If we assume that MT interventions can be prescribed, are we saying that all clients respond to certain musics in the same way? Is that even possible? Do we all really connect to the same music in similar ways? How can this be? Is my reality your reality? Can you find two IPods on the planet that are loaded with the same music??

When visiting a music store, when we actually left the house to buy music (and music buying was social activity), I remember how the stores would categorize music by styles or genres: Aisle 1, Pop music; aisle 2, Rock; aisle 3 Jazz music; aisle 4, Classical music; aisle 5, Rap Music; and aisle 6, Relaxation music- what’s wrong with these categories? Well, what first strikes me is that they are indeed styles of music, except for one…”Relaxation” music. Relaxation isn’t a style, it’s some kind of cause-and-effect based on listening to music. So, in other words, when you listen to this (relaxation) music, you should become relaxed. This is a huge problem for me- being that the very music that is classified as being relaxing has the opposite impact on/in me. In fact, when I listen to “relaxing” music, it sometimes makes me anxious, bored, and I do anything I can to remove myself from it. This is not to say that others don’t feel or become relaxed when listening to this music. I’m only suggesting that music may impact humans in different ways based on their emotional and personal make up- the very make up that makes them (us) unique as people. Do we experience things the same? Is my reality the same as yours? Doesn’t this relate to musical experiences? AND, if we can remove ourselves from this musical experience and say, “when you feel this way, play this…,” why then even have live musical experiences in music therapy? Just use CDs all day, yes?

How does the above example relate to music therapy? Or, does it all? How do we match musical experiences to client needs? Is there a special music that “goes with” autism? Is there a special music “goes with” cancer care? And so on…can it all really be that “simple”?

So, how do we “match” musical experiences with/to/for clients? Are we “matching” musical experiences for clients: Based on pathology (core deficits of that pathology)? Based on the client, as he/she behaves (how they look and act; behaviors)? Based on the client’s needs (how pathology impacts his/her quality of life)? Based on our musical likes and dislikes (whose needs are we meeting)? Based on the why’s and how’s of the musical interactions (focus on here-and-now interactions)? Or, Based on past evidence, that has nothing to do with this particular person (can we remove the person from their unique cognitive, social, musical, etc. abilities?)

I think that the above questions apply to all music therapy methodologies and approaches. Thoughts???

Thanks for reading and I look forward to your ideas and thoughts.

Best,

John

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About drjohnmtbc

John A. Carpente, PhD, MT-BC, LCAT, NRMT, Assistant Professor in Music and Music Therapy at Molloy College, is the Founder and Executive Dir

22 responses »

  1. There is no question that music can be prescribed. As for people not responding the same way to certain music, that can also be said of any drug or pharmaceutical interventions. Never the less, certain general elements of music can be, and often should be prescribed. Not genres, particular artists, or tunes, but the more general elements. I prescribe slow, quiet music for stress-reduction listening. I don’t say “New Wave”, “Nocturns”, or the like. But certain prescribing 20-minutes of listening to certain musical elements is quite possible. The client will select the “genre” or “artist”, but I will suggest what type of music. For instance, I always instruct parents not to obtain children’s CDs that have excessive auditory information such as full orchestras, electronic sounds, etc. And the like. So prescribed listening is definitely something that works! Since the clinician knows his clients, s/he can certainly make important recommendations. I don’t see the problem.

    • drjohnmtbc says:

      Hi Dori,
      Thanks for your examples, very interesting. It sounds like, based on your reply that the clients are selecting their own music (genre), yes? I’m not sure that that would be prescritive ( we may be defining prescription differently). For example, would a medical doctor ask the patient, “what kind of medicine would you like for me to prescibe?”
      Also, in your reply you mentioned that you instruct parents on what CDs to play for their kids…just so i understand, because I also work with children and parents: is this a general thing/protocal that you do with all parents? do you assume that all of the children that you are working with will go on auditory overload whwn listening to music? And, can we, as therapists remove oursleves from the child’s expereince in music? I’ve worked with children who exibhit both, hyper and hypo responses to the music. Some are over reactive and some are under reactive to certain elements within the music. I feel that if you’ve seen 1 child with autism, that you’ve seen still only 1 child with autism, and i think that they are expereincing musical individually and diffierently. For example: I’ve worked with kids, that when engaged in musical play display discomfort when the musical dynamics increased. Some of the kids would just withdral from the musical interaction and begin to enageg in self-stim activity and then there are kids who will grimace, maybe put a hand to their ear, too, however, they still continue to play in a related way. There is something about the expereince in music making that became more important to the child then meeting a usual sensory need (that may be a part where the therapy is- adpating, adjusting, and assimilating in order to maintain the musical dialgue/relationship. In addition, i’m also thinking about the goals and the intent of the music for this specific child before suggesting a home-based music plan for parents to emply at home? if i’m dealing with a child, for example, who has autism, i never ask a parent to just play a CD. Because autism is a disorder in relating and communicating, the focus of a home-based music program, in my own work, needs to include a program that targets the child’s ability to relate and communicate within musical play (musical expereinces), whereby helping mom and dad relate with their child through the expereinces of music making and helping them to develop a musical relationship with their child; and their music, that they find engaging and meaningful with the child, may be completely different to that of tha music that the child and I engage in. So, I do not suggest CDs. I suggest things that they can do with the CDs until they (parents) feel comfortable engaging in musical-play with out the CD, but the interaction is all about the expereince of being in music together (in my thinking). All of this being said, Im not saying that auditory issues do not exist, because i know that they do (as does motor planning, sensory moduation, etc.). Individual and musical differences need to be understand and incorporated into the home-based plan as well.
      Thanks again for your thoughts and ideas.

      Best,

      John

  2. Patti Catalano says:

    What great questions. I think you are right – these questions apply to all methodologies and approaches of music therapy. I have been in that same boat as you – music called relaxing has made me jittery and it made me want to crawl out of my skin. But for the person next to me, it may have a different effect. I still remember the out of body experience I had in college when I was trying to nap and my boyfriend put on Pink Floyd’s “Wish You Were Here” in the background, thinking it would help me relax. Caught in that twilight between wakefulness and sleep, and totally unaided by any mind altering addition, it became mind altering for me and made me feel very anxious. I had to get up and turn it off. So, no, we can’t prescribe specific music based on etiology of a disease process. We can put together within our own discography ideas for what has worked in the past with clients or what might work based on what outcome you are working on, but it still needs to be based on the client’s response to it. I could have several songs for gait training at particular metronome markings that are matched with the client’s current gait and goal gait pace in my collection but I still need to keep in mind that what may arouse the client’s motivation to keep working with the music is going to be as important as the initial beat that helped him entrain and move to the beat. So when choosing music, I take into account most of your questions, except my own taste in music which is irrelevant to the needs of my clients. I will choose music based on the core deficits that my client exhibits, what his needs are, what music he likes that will be engaging to him and allow him to work on those needs. It will be different for each person but I will use past knowledge to help me find out what will be good for him currently. It’s sort of a deductive process, based on knowledge of the client (and knowledge the client shares), knowledge of the process, and observation of the client’s response to the music. Some of our clients are nonverbal so we really have to use the observation process to assess the effect of the music. We also know that response to even preferred music can be based on time of day and mood. Use of preferred music will also have to be tempered with the outcome sought. I try to get a broad array of preferred music from my clients. If my client with autism gets so excited about certain preferred music that he becomes dysregulated and is no longer open to new learning, then it is not doing him any good. What my nervous system will tolerate in the morning is different than what it will tolerate throughout the rest of the day. I had a good laugh a few years ago when a young man told me that listening to heavy metal helped him relax on his commute home. I totally understood – one size does not fit all.

    • drjohnmtbc says:

      Hi Patti,
      thanks for your ideas. Yes, i too believe that there are so many clinical variables that determine the therapist’s musical choices; and understanding and repecting the child’s nervous system is so important, as is understanding his individual/musical differences that may be interfering in musical interactions. I think i’m curious to know…the question derives from the following: the musical choices we make as therapists, yes, are client driven, as we both pointed out, however, are they (musical choices) therapist-client (relationship driven) driven? In other words, what about the relationship between client-therapist (musical and non-musical)? To that end, let’s say that in working with client “A,” you come to the clinical conclusion that he appears to be related, engaged and more musically resposnsive when you play music “B”. Is this to say that if another therapist came in to work with the same client, and he/she (therapist) also played music “B,” would the client respond/react in the say way in which he/she engaged when you employeed the musical intervention?

      Thanks again!

      John

  3. Noel Anderson says:

    I do not believe particular genres can be prescribed. However, I think that at times it is appropriate to prescribe specific methods in music therapy, such as Melodic Intonation Therapy (MIT) or Rhythmic Auditory Stimulation (RAS). I suppose we never know what the precise outcome will be, but since we know the needs of the client we can use techniques that have previously addressed similar goals and objectives. The music genre can then be tailored to the clients’ specifications.

    • drjohnmtbc says:

      Hi Noel,
      Thanks for your response. I’m not sure I agree with prescriptions in my own MT work. For me, prescription implies that there are some sort of rules or an understanding of what the outcome will be. Iit also implies, for me, that it doesnt matter who is administering it. and , if it is is dependent on who is adminsitering it, then how can it be a prescription- does that make sense? (i guess it all depends on how we define “presciption”). However, I do believe that the application of an MT method (i.e. song writing, improv, receptive music, etc.), should be flexable and guided based on the client’s needs, goals, etc. Also, as a side note, we may be defining MT methods differently.
      Thanks again,

      John

      • Noel Anderson says:

        True, we must make sure our definitions match up. I somewhat agree with your definition of prescription. To me, prescription implies an expected outcome will be produced. However, I agree with Dr. Berger that, “As for people not responding the same way to certain music, that can also be said of any drug or pharmaceutical interventions.” Expectations are not always met. However, I believe in order to practice we all have to have some expectations or objectives for our clients, other wise what’s the point.

        By the way, thanks for making this blog and sharing your thoughts.

      • Brian Abrams says:

        Good point, John. To respond to Noel’s point below, the whole problem with “expected outcome” with persons is that as soon as we predict outcomes with persons, we contradict their agency. It’s one thing to work together with clients for a particular outcome, but that is not analogous to the predictability with which organisms and “tissue” respond to biochemical intervention in a law-like, natural science sense. The latter paradigm does not require agency to “work” (i.e., “it works”) whereas the former does (“I work” or “We work”). The analogy doesn’t hold up as long as we’re working on the level of persons, versus organisms and tissue. Goals and objectives in therapy are the client’s goals–not the therapist’s. The therapist’s job is to provide opportunities, not manipulate clients into specific outcomes. It’s like the adage about leading the horse to water–the leading is the therapist’s business, but the drinking is the client’s. We don’t even “predict” whether or not the horse will drink–we simply extend the highest quality opportunity possible (of course, I’m speaking of persons, not horses, as does the metaphor in the adage)!

      • Noel Anderson says:

        I understand what you’re saying Dr. Abrams. Working in a school environment, I find it hard to have no expectations though. For example, IEP goals are chosen based upon if a child is expected to meet those goals by the end of the school year.

      • Brian Abrams says:

        Noel,

        Yes, but remember, the learner is supposed to be a member of the IEP team–a collaborator, working with the others in her or his own educational interests. Essentially, she or he is an agent, who should have the chance to appropriate the opportunities that all of the other members of the IEP team are affording her/him.

        If we agree that the system isn’t right, and that persons and art should not be reified, let’s work to change this, however gradually it needs to move. Of course, that’s the big question…I am not so sure everyone agrees that it’s actually a problem when persons and art (in what should be social and artistic contexts) are considered to be “things.”

        Brian

      • Noel Anderson says:

        Dr. Abrams,

        Unfortunately, I work with severely disabled students who are not able to participate in the IEP team.

        I think I need to do more research for myself to determine my stance on the issue, and see the perspective from different views. I do agree, however, it bothers me terribly when human beings and art are considered “things”.

      • Brian Abrams says:

        Noel,

        But come back to the original point–whose outcome is being predicted? Does level of functioning really have anything to do with who “owns” the outcomes?

        No learner under the age of 18 (or otherwise proclaimed legally dependent) has full legal authority to represent themselves in legal contexts–but that is not the same as inclusion of the child as person/agent in their own treatment. The IEP does not grant full legal authority to the learner no matter how high their functioning–therefore, level of functioning is not relevant here. The way a child with high verbal capacity “participates” will be qualitatively different from how a child with a more severe cognitive impairment participates. The point is that both participate. Personally, I would seriously question whomever is instructing you that learners below a certain level of functioning “cannot” participate. I have worked with persons in “vegetative” states who are included as agents in their own treatment.

        The philosophical stance is the point here–that no matter what the person’s functioning level, their goals are THEIR goals, not the therapist’s, to meet. Therefore, predicting outcomes, on the level of a person, is equally de-humanizing, regardless of level of functioning. Prediction belongs to the natural sciences, not to the arts or humanities, where relationship-based therapies are located.

      • Brian Abrams says:

        I am concerned, in a general sense, about perceptions out there about when a client (or, learner with an IEP) is considered to be a part of their own treatment process. Here, for example, is a paraphrase of the IDEA law specifically around the transition team:

        “Students, no matter what or how significant their disability may be, are the most important people involved in transition. They should be as actively engaged as possible in all aspects of their transition process. The IEP team must specifically invite the student to attend any IEP meeting in which the team will be considering transition service needs or needed transition services. The transition planning process should be done with, not for the student. The student’s IEP transition plan must be based on his or her individual needs, choices, and preferences with goals that reflect what the student is interested in doing now and what he or she will want and need when high school is finished. Preparing together for IEP meetings gives students and parents the opportunity to identify and discuss the student’s goals for the future. If the student does not attend, schools must ensure that the student’s preferences and interests are considered when developing the IEP transition plan.”

        Thus, regardless of severity of disability, it’s interesting how the law actually protects the learner’s agency.

        Just to be clear: I’m not meaning to pick on you at all, Noel…in fact, I appreciate very much your openness in thinking about these matters in a fair and balanced way. I think this topic that John posted is an extremely important one and requires a great deal of open dialogue, and I’m grateful to all who are participating in this conversation. I just believe it’s worth emphasizing this particular point (and points like it), for all to see, as we need to make this clear to others and be the best advocates for our clients/learners as we can be.

        Thanks!
        Brian

  4. Doug K says:

    RAS? Is that one of those things music therapists have been doing forever that NMT is trying to monopolize?

    • Noel Anderson says:

      I think the issue is we have been calling it “thing” for so long, no one knows what we do until we put a name to it and a definition.

      • patticatalano says:

        And RAS has been used in the physical therapy realm, not just NMT. Just as MIT started in the speech therapy realm. It helps us identify techniques and allows us to talk on a common ground about those techniques. We are still using our creativity within those therapeutic music experiences. But it helps me in talking to other allied health professionals when co-treating.

  5. Brian Abrams says:

    Once again, excellent post, John.

    I think the issue, once again, is our definition of music.

    If we are to understand music as a physical sound stimulus interacting with nervous systems, then I suppose we can apply the very same principles as are applied in natural science based, physical medicine. That is–to assess the specific cause-effect interactions among the variables and, based upon reasonable prediction of the outcomes rooted in these variable relationships, prescribe the stimulus that will “cause” the targeted outcome.

    The problem is that, based upon the way we talk about and encounter music in an everyday sense, eludes aural stimuli. No matter how hard we try, we cannot circumscribe that which “counts” as music, and differentiate it from that which does not “count” as music, on the level of aural stimuli. Berlyne and Meyer gave it a good shot–but there are far too many examples of music that come no where near their criteria for sound sufficiently organized for hedonic response. And then, of course, we have the problem of silence (i.e., rests). While one might argue that the silences in music are merely a part of the sound context, one could counter-argue: But how much silence can there be before there is finally no music (take, for example, John Cage’s 4’33”)?

    If we consider music to be art, then we may ask, is any art reducible to constituent variables or a conglomeration of stimuli? Perhaps, if art is in “the thing.” But when art is fully reified, commoditized, and removed from its personal and social context, is it really art? Garred (2006) is clear that music (as art) is not “located” neither in pressure waves in the air, nor as neurological impulses in the brain–but rather in a dialogical exchange. For Garred, music is not an “it,” but a “thou,” in the same sense that a person is not an “it,” but rather a “thou.” Would one “prescribe” a person for another person (the song “Matchmaker, Matchmaker” from Fiddler-on-the-Roof comes to mind, but only in a comical sense, of course!). I think we would agree that the answer is “no”–any more than we would say Dr. Martin Luther King’s Address (as is evoked or me by the occasion of Black History Month) should be “prescribed” to “treat” civil injustice.

    Following this line, “prescription” based upon natural science, cause-and-effect principles is simply a category error–a fallacy–when applied to art, qua art. Again, if we follow this line, then art does not involve brains interacting with physical media–it involves PERSONS interacting with AESTHETIC WAYS OF BEING (and BEING-TOGETHER), as persons with IDENTITY and AGENCY, whether in the therapeutic context of re-learning to walk after neurological injury, or plumbing the depths of the meaning of life. The fact that brains shift while engaging in a social experience is arbitrary–as arbitrary as the fact that there is a particular type of ink on the paper upon which Mozart recorded his masterworks. Juxtaposition of electrochemical activity does not contain the meaning–nor does it “contain” human agency. PERSONS transcend their brains, and that which occurs on the level of the PERSON (i.e., art), likewise transcends neurological stimulus. Art, by this way of thinking, when reduced to its constituent parts, features, etc. (in the same sense of physiological variables) would simply cease to be what it is, and therefore does not “fit” as an analogy to medicine (or medical intervention) in a natural science sense, at all.

    Thus, even if we agree that “one size” never “fits all,” the entire question of whether even a very individualized “prescription” remains in great doubt, if we reject the notion of music as an aural stimulus that is reducible to constituent causal variables.

    I am grateful that reductionism works in natural science and medicine. It’s a good thing. It works. But simply because it works in natural science does not mean we need to apply that to the expressive arts therapies, in any analogous sense, in order to legitimize those therapies.

    Thanks again for this very provocative post, John!

    Brian

  6. WONDERFUL Post.thanks for share..more wait .. …

  7. John Pietaro says:

    Hey John,
    CONGRATULATIONS on the new blog!

    Important issues here and though I may no longer be a practicing MT, I would like to offer that something as deeply evocative as creative arts therapies is, in a sense, always custom developed for the client or patient. All music therapists need to be innovative when it comes to developing tx and while there may be certain staples, we need to create visceral means to reach those who have very different experiences and responses to music. Music-based tx of course differs greatly from a record store (God, don’t we miss them, even with their failings LOL) as any store is based on profit-margins and desperately trying to sell customers a product. From what I recall of the field, there is little capitalist enterprise ruling it at this point! I think its pretty clear that you wouldn’t force treatment into a cookie-cutter but your questions raises some serious consideration and allows others to think through how important the personlization of tx is.

    peace—and best of luck with this and your many other powerful ventures, ol muck n mire,
    jp

  8. Tara says:

    Thank you all for this very important dialogue. -Tara

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