Just a Song Sunday: What Makes My Music Music Therapy?

One of the constant questions that music therapists are challenged to answer usually goes along the lines of this type of conversation:

• Well, what do you do?
• I'm a music therapist.
• (Several seconds of silence) So, what does a musical therapist do?
• (Internal sigh about the several different tracks that the conversation can take - should I start with the whole "musical" thing? How much does this person REALLY want to know, etc.) Well, basically, I use music to help my clients move towards their own personal goals.
• Oh. So, like singing songs to them?
• Sometimes. Sometimes I help them use music to motivate themselves to complete tasks. Sometimes I use music to help them calm down. Sometimes I encourage them to make their own music to express their emotions. I use music in many different ways to help my clients get to their own goals.
• Oh, I do that. I listen to my "workout" playlist during my time at the gym. I have a playlist for studying and for cleaning the house.
• I'm glad that you have music that you use as a tool. What I do is a bit more complex than a playlist. I use my knowledge and education of music, psychology, neurology, and human development to shape the musical experience to each individual I see during music therapy sessions.

Usually, at this point of the conversation, my audience is finished. They have a bit of understanding about what I do. I think that many of them might also think that they are doing music therapy themselves. There are comments and questions that follow - "Do you have to go to school to do that?" "I know exactly what that is. My niece goes to a nursing home to sing. Those people love to hear her sing." "I sure wish I had some musical talent." "Why didn't you decide to sing professionally?"

Each one of the encounters that I have had over the years has challenged my thought process about the differences between using music for a therapeutic benefit and music therapy. I am still challenged by this concept, and I try to write about it each time it comes back to the forefront of my attention.

For me, the difference between music for a therapeutic benefit and music therapy comes down to one thing - a therapist.

At this point, I feel compelled to make a specific statement. I am a music therapist with many years of education, so I am completely biased when it comes to this topic. There is no argument in my head when it comes to which is better for a client - a playlist or a music therapy session. I am on the side of the music therapy session all the time! So, remember that as you read a bit more.

In my mind, there is a significant difference between what I do in a music therapy session and what an occupational therapist who includes music does during a session. (For the record, I have absolutely nothing against an OT using music in an OT session as long as that OT acknowledges that he/she is not doing music therapy but is doing music-enhanced occupational therapy. Fine line, but one that is important to me.) The OT who uses drumming to enhance fine and gross motor development, to increase social interactions, and to offer a different format to the clients in the session is doing things with an OT eye - they look for things a bit differently than I do. That does not mean that the OT is not providing their clients with a therapeutic benefit through the drumming, but the music therapist is going to approach the drumming itself a bit differently.

Now, the challenge comes in explaining why the music therapist and the OT use drumming differently during their therapeutic sessions.

My mother, an Occupational Therapist by the way, would occasionally sing to her clients. She found that singing would engage her clients' interest and would, on occasion, motivate them to finish their exercises and tasks more quickly than silence. I would often follow her around her day during my vacations home, and I would put in music and musical elements throughout her sessions (with her permission, of course). She often remarked that she got through all of the things that her clients needed to do much faster when I was using sounds, tempo, body percussion, and improvised songs to support what she needed her clients to do.

One little guy was working on fine motor strength and pincer grasp development. Mom had made a game with a can, a lid, and some poker chips. The client had to push the poker chips through the lid into the can. Some of the slots in the lid allowed the chips to fall through easily. Others needed some strength. The client had been doing the task for several weeks, and, in general, seemed unable to focus on most tasks for more than 60 seconds at a time. (He was very little.)

Mom sat the task, the client, and herself at a table. She demonstrated how the task worked and the client started. The client pushed three chips through the lid and then tried to leave. Mom demonstrated again, and this time, I added a sound to the process. The client froze, turned his head, and picked up a chip. He started to push the chip through a slot in the lid, and I started a sound. He looked at me again, and picked up a different chip. This chip went into a different slot, and I changed the sound. He worked through the remainder of the chips without stopping, listening to the sound that I made when he did his work.

Was what I was doing music therapy? I don't think so. I think what was happening was sound-supported occupational therapy. There was nothing in my music therapy training that I used to make the process happen other than I was more primed to think about a sound element than my Mom. There was nothing that would keep my mother from replicating what I did with sound with the same student at a later date. She wasn't doing music therapy, but she was using sound to motivate her client.

So, what is the difference between what I was doing with my Mom's client and what I would do with my own client?

Initially, the goals that my Mom established for that young client were specifically occupational therapy in nature. The goals that I would have would not be focused solely on fine motor strength development using only the can, lid, and chips. There would be some focus on interactive music making between myself and the client including the use of instruments, sound making, and fine motor focused TMEs.

When I am engaged in a music therapy session, I am fully engaged in making the music "fit" my client. I present the music using different tempi, pitches, rhythms, chord structures, forms, timbres, and lyrics to work with the behaviors, preferences, and interests of each client. I know the influence of music on the neurology and physiology of human beings. I know what happens when you can find the perfect tempo for a person to be able to coordinate his or her motor patterns. I also know what happens when you don't find the right tempo. I think that this is the primary difference between being a music therapist and being a person who helps others get to therapeutic goals by using music.

It's difficult to put this into words, because at the end of the day, all therapists are trying to get their clients to desired outcomes. We all look for things that motivate our clients. We all want our clients to reach full function in the world. We all try everything we can to engage our clients. There is a fine line between my use of music in a music therapy session and an OT using music in his or her OT session. 

The difference really becomes the viewpoint and the training of the therapist, doesn't it?

What makes my music music therapy? My knowledge of music, of neurology, of psychology, of human development, and of the effect of all these things on each client that comes before me. The application of my knowledge can help my clients reach their therapeutic goals. I can use my knowledge to help my clients because I know both what my clients do, need, and prefer and I can adapt my music to the clients in front of me.