manner, other victims of trauma, such as refugees, can benefit from musicbased interventions. Those who have fled their homeland in the face of violence and fear, in a desperate effort to resettle in a new country, may understandably experience feelings of separation, isolation and general loneliness (Baker & Jones, 2006). In such cases, music therapy can assist in reducing outwardly aggressive behaviour and also provide a language in which the clients are able to more effectively express their feelings. Further, Baker and Jones recommend music therapy as a useful and practical alternative to the more traditional forms of school discipline.

Music and the Classroom Music therapy uses music as a tool to induce positive behavioral changes (Gasalberti, 2006, p. 134). While Gasalberti emphasises the benefits of music therapy for children with autism or speech difficulties, positive behavioural change, including a decrease in aggression, hyperactivity or generally poor conduct, has the potential to benefit everyone within a classroom setting (Baker & Jones, 2006), including the teacher (Cheek, Bradley, Parr, & William, 2003), as the continual need to manage challenging classroom behaviour can contribute significantly to teacher stress and anxiety (Groundwater-Smith, Ewing, & Le Cornu, 2007). Individual or group programmes may be instigated as required and can be tailored to meet specific needs, such as assisting the student to complete tasks that form part of his or her individual education plan, increasing levels of communication, or fostering the development of social skills (Patterson, 2003). Gallegos (2006) explains that although some group musical activities, such as participation in a choir or band, may not be interactive in

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and of themselves, the sense of belonging to the group can overflow into non-musical settings and offer the opportunity for increased levels of inclusion and subsequent social interaction. While not in a school setting, this point is clearly illustrated in the experience of a woman who had been a victim of domestic violence, and whose priest encouraged her to join the church choir. Mary explains her amazement as she realised the true purpose for the choir activity.
When I joined the choir, the first week I went, they talked for about half an hour and then they started to sing. And I thought, This is funny. Ive been to school choirs with the nuns. You go to choir, and you sing and you come home and thats it. So I never said anything. But the next week I went to choir and they started singing straight away and I thought, Ohh, that must be a once off. And half way through, here they are all talking again So anyway, I started to listen to what they were saying and I realised that all of these women at that stage had had a problem and serious crisis in their lives and Father had helped each one of them through that crisis. And this was his way of building a support group. He brought them together in the choir and if they talked, well that was fine. And if we sang, that was fine And so I realised that, the choir wasnt the thing. If we sang, that was lovely. And if we sang in tune, that was a miracle. But he wasnt worried about that either He had this support group to help these people through their thing. So he was way ahead of his time. (Baker, 2010, p. 160)

Regardless of whether the client is an adult or a child, for the therapeutic process to be truly effective it is necessary to create a positive connection between the client and the therapist (Preti & Welch, 2004). Goodman also highlights the essential nature of this relationship. Further, Music Therapy Groupwork with Special Needs Children presents a range of case studies of children experiencing different disabilities and offers assistance for the music therapist who may be required to incorporate a number of different cases in the same group therapy session. Additionally, Goodman offers a range of strategies designed to assist children with special needs, such as those who are experiencing learning difficulties and communication disorders, or visual impairment, or some level of physical disability. She also highlights key considerations for children in each category. This volume provides a comprehensive coverage of music therapy and its role in assisting children with special needs. Advantages of Music Therapy Possibly the key advantage of music therapy is its versatility. Interventions may be as short or as long as necessary for patient comfort or individual attention and interest levels (Preti & Welch, 2004). As music is a universal medium, this form of therapy has the potential to cross boundaries of age, culture, language and experience (Baker & Jones, 2006; Robarts, 2006; Sorrell & Sorrell, 2008). Interventions may be simple or more complex depending on specific needs, and may involve quiet listening to a selection of musical pieces, or more direct involvement with song, or the use of an instrument in either a group or private setting (Hilliard, 2003; MacIntosh, 2003). Some clients may be able to self-administer their therapy sessions, making scheduling more flexible and convenient (Siedliecki & Good, 2006). While therapists do develop the most appropriate intervention for the client, music can be chosen by the individual as there are no set rules that determine the choice of music and each situation is viewed as unique (Robarts, 2006). Music therapy has a wide range of applications and can function hand-in-hand with other forms of treatment, allowing clients the greater benefit of a holistic intervention programme. Throughout the life-span, and across many of the circumstances of life, it would appear that music therapy has the capacity to make a significant and unique contribution to the overall health and well-being of the individual.

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