Barbara L. Wheeler, Carol L. Shultis, Donna W. Polen - Clinical Training Guide For The Student Music Therapist-Barcelona Publishers (NH) (2005) PDF

Clinical
Training Guide
for the
Student Music Therapist
Barbara L. Wheeler
Carol L. Shultis
Donna W. Polen
Copyright © 2005 by Barcelona Publishers
All rights reserved. No part of this book may be reproduced

in any form whatsoever, including by photocopying,
on audio- or videotape, by any electronic means,
or in information storage and retrieval systems.
For permission to reproduce, contact
Barcelona Publishers.
ISBN 1-891278-27-4
246897531
Distributed throughout the world by:

Barcelona Publishers
4 White Brook Road
Gilsum NH 03448
Tel: 603-357-0236 Fax: 603-357-2073
Website: www.barcelonapublishers.com
SAN 298-6299
Cover design:
© 2005 Frank McShane
Acknowledgments
Many people have helped to make this book possible. We would like to acknowledge our many
clients, students, and interns. They have been the inspiration for this book and have taught us
much. They have also helped us to know what needed to be included in the book.
We would like to thank Anthony Meadows for his help with Chapter 4, Clinical
Assessment. He was willing to assist us with his expertise in this area and we are grateful. He is
the first author of that chapter.
We thank Kenneth Bruscia for his support in the creation of this book. That has included
his willingness to provide feedback and share materials as well as publish the book.
We also thank Barbara Reuer for reading all of the chapters and giving us feedback. The
generosity with which she shared her time and expertise is truly appreciated.
Thank you to Korin Kormick for assistance with computer problems in producing the
book and to Cheyenne Mize for proofreading.
Barbara Wheeler would like to acknowledge the support of her former university,
Montclair State University, through a sabbatical during which the initial draft of this book was
developed. She also thanks her coauthors for all of their expertise and work on this book.
Carol Shultis thanks her husband, Gary, for his support during the process of writing this
book. She also thanks Kenneth Bruscia for helping her become a better writer.
Donna Polen would like to recognize the support of her coauthors for their honesty,
humor, and insight as we shared this process. She would also like to acknowledge the loving
support of her mother, Nancy.
We hope that the use of this book will enrich the education of future students, practicum
students, and interns and will enhance the services they provide to clients. It is because of the
growth and learning we have received from our clients, students, and interns, and the joy of
contributing to the growth of young therapists, that we are motivated to attempt to capture what
these experiences have taught us and share it with others.
III
Permissions
The authors thank the following for pennission to reprint material in this book:
Kenneth E. Bruscia for pennission to reprint:

General Behavior Checklist
Strategy/Activity Fonn
Guidelines for Activity Planning
Mary M. Wood for pennission to reprint:
A chart on stages of development in Developmental Therapy, from Developmental Therapy
(1975), Baltimore, MD: University Park Press.
The American Music Therapy Association for pennission to reprint:
An adapted chart from Hadsell, N. A. (1993). Levels of external structure in music therapy.
Music Therapy Perspectives, 11,61-65.
Portions of an assessment from Layman, D. L., Hussey, D. L., & Laing, S. J. (2002). Music
therapy assessment for severely emotionally disturbed children: A pilot study. Journal of
Music Therapy, 34, 164-187.
iv
About the Authors
Barbara L. Wheeler, PhD, MT-BC, NMT, is Professor and Director of Music Therapy
and a University Scholar at the University of Louisville, Kentucky. She was previously on the
faculty of Montclair State University, New Jersey, from where she received the designation of
Professor Emerita.
Barbara has been active in music therapy since 1969, and her clinical work has been with
children and adults with a variety of problems. She worked in three state hospitals with adults
with emotional disorders and addictions and was employed at two different schools for children
with special needs. She worked at the Creative Arts Rehabilitation Center in New York City,
directed by Florence Tyson; studied at the Nordoff-Robbins Music Therapy Center at New York
University with Clive and Carol Robbins; became a Certified Paraverbal Therapist under Evelyn
Heimlich; and studied Neurologic Music Therapy (NMT) and is an NMT Fellow. Most recently,
she has helped to create music therapy programs at Norton Audubon Hospital and Baptist East
Hospital in Louisville. In addition to being a music therapist, she is a licensed psychologist in
New York (license currently inactive).
Barbara has written a number of articles and chapters on music therapy, and her research
interests and publications include both quantitative and qualitative research. She edited the books
Music Therapy Research: Quantitative and Qualitative Perspectives and Music Therapy
Research (2 nd Edition).
Barbara is Vice President of the American Music Therapy Association (AMTA). She is
on editorial boards of several journals and is a discussion editor of Voices: A World Forum for
Music Therapy. She was honored with the 1999 Publication and Research Award given by
AMTA and the 2005 Service Award given by the Southeastern Region of AMTA. She was
previously Chair of the Council on Education and Training of the World Federation of Music
Therapy. She frequently speaks and consults about music therapy around the world.
Carol L. Shultis, M.Ed., FAMI, LPC, MT-BC, is Director of Music Therapy and
Recreation for Forbes Road Nursing & Rehabilitation Center in Pittsburgh, Pennsylvania, a
campus of the former Forbes Health System, where she has served as Clinical Training Director
since 1981. Her current work focuses on the psychological impact of illness and disability.
Clients include those experiencing chronic illness, post acute care rehabilitation, terminal illness,
ventilator dependency, dementia, and those in residential care for the frail elderly.
In her role as Clinical Training Director, Carol has supervised the training of 87 music
therapy interns. Many Forbes alumni have offered clinical training, done research, and published
in the field. As a Clinical Supervisor for Duquesne University's Music Therapy Program, she has
worked with over 100 music therapy practicum students. Additional student work has included
music therapy students from Slippery Rock University and human services students from Geneva
College, Oberlin College, and the University of Pittsburgh. From 1981-2001, her work at the
Forbes Health System included clinical services to psychiatric and medical/surgical patients in
acute care; hospice families in inpatient and home care programs; and frail elderly, chronically ill,
and rehabilitation patients in long-term care. She has maintained a small private practice in the
Bonny Method of Guided Imagery and Music since completing training in 1994.
Carol has presented at regional, national, and international conferences, offers continuing
education programs for music therapists locally and at conferences, co-taught the supervisory
course for prospective Clinical Training Directors at the Mid-Atlantic Regional conference for 7
years, and is published in Psychiatric Times. She has guest lectured at Duquesne University,
University of Pittsburgh, and Bloomsburg University.
v
Carol served the music therapy profession as Advisor to the Mid-Atlantic Chapter of the
National Association for Music Therapy (NAMT) student group (1983-1995), as Advisor to the
Executive Board of the NAMT student organization from 1985-1996, as member (1983-1985)
and Chair (1985-1996) of the NAMT Student Affairs Advisory Board, and as a member of the
NAMT and AMTA Assembly of Delegates (1995-2003).
Donna W. Polen, MT-BC, is Coordinator for Music Therapy at Finger Lakes Develop-
mental Disabilities Service Office in Newark, New York, where she started the program in
December 1980. Donna has trained over 60 interns since establishing an intern training program
in 1983. She also works as a public school consultant, collaborating with special educators, music
educators, and other special service providers. She previously served as adjunct faculty at Finger
Lakes Community College in Canandaigua, New York, having been recruited by the College's
Nursing, Music Technology, and Massage Therapy faculty to write a curriculum and teach their
Introduction to Music Therapy elective course. Donna coauthored a chapter in Inside Music
Therapy: Client Experiences.
Donna's clinical practice has been largely concentrated on working with adults with
developmental disabilities and related challenges such as autism, severe communication
disorders, and dual diagnosis including borderline personality disorder, bipolar disorder, schizo-
phrenia, and intermittent explosive disorder/solitary aggressive type. She also has experience
working with survivors of traumatic brain injury as well as with children and adults confronted
with terminal illness, including amyotrophic lateral sclerosis (Lou Gehrig's Disease) and various
dystrophies.
Donna has been active on state, regional, and national levels, serving the Mid-Atlantic
Region (MAR) and AMT A in a variety of roles. As the MAR Representative to the Clinical
Training Committee from 1987-2001, she coauthored the curriculum for the course for training
directors and supervisors and served on the Professional Competencies Subcommittee of the
Education Committee. She has served the MAR as an Assembly Delegate since 1987 and as Vice
President for Conference Planning in 1992 and 1993, and represented the region to the New York
State School Music Association. Donna has been serving as Chair of the New York State Task
Force on Occupational Regulation since 2000 and the New York State Group of Eight since its
formation in 2003, monitoring state licensure for creative arts therapists practicing psycho-
therapy. In January 2005, Donna accepted a 4-year AMTA Presidential appointment to the
AMT A Education and Training Advisory Board.
VI
Table of Contents
Acknowledgments iii
Permissions iv
About the Authors v
Table of Contents vii
Introduction: How to Use This Book

Chapter I Doing Music Therapy: An Exploration 3
Chapter 2 Increasing Levels of Involvement 15
Chapter 3 The Process of Planning for Music Therapy 21
Chapter 4 Client Assessment* 27
Chapter 5 Goals and Objectives 57
Chapter 6 Planning Music Therapy Strategies 65
Chapter 7 Organizing the Session 73
Chapter 8 Improvising Experiences 81
Chapter 9 Performing or Re-Creating Experiences 91
Chapter 10 Composing Experiences 101
Chapter II Listening Experiences 109
Chapter 12 Further Considerations in Planning 119
Chapter 13 Facilitating Client Responses 135
Chapter 14 The Role of Music 147
Chapter 15 Working With Groups 157
Chapter 16 Working With Individuals 167
Chapter 17 Documentation Strategies 173
Chapter 18 Self-Assessment for the Music Therapist 179
References 189
Author Index 205
Subject Index 209
* Anthony Meadows is the first author of Chapter 4, Client Assessment.
Vll
Clinical
Training Guide
for the
Student Music Therapist
Introduction:
How to Use This Book
Weare pleased that you are reading this book, Clinical Training Guide for the Student Music
Therapist, and hope and expect that it will make your journey toward becoming a music therapist
stimulating and, thus, enjoyable and rewarding.
This book is designed for use by music therapy students at all levels of training. We
recognize that clinical training progresses as students move through their education and clinical
experiences, and that students have different needs at each level. On the other hand, many of the
same issues must be dealt with at each level. To attempt to meet these needs, we have divided the
levels of involvement into three areas: (a) observing, participating, and assisting; (b) planning
and co-leading; and (c) leading. We expect students to be able to use the book in different ways
at each level and have structured the chapters to facilitate this, including progressive assignments
and suggestions of related readings.
These three levels are designed to reflect the gradually increasing involvement and levels
of responsibility of students as they progress through their music therapy training, from the first
clinical observations through the internship. The amount of time spent in each, though, will be up
to individual instructors and students. Students beginning their clinical experience will generally
enter at the first level of involvement: observing, participating, and assisting. During this time,
they learn what professional music therapists do in a session. They may do this through
observing sessions or may participate in the sessions and assist in various ways. Assisting
typically includes helping clients with their placement or positioning in the session, with
positioning or playing instruments, with finding their page in song books, or in other ways that
facilitate their involvement. When students move to the second level of involvement, planning
and co-leading the session, they gain skills in planning and may co-lead with either the
supervising music therapist or another student therapist. Students begin to gain the skills
necessary for leading music therapy sessions but still do this with considerable support from their
co-therapist, whether that is another student or the music therapist. Finally, at the third level,
students are leading the music therapy session. At this point, they have the skills needed to make
the decisions involved in leading yet are still receiving considerable support from their
supervisor and probably from faculty and student peers.
It is up to individual instructors and students to determine how quickly students will
move through these three levels. Considerations include the structure of the university program,
the student's strengths and confidence, whether or not a music therapist is available as an on-site
supervisor, and whether and how much a faculty member is available to supervise. Due to these
considerations, which will be different for each student, it is not possible for the authors to
suggest the rate at which students will move through the levels.
Because many of the issues that a student or therapist deals with are the same at each
level of involvement, we encourage students to go through the book several times, focusing
differently with each level. To help with this process, the assignments at the end of each chapter
are divided into each of the three levels mentioned above. Students are expected to do different
assignments depending upon their level of involvement.
2 0 Clinical Training Guide
Faculty will, of course, decide exactly how to utilize this book and each chapter. We
suggest, though, that chapters be read and discussed several times as the student moves through
the clinical training process, with different emphases at each point.
This book is designed to meet the needs of music therapy students in the United States,
although it may be used by students in other countries, provided that philosophies of training are
similar. Graduates of music therapy programs in the U. S. are expected to meet the AMTA
Professional Competencies (American Music Therapy Association, 2003). Material throughout
the book will help students to meet these competencies.
Because music therapy students must be prepared to work with any population, this book
is designed to be used with a diverse array of clientele. In some parts of the book, examples are
provided for specific clientele. In others, the student, clinical supervisor, and instructor will make
the specific connections. Some terms and conventions are different from setting to setting.
Knowing that this is the case, we have tried to address these differences in some areas, but in
others the adaptations will have to be made by the reader. In general, we have used client and
clients to refer to the people with whom music therapists work; exceptions to this are when those
receiving services are referred to in a different way in a particular setting (for example, patients
in a medical setting).
We hope that this book will be your companion on your exciting journey toward
becoming a music therapist, and that it will help you to acquire the skills that you need to make
this journey as productive and positive as possible.
Doing Music Therapy:
An Exploration
You are on the way to becoming an effective music therapy clinician-what an exciting path!
The potential for music to help uplift and heal has motivated you to commit to your training and
is why you are reading this book.
The process of becoming an effective music therapist takes time. As you learn and grow
throughout your educational career and early years of work in the field, you will enjoy many
peak moments and a measure of frustration as well. Don't worry, though, it's all part of learning
what music therapy is, what it means to do it, and what it means to be a music therapist.
Before beginning any clinical work as a student therapist, it is helpful to understand the
fuller context of your work, which involves consideration of: (a) what it means to do any kind of
therapy, (b) what it means to do music therapy, and (c) what is involved in the therapy process.
This chapter is organized around these three considerations and will point you to further
discussion later in the book.
A first step in understanding what it means to do therapy involves developing a concept
of health and wellness. With a clear understanding of this (grounded in knowledge of yourself),
you are ready to consider the second step: How a therapist can help to promote health and
wellness. The third step is to develop a working definition of music therapy and understand some
of the theories behind it. The therapy process involves: knowledge of the potentials and
challenges associated with a condition or diagnosis; assessment skills; treatment planning skills;
implementation skills including clinical musicianship; documentation skills; and interpersonal
skills to work with clients and their significant others, staff, and community. It also includes our
ethical thinking, our ability to self-monitor, and our willingness to continue to grow personally.
All of this information is helpful in learning what music therapy is and how to do it.
Doing music therapy also requires the development of an understanding of the therapeutic use of
the self.
Doing therapy, with or without music, is a complex process. Many factors affect the way
in which music therapy is provided. How the treatment team understands what music therapy can
offer to a given client will affect what you, the music therapist, are able to do with that client.
Part of your job will be to educate the team about what is happening in your sessions, how it is
benefiting your clients, and how music therapy might help other clients.
As therapists, we bring to our work preconceived notions (which mayor may not be
accurate) about the importance of therapy. All therapists have ideas about engaging the client in
therapy and how that might be accomplished. We all have ideas about the role the therapist plays
in the process and the roles of family, friends, physicians, administrators, and staff from other
disciplines. Music therapists also have notions about the role of music in music therapy. As
professionals, music therapists have a responsibility to continually examine our work and
approaches and to continue the process of self-growth-which, for a music therapist, includes
musical growth. Chapter 18, Self-Assessment for the Music Therapist, will offer some
information to help you continue your journey of growth in music therapy.
If this is your first music therapy experience, you may not yet grasp all of these ideas. In
a first clinical experience, it is important to begin to understand what it means to interact with
clients, to notice your personal responses to clients and therapy processes, and to observe how
4 D Clinical Training Guide
staff and family members perceive music therapy. In your initial clinical experience, you may be
observing only-take advantage of this opportunity to really pay attention to what the therapist is
doing and how the clients are responding. Read about the population or diagnostic group to
develop an understanding of what it means to be a child with a developmental disability, an adult
with a physical disability, or an older person experiencing loss. But, first and foremost, begin to
become aware of what therapy is, how it is done, why it is done, who a therapist is, and what
kind of a therapist you hope to become.
Understanding Therapy
Let us begin our discussion of what therapy is by realizing that all therapy is about change and
growth. It is about assisting a client to function more fully within his or her potentials. It is a
process facilitated by a therapist that, when effective, results in positive outcomes for the health
and well-being of the client.
From a more psychological perspective, therapy can be described as a process that helps
clients to (a) explore self and situations, (b) come to a deeper understanding of each, and (c)
move to action (Egan, 1975). Dobson (1988) further describes therapy as:
Teaching people, notably in groups, how to lead effective lives by mastering the
continuing challenges of development. When that development is disrupted by
particular concerns, "therapists" help alleviate those problems ... they not only
make certain that clients acquire the knowledge and skills to prevent or
overcome similar problems in the future, but also help clients increase their
general psychological effectiveness. (p. 210)
Ivey and Simek-Downing (1980) suggest that, in order to respond flexibly and creatively
to another human being, we need to develop our understanding of several psychological theories
and more than one worldview. This suggests that, in your development as a music therapist, you
will be well served by reading, considering, and embracing as many new perspectives as you can,
allowing your worldview to continually develop and become more flexible.
In addition, as you develop as a music therapist, consider the value of undergoing your
own personal therapy. In a discussion of growth theory, Maslow (1999) states, " ... only the one
who respects health can do therapy" (p. 61). He refers to the concept of active experiencing,
which is characterized by physical, emotional, and intellectual self-involvement; a recognition
and ongoing exploration of one's abilities; the finding of one's own pace and the acceptance of
that pace in not taking on too much at once; gains and improvements in skills that can be
transferred to various tasks; and the opportunity that arises as a result of active participation to
discover and uncover new interests and potentials.
As therapists, of course we want our clients to experience these things, but they also hold
value for you in your own development as a therapist. The AMTA Professional Competencies
(American Music Therapy Association, 2003) speak directly to the importance of such ideas.
These competencies include:
• Recognize the impact of one's own feelings, attitudes, and actions on the
client and the therapy process;
• Establish and maintain interpersonal relationships with clients that are
conducive to therapy;
Chapter I Doing Music Therapy D 5
• Use oneself effectively in the therapist role in both individual and group
therapy, e.g., appropriate self-disclosure, authenticity, empathy, etc., toward
affecting desired behavioral outcomes;
• Accept criticism/feedback with willingness and follow through in a
productive manner;
• Resolve conflicts in a positive and constructive manner;
• Express thoughts and personal feelings in a consistently constructive
manner;
• Demonstrate critical self-awareness of strengths and weaknesses.
It is clear that knowing yourself and your abilities and potentials and being willing to continue
growing are crucial to your development as a therapist.
Understanding Music Therapy

We begin this section by first looking at a definition of music therapy. We will then consider
several theories that expand our understanding of music therapy and how and why it works.
Definition
Perhaps Bruscia's (1998a) definition will help you to examine your own ideas about the field. It
can also help you to begin to appreciate the benefits and limits of a working definition so you can
change it to reflect your ongoing experience and learning. Music therapy is, according to
Bruscia, "a systematic process of intervention wherein the therapist helps the client to promote
health, using music experiences and the relationships that develop through them as dynamic
forces of change" (p. 20). This definition takes into account the following:
• Music therapy is systematic-it is not haphazard;
• It is a process-it takes place over time;
• It is an intervention-this implies that something is done;
• The therapist helps the client-this clarifies the direction in which the help occurs;
• The goal is to promote health-although health has various definitions, therapy is
intended to make it better;
• Music experiences are utilized-music therapy is based in musical experiences;
• Relationships evolve from these musical experiences-these may be relationships
between therapist and client, client and music, and/or therapist and music;
• The process is dynamic-things are in movement;
• Forces of change are operating-the movement is toward change.
This is a useful definition with which to begin and from which your growing understanding of
music therapy can evolve.
Theories
Some authors describe music therapy in terms of aesthetics, while others focus on meaning and
still others view it from a scientific perspective. Aigen (1995) and Kenny (1989) speak of the
importance of aesthetic considerations in music therapy work. Aesthetics and beauty play a
major role in the outcome of the therapy process for these authors.
Aigen (1995) suggests that therapeutic progress is measured by changes in the aesthetic
quality of the music and describes the importance of aesthetic expression as a focus for the
client's emotional resistance that finds release in the rhythmic movement of the music (p. 250).
He believes that this serves as a precursor for expressive and communicative development, and
that it is this discharge of emotional resistance into expression that makes music therapy
effective.
Kenny (1989) posits that, because the therapist and the client are aesthetic and the
expression or communication of that aesthetic to the world is movement toward wholeness,
music therapy is a pull toward wholeness created by the musical space between the therapist and
the client. For Kenny, music provides a safe space for change, growth, and recovery. The
therapist's role is to work with the client in the musical space in order to get to know one
another, seeking the moment when a new field emerges, when the searching takes on a recurring
form or "a particular tonality or dynamic, they know each other and there is security and
confidence enough to initiate a sense of play and experimentation. At some point this
experimentation bursts into an open space-the field of play" (p. 82). The therapist works
musically with the client within this space, using experimentation, imitation, and modeling to
encourage the client to reach beyond the safety of the familiar.
Other theoreticians look at the meaning that is inherent in music therapy. This meaning
may be attributed to our participation in the creation of music. Creating music is deeply
connected to our cultural heritage and our identity. In improvisational music making, the dialogic
nature of the experience is a source of meaning as well. For Ruud (1998), meaning is a result of
the interaction between music makers and their awareness of the influences of culture. As such,
music therapy may lead to change in the self-concept of the client, allowing the client more
possibilities for living in the world.
For Stige (2002), meaning in music therapy is co-constructed; in other words, it is based
on both the client's and the therapist's constructions or understanding of what is occurring. Stige
also sees meaning as culturally-based and extends the practice of music therapy into the
community as health promotion by embracing programs designed to lead to normalization of
individuals typically excluded from community music making. Stige describes music therapy as a
culturally authorized form of ritual or repeated practice developed to help people with problems
in living (p. 219). This ritual serves as a safe container for personal experiences and may be seen
in relation to public and social functions.
Focusing on music therapy as a science and the need for music therapy to be research-
based, Thaut (2000) describes a model for achieving therapeutic goals. The music therapy that
Thaut finds valid is based upon scientific evidence and limits interventions to those that have
been proven successful. This success is often found through research in related fields, with music
experiences then being added in a parallel form. It is the music therapist's job to translate the
nonmusical exercises that have been shown through research to achieve desired outcomes into
parallel musical experiences, thus leading to music-based success in meeting stated goals (p. 12).
The theories presented here are diverse and cover a range of ideas as to why music
therapy works as it does. These and other theories help to provide a solid basis for understanding
what music therapists do.
Chapter I DOing Music Therapy 0 7
Understanding the Therapy Process

The basic structure of the therapy process involves defining needs, planning interventions, and
measuring outcomes. We usually speak of this as assessment, treatment planning, and evaluation.
This process unfolds in incremental steps in some settings, although in short-term settings the
steps may happen almost simultaneously. We will discuss and expand upon these processes
throughout this book. In Chapter 4, we will discuss the assessment process. Treatment planning
involves the creation of goals and objectives, followed by the design of interventions or, in the
case of music therapy, musical experiences that will assist the client in moving toward the
identified goals. Chapters 5, 6, and 7 provide information on these areas. The chapters that
follow them discuss various aspects of what occurs during the music therapy sessions
themselves. Evaluation of outcomes, discussed in Chapter 17, can occur at various intervals and
is measured differently in different settings.
Knowing What to Do
In order to plan for a music therapy session for any client or group of clients, the music therapist
must know the following: (a) client needs, (b) the therapist's role, and (c) how to use music. All
of these topics are typically covered in music therapy coursework. If you are beginning your first
practicum, you may not know much of this information yet and will need to ask questions and
read and observe closely. If you are a more experienced student, you are in the process of
developing a personal therapeutic style that will allow you to incorporate who you are with what
you know into an approach to working with clients. If you are beginning your internship, you
have most likely explored these areas in numerous formats and are now challenged to integrate
that information into your therapeutic style as it continues to take form. If you are clear about
what the client needs, how to help the client move toward the goals, and how to use music to
facilitate that movement, you will know what to do during your sessions.
Defining Client Needs

In order to work effectively with any client or group, the therapist must have a basic
understanding of the needs of the client or group. Needs are both general (as defined by the
characteristics of a population or diagnostic group) and individual (as defined by the unique life
experiences of any given person). The normative characteristics of a client population will give
the therapist a general sense of the questions to be formulated for the assessment process.
Knowing the issues or problems that are common in a client population helps the therapist to
define assessment experiences and to watch for specific kinds of responses and information, as
well as providing hints for interacting with the client. For example, a therapist who understands
the loss and the associated stress responses related to aging will hold that framework in mind
when working with an aging person regardless of the person's diagnostic group. An older adult
who has just had a cerebral vascular accident (stroke) and is receiving physical rehabilitation for
the subsequent physical changes is also experiencing many losses and stressors. The therapist
can more effectively understand how to intervene and contribute to the client's overall recovery
if the effects of loss and stress are included in the planning process, in addition to the musical
experiences that will help to develop fine motor control in the client's arm and hand.
Understanding a client's needs requires a thorough assessment of that person. During

assessment, you will consider many factors, including strengths; needs or wealmesses;
background information including diagnosis or symptoms; current and previous treatment for this
problem; musical experience and preferences; educational, social, and cultural background;
mood; and any precautions that may affect music therapy interventions.
Understanding the Therapist's Role

Your role as a therapist in any given client's life is determined by a number offactors: the setting
where the therapy is being provided, the other team members involved in treatment, and the level
of intervention being offered (for example, whether music therapy is serving as a primary therapy
or as an adjunctive service). How you understand your role as a therapist and the personal
qualities you bring to the therapeutic relationship also affect what you do.
In considering these factors, you might begin by looking at the setting in which music
therapy is to be provided. While some generalizations can be made about the differences between
outpatient versus inpatient or residential services, it is important to consider how each setting
uniquely defines how services can be offered. For example, a once-a-week outpatient session
with the music therapist may be a highlight of a client's week, but it only represents a small
fraction of the client's life, so the therapist will want to craft an intervention that can carry the
client through to the next session. In spite of this fact, the music therapy session may be very
important to the client. Music therapist Barbara Reuer, referring to a hospital music therapy
session, speaks to how important a one-time visit can be:
When you are doing bedside work at a hospital, most times it is a once-in-a
lifetime experience for the patient. How the therapist interacts with that patient is
crucial. When you see patients and/or families in medicallhospice settings, every
moment for them can be life-changing and forever memorable. Everything is
augmented in their lives because of the intensity of what that person may be
experiencing. One cannot underestimate the importance of a one-time visit.
(personal communication, March 13,2005)
The therapist may wish to provide at-home resources, exercises, or homework to extend
the therapy process. In the case of children, adults with developmental delays, or others with
disabilities, parents or caretakers can be taught skills to extend the benefits of music therapy
interventions beyond the session. Whether music therapy is provided in a clinic or school setting
or in the client's home (as is often the case in hospice work, for instance), the setting will impact
the timing of treatment and the options available to the therapist. For example, the family of a
hospice client being seen at home may be very protective of a client, limiting the time the
therapist can spend in the home. This requires that the therapist choose a musical experience that
fits the timeframe available. Timing may also be affected as sessions are scheduled around a
family's life.
When working in an inpatient setting, it is essential to consider the length of stay for the
clients. When approaching a client for whom your first intervention is likely to be your only
intervention, the student music therapist should use caution and respect. It is important to build
rapport and trust but also to set limits on how much is done in a single session. What can you
do-and what should you avoid doing so as not to leave the client hanging following a single
encounter? This is quite different than building a relationship with a client over time, gently
engaging the client with the music to move toward longer range goals and allowing time for
closure when your work together is drawing to an end.
Chapter I Doing Music Therapy 0 9
When working at a residential facility, first find out how long clients live at the facility.
Whether or not the clients are close to your age will also impact how you as a student music
therapist relate to this population. You must also be careful to develop an understanding of the
appropriate boundaries of a therapeutic relationship. A productive relationship with clients
depends on clearly establishing therapeutic distance while at the same time building a bond of
trust. Of course, this applies to all settings but becomes especially relevant in long-term
situations.
All of these issues impact the therapeutic use of self in the music therapy process. Take
time to consider how you relate to clients and how that relationship impacts the clients'
responses to your music therapy interventions. This will help you to develop a therapeutic style
that is unique to you while remaining within the boundaries of ethical and effective practice.
Another important aspect of being a music therapist is your relationship with the
treatment team. Understanding how a given treatment team is structured is essential for
understanding your role. Be sure to learn who else is working with the client and find out about
the primary team goals for this client. It is also helpful to know who sets the goals: Is it a
physician, a team leader, or the team in consultation with all members? It is also vital to know
what role music therapy can play in helping the client to reach the goals within the context of this
particular treatment team. In some settings, all team members work on team goals, while in
others the team sets general goals and each therapist writes discipline-specific goals. What goals
are you addressing as a student therapist, and how are these defined? You may be given specific
goals to address by a supervisor, you may be asked to assess a specific client or group and set
goals yourself, or you may use generic goals as you learn to select more specific goals as a part
of your development as a music therapist.
In order to set appropriate therapeutic goals for any client or group, the therapist must
understand not only the client's needs but also the implications of working toward a goal. How
will this goal contribute to the overall quality of life for this client? Let us look at a common goal
area that student therapists address-"socialization skills." How can changes in socialization
make a difference for this person or persons? It might be that the ultimate value of increased
social contact will be that the client is less isolated and withdrawn and less prone to symptoms of
depression. Perhaps because of relationships built in the music therapy group, the client will be
motivated to join in other programs within a facility and thus become more engaged in life.
Another potential benefit for the client is the development of a more positive attitude toward the
treatment process itself because of shared experiences with others undergoing similar treatment.
By keeping these interrelated factors in mind, you will be able to set the most useful goals for the
client. After considering these possible outcomes, the therapist may find that a more accurately
stated goal is "interact with peers outside the group setting as observed on the unit." Another
goal that may arise from thinking through these factors is "demonstrate increased compliance
with treatment, which may be the result of interaction with others experiencing a similar
treatment." In this case, socialization skills are more clearly defined as "sharing of thoughts or
feelings about current treatment," which has led to a clearer and more measurable outcome.
The therapist must also consider the client's role in setting goals. Often, the client's role
is affected by the therapeutic relationship. The therapist may also evoke goals from the client (or
from the family or responsible party) that are more meaningful to the client than those the
therapist would have created independently. It is important for the therapist to understand that
interaction and relationship with the client or responsible party may affect this part of the goal-
setting process as well as the delivery of services.
Finally, the therapist's understanding of the self and definition of therapy affects his or
her work. The therapist's belief system can hinder rapport and effectiveness with the client. The
therapist's own issues can and will affect how he or she views the client and the client's needs.
The ability to separate our personal responses to the client, setting, process, music, and treatment
team from the therapeutic relationship is essential to becoming an effective music therapist. The
therapist's ability to utilize knowledge of self to enhance treatment and the therapeutic
relationship is equally important.
Working With the Music

Music offers an almost limitless combination of possibilities in the therapeutic session. Music
can be sung, played, and composed. Music can be a catalyst for movement, or it can be the focus
of listening.
What we sing, who sings, and how we accompany the singing are just a few of the
factors that affect what we do with the music in music therapy. Students who find themselves
singing a lot of songs to and with clients may not be aware of all that may be happening in that
interaction. Singing client-chosen songs may give the client a sense of control over a part of
treatment and the environment; can help him or her to connect to deeper levels of meaning; may
alter mood; can lead to reminiscing, discussing concerns, bringing a new perspective to a
situation; or may be the foundation for a song-writing experience. Singing may have multiple
uses in a session, including:
• Building rapport;
• Eliciting relaxation response;
• Stimulating memory;
• Expressing emotion;
• Increasing breathing depth.
When we play music, we may improvise, we may play or perform composed music, or
we may playa pattern such as an ostinato to accompany an ensemble experience. Again, what we
play, with whom we play, what instruments are used, and whether the therapist or the client
selects the instruments all impact what we do in the session. Clearly, playing a solo on a familiar
instrument to share something about oneself with a group is a different experience than playing
in a group improvisation using nonmelodic percussion instruments. With careful structuring of
these experiences, the therapist can address multiple goals. The choice of what to do in the
session must be based on how well the musical experience will meet the client's needs.
In music therapy sessions, composing most often occurs through writing song lyrics.
Treatment can be even more effective if clients can also be encouraged to create the melody and
harmony for a song. A group of clients might also work together to create a piece of music that
expresses a pre-selected topic. Or the group may work more freely, allowing a melody to emerge
from piecing together various improvisations. A more structured approach to this might be to ask
each group member to contribute a four-beat rhythm pattern, then work together to determine
what combination of rhythms the group would like to use in creating a piece of music. The
patterns might be repeated as many times or altered as desired. Each group member might then
be allowed to determine the direction of the line and the width of the interval, thus creating a
melody. Assisting the group members in linking these ideas into a playable or singable melody
requires patience and faith that music can emerge from the group's experimentations.
Music can be used as a catalyst for movement through a structure, for example dancing
(or adapting) the movements of the "Hokey Pokey." Or it can be free and flowing as clients use
props (such as scarves) to imitate sounds visually and kinesthetically. Moving can be rhythmic,
as in marching, or it can be fluid and ballet-like. Any movement to music will be designed with
Chapter I Doing Music Therapy 0 I I
the goals and objectives for the clients in mind. Using movement with some populations will
require physical precautions, which the student therapist is reminded to consider beforehand.
You can also use listening experiences in many ways. Clients might analyze song lyrics,
diagram musical expression, identify patterns, or enumerate the different sounds they hear.
Listening might be part of a relaxation exercise or an imaging experience, or it can be a
foundation for group reminiscing. Listening to music made by others, including other group
members, may help clients identify with the expression of an emotion, find a kindred spirit, learn
more about a peer, or develop empathy for another. How and when to use listening is again
dependent upon the goals and objectives set for the client or group. Throughout your training you
will be building a repertoire of ideas for listening. Learn to listen-to the music, to the lyrics, to
the rhythm, to the predominant expression, to the subtle qualities of the music around you. You
can find subtleties and richness in any kind of music.
Bruscia (1998a) divides the possible uses of music into four categories: improvising,
performing or re-creating, composing, and listening experiences. These categories, which offer a
helpful way to begin thinking about the uses of music in therapy, are explored in later chapters of
this book. It can also be helpful to begin to organize your own ideas about how to use music
experiences in therapy. Record your ideas and those of your classmates in a notebook or on a
computer file or index card. This will help build your repertoire of available music experiences
as you begin working with clients. Many of these experiences will be adaptable for use with
different populations and will help to prime the pump of creativity when you need an idea to
work with a group or an individual.
Bruscia (1998a) offers us a reminder that "although music therapy involves all levels of
music experience, the closer the client's experience is to the purely musical level, the more
certain we can be that it is truly music therapy" (p. 112). Begin now to accumulate musical
experiences that will be useful to you and your clients as you work.
For Further Reading

Benjamin, A. (1987). The Helping Interview (3 Td Ed.). Boston: Houghton-Mifflin.
Bruscia, K. (2000b). The nature of meaning in music therapy: Kenneth Bruscia interviewed by
Brynjulf Stige. Nordic Journal of Music Therapy, 9(2), 84-96.
Cameron, J., with Bryan, M. (1992). The Artist's Way: A Spiritual Path to Higher Creativity.
New York: G. P. Putnam's Sons.
Camilleri, V. A. (2001). Therapist self-awareness: An essential tool in music therapy. The Arts in
Psychotherapy, 28, 79-85.
Chase, K. (2003). The Multicultural Music Therapy Handbook. Columbus, MS: SouthernPen
Publishing.
Crowe, B. J. (2004). Music and Soul Making: Toward a New Theory of Music Therapy. Lanham,
MD: Scarecrow Press.
Dass, R., & Gorman, P. (1985). How Can I Help? Stories and Reflections on Service. New York:
Alfred A. Knopf.
Frank, J. D. (1974). Persuasion and Healing (Rev. Ed.). New York: Schocken Books.
Pavlicevic, M. (1997). Music Therapy in Context. London: Jessica Kingsley Publishers.
Assignments-Doing Music Therapy

Level I-Observing, Participating, and Assisting
1. Describe your current understanding of what it means to do therapy and to do music therapy.
Be sure to include:
• What you think about people who need help;
• What you think about the importance of someone's cultural background;
• What you think music can do for others;
• What you think about therapy;
• How you view your role in the music therapy process.
2. Make a list of life experiences that drew you to music therapy. Write a short paragraph about
one of those experiences and describe why and how you think it has contributed to your
interest in music therapy as a profession.
3. Write a musical experience in each of the following areas that you could use in practicum
work: improvising, performing or re-creating (singing, playing, and/or moving), composing,
and listening.
4. Describe an experience from your current practicum setting that helped you to understand
what it means to do music therapy. What did you see and how did you respond to it? Write
both objective observations and your subjective response.
Level II-Planning and Co-Leading

1. Rewrite your understanding of therapy and music therapy considering the topics listed in
Question #1 of Level I. Note how your understanding of the music therapy process has
changed.
2. Describe an experience you have had as part of a practicum that helped you to better
understand the importance of the therapeutic relationship in doing music therapy.
3. Describe an experience you have had as part of a practicum experience that enhanced your
understanding of what it means to help others move toward functioning more effectively in
life as a result of a music therapy intervention.
Level III-Lead ing

1. Write about your current understanding of therapy and music therapy, including the factors
listed in Level I assignment #1 and any other comments that illuminate your position. Note
changes in your understanding of this process over all three levels.
2. Think of a time in your clinical work that you had contact with another member of the
treatment team or of another discipline concerning a client. Reflect on how you handled it.
Did you share information with the other person so that both of your understanding of the
Chapter 1 Doing Music Therapy 0 13
client was deepened? Did you provide infonnation so as to expand the other person's
understanding of music therapy? Think about your feelings about the encounter. Did you feel
clear about your role and the role of music therapy? Did you have any feelings of insecurity
or defensiveness? Share and explore whatever feelings you had.
3. Write a short description of how you understand the therapeutic use of self and its role in
music therapy.
4. Describe a practicum experience where when you finished leading a session (or portion of a
session) you said to yourself, "Yes, that's it, I just did music therapy." What was it about the
experience that told you it was music therapy? How did you respond internally when you
realized that you had just been involved in a music therapy moment?
Increasing Levels of
Involvement
As explained in the Introduction, this book is arranged for future music therapists to use at
various levels of their training. This chapter examines some of the experiences that students may
have at each level of this process, including: observing the music therapy session; participating
and assisting as a student therapist; planning and co-leading; and, finally, leading the session.
Since the tasks and challenges may be different at each level, this chapter is intended to help you
understand and take advantage of those differences.
Observing the Session

Whether you are entering into the clinical world as an entry-level student or are further along in
your education and training, you will undoubtedly encounter many new sights, sounds, feelings,
and experiences. You will learn best if you allow yourself to experience all of these new stimuli
and observe your own responses. When you do your first observation (or on your first visit to a
new site), consider the following elements that may influence your experience:
• The overall physical environment of the facility (location, size, age, and so forth),
• The clients,
• The staff,
• The music therapist and the music therapy environment (variety of instruments and
equipment, arrangement of room, and so forth),
• The music therapy session structure (opening and closing, types of instruments and
music used, techniques or interventions implemented, and so forth),
• Your own reactions to the music therapy session.
In addition, consider the social and emotional environment from a client's perspective
and as a staff member might be experiencing it. Also consider the client's response to you, to
staff, and to the therapy process. Be especially aware of the following:
• Body language,
• Tone of voice,
• Arrangement of the therapy space,
• The sequence of events before, during, and after the therapy session,
• How the session ends,
• Where the clients return to when the session is over.
When you return from your observation experience, we strongly recommend that you
write a journal or log entry about what you have experienced. You might use the elements listed
above to help you or follow the format provided by your instructor or clinical supervisor.
Observing is a very important part of working in music therapy. If you are an entry-level
student, you may even find that you are observing for most or all of a semester. Developing sharp
observational skills will serve you well during your training and throughout your professional
career.
Participating and Assisting

Once you have become familiar with a setting or have gained enough experience to be an active
member of a therapy setting, you may be invited to participate in the therapy experience with the
clients. Each therapist will have different ideas of how to integrate you into the session, but a few
general guidelines may be helpful.
• Keep in mind that you are participating in the therapy of another. This session is not
designed to address your needs, and, as such, even if the process stirs up an issue that
is real for you, you must edit your responses so that the focus of the therapy remains
on the clients.
• Monitor your participation and keep your responses simple so as not to overshadow
the client's responses.
• The therapist is the leader/facilitator of the session, and you must monitor your
inclination to be helpful to clients or the therapist. Participation means just that-
participate in the music experiences with the clients and be aware of your responses.
Be acutely aware ofthe clients' responses as practice for your future role as therapist.
Participating in other therapists' sessions gives you a unique opportunity to learn about
and gather music therapy interventions for later use in your own sessions. You also have the
opportunity to observe your own responses to the many interventions that are used in music
therapy. There is no substitute for personally experiencing processes that you will be asking a
client to do when you are the leader of the session. Participate with constrained enthusiasm, offer
encouragement to the clients as appropriate (the therapist in charge will guide you), learn all that
you can about musical interventions, and monitor and log your personal responses to the music
experiences. You may use your logs to answer specific questions as assigned by your instructor.
When it is time to assist with the session, you will have many options. Your supervising
therapist may ask you to do specific things-for example, assist a client with holding and playing
an instrument or support a child in successful group participation by raising her hand to take a
tum. At other times, what you are expected to do may be more open and left to your own
judgment. In this case, you will need to monitor both your own and the client's behavior and
responses to insure that you are being helpful but not doing too much. In either case, your role as
a helper is meant to do just that-help the client to get what he or she needs to from the session.
Planning and Co-Leading

You have now had an opportunity to observe the clients, to share in their experience of music
therapy in this setting and possibly to assist, and to begin to understand the purposes of therapy
for this client or group of clients. Planning a session will be dealt with in detail in later chapters.
At this time, you are to focus your attention on the importance of planning and how it affects the
outcome of co-leading a session.
Planning in therapy is a prerequisite for working with clients. You must have an idea of
your goal or target in order to plan a map or route to get there. Once the goal or target has been
defined, you might consider a number of routes, just as you could go on a trip via the interstate
highway or take the scenic route. Deciding which route to take will depend on the responses of
the clients to your interventions and on your current level of skill and knowledge. Even with the
most thoughtful planning, you may discover that you begin traveling on one route but that client
responses lead you to choose another route.
Chapter 2 Increasing Levels of Involvement 0 I7
Whether you are working with another student or the music therapist at a clinical site,
planning to co-lead a session requires clear communication about the intended destination,
discussion of the options or routes to travel, and assignment of roles in this journey. Each
therapist involved in the process must be prepared to ask questions of the other in order to clarify
what will happen during the session-even when you are a student working with a professional.
This discussion lays the groundwork for flexibility in dealing with unanticipated things that come
up. For example, when the planning process has made it clear that Therapist A was thinking of
using Song A, but the final plan was determined to include Song B, Song A remains an option if
the client seems to need whatever Song A could offer. Therapist B can then invite Therapist A to
insert Song A if it is appropriate to the needs of the client as the session unfolds. This level of
cooperation provides clients with the best that both therapists have to offer.
Leading
Now that you have had the opportunity to observe and participate in music therapy sessions, and
to assist with, plan, and co-lead sessions, you are ready to take on the leadership of a session
independently. You may experience a myriad of emotions as you plan to lead a session on your
own for the first time. One person might be very excited and eager to put into action what has
been learned, while another might find the prospect of being responsible for a client or group of
clients anxiety-producing. It would be normal to feel both of these emotions and many others.
What you feel before leading a session independently is not as important as how you respond to
your feelings. You will do better work if you acknowledge your emotional response to the task
and prepare yourself to deal with the realities of your assignment. To increase your chances of
successfully leading a session, try the following:
• Prepare by gathering information about your clients. This may be an assessment that
you do yourself or may be based on information provided to you by the therapist or
staff at your clinical site.
• Plan your session to achieve goals that are appropriate for your clients. Initially, use
music and equipment with which you have skill and comfort.
• Don't be afraid to ask your professor or clinical supervisor for feedback, assistance,
or support.
• Approach your first independent session with confidence; remember that you have
something valuable to offer to your clients. Keep your focus on the needs of the
clients and try not to focus on your own performance. This will go a long way in
helping you to avoid the pitfalls of performance anxiety while working as a therapist.
For Further Reading

Farnan, L. A. (2001). Competency-based approach to intern supervision. In M. Forinash (Ed.),
Music Therapy Supervision (pp. 117-134). Gilsum, NH: Barcelona Publishers.
Hanser, S. B. (1987). Observation and feedback techniques for student practica. In C. D. Maranto
& K. Bruscia (Eds.), Perspectives on Music Therapy Education and Training (pp. 149-157).
Philadelphia: Esther Boyer College of Music, Temple University.
Standley, J. (1991). Music Techniques in Therapy, Counseling and Special Education. St. Louis,
MO: MMB Music.
Wheeler, B. L. (2000). Music therapy practicum practices: A survey of music therapy educators.
Journal ofMusic Therapy, 37, 286-311.
Wheeler, B. L. (2002). Experiences and concerns of students during music therapy practica.
Wright, L. M. (1992). A levels system approach to structuring and sequencing pre-practica
musical and clinical competencies in a university music therapy clinic. Music Therapy
Perspectives, 10, 36-44.
Assignments-
Increasing Levels of Involvement
1. As a new music therapy student, you may be experiencing an ocean of stimuli. Using your
journal or log, choose one response to your observation that stands out in your mind and write
about it. This response may be positive or negative. Describe it as fully as you can, and then
explore how it connects to your own life experience. What in your life affects how you
responded to the clients, the therapy, and/or the environment? Or create a chart with the
headings positive, negative, neutral and categorize your responses to the experience under
these headings. What does this raise in your mind? What opportunities do you see?
2. Reread your log entry about participating in a session with clients. Did you identify more
with the clients or with the therapist? Was your energy focused more on how the clients were
responding to the musical intervention, on what the therapist was doing, or on your own
responses to the musical intervention? What can you learn about yourself as you reflect on
what drew your attention the most? What might this say about your ability to separate your
own issues from those of the clients when the music is happening? What will you do in the
future to help you separate your issues from those of the clients?
3. Think about your skills and abilities to work with a therapist in a session. Consider your
current skills and abilities, and determine what you are able to provide to clients and what
some short-term goals for your own skill development might be. Choose one area and write a
goal for yourself and an action plan to begin working on that skill.

1. Choose something you have observed in your current clinical placement that is emotionally
charged for you. Write about it for 10 minutes without putting your pen down (or, if you are
doing your log on the computer, type for 10 minutes without stopping). When you have
finished, read what you have written and see what you have learned about your response to
the observation. Notice what drew your attention and how that might color your perception of
what you observed. Summarize your learning in a statement or short paragraph. Reflect on
how your response might affect your work as a music therapist, then write another statement
or short paragraph about that.
2. You are planning to co-lead a session with the therapist at your clinical site. The clients have
a variety of needs, but most common are the needs for social connections in order to combat
loneliness and depression and for some structure in their daily lives. The therapist has a long-
standing program that uses primarily singing and songwriting. You would like to try
Chapter 2 Increasing Levels of Involvement 0 19
something different with the group. Write a paragraph describing how you might introduce a
new experience to the group. Be sure to clarify why you think this would be useful for these
clients so that you can discuss it with the therapist.
3. You are going to be co-leading with another student. Plan a session for a group of older
adults in a nursing home. The goal for the group is to improve the quality of life via enhanced
sense of worth. What music therapy strategies come to mind when you begin to think about
this group? What questions would you ask your co-therapist in order to plan to carry out this
session together? (Think of specific plans regarding what to do and who will do it.)
Level III-Leading
1. Using your journal or log entry, review your response to something you have observed in
your clinical setting or to an experience when you were leading a session. Pinpoint moments
of identification. With whom were you identifying-with the clients, with the therapist, with
other staff who may have been present? What does that tell you about yourself? How could
this identification affect your work as a music therapist? Write your answers to these
questions to share with your instructor.
2. Choose something about the experience of leading that stands out in your mind. Write about
it, describing as fully as possible what you experienced at that time, how you are responding
as you write, and why you think the experience has meaning to you. Trace the origin of that
meaning through your life experience in order to learn about your own development as an
individual and a therapist. Submit a summary to your professor that describes how your
therapeutic style is affected by your life experience as revealed in this incident.
3. Think about a session that you recently led, using your journal or log to help you to
remember the details. What was successful about your leadership? What could have been
changed? How did you feel being in this role? You will probably have other thoughts and
feelings as you write about the session. Write about and reflect upon all of them.
4. Look at your journal or log from a previous clinical site assignment. Choose a session when
you felt you needed to know something or do something that was not available to you during
that session. Describe what you need to learn or what skill you need to develop. Describe
how you have addressed that need in yourself (if you already have done so) or how you can
address it now. Write a goal and an action plan for yourself and give yourself a target date.
Begin to include your own progress toward this goal in your journal or log for this clinical
site.
The Process of Planning
for Music Therapy
This chapter is intended to help you consider certain issues that form the basis for how you
organize and provide music therapy. The focus here is on your personal beliefs and awareness as
they apply to what you believe and do as a therapist. Thus, this chapter will consist of several
questions and exercises to help you begin to develop this awareness, which will help to insure
that you are working in a manner that is congruent with your beliefs and personality. Later, in
Chapter 12, Further Considerations in Planning, we will look at how others have developed some
of these same areas.
There are a number of things to consider as you begin to plan the content and sequence
of a session. All of these, of course, are aimed at developing a session that is most profitable for
your clients. The result will be a session in which the goals are appropriate to meet the needs of
your clients, and the procedures that you use are both appropriate to the goals for the clients and
congruent with your values, skills, and knowledge.
Before exploring personal beliefs and values, though, it is important to have a context for
understanding the client. Underlying all work in therapy is a sense of who the client is, why he or
she has entered a therapy relationship, and what the outcome of that therapy is intended to be.
The Client's Perspective
What Is Important for the Client?

It is very important to keep in mind that our clients are, first and foremost, people. No matter
how many challenges or diagnoses they have or how many restrictions in their functioning, they
are unique, complex, evolving human beings. There are some questions that we might ask about
the person with whom we are working and things that we may discover that will help us treat him
or her as an individual. You may want to think about the following:
• What does he or she like to do? Consider the kinds of things your client enjoys
doing, is good at doing, with whom he or she enjoys doing these things, and where
these things are done.
• What does he or she not like to do? Consider the things the client does not like to do,
resists doing, or may find boring, frustrating, or undesirable.
• What would he or she like to change? Consider what the client dislikes about him- or
herself, finds to be unproductive about his or her personal behavior, experiences as
obstacles to living life to its fullest, and would like to change.
• What does he or she picture for life in the future? Consider what he or she wants
from life, what image he or she has for the future, and what hopes or desires he or
she has for life.
• How can we help to make these things happen? Consider the supports that he or she
has, the supports that he or she needs, which, if any, of these supports music therapy
can provide, the methods that can be used to provide them, and what could
compromise his or her safety, participation, or success and thus should be avoided.
In answering each of these questions, think about the following: What do you see, hear,
observe, sense, or understand that leads you to these answers?
What Can the Client Gain From Music Therapy?

While the questions in the above section are important and help us to see our client as a person,
we also need to be aware of what the person needs to function better and to be healthier-in
other words, why he or she was referred to treatment and to music therapy. Many of these issues
will be addressed in Chapter 4, Client Assessment, but it is helpful at this point to do some
thinking about these questions. You can learn a lot by noticing on an intuitive level what he or
she communicates while you are talking or playing music together, or what you observe that he
or she needs in order to function more fully or to be healthier.
The process of assessing the client for music therapy is more complex than simply
responding to these considerations, and it is important to remember that music therapy cannot
help with all problems. But your initial observations will give you intuitive sense of how you
might be able to help the person.
The Music Therapist's Perspective
How Do I Feel About the Client?

It is important to become aware of our own feelings as we begin our work in music therapy. Our
feelings form the basis of how we relate to our clients and show us where we need to work to
improve our ability to relate to people. As music therapists, we may work with people who have
various types of life or health circumstances or disabilities. It is helpful for us to be aware of our
feelings towards people who find themselves in any of these circumstances. Each of these
reactions can give us information about our underlying attitudes and beliefs about what it means
to be healthy and normal.
It can be helpful to examine how we feel when we see a person with a disability. For
example, we may feel uncomfortable. We may want to reach out to help the person or we may
shy away, perhaps out of fear of not saying or doing the right thing. We may find ourselves
turning away from someone with a particular disability or avoiding eye contact. Some people feel
uncomfortable when a person with a physical disability is struggling to cross the street. If you
have ever had the experience of offering to help a person in this position but been told that he l
did not need help, think of how you felt.
You may realize that you look the other way when you see someone with an unusual
physical appearance, or that you try to look at her when she is not looking. In either case, it can
1 We are referring to a person as either "he" or "she" in this section in order to help the reader identify specific
instances in which these feelings were experienced.
Chapter 3 The Process of Planning D 23
be helpful to be aware of what you feel as this occurs. You may have listened to someone who
stutters trying to say a word and not !mown if you should try to help him find the word or just
wait. Again, think about how you felt at this time. If you have ever encountered a person who
was exhibiting mental health difficulties in the community, think of how you reacted and felt.
You may have had personal challenges in school or helped a family member cope with
learning or other school-related difficulties. This may make you more sensitive to the needs and
feelings of children who are having problems in school.
If you have been involved with people who are dealing with a terminal illness, it will be
helpful to think of your feelings during this process. Maybe you were uncomfortable with the
dying process, or perhaps you feel that you came to a better understanding and acceptance of it
during that time. In either case, being aware of your feelings about death and dying will help you
to deal with them and perhaps be ready to grow in your understanding and acceptance of them.
It may be helpful also to think about how you feel when people you !mow have
encountered difficulties. Perhaps a friend has had to deal with a life-threatening illness, or a
family lost their home and had to go to a shelter. Think of how you responded to this kind of
situation. Think about how you feel when you watch a television movie about a painful life
event, whether you identify with the person struggling or with those who come to the aid of that
individual. This may tell you something about your personal attraction to the helping professions.
We may have many reactions when dealing with people with disabilities and challenges.
It is not possible to say whether our reactions are right or wrong, normal or abnormal. However,
we can use our awareness of them to help us understand our feelings about people who may be
different from us or who are encountering difficult situations and to grow from our awareness.
What Is My Personal Theory of Helping?

An important influence on the music therapist's work is what may be called a "Personal Theory
of Helping." The development of such a theory will help the therapist in many ways. You will
develop your own theory based on your beliefs about various aspects of the helping process. It
ultimately becomes a reflection of who you are and how you see the world and the place of
therapy within this world. This theory serves as a guide for making decisions as part of the
therapy process. It will be revised over time as you mature and your views change.
Addressing certain questions may be helpful as you develop your personal theory of
helping. Brammer and MacDonald (1999) suggest that a theory of helping should assist the
therapist in answering some of the following questions:
• What are the goals of helping-what am I trying to do as a helper?
• What stages in the process of helping do I tend to follow?
• What methods work best to achieve the helpee's goals?
• How can the helpee be enlisted in the helping process?
• How can helpees learn to apply these helping skills to their future problems?
• How do I !mow that the helping process was truly helpful-how do I !mow
as a helper whether or not I have succeeded? (p. 168)
In developing a theory of helping, these same authors (Brammer & MacDonald, 1999)
suggest that people developing a helping theory examine their values and goals, the nature of
humanity as they see it, and how they think that behavior change occurs.
Your theory of helping may also embrace the philosophy embodied in one or more
psychotherapeutic frameworks or be part of a framework based on a theory of music therapy.
These are discussed in other parts of this book, and we will consider them in greater detail in
Chapter 12, Further Considerations in Planning.
How Do I Find Music Helpful?

Since the tool that we use in music therapy is music, it is also helpful to explore our own
relationship with music. Think about how you use music in your own life. Perhaps you turn on
recorded music when you get home, or maybe you play live music. Consider your purpose in
doing so. Maybe it serves to help you relax and relieve stress, or perhaps you find that it gives
you energy. Think about the types of music you choose for listening or playing at various times
and in different situations and how you are using music to meet your own needs.
There are obviously many ways for us to use music, and it will be helpful to explore
these in our own lives. You might also think of times that you have felt uncomfortable listening
to music and what may have elicited this discomfort.
Your exploration of the place of music in your own life will give you insights as you
consider how you can help your clients use music in their lives. Opportunities to consider these
concepts more extensively will be presented in Chapter 14, The Role of Music.
Ethical Considerations
Each of us has ethical standards that we follow in our personal lives. Of course, these may vary
from person to person. There are ethical as well as legal standards that govern our societies,
although there is also room for variation in some of these areas. In Chapter 12, Further
Considerations in Planning, we will speak of the ethical standards that have been developed to
govern the professional work of music therapists. At this point, though, it is helpful to explore
our personal ethical standards.
Begin by asking yourself how you decide whether what you are doing is right or wrong.
Do you look to an external source such as the Bible (or Koran, or a similar source) or to what
your parents taught you? You have probably internalized much of what you have been taught so
that, while it may be based on the Bible or what your parents taught, you may not consciously
think about the source but rather do what comes naturally. Think about the process that you
follow when you consider whether something is right or wrong. Think also about whether you
have ever done something, then felt that it was not right and gone back and made amends or
changed it, and the process that led to this decision. Consider whether you judge others as doing
things that are right or wrong, and if you do, whether it ever occurs to you that their values or
ethical standards may be different from yours but not necessarily wrong. Consider how you
would determine for sure if they were wrong or right, or whether this determination can be made.
Reflecting on these issues is the beginning of developing skill in ethical thinking. Since
ethical dilemmas occur in all areas of our lives, it is helpful to begin thinking about how each of
us defines our boundaries between ethical and unethical, right and wrong.
All therapists are confronted with ethical situations that test our personal and
professional boundaries, ask us to choose between two or more difficult paths of action, and
force us to choose the action that will do the least harm to a client in a given situation. The
process we use for making these decisions is a result of how we were raised, our life experiences, and
the amount of time that we have devoted to reflecting on how we might respond to ethical dilemmas.
Chapter 3 The Process of Planning D 25
For Further Reading

Carkhuff, R. T. (2000). The Art of Helping in the 21" Century (8 th Ed.). Amherst, MA: Human
Resource Development Press.
Corey, M. S., & Corey, G. (1998). Becoming a Helper (3 rd Ed.). Pacific Grove, CA: Brooks/Cole
Publishing Co.
Corey, G., Corey, M. S., & Callanan, P. (1988). Issues and Ethics in the Helping Professions (3 rd
Ed.). Pacific Grove, CA: Brooks/Cole Publishing Co.
Dileo, C. (2000). Ethical Thinking in Music Therapy. Cherry Hill, NJ: Jeffrey Books.
Katsh, S., & Merle-Fishman, C. (1998). The Music Within You (2 nd Ed.). Gilsum, NH: Barcelona
Publishers.
Assignments-The Process
of Planning for Music Therapy

1. A number of questions were asked and issues were raised under "What Is Important for the
Client?" Think of a person in the session in which you are involved and reflect on these
questions and issues in relation to this person. As stated in the chapter, as you answer each
question, ask yourself to think about the following-what do you see, hear, observe, sense,
or understand that leads you to these answers?
2. Consider your reactions as discussed under "How Do I Feel About the Client?" Think about
your feelings about the problems and issues discussed and write about them.
3. Reflect on the questions asked under "What Is My Personal Theory of Helping?" As you
answer them, consider who you are and how your life experiences have led you to this point
and to these answers. Compose a summary of your reflections.
4. Discuss some of your own responses to music as raised under "How Do I Find Music
Helpful?"
5. Think of a time when you had to decide what was right or wrong. What guided you in your
decision? Reflect on whether this guidance was from an external source, whether it was
initially external but had been internalized, or whether you can trace it in some other way.

1. As you did in Level I, think of one or more people in the session in which you are currently
involved. Reflect on the questions and issues raised under "What Is Important for the
Client?" in relation to this person or people. As before, ask yourself to think about the
following-what you see, hear, observe, sense, or understand that leads you to these answers.
2. Begin to develop your personal theory of helping. You will base this partly on your earlier
answers to the questions under "What Is My Personal Theory of Helping?" but will want to
think beyond them to understand how they influence you and to use this awareness as you
continue to develop your own theory of helping. First, think about and review what you
wrote before, then begin writing. Developing a personal theory of helping is not an easy
process, but as you write and reflect and revise, it will come together over time.
3. Think of a recent time in which you used music. Reflect on how and why you used it,
considering the discussion presented under "How Do I Find Music Helpful?"
4. Think of an ethical issue that you have confronted and reflect on where you found your
guidance in making the decision.
Level III-Leading
1. Review your answers from the questions at the previous level. Reflect on how you have
changed your views and what experiences, insights, and growth have led to these changes.
No particular format is suggested for this, as you will have begun to develop your own
process for doing this kind of thinking at this point.
2. Continue to develop your personal theory of helping. Refer back to this as you continue to
develop as a music therapist, and expect that it will continue to change and grow as you do.
Client
Assessment l
In the broadest sense, the ideas presented in Chapter 2, focusing on observing what happens in a
music therapy session, and Chapter 3, helping you learn to plan for music therapy, represent
aspects of assessment. Both of these chapters asked you to focus your attention on what you see
clients doing in a music therapy session, interpret their musical and nonmusical behaviors, and
develop a therapeutic plan based on your observations. All three of these aspects-observing,
interpreting, and planning-are integral to the process of assessment, the focus of this chapter.
The element that distinguishes music therapy assessment from other types of assessment (for
example, educational or psychological assessment) is that the assessment typically occurs while a
client is engaged in a music experience, usually improvising, performing or re-creating,
composing, or listening to music. These will be discussed in detail in Chapters 8 through 11.
Any type of music therapy assessment involves observing the client making or listening
to music under specific musical conditions that enable the therapist to assess the client's abilities
and needs. In so doing, the therapist draws conclusions about the client that influence the client's
music therapy in some way. Sometimes the purpose of assessing the client is to prescribe
treatment (Bruscia, 1993), where the therapist determines which types of music therapy
experiences (participating in musical activities, improvising, discussing songs, and so forth)
would best meet the client's needs. In other situations, the purpose of assessment is to diagnose
the client (Bruscia), whereby the therapist engages the client in different musical experiences in
order to determine whether the client has a particular kind of condition, such as autism or a
learning disability. The purposes of assessment are quite varied; besides diagnosis and
prescription, assessment can focus on interpretation, description, and evaluation (Bruscia). More
will be said about these differences later.
Another element of assessment is that information about the client, both musical and
nonmusical, can be gathered in a variety of ways. Sometimes, the therapist briefly interviews the
client and, based upon this interview, decides how the music therapy session will unfold, usually
within the same session. This may be the case in medical settings, in which the therapist may only
meet the patient once and the purpose of therapy is to manage the patient's symptoms. In other
kinds of assessments, the therapist engages the client in very specific sequences of musical
activities and records the client's ability to complete the tasks presented. This is quite often the
case in educational settings, where music therapists are interested in assessing a client's skills in
order to develop a music therapy treatment plan. Consequently, the degree of organization and
formality also varies considerably in music therapy assessments. In some situations, the
assessment phase is limited to a brief verbal interview to determine the nature of the client's
immediate problems or concerns. In other situations, the client's assessment is formalized, with
the client and therapist meeting for a specific period of time to conduct the assessment; only after
the assessment is completed, interpreted, and placed in a written form does the client move into
the treatment phase of therapy, and only if this is indicated by the findings of the assessment.
The final element of an assessment to be considered is the manner in which the
assessment is documented and presented to others. In some situations, the therapist is the only
I Anthony Meadows is the first author of this chapter. The coauthors are grateful for his assistance and willingness to
share his expertise in this area. All authors are grateful to Kenneth Bruscia for generously sharing his work in this
area and his extensive unpublished materials on assessment.
one who deals with the assessment. For example, in a medical setting, where assessment and
treatment can occur within the same session, the therapist may only record a brief written
description of the goals and outcomes of the session in the patient's chart without any broader
discussion of the patient with other staff members. In other situations, the assessment of the client
may lead to a detailed written report that is shared or discussed with others. This may include the
client him- or herself, the client's family, or the clinical team. There are many variations in the
manner in which the music therapy assessment can be communicated to others; this largely
appears to depend on the setting in which the music therapist works and his or her role on the
treatment team.
Standards for assessment are included in the AMTA Standards of Clinical Practice
(American Music Therapy Association, 2002) and provide guidance in assessment. They include
the general categories of functioning to be assessed, the appropriateness of methods used, and
other aspects to consider in assessing a client. They specify that the assessment procedures and
results will become a part of the client's file and that the "results, conclusions, and implications of
the music therapy assessment will become the basis for the client's music therapy program and
will be communicated to others involved with provision of services to the client. When
appropriate, the results will be communicated to the client." It is a good idea to refer to these
assessment standards while learning and doing assessments, as they provide guidance for
planning, implementing, and reporting music therapy assessments.
Reviewing the Assessment Process

Regardless of formality or setting, music therapy assessment usually involves:
• Observing the client making or listening to music under specific musical conditions
that enable the therapist to assess the client's abilities and needs;
• One or more of the following goals: diagnosis, prescription, interpretation,
description, evaluation (Bruscia, 1993, 2003);
• Varying degrees of complexity. In some situations it may be limited to a brief
interview, while in others in may involve an extended period of engagement and
observation;
• Variations in the ways in which the assessment is recorded and communicated to
others.
In the sections that follow, we will go into more detail discussing the various stages and
dimensions of the assessment process. As such, this will include:
1. Receiving a referral;
2. Gathering background information on the client;
3. Determining the purpose and type of assessment that is needed;
4. Administering the assessment;
5. Interpreting the data;
6. Creating a report and communicating the findings.
Toward the end of the chapter, we will also introduce you to assessments for different
clinical populations and discuss these according to the dimensions outlined earlier in the chapter.
Chapter 4 Client Assessment D 29
Why Music Therapy Assessment?

Before we proceed into the details of the assessment process, let us consider why we need music
therapy assessment at all. Are we not able to rely on the assessments of other related professions?
While existing assessments for learning and psychological development, for example, can
be helpful, it is only through music therapy assessment that we can know the strengths and needs
of the music therapy client. This has a twofold advantage. First, it enables the music therapist to
observe and interpret the ways in which the client uses the musical media available to him or her
and consequently identify treatment goals from within the musical media themselves. Second, it
allows the therapist to make some determination about the actual music therapy experiences that
will be most beneficial for the client. In order to meet the goals of therapy, should the client be
improvising, performing or re-creating, composing, or listening to music? Should the sessions be
structured, semi-structured, or created spontaneously according to how the client presents at the
beginning of the session? These questions can be explored and are often answered as an outcome
of the assessment process. So, in music therapy assessment the outcomes of assessment are not
just a determination of the treatment goals but also the musical modality (for example,
improvising, writing songs, participating in musical activities) that best facilitates these goals. In
addition, the music therapy assessment can give the therapist guidance as to the subsequent
structure and sequence of sessions (to the extent to which predicting a session sequence is
possible and desirable).
There are also other benefits to undertaking a music therapy assessment with a client.
Clients may perform differently in music than in other modalities (Bruscia, 1988; Coleman &
Brunk, 2003). For example, children with autism or Rett syndrome may engage in or respond to
musical activities in ways that are different from activities that are verbally based. This in turn
may provide insight into the child's skills and strengths that were not previously evident.
Additionally, some service providers require a music therapy assessment and treatment plan in
order to justify the provision of music therapy or for reimbursement purposes (Scalenghe &
Murphy, 2000). Finally, a clinician cannot ethically provide services to a client without making
some assessment of the client's needs and the kinds of interventions that are appropriate in
meeting these needs.
The Process of Assessment

Receiving a Referral
The process of assessing a client often begins with a referral. A referral is a request by a staff
member or agency to see the client for music therapy, although in some situations clients will
refer themselves. The referral may be made because the client is experiencing a symptom that can
be addressed by a music therapist (such as pre-surgical anxiety) or because the overall goals of
treatment can be addressed in music therapy (such as a drug rehabilitation program). The purpose
of assessing the client is to determine his or her suitability for music therapy.
Gathering Background Information

Almost every assessment involves gathering background information on the client. This can take
various forms, including one or more of the following:
1. Reading the client's chart or file;

2. Interviewing the client;
3. Interviewing family members;
4. Discussing the client with staff members.
Typically, the purpose of gathering this background information is to gain: (a) an
understanding of the person, (b) knowledge of major events in the person's life and their impact,
(c) medical conditions and medications taken, (d) an understanding of the types of programs
(educational, therapeutic, and so forth) in which the person has been involved, if any, and the
outcomes of these programs, (e) an understanding of the client's relationship with music,
previous music experiences, and so forth, (f) his or her spiritual or religious values and beliefs,
and (g) the current needs and goals. Depending on the setting, it may also be necessary to learn
about therapeutic methods undertaken with the client. For example, in some settings, behavioral
interventions, reward systems, or specific forms of consequences (for example, time out) may be
utilized with the client, and it may be necessary for the music therapist to understand these
interventions and incorporate them into sessions. This will depend largely upon the philosophy of
the setting, and the personal philosophy of the music therapist.
The breadth and depth of information on the client varies considerably with each stage of
the assessment process. In some situations, such as those in which you expect to see the client for
an extended period of time and in intensive therapy (as is often the case with the Bonny Method
of Guided Imagery and Music), you will gamer a comprehensive understanding of the client's
history, needs, and goals. In other situations, such as where you only meet with the client once,
you will only gather information necessary for addressing the client's immediate needs.
Regardless of the extent to which you gather background information, you need to build an
understanding of the client that helps you contextualize your music therapy assessment and
subsequent goals of treatment.
Determining the Purpose and Type of Assessment

The next stage in the assessment process, determining the purpose and type of assessment, is by
far the most complex and difficult to understand because of the number of variables that need to
be considered in selecting and completing a music therapy assessment.
The first element that needs to be considered is the overall purpose of the assessment. As
previously mentioned, there are five main purposes in assessing a client in music therapy that
have been defined by Bruscia (1993, 2003): diagnosis, interpretation, description, prescription,
and evaluation. These will be discussed in some detail below.
A second element to consider is the domains (Bruscia, 2003) of the assessment, which
Bruscia defines as "those aspects or facets of the human being that the music therapist is trying to
understand" (personal communication, April 12,2005). For example, do you want to understand
how much arm movement a client with cerebral palsy has while playing the drum, or do you wish
to understand the music listening preferences of an adult with late stage cancer? The first question
involves assessing the physical skills or abilities of the client, whereas the second question
involves assessing the music preferences of the client. Bruscia (1993,2003) has identified various
domain areas related to music therapy assessment. Seven of these-biographical, somatic,
behavioral, skill, personality or sense of self, affective, and interactional-will be described in the
forthcoming section, Domains of Assessment.
The third element to consider is the sources of musical information (Bruscia, 1993). As
we discussed earlier, from what types of musical experiences do we need to be gathering the
assessment data? Should the client be improvising, performing or re-creating, composing, or
Chapter 4 Client Assessment D 3 I
listening to music? Each of these ways of creating and experiencing music allows you to gather
different kinds of information on the client.
In summary, you need to consider the following when undertaking an assessment:
• The overall purpose of the assessment: diagnosis, interpretation, description,
prescription, evaluation,
• The domains: biographical, somatic, behavioral, skill, personality or sense of self,
affective, and interactional,
• The sources of musical information: improvising, performing or re-creating,
composing, or listening to music.
Overall Purpose of the Assessment

As stated above, the purpose of the assessment may be diagnostic, interpretive, descriptive,
prescriptive, or evaluative. It is common for assessments to have more than one purpose. Thus, an
assessment may be both descriptive and evaluative or both interpretive and prescriptive, and so
forth.
Diagnostic Assessment
The first general focus of assessment is diagnostic? As the word implies, diagnostic assessments
are concerned with efforts to "detect, define, explain, and classify the client's pathology, focusing
primarily on its causes, symptoms, severity, and prognosis" (Bruscia, 1993, p. 5). When music
therapy assessments are diagnostic in nature, musical criteria are used to determine whether the
client has a condition, to determine the type of condition the client has, or to determine how the
client experiences or perceives the condition.
Wigram's Music Therapy Assessment for the Diagnosis of Autism and Communication
Disorders in Children (2000a, 2000b) is an example of a diagnostic assessment. Wigram's
assessment was developed as one aspect of the assessment of children who exhibit features of
autism spectrum disorders but for whom the diagnosis is not completely clear, since they may not
have all of the features or may exhibit features of other diagnoses as well. Wigram's focus is on
using "musical events as the starting point to explain psychological, pathological and emotional
behaviour" (2000b, p. 77). Wi gram modified two of Bruscia's (1987) Improvisation Assessment
Profiles, the Autonomy and Variability profiles, to help differentiate children with autism from
those with another form of pervasive developmental or communication disorder. The information
gained from using these two scales can illuminate characteristics of these diagnoses. Wi gram
(2000b) says that at times the frequency and duration of musical events that take place during an
improvisation might be counted, as might the number of musical acts and dynamic levels. He also
speaks of qualities of the music making and interaction that can be assessed through music
therapy.
2 It is important to distinguish the purposes of diagnostic assessments by music therapists, or of music therapists
gathering diagnostic information, from diagnostic work that is done by professionals in some other disciplines.
Music therapists are not allowed by law to diagnose; diagnosis is the purview of some other disciplines whose
training and scope of practice includes diagnosis. Thus, the information that a music therapist can discover about a
client that can be used in diagnosis can be used to understand the client and may assist those who are charged with
making a formal diagnosis. Within these boundaries, it should be understood that the information that a music
therapist can provide through a diagnostic assessment can be uniquely discovered through music therapy and can
perform a valuable function in understanding the client.
Interpretive Assessment
The second general focus of assessment is interpretive, in which "efforts are made to explain the
client's problems in terms of a particular theory, construct, or body of knowledge" (Bruscia,
1988, p. 5). The first step in doing an interpretive assessment is to gather samples of the client's
music making or responses to music, and the second step is to make inferences about these
responses with reference to the chosen construct or theory. The assessment may be designed
according to a particular theory or may be a general inventory that allows interpretation according
to a variety of theories depending on which is most relevant to the client's responses.
Examples of interpretive assessments include an assessment by Rider (1981) in which he
sought to discover if the ages at which children could perform musical tasks that involved
increasingly complex levels of cognitive functioning correlated with the difficulty of the tasks.
His framework was the developmental theory of Piaget, and the musical tasks were modeled after
nonmusical tasks used by Piaget. Since Rider's assessment sought to explain the children in terms
of Piaget's theQry, this assessment qualifies as an interpretive assessment.
Another example of an interpretive assessment comes from Priestley's (1975, 1994) work
in Analytical Music Therapy. Priestley's work was grounded in the psychoanalytic constructs of
Freud, Klein and Jung, wherein she would interpret the musical improvisations of her clients
according to the relevant constructs, such as defense mechanisms, ego, id, superego, and drives.
Descriptive Assessment
The third focus of assessment is descriptive, in which efforts are made to understand the client
and the client's world only in reference to him- or herself (Bruscia, 1993). In descriptive music
therapy assessments, the client's musical experiences are meaningful in and of themselves and in
relation to other facets of the client's life.
Scalenghe and Murphy (2000) provide a sample music therapy assessment for managed
care that is descriptive (pp. 28-29). This assessment is divided into nine major areas: history of
present illness, behavioral observations, motor skills, communication skills, cognitive skills,
auditory perceptual skills, social skills, specific musical behaviors, and summary and
recommendations. Within each of these assessment areas the client is described according to the
level of skill exhibited. For example, when discussing the client's communication skills (in the
subcategory of receptive language), the authors describe the client as demonstrating "the ability to
follow one step commands, presented verbally, such as pick up the maraca, put the drum stick
down, clap your hands to the music. . ." (p. 28). In this assessment, typical of descriptive
assessments, the client is thoroughly described in terms of his or her skills and needs, with a
summary and recommendations oriented toward identifying the goals of treatment.
Prescriptive Assessment
The fourth focus of assessment is prescriptive, intended to determine treatment needs of the client
and to provide a database for formulating goals, placing the client in the appropriate programs,
and identifying the most effective methods of treatment (Bruscia, 1993, p. 5). Prescriptive
assessments have multiple purposes, for example, determining:
• Whether music therapy is needed and whether the client wants music therapy;
• Whether there are any contraindications for participating in music therapy;
Chapter 4 Client Assessment 0 33
• Which methods of music therapy are most suitable (for example, improvising,
listening to, creating music);
• The kinds of materials that are appropriate for the client's age, maturity, and
interests;
• Whether the client has the prerequisites for participating in existing music therapy
programs.
In all cases, these questions require comparing what the client needs and wants to what music
therapy can provide.
The Special Education Music Therapy Assessment Process (SEMT AP, Brunk &
Coleman, 2000; Coleman & Brunk, 2003) is an example of a prescriptive assessment. This
assessment compares the child's performance on musical and nonmusical tasks that are part of the
Individual Education Plan (lEP) goals and objectives, or the goals that have been set for the
child's education. This assessment, described later in this chapter, meets the criteria of a
prescriptive assessment because it (a) attempts to determine whether music therapy is indicated
for a child, and (b) suggests those musical activities which will best meet the child's IEP goals.
Evaluative Assessment
The fifth focus of assessment is evaluative, wherein the purpose is to establish a basis for
determining progress. These types of assessments are concerned with gathering data on the client
prior to beginning music therapy, then using these data as a baseline for determining the effects of
treatment.
As an example of an evaluative assessment, Liberatore and Layman (1999) developed the
Cleveland Music Therapy Assessment to assess infants and young children experiencing
developmental delays due to medical conditions. According to Chase (2002), one purpose of this
assessment is to "document the positive impact of music therapy" (p. 25) by using the results of
the initial assessment as a baseline from which to measure changes in the children's abilities as a
result of music therapy.
Domains of Assessment
Although these general purposes of assessment give you guidelines about where to focus your
attention with the client (that is, diagnosis, interpretation, and so forth), you now need to consider
the specific goals of your assessment. In the section that follows, you will be introduced to
various domains (Bruscia, 2003) of assessment in music therapy. Each domain has its own
specific character and focus. Further, as you become familiar with the various types of music
therapy assessments, you will begin to see that some assessments focus comprehensively on only
one domain (for example, Bonny, 1980, Music Experience Questionnaire), while others contain
elements of multiple domain areas (for example, Coleman & Brunk, 2003, SEMTAP).
Biographical
This domain is concerned with gathering background information on the client, as outlined earlier
in this chapter. This includes a broad range of information on the client-education, interests,
important life experiences, relationship to music, medications, clinical diagnoses, previous
experiences in therapy, and so forth-from a variety of sources. Although gathering biographical
information often occurs prior to undertaking a music therapy assessment, it can sometimes occur
within the assessment itself. When this occurs, formal guidelines can be given for gathering
information (for example, Coleman & Brunk, 2003), or it can be gathered in an open-ended
interview (for example, Priestley, 1994).
The focus of biographical information gathering varies considerably, depending on the
reason the client has come to music therapy. For example, if the client is experiencing pain
related to having cancer, then a biographical assessment may focus more on the history of the
client's illness, medications, previous attempts to moderate the pain experience, and the like. On
the other hand, if a client is having difficulty in a close relationship and is coming to therapy to
work through this relationship problem, the therapist is more likely to gather information about
the history of the client's relationships with significant others, including parents, siblings, and so
forth. Thus, while biographical assessment can involve a broad range of information gathering, it
is usually focused according to the specific problems the client is experiencing or the goals that
have been established for the client in other treatment modalities (for example, verbal therapy).
Somatic
This domain is concerned with gathering information about the client's physiological and
psychophysiological responses to music (Bruscia, 2003). This includes physical responses to
music making and listening, such as measurements of heart rate, respiration, blood pressure,
EEG, and EMG. 3 Additionally, it includes psychophysiological responses to music making and
listening, such as pain perception, consciousness, tension, fatigue, and anxiety, among a vast
range of measures (Bruscia, 2003).
As this domain might suggest, assessments in this area are quite often not unique to
music therapy. For example, Sandrock and James (1989) reviewed assessment instruments used
to measure various psychophysiological responses to music and identified 10 distinct inventories,
scales, and checklists, none of which had been designed by a music therapist. These inventories
included the State-Trait Anxiety Inventory (Spielberger, 1983), the Beck Depression Inventory
(Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), and the Unpleasant Events Schedule
(Lewinsohn & Talkington, 1979). These measures have typically been used in evaluative
assessments to measure changes in response to music therapy interventions.
When gathering somatic information, music therapists are often concerned with the
effects of a music experience (typically listening to or performing music) on one or more aspects
of a person's physiology or psychophysiology. For example, Wigram (1997) assessed the effects
of vibroacoustic therapy (Skille, 1997) on arousal levels, hedonic tone, blood pressure, pulse rate,
and mood prior to, during, and after treatment using a variety of mechanical (such as a blood
pressure monitor) and self-report measures (UWIST Mood Adjective Check List, Matthews,
Jones, & Chamberlain, 1990). Other examples include the assessments of Bradt (2002) and
Scartelli (1989).
Behavioral
This domain deals with the client's observable behaviors. According to Bruscia (1993):
Behavioral assessment is the process of observing and analyzing what the client
does or how the client conducts himlherself. This includes overt action, reaction
3 EEG stands for electroencephalogram and is a measure of brain waves; EMG stands for electromyograph and is a
measure ofmusc1e functioning.
to stimulation, or interaction with the environment that can be seen, heard, or

otherwise noted by the therapist. Behaviors may be assessed in isolation, in
reference to their stimulus or reinforcement conditions, or as an integral part of
their interpersonal and environmental contexts. (p. 43)
Bruscia (1993) suggests that four main approaches to behavioral assessment have been
undertaken in music therapy: (a) measuring clearly defined isolated behaviors (for example, eye
contact) and using these measures as a baseline for determining the effects of treatment, (b)
charting the behavioral interactions between clients (for example, number of times one client
touches another inappropriately), (c) rating clients according to their tendencies to exhibit
behaviors or behavioral categories in a specially designed inventory (for example, number of
times the client followed the directions of the therapist in a session), and (d) recording entire
sequences of behaviors and then analyzing them according to content, sequence, or structure (for
example, while a client performs in a group instrumental piece).
A number of music therapists have developed assessments that focus on clients'
behavior. These include Bitcon (2000), Boxill (1985), Boone (1980), and Merle-Fishman and
Marcus (1982) for children and Hanser (1999) for general use. When reviewing the assessment
inventories used by music therapists with clients with mental retardation, M. Cassity (1985)
found that the adaptive music behaviors most commonly included were: following directions
(97%); making eye contact with therapist, instruments, or materials (90%); imitating rhythms,
melodies, or movements (85%); fine and gross movements (75-76%); attention span (67%);
knowledge of names and body parts (62%); and vocalizations (57%).
The General Behavior Checklist, developed by Bruscia (1993) and shown in Table 4.1,
considers broad areas of client behavior and responses in the areas of (a) motivation, (b)
nonverbal interaction, (c) communication skills, (d) relationships, (e) adaptive behaviors, (f)
aggressiveness, (g) energy, (h) physical capabilities, (i) reality orientation, and (j) motor
deviances. This inventory serves "as a guide for observing and recording whether or not the client
exhibits each of the behaviors listed" (p. 54).
Other methods for behavioral assessment (Bruscia, 1993) include: (a) measuring targeted
behaviors, in which specific behaviors are examined in detail, assessing the conditions under
which they occur; (b) measuring interactive behaviors, in which the therapist examines how the
behavior of one person affects or is influenced by the behavior of another; and (c) documenting a
behavior stream, which involves recording a wide range of behaviors sequentially within a
specific time period (for example, the first 5 minutes of a session).
Skill
This domain entails a broad range of musical and nonmusical skills demonstrated by the client
(Bruscia, 2003), including: (a) sensorimotor skills involved in music making and listening (gross
motor, fine motor, visual motor, reflexes, coordination, postural, and so forth); (b) perceptual
motor skills involved in music making and listening (perception of figure-ground and part-whole
relationships, visual and auditory discrimination skills, and so forth); and (c) cognitive skills
involved in music making and listening (attending skills, short-term and long-term recall, choice-
making, basic academics such as colors, numbers, reading, writing, telling time, size
discrimination, spatial relationships, sequencing, problem-solving, cause and effect, modes of
response and learning styles, and so forth). The skill domain also includes creative abilities (the
client's capacity for creating and responding to music) and musical skills (technical music
making, ability to read music, match pitch, imitate rhythm, and so forth).
Table 4.1
General Behavior Checklist (Bruscia, 1993)
Used with permission.
Motivation Aggressiveness
Attends sessions Screams/tantrums
Participates Verbally attacks therapist
Works towards goals Verbally attacks other clients
Nonverbal Interaction Physically attacks therapist
Eye contact Physically attacks other clients
Physical contact Destroys property
Musical contact Energy
Communication Skills Hyperactive/hypoactive
Understands language Impulsive/reflective
Speaks Fast moving/slow moving
Signs/gestures Tired/energetic
Reads and writes Physical Capabilities
Relationships Walks independently
Interacts with therapist Uses arms and hands
Relates positively to therapist Has tremors or spasms
Interacts with other clients Vision loss
Relates positively to other clients Hearing loss
Takes leader role in group Seizures
Takes follower role in group Toilets self
Works towards group goal Reality Orientation
Adaptive Behavior Temporal orientation
Stays in room Spatial orientation
Stays in seat Sense of identity
Attends Short-term memory
Behaves relevantly Long-term memory
Follows rules Hallucinations/delusions
Goes along with wishes of others Relevance of behavior
Waits for tum Motor Deviances
Handles materials responsibly Rocking
Shares materials with others Tapping
Behaves safely Perseverative movements
Stereotypic fingerlhand movements
Stereotypic head movements
Stereotypic arm movements
Twirling
Tics
Grimacing
Liberatore and Layman (1999) developed the Cleveland Music Therapy Assessment of
Infants and Toddlers to assess the skills of infants and toddlers who were at risk. Their
assessment scales are divided into distinct developmental time periods (such as 0-3 months, 3-5
months) and identify specific skills within each period according to (a) cognitive skills, (b) gross
motor skills, and (c) fine motor skills. The assessment procedure requires the music therapist to
design activities in which these skills can be observed and assessed.
Numerous other skill assessments have been developed, including Nordoff and Robbins'
(1971) 13 categories of musical response and Boone's (1980) Diagnostic Assessment of Music
Related Expression and Behavior (DAMREB).
The section on task analysis in Chapter 6, Planning Music Therapy Strategies, can help
you to further understand the kind of procedural thinking necessary to take a series of random or
unconnected skills and behaviors and weave them into a meaningful and beneficial experience of
skill development for your clients.
Personality or Sense of Self

This domain involves gathering infonnation on the psychological nature of one's self, including:
(a) self-awareness, (b) self-esteem, (c) identity fonnation, and (d) unconscious aspects of
personality (Bruscia, 1993). Personality assessments also fall within this category (for example,
Cattell & Anderson, 1953).
The vast majority of assessments in music therapy focused on one's sense of self have
been projective in nature, and many of these have their origins outside music therapy. Projective
assessments are based upon the premise that clients can project conscious and unconscious
aspects of themselves onto or into musical materials. This can include interpreting sounds or
music, rating musical excerpts while listening to them, or improvising music on various givens,
such as playing a family member or emotion.
Several projective assessments have been developed, all of which use recorded music or
sounds to elicit responses from listeners (Ball & Bemardoni, 1953; Bravennan & Chevigny,
1964; Bruscia & Maranto, 1985; Husni-Palacios & Palacios, 1964; Shakow & Rosenzweig, 1940;
Van Den Daele, 1967; Wilmer & Husni, 1953). In some situations, musical excerpts are used (for
example, Van Den Daele, 1967), whereas in others, distorted or nonmusical sounds (such as a
train) are used (for example, Wilmer & Husni). In some of these assessments, the listener or
client is asked to write down whatever comes to mind after listening to the sound, while in others
he or she is asked to narrate a story while the music plays. Various fonns of analysis have been
developed, including content analysis, structural analysis, and the interpretation of the client's
responses according to a theory or construct (for example, Freud's theory of psychosexual
development or Piaget's theory of cognitive development).
Taking a different approach, Cattell and Anderson (1953) were among the first to develop
a systematic assessment of personality based upon music preferences. According to them, the
"power and immediate connection of musical stimulation with emotional experience, and the
many indications that unconscious needs gain satisfaction through this medium, have long
pointed to measures of musical preference as effective avenues to deeper aspects of personality"
(p. 446). To meet this goal, they developed the IPAT Music Preference Test, consisting of 100
musical excerpts of various genres and styles. Clients were asked to listen to each excerpt and
rate it according to the extent to which they liked, disliked, or were undecided about the piece.
Cattell and Anderson proposed that there would be differences in the preferences of various
diagnostic groups (for example, people with schizophrenia or depression) and that such an
instrument could therefore be used for diagnostic purposes.
Emerging from his clinical experiences with both adults and children, Bruscia (1987)
developed the Improvisation Assessment Profiles (lAPs). The lAPs are "designed to provide a
comprehensive method for assessing client[s] through an analysis and interpretation of their
musical improvisations" (Bruscia, 1993, p. 84). The lAPs involve three interrelated procedural
stages, which usually take several sessions to complete: (a) clinical observations of the client
improvising under a variety of musical and interpersonal conditions, (b) musical analysis of the
improvisations, and (c) interpretation of the data. While Bruscia (1993) describes the main
assessment domains of the lAPs as emotional and interpersonal, this method of assessment has
been placed within the personality or sense of self domain because of the comprehensive intra-
and interpersonal nature of the assessment process and the fact that the interpretive levels of the
lAPs involve examining both conscious and unconscious aspects of the person and their
implications for therapeutic goals and treatment.
Affective
This domain involves gathering information on the ways in which a client responds emotionally
while listening to music or expresses him- or herself emotionally when making music. It also
involves the preferences clients have for listening to music.
In order to map out the emotional responses of clients to improvising music in Analytical
Music Therapy, Priestley (1994) developed The Emotional Spectrum, consisting of the following
main emotions: freeze-fear, flight-fear, defensive fear, anger, guilt, sorrow, love, joy, and peace.
Priestley asked her clients to create improvisations on each of these emotions, then played back
the improvisations to the clients, asking them for their reactions. In this way, a rich battery of
information was gathered about clients' emotional expression while making music and their
associations with these emotions.
While Nordoff and Robbins' (1971) 13 categories of musical response look at the
musical skills of the child, they are simultaneously concerned with the ways in which the child
responds to the mood or changes of mood in the music. Thus, the assessment process is
concerned with understanding the child in both musical and emotional terms.
Various other assessment scales are concerned with understanding how a person responds
emotionally while listening to or performing music (Hoffren, 1964; Robazza, Macaluso, &
D'Urso, 1994; Steinberg & Raith, 1985). For example, Asmus (1985) developed a nine-element
rating scale for the measurement of affective responses while listening to music, finding that over
75% of raters used the following dimensions of affect when rating the pieces: evil, sensual,
potent, humorous, pastoral, longing, depression, sedative, and activity.
Interactional
Ultimately, music making in therapy is a shared experience, even if it is just one therapist and one
client making music together. The interactional domain is primarily concerned with the following
four interactional dimensions (Bruscia, 2003): (a) communicativeness-the extent to which the
client communicates with others; (b) the client-therapist relationship; (c) peer relationships and
group skills in music therapy; and (d) family relationships.
Interactional assessments have been approached in a variety of ways (Goodman, 1989;
Hough, 1982; Pavlicevic & Trevarthen, 1989). Broucek (1987) developed an interactional
assessment based upon the theory of Harry Stack Sullivan. She drew parallels between musical
interactions and designated interpersonal behaviors, suggesting that disturbed behavior would be
manifest in musical interactions. By assessing these interactions, the therapist could develop an
understanding of the client's problems and how these could be resolved musically. Pavlicevic and
Trevarthen (1989) took a similar approach to assessing the joint musical improvisations of clients
with schizophrenia and depression. They were primarily interested in the diagnostic potential of
analyzing their clients' improvisations in order to determine whether there were any differences
in the levels of musical contact of adults with differing psychiatric diagnoses. To meet this goal,
they developed the Index of Music Experience and the Music Improvisation Rating Scale.
Sources of Musical Information

As is already apparent, the same musical experiences are used to assess clients for music therapy
that are used in music therapy treatment: improvising, performing or re-creating, composing, and
listening (Bruscia, 1993). These experiences will be used later in this book as a framework for
organizing music therapy sessions; at this time, they will be discussed as means of assessment.
Each kind of music experience offers a different way of gathering information about the client.
For example, listening assessments are primarily concerned with gathering information about the
ways in which a client hears, receives, or reacts to sound (Bruscia), whereas improvisational
assessments are primarily concerned with the ways in which "the client extemporaneously makes
up music or creates expressive sound forms while singing or playing" (Bruscia, p. 16). Notice that
the first has to do with receiving the music, while the latter is concerned with creating and
receiving the music simultaneously. This, in tum, has implications for the type of assessment
information you want to gather on the client. Do you want to understand how a client perceives or
takes in something, or how he or she creates something? Thus, the musical media themselves are
important because of the nature of the tasks and challenges contained within each experience.
Improvising Assessments
When improvising is used as the vehicle for assessment, the therapist is concerned with the ways
in which the client creates music while playing or singing. Improvisational assessments can be
concerned with solo, duet, or ensemble playing, referentially or nonreferentially and with or
without lyrics. Improvising is also well suited for projective assessment because the ways in
which "the person creates and produces hislher own music extemporaneously-to meet musical
and interpersonal demands given in the here-and-now-is a manifestation of how the person
relates to self and other at conscious and unconscious levels" (Bruscia, 1993, p. 16).
Improvisational assessments are particularly appropriate for people who have trouble
expressing themselves verbally, for those with identity and self-awareness issues, for
interpersonal and communication problems, and for those who lack spontaneity (Bruscia, 1993).
Performing or Re-Creating Assessments

Performing or re-creating assessments are concerned with assessing the ways in which the "client
learns or performs vocal or instrumental music, or reproduces any kind of sound form or musical
pattern presented as a model" (Bruscia, 1993, p. 13). According to Bruscia, there are three
primary media: vocal, instrumental, and movement. In vocal experiences, the client is engaged in
a variety of tasks that focus on the ways in which he or she uses his or her voice, imitates sounds
and melodies, learns songs, sings from notation, sings in an ensemble, and so forth. Instrumental
experiences are concerned with the ways in which the client manipulates instruments, imitates
sounds, rhythms, and melodies on instruments, learns pre-composed pieces, plays in ensemble,
reads from notation, and so forth. Movement experiences are concerned with the ways in which
the client uses his or her body and performs rhythmic body tasks, sequences of movements,
movement dramatizations, and so forth.
Re-creative assessments are particularly well suited to assessing within the skill domain
because the therapist has the opportunity to observe a range of skills as they are contained with
each recreative experience (for example, vocal or instrumental motor skills, rhythmic skills, tonal
skills). As such, Bruscia (1993) identifies two main objectives to skills assessments: (a) to
identify a developmental delay of disability; and (b) to identify loss of function due to organic
injury or disease, delay, or disability. A third objective in skills assessment is the identification of
baseline knowledge and abilities that may serve as evaluative measures in treatment.
Composing Assessments
Composing (or creative) assessments are concerned with examining the ways in which the client
composes a song or instrumental piece, usually with the help of the therapist. Herein, the therapist
may be interested in how the client creates and organizes the composition (skill domain). These
experiences are appropriate for projective assessments. They are useful for people who have
problems focusing on a task, making decisions and taking responsibility for them, or organizing
and sequencing ideas, and a need for documenting inner feelings or achievements (Bruscia,
1993). Composing may also be an effective assessment style for clients who have difficulty using
verbal interaction but who may be able to share thoughts and feelings in songs or instrumental
music forms.
Listening Assessments
Listening or receptive experiences are those in which the client hears, receives, or reacts in some
way to an auditory stimulus, which may be music or any of its components. The music may be
live or recorded and of any type. The client may be asked to respond verbally or nonverbally
(Bruscia, 1993). Listening assessments address a broad range of domains. For example, in
projective listening assessments (Cattell & McMichael, 1960; Mazzagati, 1975; Van den Dale,
1967) the client responds to music and sounds affectively, for the purposes of understanding
conscious and unconscious aspects of the person's personality. Listening assessments can also be
used for the somatic domain, wherein the therapist observes the physiological and
psychophysiological responses to music, or in the skill domain, where the therapist is concerned
with the receptive skills of the client (for example, ability to apprehend the sound or distinguish
sounds).
According to Bruscia (2003), listening assessments are indicated for clients who need to
(a) be activated or soothed physically or emotionally, (b) learn to listen, (c) examine their own
feelings and ideas, (d) reminisce, and (e) have spiritual experiences.
Conducting the Assessment

Once you have established the overall purpose, domains, and sources of musical information for
your assessment, several procedural steps follow naturally: (a) gathering the data, (b)
summarizing and/or interpreting the findings, and (c) reporting the findings.
As you prepare for each assessment, it is important to consider the practicalities of
conducting an assessment. Two main elements-space and time-should be considered. Ideally,
find a physical space that allows uninterrupted privacy with a minimum of extraneous noise.
Additionally, make sure this room is of adequate size and contains all the musical materials you
will need to complete the assessment. Sometimes these can be set out in advance (Wigram,
2000a), whereas in other situations you will need to present to the client only those instruments
that are needed for each task.
Wherever possible, choose a time of day that gives the client his or her best opportunity
of responding to the assessment tasks (Liberatore & Layman, 1999). Sometimes it may be
necessary to conduct an entire assessment in smaller blocks of time because the client is not able
to manage the entire assessment in one sitting.
Gathering the Data

You can begin to see that there are many ways to gather data on the client. Gathering data, which
refers to the actual way in which you collect information on the client, is different than sources of
musical information, which refers to the type of musical experience from which you observe the
client. Bruscia (2003) has identified the following methods of gathering data:
1. Record survey: Gathering information from written sources such as files and charts.
2. Tasks and activities: Gathering information by observing the ways in which the client
completes various tasks and activities.
3. Verbal inquiry: Interviews, in-therapy conversations, and questionnaires.
4. Observations: Observing the way the client conducts him- or herself In and
sometimes out of music therapy.
5. Tests: Objective and projective tests.
6. Physical measurements: Heart rate, blood pressure, and so forth, measured by
machines.
7. Analysis of materials: Analyzing musical materials such as improvisations;
interpreting these according to specific theories or constructs.
8. Indirect methods: Interviewing family, staff members, and so forth.
Notice that different assessment needs suggest different methods of gathering data. For
example, if a music therapist is interested in assessing the effect of music listening on blood
pressure, heart rate, and stress levels, then he or she is likely to use physical measures and tests.
If, however, the music therapist is interested in the levels of interaction between the client and
therapist, then he or she is likely to analyze the musical materials of the session.
Summarizing and/or Interpreting the Findings

Once you have collected your data, you need to summarize and/or interpret these findings. In
some assessments this involves collating and summarizing scores or ratings or indicating whether
a skill or behavior is present or absent. Examples include Bruscia's (1993) General Behavior
Checklist (see Table 4.1) and Liberatore and Layman's (1999) Cleveland Music Therapy
Assessment, both of which require the therapist to indicate whether certain behaviors or skills are
present or absent.
Taking a different approach, Priestley (1994) developed the Patient Questionnaire for use
in Analytical Music Therapy. This assessment is used to gather descriptive information on the
client at the beginning of therapy. Priestley developed categories of questions around various
aspects of the biographical domain such as family history, musical history, present psychological
condition, goals, and spiritual life. Responses to each of these areas are written down by the
therapist, and this information can then be combined with other sources of information, such as
the Emotional Spectrum and interpretations of the client's improvisations, to gain an overall
psychological picture of the client.
Taking yet another approach, Shultis (1995) developed the Music Therapy Assessment
and Initial Treatment Plan (see Table 4.2) to assess clients in medical settings. Her assessment
covers several different domains, including biographical (diagnosis, medical history, musical
history, current therapies) and behavioral (presenting affective state), and then provides sections
through which the goals and types of music therapy interventions are indicated. Notice that in her
assessment, the music therapist is required to provide some written information, then check those
affective areas that were observed during the assessment.
Table 4.2
Music Therapy Assessment and Initial Treatment Plan (Shultis, 1995)
Patient information: diagnosis, length of stay at referral, reason for referral, referral source, previous
hospitalizations/treatment, and level of orientation
Support systems: family/friends/living arrangements
Current problems: things such as pain control, sleep disturbance, nutritional deficiencies, breathing
difficulties, anxiety, depression, anger, acting out, agitation, noncompliance, confusion, need for palliative
care; and treatments or therapies (include medications for pain, anxiety, depression, psychosis, sleep)
Musical history/preferences:
Observations made during assessment: for example, does the client exhibit anxiety; is he or she talkative,
unresponsive, and so forth?
Treatment assignment: individual sessions and frequency versus group assignment and schedule
Goal areas for treatment: areas such as anxiety, depression, pain management, coping skills; also indicate
treatment team goals for this patient
Treatment interventions: (indicate all that were used in gathering data and the client's responses)
_singing _ leisure/music skills building _ lyric writing
_ musical games _ composition of music _ lyric analysis
_ improvisation _ playing instruments -
music as nonverbal communication
_ imagery for relaxation _ imagery for self exploration
_ patient-selected music - other
_ for self-expression
_ for independent listening
_ relaxation training/techniques
Objectives for treatment: Target Short Form for
As a result of these interventions, the patient date charting
_ will demonstrate a decrease in symptoms of anxiety by U anxiety)

Additional objectives in the assessment address patient needs related to agitation, breathing, cognition,
coping skills, depression, nonverbal communication, pain, post-discharge resource access, relaxation skills,
self-expression, and verbal response level.
Reporting the Findings

The final procedural step involves reporting the findings to others. In some clinical situations, the
report is given to other team members, while in others, it is communicated verbally during a team
or family meeting. In yet other situations, only the music therapist (or members of the music
therapy department) sees the report. The choice of to whom the findings are communicated
depends largely on the setting in which the music therapist works and the specific goals of the
assessment. For example, if the purpose of the assessment is diagnostic (as in Wi gram, 2000a,
2000b), then the findings are likely to be reported to others. If, however, the purpose of the
assessment is descriptive, the music therapist may be the only one who knows of the findings. Of
course, these are merely guidelines to help you think about reporting the findings and to help you
understand that they can be reported in a wide variety of ways.
The relationship between assessment and establishing the goals of treatment will be
discussed in more detail in Chapter 5, Goals and Objectives, and Chapter 6, Planning Music
Therapy Strategies.
If Music Therapy Is Not Recommended

Almost every music therapy assessment requires the therapist to ask a basic question: Is music
therapy recommended for the client? In some assessment situations, this is easily answered: The
client may not be responsive to music, may not be engaged or interested in the music therapy
strategies, or may not respond in a way that is sufficiently different from other, nonmusical,
therapies (such as speech therapy) to warrant inclusion in a music therapy program. However, to
examine this question thoughtfully, several factors warrant consideration.
While a client may not be responsive during the music therapy assessment, this does not
necessarily mean that he or she is not suitable for music therapy. In some clinical situations,
nonresponsiveness may be the therapeutic issue presented by the client, so that the music
therapist is able to observe and assess the ways in which the client is nonresponsive, how this is
exhibited musically, how nonresponsiveness sounds, and the various associated nonmusical
behaviors. The purpose of assessing the client may be to describe (descriptive assessment) the
client with a focus on his or her nonresponsiveness or to interpret (interpretive assessment) the
nonresponsiveness according to a theory or construct (for example, that nonresponsiveness is a
form of resistance that could be understood in a larger psychological way).
Similarly, while resistance, agitation, avoidance, or even aggression may be indicators
that music therapy is not recommended, these same behaviors can also be the very reason the
client was referred to music therapy. For example, a client with Alzheimer's disease may be
referred to music therapy because of increased agitation and aggressiveness toward others. The
purpose of the assessment process may be to observe the client's aggressiveness and agitation in
music therapy and examine the ways in which various musical interventions mediate, reduce, or
otherwise change the client's behavior.
Assessing the suitability of a client for music therapy is therefore context bound. In some
clinical situations, the behaviors and responses of a client may be indicators that the client is not
suitable for music therapy, whereas in others, these same behaviors may be manifestations of the
client's therapeutic issues, which can then be observed and assessed within various kinds of
music experiences (sources of musical information).
Reviewing the Assessment Process

Let us take a few moments to review the materials we have covered so far in this chapter. Music
therapy assessment is a process that involves:
• Observing the client making or listening to music under specific musical conditions
that enable the therapist to assess the client's abilities and needs;
• One or more of the following goals: diagnosis, prescription, interpretation,
description, evaluation (Bruscia, 1993,2003);
• Focusing on one or more of the following domain areas: biographical, somatic,
behavioral, skill, personality or sense of self, affective, and interactional (Bruscia,
1993);
• Information gathered from one or more of the following four musical sources:
improvising, performing or re-creating, composing, or listening to music.
The assessment process usually involves the following procedural steps:
1. Receiving a referral;
2. Gathering background information;
3. Determining the goals and type of assessment;
4. Implementing the assessment;
5. Interpreting the data;
6. Creating a report and communicating the findings.
Issues in Music Therapy Assessment

Before we move into examining several music therapy assessments in detail, let us briefly
examine some of the current issues in music therapy assessment.
Taking a Quantitative or Qualitative Approach

The first issue for consideration is the extent to which your assessment needs to be approached
from a quantitative or a qualitative perspective (Bruscia, 1993). For our purposes, we may think
of a quantitative assessment as when the music therapist is interested in gathering information
about various aspects of the client's behavior or condition and attempting to do this using
numbers, inventories, or other methods that provide a numerical measure of the person's skill,
attribute, or response. For example, Liberatore and Layman's (1999) Cleveland Music Therapy
Assessment is a quantitative assessment because the music therapist rates (using yes or no) the
extent to which a particular skill or behavior is present. Based upon a tally of skills, the music
therapist can determine the developmental level of the client and the extent to which music
therapy is indicated for that person. A qualitative assessment is more concerned with describing
the ways in which clients respond to or work with various music experiences. This may also
include interpreting the client's music making according the nonmusical theories or constructs.
Many biographical assessments are qualitative because the information gathered is descriptive
and cannot be reduced to numerical values. An example of a qualitative assessment is Bruscia's
(1987) Improvisational Assessment Profiles (IAPs), which are based upon interpreting the music
improvisations of clients according to several interrelated procedural steps.
When it is important to know how well or how much a client performs or whether he or
she has certain kinds of skills, behaviors, or characteristics, then a quantitative assessment is
likely to be indicated. For example, when measuring physiological responses to music, it is likely
that the music therapist will want to know how high the client's client blood pressure is, what his
or her heart rate is, and how much this changes while listening to music. If, however, the therapist
wishes to know how the client feels while listening to his or her own improvisation or that of a
parent or partner, then the music therapist is more likely to want to do this qualitatively.
Reliability and Validity Issues

A second issue concerns the reliability and validity of music therapy assessments. This issue has
not been adequately addressed in music therapy assessment, even though it has been raised
previously (Bruscia, 1988). Reliability and validity are only associated with quantitative
assessments. Reliability refers to the extent to which the data collected are free from
measurement errors (Meadows, 2000). That is, do the data accurately represent the phenomenon
observed, or are they distorted, misrepresented, or incompletely recorded? Validity refers to the
extent to which the assessment measures the construct under investigation and, as such, is an
"indication of its utility and meaningfulness in clinical and research situations" (Meadows, p. 9).
For example, Meadows conducted a validity study on the Guided Imagery and Responsiveness
Scale (GIMR) developed by Bruscia (2000a). Bruscia argued that responsiveness to the Guided
Imagery and Music experience was an indication of psychological health, and that scores on the
GIMR should therefore be positively related to other measures of health and negatively related to
measures of psychological defensiveness. In order to assess the validity of the GIMR, a series of
studies were conducted to examine the relationships between scores on the GIMR and two
measures of psychological health. While such studies are important in the development of
assessments in music therapy, little is being done to evaluate the reliability and validity
assessment measures.
Another ongoing issue in music therapy assessment is the extent to which assessments
need to be norm referenced or criterion referenced (Coleman & Brunk, 1997). Again, these issues
relate only to quantitative assessments. Norm-referenced assessments "describe a student's
performance in comparison to some known group. For example, a 6-year-old student might be
compared to other 6 year-old students" (Coleman & Brunk). "Criterion-referenced assessments
describe a student's performance in terms of specific behaviors or skills. The objective of a
criterion-referenced assessment is not to determine a mental age or IQ, but rather to evaluate the
student's ability to perform particular skills in a particular setting" (Coleman & Brunk). Coleman
and Brunk explain that, because the purpose of music therapy assessment (in school settings) is to
show how a student performs specific IEP skills with and without the use of music therapy
strategies, such music therapy assessments are criterion-referenced.
Very few music therapy assessments are norm referenced. As described above, norm-
referenced assessments allow comparison to some known group. Large numbers of people are
tested with the tool in order to get data for norm-referenced assessments. Information is then
provided as to how various portions of the group scored on the assessment. This information can
then be used to compare the performance of an individual or group to the larger group that was
tested. There are some areas, particularly those in which music therapy assessments are used for
diagnostic purposes, in which norm-referenced assessment data would be strongly indicated,
allowing comparisons of the performance of a client that one music therapist assesses with others
who have similar diagnoses or characteristics. Since many tests in psychology are norm
referenced, it seems important for music therapists to consider the need for more norm-referenced
music therapy assessments.
Assessment for Various Populations

Now that we have covered the major elements of music therapy assessments, we will spend time
introducing and describing a sample of music therapy assessments with various client groups.
Each of these assessments includes dimensions of the elements that we have already discussed:
overall purpose (diagnosis, interpretation, description, prescription, evaluation), domain
(biographical, somatic, behavioral, skill, personality or sense of self, affective, interactional), and
source of musical information (improvising, performing or re-creating, composing, listening). In
addition to the assessments that we describe in some detail, we will also mention other
assessments that, of course, could also be examined according to these criteria.
Children With Special Needs

The Special Education Music Therapy Assessment Process (SEMTAP, Brunk & Coleman, 2000;
Coleman & Brunk, 2003) was developed in response to the need of music therapists working in
public school settings to be able to determine if music therapy is required in order for a student to
benefit from their academic placement. The authors indicate that the SEMTAP is a standardized
process rather than a standardized assessment tool, and that this distinction is important in that it
allows each therapist to effectively communicate their findings to the child's parents and service
providers in a consistent manner. In the SEMTAP, the emphasis is on testing a student's response
to certain tasks that are specifically connected to already-existing objectives in the IEP. An
assessment report from an assessment process following the SEMTAP model is shown in Table
4.3.
To summarize, this assessment has the following features:
• Focus: prescriptive,
• Domains: somatic, behavioral, skill, affective, interactional,
• Sources of musical information: improvising, performing or re-creating, composing,
listening,
• Method of data collection and analysis: descriptive written summary,
• Reporting findings: written report; see Table 4.3 for an example.
Table 4.3
Assessment Report Using SEMTAP Approach 4
Student Name: Judy Jones

DOB: Mar. 22, 1998
Grade: Kindergarten
Address:
School:
District: Dates of Assessment: Aug. 10 and Aug. 14,2004
Evaluator: Barbara L. Wheeler, PhD, MT-BC
Purpose of Assessment
To determine if music therapy, as a related service, provides significant assistance or motivation for the
student to perform IEP skills.
Elements of Assessment
Review of most recent IEP
Interviews with IEP team members and supportive staff
Observation in two nonmusical settings
Preparation of a music therapy assessment session
Administration of a music therapy assessment session
Preparation of a written report
Classroom Observation
Judy was observed in two settings. The first, on Aug. 10, was in an outdoor art lesson where the children
were "water painting." Judy worked alone and was quite focused on the project. She often sang to herself
while painting. She did not interact with or appear to notice the other children. She did not indicate, either
verbally or with eye contact, recognition of the teachers or respond to a greeting. She was also observed on
Aug. 14 in a physical education class. This was held on the outside playground. At the beginning of the
observation, she had been asked to leave the swing and come to where the class was listening to the teacher
give instructions. She was resistive to this, but came willingly when her regular classroom aide assisted her.
As soon as the children were allowed to go to various playground activities, she went back to the swing and
remained there for the duration of the class. She used the swing appropriately, several times trying new
ways to get it to move (such as twisting). She did not interact with or show any awareness of others,
children or staff.
Review of IEP and IEP Goals

Judy's IEP indicated that, in the communication area, she speaks often but does not use speech
appropriately to request items. Cognitively, she has problems with basic pre-academic skills, such as
identifying shapes, colors, and letters. Socially, she seldom makes eye contact and generally participates
only individually in activities without exhibiting cooperative behavior. Physical and behavioral skills were
felt to be progressing well and thus were not prioritized to be addressed in the music therapy assessment.
Music Therapy Assessment Results

Communication Skills
IEP goal assessed: Judy will demonstrate effective communication skills in the area of requesting preferred
items.
Judy verbalized "Hello Judy" very clearly and appropriately in response to an improvised hello song. Her
response was supported by the structure of the song, which included the words, the request that she repeat
them, and a space for her response. She did not consistently verbalize requests (for instruments or songs) as
asked, nor did she verbally label objects so that her words could be understood.
4 This report was adapted from an actual report using the SEMTAP model. All identifying features have been changed
for confidentiality.
Cognitive Skills
IEP goal assessed: Judy will demonstrate effective object naming in the areas of shape naming.
Judy was asked to point to shapes, letters, and colors. While she pointed willingly, she was not always
correct in her choices, particularly for shapes. The structure of songs (rhythm, melody, and spaces)
appeared to help her structure some of her responses, even when they were not correct.
Social Skills
IEP goal assessed: Judy will demonstrate effective social skills in the area of making eye contact.
Judy often does not make eye contact when speaking or when spoken to. On several occasions, she made
eye contact as part of singing or another musical interaction.
Results
Judy demonstrates positive responses in the following skill areas in response to music stimuli:
Verbalizations
Identifying colors, shapes, letters
Eye contact
Recommendations
Judy responds well to various musical stimuli including singing, playing instruments, and movement to
music. She verbalized "Hello Judy" very clearly and appropriately during a hello song. The structure of
songs seemed to help her structure cognitive responses (recognition of colors, shapes, letters), even when
they were incorrect. Eye contact occurred as part of singing and in other musical interactions. She appears
motivated and structured by musical activities. Thus, music therapy is a viable means of working towards
her educational needs and it is recommended that weekly music therapy services be included in her IEP.
Suggested goals and objectives
Goal I: Judy will demonstrate effective communication skills in the area of requesting preferred
items.
Objective la. When given a prompt, Judy will verbalize two requests for instruments during the music
therapy session for 3 consecutive probes.
Objective lb. Judy will independently verbalize two requests for instruments during the music therapy
session for 3 consecutive probes.
Goal 2: Judy will demonstrate effective object naming in the areas of shape naming.
Objective 3a. When presented with the following shapes-circle, square, triangle, rectangle, star, heart,
diamond-Judy will correctly choose named shapes for 3 consecutive probes.
Objective 3b. When presented with a shape, Judy will say the name of the shape for 3 consecutive trials
per shape.
Goal I: Judy will demonstrate effective social skills in the area of making eye contact.
Objective la. When given a prompt to "look at me," Judy will hold eye contact for 3 or more seconds for
3 consecutive probes.
Objective lb. Judy will hold eye contact for 3 or more seconds when instruction begins with no verbal
prompt for 3 consecutive probes.
Assessment report submitted by:
Barbara L. Wheeler, PhD, MT-BC

Date:
Layman, Hussey, and Laing (2002) designed the Beech Brook Music Therapy
Assessment for Severely Emotionally Disturbed Children. This assessment measures four
domains: (a) behavioral/social functioning (including play skills, attention to task, attempting
activities, impulse control, compliance with structure, eye contact, and personal boundaries), (b)
emotional responsiveness (including facial affect, coping skills, handling mistakes, and display of
affection), (c) language/communication abilities (including response to simple directions, self-
expression, expressive language, response to praise, and answering questions), and (d) music
skills (musical awareness, responses to music, responses to cue, imitation, and vocal inflection).
The authors measured responses along a continuum that ranged from defensive/withdrawn to
disruptivelintrusive, with target behaviors assuming the middle range of the continuum. Examples
from their scale, one for behavioral/social and another for musical, are shown in Table 4.4. The
authors indicated that their assessment tool fared well in a pilot application, with good reliability
(Layman, Hussey, & Laing). They stressed the importance of using language in the assessment
process and resulting documentation that is easily understood by clinicians other than music
therapists, in addition to pursuing development and use of a standardized assessment approach in
order to advance research.
• Focus: descriptive, prescriptive,
• Domains: behavioral, skill, affective, interactional,
• Sources of musical information: improvising, performing or re-creating, listening,
• Method of data collection and analysis: rating scales,
• Reporting findings: written summary, with results communicated to child's treatment
team.
Table 4.4
Beech Brook Music Therapy Assessment for Severely Emotionally Disturbed Children,
Sample Areas Assessed (Layman, Hussey, & Laing, 2002)
Used with permission from the American Music Therapy Association.
Behavioral/Social
Play Skills D efIenslve

. IW Ithdrawn Target Bh
e aVlOr IsruptlveII ntrusIVe
2 1 0 1 2
Did not Demonstrated Consistently Insisted on Frequently
participate or some took turns with own turn/way insisted on
play interaction therapist 1-2 times in own turn/way
instruments; (parallel (cooperati ve session; did throughout
appeared play) play) not take turns session
afraid, tired, with therapist ( overpower-
shy 1-2 times ing); did not
take turns
Musical
Musical
Awareness De fIenslve
. IW'It hdrawn Target B eh aVlOr
. . II ntruslve
Isruptlve
2 1 0 1 2
Inconsistently Consistently Consistently Did not alter Displayed
altered tempo altered tempo altered temp tempo and/or overpowering,
and/or and/or and/or dynamic dynamic to loud
dynamic to dynamic to to match match outside dynamics
match outside match outside stimulus, even throughout
stimulus outside stimulus in- when given session
when given 1 stimulus dependently promptsl
prompt or cue when given 1 cues
prompt or
cue
Adults With Developmental Disabilities

Polen (1985) developed an assessment for adults with developmental disabilities, the Music
Therapy Assessment for Adults With Developmental Disabilities, a summary of which is shown
in Table 4.5. In this assessment, tre therapist observes and documents musical responses of the
client and interprets them to determine musical and nonmusical strengths, needs, and interests.
This information is then used in planning the client's treatment. Rather than include the complete
checklist here, descriptive information is provided on the domains tested under a broad range of
headings: sensorimotor, cognitive, communication, and affective/emotional development.
• Focus: descriptive, prescriptive,
• Domains: somatic, behavioral, affective, interactional,
• Sources of musical information: improvising, performing or re-creating,
• Method of data collection and analysis: checklist,
• Reporting findings: written report submitted to client chart; verbal report presented to
team at treatment planning meeting.
Chapter 4 Client Assessment D 5 I
Table 4.5
Music Therapy Assessment for Adults With Developmental Disabilities (Polen, 1985)
Sensorimotor Development
In this portion of the assessment, areas that are addressed include:
Gross motor: positioning (of client or instruments), hand dominance, ability to maintain a steady beat at
varying tempos (hands separately, hands together, hands alternating), ability to cross midline;
Fine motor: functional grasp (varying diameter), digital control (finger isolation, single-finger and
alternating finger patterns on piano, plucking guitar strings);
Diaphragmatic motor: lip closure, produce tones vocally or on a hom, ability to sustain tones vocally or
instrumentally.
Cognitive Development
This section of the assessment addresses a broad range of skills from basic concepts to more sophisticated
areas of academic knowledge and classification skills. It is often the case that much of this section may not
be presented to a client based on their functioning level.
Attending skills: can sustain active involvement in tasks (instrumental, vocal, movement, verbal), ability to
indicate preferences through sustained engagement;
Recognition skills: recognizes familiar people or objects (verbally/nonverbally), remembers name or
function of new instrument from start to end of session and from session to session;
Recall skills: can imitate simple rhythm patterns on like-timbred (drum/drum) and unlike-timbred
(piano/drum) instruments, ability to imitate complex (longer or syncopated) rhythm patterns on like-
timbred (drum/drum) and unlike-timbred (piano/drum) instruments, recalls function of Hello and
Goodbye songs;
Choice-making: can choose between two, among three, open-ended, self-initiated;
Basic academics: abilities in areas such as reading, writing, colors, numbers, temporal relationships, spatial
relationships.
Communication Development
Areas addressed in this section include not only receptive and expressive communication skills but also pre-
verbal and nonverbal communication, areas in which music therapy may be able to offer information
regarding the client that others disciplines may not be able to access as readily.
Receptive communication: ability to follow simple (one-step) and complex (multi-step) directives given
verbally or musically;
Expressive communication: modes of communication used (verbal, gestures, sign, communication device,
and so forth), sings "hello," "goodbye," name, and so forth, creates lyrics to a song in phrases or
sentences;
PreverbaVnonverbal communication: imitation skills (nonsense syllables, speech rhythms [by beating them
on a drum or by vocally sounding the number of beats]), ability to vocalize responsively in tonality,
ability to vocalize a sequence of pitches responsively, ability to vocalize in phrases performing
auditory closure.
AffectivelEmotional Development
This section of the assessment draws much of its information from engaging the client in improvisation
experiences. Many of the comments that may appear in this section of a formal report might also seem
appropriate for the Communication area, as the two domains share common ground in improvisation
experiences.
Verbal expression of emotion: identifies various emotions (anger, sadness, happiness, and so forth) in
music, identifies various emotions in relation to self (verbally or musically), as well as causations;
Nonverbal expression of emotion through musical creativity: initiates original rhythmic or melodic patterns,
initiates changes in tempo, dynamics or meter, explores use of instruments, improvises instrumentally,
vocally, or through movement, initiates musical jokes or games.
Adults With Psychiatric Disorders

Several music therapy assessments have been developed for adults with psychiatric disorders.
Braswell, Brooks, DeCuir, Humphrey, Jacobs, and Sutton (1983, 1986) used the Music/Activity
Therapy Intake Assessment for Psychiatric Patients to examine the attitudes of clients with
psychiatric problems, examining self-concept, interpersonal relationships, and altruism!
optimism. Cohen and Gericke (1972) devised an assessment that combined clinical observation
with information on musical ability, leading to recommendations about treatment.
Cassity and Cassity (1998) surveyed clinical training directors for information on areas of
non-music behavior that they assessed and treated most frequently during music therapy sessions.
They then asked them to write two patient problems assessed and treated most often for each
area, and two music therapy interventions used for each of these problems. They developed and
organized this into a comprehensive manual, Multimodal Psychiatric Music Therapy for Adults,
Adolescents, and Children: A Clinical Manual.
In an assessment focusing on music experiences and responses, Pavlicevic and
Trevarthen (1989) analyzed joint musical improvisations of clients with schizophrenia and
depression. They were interested in whether there were differences in levels of musical contact of
adults with differing psychiatric diagnoses.
Older Adults With Age-Related Needs

Hintz (2000) describes a music therapy assessment that addresses client strengths, needs, and
functioning levels, and can be utilized in both long-term care and rehabilitation settings. The tool
specifically targets the following areas in the skill domain: expressive musical skills, receptive
musical skills, behavioral/psychosocial skills, motor skills, and cognitive/memory skills. Results
of the testing are then interpreted and used in determining placement in music therapy services
and specific treatment and program recommendations.
Two assessments have been developed to evaluate aspects of music therapy for people
with dementia. Lipe (1995) used music task performance to assess cognitive functioning of older
adults with dementia. York (1994) developed the Residual Music Skills Test (RMST) to measure
music behaviors of people with probable Alzheimer's disease. Following accepted test-
development procedures, both assessments were correlated with non-music assessments or related
skills to evaluate the validity of these assessments (York).
The Musical Assessment of Gerontologic Needs and Treatment: The MAGNET Survey
(Adler, 2001) was designed to correlate with the Minimum Data Set (MDS), a multidisciplinary
assessment used for treatment planning in long-term care facilities. Background information,
musical preferences, and observable behaviors are collected in the initial part of the survey. The
following areas are assessed in the session and included on the assessment form: cognition;
emotional status; memory; motor skills; musical participation; musical preferences; musical
skills; observable behaviors; reality orientation; sensory processing, planning, and task execution;
singing; social interactions; and speech and communication. The assessment leads to a treatment
plan, also included on the assessment form. It includes a model session from which the
information needed to complete the assessment can be gained.
People in Medical Settings

Approaches that have been taken to assessment in medical settings include biographical interview
(Dileo & Bradt, 1999; Zabin, 2005), rating scales (Loewy, 1999; Loewy, MacGregor, Richards,
& Rodriguez, 1997), interpretation of musical materials (Dileo & Bradt, 1999; Loewy, 1999), and
standardized physiological and psychological measures (Lane, 1991; Sandrock & James, 1989).
Scalenghe and Murphy's (2000) music therapy assessment in the managed care
environment provides a comprehensive descriptive assessment of clients, divided into nine major
areas previously outlined in this chapter (history of present illness, behavioral observations, motor
skills, communication skills, cognitive skills, auditory perceptual skills, social skills, specific
musical behaviors, and summary and recommendations). The purpose of this assessment is two-
fold: (a) to describe the skills of the client in these areas and consequently identify therapeutic
goals, and (b) to meet the assessment requirements of the managed care setting and, in so doing,
advocate for the inclusion of music therapy in the therapeutic milieu.
Zabin (2005), Dileo and Bradt (1999), and Loewy (1999) describe qualitative, semi-
structured interview approaches to assessing clients. Zabin, in work with hospice patients who are
near death, describes how she begins each assessment with a brief interview (with the patient,
patient's family, or both) in order to understand the patient's background, musical interests, and
present situation. Based upon this interview, Zabin immediately begins singing or playing music
for the patient and his or her family (if they are present), and additional assessment information is
gathered inductively as the session unfolds. In her work with children experiencing severe pain,
Bradt (Dileo & Bradt, 1999) also uses a biographical interview. However, Bradt's emphasis is on
understanding how the patient uses the musical media presented to him or her to express his or
her experience of pain, "the meaning of the pain, nonverbal characteristics of the pain, as well as
evidence of pain related suffering (feelings of helplessness, hopelessness, and so forth)" (p. 184).
Based upon this information, Bradt develops a music therapy entrainment to address the child's
pain experience.
Loewy (1999) describes the purpose of her music therapy pain assessment as being to
"understand and feel the pain of the patient as well as it can be defined by him or her" (p. 195). In
addition to asking patients to comprehensively describe their pain, she also has them improvise
their pain, because these improvisations "provide clues on how to address physical aspects of the
tension" (p. 195). By playing with her patients, Loewy is also able to assess the types of
interventions needed to ameliorate the patient's pain and define the therapist's role in doing so.
Thompson, Arnold, and Murray (1990) describe a systematic, hierarchical assessment for
patients who have recently suffered a cerebrovascular accident (CV A) to determine their current
level of functioning. Typically taking three 30-minute sessions to complete, this descriptive
assessment covers six major areas of functioning: (a) orientation (self-recognition and memory),
(b) visual (memory, perception, discrimination), (c) auditory (identification of sounds,
discrimination of sounds, abstract thinking related to songs, counting, and spelling), (d) motor
(identification of body parts, sensory awareness, body integration, body use; musical and
nonmusical), (g) communication (presence of various communication disorders such as aphasia
and agnosia, articulation, respiration, phonation, vocal range), and (e) social (affect, range of
social behaviors, self-control, self-concept).
Assessments of music-related medical conditions have also been developed, although not
by music therapists. These include the diagnostic assessment of Amusia (Berman, 1981),
musicogenic epilepsy (Critchley, 1977), and music alexia (Horikoshi, Asari, et aI., 1997).
Summary
Music therapy assessment is a process that involves observing the client making or listening to
music under specific musical conditions that enable the therapist to assess the client's abilities. It
has one or more of the following goals: diagnosis, prescription, interpretation, description, or
evaluation (Bruscia, 1993, 2003) and involves focusing on one or more of the following domain
areas: biographical, somatic, behavioral, skill, affective, or interactional (Bruscia, 1993).
Assessment information is gathered from one or more of the following four musical sources:
improvising, performing or re-creating, composing, listening.
The assessment process usually involves the following procedural steps: (a) receiving a
referral, (b) gathering background information, (c) determining the goals and type of assessment,
(d) implementing the assessment, (e) interpreting the data, and (t) creating a report and
communicating the findings.
Once the assessment is completed, the therapist can make a number of decisions about
how to proceed with the client. These include addressing the following:
1. Is the client suitable for music therapy?
2. Should the client be seen individually or in a group?
3. What are the goals of music therapy treatment?
4. What kinds of musical experiences should the client be undertaking (for example,
listening, improvising)?
Although it is easy to think of assessment as a distinct phase of the therapeutic process, in
actuality assessment is usually an ongoing part of the treatment process-while you gather an
understanding of the client before you begin treatment, you are constantly reassessing the client
according to responses in sessions, and in this way you are expanding upon and clarifying your
original understanding of the client.
For Further Reading

Bruscia, K. E. (2002). Client assessment in the Bonny Method of Guided Imagery and Music
(BMGIM). In K. E. Bruscia & D. E. Grocke (Eds.), Guided Imagery and Music: The Bonny
Method and Beyond (pp. 273-295). Gilsum, NH: Barcelona Publishers.
Dalton, T. A, & Krout, R. E. (2005). Development of the Grief Process Scale through music
therapy songwriting with bereaved adolescents. The Arts in Psychotherapy, 32, 131-143.
Grant, R. (1995). Music therapy assessment for developmentally disabled clients. In T. Wi gram,
B. Saperston, & R. West (Eds.) The Art and Science of Music Therapy: A Handbook (pp.
273-287). Chur, Switzerland: Harwood Academic Publishers.
Gregory, D. (2000). Test instruments used by Journal of Music Therapy authors from 1984-1997.
Journal of Music Therapy, 37, 79-94.
Isenberg-Grzeda, C. (1988). Music therapy assessment: A reflection of professional identity.
Loewy, J. (2000). Music psychotherapy assessment. Music Therapy Perspectives, 18,47-58.
Oldfield, A (1993). A study of the way music therapists analyse their work. Journal of British
Music Therapy, 7(1), 14-22.
Shippen, M. E., Simpson, R. G., & Crites, S. A (2003). A practical guide to functional behavioral
assessment. Teaching Exceptional Children, 35(5),36-45.
Wigram, T. (1995). A model of assessment and differential diagnosis of handicap in children
through the medium of music therapy. In T. Wigram, B. Saperston, & R. West (Eds.), The
Art & Science of Music Therapy: A Handbook (pp. 181-193). Chur, Switzerland: Harwood
Academic Publishers.
Assignments-Client Assessment
I-Observing, Participating, and Assisting
1. a. Select a client from the session that you are observing. Gather information (for example,
biographical, somatic, affective) by talking with the client and speaking with others who
work with the client. Be sure that this includes a clear understanding of the current goals
of treatment. Then make a brief summary of the information on the client and identify the
most important elements. Next, determine two domains in which you think the client
might benefit from music therapy.
b. For the same client, read the chart and select two domains in which the client may benefit
from treatment.
c. Compare what you were able to find out when you gathered information without looking
at the chart with what you discovered when you got the information from the chart. Write
up your compansons.
2. Use the General Behavior Checklist (see Table 4.1) to observe the behavior of one of the
clients in the session. Write down what you find, then summarize what you have discovered
that could be useful in determining the treatment needs of the client.
3. Select a client from the session that you are observing. It can be the client from the previous
question. Select two domains (biographical, somatic, behavioral, skill, personality or sense of
self, affective, or interactional) in which you feel that it would be useful to have information.
Determine the sources of musical information-improvising, performing or re-creating,
composing, listening-that would be useful for gathering the desired information. Then
specify one way that you could use each of the relevant sources of musical information to
gather information that you would desire. Write down what you would do; at this point, you
will not actually perform any aspect of the assessment.
II-Planning and Co-Leading

1. Select one client from your clinical setting. Then select an existing assessment that could be
relevant for this person; it can be one that was described or mentioned in the chapter or one
that is used in your clinical setting. Select one or two domain areas and identify the sources of
musical information in which the client would need to be engaged in order to gather the data.
(This will be easier to do with some populations than others, as assessments are more
plentiful in some areas than others and the information to be assessed is also more accessible
to a student in the process of learning how to do this.)
2. Find three music therapy assessments in the literature. You may use assessments that were
referred to in this chapter, except for those that were described in detail. Examine the ways in
which they have been constructed. Identify the purpose, domains, and sources of musical
information. Then discuss the relevance of these existing assessments to your clients.
3. Select one client with whom you are working, then select one domain on which you will
focus your assessment. You may do this assignment as part of the regular music therapy
session, or you may see the client individually. Be sure that you treat gathering this
assessment information ethically, making sure that the client is not compromised in any way
and that he or she understands, as fully as possible, the purpose of the assessment session.
Think of two ways of assessing the client's abilities or skills in the chosen domain and decide
what sources of musical information you plan to employ in order to observe and measure
these behaviors. In some cases, you may use procedures used by the music therapist who
normally works with your clients.
Before beginning your assessment, decide how you plan to approach the session. Given
the sources of musical information that you have selected, how will you plan and sequence
the assessment session? Your assessment session or portion of the session may look very
much like a regular music therapy session, and it will be helpful to have a session plan for the
assessment just as you would if you were in charge of a regular session. As a learning
experience, it is probably easiest if you can assess the client in a specially designed session,
but if this cannot be arranged, you may do it as part of the regular music therapy session. (If
this is the case and you are working in a group, your therapy plan will be for everyone but
your specific observations or measurements will be for the person you are assessing.)
Create a data sheet to record the information, or, if possible, use audio- or videorecording
to capture what occurs. Consult with your supervisor to insure that any recordings adhere to
ethical and confidentiality guidelines. An alternative possibility is that another student or your
supervising therapist may help you take down information.
When you have completed your assessment, write down the following:
a. Information on the person's functioning within the domains that you assessed
b. How the person responds to various musical strategies
With this information, you will be able to determine appropriate goals within the domains
that you assessed. You will also be able to plan appropriate means of working toward the
goals and will be on the way to planning successful music therapy sessions.
III-Lead ing
1. Repeat the assessment process and procedures that you did in Question #3 in the previous
section, but do it with two clients and assess three domains. When you have completed your
assessment, write down the following: (a) how the person functioned in each domain that you
assessed, (b) how the person responded to various musical strategies, and (c) one goal for
each domain that you assessed.
2. Carry out a prescriptive or descriptive assessment in your clinical setting. Assess one client in
two or three domains. Report the results of your assessment and their implications for
planning the treatment needs of the clients.
3. Reflect on your experiences with assessment up to this point. Write about the areas in which
you feel that your assessment concepts and procedures have been successful in gaining
information that you need. Then write about areas in which you feel that your assessments
have been less successful. Analyze these as to whether there are problems in how you
conceptualize the assessment areas or how you carry them out. Develop a plan for making
them work more successfully. (This process of self-assessment is the same that you will be
encouraged to follow in other aspects of your music therapy clinical work.)
Goals and
Objectives
As stated earlier, assessment leads to the ability to plan appropriate and meaningful treatment for
the client. This treatment plan includes establishing goals and objectives. Whether a music
therapist operates within a framework that uses concrete goals and objectives or works to help
the client evolve through the musical interaction without having pre-stated goals and objectives
in mind, it is essential that the music therapy have a focus or aim. This focus often forms the
basis for the goals for music therapy.
Establishing Goals
Music therapy goals may be established in several ways. One is to base them on the findings of
the assessment, as outlined in the previous chapter. In some settings, the treatment team
establishes goals for the client. In these cases, the music therapist does not do a formal
assessment but formulates goals for music therapy based on the team's assessment and goals,
together with a less formal assessment gleaned from the first contacts with the client as well as
what is found in the client records.
An effectively written goal statement includes a level of specificity about the direction in
which change is sought, but without being too precise. It states the type of change that it is hoped
that the client will make with enough precision that it establishes a focus and also communicates
this to others who are concerned with the treatment process. The authors' preference is to be
more specific than, for example, "improve socialization" or "develop communication," since
such broad goals can convey myriad levels of behavior. (The goal "improve socialization" could
mean anything on the spectrum from an infant focusing a gaze at a caregiver to a young adult
becoming more comfortable with interpersonal relationships appropriate in dating.) Therefore,
such goals as "learn to take turns" or "decrease anxiety in a social situation" in the social realm
and "increase frequency of eye contact" or "increase topic-based verbalizations" in the area of
developing communication are more desirable.
Broad goals are useful in helping the therapist understand the area of treatment to be
addressed. These might be thought of as purpose statements that help to define the overall intent
of the therapy process. More specific goals help to define the desired outcome of the therapy.
These goals provide a focus for the development of objectives that can be used to measure
progress toward goals for each individual client.
Since goals may be stated somewhat differently in various settings, the music therapist
will need to adapt the style of writing goals to what is appropriate in his or her setting. In some
situations, therapists find it useful to have long-range as well as short-term goals. In this
situation, the long-range goal may be for a year with short-term goals for a period of several
months or a semester. In some settings, these short-term goals may be for as little as one week or
one session; thus, it becomes very important that these goals be stated clearly. These various goal
levels are not elaborated here but can be developed when the need arises using the principles
discussed here. One of the best ways to learn how to write effective goals is to study the goal
statements written by other music therapists and those in the particular treatment setting.
A useful goal conveys the direction of the desired change (for example, improve,
increase, decrease) and describes the desired behavior with a moderate degree of specificity.
Goals will generally be appropriate for a period of time ranging from a single session to several
months or more. In many treatment settings, goals have specific target dates based on the pattern
of treatment plan review for that setting. For example, students in school have individual
education plans (IEPs) that are reviewed at least annually, while residents of long-term care
facilities have care plans that are reviewed quarterly. Therefore, goals for practicum work may
continue for the entire semester or be altered according to the pattern of the treatment setting.
Some sample goals include:
• Improve visual tracking;
• Develop one-word response;
• Follow two-step command;
• Increase reality orientation;
• Increase verbal interaction;
• Improve range of motion;
• Increase creative self-expression;
• Increase independent use of leisure time;
• Increase appropriate verbal responses;
• Increase verbalization of thoughts and feelings regarding current medical situation.
Establishing Objectives
Once goals have been established, the music therapist usually identifies objectives. These
objectives define outcomes expected to occur in the session and will indicate whether or not the
goal is being achieved. Objectives are thus small, observable, and measurable. Since objectives
are behaviors that you expect to observe in the session, they will be specific to the musical
strategies that you plan to employ and will change from session to session as your procedures
change. In addition, objectives will often change from session to session as the client
accomplishes each objective and comes closer to reaching the goals. Unlike objectives, goals are
unlikely to change quickly.
One format for establishing objectives consists of three parts: (a) conditions, (b)
behavior, and (c) criteria. As can be seen in the samples below, the conditions refer to what is
expected to occur in the session that will provide the opportunity for the behavior to be observed,
the behavior is what is targeted for the client to do at that time, and the criteria indicate how well
or how many times the behavior is expected to be performed.
Sample objectives, defined under the previously listed goals that they support, include:
Goal
• Improve visual tracking
Objectives
• When instrument is moved horizontally in front of child's face, child will follow
instrument with eyes 80% of the time.
Chapter 5 Goals and Objectives 0 59
• When instrument is moved vertically in front of child, child will follow with
gaze 2 out of 3 times.
Goal
• Develop one-word response
Objectives
• When therapist sings a song with the space for a one-word response, child speaks
or sings one word in the space 2 out of 3 times.
• When child is asked a question requiring a one-word response, child will
respond with one word 100% of the time.
Goal
• Follow two-step command
Objectives
• When song is sung asking for the performance of a two-step command, child
performs the command within 5 seconds with a maximum of one error.
• When child is given a two-step command, child performs the command with a
maximum of one verbal or physical prompt.
Goal
• Increase reality orientation
Objectives
• When therapist asks client to name the day of the week, client will state the
correct day 3 out of 4 times.
• When client is asked the year, he will say the correct year within 10 seconds.
Goal
• Increase verbal interaction
Objectives
• During planned break in lyrics of song, client will face another client and answer
the question posed by the song with a maximum of one prompt.
• When requested by therapist, client will verbally state how she feels.
Goal
Improve range of motion
Objectives
• During music and movement activity, client will move arms in direction up or
down as modeled by therapist, with at least 12" movement between the two
directions.
• During the song "Hokey Pokey," client will perform at least half of the actions.
Goal
• Increase creative self-expression
Objectives
• When invited to improvise a sound to describe client's current feeling, client will
choose an instrument and demonstrate a sound to reflect feeling.
• When the group topic is spring, client will provide at least one phrase for
original song describing spring weather and memories.
Goal
• Increase independent use of leisure time
Objectives
• When offered a list of resources available, the client will choose one musical
activity for use during leisure time.
• When provided with a preferred musical resource, the client will report use of
the resource between sessions along with writing a log entry to document use.
Goal
• Increase appropriate verbal responses
Objectives
• During group singing, client will demonstrate the ability to sing with the group
rather than making up own lyrics.
• When interacting with group members, client will remain focused on the task
presented and respond to group members with appropriate verbal statements.
Goal
• Increase verbalization of thoughts and feelings regarding current medical
situation
Objectives
• When provided with tools and structure for creating an original song, the client
will describe her reaction to being hospitalized.
• When engaged in imagery to music, client will use metaphor to describe current
responses to medical condition.
As mentioned above, the objectives are expected to change over time. Keeping in mind
that many clients (as well as non-clients) do not change quickly, the changes may be slow and
gradual. In short-term settings where contact with the client is brief, the objectives need to be
constructed to allow the therapist to identify a small change that can be defined as a step toward
the desired goal. While some objectives will typically change over time (an objective may
change from "when therapist plays an instrument, child will tum in the direction of the sound
30% of the time" to "when therapist plays an instrument, child will reach for the instrument 30%
of the time), in other cases only the percentage of desired responses will change to reflect an
improvement (the objective may change from "when therapist plays an instrument, child will tum
in the direction of the sound 30% of the time" to "when therapist plays an instrument, child will
tum in the direction of the sound 60% of the time"). In the case of people with progressive
illnesses such as dementia, the objectives may not yield changes in a positive direction; indeed,
the client may lose ground in a number of areas. The goal of the music therapy in this latter case
might be to preserve functioning for as long as possible.
Part of the value of having objectives is that they help the music therapist focus on how
much of the behavior should be sought or how well the client is expected to do at any particular
time. Properly set objectives will be achievable over a period of time. If the client is consistently
not meeting the objectives that have been set, or is routinely exceeding them, it is likely that the
objectives were not set correctly. In these cases, the therapist should reevaluate the expectations
and set new objectives.
Once the objectives are properly stated, they are not difficult to measure. It is through
measuring objectives that we determine when to change them and also whether the goals are being
met. It is important for goals and objectives to be reviewed regularly and changed as the client's
responses warrant. You wi1lleam how to do this in Chapter 17, Documentation Strategies.
Chapter 5 Goals and Objectives 0 61
Different Formats
for Different Settings
It is of crucial importance to develop your abilities to establish appropriate and meaningful music
therapy goals and objectives, to create effective methods for implementing goals, and to design
workable strategies for obtaining data and documenting your work. Once you have developed
these skills, you may find yourself delivering services in settings that have very different
requirements and needs related to the development, implementation, and ongoing documentation
and evaluation of clinical intervention.
One example of this is the recent increase of music therapists working in settings where
service providers focus on determining the desires and interests of clients. While the goals
(outcomes) may ultimately be the same (for example, to increase verbal interaction, improve
range of motion), rather than establishing one goal and several objectives that may concentrate
on what the client will do, the therapist may establish one plan or goal that encompasses several
objectives (skills) that the client wants to do.
If the therapist is working in a setting where clients are able to actively participate in the
development of their plans, this can be an exciting and interesting addition to the process of
establishing a relationship and creating a truly meaningful method to help the person reach his or
her goals. If, on the other hand, the therapist is working in a setting in which clients are unable to
participate in this process due to cognitive, physical, communicative, and/or emotional
challenges, the actual process of developing the plan may resemble that of developing the more
traditional goals and objectives but will result in a different format.
Some examples of client-driven music therapy outcomes and skills are provided to help
you familiarize yourself with the different format. Always be aware that, regardless of the format
of documentation required by various agencies and regulations, as the person providing music
therapy services, you need to have a focus in mind of how to implement the goals and document
the responses of the client and the effectiveness of your strategies.
Music Therapy Outcome
• Client wants to participate in music experiences that offer opportunities to
engage in structured relaxation training, development of enhanced self-esteem,
and further development of effective communication skills in social and learning
expenences.
Skill-Building Areas for Documentation
• Increase the length of time the client remains still (physically and verbally)
during use of the Somatron® Wedge;
• Increase client's positive self-statements in response to questions from the
therapist relating to client's effective use of the Somatron® in therapy, as well as
relating to other experiences in therapy;
• Increase ability to engage in social and learning experiences with peers and
adults immediately following therapy.
• Client wants to participate in music experiences that offer opportunities for
further development of receptive and expressive communication skills, basic
cognitive concepts, and enhanced self-expression.

• Learn and sing question/answer learning songs dealing with a variety of
academic and social concepts;
• Increase independence in writing answers to question/answer learning songs;
• Increase the amount of time client sustains tones either vocally or through
playing the single-reed hom;
• Increase frequency of participating in instrumental improvisations.
• Client wants to learn how to express herself more effectively and feel better
about herself, as well as improve her ability to relax.
• Learn and sing new songs from the standard and popular repertoire,
concentrating on breath support and articulation;
• Practice already-known question/answer learning songs as well as learn new
ones dealing with a variety of academic and social concepts;
• Increase the amount of time during instrumental improvisations that client is
actively using both hands functionally;
• Explore a wider variety of styles, rhythms, dynamics, and phrasing.
For Further Reading

Boyle, M. E., & Krout, R. (1987). Music Therapy Clinical Training Manual. St. Louis, MO:
MMB Music.
Cassity, M. D., & Cassity, J. E. (1998). Multimodal Psychiatric Music Therapy for Adults,
Adolescents, and Children: A Clinical Manual. St. Louis, MO: MMB Music.
Hanser, S. B. (1999). The New Music Therapist's Handbook (2nd Ed.). Boston, MA: Berklee
Press. See especially Chapter 6, Goals, Objectives, and Target Behaviors.
Krout, R. (1986). Music Therapy in Special Education. St. Louis, MO: MMB Music.
Krout, R. (1987). Music therapy with multi-handicapped students: Individualizing treatment
within a group setting. Journal of Music Therapy, 24, 2-13.
Madsen, C. H., Jr., & Madsen, C. K. (1983). Teaching/Discipline: A Positive Approach for
Educational Development (3Td Ed.). Raleigh, NC: Contemporary Publishing Co.
Standley, J. M., & Hughes, J. E. (1996). Documenting developmentally appropriate objectives
and benefits of a music therapy program for early intervention: A behavioral analysis. Music
Therapy Perspectives, 14, 87-94.
Wheeler, A. H., & Fox, W. L. (1972). A Teacher's Guide to Writing Instructional Objectives.
Lawrence, KS: H & H Enterprises.
Wolfe, D. E., & O'Connell, A. (1999). Specifying and recording treatment objectives within a
group music therapy setting. Music Therapy Perspectives, 17, 37--41.
Chapter 5 Goals and Objectives D 63
Assignments-Goals and Objectives

1. For the group or individual you are observing or with which you are assisting, list three goals
that you believe the therapist has established. Write them in the style suggested in this
chapter. Then ask the therapist what his or her goals are. Compare your goals with those of
the therapist, including things that you believe influenced discrepancies; do this in writing.
2. Once you have goals that make sense for your clients, having taken into account the
therapist's goals for the session, you can begin to establish objectives. Write two objectives
for each goal, including conditions, behavior, and criteria, then review them with the
therapist for feedback. Again, write down what you have discovered, including possible
reasons for discrepancies.
3. If appropriate for the level of functioning, state a music therapy outcome for one of the
clients in your group in terms of a client-driven outcome. Then state a skill-building area for
documentation, following the format suggested in this chapter.

1. Imagine that you are the music therapist working with a group of three 8-year-old children
with moderate levels of mental retardation. They are working on pre-reading skills such as
letter recognition, on identifying their right and left hands and sides of their bodies, on safety
awareness, on identifying emotions, and on social skills such as sharing and taking turns.
Formulate at least three goals that you might set for these children and at least one objective
for each goal.
2. Do a similar exercise, but for a group of older adults with early to moderate dementia. The
type of goals that they will have is up to you. Formulate at least three goals and at least one
objective for each that you might set for these people.
3. If you are working with a group, state group goals and objectives as well as individual goals
and objectives. The goals for the group may be the same at times as those for individuals, but
at other times they will be different but complementary. Discuss the two sets of goals with
your supervisor or peers to see how you might work on both group and individual goals in
one seSSIOn.
Level III-Leading
1. Look at the general goals that you worked with in your assignments for Chapter 4, Client
Assessment, including your notes from your assessments. List each goal under the person for
whom it applies-some of your goals may be listed for only one person, others under several.
Then, using the suggestions for wording that are provided in this chapter, write each goal in
the accepted format, including the direction of change and an appropriate level of specificity.
Finally, write two or three objectives for each goal, including conditions, behavior, and
criteria.
2. Repeat the steps in the previous question (#1) for all ofthe goals that are applicable to clients
in your current clinical setting.
3. If you are working with a group, state group goals and objectives as well as individual goals
and objectives (as in Question #3 in Level II). Develop the wording for these goals and
objectives until they are realistic for your work with this group-in other words, so that they
guide your session.
Planning Music Therapy
Strategies
One of the first questions that music therapy students usually have is: What do I do in a session?
Although beginning students may not realize it, the real question is: What do I do to meet the
needs of the client? And that question naturally leads to the question: How do I do what is
required to meet the client's needs? This is the key question-it is what music therapy students
work on and progress toward as they move through their music therapy education, and it is the
focus of this chapter.
Much of the supervision that you will receive has to do with just this issue. As you plan a
session, you will combine several music therapy strategies (also called activities, experiences, or
methods) to form a session that allows you to work toward the goals and objectives that have
been established. It is also important that each portion of the session be at an appropriate level
for the client, be interesting and rewarding in order to encourage involvement, and help the client
progress toward the goals and objectives.
The steps discussed in this chapter rely on the information gained from the assessment as
presented in Chapter 4, then take into consideration the goals and objectives determined to be
important as discussed in Chapter 5. In this chapter, we learn to plan the strategies or activities
that we will use to work towards these goals and objectives. We will then take these strategies
and formulate them into a session, discussed in Chapter 7, Organizing the Session, and in later
chapters.
Music therapists use a variety of approaches to determine appropriate strategies for
working with a client at the client's identified level of functioning. All are ways to help the client
achieve his or her goals. All rely on information gained from the assessment and from ongoing
observation.
In this chapter, we will look at ways to determine appropriate strategies: what you need
to accomplish through the strategy in light of the client's level of functioning, and how you
sequence the steps in the activity itself. We will consider three different but related elements that
may inform our decisions: task analysis, skill analysis, and level of development. After looking at
these, we will discuss criteria that can be used to evaluate whether the strategy is appropriate.
Two forms will assist you in planning strategies. The Strategy!Activity Form in Table 6.1 can be
used to help to organize your planning, and Guidelines for Activity Planning in Table 6.2 will
give you ideas to consider in planning for various populations.
Table 6.11
Strategy/Activity Form (Bruscia, 1993)
Used with pennission.
Date:
Music Title: The name of the song, instrumental piece, play, etc. Leave blank if there is no
composition.
Source: Where you found the music or activity, including author, title, and page.
Population: The diagnostic classification of the clients for whom this activity was planned.
Activity Type or Title: Specify whether this is a greeting song, goodbye song, vocal call and
response song, movement-action song, instrument action song, chant, song sung with
instrumental accompaniment, instrumental ensemble, notated song or piece, structured
movement to music, dance, etc.
Musical Characteristics: Describe the fonn of the song or piece; its rhythmic, melodic, and
hannonic characteristics; how the parts are divided between the players; elaborateness of the
score and accompaniment; difficulties that might be encountered by the client.
Skill Requirements: What skills will the client need to participate in this activity?
Area of Concern: Each area of concern represents abilities and skills in a specific area of living.
The most common are:
• Sensorimotor development: reflexive responses, sensory acuity or awareness (visual-
motor, auditory-motor), fine motor, and gross motor skills.
• Perceptual development: auditory or visual perception of figure-ground, part-whole,
same-different; identifying similarities (conserving) and differences (discriminating)
between stimuli.
• Cognitive development: breadth, depth, and duration of attention; short- and long-tenn
memory; learning style; academic concepts and skills; ability to make inferences or
abstractions.
• Behavior: adaptive or maladaptive behaviors in a music setting; impulsivity,
destructiveness, aggression, etc.
• Emotions: range, variability, and appropriateness of feelings; expressivity; preferences,
moods, etc.
• Communication: receptive and expressive abilities in speech, language, and other
modalities.
• Interpersonal: awareness, sensitivity, intimacy, tolerance in relation to others;
interactional skills; group skills; role behaviors; ability to fonn relationships.
• Self-help: toileting, dressing, eating, grooming, hygiene.
• Community living: skills required for independent living such as safety, transportation,
money management, shopping, etc.; appropriate use of leisure time; vocational pursuits,
job skills, social behaviors at work, etc.
• Medical: abilities or skills necessitated by illness, medical treatment, or hospitalization.
• Musical experience: preferences; vocal or instrumental skills; practice habits; repertoire;
ensemble skills; improvisational skills; musical tendencies when perfonning,
improvlsmg, or composing.
• Creativity: fluidity, divergence, originality, inventiveness.
• Spiritual: issues pertaining to religion, divine being, etc., that may be of concern to
client.
1 Thank you to Kenneth Bruscia for allowing us to use and adapt this fonn.
Chapter 6 Planning Strategies D 67
Therapeutic Goals aud Objectives 2

Goal 1:
Objectives:
Goal 2:
Objectives:
Environment: What instruments, props, furniture, materials, scores, cues, reinforcers, etc., will
you and the client need for this activity? How will the room be arranged with regard to the
equipment, furniture, open space, and people? What kind of atmosphere do you need?
Step-by-Step Method of Presentation: Describe in detail how you plan to engage the clients in
this activity, including: How you will break down the activity into steps; the verbal
instructions you will give prior to each step; the various prompts, cues, and supports you will
give. Be very specific and complete about what you will say and what you will do as well as
what you expect the clients to do at each step. Use this format:
Step One:
Therapist:
Client:
Step Two
Therapist:
Client:
Activities That Precede and Follow:
Evaluation of Effectiveness of Strategy:
2 Although goals and objectives were discussed in Chapter 5 of this book, the definitions that Bruscia includes on this
form may be useful and are quoted here:
Goal. A goal is a statement that describes the direction of the therapist's efforts and the end towards which that effort
is directed. Grammatically, a goal consists of an infinitive phrase, a direct object, and the necessary modifiers (e.g.,
to eliminate self-injurious behaviors). Notice that the doer or implied agent is the therapist not the client. The
infinitive phrase reveals not only the current functioning level of the client, but also the direction of the therapist's
efforts. For example, "to establish" implies that the client does not do something and that the therapist will work to
elicit it for the first time; "to increase or decrease" implies that the client already does something and that the
therapist will try to change the frequency of its occurrence; "to improve" implies that the client already does
something but not very well and that the therapist will try to develop it further. The direct object and the modifiers
give details about the areas of concern cited above.
Objective. An objective is a statement that describes what the client will be doing as a result of the therapist's efforts
and as evidence that the goal has been achieved. Notice that the doer or agent here is the client rather than the
therapist. Grammatically, an objective is a full sentence, starting with the phrase "The client will," followed by a
verb that describes the client's actions, and modifying phrases which give details about the stimulus, reinforcement
conditions, and desired frequency, accuracy, intensity, etc. Examples are: The client will sing back four-bar
melodies with accurate pitch after one presentation, or, The client will play assigned instruments at the appropriate
spot in the piece, without visual prompting. A goal has more than one objective when its accomplishment requires
several steps or when the client needs to generalize the same objective from one situation or setting to another.
3
Table 6.2
Guidelines for Activity Planning (Bruscia, 1993)
Every client population has its own problems and needs that will affect participation in music
therapy. The following are some basic questions to ask when planning interventions.
Therapeutic Priorities: Identify the most important areas of concern, goals, and objectives
when working with this population.
Medical Needs: Does the client have any medical conditions that contraindicate any form or
level of participation in music therapy? What special precautions must be taken to insure the
medical safety of the client? Does the client have seizures? Is the client taking any
medication, and, if so, what effects can be expected?
Physical Needs: What are the client's physical capabilities? Can he or she stand up, walk, sit up
straight, use arms, hands, and fingers? Does the client have a visual or hearing impairment?
Is he or she toilet trained, able to indicate toileting needs, use toilet independently?
Environmental Needs: What special precautions should be taken in organizing the room or in
the furniture and equipment in the room? How should clients and therapist be situated in
space? What kind of physical atmosphere is needed?
Musical Needs: What kinds of musical experiences and activities are needed and preferred:
listening, improvising, re-creative, creative? Should the media be vocal, instrumental, or
movement? What styles of music are most appropriate and preferred? What kinds of musical
direction and support are generally needed? Should the music be stimulative or sedative,
flexible or structured?
Communication Needs: What kinds of instructions, cues, prompts, and communication
supports do clients need? How will verbal and nonverbal forms of communication be used in
tandem? How should instruction be paced and broken down? Is review necessary? What
extra aids are needed?
Session Needs: Do clients need free-flowing or structured sessions? What kinds of warm-ups or
preparations are needed before beginning? What are closure needs?
Emotional Needs: What kinds of emotional issues are likely to arise? How well do clients relate
to therapist or others? What emotional needs must be met?
The basic and ongoing question is: How do I insure the safety of the client while also
addressing therapeutic needs?
3 Thank you to Kenneth Bruscia for allowing us to use this form.

Chapter 6 Planning Strategies 0 69
Task Analysis
The assessment process will have helped you to gather information about the client and his or her
level of functioning, interests, and so forth. It may be helpful to refer to Chapter 4, Client
Assessment, to review some of this information. You then need to translate this information into
appropriate strategies for working on the needs determined from the assessment. It is important
that the strategies be sequenced correctly in order to help the client move from what he or she
can do to what you are helping him or her learn to do. To accomplish this, you will often perform
a task analysis. A task analysis is just what the name says: an analysis or breakdown of the task
to be performed. It involves listing all of the steps that are involved in performing the task in the
order in which they need to be accomplished.
Task analyses can be conducted in various domains. Gagne and Briggs (1974) classify
learned capabilities into intellectual skills, cognitive strategies, verbal information, attitudes, and
motor skills. These domains are often used in the field of instructional design, from which task
analyses have evolved.
Music therapists often do a task analysis in order to determine the sequence and the steps
to follow to help the client reach a desired behavior. Presenting tasks in the proper sequence is
important for any client or group of clients but is particularly important when working with
people at lower levels of functioning, as these people are less able to catch on to or learn a skill
that they have not been specifically taught. Therefore, in this section we will use an example of a
task analysis with a lower functioning client.
As a beginning music therapy student, you may become so focused on the goal
(response, outcome) that you are attempting to elicit that you forget that there are actually many
smaller steps that lead up to the desired response. By training yourself to look for these smaller
steps you will find that you are better able to organize experiences and present tasks in ways that
provide for a more stimulating and successful session with your clients. Doing a task analysis is
one fairly straightforward way to accomplish this.
As an example of the usefulness of a task analysis, think about a simple daily activity
such as brushing your teeth. While the desired outcome is good oral hygiene as achieved through
efficient brushing of teeth, a number of steps are required to reach that end result. Steps include:
• Gathering needed supplies (toothbrush, toothpaste, water, towel),
• Combining these supplies in the appropriate ways (squeezing toothpaste on toothbrush,
applying toothbrush to teeth),
• The action needed to actually brush the teeth (grasping the toothbrush, the brushing
motion, movement of the toothbrush to all areas of the mouth), and so forth.
Miss one step-let's say letting the toothpaste fall into the sink rather than successfully
squeezing it onto the bristles of the brush-and the end result, good oral hygiene, is not achieved.
Transfer this same skill set to the music therapy context. Suppose that you are working
with a client for whom learning to brush his teeth is a goal. Perhaps he has achieved the skills
needed for the earlier steps in the process but needs to develop enough hand coordination and
strength to grasp the toothbrush and form the brushing motion. You have been asked to work on
these skills in music therapy.
Since there are many things that can be done in music therapy to work on hand
coordination and strength, we need to choose (at least) one strategy on which to focus. For our
example, let's use playing the drum. Since our client only needs to use one hand to brush his
teeth and since it is generally easier to play the drum with one hand than with two, we will focus
on playing the drum with the client's dominant hand. The task analysis for the task of grasping
the stick and playing the drum might be as follows:
1. Allow stick to be placed on hand;
2. Wrap fingers around stick;
3. Close hand around stick;
4. Tum hand over so that hand is on top of (held) stick;
5. Raise hand;
6. Lower hand and stick quickly onto drum surface, without letting loose of drumstick;
7. Let drumstick come off of drum quickly or bounce off of drum, while still
maintaining grasp;
8. Repeat steps 5 through 7 more than once.
It may be useful for you to look at some other examples of music therapy task analyses to
prepare for doing your own. Hanser (1999) presents a task analysis of the steps necessary for a
child to be able to perform the movements to the song, "Head, Shoulders, Knees, and Toes" (p.
174). Boyle and Krout (1987) present two task analyses, one for courteous selection of partners
for a movement activity and the other for playing I and V7 on the harmonica (pp. 19-25).
SI<ill Analysis
The client must have the skills required to complete the steps in the task analysis in order for it to
be appropriate. A skill analysis is done in order to identify the prerequisite skills needed to
perform the tasks.
If the client does not have the skills required for the steps in the task analysis, then that
particular task analysis is not useful, and it would be better to focus on a different task. In the
toothbrushing example above, the client must be able to do certain things in order for the task
analysis as presented to be useful. If the client is unable to coordinate grasping the toothbrush in
one hand while squeezing the toothpaste onto the bristles with the other, establishing a goal of
brushing his or her teeth independently would be setting the client up for frustration and failure.
It would be more appropriate to start by working on strengthening grasp and improving bilateral
hand coordination. This example illustrates the value of the assessment process in developing
appropriate goals and objectives and then successfully presenting tasks in therapy.
In order to be able to accomplish the steps in the task analysis for learning to brush one's
teeth, it would be important to determine whether the client had adequate grasping skills,
intentionality or goal-directed behavior, receptive language skills to understand instructions, fine
motor coordination for moving the toothbrush in the mouth, attention skills needed to participate
in instruction, and retention skills needed to remember the sequence. If these skills are not there,
you need to establish the prerequisite skills before using a task approach to teaching the sequence
of behaviors.
Chapter 6 Planning Strategies 0 71
Level of Development
The third approach that is relevant to determining appropriate procedures for a music therapy
session is the client's level of development. Information on developmental level is presented in
Chapter 12, Further Considerations in Planning, and much of our discussion of this area will be
covered when we reach that chapter. For now, though, let us say that utilizing a developmental
approach in music therapy means that the therapist seeks to identify the developmental stage at
which the client is functioning by comparing the client's skills to the diverse musical tasks or
competencies demonstrated by normal children at each stage. For many children with delayed or
atypical development, the developmental level will be uneven or will lag behind the normal skills
for that chronological age. Developmental level can be applicable to clients of all ages.
Once the client's developmental level is known, two things can be done in planning.
First, the next skills to be learned in normal development can be the focus of the music therapy
sessions. Second, musical tasks typically done by children at that developmental level can be
used with the client, since they are likely to be both engaging and useful for building the
necessary skills.
Evaluating Music Therapy Procedures

Following the music therapy session, the therapist will, of course, evaluate how well the client
was able to perform the activities that were presented. This is done through evaluating the
objectives for the session and is discussed in Chapter 17, Documentation Strategies.
It is also helpful to evaluate the effectiveness of the procedures used in the session. Just
as you look at the client's success in achieving the objectives, you want to look at your success in
presenting appropriate strategies for working on them. There are a number of ways to do this. All
of these involve self-reflection as well as reflecting on the session and the client's response to
what was presented.
It is recommended that you go through every portion of your session and evaluate both
the client's response and your own reaction to what you did. In evaluating the client's response,
consider how the client responded emotionally and whether it appeared that he or she enjoyed the
experience, as well as how successful he or she was in accomplishing what was expected.
For Further Reading

Borczon, R. M. (2004). Music Therapy: A Fieldwork Primer. Gilsum, NH: Barcelona Publishers.
Hadsell, N. A. (1993). Levels of external structure in music therapy. Music Therapy
Standley, J. (1991). Music Techniques in Therapy. Counseling and Special Education. St. Louis,
MO: MMB Music.
Watson, D. E., & Wilson, S. E. (2003). Task Analysis: An Individual and Population Approach
(2 nd Ed.). Bethesda, MD: American Occupational Therapy Association.
Wolfe, D. E., & O'Connell, A. (1999). Specifying and recording treatment objectives within a
group music therapy setting. Music Therapy Perspectives, 17. 37-41.
Assignments-Planning
Music Therapy Strategies
1. Select a simple musical task on which you can perform a task analysis. If possible, make this
something that the individual or an individual in the group with which you are working could
use. Examples would be to produce a ringing tone on a resonator bar or make a sound on a
kazoo. Write a task analysis of the steps leading to being able to do this.
2. Do a skill analysis of the skills needed to perform the task that you analyzed in the question
above.
3. Write out the developmental skills that you see as necessary in order for a person to do the
task from question #1; this will have much in common with the skill analysis from question
#2.

1. Select a non-music task that is in the cognitive, verbal, or motor skill domain to be used with
an individual or group to which you are assigned. Make this as appropriate for your session
as possible while being applicable for someone for whom a task analysis is appropriate.
Write a task analysis for this task.
2. Use the task analysis to help the person for whom it is appropriate to learn the task. Keep a
log of how useful it is and, after completing the task, write comments as to its usefulness and
what might improve this.
3. Fill out the Strategy/Activity Form as an aid in planning one of your sessions.
Level III-Lead ing

1. Select a task appropriate for your session that is in a different domain (such as cognitive,
verbal, or motor skill) than that focused on in Level II. Write a task analysis for this task, and
then use the task analysis to help in learning this task.
2. Use the Strategy/Activity Form as an aid in planning one of your sessions.
3. Use the form, Guidelines for Activity Planning, to assist in planning for one of your sessions.
Organizing
the Session
The culmination of all of the preparation that you have been doing is the music therapy session
itself. What actually occurs in the session is the focus of much of the therapist's energy.
Some sessions are planned carefully in advance, and deviations from the plan occur only
when necessary in order to meet clients' needs. One thing to emphasize about a session that has
been this carefully planned is that the planning is only for what you expect will occur. There must
always be room for changes in the plan. These may occur because different clients come to the
session than expected, because they come in different moods or frames of mind than anticipated,
or because something comes up in the session that calls for a change of plans. The ability to
accommodate changes in the plan is essential, and the more skillfully the therapist adapts to these
changes, the more effectively he or she will work.
The approach to some sessions is more spontaneous and can be thought of as a structured
looseness. Although the therapist still has certain guidelines and boundaries for what is expected
and acceptable, and anticipated outcomes for the session are defined, the actual sequencing and
structuring of the session and tasks within it may be more fluid in nature. Often, the clients may
have goals for decision-making, choice-making, and assuming independence and responsibility.
In these cases the therapist may actually defer the planning in order to preserve these
opportunities for the clients.
Music therapists working in both structured and spontaneous modes remain focused on
the goals and objectives established for the clients and aware of how the clients are doing in
working toward those goals.
There is no single way to organize a music therapy session. Nonetheless, many therapists
follow a basic three-part sequence: (a) some type of warm-up or introductory experience, (b) one
or more experiences comprising the main part of the session, and (c) a closing or wrap-up
experience. Following this structure provides a dependable framework that can be comforting to
clients, can contribute to the meaning of the therapy session, and can help the therapist achieve
consistent outcomes.
The opening experience serves to bring participants (including the therapist) together by
allowing them to state who they are and something about their mood or state of mind and to begin
to focus on the tasks and goals ahead. While music therapists sometimes call this a "hello song," this
is a misnomer: The opening does not need to be a song and certainly does not need to say hello.
While a song is often used as part of the opening, the opening may also include an improvisation
or verbal introduction. It often includes an opportunity to find out how participants are feeling or
for them to share something from their week. The opening time may provide an opportunity for
the music therapist to provide an overview of the purpose of music therapy, if appropriate.
The main portion of the session is where the primary work occurs. This section is
comprised of whatever the therapist or clients select. It is normally the longest part of the session
and may include various combinations of improvising, performing or re-creating, composing, and
listening experiences. These are described in detail in Chapters 8 through 11.
The closing or wrap-up experience provides closure. This may be a musical closing and,
as with the opening experience, may be consistent from session to session. It is often structured to
provide a time for clients to share what they have gained from the session or how they are feeling
at that time. It may include verbal or musical communication. The therapist should allow enough
time before the scheduled end of the session for all participants to express themselves so they can
move on with their day.
Setting Up the Environment

There are a number of decisions that the music therapist makes concerning the room set-up, the
equipment and instruments to be used, and materials to have on hand. Considering the
consequences of these decisions ahead of time will help insure that the session stays focused on
issues that need to be addressed, not on logistical problems.
Room Arrangement
There are several considerations regarding room arrangement. The first is the arrangement of the
chairs. An arrangement in a circle or semi-circle facilitates interaction, as group members will
then be able to see one another. Occasionally, it works well to sit around a table. This has the
advantage of allowing materials to be placed on the table, but the disadvantage is that the table
becomes a barrier, physically and psychologically. In addition, tables make it more difficult for
the music therapist or any assistants to move from person to person. There may be occasions in
which rows work well, particularly if people need to be able to see something on the wall such as
a chart or an illustration. However, sitting in rows does not promote interaction, so this
arrangement should be used with caution.
The seating arrangement is just as important when preparing for an individual session.
Consider whether the client needs special positioning in order to facilitate increased eye contact
with the therapist or to allow the therapist to easily provide physical assistance to the client. Are
there concerns about close physical proximity that could create anxiety for the client? If the client
is dependent on a wheelchair for mobility, be sure that there is adequate space for the wheelchair
to be positioned without it becoming a barrier to contact with the therapist or with instruments.
Once the decision about the room arrangement is made, it is important to be sure that the
arrangement occurs. This requires that the music therapist allow time prior to the session to be
sure that chairs and equipment are in place and other necessary items have been prepared. There
should be room for people to walk around or in and out of the room, as needed. Everything
should be ready when the clients begin to arrive. (There may be an occasion in which part of the
therapy is for clients to assist with setting up the room. This would be a special situation and is
certainly acceptable, if it serves a purpose.)
After people have arrived for a group, the room arrangement may still require attention.
Decide what to do with empty chairs. It is often a good idea to remove the empty chairs, since
leaving them in contributes to a sense that the group is not complete or is not as unified as it
might be. Of course, additional members may arrive later, and the music therapist needs to decide
whether to add chairs when they come or leave the chairs available for them. It is recommended
that this decision be made consciously and with regard for its impact rather than due to
convenience or lack of thought.
Equipment and Instruments

Equipment that may be needed in the music therapy session includes a piano or keyboard, other
musical instruments, music stands, and a stereo/compact disc player. As with the set-up of the
Chapter 7 Organizing D 75
room, this needs to be planned in advance, both to insure that they are available and so that they
can be strategically placed around the room.
Many other instruments are used by music therapists. There are reasons that they might
be chosen and considerations in using them. Some of these instruments are variations of
instruments used in orchestras and bands, often simplified for music therapy as well as classroom
music purposes. A good way to get an overview of the instruments that are available is to look
through a good catalog. It is also beneficial to visit the exhibit hall at a music therapy conference,
where you have the opportunity to see and often playa variety of instruments as well as review
printed music and other materials and resources. We will discuss instruments by category.
Pianos and keyboards. The decision about whether to use a piano or a keyboard may
depend on availability. But if the music therapist has the option of choosing one or the other, it is
good to consider the benefits and drawbacks of each. They are not equivalent instruments. The
piano has a unique sound and provides a traditional sound for accompaniment. Many older adults
may relate well to the piano as an accompanying instrument. It is also very substantial and may
be useful when the music therapist is playing along with one or more clients. Pianos may be
difficult to move and need to be kept in good condition and tuned regularly. Electronic keyboards
come in various types. One advantage of a keyboard is that it is portable and can be taken to other
rooms or floors; a keyboard may also be placed close to a client. Some keyboards can be
programmed with various sounds, rhythms, and so forth, and some of these features may be
helpful in the music therapy session. Keyboards may be programmed to provide an
accompaniment, to sound like a variety of different instruments, to repeat a phrase, and for a
myriad of other features. It is often a good idea to have a stand for the keyboard. Disadvantages
of keyboards are that they come in a variety of sizes and types, and the music therapist needs to
be familiar with the particular keyboard that is available. Some keyboards have small keys; others
do not have an entire keyboard and may be missing low or high notes that the therapist needs. If
batteries are used, it is important to be sure that they are fresh. It is always a good idea to have a
backup set of batteries or an adapter in case the batteries lose their power. Using a cord and an
adapter eliminates the need for batteries but limits the mobility of the keyboard and may be a
hazard for people to trip over. The final point to keep in mind about using a keyboard is that it is
not a piano. Use the keyboard when a keyboard is most appropriate and a piano when a piano is
needed.
Accompanying and chordal instruments. This category includes pianos and keyboards,
discussed above, and guitars, ukuleles, autoharps, and Qchords®.' Guitars and ukuleles can be
used for accompaniment and can also be taught (sometimes in simplified form) to music therapy
clients. Autoharps and Qchords® are useful in that they can be placed over the laps of the therapist
and client or otherwise put between them, leading to a shared experience. Autoharps must be kept
in tune and time must be allotted for this. The Qchord®, which is shaped somewhat like an
autoharp, has a number of features that make it useful, including the ability to continue playing an
accompaniment once started (when programmed to do so) and to create a nice sound with little
effort.
Drums. There are many types of drums, and they have various uses. They may be played
with simple or very complex rhythms. Drums make a variety of sounds, and this variety can
contribute to the sound of the ensemble or composition. Some can be tuned to various pitches.
Some are played with the hand, with various sounds achieved with different hand positions, while
others are played with sticks or mallets. One advantage of a drum is that it can be played by
almost anyone. Some drums, called hand drums, are held in one hand, in the lap, between the
legs, or under the arm. Others are placed on the floor. Some floor drums require stands; it is
important that such stands be sturdy and fit the instrument properly. Since drumming can be very
1 The Omnichord® and Qchord® are digital instruments developed by the Suzuki Company. The Omnichord® was
developed first but has now been replaced by the Qchord®.
loud, the music therapist should be aware that people have different levels of sensitivity to sound.
It is therefore a good idea to have earplugs available for clients who might like to use them.
Sticks and mallets. Both drums and melodic percussion instruments (such as the
xylophone) are played with sticks or mallets. A mallet has a covering on the end, while a stick
does not. There are a number of considerations in selecting and using sticks and mallets. The head
of a mallet makes a difference in the sound, so it is important to test the mallet on the selected
instrument. Several mallets may be needed to produce different sounds. Most instruments are
usually played with two sticks or mallets, but there are situations in which only one should be
used. One of these would be when a child is just beginning to play the instrument or does not yet
have the coordination necessary to use both sticks. Another would be when the player is not
physically able to use both hands, perhaps due to a stroke. Some instruments, such as resonator
bells, are intended to be played with only one stick. Small children will require shorter sticks than
larger children or adults. Finally, there will be instances in which the end of the stick that is held
needs to be made larger or otherwise adapted to the needs of the person playing.
Additional percussion instruments. There are many percussion instruments in addition to
drums. Some of these are from Latin or African traditions. Some are orchestral instruments that
have been adapted by music therapists. Some are simple classroom instruments. They make a
variety of sounds and require varying levels of skill, although most can be played very simply.
Melodic percussion. Melodic percussion instruments are melodic instruments that are
played with a mallet or stick. Some of the finest quality instruments have been developed for use
in Orff Schulwerk and are often referred to as OrfJ instruments. They include glockenspiels
(small instruments with metal bars), metallophones (with softer metal bars), and xylophones (with
rosewood bars). Each of these types of instruments comes in several ranges, often soprano, alto,
tenor, and bass. The bars for these Orff instruments are placed on a frame but can be taken off
easily. This allows for only some of the notes to be included and is often done so that a pentatonic
or other scale may be used. A bar of the same type as on the metallophone and xylophone, but in
a low range, may be put on an individual frame and is called a resonator bar.
A pentatonic marimba is similar to the melodic instruments just described, but not part of
the Orff tradition. The bars, which cannot be removed, are arranged in a pentatonic scale. This
can be useful when a portable instrument is needed, for instance, when it is to be played from a
hospital bed. Small xylophones that do not come from the Orff tradition are also available, but the
bars will not be removable and they are generally not of the same fine quality. There may be
situations, though, in which these less expensive instruments are preferred.
Another type of melodic percussion instrument is a resonator bell or tone bar. These are
individual bars that generally come in a set. One or more bars can be assigned to an individual
client or to each group member. They are generally placed on a table in front of the player or may
be held. Holders are available if several of these are to be used by the same person.
Several instruments have been developed that are hit with a beater built into the
instrument. Handbells are the largest and most expensive of these. These are the same handbells
used in churches; they have a rich, vibrant sound. They are, however, expensive and heavy and
require special care; for the most part, they have been replaced in music therapy by other
instruments, primarily tone chimes made by Suzuki and other companies. Both of these have
good sounds and can be played by people with only one functional hand.
Wind instruments. There are a number of simple wind instruments. These include
recorders, which require some skill in order to play but are within the reach of many music
therapy clients. A simpler but somewhat similar instrument is a tonette.
There are several instruments that do not require any finger movements. These include
kazoos and slide whistles. Different notes on the kazoo are made with the lips and breath. Slide
whistles require modest two-hand coordination.
Single reed horns were developed largely for use with Nordoff-Robbins music. Each of
these horns has a place to insert a reed that is tuned to one note, giving the therapist control over
the notes that are played. Bird calls are used in some Nordoff-Robbins music, in addition to being
used elsewhere. They are unique instruments that can be enjoyable to play.
Electronic instruments. There is a rapidly increasing number of electronic instruments
available. An advantage of these is that clients with a variety of physical limitations may play
them or use them in other ways, such as to compose. Many adaptations can be made to
accommodate such limitations. For example, a switch may be devised to allow a person to select
notes without having the fine motor coordination normally required to play a keyboard. Other
adaptations may be similar to or modeled after those described in the next paragraph.
Adaptive instruments or materials. It is important to be aware of the physical abilities and
limitations of your clients and to be prepared to provide special instruments or adapt instruments
so each client can have a successful instrumental experience. 2 Numerous instruments are
commercially available, especially for individuals with physical challenges. These include
adaptive instrument stands, wheelchair clips for paddle drums, velcro straps, and so forth.
Sometimes adapting an instrument is simply a matter of trying a variety of positioning options,
but you may find that you are working with some clients who need a more individualized
approach. For example, you may have a client who can produce strong tones on a reed hom but is
unable to grasp it, or perhaps you are working with someone who can maintain a steady beat on a
drum with his or her hand but is unable to grasp a mallet or stick. Be creative in your approach to
such situations. Depending on the setting in which you are working, you may have access to
occupational and physical therapists or adaptive equipment specialists who can fabricate
materials for your use, or you may decide to adapt some equipment on your own. The most
important thing to keep in mind is that it is your responsibility, as the therapist, to facilitate
success for your clients.
Materials
A wide variety of materials may be used in music therapy sessions. These may include song
sheets, charts that are hung on the wall, and books of music.
Song sheets. There are a number of considerations when song sheets are needed for the
session. One is whether the people in the session will be able to read them. Many people,
particularly older adults, cannot see without glasses and may not have glasses, or cannot see well
enough to read even with glasses. Many children are still in the process of learning to read or
have disabilities that prevent them from being able to read song sheets. Some people for whom
English is not their native language may have difficulty reading English, although they might be
able to read well in their native language. In addition, it is always possible that people in the
session never learned to read. This is particularly likely with older adults from certain
backgrounds.
Another consideration is whether song sheets are needed for the songs being sung. If the
songs are very familiar, people may not need song sheets. If that is the case, it is probably better
not to use song sheets, as they will add unnecessary clutter to the session. In many cases, though,
people will not be able to sing the songs from memory, so song sheets or ready-made books that
include the songs should be provided. While books that include the desired songs in an acceptable
format are obviously the simplest to use, there will be times that the music therapist will prefer
making song sheets in order to include the necessary qualities and songs.
2 A variety of adaptive instruments are described by Clark and Chadwick (1979) in Clinically Adapted Instruments for
the Multiply Handicapped. Some of the adaptations that they describe are now commercially available. Many
adaptive instruments can be viewed and purchased through www.adaysworkmusiceducation.com.
For clients who do not read music, there is no reason to have the notes included on song
sheets, and song sheets that include only words are easier to type and less cumbersome to use.
The words should be typed using a typeface that is large enough and dark enough for the cleints
to read. Remember when typing that the spacing of the lines helps to guide the singer through the
song; in other words, begin new lines on separate lines of the song, leave space between verses,
and so forth. It is also recommended that song sheets be kept together in one book, with the pages
clearly labeled.
Charts. There are a number of uses for charts in music therapy sessions. These charts
may be hung on a wall or board so that clients can see them. Sometimes words of a song will be
written on a chart rather than on a song sheet, or the chart may include an instrumental
arrangement, possibly in a simplified form. We will discuss some practical aspects of making and
using charts.
The main issues around chart use are similar to those with song sheets: Be sure that the
people involved will be able to see and comprehend the chart and that a chart is the best way to
present the material. One advantage to a chart is that it allows the therapist to direct everyone's
attention to the same place, thus focusing and holding people's attention. This can be important in
helping members of a group to work together. (When the same material is presented on a song
sheet, the therapist has little ability to help each group member focus or keep track of where to
sing or play.) However, the room or seating arrangement may not allow everyone to see the chart,
and this needs to be considered beforehand. Another consideration is the amount of material to be
included on the chart. Too much material may suggest that a piece of music is too complex to be
contained on a single chart and is therefore too complicated for the music therapy setting.
Once the decision has been made to use a chart, the chart needs to be made so that it will
be useful and visible to everyone. It must be large enough for clients to see; any lines and colors
must be clear enough to be seen, and the organization must be clear.
It is a good idea to invest in some large pieces of tag board or very heavy paper.
Sometimes these must then be taped together to make a large enough chart. A good way to
determine the size of the tag board that is needed is to think through or write out what will be
included on the chart, then buy accordingly. Writing out what will be on the chart is a good way
to plan the spacing; it is certainly easier to make changes on a paper draft than on a large piece of
tag board.
For Further Reading

Birkenshaw-Fleming, L. (1989). Come On Everybody Let's Sing! Toronto, Canada: Gordon V.
Thompson Music.
Bruscia, K. E. (1987). Improvisational Models oj Music Therapy. Springfield, IL: Charles C.
Thomas. See Chapter 34, General Principles of Practice.
Chavin, M. (1991). The Lost Chord. Mt. Airy, MD: ElderSong Publications.
Come Join the Geritones. (n.d.). Lake Forest, IL: The Geri-Tones.
Farnan, L., & Johnson, F. (1988b). Music IsJor Everyone. New Berlin, WI: Jenson Publications.
nd
Nordoff, P., & Robbins, C. (1983). Music Therapy in Special Education (2 Ed.). St. Louis, MO:
MMB Music.
Robbins, Carol, & Robbins, Clive. (1980). Music Jor the Hearing Impaired and Other Special
Populations. St. Louis, MO: MMB Music.
MO: MMB Music.
Assignments-Organizing the Session

1. Recall a session you recently observed. What decisions do you believe the therapist in charge
of the session made regarding the room arrangement for the session? How does the
arrangement vary from week to week, or how have you noticed it evolving over time? What
effects have you seen from various arrangements? Discuss these with the therapist.
2. What equipment and instruments has the therapist used? How has he or she made the
decisions? What effects have you seen of differing equipment and instruments?
3. What materials has the therapist used in the session and what were the effects? Consider
some different materials not used so far by the therapist. How do you think the use of these
materials would impact the session?

1. What decisions have you made regarding the room arrangement for your session? How has it
varied from week to week or evolved over time? What effects have you seen from various
arrangements?
2. What equipment and instruments have you used? How have you made the decisions? Are
there some cases in which, upon reflection, you wish you had made different choices, and if
so, why? What effects have you seen of differing equipment and instruments?
3. What materials have you used in the session and what have the effects been? How do you
think you could have used materials more effectively?
Level III-Leading
1. What decisions have you made regarding the room arrangement for your session? Try some
different arrangements and see how they affect the session.
2. What equipment and instruments have you used? How have you made the decisions? Try
some different choices. What are the effects of altering the equipment and instruments?
3. What materials have you used in your session and what have the effects been? Try some
different materials and note their effects.
Improvising
Experiences
This is the first of four chapters about the types of musical experiences that may take place during
a music therapy session. The focus of these chapters is not on specific musical experiences or
activities as these are available in other resources in the music therapy literature. The intent here
is rather to present general ideas and comments on variations of musical experiences.
Improvising happens when the client makes up music vocally, instrumentally, or with any
body part or medium that is available, individually or with others. The therapist helps the client to
structure the experience and may improvise with the client or guide in other ways (Bruscia,
1998a).
Improvising experiences may include instrumental or vocal referential and nonreferential
improvisations, with referential improvisations intending to portray something nonmusical in the
music and nonreferential improvisations referring only to the sounds or the music. Improvising
experiences may include body improvisations and mixed media improvisations in addition to
vocal and instrumental improvisations. A final variation is a conducted improvisation in which
the client gives cues to other vocalists or instrumentalists, directing their improvisation (Bruscia,
1998a).

Using improvising experiences with children with special needs can be especially valuable in
helping the therapist discover what types of music and instruments are motivating and stimulating
for the children. This makes improvisation especially useful for assessments. Due to the
developmental level of most children with special needs, these experiences will most often be
nonreferential. An example would be presenting a child with a standing drum and a pair of
mallets and allowing him or her to initiate playing the music without giving initial rules to follow.
This can uncover information about sensorimotor skills (grasp, bilateral coordination), cognitive
concepts (imitation or repetition of patterns), communication skills (tum-taking or continuous
beating), affective/emotional development (playing musically or using the drum to make noise),
and much more. Engaging in improvisation can help a child with autism, who may have difficulty
with transitions or changes, experience mobility of rhythm on an internal basis and immediately
externalize it. The therapist may initially follow the child's improvising and gradually try to
introduce changes to help the child better organize his or her responses. Body improvisations can
also provide a stimulating experience for a child. Improvisation in therapy can also be an
invaluable tool for evaluation through providing a way to measure various musical responses and
their development over time.

Improvising experiences in therapy with adults with developmental disabilities facilitates the
development of nonverbal communication and expression of emotion. Even for clients who have
verbal skills, the opportunity to express themselves through improvisation may be less
threatening than talking. Improvisation provides an expanded range of expression, while using
words often limits communication. Depending on the cognitive level of the client, improvising
experiences may be nonreferential or referential, vocal or instrumental, and may also include
body percussion and mixed media experiences. In a group setting, improvisational experiences
can enhance the opportunities for developing relationships with other group members as a result
of the musical development over time. Group improvisation heightens feelings of belonging and
productivity through contributing to a group undertaking. It also provides natural opportunities
for group members to experiment with leadership roles as well as to practice tum-taking, sharing,
and following.

Improvising experiences for adults with psychiatric disorders serve many purposes. These
experiences may be used to help a client who is experiencing a psychotic episode focus on the
external here-and-now reality, or to assist a person in crisis with expressing the emotional trauma
nonverbally. Improvisation experiences ranging from structured to free and from referential to
nonreferential have been used with this population.
A simple improvising experience for a group involves presenting a variety of instruments
and asking each participant to choose one. Group members are first instructed to listen to a free
improvisation begun by a volunteer or the group member with the instrument the therapist has
identified as the lead instrument (for example, the alto xylophone). Group members are then
invited to join the improvisation by adding a sound when they feel ready. As the music unfolds,
the therapist's role can be small or large. This is a time when the therapist's sensitivity to the
clients' music is very important, as group members are given the freedom to create but offered
enough musical support from the therapist to work together. Should the group be unable to work
together with or without the therapist's guidance, this can be discussed after the experience.
Group members may be asked to reflect on how they listen, how they work with others, how they
respond to the unexpected, and how they interact in uncomfortable situations, as well as consider
other relationship issues arising from this experience. A simple improvisation may become the
focus of an entire session as group members explore verbally and then improvisationally how
they relate to one another through the music.
More complex improvisational experiences can be created through the use of ensemble.
Members are assigned specific parts to play for a portion of the improvisation, while a solo or
duet is created improvisationally either over the group ensemble or in designated places within
the structure of the music. This form of improvisation can be referential, although it is most often
nonreferential. This style of improvisation requires the therapist to assume more responsibility for
structuring the musical experience. While group members need not provide as much organization
for the music, the improvisers are provided with a smaller and tighter structure within which to
work. The therapist may find this type of improvisation useful for clients who need more help in
organizing their external world.
Chapter 8 Improvising D 83

To create a referential instrumental improvisation for a group of older adults, the therapist might
ask members to select simple percussive and melodic instruments, then work with the group to
establish a theme (perhaps of an upcoming holiday or season, or an emotion) and perform a
referential improvisation based on that theme. This could be followed with a discussion of
feelings elicited by the improvisation, including associations and memories related to the theme.
A theme of springtime, for instance, is likely to elicit memories and feelings of spring.
Substituting the use of voices for the instruments could create a vocal improvisation. Similarly,
the use of various body parts could create a body improvisation, and combining more than one
medium in the improvisation could lead to a mixed media improvisation. The music therapist's
role would be to facilitate the improvisation and might include playing with the clients.
A nonreferential instrumental improvisation would follow a similar format but without
specifying a theme. The improvisation in this case would be music for its own sake without
reference to anything outside of the music. The discussion that follows could focus on feelings
about the music and the experience. As with the referential improvisation, nonreferential
improvisation can be adapted for use with vocals, body parts, or mixed media. In structuring a
nonreferential improvisation, the therapist may offer anywhere from very little to quite a lot of
direction, depending upon the abilities of the group members.
Improvisation may also be used with individuals. The therapist may invite the client to
use either the referential or nonreferential format to meet a wide range of goals. For example, the
therapist may ask the client to improvise the sound of a specific emotion (referential) or may ask
the client to play whatever he or she would like (nonreferential). The therapist may then intensify
the experience by entering into the improvisation musically with the client or may engage the
client in a discussion of the process.

Most acutely ill medical patients are seen individually, often in a hospital room. This creates
some logistical issues, as there may be a roommate or a person in the room next door who may
also be affected by the music experience. Special attention should be given to the needs of those
in close proximity to the patient when planning for music therapy interventions. This may mean
including the roommate in the session, modifying the session so as not to disturb the other person,
or even not having the session if there is no way to avoid disturbing the other person in the room.
Medical patients often experience a wide range of emotions and physical symptoms.
Offering an experience in which the patient is able to give musical sound to the pain, anxiety, or
sadness associated with illness and hospitalization can be very effective. Keeping in mind that
improvisation may be unfamiliar to the patient, the therapist might offer a few selected musical
instruments with which to work, perhaps an ocean drum, glockenspiel, pentatonic marimba,
autoharp, or Qchord®. All of these instruments can be used with minimal instruction, and each
offers a different type of musical experience. The improvisation may be referential ("play the
pain") or it may be more open ("play whatever you need to express or say in the music").
Following the music, the therapist may wish to process the experience verbally or may use more
music or a related art experience such as drawing to assist the patient in working with the material
expressed in the music.
Note that the improvisation experiences suggested for older adults and people in medical
settings have some similarities; these suggestions may also be similar to those for the other client
groups that have been described. This is because all people share the basic need to express
emotions. Improvisations may also be fruitfully used to meet unique needs of these populations.
Uses in the Music Therapy Literature

The work of Nordoff and Robbins (1971, 1977), based on clinical improvisation, has led the way
in the use of improvisation with children who have special needs. Many therapists have used and
evolved the Nordoff-Robbins approach. One example is Robarts' (Trevarthen, Aitken, Papoudi,
& Robarts, 1998) work with children with autism, which includes a case study using
improvisation in the successful treatment of a child with autism. This boy was 3 Y2 when he began
music therapy. Robarts describes her work and includes the issues that were important during
each stage of work, as well as her interpretation of the child's responses. This case is valuable
because of the detail that it provides in using improvisation.
Crocker (1956,1958) describes the use of improvised music as a projective technique in
which the therapist improvises and the child responds through associations, telling stories, and
discussion of the responses. Paraverbal therapy, developed by Heimlich and closely related to
music therapy, uses improvisation in a number of ways. Bruscia (1987) includes play
improvisations, musical story improvisations, and song improvisations as employed by Heimlich
(1965, 1972) and other paraverbal therapists (McDonnell, 1983; Wheeler, 1987b).
Salas and Gonzalez (1991), working with a blind 4-year-old girl, offer another example
of the use of improvisation with children with special needs. These authors describe
improvisational work on several instruments-including the violin-and its effect in helping this
child to express herself, primarily through her beautiful voice. The changes in the child as a result
of the music therapy were dramatic.
Improvisation can be used with groups of children as well as individuals. Carter and
Oldfield (2002) describe their use of a structured improvisation in which children are encouraged
to "play freely" while the piano plays, then stop when the piano stops. The use of improvisation
with a group of mothers and young children is also described (Oldfield & Bunce, 2001).

Watson (2002) describes an improvisational approach with a woman with severe developmental
disabilities. The goal of the sessions was to "experience affective musical contact with the
therapist" (p. 105). To accomplish this, the music therapist uses her voice and a metallophone to
contact the client. Watson does not include an entire case study but rather small segments from
the work with detailed analyses of what occurred in the sessions. Because of these detailed
analyses, this case can provide a rich understanding of what can occur in an improvisational
session with a person with severe disabilities.
Clarkson (1991) shares the case of a 22-year-old man with autism who was nonverbal
and prone to acts of violence against himself and others. She reviews the process of 2 years of
Chapter 8 Improvising 0 85
weekly individual and group music therapy sessions in which she blended the improvisational
approach of Nordoff and Robbins with other standard music therapy techniques, incorporating a
wide variety of instrumental experiences as well as dance. She addresses the following goals:
increase direct eye contact; encourage use of sign language; increase choice-making; increase
tolerance of physical contact; initiate movement; increase discrimination of rhythmic patterns.
Along with the client's participation in a group, improvisational music therapy proved successful
in helping the client improve interpersonal interaction and communication skills while also
enhancing his natural musicianship.
Boxill (1985) describes the use of "Our Contact Song," which she describes as "a
composed or improvised song that lends itself to improvisational changes and adaptations. It
becomes a fountainhead for a myriad of activities and experiences, always changing and being
transformed in the service of therapeutic goals" (p. 81). This song, which is often improvised, is a
cornerstone of Boxill's approach. She says, "Our Contact Song is the first reciprocal musical
expression, the first two-way musical communication, the first overt musical indication initiated
by the client of an awareness of the existence of another" (p. 80).
Aigen (2002) illustrates the use of popular musical styles in Nordoff-Robbins clinical
improvisation with a nonverbal man with a developmental delay when beginning the music
therapy process at 27 years of age. Aigen describes the course of this man's therapy over a
number of years, using popular musical idioms for the improvisational music therapy process.
Aigen connects what is happening musically with the goals that are being met through the music.
This example is published with an accompanying CD featuring the musical examples described in
the book.

Many examples of using improvisation with adults with psychiatric disorders are available. A
book by Borczon (1997) contains several examples of the use of improvisation with adults in
treatment for chemical dependency and/or psychiatric difficulties. One example (Chapter 6), with
a group of adults in treatment for chemical dependency, is a session in which he told a story while
having the group members participate in the story musically by improvising. He then helped the
group members to relate to themes that grew from the story. Many of their responses allowed
them to go deeply into feelings that they needed to work with and express.
Adults in acute psychiatric treatment in a short-term hospital unit used improvisation to
express unnamed emotions and bring them to consciousness (Shultis, 1999). Group members
were also asked to play an instrument to reflect their current emotional state; other group
members offered feedback describing the music or the emotional quality of the sound. The
improviser could gain insight into the expressed emotions when hearing it described by others or
might find words to more accurately describe the emotion that was previously felt but not
consciously owned.
Another example of the use of improvisation with adults is in Analytical Music Therapy,
developed by Mary Priestley. While Analytical Music Therapy requires special training beyond
the basic music therapy training, music therapy students should be familiar with this approach
(Eschen, 2002; Priestley, 1975, 1994). Another of the many available examples is the work of
Austin (1999), who uses vocal improvisation in working with adults with emotional difficulties.

Bright (1991) suggests allowing time in each session for free creativity and gives suggestions for
using a theme as a stimulus for free group improvisation with movement, instrumental work, and
vocalization (referential improvisation).
Reuer, Crowe, and Bernstein (1999) have developed a variety of group percussion
strategies that can be used with older adults, with a focus on promoting wellness in older adults.
They describe a number of techniques utilizing egg shakers, paddle drums, and other percussion
techniques, including a number ways to use improvisation.
Scheiby (1999) describes an adaptation of Analytical Music Therapy in a "supportive
music psychotherapeutic approach" (p. 270) with a group of older adults who had mild to severe
dementia and depression along with a variety of neurological problems including strokes. The
case study that she describes includes the use of improvisation to support a person feeling lonely
and sad and to help other group members get in touch with their feelings.
D. Aldridge (1996) describes the use of Nordoff-Robbins-based improvisation with a
woman in the early stages of Alzheimer's disease. Connections were made between the woman's
playing and the characteristics of Alzheimer's, thus providing insight into the appearance and
progression of the disease (pp. 197-203).

Ann Turry (1997) describes the use of clinical improvisation to alleviate distress during medical
procedures in young children who are hospitalized. She suggests uses of music therapy and
improvisation before, during, and after medical procedures and describes considerations in using
music therapy in this setting.
In an example of the use of improvisation with adults with medical problems, G.
Aldridge (1996) describes the use of melodic improvisation with women with breast cancer. In
addition to giving an overview of what she discovered in researching this area, she provides a
case study of melodic improvisation with a woman in the week following surgery for breast
cancer. Also working with adults, Gustorff (2001) describes music therapy with people who are
in comas in intensive care. She generally begins by breathing in rhythm with them, then lets an
improvisation flow from this rhythm. She says, "I take up the breathing rhythm, breathe with the
patient, and finally sing following his rhythm (without text, vocalizing). I go to meet him
musically at his current position and share with him one of his more intimate, life-giving rhythms.
The singing improvisation, which develops jointly with the patient, is geared exclusively to his
powers" (p. 67).
Considerations
As the summaries above demonstrate, there are many ways to use improvising experiences. Some
people assume that improvisational experiences use only piano, always include the therapist
along with the client, or follow only a particular musical style such as jazz. In actuality, many
improvisations use only simple rhythm instruments, are done by a client alone or by an entire
group, and utilize a variety of styles and modalities, including atonality.
Another point that may not be appreciated by the novice improviser is that most
improvisation, while it may appear unstructured, does in fact depend on an underlying structure.
Many a new therapist is surprised to give instruments to a group of children, for example, and ask
one to playa drum, assuming that that child will keep a beat and thus provide grounding for the
group-only to discover that the child has no sense of a steady beat, and to watch the
improvisation fall apart. Part of learning to use improvisation effectively is understanding the
amount of structure that is helpful but not too controlling.
Improvisational experiences will often be combined with other music therapy experiences
to form an entire session. Indeed, there may be times that a planned strategy turns into an
improvisational one, to the benefit of all.
Improvisational experiences are not appropriate for all clients. Deciding on the level of
structure in the improvisation, or when not to use improvisation, is made based on the unique
needs of the client. The main considerations have to do with the abilities of the clients and what
you hope to accomplish through the improvisation.
While music therapy improvisational sessions can be conducted by novice therapists or
improvisers, improvisations can become more sophisticated and the therapist's role more
important as his or her skills in improvisation and therapy increase. Facilitating an
improvisational session requires a high level of skill, particularly with some populations and in
certain settings.
Examples of music therapy sessions based on improvisation are found in Music Therapy
and Group Work: Sound Company (Davies & Richards, 2002). Students are encouraged to read
these and other examples to get a better idea of how improvisation and group therapy interrelate.
Materials
The most obvious materials necessary for facilitating improvising experiences are a wide variety
of instruments for client use, including pitched instruments (barred instruments, tunable drums,
and so forth) and unpitched percussion (shakers and so forth), wind instruments (reed horns,
whistles, and so forth), string instruments (guitar, autoharp, and so forth), and piano. Body
percussion and vocal improvisation are also important experiences within improvisations. Other
items can also be used-be creative! Think of the exciting music produced through use of paper
and plastic bags, brooms, trashcan lids, and small cardboard gift boxes by the creators and
performers of the very popular show Stomp. In addition, don't overlook the improvising
opportunities provided by electronic instruments and computers.
People often improvise with a collection of simple rhythm and melodic instruments. In
this case, it is best to select instruments with varying pitches, ranges, and timbres. However, it is
important that melodic instruments be able to play in the same key. If you are using Orff
xylophones or other instruments with removable bars, or other pitched instruments such as reed
horns, tone chimes, and so forth, be sure that you prepare the instruments in the same key as the
other instruments that will be used in the improvisation.
Tips for Using

There are many ways to learn to improvise. You may learn the process by experimenting with
your own musical skills, by engaging in workshop and classroom sessions that teach about
structuring improvisation (such as Orff training), or by improvising with clients and letting them
teach you what they need from you. Wigram (2004) provides many suggestions for learning to
improvise in Improvisation: Methods and Techniques for Music Therapy Clinicians, Educators
and Students, intended to
function as a method book-a tutor, a 'practice' book that gives concrete,
practical examples in the text. .. of how to explore the potential and freedom of
musical improvisation, and how to use that freedom both in developing
improvisational skills and then applying those skills in therapeutic interventions.
(p.23)
The key is to be clear about your intent and to bravely begin. It is sometimes helpful to
begin with more planned procedures and introduce improvisation as a segment of a musical
experience. For example, you might have a group keep a steady beat or playa simple rhythmic
ostinato pattern while one player improvises over the sound. Initially, the therapist may play this
improvisation as an example for the clients, or a client who is ready for this challenge may play it.
You can gradually allow the ostinato players to move away from the prescribed rhythm and begin
to "add a sound that fits with what the improviser is playing." This will allow a group to
gradually move into the improvisational experience while keeping it structured for the sake of
inexperienced improvisers, therapist or clients.
Some students are intimidated by improvisation. Often, this is because they have the idea
that there are rights and wrongs when improvising. While it is a good idea to practice improvising
when you are away from your therapy session, it is also important to just do it in the session. If
you just move ahead with an improvisation, with you on one instrument and your client on one or
more other instruments, you will probably discover that you can improvise. Once you are more
comfortable improvising, you can work to refine your improvisational and clinical skills.
Another misconception is that improvisations have to be complicated. They do not! You
may want to begin with an improvisation in which you playa steady beat on a drum and your
client plays another instrument. Many therapeutic goals can be accomplished with this kind of
simple improvisation.
Similarly, improvisations do not have to be tonal or use a traditional western scale. Many
clinical improvisations are intentionally not tonal. Once again, as you progress, you will be able
to build your skill in utilizing the improvisation to help your clients reach their clinical goals.
Do not assume that each client will be able to play in rhythm or that clients will
necessarily play together or listen to each other as they play. These skills require a higher level of
musical and interpersonal sensitivity than some clients possess. These may be part of their
clinical goals, but do not be surprised ifthey do not occur automatically.
Finally, keep in mind that your role as music therapist is to facilitate the improvisation.
This may mean playing a basic beat or maintaining a grounding for the improvisation. It means
that throughout the improvisation you should remain aware of what is occurring with the clients,
both musically and personally. When we can balance and facilitate these aspects and use
improvisation to help our clients grow, improvising experiences can be very rewarding!
For Further Reading

Aigen, K. (1998). Paths of Development in Nordoff-Robbins Music Therapy. Gilsum, NH:
Ansdell, G. (1995). Music for Life: Aspects of Creative Music Therapy with Adult Clients.
London: Jessica Kingsley Publishers.
Bruscia, K. (1987). Improvisational Models of Music Therapy. Springfield, IL: Charles C.
Thomas.
Dvorkin, J. (1982). Piano improvisation: A therapeutic tool in acceptance and resolution of
emotions in a schizo-affective personality. Music Therapy, 2, 52-62.
Gardstrom, S. C. (2001). Practical techniques for the development of complementary skills in
musical improvisation. Music Therapy Perspectives, 19, 82-87.
"Jazzy," Hunter, L. L., & Polen, D. W. (1999). Jazzy the Wonder Squirrel. In J. Hibben (Ed.),
Inside Music Therapy: Client Experiences (pp. 87-95). Gilsum, NH: Barcelona Publishers.
Lee, C. (1996). Music at the Edge. London: Routledge.
Logis, M., & Turry, A. (1999). Singing my way through it: Facing the cancer, the darkness, and
the fear. In J. Hibben (Ed.), Inside Music Therapy: Client Experiences (pp. 97-117). Gilsum,
NH: Barcelona Publishers.
Mack, G. (1999). Adventures in Modes and Keys. Miami, FL: Warner Bros. Publications.
Robbins, Clive, & Robbins, Carol. (1998). Healing Heritage: Paul Nordoff Exploring the Tonal
Language of Music. Gilsum, NH: Barcelona Publishers.
Ruud, E. (1998). Music Therapy: Improvisation, Communication, and Culture. Gilsum, NH:
Turry, Alan, & Marcus, D. (2003). Using the Nordoff-Robbins approach to music therapy with
adults diagnosed with autism. In D. Wiener & L. Oxford (Eds.), Action Therapy With
Families and Groups (pp. 197-228). Washington, DC: American Psychological Association.
Assignments-Improvising Experiences
1. Describe a time when you saw the therapist use an improvisational experience in a session (a
videotape or demonstration is acceptable). Describe what the therapist did, what the clients
did, what you saw in the interaction, and what you observed to be potential benefits of the
process. Also describe any techniques that you observed in this situation that might help you
to structure an improvisational experience with a client.
2. Review the improvising experiences suggested by Bruscia (1998a) and described in the
second and third paragraphs of this chapter. Describe a possible use of the technique for your
population. Try to find an example that is different from those given in this chapter.
3. For one of the populations specified in the chapter, find an example of the use of improvising
from the literature. Describe it and provide the source.

1. Review the improvising experiences suggested by Bruscia and discussed in this chapter. List
three possible uses of the technique for your population. You may use examples from the
book, but it will be more useful if you can find some that are different. If you have used
improvising in your sessions, reflect on how it succeeded. If it did not succeed, what could
you have done differently to improve the outcome?
2. Plan a session using improvising experiences. What are the advantages to using improvising
experiences in this setting rather than some other type of experience? After the session, write
about how the clients responded. Did you notice anything positive in their responses? In what
ways could you have facilitated things so that they might have been more beneficial?
3. Plan a session using improvising experiences for a group of children with varying
classifications in a self-contained classroom. State your desired goals and objectives, and
describe how you would structure the session. Include three different improvising
experiences in your plan.
Level III-Leading
1. Plan for and use one or more improvIsmg experiences in your session. Describe the
experience and classify it as to referential or nonreferential, instrumental or vocal. After the
session, write about how the clients responded. Reflect on how well the experience succeeded
in reaching your objectives. If it did not succeed, describe why it may have been problematic
and what you could have done differently to improve its success.
2. Give an example of an improvising experience for each of the populations specified in the
chapter (children with special needs, adults with developmental disabilities, adults with
psychiatric disorders, older adults with age-related needs, people in medical settings). Specify
possible goals and objectives for each improvisation. The example that you give should be
different from those provided in the chapter or from those used earlier. From your experience,
tell how you think that people in each population would respond to the improvising
expenence.
3. For the population with which you are working, find an example of instrumental improvising
and an example of vocal improvising from the literature. Write a summary of each and
indicate the source.
Performing or
Re-Creating Experiences
In perfonning or re-creating experiences, the client learns or perfonns pre-composed music, or
reproduces any type of musical fonn presented as a model. These also include structured music
experiences in which the client perfonns predefined roles or behaviors (Bruscia, 1998a).
Variations of re-creating experiences include: instrumental and vocal re-creation in which
the client plays or sings in a prescribed or written manner, thus reproducing structured or pre-
composed musical materials or songs; musical productions; musical games and activities; and
conducting (Bruscia, 1998a).

Perfonning or re-creating experiences can provide children with special needs with a unique
opportunity to combine the development of functional skills (such as attending, memory, and
sequencing skills) and academic achievement with broad enhancements in self-esteem and the
development of peer relationships. For example, the client may be engaged in learning basic or
adapted music notation in order to play a simple piece on resonator bells, which can
simultaneously address skills in reading, math, or color identification. The client may then
perfonn the same piece as part of a small recital experience for classmates, which also serves to
enhance the child's self-image and expand how peers and teachers view him or her. The client
may next transfer this skill to playing a small but pivotal percussion line in the school band
concert, where he or she can interact with a much wider social circle than ever before.

Perfonning or re-creating experiences can produce similarly broad results with adults with
developmental disabilities. Additionally, these types of music experiences provide numerous
opportunities for helping clients practice social situations and expectations within the structure of
the music therapy environment and then transfer these skills to actual social settings. Examples of
this include learning pre-composed therapy songs that deal with personal care, social situations,
or managing difficult emotions. When clients learn and internalize the song structure (melody,
hannony, rhythm), they develop a tangible tool they can access when needed.

Adults with psychiatric disorders may frequently be involved in creating and perfonning music
together. This may include group singing, ensemble music making, dancing, and solo
perfonnance. Such experiences present opportunities for clients to be themselves in a musical

environment, to receive feedback from others about their perfonnance, and to deepen their sense
of competence and self-worth.
Group singing may be used as a recreational program or may be a part of a group therapy
experience. Choosing songs that have meaning to the client, sharing their personal significance,
and singing them with a group can all lead to a deeper sense of being understood or heard by
others and can deepen the bonds among group members.
Rewarding music ensemble experiences may be accomplished using instruments that
require little or no previous musical training. Such simple musical works as Fun for Four Drums
(Nordoff & Robbins, 1968a) and A Garden of Bell Flowers (Levin & Levin, 1977) can be
perfonned with simple instructions from the therapist. The therapist carries the bulk of the
responsibility for creating the musical portrait in sound, while the clients are responsible for
contributing their musical motifs at the appropriate time. This may also help to develop reality-
based here-and-now responses for those experiencing psychosis.
Dancing is a popular activity with adults with these difficulties, as this common social
experience is not so common in the lives of many such clients. The existence of the safe
environment and clear boundaries, together with the rhythm of the music, allows for an
appropriate and enjoyable physical closeness that can be a powerful motivator for some clients.
For clients with psychoses, dancing can work well as a reward after a more task-oriented session.
A solo perfonnance within a group setting or as a part of a talent show is also a common
use of music with this population. The music therapist often takes on the role of teacher and
coach, preparing and supporting the client before, during, and after the perfonnance. Clients reap
many benefits from these experiences, including increased self-confidence, appropriate attention,
and a sense of belonging to the treatment community.

Sing-alongs are frequently included in music therapy with older adults and typically involve
singing familiar songs. Since singing is a social activity in most cultures, it is a logical way to
involve people. In addition, singing is fun! Memories or feelings elicited by the music may be
processed verbally, extending the sing-along to include reminiscence and other fonns of
engagement.
Re-creating experiences also include songs or other compositions where participants
perfonn a composed part. A popular song that may be used at many ages, "The Hokey Pokey," is
a good example. Re-creating experiences also include instrumental perfonnance experiences
where clients use tone chimes or percussion instruments, for example, to play specific parts of a
song. Many simple songs designed for use in Orff music education can be adapted for use with
older adults, as can music used in music therapy with other populations.
Older adults may also enjoy and benefit from perfonning music that they have known
earlier in their lives. While some may not feel that they are still able to perfonn, they can still get
great fulfillment from participating. Often, people who did not perfonn when they were younger
may find that they enjoy it when they are older. Some music stores have promoted the
opportunity for healthy older adults to learn to play instruments. Music therapists are often sought
to assist with these programs because of their skill in adapting musical learning to people's
individual needs.
Chapter 9 Performing or Re-Creating D 93

Medical patients are often involved in perfonning or re-creating music therapy experiences
through singing. Songs may be chosen as a means of self-expression, as a connection to the
patient's outside world, because of their value and meaning to the patient, or because they
introduce a topic or theme to be explored in the session. Singing also provides physical benefits,
particularly for those with respiratory ailments, as the deep breathing required for singing can
facilitate productive cough in patients with pneumonia and chronic lung disease. Singing and
deep breathing can also lead to physiological relaxation.
Simple instruments may also be used in re-creating experiences with patients in medical
settings. Resonator bells or tone chimes can be used to play simple melodies. Often, each patient
will be given one or two notes to play. Music can be perfonned by ear, by using a simple chart, or
the music therapist may indicate when the patient is to play. Rhythm instruments and a Qchord®
may also be useful. Not only can these experiences be musically satisfying, but they help patients
rebuild strength they may have lost through being bedridden.

Nordoff and Robbins (1983) outline a number of uses of pre-composed music for children with
special needs, and Robbins and Robbins (1980) do this for children who are deaf and hard-of-
hearing as well as other children. They and their colleagues have composed and published a
variety of songs for work with children, including books of songs (Levin & Levin, 1997, Nordoff
& Robbins, 1962, 1968b, 1980a, 1980b, 1980c, 1995), musical plays (Nordoff & Robbins, 1966,
1969), and songs with instrumental accompaniments (Levin & Levin, 1977, 1998,2004; Nordoff
& Robbins, 1968a, 1972, 1979). Additional contributions of songs and music with instrumental
accompaniments to this genre of music therapy literature include Themes for Therapy (Ritholz &
Robbins, 1999) and More Themes for Therapy (Ritholz & Robbins, 2002). These resources are
highly recommended for people working with children, whether or not they use the Nordoff-
Robbins approach.

Boxill (1985) describes singing an opening song in which members are acknowledged by name
and involved in various ways, including playing rhythm instruments (pp. 145-150), illustrating
the use of re-creative strategies using both vocal and instrumental music. She also describes the
use of re-creating techniques with a 29-year old man with moderate mental retardation who had
hemiplegia and used a wheelchair (pp. 131-133). This man enjoyed the song "Guantanamera,"
and Boxill used it in its original fonn and then matched and reflected the man's drum beating.
She reported that the trust and pleasure generated allowed him to begin to beat the drum in a more
coordinated manner. They also used another song, "Kum ba Yah," to work on articulation.
Music Is for Everyone (Farnan & Johnson, 1988b) contains music composed especially
for people with severe developmental disabilities. While the authors do not give clinical
examples, the songs they provide are appropriate both for children and adults with developmental
disabilities. Titles include "Pick Your Head Up," "Pick a Bell or Pick a Maraca," and "Touch the
Tambourine." A second book by the same authors, Everyone Can Move (1988a), also contains
songs composed for this population.
Some songs created for children with special needs may be easily adapted to use with
adults with developmental disabilities. Much of the Nordoff and Robbins music and the
instrumental and vocal pieces by Levin and Levin are ageless in their lyrical content and musical
structure.

Rubin (1976) details the use of handbells in music therapy, including appropriate goals and the
advantages of handbell groups. She illustrates a coding system that allows participants to play at
the proper times without having to read music.
Engaging people who experience psychosis in the rhythmic playing of pre-established
patterns can be useful in helping to organize their thinking processes. Shultis (1999) used
rhythmic drumming to focus clients' attention and found they were often more verbally organized
after playing.
Reed (2002) describes the use of a gospel choir with adults classified as mentally
disordered offenders in a state hospital setting. Employing a structure that generally begins with a
call-and-response warm-up song, the group then learns new material using lyric sheets, and songs
are eventually memorized. Techniques are adapted to the learning level of each member. Sessions
always end with the repetition of songs learned earlier in the session, and a closing prayer. Reed
suggests the following goals among those that may be accomplished through the gospel choir:
provide an outlet for emotional expression; serve as a bridge to social participation; demonstrate
an acceptance of guidance, leadership, and social feedback; attend the group on time and without
prompting; and gain a new leisure skill.

Many music therapists incorporate sing-alongs into programs with older adults. Chavin (1991)
finds sing-alongs helpful for people with dementia and suggests some modifications in order to
meet their needs. She also offers several ideas for making sing-alongs as effective as possible.
Shaw (1993) provides month-by-month examples of sing-along ideas and other experiences
appropriate for holidays and seasons. Clair (1996) gives suggestions for using singing with people
even into later stages of dementia but acknowledges that with the progression of dementia, clients
will not be able to remember the words to many songs. She points out, though, that songs learned
early in life will be retained longer than those learned later.
Clair (1996) also finds that people with dementia can do ballroom dancing quite far into
their illness, especially with their spouses as partners. Others (Chavin, 1991; Gfeller & Hanson,
1995) also use dancing and other movement techniques in music therapy sessions with older
people.
Chapter 9 Performing or Re-Creating 0 95
The use ofperfonning experiences with instruments is described frequently, often as part
of a rhythm band. The use of rhythm instruments should be structured in some way. Although
untrained people frequently hand clients rhythm instruments and have them play with no
particular structure or goal in mind, this is not recommended. Chavin (1991) uses rhythm
instruments with people who need to walk (or pace), accompanying a song that the client and
therapist sing together. Gfeller and Hanson (1995) provide a number of useful ideas for
structuring perfonning experiences utilizing rhythm instruments. Instruments may also be used in
other ways. Shaw (1993) describes the use of a bell band, where each participant has a resonator
bell and beater and plays a familiar tune when pointed to by the leader.
Clair (1996) describes the important role that music can play in helping healthy older
adults remain healthy. She points out that many older people who are healthy have the time and
energy to develop or relearn musical skills. Clair describes a number of instances in which older
adults learned or relearned musical instruments and the positive effects on self-esteem and social
interaction that grew from these experiences. In one example, healthy older adults who took
organ lessons were found to have positive emotional, lifestyle, and physical changes compared
with those who did not receive the lessons (Koga & Tims, 2001).
Reuer, Crowe, and Bernstein (1999) describe a number of percussion-based strategies for
working with older adults with a focus on promoting and maintaining wellness. Glassman (1983)
organized a talent show to meet the needs of healthy older people attending a senior center. She
describes the entire process from the auditions through set design and staging, culminating in the
perfonnances and the reactions of participants.

Marley (1996) uses pre-composed songs and simple musical instruments with hospitalized infants
and toddlers in a child life program. She describes several techniques using pre-composed songs.
These songs, sung a number of times while the music therapist sways with the child, are intended
to encourage a comfortable rapport between the adult and child. She also describes a rhythm band
where the child plays an instrument to the accompaniment of recorded music.
Magee (1999) sings familiar pre-composed songs with adults with multiple sclerosis. In a
research study comparing the impact of singing familiar pre-composed songs with improvising,
she found that pre-composed songs helped the patients connect to important people and events in
their past with which the songs were associated. Her discussion includes many examples of the
impact of these songs on the patients.
Considerations
Sing-alongs are sometimes misunderstood as being all that music therapists do. This is certainly
not the case. Some music therapists even avoid sing-alongs because they don't want to fall into
this stereotype. There are actually some very appropriate uses for sing-alongs. By using music
from the client's life in the sing-along, the therapist gives the client something to relate to. This
may lead to a higher level of involvement than with many other approaches.
Keep the music that you will need on hand and be familiar enough with it so you can
accompany or assist on the spot. Music therapists have varying opinions on whether music needs
to be memorized or whether it is satisfactory for the therapist to use the music as they play or
sing. The best guidance is not to let your attention to the music compromise your attention to your
clients. If this means that you must memorize music, by all means do so. It is always a good idea
to have some familiar songs memorized so you can be spontaneous when the need arises. You
will also want to develop the ability to play, accompany, and sing using music or chord charts
while giving most of your attention to your clients. In your beginning work, choose songs that are
familiar to you, songs that you can accompany and sing while keeping your primary focus on the
clients. You will naturally develop your repertoire of songs as you gain experience.
Materials
Some materials, including numerous books of music for instrumental activities, have been
suggested in this chapter. These are all useful, and it is highly recommended that you be familiar
with them. There are many other resources. If you are not able to find what you need in the
available books, though, you may choose to compose your own music. After all, many of the
pieces in the books mentioned in this chapter were inspired by people's clinical needs.
As with other art forms, there are guidelines for composing music to be used effectively
in performing experiences. While extensive instruction in composing is beyond the scope of this
book, we can point you to some good resources, including Music for the Hearing Impaired and
Other Special Populations by Robbins and Robbins (1980) and Songwritingfor Music Therapists
by Brunk (1997). Bruscia (1987) provides a brief summary of the use of songwriting with
substance abuse clients (as used by M. Murphy) in a group setting in Improvisational Models of
Music Therapy (pp. 396-397).
While the focus of some of these materials is on composing music with clients, much of
what is written also applies to composing for clients. Briefly, you must be sure that the parts that
you intend for clients to sing or play are appropriate for their needs and skills. In general, you will
have better success with brief instrumental parts than with more complex ones (although there are
certainly situations in which more complex parts may be useful). If you are going to be directing
a group of clients, consider how many people will be able to play at once and how you will let
them know who is to play; let these considerations guide your development of the musical
content. When composing lyrics, be sure that they follow the inflection of speech and that the
most important words fall on the strong beats. These are just a few very basic suggestions for
composing; the books mentioned above have more extensive instructions.
You will need songbooks for many sing-alongs. Some suggestions for these were
mentioned in Chapter 7, Organizing the Session. Of course, the songs should be appropriate for
the ages of the people in your sessions. For most purposes, having the words alone will suffice,
but there will be situations in which you also want to provide the music, either the melody alone
or sometimes even the harmonization. It is often a good idea to have songsheets in a book with
numbered pages and a table of contents to help people find the songs during the sessions. Some
songbooks are commercially available, and you can also make your own. Two good collections
that include very old songs are Sing Along Senior Citizens by Grant (1973) and Come Join the
Geritones (n.d.). For clients with more complex physical disabilities, it may be more helpful to
use single songsheets, which are easier to hold. This facilitates attention and is physically less
demanding for weakened or deformed hands.
Tips for Using

Many of the considerations mentioned under Materials apply to this section. As you use
performing or re-creating experiences in your sessions, you will be using many of the conducting
and leadership skills that you have developed. Although your style will vary with the situation,
some of the sessions that you lead using these strategies may seem as though they are for
entertainment or for education. It is up to you as therapist and session facilitator to insure that you
are working toward therapeutic goals. In a sing-along, for instance, remember to pay attention to
what your clients would like to sing, why they would like to sing it, how they sing, and their
memories and associations to the songs. All of these things make the session more therapeutic-
although it may also be entertaining!
As another example, if you are leading a group that is playing simple instruments and
using a color-coded chart, it might be easy to feel that you are conducting a recreational activity
rather than a music therapy session. These types of experiences do have some things in
common-you must conduct the group with skill in order for them to play at the correct time.
But, as therapist, you want to do more than provide a successful musical experience. You want to
be sure that each client is playing the instrument that is best for his or her needs and skills, and
that each person is doing as much of the playing as he or she can do-and you want to provide
assistance when needed. You may also want the clients to talk about how they feel about their
playing. These are what make the session go beyond a valuable musical experience to become
music therapy.
For Further Reading

Bitcon, C. H. (2000). Alike and Different (2 nd Ed). Gilsum, NH: Barcelona Publishers.
Bright, R. (1988). Music Therapy and the Dementias: Improving the Quality of Life. St. Louis,
MO: MMB Music.
Cordrey, C. (1994). Hidden Treasures: Music and Memory Activities for People with
Alzheimer's. Mt. Airy, MD: ElderSong Publications.
Palmer, H. (1981). Hap Palmer Favorites. Sherman Oaks, CA: Alfred Publishing Co.
Shaw, J. (1993). The Joy ofMusic in Maturity. St. Louis, MO: MMB Music.
Theurer, K. (2003). The Bells Are Ringing: The Magic of Using Handchimes in Music Therapy
for People Living with Dementia. Vancouver, BC, Canada: Author.
Assignments-Performing or
Re-Creating Experiences
1. Describe a time you witnessed the therapist using a performing or re-creating experience
(videotape or demonstration are okay). What did you see growing from this experience that
was helpful for the clients? Were there ways in which you felt that more benefit could have
been achieved? If so, how would you make that happen?
2. Go through the performing or re-creating experiences suggested by Bruscia (1998a) and
described in the first two paragraphs of this chapter. Describe for your population a possible
use of the technique. Try to use one that is different from the examples provided in the book.
3. For one of the populations specified in the chapter, find an example of the use of a
performing or re-creating experience from the literature. Describe it and provide the source.

1. Go through the performing or re-creating experiences described by Bruscia and discussed in
this chapter. Describe for your population three possible uses of the technique. Use different
examples from those you used in the earlier assignment on this topic. You may use examples
from the book but try to find some that are different. For those that you have used in your
sessions, reflect on how well they succeeded. If they did not succeed, reflect on what you
could have done differently to improve the outcomes.
2. Plan a performing or re-creating experience for the session with which you are involved.
What are the advantages to using performing or re-creating experiences in this situation rather
than some other type of experience? After the session, write about how the clients responded.
Were there particularly positive things about their responses? In what ways could you have
facilitated differently to produce better results?
3. Plan a session using performing or re-creating experiences for a group of adults in a
psychiatric hospital, with diagnoses of depression, bipolar disorder, and schizophrenia. State
the goals and objectives that you would have and describe how you would structure the
session. Include three different performing or re-creating experiences in your plan.
Level III-Leading
1. Plan and use one or more performing or re-creating experiences for your session. After the
session, write about how the clients responded. Were there particularly positive things about
their responses? If you used more than one experience, how were their responses to the
various experiences similar or different? If they varied, reflect on why. In what ways could
you have facilitated differently to produce better results?
2. Give an example of a performing or re-creating experience for each of the populations
specified in the chapter (children with special needs, adults with developmental disabilities,
adults with psychiatric disorders, older adults with age-related needs, people in medical
settings). Specify possible goals and objectives for each experience. The example that you
give should be different from those provided in the chapter or from those used earlier. Based
on past experience, tell how you think clients in each population would respond to the
expenence.
3. For the population with which you are working, find two examples of the use of performing
or re-creating experiences from the literature. Describe them and provide the sources.
Composing
Experiences
In composing experiences, the therapist helps the client write songs, lyrics, or instrumental pieces
or create any kind of musical product (Bruscia, 1998a).
Variations include: song parodies where the client changes only a portion of an existing
song while maintaining the melody and accompaniment of the original song; songwriting where
the client composes an original song or part of it (lyrics, melody, and so forth) with help from the
therapist, and the song is written down or recorded; instrumental composition, which is similar to
song-writing but for one or more instruments; notational activities where the client creates a
notational system and then composes a piece using it or provides notation for a pre-composed
piece; and music collages in which the client selects and sequences sounds, songs, and words to
produce a recording that explores autobiographical or therapeutic issues (Bruscia, 1998a).

Composing experiences with children with special needs often concentrate on providing the
client with an opportunity to assert some control over the way in which he or she obtains, retains,
and retrieves a broad range of educational and developmental skills and knowledge, particularly
in academic and social settings. Eliciting information from the child about concepts that hold
importance in life (for example, family, friends, teachers, classroom rules) and that impact
academic achievement can be an empowering experience as well as a learning tool.

Because there is such a range of cognitive and language function in adults with developmental
disabilities, composing experiences may take many different forms and functions in therapy.
Song parodies are often a way to provide a client with first-time success, as the use of a song that
is already familiar to the client alleviates concerns about creating melody, harmonic structure,
and so forth. Often, lyric creation in the context of a familiar song structure (whether as part of
song parody or as a step toward creating an entirely original composition) may serve as a safe
avenue for emotional expression. In some instances, simply engaging a client or group in
conversation that is topic-specific and notating their responses can furnish enough information to
create lyrics for a song. The therapist may need to establish the topic initially and facilitate the
conversation, making certain that the subject matter is important to the clients. Composing
experiences can be used to support clients with a broad range of goals, including coming to
closure with a therapist, developing a tool for retrieving sequences of information, and
recognizing important accomplishments.

Many clients in treatment for psychiatric disorders are encouraged to express themselves
verbally. Music therapy offers the opportunity to channel that expression into nonverbal forms.
Creating song melodies that express a specific mood or idea can be done with individuals or in
small groups. Clients may wish to add words or may prefer to complete the experience with
musical sound alone.
When creating lyrics with these clients, the lyric experience may be used as a tool for
expressing a specific idea or mood (here is what is on my mind), as a means of looking at a topic
or problem (this is what I think/feel about -->, as a tool for problem solving (when I
think/feel __ , I begin to wonder _ _ and then I ) or as a medium for telling a story
(before I _ _ , but now I _ _ . Someday I hope to -->. Clients often begin this experience
by stating "I don't know how to write a song." The therapist's role is to guide the client through
the process, offering the level of structure needed to achieve success.
Another form of composing can be accomplished by inviting the clients to create lyrics
about a topic. The therapist then improvises music to express the emotional message of the
lyrics, accepting guidance from the client as to how to shape the improvisation. Clients have
responded to this style of composing with such statements as, "That music sounds like I feel. It
makes me feel that others can understand me."
More structured composing experiences can be designed in which clients create a
melody using a predetermined pattern or code. Clients can create a short motif or a longer phrase
of music that can be joined together to create a composition. This can be done in a group setting
or with an individual client.

Older adults may have varying levels of cognitive functioning. At any level, they can be engaged
in songwriting or composing experiences with varying amounts of structure. For those with
cognitive impairments, the goals are likely to focus on giving expression to thoughts and feelings
in a form that is easier than expressing them verbally. The degree of structure and the therapist's
facilitation skill will be the keys to success for those with cognitive impairments. For those with
higher levels of cognitive functioning, goals may focus more on expression of emotion.
Group composition also meets goals related to working together, feeling part of a group,
and achieving a sense of accomplishment. For example, a group may be guided through a
thematic discussion at a very simple level (such as "Name something you think about in the
spring"). A list of personal ideas may be gathered together and orchestrated with sound or may
be given a melody and even a harmonic structure (perhaps chosen from two selections played for
the group). Those with cognitive impairments can often make choices between two options; thus,
in composing experiences at this level, the therapist must provide much of the material for the
group to work from if members are unable to spontaneously offer ideas.

Hospitalization is filled with uncertainty. Creation of song lyrics or melodies and harmonies
provides patients with a structure to express the emotions behind their fears and concerns. These
Chapter 10 Composing 0 103
songs often look at the realities of the hospital experience and project into the future the patient's
wishes and hopes. The therapist helps the patient to structure the expression and to process its
meaning when appropriate. The therapist's skill in facilitating the composition influences the
patient's response, especially for patients with no previous musical training or experience. The
therapist might offer the beginning of a lyrical or melodic line and invite the patient to complete
the phrase. The therapist might brainstorm with the patient about the hospital experience,
identify themes, and assist the patient in creating phrases that correspond to those themes. Music
might then be created based on the patient's choices. When patients are asked to choose the
tempo, mode, harmonic patterns, direction of the melody, and other elements of the music, it
greatly assists them in composing music that reflects their inner self.
Songwriting can also serve as an evaluative tool for illuminating progress in a
rehabilitation setting. For example, when utilized with those who have had traumatic brain
injuries or strokes, the complexity and lucidity of the lyrics in combination with harmonic,
rhythmic, and melodic sophistication can provide the therapist with tangible outcomes for
measuring improvements in emotional stability and long-term recall as well as offering a window
into the client's outlook for the future.

Songwriting with young children takes place through improvisation, since they do not have the
reading skills required for actual songwriting. Therefore, the examples of the use of this
technique in the music therapy literature are with older students and adolescents. Gfeller (1987)
uses songwriting as a tool for reading and language remediation as part of the language
experience approach, which utilizes children's spoken language as a basis for writing and then
reading. She describes a sequence of steps for using songwriting to elicit these language
experience stories.
Rio and Tenney (2002) describe the use of composition in a case study of a 16-year old
male in a juvenile offenders' residence. After the therapist had a sense of what the boy wanted to
write about and the style, the boy was given a sheet of paper with some original lyrics of a song,
then blanks for him to complete the lines. He wrote several songs in this way, one of which
contained numerous expletives. Later, when his attitude had changed, he altered the song to
reflect a more positive attitude. Robb (1996) describes a number of songwriting techniques for
helping adolescents who have had traumatic injuries to restore emotional and physical well-
being. She includes a fill-in-the-blank format, group songwriting, improvisational songwriting,
and discharge songs. Her article offers additional suggestions for developing songwriting
techniques.

Although the use of composing with people with developmental disabilities needs to be at a very
basic level due to limitations in language and other skills, Boxill (1985) illustrates its use with
this population. Using call-and-response singing, group members called out foods that they
would eat on Thanksgiving Day, and each was put into a verse of a Thanksgiving song (p. 152).
Fischer (1991) describes her work with a young adult male who had developmental disabilities
and autism. Through a combination of discussion and drawing, the client was able to engage and
participate in songwriting experiences that started with safe topics such as food, resulting in the
"Food Song" and progressing to more challenging subjects that produced the "Fear Song" and
the "Self Song" (pp. 359-371).

Ficken (1976) describes the use of songwriting in a psychiatric setting. He shares methods that
require varying degrees of creativity and skill, beginning with asking clients to substitute their
own lyrics for specific words in popular songs. He then suggests adding a new verse to an
existing song or composing a song parody. These techniques could lead to writing lyrics that are
not based on already existing lyrics. Ficken also suggests exercises that lead to music writing and
melody construction, and enhancing clients' melodies by playing accompaniments and joining
song fragments into compositions. He provides examples of the use of these techniques with
clients with psychiatric difficulties.
Gallagher and Steele (2002) describe a music therapy program for people with combined
substance abuse and mental illness issues. They find songwriting to be a particular favorite of the
clients. They share their use of several songwriting techniques and give examples of the resulting
songs.

Chavin (1991) uses lyric substitution and an adaptation of that technique, silly/nonsensical songs.
Silly/nonsensical songs are composed by deleting words from a familiar song, then asking
participants to give different kinds of words, "the more unusual, the better" (p. 66). Chavin
instructs, "After the list is finished, fill in the words on a large piece of paper for everyone to
read and sing the 'silly song' you've just written" (p. 66).
Silber and Hes (1995) speak of their work using songwriting with patients diagnosed
with Alzheimer's disease. Although they acknowledge the apparent contradiction in having
people with Alzheimer's disease write songs, since songwriting ability seems dependent upon
skills that people with Alzheimer's have lost, they report that clients were able to write songs and
poetry with the proper assistance. They describe three techniques for achieving this: (a) The
music therapist sings one phrase at a time from an existing melody and encourages the clients to
find and adapt words to it, (b) the music therapist composes a new melody and the clients
provide a text, and (c) the music therapist provides a theme for writing poetry to background
music. The authors provide examples of songs written in their sessions.

Hadley (1996) expresses the value of using songs with children in the hospital:
Songs may be selected by the therapist to give reassurance, to deal with
separation anxiety and isolation by offering comforting images of home and
family, to stimulate expression of feelings, and to instill hope about recovery.
Alternatively, children may create their own songs. The songwriting process can
enhance a child's expression of feelings. (p. 20)
Edwards (1998) describes the use of songwriting for children with severe bum injuries.
She suggests that the music therapist who uses songwriting with these children be sure the child
is comfortable, then offer the child a chance to write a song, understanding that it should be
respected if the child declines. She then suggests that the therapist should offer options for the
melody and accompaniment and even make suggestions for lyrics, but avoid interventions that
direct lyric choices. She further suggests the child be allowed to determine what is to be done
with the song at the end of the session. Edwards includes song composition, song improvisation,
and song augmentation (expanding on an existing song) as possible types of composition.
O'Callaghan (1995) discusses songs written by palliative care patients in music therapy.
Her steps include: offering songwriting to the patient; suggesting a topic; brainstorming with the
patient about the chosen topic; grouping the ideas into related themes; determining the key,
rhythm, mood, melody, accompaniment, dynamics, tempo, instrumentation, and voicing;
allowing the patient to name the title; and writing up and recording the song.
Reuer (2005) has developed a Music Therapy Toolbox for medical settings. One of the
items in this toolbox is lyric substitution. She includes specific songs that she has found
successful and suggestions for what can be substituted in them.
Considerations
There are many ways to structure composition, ranging from utilizing music and words from a
pre-composed song to substituting only single words to helping the client compose a complete
piece of music. These techniques provide opportunities to address the needs of clients on various
levels. Several articles and books in the literature provide guidelines for composition (see, for
example, Brunk, 1997; Schmidt, 1983).
Different compositional techniques require different levels of skill from the music
therapist. It is recommended that you begin with techniques that are within your skill level and
become comfortable using them, then gradually attempt those that require more skill. See the
Tips for Using section for more thoughts on this.
Materials
If you are simply composing a piece of music, you may not need many materials. You will
probably want a way to write down or record the composition. If you are working with a group,
the writing should be large enough for all to see and to enable them to participate in the process.
For an individual, it is probably more useful to write the composition on paper or record it
directly to audio tape. Sometimes the therapist will want to record the composition for later
transcription and development and bring it to the next session in a more polished form.
Other techniques require some materials. If you are using a song parody where the client
is changing part of the song, you may want to have the words, melody, or harmony of the original
song written down for reference. If you want to write down or record the song that results from
the experience, you will need a pencil and paper or tape recorder. If you are doing instrumental
composition, you will want to have the instruments for which you are composing. If you are
doing a notational activity, you will need paper on which to write the notational system. If you
are making a music collage, you will need to have a collection of songs from which to select the
portions to record. These will generally be recorded music but could also be performed live. You
will also need a means of recording the collage.
Tips for Using

Composing music can be very intimidating for students and professionals, since you do not know
how the composition is going to end! Many music therapy students and therapists do not have the
skills to make up accompaniments spontaneously and so are afraid to attempt compositions. One
suggestion for dealing with this is: Begin with simple techniques and then build up to more
complicated techniques. Another suggestion is: Just do it! It is often more frightening to think
about composing than to actually do it.
It is likely that a lot of the fear involved in composing comes from feeling that you are
trying to create something out of nothing and an accompanying sense of inadequacy. In a manner
of speaking, this is true. However, when composing for the clinical setting you already have lots
of materials available to you. You just have to know where to look-and listen-for them.
Songs and instrumental pieces are created all the time in the course of a therapy session.
If you are able to audio- or videotape your sessions (make sure you have permission and that any
required confidentiality forms are processed), this can be quite helpful not only in reviewing
client behaviors and your own interactions with clients but also in remembering and transcribing
important events. These significant events may take many forms including verbal, vocal, or
lyrical; rhythmic, harmonic, melodic, or timbral. Melodic or rhythmic themes that escaped you
when you were in the midst of facilitating the session may suddenly emerge when reviewing
session tapes. Even if the tape review doesn't result in a set of lyrics, a melody, or an
instrumental piece, it will most certainly help you sharpen your ability to recognize and identify
patterns, musical and otherwise, in your work.
While it is true that many songs and other compositions used in therapy are
spontaneously born in a music therapy session, there are other times when a music therapist must
compose a piece outside of therapy and bring that composition into the session for the benefit of
clients. As mentioned earlier, start with simple techniques and always keep in mind the clients
for whom you are composing in order to insure that the piece will provide them with a musically
and therapeutically successful experience. If the composition is meaningful and motivating, it
will encourage participation and success and may endure as a useful tool for other clients as well.
Care must be taken when considering whether melodic material should have words or be
instrumental. The lyric line must follow the natural rhythm and intonation of the spoken word in
order to fully support and elicit the verbal or vocal response from the client. You may find that
chanting the lyrics while tapping a basic pulse will help you to determine the melodic rhythm.
This naturally leads you to determine where the accents are and thus drives the melodic
direction. In terms of the lyrics themselves, you may obtain them from the clients during earlier
sessions or you may develop them yourself, perhaps to impart information to the clients within a
song structure.
If you are working on a melodic line for instrumental use, think carefully about the skills
of the client who might play the melody, and then write a part for a specific instrument. Is he or
she able to play just one tone bar, two in sequence, or use a full xylophone? Perhaps you are
writing a keyboard part. Will the client use one or two hands? How much digital (finger) control
does he or she have?
Another way to begin to gain the skills for using composing in music therapy sessions is
to listen to examples of the music that you expect to compose. Listening to the blues or rap, for
instance, may help your compositions to more easily emerge in the desired musical style and feel.
There are, of course, many other considerations when composing music for therapy. The
ideas in this chapter can help to get you started.
For Further Reading

Aigen, K. (1991a). Creative fantasy, music and lyric improvisation with a gifted acting-out boy.
In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 109-126). Gilsum, NH:
Amir, D. (1999). Tales from the therapy room. In J. Hibben (Ed.), Inside Music Therapy: Client
Experiences (pp. 267-275). Gilsum, NH: Barcelona Publishers.
Boone, P. (1991). Composition, improvisation and poetry in the psychiatric treatment of a
forensic patient. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 433-449).
Gilsum, NH: Barcelona Publishers.
Loveszy, R. (1991). The use of Latin music, puppetry, and visualization in reducing the physical
and emotional pain of a child with severe bums. In K. E. Bruscia (Ed.), Case Studies in
Music Therapy (pp. 153-161). Gilsum, NH: Barcelona Publishers.
Pattison, P. (1991). Songwriting: Essential Guide to Lyric Form and Structure. Boston: Berklee
Press.
Perilli, G. (1991). Integrated Music Therapy with a schizophrenic woman. In K. E. Bruscia (Ed.),
Case Studies in Music Therapy (pp. 403-416). Gilsum, NH: Barcelona Publishers.
Rykov, M. (1999). Sometimes there are no reasons: Marco's Song. In J. Hibben (Ed.), Inside
Music Therapy: Client Experiences (pp. 203-207). Gilsum, NH: Barcelona Publishers.
Smith, G. H. (1991). The song-writing process: A woman's struggle against depression and
suicide. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 479-496). Gilsum, NH:
Assignments-Composing Experiences
1. Describe a time when you observed the therapist using a composing experience (a videotape
or demonstration is okay). What did you see growing from this experience that was helpful
for the group members? Do you feel the clients could have benefited more? If so, what other
composing experiences would you offer?
2. Go through the composing experiences suggested by Bruscia (1998a) and described in the
first two paragraphs of this chapter. Describe for your population a possible use of the
technique. Try to use an example that is different from those given in the chapter.
3. For one of the populations specified in the chapter, find an example of the use of composing
from the literature. Describe it and provide the source.

1. Go through the composing experiences suggested by Bruscia and discussed in this chapter.
Describe for your population three possible uses of the technique. Use different examples
from those you used in the earlier assignment on this topic. You may use examples from the
book but try to find some that are different. For those that you have used in your sessions,
reflect on how well they succeeded. If they did not succeed, reflect on what you could have
done differently to improve the outcomes.
2. Plan a composing experience for the session with which you are involved. What are the
advantages to using composing experiences in this situation rather than some other type of
experience? After the session, write about how the clients responded. Were there particularly
positive things about their responses? In what ways could you have facilitated differently to
produce better results?
3. Plan a session utilizing composing experiences for a group of children who might be seen in
an after school program. Give some information about the children, including their age,
diagnoses or classifications, and behavior. State your goals and objectives and describe how
you would structure the session.
Level III-Leading
1. Plan one or more composing experiences for your session. After the session, write about how
the clients responded. Were there particularly positive things about their responses? If you
used more than one experience, how were their responses to the various experiences similar
or different? If they varied, reflect on why. In what ways could you have facilitated
differently to produce better results?
3. Give an example of a composing experience for each of the populations specified in the
chapter (children with special needs, adults with developmental disabilities, adults with
psychiatric disorders, older adults with age-related needs, people in medical settings).
Specify possible goals and objectives for each composition. The example that you give
should be different from those provided in the chapter or from those used earlier. Based on
past experience, tell how you think clients in each population would respond to the
composing experience.
3. For the population with which you are working, find an example of the use of a composing
experience from the literature. Describe it and provide the source.
Listening
Experiences
In listening experiences, the client listens to music and responds silently, verbally, or in another
modality. The music may be of any type. The music is selected and presented in a manner that
targets the therapeutic goals of the client (Bruscia, 1998a). Music therapy utilizing listening
experiences is also referred to as receptive music therapy.
There are many variations of listening experiences, including: somatic listening, where
vibrations, sounds, and music directly influence the client's body; music anesthesia, where music
is used to help reduce the effects of pain; meditative listening, where music is used to help with
relaxation, meditation, or stimulation of the senses; subliminal listening, where sounds or music
are used to mask the delivery of subliminal messages to the unconscious mind; eurhythmic
listening, where music is used to rhythmically organize and monitor the client's motor behaviors;
perceptual listening, where music listening is used to improve various auditory skills; action
listening, where musical cues are used to elicit specific behavioral responses; contingent
listening, where listening serves as a reward for a particular response; mediational listening,
where music is paired with information or experiences to help in learning or to make something
more memorable; music appreciation activities, where music is used to help the client understand
various components and functions of music; song (music) reminiscence, where music listening
evokes memories of past experiences; song (music) regression, where music is used to help the
client re-experience the past; induced song (music) recall, where the therapist helps the client to
recall, either consciously or unconsciously, a song that spontaneously comes into the client's
awareness; song (music) communication, where the therapist asks the client to bring in a piece of
music that communicates something; song (lyric) discussion, where the therapist brings in a song
to serve as a stimulus for discussion; and projective listening, where the therapist presents music
for the client to identify, describe, interpret, or free-associate to (Bruscia, 1998a).

Children are typically directed to do something as part of many listening experiences, as doing is
a way of promoting children's involvement with the music. Thus, purely receptive experiences
with children are somewhat limited. At times, the music therapist will use imagery and music
with children, perhaps to help them think through a situation. Relaxation exercises appropriate to
a child's level of functioning might be used and could include background music. The
Somatron®), often used with guided imagery, can assist children's relaxation or sensory
awareness.
) Somatron® is a device that produces physical vibrations when connected to a sound source. Somatron® has
developed a variety of products that do this. See www.somatron.com for additional information.

The use of receptive experiences in therapy with adults with developmental disabilities can be
challenging, as often these clients do not possess the cognitive and attentional abilities to benefit
from these experiences. Somatic listening, particularly through the use of vibroacoustic
experiences (such as can be presented through use of Somatron®), is one area that can provide
some clients with a tangible, externalized experience of relaxation. Many adults with
developmental disabilities may additionally suffer from emotional or behavioral difficulties.
Vibroacoustic music experiences, paired with modeling and prompting from the music therapist,
can help the person begin to learn new ways of processing and responding to external stimuli.

Listening to music is often the first step for adults with psychiatric disorders to become involved
in the music therapy process. Music therapy may be unfamiliar to these clients, and the idea of
playing instruments or singing may be uncomfortable or unappealing. Beginning with preferred
music listening allows the therapist to build a relationship with clients based on a musical
experience. Sharing preferred music (or music chosen from a selection of available recordings)
with a group can be structured to allow clients to introduce themselves to the group, to tell
something about themselves, or to present music that has meaning for them that they are not
ready to share verbally. These clients also often appreciate the structured relaxation session with
music, which lets them be the passive recipients of care instead of having to actively work at
therapy. Listening to specific pieces of music or songs may also be used as a bridge to
discussions of topics that are relevant to them. Monitoring their responses to a piece of music can
be enlightening, as clients develop increased self-awareness through listening experience.

Reminiscence experiences offer several distinct benefits when working with older adults. First,
for people nearing the end of their lives, accessing memories of their past can help them validate
the meaning of their lives. Second, when memory loss occurs, whether through normal aging or a
more serious affliction such as Alzheimer's, past memories can often be more successfully
accessed through reminiscence experiences. In addition, music appreciation sessions are often
used to help maintain and stimulate the cognitive skills of well-functioning older adults.
Several variations of music listening can be used in working with older adults whose
functioning has decreased markedly. The organization of motor behaviors that can be
accomplished with eurhythmic listening can be very useful for people with decreased motor
functioning, who may not respond as well to verbal commands as they do to music. In addition,
perceptual listening may help the auditory skills of people at lower levels of functioning.
Several other listening techniques lend themselves well to working with older adults.
Somatic listening and music anesthesia can both be used to stimulate or to decrease physical
pain, for example. Music relaxation and meditative listening may both be used to help people
relax and reduce stress.
Chapter II Listening D I I I

The focus of a hospitalization is the patient's physical recovery, and often little or no attention is
given to the emotional impact of the hospitalization experience. Patients can find themselves
experiencing emotions yet be unable to focus on them, describe them, or appreciate how they are
connected to the hospitalization. When patients are offered or are able to choose music that
expresses their emotional states, it can be a powerful acknowledgement of their internal
experiences. This essentially nonverbal technique for clarifying emotional responses to
hospitalization is also useful for patients on ventilators who are unable to talk.
Listening to music for relaxation and pain management is obviously very useful for
medical patients. Patients may be assisted in choosing music to keep at bedside when they need
to decrease anxiety, to induce sleep, or to manage pain. Listening may be coupled with imagery
experiences to develop associational cues for relaxation or decreased pain. The development of
associational cues is an adaptation of a technique used by Dolan (1991) for treating patients
experiencing post-traumatic stress disorder resulting from sexual abuse. The client is asked to
associate an image with a music-induced relaxation response. The client is then instructed to
practice with this music and image until the image alone can evoke the relaxation response. This
is based on principles of respondent conditioning and is related to systematic desensitization (see
discussion of these techniques in Chapter 13, Facilitating Client Responses).

Although the majority of music therapy techniques for children involve them in making music,
there are some examples of using music listening or background music with children. One of
these is Herman's (1991) use of music as background for playing with water, playing in sand,
and finger painting with a 9-year old boy with severe emotional difficulties. In each case, the
music helped to structure the boy's work with these other media and thus contributed to the
success of the treatment.
The use of vibroacoustic therapy with a 14-year old boy with moderate mental
retardation and visual and motor disabilities was described by Persoons and De Backer (1997).
The boy received vibroacoustic therapy prior to a music therapy session in which he played and
improvised. After a number of sessions, it was found that his tension decreased markedly with
the vibroacoustic therapy.
Wyatt (2002) gives several examples of the use of receptive music therapy techniques
with juvenile offenders. One technique is "Name That Jam," in which the therapist records song
samples that represent a variety of musical genres. The group is divided into teams, and clients
work in groups to identify the artists and song titles. The goals are to provide a positive listening
experience and to establish relationships, so interaction and cooperation are emphasized.

Contingent listening involves the use of listening techniques. Saperston, Chan, Morphew, and
Carsrud (1980) compared music listening and juice to reinforce people with profound mental
retardation for learning a skill (reaching for and touching an object). The musical reinforcement
was "Jingle Bells," played live on a soprano metallophone. While live music can be used as
reinforcement, recorded music can also work in many situations; for example, in a study by
Wolfe (1980), appropriate head posturing by individuals with cerebral palsy automatically
triggered contingent music.
Boxill (1985) describes the use of receptive music therapy techniques in a group session
with a 20-year old woman with severe mental retardation (pp. 127-131). When the woman's
behavior became agitated, the therapist played a lullaby in an attempt to relax her while the aide
was instructed to take the woman's hands and sway back and forth with her, humming along with
the therapist. While the woman moved to the music, she also began to hum, the first sounds that
she had ever made in response to music. This led to the entire group's involvement in the
humming and swaying and later to enough improvement in the woman's behavior that she was
able to discontinue individual music therapy sessions in favor of group sessions. While swaying
to music is an example of the use of listening experiences, or receptive music therapy, the
humming would probably be considered a basic example of improvising or re-creating. This,
then, is an example of how the music experiences do not always occur in discrete categories but
may cross over and include several at the same time.

Borczon (1997) describes listening to music, reading the lyrics, and discussing what has been
heard with a group of adults in a chemical dependency recovery program. Group members guess
what stage of treatment the singer might be in, which draws them into the music and helps them
reflect their own treatment issues.
In her program for offenders with mental disorders, Reed (2002) created two music
listening groups, soul and rock, based on client taste. Members of these groups chose recordings
in advance, then played two selections of music during the session. Goals were to improve active
listening skills, increase tolerance for group activity, increase tolerance of the choices of others,
and develop constructive use of leisure time.
Goldberg (1989) describes the use of music listening as a component of a program for
acute psychiatric treatment on a short-term unit of a university hospital. Her description includes
uses of listening in music activity therapy but primarily focuses on the use of listening in music
psychotherapy.
It is common for clients with psychiatric challenges to have difficulty talking about
emotional states. Listening may lead to discussion of emotions, then to increased use of verbal
descriptors to name and express emotion. As group members listen and describe the music, they
learn vocabulary for emotional expression from one another (Shultis, 1999).
Chapter II Listening D I 13

A number of writers have described the use of music listening to stimulate reminiscence with
older adults. Chavin (1991) and Cordrey (1994) describe the use of reminiscence groups with
people with dementia, both making the point that reminiscence activities can help to stimulate
memories that those with dementia may not be able to retrieve on their own. These authors
include topics around which to focus the reminiscence, including "You Must Have Been a
Beautiful Baby," suggested by Chavin (pp. 44--45) and including various aspects of babies,
including discussion of memories of being pregnant and having babies. Other songs and themes
suggested by Chavin include: "Toyland," "School Days," and "Sentimental Journey." Chavin
reminds us the memories are not always positive, saying that "tearful reactions to music and
memories are not uncommon and are not always negative" (p. 42). Cordrey suggests topics such
as Memories of Dad, Symbols of Christmas, and School Days. Shaw (1993) provides a number
of examples of the use of reminiscence with older adults, oriented around seasonal themes
presented for each month of the year.
Receptive music experiences are also used with older adults who do not have dementia.
One type, such as music appreciation, may be especially helpful for those with higher cognitive
abilities and may provide a useful source of stimulation. These discussions will often lead to
processing of personal issues (Bright, 1991) as well as reactions to the music. Other receptive
experiences may be structured for people with different needs, such as a need for comfort or to
help with orientation. Gfeller and Hanson (1995) provide examples of how to structure listening
to music into sessions.
Listening experiences may also be used to reduce stress. Hanser (1990) and Hanser and
Thompson (1994) utilize specially programmed tapes in a study of methods for reducing stress in
older adults in their homes. Clair (1996) describes a number of receptive music techniques that
can be useful in helping residents to relax and relieve stress and pain.

There are many examples of the use of receptive techniques in medical settings. Included in this
category are some instances of recorded music being used by medical personnel as an adjunct to
medical treatments or situations, classified by Dileo (1999) as music medicine (see Standley,
2000, for additional information on these uses of music). The examples presented below,
however, are of receptive music therapy techniques that are utilized by music therapists.
Music therapy in medical settings includes applications of music in a vibrational form.
Skille (1997) reports the use of vibroacoustic therapy with applications in the areas of pain
disorders, muscular conditions, pulmonary disorders, general physical ailments, and
psychological disorders. Numerous other examples of the use of vibroacoustic therapy (not all in
medical settings) are provided by Wigram and Dileo (1997). Chesky and Michel (1991) describe
music presented through a vibrational table. Somatron® is another example of the use of music in
a vibrational form.
Standley (1992) describes the use of recorded music to decrease nausea and emesis
among patients receiving chemotherapy. Reuer (2005) describes a number of techniques for
utilizing music and imagery and music listening in medical settings.
Hurt, Rice, McIntosh, and Thaut (1998) utilize Rhythmic Auditory Stimulation (RAS), a
technique of Neurologic Music Therapy, in gait training for patients with traumatic brain injury.
I 14 D Clinical Training Guide
This technique utilizes the orgamzmg ability of rhythm to help patients with various gait
problems to organize and coordinate their movements. The music therapist assesses the patient's
current gait and selects music that will support the desired changes. There is extensive empirical
evidence of the effectiveness ofRAS (see http://www.colostate.edu/depts/cbrmD.
Considerations
Receptive experiences come in many varieties. Some, such as music appreciation, are similar to
what may be done in music education. Receptive experiences will be most useful for people who
have the capacity to listen and truly receive the music; if a person does not have the capacity to
focus on the music and experience it, receptive experiences are probably not the most appropriate
to use.
Reminiscence can be very useful in the right situation, but the therapist must be prepared
for unpleasant memories to arise. All of the memories are part of the client's life and can be dealt
with productively. This does not mean that they should always be explored, though. While it is
often helpful for a person to work through emotions elicited by the music, at times it is better to
help the person contain a memory. This might occur if the person is too fragile or disturbed to
deal with the feelings, or if there is not enough support in the environment to help him or her to
cope.
It is important to remember that not everyone finds the same music relaxing. For this
reason, it is often a good idea to let the client select the music. However the music is chosen, it is
important to observe the client's responses to determine whether the music is functioning as
expected. If the music is not having the desired effect, the therapist should consider altering the
music. Maranto (1996), Spintge (1989), and Stratton and Zalanowski (1984) discuss aspects of
selecting music for relaxation.
Materials
Music listening most often happens through playing a recorded version of the music, usually a
CD. It is important that both the music recording and the equipment upon which it is played are
of good quality. Although it requires budgeting extra money to purchase good equipment, it is
money well spent. It is important that music-the tool of the music therapist-sounds good.
Music therapists should keep abreast of current technology. Advances in digital
technology make this a rapidly changing area. Some of the vibroacoustic techniques involve
specialized technology for which the therapist will need training. An additional consideration
may be the high cost of technologically sophisticated equipment.
Anyone who is using music listening with clients will want to have a range of music for
this purpose. For some ages, this can include music that has been collected over the years, but in
the case of those who want to listen to current music, this needs to be constantly updated. Money
will obviously need to be budgeted for this. Some music therapists feel that it is all right to use
their personal music collections in working with clients. This does allow the therapist to continue
using his or her music collection when moving to a different facility. While this can be
beneficial, therapists should not hesitate to ask employers to pay for music. Music is an integral
part of any music therapy program and should be supported.
Chapter II Listening D I 15
It is also important to acquire music legally. Illegally downloaded or copied music

should never be used in music therapy sessions (or by music therapists). Additionally, it is
important to be aware of how the law affects the use of music in public spaces. 2
Tips for Using

The choice of music is always important. Often, it makes the most sense to have clients choose
the music that they want to hear. At other times, the therapist will want to choose the music, for
example if the client is unable to choose or if the therapist wants to elicit a particular mood. As
discussed earlier, the therapist should observe the client's responses to be sure that they are as
expected.
Inexperienced therapists may forget to check that a power source for a boom box will be
available. This can be a cord and a working outlet, or working batteries. While many music
therapists have probably made the mistake of not checking the power prior to the session, it is
unlikely that they make this mistake again as it really hurts a session when the music isn't
available!
For Further Reading

Bonny, H. (2002). Music Consciousness: The Evolution of Guided Imagery and Music. Gilsum,
Brodsky, W., & Sloboda, J. A. (1997). Clinical trial ofa music generated vibrotactile therapeutic
environment for musicians: Main effects and outcome differences between therapy
subgroups. Journal ofMusic Therapy, 34, 2-32.
Bruscia, K. E., & Grocke, D. E. (Eds.) (2002). Guided Imagery and Music: The Bonny Method
and Beyond. Gilsum, NH: Barcelona Publishers.
Hurt-Thaut, C., & Johnson, S. (2003). Neurologic Music Therapy with children: Scientific
foundations and clinical application. In S. L. Robb (Ed.), Music Therapy in Pediatric
Healthcare: Research and Evidence-Based Practice (pp. 81-100). Silver Spring, MD:
American Music Therapy Association.
Journal of the Association for Music and Imagery contains many articles on Guided Imagery and
Music.
Maranto, C. D. (1993a). Applications of music in medicine. In M. Heal & T. Wigram (Eds.),
Music Therapy in Health and Education (pp. 153-174). London: Jessica Kingsley
Publishers.
Skille, 0., & Wi gram, T. (1995). The effect of music, vocalisation and vibration on brain and
muscle tissue: Studies in vibroacoustic therapy. In T. Wi gram, B. Saperston, & R. West
(Eds.), The Art & Science of Music Therapy: A Handbook (pp. 23-57). Chur, Switzerland:
Harwood Academic Publishers.
Summer, L. (1990). Guided Imagery and Music in the Institutional Setting (2 nd Ed). St. Louis,
MO: MMB Music.
2 Additional information about copyright can be found at www.copyright.gov.

Summer, L. (2002). Group music and imagery therapy: Emergent receptive techniques in music
therapy practice. In K. E. Bruscia & D. E. Grocke (Eds.), Guided Imagery and Music: The
Bonny Method and Beyond (pp. 297-306). Gilsum, NH: Barcelona Publishers.
Walters, C. L. (1996). The psychological and physiological effects ofvibrotactile stimulation, via
a Somatron, on patients awaiting scheduled gynecological surgery. Journal of Music
Therapy, 33, 261-287.
Assignments-Listening Experiences

1. Describe a time when you observed the therapist using a listening experience (a videotape or
demonstration is okay). What did you see growing from this experience that was helpful for
the group members? Do you feel the clients could have benefited more? If so, what other
listening experiences would you offer?
2. Go through the listening experiences suggested by Bruscia (1998a) and described in the first
two paragraphs of this chapter. Select a listening experience from this list that is suitable for
your population and describe how it might be used. Use an example that is different than
those given in this chapter.
3. For one of the populations specified in the chapter, find an example of the use of receptive
music therapy from the literature. Describe it and provide the source.

1. Go through the listening experiences suggested by Bruscia and discussed in this chapter.
Select three possible listening experiences that you have used or that might be used for your
population and describe their use. For those that you have used in your sessions, reflect on
how well they succeeded. If they did not succeed, reflect on what you could have done
differently to improve the outcomes.
2. Plan a listening experience for the session with which you are involved. What are the
advantages to using listening experiences in this situation rather than some other type of
experience? After the session, write about how the clients responded. Were there particularly
positive things about their responses? In what ways could you have facilitated differently to
produce better results?
3. Plan a session utilizing listening experiences for a group of people in a rehabilitation setting.
State your goals and objectives and describe how you would structure the session. Include
three different listening experiences in your plan.
Chapter II Listening D I I 7
Level III-Leading
1. Plan and use one or more listening experiences in your session. After the session, write about
how the clients responded. Were there particularly positive things about their responses? If
you used more than one experience, how were their responses to the various experiences
similar or different? If they varied, reflect on why. In what ways could you have facilitated
differently to produce better results?
2. Give an example of a listening experience for each of the populations specified in the chapter
(children with special needs, adults with developmental disabilities, adults with psychiatric
disorders, older adults with age-related needs, people in medical settings). Specify possible
goals and objectives for each population. The example that you give should be different from
those provided in the chapter or from those used earlier. Based on past experience, tell how
you think clients in each population would respond to the listening experience.
3. Find two examples of the use of listening experiences with your population from the
literature. Describe them and provide the sources.
Further Considerations
in Planning
In this chapter, we will work with some of the ideas that were introduced in Chapter 3, The
Process of Planning for Music Therapy. Here, however, we will go beyond our personal attitudes
to consider the viewpoints of others. As you read this chapter, be sure to keep your earlier
responses in mind; they will be very important as you integrate your own and others' ideas into a
personal philosophy and style of working.
There are a number of things to consider as you begin to plan a session. All of these, of
course, are aimed at developing a session that is most profitable for the clients. The result of all
this planning will be a session with goals that meet the needs of the clients and procedures that
are both effective and congruent with your values as a music therapist.
Characteristics of the Client

Music therapists should be aware of and comply with professional standards of practice. The
AMTA Standards of Clinical Practice (American Music Therapy Association, 2002) address the
following areas: referral and acceptance, assessment, program planning, implementation,
documentation, termination of services, and continuing education. Specific standards have also
been adopted for the following areas: addictive disorders, consultant, developmental disabilities,
educational settings, geriatric settings, medical settings, mental health, physical disabilities,
private practice, and wellness.
Diagnosis
Some music therapists base much of their planning on the diagnosis of their clients, while others
plan based only on the behaviors they observe in the session, without taking diagnoses into
account.
Therapists who choose to take the diagnosis into consideration find that knowing the
diagnosis and what it implies provides important information in planning for the needs of their
clients. Certainly, knowledge of the diagnosis expands what the music therapist knows about the
client, adding to the likelihood that the music therapy will be effective. It also provides some
predictability about the client's behavior and a context for understanding what is occurring. For
instance, if a client has a diagnosis of bipolar disorder, mixed type, the therapist knows that the
person's mood may fluctuate between depressed and manic. Thus, when the client expresses
varying moods during a session, the therapist is not surprised because he or she understands that
the mood change was probably induced by the illness, not something that happened during the
session. Similarly, the therapist realizes that a child with a diagnosis of attention deficit disorder
is likely to have a short attention span and does not automatically assume that this occurs because
of something being done wrong in the session.
This ability to anticipate possible behaviors and reactions is the very reason that some
people feel that it is not helpful to know a client's diagnosis; they are concerned that therapists
who know the diagnosis and thus anticipate certain behaviors will look for those deviant
behaviors and not expect the client to achieve as much as might otherwise be possible. While this
is a reasonable concern, since there is so much to be gained from the knowledge of the client's
diagnosis, a better solution seems to be to work to put aside the portion of that knowledge that
would limit expectations. Certainly it is important to expect both as much as is realistic and
possible from our clients.
The Diagnostic and Statistical Manual of Mental Disorders (4th Edition, Text Revision;
DSM-JV- TR; American Psychiatric Association, 2000) contains numerous diagnoses and their
associated characteristics. It is important for music therapists to be familiar with this book, as it
serves as a reference for psychiatric diagnostic information. Diagnoses are made on five axes, the
first two of which contain various diagnostic categories. Axis I diagnoses are "clinical disorders
[and] other conditions that may be a focus of clinical attention" (p. 26) and include: disorders
first diagnosed in infancy, childhood, or adolescence; substance-related disorders; schizophrenia
and other psychotic disorders; mood disorders; anxiety disorders; somatoform disorders;
factitious disorders; dissociative disorders; sexual and gender identity disorders; eating disorders;
sleep disorders; impulse-control disorders not elsewhere classified; adjustment disorders; and
other conditions that may be a focus of clinical attention (pp. 13-26). Axis II diagnoses include
personality disorders and mental retardation (developmental disabilities).
Two music therapy books are devoted exclusively to music therapy for clients with
psychiatric disorders: Music Therapy in the Treatment of Adults with Mental Disorders (Unkefer
& Thaut, 2002) and Multimodal Psychiatric Music Therapy for Adults, Adolescents, and
Children (Cassity & Cassity, 1998). These books provide a wealth of information for working
with people with these difficulties.
Unkefer and Thaut (2002) and their collaborators provide suggestions of music therapy
interventions based upon the diagnoses of adult clients with psychiatric difficulties. They have
determined the major categories of adult emotional disorders that music therapists work with,
including: schizophrenic disorders; bipolar disorder, depressed episode; bipolar disorder, manic
episode; and generalized anxiety disorder. For each category, they list the following: diagnostic
symptoms, clinical features, characteristic behaviors, needs, music therapy interventions,
programs, and techniques. For each diagnostic symptom, the additional categories are filled in,
giving a number of symptom- and behavior-focused strategies for working with adults with
emotional challenges.
Cassity and Cassity (1998) surveyed music therapy clinical training directors working in
facilities treating people with psychiatric disorders. They asked the directors to select areas of
nonmusic behavior that they assessed and treated most frequently during music therapy sessions.
They then asked them to write two client problems that they assessed and treated most frequently
for each of the selected areas. Finally, the directors were asked to list two music therapy
interventions that they used most frequently to treat each of the client problems. The authors
used Lazarus' (1976; 1989) Multimodal Therapy model to classify the problems and
interventions. Following this model, the music therapy strategies address problems in the
following areas: behavior, affect, sensation, imagery, cognitive, interpersonal, and drugs (this
latter category encompasses any concerns about the client's state of health). The book presents
an extensive collection of music therapy procedures for working on the problems specified by the
clinical training directors, classified by the area addressed.
In a special education setting, classification performs a similar function to that provided
by diagnosis in psychiatric work. The classification systems in various states are based on federal
regulations and are therefore similar, but with slight variations in terminology. Typical special
Chapter 12 Further Considerations 0 121
education classifications include: autism, deaf-blindness, emotional or behavioral disability,

health impairment, hearing impairment, learning disability, multiple disabilities, orthopedic
impairment, speech or language impairment, traumatic brain injury. There is generally a
classification for mental retardation, but it is often called by another name, sometimes
"developmental disability." There is also typically a rather general classification for young
children with developmental delays, postponing classifying children into specific categories until
they are older.
Developmental Level
It is useful for music therapists to know the developmental level at which their clients are
functioning, which is often different from their chronological age. The importance of knowing
the client's developmental level, particularly for children, is that this allows treatment plans to
proceed in the logical order in which development naturally occurs. Even though children for
whom music therapy is appropriate may not be developing in the expected order, interventions
are often most effective if planned to meet developmental needs. This means that the new skills
the therapist is helping the client to develop will be based on skills the client has already
achieved. This information may also be useful when working with adults who function at low
developmental levels.
There are numerous approaches to understanding development. Piaget (Wadsworth,
1989) focuses on cognitive development; Freud (1938) on the role of psychosocial development
in pathology; and Erikson (1950/1963) on psychosocial tasks that must be mastered at each stage
of development, from infancy to old age.
From a descriptive point of view, developmental charts are available that identify what a
child can typically do at each age. These charts can be useful in learning to track childhood
development and knowing what may be expected at different stages. It may be useful to keep one
of these charts for reference. A useful chart for children (or adults) who are functioning in the
first 3 years of normal development is available from the Hawaii Early Intervention Program
(Forano, 1979).
Several things must be kept in mind when referring to these charts. One is that children
develop at varying rates, so variations from the milestones listed are to be expected. Another is
that, when children have developmental problems, as do many of the children seen in music
therapy, their development is likely to be less even than that of children who are developing
without specific delays. This means that they may work on or accomplish many developmental
tasks in different orders than is considered typical or may seem to have mastered a task and then
lose the skill, only to have to work on it again.
The best way to begin to really understand normal child development is to spend time
around children who are developing without specific delays, as that helps the abstract behaviors
shown on a chart come alive.
Greenspan's Approach to Development

Greenspan's developmental framework (Greenspan, 1992; Greenspan & Wieder, 1998) can be
very useful for music therapists. Greenspan and his colleagues find that children with
developmental challenges frequently respond differently in three areas: (a) sensory reactivity, the
way they take in information through the senses; (b) sensory processing, the way they make
sense of the information they take in; and (c) muscle tone, motor planning, and sequencing, the
way they use their bodies and later their thoughts to plan and execute responses to the
information they have taken it (Greenspan & Wieder). They provide detailed information on
assessing functioning in these areas in order to understand an individual child's reactions and to
engage the child in interactions to aid their development.
In their work with children, these clinicians have found that six types of emotional
interactions correlate with six early phases of development and that "appropriate emotional
experiences during each of these phases help develop critical cognitive, social, emotional,
language, and motor skills, as well as a sense of self' (Greenspan & Wieder, 1998, p. 70). These
milestones include:
• Milestone I: Self-Regulation and Interest in the World. In this phase, the infant
learns to balance a growing awareness of sensations with the ability to remain calm.
These researchers find that these skills are the most basic building blocks of
emotional, social, and intellectual health. A child with difficulties in this area may
cry and be upset because he or she is not able to regulate incoming sensations, or be
lethargic and appear lazy because not enough sensations are being perceived.
• Milestone II: Intimacy. In this phase, the child has learned to seek out the faces of
the primary caregivers, to look them in the eye, and to smile, thus providing the
building blocks for later relationships. A child who does not develop this ability
(possibly due to problems in the previous stage) will not make adequate emotional
connections with others, leading to a reduction in response from others, thus leading
to increasing problems with intimacy.
• Milestone III: Two- Way Communication. This phase involves opening and closing of
circles of communication. For example, the child may smile at the mother and the
mother smiles back in response, or the child reaches out to the father and the father
reaches back to the child. From this, the child begins to learn that he or she can have
an impact on the world. Children without this skill (possibly due to developmental
problems in one of the above areas) will need extra assistance learning to engage
socially.
• Milestone IV: Complex Communication. The child in this phase has acquired
gestures and, by linking them together, uses them as a vocabulary to express wishes.
The child can therefore be clearer about what she or he is wanting and take initiative
in new ways. The child can also be more creative as he or she can express more
complex thoughts. The child's sense of self builds as he or she engages in longer and
longer conversations. These experiences with communication also establish the basis
for speech.
• Milestone V: Emotional Ideas. In this stage, the child learns to express ideas first
through play, then with play comes increased use of words. Eventually, the child
begins to realize that symbols stand for things, and with this comes awareness that
words can communicate emotions. Eventually, the child learns to manipulate ideas
and to use them in ways that meet his or her needs.
• Milestone VI: Emotional Thinking. The child in this stage begins to connect what
were previously separate emotional thoughts, leading to the ability to express a wider
range of emotions. Through this expression and expanded play, the child begins to
understand more and more of what makes me. He or she becomes fully able to
communicate ideas and feelings verbally.
The milestones are presented without any reference to age-specific achievement, since
the children for whom they have been developed usually do not achieve them at the normal or
expected age. Greenspan and his colleagues use these milestones as a framework to help parents
and professionals understand what their children need and how to focus their work. This can
serve as a framework for music therapists as well.
Developmental Therapy
Music in Developmental Therapy (Purvis & Samet, 1976) follows the outline of a curriculum that
incorporates principles of development into special education (Wood, 1975; Wood, Quirk, &
Swindle, in press). Wood's Developmental Therapy sets goals for four areas of the curriculum:
behavior, communication, socialization, and academic skills. Goals are established for each of
five developmental stages under each of the four areas. Goals for each curriculum area at each
stage of development are listed in Table 12.1.
Music in Developmental Therapy (Purvis & Samet, 1976) contains suggested learning
experiences for a number of objectives under each goal and suggested music therapy procedures
for achieving them. Although the book is out of print and may not be available to most music
therapy students, the stages and areas can serve as a guide for formulating your own objectives
and procedures.
Needs of the Client

Level of Structu re
One of the challenging but also fascinating qualities of music therapy is the breadth of its
application. Music therapy can be used to elicit responses from a person in a coma or a child with
multiple disabilities, just as Guided Imagery and Music or music psychotherapy can be used with
high-functioning adults. Witnessing the power of music therapy to heal is one of the great
rewards of being a music therapist. The rewards are what keep many music therapists in the
field l but are not the subject of this chapter-it is the challenges that are being addressed here.
Music therapy clients vary widely in their level of functioning. Some need stimulation to
elicit even the slightest response while others have no clinical problems but are seeking higher
levels of self-awareness or creativity. There are certain generalizations that may be made about
clients at various levels, and these generalizations may be helpful in planning and treatment. One
such generalization is that lower levels of function require greater structure while higher levels
require less structure. This applies to the psychotherapeutic framework used, to work at different
developmental levels, and to work with varying diagnoses.
I Students who are considering the rewards of music therapy may be interested in reading a qualitative research study
by one of the authors on her pleasure in working with children with severe disabilities (Wheeler, 1999).
Table 12.1
Stages of Development in Developmental Therapy (Wood, 1975)
Used with pennission from Mary M. Wood.
Sta2e Behavior Communication Socialization Academic Skills

I to trust own to use words to gain to trust an adult to respond to the environment
body and skills needs sufficiently to with processes of classification,
respond to him discrimination, basic receptive
language concepts, and body
coordination
II to success- to use words to affect to participate in to participate in classroom
fully others in constructive activities with routines with language
participate in ways others concepts of similarities and
routines and differences, labels, use, color;
activities numerical processes of ordering
and classifying; and body
coordination
III to apply to use words to to find to participate in the group with
individual express oneself in the satisfaction in basic expressive language
skills in group group group activities concepts; symbolic
processes representation of experiences
and concepts; functional semi-
concrete concepts of
conservation; and body
coordination
IV to contribute to use words to to participate to successfully use signs and
individual express awareness of spontaneously symbols in formalized school
effort to group relationship between and successfully work and in group experiences
success feelings and behavior as a group
in self and others member
V to respond to to use words to to initiate and to successfully use signs and
critical life establish and enrich maintain symbols for formalized school
experiences relationship effective peer experiences and personal
with adaptive, group enrichment
constructive relationships
behavior ind~endently
Based on:
Wood, M. M. (1975). Developmental Therapy. Baltimore, MD: University Park Press.
Chapter 12 Further Considerations D 125
A continuum from directive to nondirective may be applied to the psychotherapeutic

framework adopted by the music therapist. Some philosophies of therapy are more directive than
others, leading music therapists embracing those philosophies to be more structured in their style
of facilitating sessions. People practicing behavior modification, for instance, are likely to be
more directive than those using some other approaches. A music therapist working to shape
behaviors through the use of contingent music will be quite directive, for example, while a music
therapist embracing a humanistic approach is likely to be less directive. A music therapist
utilizing improvisation to explore feelings may be quite nondirective although may be directive
on some occasions. It is not possible to make definitive statements about these styles, but it can
be useful to be aware of these possibilities.
Levels of psychotherapy as they apply to music therapy have been conceptualized by
several music therapists (Bruscia, 1998a; Maranto, 1993b; Unkefer & Thaut, 2002; Wheeler,
1983, 1987a). A comparison of the classification by Wheeler with the one by Unkefer and Thaut
is given in Table 12.2.
The concept of varying levels of structure also applies to developmental levels or levels
of illness. Developmental levels generally progress as children get older, so that older children
are at higher developmental levels and thus require less structure. This also applies to clients
with developmental problems. Older children at lower developmental levels are likely to need or
be able to tolerate less structure as their developmental level advances. Developmental music
therapy (Purvis & Samet, 1976) takes into account this advancing need for less structure, where
suggested activities at higher stages include less structure than those at lower levels.
Hadsell (1993) proposes three levels of external structure for music therapy clients, and
suggests procedures for providing structure in the areas of time, space and equipment, choices,
materials, instructions, and activities. Her suggestions are summarized in Table 12.3.
The work of Wheeler (1983, 1987) and Unkefer and Thaut (2002) with levels of
structure in music as psychotherapy was also applied to the diagnoses of the clients, with the
suggestion and some evidence that clients with certain diagnoses that might be considered more
primitive benefit from greater levels of structure. According to this framework, clients with
diagnoses implying less primitive personality organization require less structure. Unkefer and
Thaut have also suggested clients and problems for which each level of psychotherapeutic
intervention is appropriate. Clients suggested as appropriate for each level are outlined in Table
12.4.
Table 12.2
Levels of Music Therapy Practice (Unkefer & Thaut, 2002; Wheeler, 1983, 1997a; Wolberg,
1977)
Wheeler Unkefer & Thaut

(based on Wolberg)
First Level MT as Activity Therapy Supportive, Activities-Oriented MT

Goals achieved through use Goals achieved through active involvement in
of therapeutic activities therapeutic activities; any verbal processing focuses
(including verbalization when on here-and-now and overt behavior during session;
appropriate); understanding activities aimed at strengthening defenses,
why a behavior occurs is not supporting healthy feelings and thoughts,
considered important. developing appropriate mechanisms of behavior
control, reassuring reality stimulation; activities
tightly structured to promote success, support,
reduction of anxiety.
Second Level Insight MT With Reeducative, Insight, and
Reeducative Goals Process-Oriented MT
Music may be used to elicit Active involvement in therapy is complemented by
certain emotional and/or verbalization; activities designed for feelings and
cognitive reactions necessary thoughts that are then subjected to verbal processing
for the therapy. The major within therapy session; therapeutic emphasis is on
focus is on feelings, the exposition of personal thoughts, feelings, and
exposition and discussion of interpersonal reaction; focus of attention is on here-
which lead to insight, and-now of the interactional process between MT
resulting in improved and clients; aimed at helping client to reorganize
functioning. values and behavioral patterns, to acquire new
tension- and anxiety-relieving interpersonal
attitudes.
Third Level Insight MT With Reconstructive, Analytically,
Reconstructive Goals and Catharsis-Oriented MT
MT elicits unconscious Therapeutic activities utilized to uncover, relive,
material, which is then and resolve unconscious conflicts; unconscious
worked with in an effort to material is elicited, then used to reorganize the
promote reorganization of the personality by living through, with insight, deepest
personality. fears and conflicts.
Based on:
Wheeler, B. L. (1983). A psychotherapeutic classification of music therapy practices: A continuum of
procedures. Music Therapy Perspectives, 1(2),8-12.
Wheeler, B. L. (1987a). Levels of therapy: The classification of music therapy goals. Music Therapy,
6(2),39-49.
Unkefer, R. F., & Thaut, M. H. (Eds.). (2002). Music Therapy in the Treatment ofAdults with Mental
nd
Disorders (2 Ed.). S1. Louis, MO: MMB Music.
Wolberg, L. R. (1977). The Technique ofPsychotherapy (3 Td Ed., P1. 1). New York: Grone & Stratton.
Table 12.3
Levels of External Structure in Music Therapy (Hadsell, 1993)
Used with permission from the American Music Therapy Association.
Level Time Space/ Choices Materials Instruc- Activities

Equipment tions
One Specific time MT controls; Initially no MT creates MT gives 1- Conducted
(Maxi- allotted for each item or options materials to or 2-step step by step to
mum) each activity; activity given, later support instructions; elicit highly
consistent occupies a two choices; objectives; maybe structured,
sequence; specific therapist items con- written or simple
minimal time space, determines structed for illustrated responses;
between unchanged choices sturdiness; with desired
activities from session based on materials pictures; MT behaviors
to session; assessment placed so may demon- task-analyzed
consistent use of client therapist has strate desired into careful
of equipment preferences control responses sequences
Two Scheduled MT controls MT gives Maybenum- MTmay Activities are
(Mod- activities use of space several erous and give simple designed to
erate) during and equip- options to varied to ad- to moderate- elicit moder-
seSSIOns mentbut can clients; dress similar ly complex ately complex
generally vary from clients may objectives; instructions responses;
have allotted session to have limited clients may with several fewer steps
times and session; space direct input help to create sequential needed than at
sequences, rearranged by into by stating response previous
but with MT as needs alternatives preferences; levels; writ- level; tasks
some change; client offered may help in ten instruc- may not be
variation; requests caring for tions maybe specifically
client input incorporated objects used in step- analyzed
considered in into planning leading to by-step since clients
planning more avail- format; MT may master
able demonstrates several small
materials as needed steps at once
Three Session time Space used MT offers Clients may MTmay Activities
(Mini- is loosely flexibly with options; MT collaborate give com- maybe
mum) scheduled; equipment and clients withMT in plex verbal planned by
flexibility and materials work togeth- creation of or written in- bothMTand
built into placed for er to devise appropriate structions; clients; both
planning; mobility; alternatives materials; clients may may decide
activities can items easily consistent clients have request clari- on steps
take varying accessible to with thera- access to fication needed to
time as clients; clients peutic materials and through complete
needed andMTcan objectives; maybe explanation objectives;
rearrange questions of responsible or demon- steps maybe
room as preference for bringing strations; arranged for
necessary maybe them to language greater
open-ended seSSIOns level varies effectiveness
Based on:
Hadsell, N. A. (1993). Levels of external structure in music therapy. Music Therapy Perspectives, 11,
61-65.
Table 12.4
Levels of Music Therapy Practice and Clients Appropriate for Each Level (Unkefer &
Thaut, 2002; Wheeler, 1983, 1997a)
Wheeler Unkefer & Thaut
First Level Music Therapy as Supportive, Activities-Oriented

Activity Therapy Music Therapy
Appropriate for most seriously ill Appropriate for clients who have
clients or those with the most serious basically sound ego structures who have
personality disorganization; could broken down temporarily under stress, for
include those hospitalized for acute or chronic clients who are
psychiatric disorders or people with fragmented, regressed, or delusional, who
chronic schizophrenia in long-term suffer from severe schizophrenic,
community treatment (research affective, or organic symptoms, or who
confirmed use with people with are too phobic and anxious to participate
schizophrenia) in more demanding levels of therapy;
these clients need support, integration,
and sealing over rather than verbal
investiKation of their~oblems
Second Level Insight Music Therapy Reeducative, Insight, and
With Reeducative Goals Process-Oriented Music Therapy
Appropriate for clients whose problems Appropriate for clients who are willing
do not cause severe personality and able to self-disclose; helps clients to
disorganization, such as substance reorganize values and behavioral patterns,
abusers, people with affective to acquire new tension- and anxiety-
disorders, neuroses/anxiety disorders, relieving interpersonal attitudes, and,
situational disorders, or personality through projection of personal thoughts
disorders; or for those with schizo- and feelings in the therapy process, to
phrenia if used over a longer period of learn to assume responsibility for them
time (research confirmed use with those
who abuse substances, people with
affective disorders, neuroses,
personality disorders)
Third Level Insight Music Therapy With Reconstructive, Analytically,
Reconstructive Goals and Catharsis-Oriented
Appropriate for clients whose problems Music Therapy
do not cause severe personality Appropriate for clients who are able and
disorganization, as above, and for motivated to commit themselves to long-
healthy people desiring additional term therapy that challenges existent
growth (research confirmed use with personality structures
those who abuse substances, people
with affective disorders, neuroses,
personality disorders, situational
disorders)
Based on:
Wheeler, B. L. (1983). A psychotherapeutic classification of music therapy practices: A continuum of
procedures. Music Therapy Perspectives, 1(2),8-12;
Wheeler, B. L. (1987a). Levels of therapy: The classification of music therapy goals. Music Therapy,
6,39-49.
Unkefer, R. F., & Thaut, M. E. (Eds.). (2002). Music Therapy in the Treatment of Adults with Mental
nd
Disorders (2 Ed). 8t. Louis: MMB Music.
The Music Therapist's Perspective

It is essential for you as a music therapist to know why you doing what you are doing. We will
discuss various aspects of this, beginning with the personal theory of helping developed in
Chapter 3, then expanding our understanding to include what has been said by others and
incorporating it into the development of our own theory. We will then apply all of these to
clarifying the rationale for our music therapy plans and treatment.
Personal Theory of Helping

The questions that you answered in Chapter 3 have been formulated into your personal theory of
helping. This theory will help you in many ways, serving as a guide in making many decisions
about therapy. It will be revised over time as you mature and your views change.
Your theory of helping may also embrace the philosophy embodied in one or more
psychotherapeutic frameworks or be part of a framework based on a theory of music therapy. To
see what others say about these areas, we will now look at how others-music therapists,
psychologists, psychotherapists-have formulated and used theories. These will include those
who see music therapy as part of a psychotherapeutic framework, and those who have developed
a theory of music therapy separate from psychotherapeutic theories.
Psychotherapeutic Framework
A therapist who embraces behavior modification as a theory will plan a session differently than
one who employs a psychodynamic framework. Just as psychotherapists use varying frameworks
for their work, so do music therapists. It is useful to be familiar with various psychotherapeutic
frameworks and to draw from one or more in one's music therapy work.
Ruud (1980) examines the psychological orientations of psychoanalytic, behavioral, and
humanistic/existential approaches and the music therapy theories derived from each, drawing
parallels between music therapists and others who employ the theoretical frameworks. Others
(Bruscia, 1987; Darrow, 2004; Wheeler, 1981) have related music therapy to a variety of
psychotherapeutic frameworks. Some authors have done extensive analyses of aspects of music
therapy within a single psychotherapeutic framework. Examples of this are a book by Madsen
(1980) on the use of music therapy and behavior modification with people with mental
retardation and one edited by Bruscia (1998b) on aspects of music therapy within a
psychodynamic framework.
Music Therapy Theoretical Framework

Some music therapists (Aigen, 1991b; Amir, 1996; Kenny, 1985, 1989) argue that music
therapists should not rely on a framework based on psychotherapy but rather need to have a
framework based on music therapy itself. These authors have written on a variety of aspects
addressing this area. Some of their ideas were presented in Chapter 1, Doing Music Therapy: An
Exploration, and will be explored more in Chapter 14, The Role of Music.
Although as a music therapist just developing your clinical skills it is unlikely you will
be ready to focus on the development of theory, it is a good time to start thinking about some
questions that may later lead to theory development. A theory is defined by Bruscia (1998a) as "a
set of interrelated principles or constructs which have been created by a theorist in order to: (a)
describe and organize a particular domain in a comprehensive and coherent manner; (b) explain
or understand related facts, empirical data, and phenomena within the domain; and (c) offer a
conceptual framework for decision making in future theory, research, and practice" (p. 243).
Having a theory is like having a map to guide us to a chosen destination. A theory in music
therapy serves as a guide as we determine how to conduct our music therapy sessions.
Though we don't usually think about it, we each use theories to guide us through many
aspects of our lives. One way to discover how we use a theory is when something doesn't
work-perhaps a light won't tum on. If our first action is to pull the cord or to flip the switch
again, the guiding thought (a theory) is that something didn't catch the first time. If this doesn't
work, we may test another theory-that the light bulb is broken. (This is an example of using a
theory to form a hypothesis that we then test.) If the light comes on once a new bulb is installed,
our hypothesis has been confirmed and our theory appears to be correct. If it does not come on,
our theory needs revision. Perhaps the next theory is that the light fixture is broken.
To begin to develop theory in music therapy, we follow a similar process. Carolyn
Kenny suggested the following steps:
We might initially reflect on our "underlying assumptions." This is a good way
to begin the theoretical thinking. The next step, I believe, is to have them design
"principles." These are "if, then" statements. Try to do this with complete
honesty, even if your principles seem "unfounded" or "unsupported." It is good
to get these out in the open and to relate the principles to the underlying
assumptions. The next step from the principles is "concept formation," and the
next is to develop a "set of concepts." Finally comes the map, or how the
concepts relate to each other. At this point you have your theory. Remember that
theories are guides or maps. You don't have to use your theory to "prove" that
you are right, though you can take that next step if you decide to do research in a
positivistic paradigm. (personal communication, July 20, 2001)
You may also wish to read what Kenny (1989) wrote about theory development in The
Field of Play: A Guide for the Theory and Practice of Music Therapy (pp. 41--44). A
comprehensive overview of the development of theory in music therapy by Bruscia (2005)
provides additional information on this topic.
Rationale for Treatment

A rationale is "an explanation of controlling principles of OpInIOn, belief, practice, or
phenomena; an underlying reason; basis" (Merriam-Webster's Collegiate Dictionary, 10 th
Edition, 2002, p. 967). Your rationale for what you are doing is most useful if it reflects your
overall way of viewing therapy and change and takes into account various aspects of the therapy.
The rationale will generally be developed prior to and as a part of learning to work with clients.
Knowing why you are doing what you are doing is a step that is often neglected, particularly in
the early stages of learning to do music therapy. Too often, students and beginning therapists
know what they want to do-which strategy to use-but don't know why. The rationale is
influenced by the therapist's personal theory of helping as well as by psychotherapy or music
therapy based theoretical frameworks adopted by the therapist.
Chapter 12 Further Considerations 0 13 1
As a student music therapist, you should always have a rationale for what you are doing
with clients. This rationale will take into account much of what we have looked at so far-the
needs of the client, your personal feelings, your philosophy of helping and the psychotherapeutic
and other theoretical frameworks that you adopt, your understanding of the role of music in the
treatment. The rationale may easily change as the situation changes. The rationale helps you to
make decisions minute by minute during the session and is something that you might tell
someone-perhaps a parent or another professional-should they ask why you are doing
something.
Questions that arise in developing a rationale for a particular intervention or approach
include the following: What does the client need? What does the group need? What has been
done before? How much time is available in the session? How many more sessions are likely to
take place? The rationale is most likely to develop from the answers to questions like this and
will probably encompass several of the answers. While it is possible to conduct music therapy
without a rationale, sessions that are based on a solid rationale are most likely to be productive.
Ethical Considerations
The music therapist must follow ethical standards in all areas of functioning, including planning
and carrying out sessions. This includes both personal and professional ethics. Being aware of
one's personal values and ethical standards is part of developing as an ethical professional.
Professional ethics are based upon personal ethics as well as more generally accepted
professional ethical standards.
Ethical standards have been developed over a period of years and cover many areas.
Most professions have adopted statements of ethical standards. The AMTA Code of Ethics
(American Music Therapy Association, 2003) covers the following general areas: professional
competence and responsibilities; general standards; relationships with clients/students/research
subjects; relationships with colleagues; relationship with employers; responsibility to
community/public; responsibility to the profession/association; research; fees and commercial
activities; announcing services; education (teaching, supervision, administration); and
implementation. Other music therapy associations also have codes of ethics, and the Certification
Board for Music Therapists (2001) has developed a Code of Professional Practice.
The AMTA Code of Ethics provides general guidelines, and students and professional
music therapists should follow it in their professional activities and consult it when they have
questions about ethical behavior in specific situations. Since guidelines are general, there will
undoubtedly be times in which they do not address a specific situation. At these times, it is a
good idea to discuss the situation with a teacher, supervisor, or colleague. Ethical Thinking in
Music Therapy by Dileo (2000) is a valuable resource when considering ethical issues. This book
will challenge you to examine your understanding of ethics and provides a step-by-step process
for addressing ethical concerns in your daily work.
For Further Reading

Briggs, C. (1991). A model for understanding musical development. Music Therapy, 10, 1-21.
Carkhuff, R. T. (2000). The Art of Helping in the 21 st Century (8 th Ed.). Amherst, MA: Human
Corey, G., Corey, M. S., & Callanan, P. (1988). Issues and Ethics in the Helping Professions (3rd
Corey, M. S., & Corey, G. (1998). Becoming a Helper (3rd Ed.). Pacific Grove, CA: Brooks/Cole
Publishing Co.
MD: The Scarecrow Press.
Egan, G. (1998). The Skilled Helper: A Problem-Management Approach to Helping (6 th Ed.).
Pacific Grove, CA: Brooks/Cole Publishing Co.
Loewy, J. V. (1995). The musical stages of speech: A developmental model of pre-verbal sound
making. Music Therapy, 13,47-73.
Wheeler, B. L., & Stultz, S. (April, 2001). The development of communication: Developmental
levels of children with and without disabilities. European Music Therapy Congress,
Naples, Italy. Available on Info-CD Rom IV, University of Witten-Herdecke (2002) and at
http://www.musictherapyworld.net/(uses Greenspan's developmental framework)
Wheeler, B. L., & Stultz, S. (July, 2002). Musical relatedness in infancy as a resource in
understanding children with disabilities. 10 th World Congress of Music Therapy. Oxford,
UK. Available on Info-CD ROM V, University of Witten-Herdecke (2004) and at
http://www.musictherapyworld.net/modules/wfmt/stuff/oxford2002. pdf. (uses Greenspan's
developmental framework)
Assignments-
Further Considerations in Planning

1. Speak with a music therapist or another professional where you are doing your clinical work
about one of the clients with which you are involved. Find out the diagnosis and some of the
characteristics that lead to that diagnosis. Write the behaviors that you observe that you think
might be associated with this diagnosis.
2. List the behaviors exhibited by a client and relate them to one of the developmental
frameworks presented (a list of developmental tasks, Greenspan's theory, or Developmental
Therapy).
3. What rationale do you think the therapist in charge of the session has? In order to answer
this, look at some of the questions that are asked in the chapter and/or discuss it with the
therapist.
4. Look at the AMTA Standards of Practice. Choose any three of the standards and reflect on
why they exist and how they might apply to your population.

1. Read the charts of three of the clients with whom you are working (or, if you are not able to
gain authorization to read the chart, speak with the therapist or other professional in charge
to get the information) to find the clients' diagnoses. Read DSM-IV-TR to learn about the
diagnoses. Describe the characteristics of the clients that have led to those diagnoses. (If you
are working in a special education setting and psychiatric diagnoses are not available, you
may be able to relate the children's classifications from their IEPs to state regulations that
include characteristics of classifications or to definitions from a special education book.)
2. List the behaviors that the three clients are exhibiting and relate them to one of the
developmental frameworks presented (a list of developmental tasks, Greenspan, or
Developmental Therapy). Use a different framework than you used at Level 1.
3. If applicable, speak of the level of music therapy that is practiced in your music therapy
session. Relate this to what Wheeler or Unkefer and Thaut say about this level of therapy
(see Table 12.2) and associate the level with the type of clients (see Table 12.4).
4. Relate the music therapy that you are doing to the theory of helping that you developed
earlier, adding information from what others have written about helping (psychotherapeutic
or music therapy theories).
Level III-Leading
1. Based on the charts, IEPs, and DSM-IV-TR or other appropriate sources, write about the
characteristics of the people in the music therapy session. Provide the rationale for your
session plans and outcomes, making connections between the characteristics of the clients
and what you are doing in the session.
2. Examine the appropriate level of structure for your group, using Tables 12.2 and 12.3. For
each, determine where your work falls and write about this, describing your reasons for
placing it where you do.
3. Begin to develop a theory of music therapy based on music therapy itself rather than external
(psychotherapeutic or other) theories. Use the process described by Kenny.
4. Revise your personal theory of helping, including information from what others have written
and your thinking about music therapy theory.
Facilitating Client
Responses
Music therapists help people to make many types of changes. Music therapy treatment may lead
to changes in behavior, changes in self-awareness, changes in skills (such as social, leisure,
motor), changes in self-management (such as stress, pain, emotions), or changes in understanding
the world in which we live. Sometimes we help people to gain insights that may later lead to
changes of behavior. At other times, we help clients to modify their behavior more directly.
Music therapists use various means of eliciting client responses, with some differences in
the techniques used with lower functioning and higher functioning clients. With lower
functioning clients, responses may be elicited through music, through physical prompts, and
through verbal prompts. Many of the same techniques are used with higher functioning clients,
but talking becomes more important since these people tend to be more verbal.
Verbal Facilitation
We each have ways that we typically interact with others, so it is natural that our verbal
facilitation as therapists will in part be built upon this interaction style. However, our natural or
habitual responses become problematic if they dominate our interactions, if we are unaware of
them and their impact, or if we cannot move out of a particular style of interacting when the
situation calls for it. Part of our training as music therapists, therefore, is to learn different ways
of interacting and their likely impact-positive or negative-and then to practice moving
smoothly and skillfully from one style of interaction to another. In time, we will be able to
manage our interactions effectively to facilitate our clients' growth. Of course, since people do
not always respond as we expect them to, we should always be ready for surprises.
Therapist Responses That Are Helpful

Verbal techniques and responses may be divided into categories in different ways, most of which
deal with their typical uses and effects. The categories described below, which may be used by
verbal therapists as well as music therapists, are followed with music therapy examples.
Listening and Understanding
Listening and understanding form the foundation of a therapist's role with clients. They involve
more than just sitting and listening passively, as the therapist engages in an active process of
gathering information and responding appropriately. The therapist responds not only to the
verbal content but to the client's total message, including nonverbal behaviors such as body
language, voice inflection and volume, breathing patterns, and so on. Listening and under-
standing also involve letting clients know that you are aware of them and what they are saying by
making eye contact and indicating your understanding through your own facial and body
gestures. They may involve touching the client when appropriate.} Verbal skills for listening and
understanding include paraphrasing, in which the client's basic message is stated in similar, but
usually fewer, words. The therapist may also use clarifying, admitting confusion about the
client's meaning and attempting to restate what the client is saying or asking the client to clarify,
repeat, or illustrate what was being said.
A music therapist may employ all of these techniques in attending to clients' verbal and
nonverbal responses, including their musical responses. As an example, a music therapist
beginning a group may ask the members to express verbally or musically how they are feeling.
As the clients share their feelings, the therapist pays attention to everything that they are
conveying-words, affect, body language, music. The therapist may structure the group so that
each client's contribution is accepted with comment or clarification, or without it. In the former
case, the therapist may use paraphrasing, clarifying, or a similar technique.
Encouraging Communication
The therapist may use several types of questions to encourage the client to communicate. When
asking questions, it is most helpful for the therapist to use questions that cannot be answered
with a simple "yes" or "no." In general, questions should be used sparingly, as they tend to put
the client on the spot and keep the therapist in a central position. The therapist may use a leading
question to help the client begin, for example, "What would you like to talk about today?" or
"Tell me more about what happened in that situation."
A music therapist may use the same types of questions to encourage communication.
When beginning a session, the therapist may ask, "Is there anything left from last week's group
that we need to complete?" or "What music would you like to sing today?" Either of these
questions may be answered verbally or, perhaps after a brief verbal response, musically. A
similar question that would lead straight into music would be, "Does anyone have an image that
they would like to share through the instruments as we begin our group?"
Reflecting and Sharing
When the therapist reflects, he or she is attempting to communicate his or her perception of the
client's world as the client sees it. Feelings, experience, or content may be reflected. When the
therapist reflects feelings, he or she uses different words than the client was using to express
those feelings. When the therapist reflects the client's experience, he or she notes the client's
body language and reflects that. Reflecting content is similar to paraphrasing. By reflecting the
content of what has been said or of a client's feelings or experience, the therapist is helping the
client find the words to express him- or herself.
When the therapist recognizes that she or he is having a feeling, it is often useful to
express it to the client. It is helpful if the therapist can separate out his or her own personal issues
from the normal human response to the client's presentation or issues; it is the latter feelings that
are often helpful to express. This area deals with the therapist's countertransference, or personal
associations, that are affecting his or her responses to the client. The therapist may also describe
I Be aware that the use of touch can have unintended consequences, such as being interpreted as having sexual
overtones or invading another person's space.
Chapter 13 Facilitating Client Responses D 137
and share feelings to serve as a model for the client. Since many clients are not aware of their
feelings, learning to share them can be very helpful.
Both reflecting the client's feelings and sharing of the therapist's feelings may occur in
music therapy. For example, a therapist who is working with a group of children and notes that
several of them are feeling angry but may not know how to express the feeling might say, "I
wonder if some children are feeling angry about what just occurred. We can talk about our anger
or play it on the instruments, as long as we don't hurt anyone or the instruments. Sometimes
people feel much better when they express their anger." Or the therapist may share his or her
own feelings about something that is occurring, perhaps saying, "When I see children crying
because their feelings have been hurt, I feel like crying, too. Sometimes when my feelings are
hurt, I do cry, or I find some music to play or listen to that helps me express my sadness." This is
likely to help the children see that their feelings are acceptable and to provide a model for how to
deal with them.
Interpreti ng
Interpreting involves an attempt to make sense of something about the client, the client's life, or
the therapeutic process. This may be done by the therapist, the client, or the therapist and the
client together. When defined in this way, interpreting is another word for finding meaning or
making sense of something that the client says or does. It is important to realize that this is a
central undertaking in many types of music therapy. Goals of interpreting are to help clients learn
how to interpret their own feelings, expressions, and behavior while also bringing them insights
into themselves and their lives. Interpretations are most helpful when they reflect both the
client's and therapist's point of view and when the therapist presents the interpretation in a
sensitive manner when the client is ready to receive and understand it. When interpretations are
wrong, or when the therapist does not present them in a sensitive, timely way, they create
distance between the client and therapist and may evoke negative feelings. Interpretation in
therapy is an art that requires considerable knowledge and skill on the part of the therapist.
Interpretations are most accurate when they are based on the therapist's own assessment of the
client as it continually unfolds, and as the therapist gains more insight into the client. Sometimes
the therapist's interpretations can also be based on a particular treatment orientation (such as
psychodynamic) or music therapy model (such as Analytical Music Therapy or GIM), all of
which require additional, specialized training.
Many examples of interpreting occur in music therapy within a psychodynamic
framework (see Bruscia, 1998b), using Analytical Music Therapy (Eschen, 2002; Priestley, 1975,
1994) or GIM (Bruscia & Grocke, 2002) and in other approaches that follow particular theories.
Examples of less formal interpretations were included in the previous section, Reflecting and
Sharing. The therapist's reflections of the perception that the children were angry or suggestion
that the children were crying because their feelings had been hurt involved interpretations of
what the children were feeling.
Giving Feedback, Confronting, and Changing Cognitions
There may be times that it is helpful for the therapist to give the client feedback. Feedback can be
useful when the client has asked for it or accepted the therapist's offer of feedback. It should be
clear that the feedback is given on the client's behavior rather than as a judgment of the client
him- or herself. It is also important to give feedback in small doses and to discuss the client's
reaction after it has been given.
At other times, the therapist will want to confront the client or challenge his or her
perceptions or behavior. These techniques are more forceful than simple feedback and are often
most effective when the client trusts the therapist. They should be used only when necessary. In
general, it is better for the client's ideas to emerge from the client's own process than from the
therapist.
Music therapists may find situations in which giving feedback or confronting is useful.
For instance, a music therapist may be working with a group that includes a client who
repeatedly states that he wants to get along with others and regrets that he always gets into
arguments. However, this client might continue getting into arguments, and it may be obvious to
everyone that he sets up situations that lead to the arguments. Perhaps the therapist and others on
the treatment team have worked with the client to increase his awareness of his behavior and to
help him in a variety of ways to change it. The music therapist may decide that the most effective
technique is to confront the client with his behavior the next time that it occurs in the music
therapy group. For example, the client may approach another client who has just begun using the
maracas and say, "I was just going to pick up those maracas, and you got them before me. Now
give them to me." To confront the client, the music therapist might intervene with, "This is an
example of how you start arguments. Mr. Smith already chose the maracas, and you have
repeated what you often do, demanding something that someone else has." This direct
confrontation could lead to a discussion with the client, perhaps including role-playing a better
way to select an instrument or to negotiate sharing the maracas. A less direct response to a
similar situation might be to give feedback. The music therapist might say, "I'm giving you
feedback since I see you doing something that leads to arguments with others. Mr. Smith already
chose the maracas, but now you are demanding them. It might be better if you wait your turn
until we choose instruments again and then choose the maracas before someone else does. Could
you think about trying that?" This feedback also includes a suggestion of a strategy or solution, a
useful technique that is separate from giving feedback.
Cognitive therapy involves modifying one's thoughts or cognitions. Such techniques may
be useful to the music therapist in helping the client learn to recognize and change thoughts that
are causing problems. These modifications are made consciously and systematically. If a man is
frequently anxious, for example, the therapist may help him to determine the messages that he is
giving himself that are causing him to be anxious, then to learn to give different messages.
Various methods of cognitive therapy are available; all result in the client being able to
restructure thoughts in order to change perceptions or behaviors.
Helping the client to change cognitions in a music therapy setting would probably be part
of larger work in cognitive therapy taken on by a client. Assuming that this were the case, a
woman might tell you that she did not want to attend the music therapy group because she felt
that she would not be successful in playing the instruments that are involved. Working with
cognitive techniques, the music therapist might help her to see the messages that she is giving
herself, for example, "I'll never be able to play the instrument. I have never been musical, and
this is certainly no time to start." Part of changing her cognitions would be to help her give
herself the internal message, "I don't know how well I will be able to play the instrument, but I
can try and it might even be interesting." This is only a very small part of the process of
cognitive therapy but should illustrate the concept. There are many excellent references on
cognitive therapy, two of which are included in the For Further Reading section of this chapter.
Chapter 13 Facilitating Client Responses D 139
Sharing Information
There are times that it is helpful to share information with a client, for example factual
information that therapists know (not necessarily because they are therapists) that clients may
need to know. There are also times that advice may be shared, although we recommend it be
given sparingly. If advice is given, it should be based on solid expertise and given in the form of
tentative suggestions.
Information or advice specific to music therapy involves sharing musical information.
An example might be sharing information about types of CD players or keyboards with a client
who is preparing to buy one of these. For these situations, the music therapist is likely to have
unique knowledge and experience that is certainly helpful and appropriate to share, although
doing so probably has minimal if any therapeutic value.
Changing Behavior
When behavior change strategies are utilized, it is under the assumption that clients are in
therapy because of behaviors that are causing them trouble. Changing the behavior, not providing
a supportive relationship, is the focus of the therapy. These strategies fall under behavioral
approaches to therapy, including behavior modification (based upon operant conditioning) and
behavior therapy (based upon respondent conditioning). Behavior modification, in particular, has
been very important in music therapy. Some of the most important behavioral strategies are
described separately below, with music therapy examples for each. The first four, modeling,
rewarding, extinguishing, and punishing, are essential elements of behavior modification;
contracting has also grown from behavior modification. The final one, desensitization, is
associated with behavior therapy.
In modeling, the client learns about new behaviors through watching another person use
those behaviors. The person performing the behavior may be the therapist, someone else in the
room, or someone on film. Role-playing is one type of modeling. Modeling is important to the
process of learning to play a musical instrument, where part of the teaching process typically
includes watching and listening to the instructor play the instrument. In most music therapy
settings, the music therapist provides a model of appropriate behavior. This may include
acceptable ways of dressing, handling strong emotions, and dealing with conflict.
Reinforcement or reward is a powerful tool in changing behavior. An effective reinforcer
must reward the desired behavior, which means that the behavior must be produced prior to the
reward, and an undesired behavior must not be rewarded. The reward must occur immediately
following the desired behavior in order to be most effective. And the reward must be strong
enough and frequent enough that the desired behavior will be repeated in order to obtain the
reward. Finally, the desired behavior must generalize to other settings. Varying the reward, using
natural settings, and rewarding certain conditions systematically will facilitate generalization.
Since music has been found to be an effective reinforcer, some music therapists allow children to
select music as a reward for appropriate or desired behaviors, while others have used a system in
which music is played contingent upon a desired behavior (that is, music is played after the client
performs a desired behavior). An example of using music as a reinforcer would be allowing a
child to playa favorite song after she has accumulated a certain number of points for behaving
appropriately. Music therapists may also use praise, touch, tokens, and other reinforcers within
music therapy sessions. When an older man who has not previously attempted singing sings part
of a song, and the music therapist praises him verbally and with a pat on the shoulder, the music
therapist is using praise and touch as reinforcers.
Extinction is used to decrease or stop a behavior. To use extinction, the therapist must
first determine what is reinforcing the behavior, then withhold the reinforcers and reinforce
competing behaviors when they occur. A music therapist who ignores a child who is repeatedly
interrupting others to ask for an instrument is attempting to extinguish the behavior of
interrupting. The way to determine if extinction has been successful (that is, if the reinforcement
has stopped) is to see if the child's interrupting decreases or stops. If the child continues
interrupting, it is possible that he is being reinforced by something other than the therapist's
attention, and the therapist should try to determine what the reinforcer is. In this situation, the
child may be receiving reinforcement from other children who are paying attention to him.
Punishment can be used to decrease a behavior. While decreasing unwanted behaviors
through extinction is preferred and is often more successful than using punishment, aversive
control (punishment) may be most useful for activities that are self-reinforcing such as self-
punishing activities in children. Punishment should be paired with reinforcement of a positive
behavior for maximum effect. For practical, ethical, and legal reasons, there are few if any
situations in music therapy in which punishment is appropriate. Further, in agencies where
punishment is used, it is generally an option of last resort and one for which staff must be trained
and which they are granted approval to use. As a student music therapist, it is unlikely that you
would be allowed to implement such strategies. The music therapist should, instead, work to
extinguish the behavior and to reinforce more positive behavior.
In contracting, the therapist and client agree on the tasks that are to be performed and the
consequences for doing or not doing them. A contract deals with specific behaviors, includes
specific rewards and consequences, and must be feasible. It may be either formal or informal. A
music therapist may ask members of a group to sign a contract in which they agree to do certain
things and include a statement of the rewards that they are to receive when they do them and the
consequences if they do not. The expectations may include things such as attending on time,
behaving in certain ways during the group, and committing to attend a certain number of
sessions. For example, a contract for a group of adolescents with developmental disabilities
might reward accomplishing these goals at a certain level for a certain period of time with tickets
to a concert. The consequence of not meeting the criteria might simply be not being able to
attend the concert.
Desensitization or counterconditioning is a method of reducing a person's emotional
responsiveness to a threatening or unpleasant situation by introducing an activity that is
incompatible with the anxiety response. Relaxation is generally introduced as the incompatible
activity. Music therapists may use desensitization and include music to complement the
relaxation. The process continues until the desired response is achieved and the person can be
around the feared item and still remain relaxed. An example with adults in short-term treatment
for emotional difficulties might be to have group members visualize an activity that causes
moderate anxiety while also practicing music-assisted relaxation techniques. In this situation,
relaxation is incompatible with high levels of anxiety surrounding the visualized activity. The
music, when paired with the relaxation exercise, becomes associated with a relaxed state and can
be used in the future as a stimulus for relaxation.
A specific form of desensitization is systematic or progressive desensitization.
Therapists who wish to use systematic desensitization should acquire additional training in this
method. It involves helping the client to understand the rationale and learn to relax, then
constructing an anxiety hierarchy that ranks stimuli from the most to the least anxiety arousing.
The client is then introduced to the item on the hierarchy that arouses the least anxiety while
relaxing, then to closer and closer approximations of what is feared while remaining relaxed.
Chapter 13 Facilitating Client Responses 0 141
Eventually, it becomes possible for the client to be in the presence of the item that formerly
aroused the most anxiety without becoming anxious.
Reassuring
When reassuring, the therapist verbally assures the client about the consequences of the client's
actions. Reassuring may include expressions of approval of the client's statement, prediction of
outcomes (such as suggesting that, due to what the client has been expressing in the session,
some sadness may occur later), or factual assurance (such as telling the client that there are
proven ways to deal with a particular problem). Reassurance should be used cautiously, being
sure the client does not feel the therapist is discounting the seriousness of the problem and
recognizing that it may be understood as support for not changing.
Reassurance tends to decrease the client's feelings, and this can be useful in certain
music therapy situations. Since there are times when this is desired, reassurance can be a useful
intervention for music therapists, as long as they are conscious of when they are using it and
what effects it might have. As an example of a situation in which reassurance could be helpful, a
music therapist working with adults with emotional difficulties might find that her clients are
more upset about what they have been dealing with than she feels they have the skills to handle;
in addition, the session may be nearly over. While neither of these is an ideal situation, it can be
very useful at this time to use the skill of reassuring. The music therapist might say, "I can see
that many of you have very strong feelings about this issue, and it is good to be able to share
them as you have. I think that, based on what you have been sharing, you will feel better having
worked on these feelings here and will be calmer this evening." Again, this is not necessarily the
most desirable outcome for the session, but reassurance can help reduce the emotional intensity
and the client's reactions to experiencing these emotions afterwards. It would be important in this
situation to inform others involved in the treatment of the group members that strong emotions
were raised in the session, and that there may be lingering effects.
Relaxation Training
Relaxation techniques may be taught to a client to help deal with responses to stress. Some of
them may help with desensitization, as described above. Relaxation techniques are often
combined with music (Hanser, 1985; Scartelli, 1989; Shultis, 1997).
Another example of using relaxation in a music therapy setting might be to provide a
class of children with a time in their day for structured relaxation training. The training might
involve instructions given by the therapist or on tape that provide for deep, slow breathing, and
systematic tensing and relaxing of major parts ofthe body, supported by slow background music.
Relaxation skills learned during such training can transfer to other parts of their lives as well.
Therapist Responses That Are Not Helpful

Bolton (1979) describes barriers to communication in three categories: judgment, sending
solutions, and avoidance of the other's concerns. We are presenting these here so that music
therapy students will be aware of these pitfalls and avoid them. When things do not go well in a
session, it can be useful to reflect on whether you inadvertently put up of one of these barriers.
It is important to note that some of these specific responses (for example, diagnosing if
you are not licensed to do so) go beyond being not helpful and may be considered illegal. Some
are actually identified as forms of abuse (for example, criticizing, name-calling, and threatening
are generally considered to be forms of psychological abuse).
Judgment
Some therapist techniques may lead to a client feeling judged. There are times when we, as
humans, do feel judgmental of people, whether we encounter these people in our daily activities
or in our work as music therapists. When this happens, we should remember that our role as
therapists is not to judge and we should do our best not to judge our clients. In addition, we need
to look into ourselves to see where these reactions, a form of countertransference, are coming
from. Judgments include the following:
Criticizing: Making a negative evaluation of the other person, his or her actions, or
attitudes.
Name-calling: Putting down or stereotyping the other person.
Diagnosing: Analyzing why a person is behaving as he or she IS; playing amateur
psychiatrist.
Praising evaluatively: Making a positive judgment of the other person, his or her actions,
or attitudes.
Sending Solutions
In most therapeutic situations, our role is to help the client find solutions, not to impose our own
solutions. Examples of sending solutions are listed below:
Ordering: Commanding the other person to do what you want to have done.
Threatening: Trying to control the other's actions by warning of negative consequences
that you will instigate.
Moralizing: Telling another person what he or she should do; preaching at the other.
Excessive or inappropriate questioning: Closed-ended questions are often barriers in a
relationship; these are those that can usually be answered in a few words-often with
a simple yes or no.
Advising: Giving the other person a solution to his or her problems.
Avoidance of the Other's Concerns
As therapists, we must remember that the concerns that the client presents are the focus of the
therapy, whether or not we feel that they are important or can be dealt with. The important thing
is that they are important to the client. The following are ways in which a therapist may avoid the
concerns of the client:
Diverting: Pushing the other's problems aside through distraction.
Logical argument: Attempting to convince the other with an appeal to facts or logic,
usually without consideration of the emotional factors involved.
Reassuring: Trying to stop the other person from feeling the negative emotions that he or
she is experiencing.
Musical Facilitation
Since much of what music therapists do deals with nonverbal behavior, including musical
responses, music therapists must also be proficient at responding nonverbally. Many of the
responses described in this chapter can also be performed musically. Although music therapists
can benefit from learning nonverbal responses that are similar to the verbal responses described,
we are focusing this section on a particular type of nonverbal facilitation, musical facilitation.
Bruscia (1987) identifies 64 clinical techniques utilized in improvisational music
therapy, most of which are nonverbal. He classified the specific techniques into nine distinct
groupings: techniques of empathy, structuring techniques, techniques of intimacy, elicitation
techniques, redirection techniques, procedural techniques, emotional exploration techniques,
referential techniques, and discussion techniques. Many of his discussion techniques are
described indirectly earlier in this chapter. Here are some examples:
• The description of encouraging communication is similar to Bruscia's discussion
techniques of probing (asking questions to elicit information) and clarifying (getting
the client to verify information that has been offered);
• The description of reflecting and sharing is comparable to Bruscia's discussion
technique of disclosing (wherein the therapist reveals something personal to the
client during a session);
• The description of interpreting is similar to Bruscia's discussion technique of the
same name, interpreting (providing possible explanations for certain experiences of
the client);
• The description of confronting, giving feedback, and changing cognitions is similar
to Bruscia's discussion techniques offeedback (stating how the client might appear)
and confronting (pointing out possible contradictions in the client's responses).
While many of the techniques (such as imitating, repeating, completing, calming, and
pausing) in the other groupings may appear to be verbal techniques based on what they are called
and could indeed be implemented verbally, Bruscia presents them as musical techniques,
providing brief as well as more detailed descriptions of how to implement the techniques and
identifying specific clinical outcomes toward which each may be most applicable. Remember
that these techniques are specifically identified and described within an improvisational context
and that they are more often used in combinations rather than in isolation. A brief summary of
the remaining groupings, as stated above, is offered.
When implementing techniques of empathy, the therapist may imitate or synchronize
with what the client is doing or match the client's energy level. The therapist may also try to
express through his or her music the same mood or emotion that the client is expressing, or may
exaggerate something distinctive about the client's response.
Structuring techniques are utilized when the therapist strives to establish rhythmic
stability by providing a stable beat or a tonal center or harmonic ground for the client's
improvising, as well as helping to define phrasing.
Techniques of intimacy include having the therapist share instruments with the client or
provide a musical gift such as a performance. The therapist may develop a short piece that serves
as a theme for the relationship and may at times create lyrical improvisations as if talking to him-
or herself about the client.
Elicitation techniques provide opportunities for the therapist to model certain skills for
the client to imitate or to present a repeating rhythm or melody, encouraging a similar response
from the client. After a structure (rhythmic, melodic, lyrical, and so forth) is established, the
therapist may leave spaces within the structure in which the client can respond or, in contrast,
may wait for a break in the client's improvisation and fill in the gap. The therapist may establish
a musical question-and-answer or tum-taking structure within the improvisation or extend the
client's response by adding something to the end of it.
When implementing redirection techniques, the therapist may introduce changes in the
music (rhythmically, melodically, lyrically, tonally, metered) or play music that is different yet
compatible with the client's music. Increasing or decreasing the dynamics, tempo, or rhythmic or
melodic tension of the improvisation may regain the client's focus, as can interrupting or
presenting instability.
Procedural techniques are indicated when the therapist decides to institute more
instructional approaches, having the client shift from one modality to another or having him or
her pause at specific points in the improvisation. The therapist may provide a general structure
and have the client experiment with improvising within the structure, or the therapist may assume
the role of conductor and even have the client rehearse a particular improvisation and then
perform and or record it.
Referential techniques may be effective in establishing context and carryover. The
therapist may pair different musical motifs with specific client responses each time they occur in
a session. The therapist may suggest that the client use something musical to represent something
else or have the client recall a particular event and reproduce it in an improvisation. Free
association exercises, fantasizing, and storytelling can also be introduced.
Finally, emotional exploration techniques are indicated when the therapist works to
provide opportunities for the client to explore and expand his or her range of emotional
experience. The therapist may improvise in such a way as to contain the client's feelings as they
improvise together or to express feelings that the client is struggling to acknowledge. The
therapist may have the client explore emotions by improvising opposite feelings and then find
ways within an improvisation to move from one type of feeling to its opposite. The therapist may
suggest that the client put components of an improvisation in a particular sequence or swap
various roles with the therapist while improvising.
Music is an essential facilitator in the music therapy session. The role of music is
expanded upon in the next chapter, The Role of Music.
For Further Reading

Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International
Universities Press.
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford.
Benjamin, A. (1987). The Helping Interview (3 rd Ed.). Boston: Houghton-Mifflin.
h
Brammer, L. M., & MacDonald, G. (1999). The Helping Relationship: Process and Skills (i
Ed.). Boston: Allyn and Bacon.
Carkhuff, R. R. (2000). The Art of Helping in the 21 st Century (8 th Ed.). Amherst, MA: Human
Corey, M. S., & Corey, G. (1998). Becoming a Helper (3 rd Ed.). Pacific Grove, CA: Brooks/Cole.
th
Egan, G. (1998). The Skilled Helper: A Problem-Management Approach to Helping (6 Ed.).
Pacific Grove, CA: Brooks/Cole.
Homme, L. (1970). How to Use Contingency Contracting in the Classroom. Champaign, IL:
Research Press Co.
Morris, K. T., & Cinnamon, K. M. (1975). A Handbook of Non-Verbal Group Exercises.

Springfield, IL: Charles C. Thomas.
Pierce, W. D., & Cheney, C. D. (2004). Behavior Analysis and Learning (3 rd Ed.). Mahwah, NJ:
Lawrence Erlbaum.
Prochaska, J. 0., & Norcross, J. C. (1999). Systems of Psychotherapy: A Transtheoretical
Analysis (4 th Ed.). Pacific Grove, CA: Brooks/Cole Publishing Co. See Chapter 9, Behavior
Therapies.
Rider, M. (1997). The Rhythmic Language of Health and Disease. St. Louis, MO: MMB Music.
Sulzer-Azaroff, B., & Mayer, G. R. (1991). Behavior Analysis for Lasting Changes. Ft. Worth,
TX: Holt, Rinehart & Winston.
Wolpe, J. (1990). The Practice of Behavior Therapy (4 th Ed.). Elmsford, NY: Pergammon.
Assignments-
Facilitating Client Responses

1. Think about the sessions where you have observed and assisted. Recall any of the helpful
therapist responses listed in this chapter (listening and understanding, encouraging
communication; reflecting and sharing; interpreting; giving feedback, confronting, and
changing cognitions; sharing information; changing behavior; reassuring; relaxing) that the
therapist or you as participant used. List and discuss the ones that you have observed, noting
the resulting responses of the clients.
2. Of the techniques described for Changing Behavior (modeling, reinforcement, extinction,
punishment, contracting, desensitization or counterconditioning, reassuring), note any that
you see the therapist in charge of your session using. (Be aware that therapists who do not
feel that they use behavior modification may still employ some of these techniques.) List
these techniques and also write how the clients respond. Then note the therapist's next
response. Analyze the sequence in terms of what you have learned about the purposes and
predicted effects of these techniques.
3. Choose two verbal facilitation techniques and practice using them in your everyday
interactions and in your music therapy sessions. Write down the situations in which you use
them and how others respond to you. Do this over a period of days and note whether you
become more effective in using these techniques.

1. Of the therapist responses that are listed in this chapter as being helpful, look at any that you
see yourself using. Write and discuss which ones you observe, noting the responses that the
clients make in return.
2. Choose two verbal facilitation techniques. Plan how you will incorporate them into your
music therapy sessions, then practice using them during the sessions. After the sessions,
analyze what you said and how the clients responded and draft a plan for gradually
increasing your skill in facilitating verbal responses.
3. Look at any therapist responses listed as not being helpful (judgment, sending solutions,
avoidance of the other's concerns, reassuring) that you see yourself using. Write down and
discuss which ones you observe, noting the responses that the clients make in return.
Develop a plan to decrease your not helpful responses in these categories. Write it out and
enact it over several of your clinical sessions. Evaluate your success with changing these
behaviors and make plans to work on additional problem behaviors.
4. Choose a musical facilitation technique that was presented in this chapter. Think of a music
therapy situation in which use of the technique could be useful. Then practice the technique
on your own. Finally, find someone who will role-play with you and practice using the
technique in this situation. Do this in several different situations until you are comfortable
using the technique.
Level III-Leading
1. Choose three verbal facilitation techniques that are different from those used in the previous
set of assignments. Plan how you will incorporate them into your music therapy sessions,
then practice using them in the sessions. After the sessions, analyze what you said and how
the clients responded and make a plan for gradually increasing your skill in facilitating verbal
responses.
2. Incorporate one of the techniques for Changing Behavior (modeling, reinforcement,
extinction, punishment, contracting, desensitization or counterconditioning, reassuring) that
you have not yet used into your session. Plan which one you will use and how you will
incorporate it. Note the responses of the clients to the technique. Following the session,
analyze what occurred and make a plan for using the technique again in the next session. If
you think that you could have used it more effectively, include ideas for how to do this in
your plan.
3. Choose a musical facilitation technique presented in this chapter and make a plan to
incorporate it into your session. Before you use it in your session, practice the technique on
your own and role-play using it with a partner. After you use it in your actual session, note
what occurred and plan for making whatever changes are necessary in upcoming sessions.
After each session, note what you did, how successful it was, and the responses of the
clients.
4. Review what you are doing in your music therapy sessions. Go over the categories of
responses and techniques that have been discussed in this chapter and used in these
assignments. Which helpful responses are you using and which techniques for changing
behavior are you using? Analyze your session and make a complete list of these. Are you
using any responses or techniques that are not helpful? Make a written plan for continuing to
increase your use of helpful responses and techniques and decrease your use of any unhelpful
responses and techniques. Review your plan periodically in order to remain cognizant of the
development of your style of responding to clients and situations that arise in sessions.
The Role
of Music
Music has been a part of people's lives throughout history and in all cultures. Thanks to modem
electronics, music has taken a different role in our lives today. It helps us to integrate our lives
and is a significant part of our life histories. The prevalence of music in everyday life has
changed our relationship with music-creating music habits (Ruud, 1998).
Music is a medium that does not lend itself easily to interpretation; it has an impact at the
affective and physical level. Its primitiveness can have an enormous effect on clients for whom
verbal interpretation is impossible (De Backer & Van Camp, 1999). The therapist holds the
responsibility to choose music for clinical intervention and may choose with a focus on the
individual, systems, behaviors, attitudes, and relationships (Stige, 2002).
The role of music is at the heart of our music therapy work. The therapist's view of the
role of music is based on his or her theoretical understanding. Authors in music therapy have
described many roles for music in clinical treatment. Some focus primarily on the aesthetic
qualities of the music and its role in connecting us to a universal order while others give primary
attention to how music connects us with others, for example, our relationships with key
individuals in our lives and our music-based community bonds. Additionally, music serves to
connect us to ourselves and to our place within our community and culture. Music is a resource
that enriches our quality of life in these and many other ways.
Boxill (1997) speaks of the importance of music, defining music as "a basic essence of
the universe and esthetic means of expression with the extraordinary power to reach the human
organism on all levels-the mind, the body, the soul; it has the power to heal, to expand
conscious awareness, to stimulate the full spectrum of emotion and feelings" (p. 10).
Ruud (1998) articulates the roles for music in music therapy. He believes music plays an
important role in the construction of identity. Music can serve as raw material for building value
and life orientation and as a way to anchor important relationships, frame our experience in a
certain time and space, and position ourselves within our culture and thus make explicit our
ethnicity, gender, and class. Music also provides important peak or transcendental experiences
that may strengthen the formation of identity and help us to feel meaning, purpose, and
significance in our lives.
Engagement with music allows clients to experience the patterns of musical structure and
the boundaries it creates, along with the flow of emotional expression achieved through singing,
playing, improvising, creating, and moving and listening to music. D. Aldridge (1996) views art
forms, including music, dance, and visual art, as primarily concerned with the expression rather
than the stimulation of emotion. For Aldridge, music and its performance are parallel processes
to healthy living.
Clair (1996, pp. 11-23) offers an overview of the many uses of music in music therapy,
which can be viewed as the clinical roles of music. She suggests that music:
• Evokes a wide range of physical responses;
• Evokes related emotional responses;
• Facilitates social integration;
• Serves as form of communication;
• Communicates emotional expression;

• Evokes associations;
• Provides meaningful engagement;
• Relieves anxiety and stress;
• Structures experiences that elicit behaviors that require self-control and
responsibility;
• Offers accessible aesthetic experience.
Connections Through Music
To Aesthetics and Universal Order

The ability of music to produce experiences that we find difficult to put into words is an
important characteristic that music shares with other aesthetic media. An aesthetic experience
produced by music implies the possibility of creating a new category of experience, experiencing
the world in a new way. This provides one of the most basic rationales for the use of music in
therapy (Ruud, 1998). Aigen (1995) suggests that "aesthetic considerations are central to clinical
music therapy process" (p. 235).
Authors writing about the role of the aesthetics of music in clinical work find that
beauty itself can have a profound impact on the well-being of clients, while the patterns
and structure of music provide other equally powerful means of helping clients. Kenny
(1989) believes that music offers the client the opportunity to move beyond the known self. It is
within the beauty of the pattern in music that the client finds safety and is able to explore. Kenny
goes on to state, "The musical improvisation encourages a person to identify a pattern or way of
organizing which has personal significance and meaning for the musicmaker" (p. 33). Aigen
(1995) says, "A hallmark of aesthetic experience is a high degree of integration and meaning,
aspects [of] which enhance personality development, cognitive functioning, and social
interaction, which are, not incidentally, important clinical goals" (p. 237).
Thaut (2000) sees music as
a culturally based art form, an aesthetic medium, that expresses and embodies
patterns, forms, and symbols associated with the structures and rules of its
specific language. As such, music intrinsically communicates two meaningful
contents: (a) its own structure and patterns, built by the grammatical and
syntactical rules of abstract sound patterns, and, based on this, (b) the perceptual
values of the listener as to the aesthetic quality, cultural meanings, and personal
associations and experiences in the music. (p. 3)
Ruud (1998) espouses that "it is the poetic or aesthetic aspect of the musical
communication ... that can transform the improvisation into a therapeutic tool" (p. 118). It is this
participatory nature of improvisation that gives rise to a sort of meaning stemming from the
dialogical nature of musical interaction.
Chapter 14 Role of Music 0 149
To Others
All kinds of music around us can be seen as flexible maps of modem life worlds. These maps
change when context changes, affecting how we see ourselves in relation to the world around us
(Ruud, 1998). Because music is deeply embedded in our culture and world, it also plays a role in
the development of culture and society and links clients to it. Music may also be seen as raw
material for social life. For Ruud, it is the transformation of sound into symbol and the
accompanying experience that links people into communities and societies. Social organization
around aesthetic activities shows that communities are not built only by people sharing the same
house, work, socioeconomic background, or neighborhood. Stige (2002) sees this connection to
society in the way a therapist chooses music for practice. These choices, whether conscious or
unconscious, are linked to values, traditions, and practices.
If we accept Ruud' s premise that music therapy concerns social groups or society at
large, improvisational music therapy is like a miniature social system. The clinical setting-the
"laboratory of music therapy"-may be regarded as a place to model or construct some of the
tools the client needs to become involved in a larger social system. Music therapy can be used to
investigate how musical dialogue is developed and maintained through improvisational
techniques (Ruud, 1998).
Music also draws us into relationships. Much of the literature focuses on the tendency
for music to encourage the human system to organize. This often means that the therapist
chooses music that will draw the client into a particular type of organization, as seen in rhythmic
entrainment (Kenny, 1989). It is assumed that when the client sees the therapist's willingness to
entrain, or join in his or her sound representations, the client may be encouraged to be more open
to explore and entrain with the therapist'S rhythms, which ideally reflect healthy patterns (pp.
36-37).
Music may assist a client to reconnect to the world outside of him- or herself within the
context of the relationship with the therapist. De Backer and Van Camp (1999) describe this
phenomenon in depression and psychosis:
When time slows down and the body no longer has the energy to free itself from
gravitation-as in depression-or when time has stopped and the subject is
excluded from a symbolically shared experience-as in psychosis-it is often
solely music which succeeds in making a connection between the concrete
untranslatable musical sound and rhythm and the extinguished tempo of the
patient. As a child who is carried and contained by the musical exchange with
his/her mother during the first period of life, a depressive or psychotic patient
can only connect again with life through those same physical and affective
exchanges. (p. 16)
To Self
Music can connect one's identity to one's expression. Music therapists may use musical genres
that are associated with cultural or societal issues with parallels to a client's personal issues
(Ruud,1998).
Stige (2002) connects musical activities-including listening, playing, creating,
performing, interpreting, and reflecting-to artifacts-such as instruments, songs, words, and
metaphors used in the music therapy process-and argues that cultural artifacts are important in
a person's development of self and identity. Thus, a person's sense of self and agency is
constituted through internalization and creative use of cultural artifacts in social contexts. From
Stige's point of view, each musical experience is connected to the self and to society.
Singing can help clients access and express feelings while also providing them with an
experience that is creative and often pleasurable. Singing is a way to melt walls-walls that were
constructed initially to protect the vulnerable child or adolescent but are no longer necessary, that
now only serve to separate the individual from the vitality of the authentic self trapped within
and that isolate a person from the outer world and meaningful connections with others (Austin,
1999). When vocal improvisation is used, it may serve to (a) establish trust, (b) comfort and
soothe, (c) access unconscious memories and/or associations, (d) work through resistance to
feelings, (e) deepen feelings, and (f) help a client who has dissociated move gently back into his
or her body and become more emotionally present (Austin).
Austin (1999) describes specific vocal techniques that can help connect the client to his-
or herself. Mirroring is especially useful when a client needs support in finding his or her own
voice. This musical reflection provides encouragement and can assist in strengthening the
client's sense of self. Clients often report that the experience of being heard and answered in the
music results in a feeling of recognition and validation. Grounding occurs when the therapist
sings the root of the chords, thereby providing a base for the client's improvisation. The client
can then explore musically and return home for refueling. When singing a cappella or with
nonharmonic instruments, the therapist can hold one note and create a drone-like effect over
which the client can improvise.
Another important aspect of connecting with the self is the choice of instruments used to
make music, as this is one of many elements in the search for one's own musical expression.
Additionally, the client's choice of instrument reveals a lot about the unconscious symbolic
meaning that he or she attaches to the instrument. Of course, the symbolic meaning of
instruments can have a variety of possible interpretations, all of which are subjective. Certainly,
the choice of instrument is influenced by the previous experience and cultural background of the
patient (De Backer & Van Camp, 1999).
Improvisation may be a good metaphor for understanding the individual. We often start
from scratch, from some preliminary ideas. Although we may have some broader notions of
where we want to go, we can never be sure of either the route to follow or the final goal. When
improvising with another person, the music we make is influenced by others in a circular
manner-as are the plans that we make for life. In the process, we may find a new tempo,
transpose, take risks, and meet crises involving a possible breakdown in the improvisation-
much as in life. Through the process of improvisation, we may come up with a product in a
certain style and thus create our own piece of musical identity, much as our personal identity is
improvised and narrated (Ruud, 1998).
Involvement with music can produce a strong, flexible, and differentiated identity and is
a potential resource for obtaining a better quality of life (Ruud, 1998). Music may be a source of
social enrichment and may stimulate communication and intellectual curiosity, to name only a
few. If being involved in music generally strengthens our sense of identity and if having a strong
and differentiated sense of identity is connected to a higher quality of life, then it follows that
music contributes to health in general (Ruud).
Using Connections Through Music

In discussing the role of music in music therapy, Bruscia (1987, pp. 8-9,503-504; 1998a, p. 39)
makes a distinction between music as therapy and music in therapy. When the client's relation-
Chapter 14 Role of Music D 151
ship to the music is primary, music is used as therapy. When the client's relationship to the
therapist is primary, music is used in therapy. Regardless of which choice is made for a specific
client, music therapy is distinguished by heavy reliance on musical experience as the agent,
context, or catalyst for the therapeutic experience. Thus, it becomes imperative for the music
therapist to understand various dimensions of musical experience and how they become
therapeutic in nature. Music offers therapeutic benefits from both its active and receptive
qualities. When therapy is active, the client is involved in performing, improvising, or
creating music. When therapy is receptive, the client listens, takes in, or receives the
music itself.
Whether your clinical work involves the use of music as therapy or in therapy, it is
necessary to develop the music skills that will allow you to design and use musical experiences
that lead toward client goals. The next section explores ways in which these musical experiences
can be used.
Developing Clinical Musicianship

As you develop a base of knowledge about various client populations and their needs and
interests, it will become increasingly apparent that you will need to develop a broad range of
musical awareness and skills. Each population and every individual served demands different
music and music experiences. Perhaps the best place to begin is to take time to examine your
own relationship with music, your musical preferences and dislikes, your musical strengths and
needs, and your use of music in your personal life.
When working with musical instruments, keep in mind that choice plays an important
role. The instrument selection of the music therapist immediately reveals something about the
possibilities and the limitation in his or her practice. It also indicates how he or she views music
as a medium, observes the client, and so forth (De Backer & Van Camp, 1999).
We will consider the development of clinical musicianship as it applies to the four main
experiences in music therapy-improvising, performing or re-creating, composing, and
listening-described by Bruscia (1998a) and in Chapter 8-11. As you consider them this time,
think about them in personal terms, as they apply to you. This is a step in expanding your musical
awareness.
Improvising Experiences
For the client, the clinical outcomes of improvising experiences may include the development of
nonverbal communication skills, the exploration of self in relation to others, the creation of an
outlet for self-expression, and experimentation within structure (Bruscia, 1998a). The value of
developing your own improvisation skills outside of the therapy setting cannot be overstated-in
a therapy session, a music therapist must be able to experiment within structure each time
instantaneous revisions must be made to the existing session plan. Appreciate that improvisation
is far more than just a way of playing music-it is a basic skill in the therapist's interaction with
the client.
Discussing piano improvisation in a purely musical sense, Chase (1974) said:
Free improvisation is a pleasure that has been denied to too many musicians. It is
often one of the first things that will be discouraged in a child. This denial is
usually based on the idea that there is a prescribed and "correct" way to use the
piano, and unless the child has mastered that, she has no right to use her own
ideas. If a child is not intimidated at a young age, she can enjoy discovering all
kinds of sound patterns on an instrument. She can develop a tremendous sense of
freedom with the instrument and with her own expressiveness. It will give her a
sense of friendship and intimacy with the instrument that can be acquired in no
other way. (p. 67)
Chase (1974) goes on to state:
Once you have discovered the pleasure of this free experimentation, enjoy it and
don't censor or judge yourself because you will only lock up your creativity
again. If you do not like what you hear, do not let yourself interfere with the
process. Eventually, when you stop thinking and evaluating and can just let it
happen, you will find that you have reopened an avenue for more interesting
creations to come to the fore. (pp. 70-71)
The beginning stages of developing improvisation skills can be intimidating. Start with a
simple structure and call on your own creative instinct. Maslow (1999) characterizes this as a
childlike sense of the world that is open to experience and is spontaneous and expressive. This is
natural in children and is found in self-actualizing, creative persons. Maslow postulates that these
qualities are either retained from childhood or regained in those who are able to express
themselves without fear of ridicule. He believes this to be a fundamental, inherent characteristic
of human nature. As you work on your improvisatory skills, allow yourself to regain this way of
knowing music.
Performing or Re-Creating Experiences

For the client, the clinical outcomes of re-creating experiences may include the development of
interpretive skills; the improvement of interactive and group skills; and the enhancement of
sensorimotor, attention, and memory skills. These experiences include singing, playing
composed music, engaging in musical games and musical shows, and conducting a group in
music making (Bruscia, 1998a).
The therapist must develop the ability to design and implement these musical
experiences in order to engage the client and facilitate participation that addresses the client's
goals. This includes skill in sequencing tasks, giving clear directions, providing cues and
assistance, and assessing the experience and making necessary adjustments to maximize
successful music making. In order to develop these skills, it may be useful to note the steps
involved when you are engaged in a re-creative musical experience in a class or other musical
group. Practice using these skills whenever you have the opportunity.
Composing Experiences
For the client, the clinical outcomes of composing experiences may include the development of
organizational and planning skills; the improvement of the ability to document and communicate
inner experiences; the refinement of the ability to sequence, integrate, and synthesize parts into
wholes; and the promotion of self-responsibility (Bruscia, 1998a).
Chapter 14 Role of Music 0 153
Here, as with improvising, you must allow the spontaneous, creative nature you were
born with to rise to the surface. Composing may have some specific musical rules, but most
important is that you learn to compose freely in order to prepare yourself to assist others in
learning to compose creatively.
Listening Experiences
The clinical outcomes of listening experiences for the client may include: stimulation or
relaxation; evoking affective states, imagery, and fantasies; facilitating memory and
reminiscence; and stimulating peak and spiritual experiences (Bruscia, 1998a). When therapy
involves listening to music, it is essential to consider whether the music has the aesthetic
qualities needed to motivate the client to engage in the therapeutic process, as well as whether it
has the physical and psychological qualities needed to induce positive changes (Bruscia). In other
words, the music selected for listening experiences should have qualities that make it worth
using. The musical knowledge that music therapy students acquire through their training provides
the basis for selecting music with the aesthetic, physical, and psychological qualities that are
desired.
Consider keeping a personal listening journal, in which you can write about the
following:
• When do you listen to music?
• Where do you listen to music?
• What music do you listen to?
• What purposes/outcomes do you hope to accomplish?
• What other sorts of activities or tasks do you engage in while listening to music?
• Do you share music listening experiences with others? If so, with whom and why?
Chase (1974) discusses the value of recording your own playing, suggesting that it is "an
excellent source for self-teaching. It reflects your playing back to yourself, for in listening to the
recording, the discrepancies between your wishful listening and your playing will be revealed"
(p. 38). In undertaking this process, you allow yourself the luxury of capturing all the nuances of
your increasing personal and clinical musicianship and the opportunity to identify themes for
future development.
Summary
This chapter has offered an overview of several theories about the role of music in music
therapy, framed within the understanding that music has three broad purposes, all related to
connection. First, music may be a means to connect us to something greater than the material
world-the aesthetic or universal order. Second, music may also connect us to the world around
us through relationships with cultures, groups, or individuals. Third, music offers us avenues to
connect more deeply to ourselves and to explore our inner world. As the therapist, you must
become fluid in your ability to work in each of these realms. This chapter offers suggestions for
exploring and developing your relationship with and skills in using music. Use the assignments
to access your own creativity and to develop the skills for providing therapeutic musical
experiences to your clients.
For Further Reading

Adams, N. (1996). Piano Lessons: Music, Love & True Adventures. New York: Delacorte Press.
Aigen, K. (2005). Music-Centered Music Therapy. Gilsum, NH: Barcelona Publishers.
Amir, D. (2001, June). How do we nurture ourselves? My personal journal with music. Voices: A
World Forum for Music Therapy. http://www.voices.no/columnist/colamir040601.html
Amir, D. (2001, July). Sometimes, it is our task to find out how much music we can still make
with what we have left. Voices: A World Forum for Music Therapy. http://www.voices.no/
columnistlcolamir300701.html. Reprinted in C. Kenny & B. Stige (Eds.; 2002), Contemporary
Voices in Music Therapy: Communication, Culture, and Community (pp. 242-243). Oslo,
Norway: Unipub Forlag.
Hesser, B. (2001). The trans formative power of music in our lives: A personal perspective. Music
Kenny, C. B. (1995). Listening, Playing, Creating: Essays of the Power of Sound. Albany, NY:
State University of New York Press.
Ristad, E. (1982). A Soprano on Her Head: Right-Side-Up Reflections on Life and Other
Performances. Moab, UT: Real People's Press.
Small, C. (1998). Musicking: The Meanings of Performing and Listening. Hanover, NH:
Wesleyan University Press.
Werner, K. (1996). Effortless Mastery: Liberating the Master Musician Within. New Albany, IN:
Jamey Aebersold Jazz.
Assignments-The Role of Music

1. Keep a personal listening journal, as described above. Include the following:
• When do you listen to music?
• Where do you listen to music?
• What music do you listen to?
• What purposes/outcomes do you hope to accomplish? (Your purpose may be as simple as
enjoyment.)
• What other sorts of activities or tasks do you engage in while listening to music?
• Do you share music listening experiences with others? If so, with whom and why?
2. Keep a music awareness journal, outlining your encounters with music in the world around
you. Include the following:
• Where are you when you become aware of music?
• What are you doing?
• What draws your attention?
• How does the music affect you?
• Do you have control over the music?
Chapter 14 Role of Music D 155
• Do you want to experience the music or would you prefer to have the option to change or
stop it?

1. Consider the four main experiences in music therapy (improvising, performing and re-
creating, composing, and listening) as described by Bruscia (1998a), but this time, think
about them in personal terms. Do a self-assessment that includes: (a) your personal
experience with each type of experience; (b) your experience as a beginning music therapist
with each type of experience; (c) what you can do to become more familiar with and
comfortable using each type of experience.
2. Describe in detail how you have designed and implemented one of the music experiences
described above. In describing it, note when you had difficulty, when it was easy or
comfortable, and when you were enjoying the musical experience yourself.
Level III-Leading
1. Consider the connections between improvising, performing or re-creating, composing, and
listening experiences. Practice the following exercise:
• Begin with a simple structure within which you can improvise;
• As you continue to develop your theme, notice how you naturally engage in re-creating
it, exploring different colorations in it each time you explore it;
• Experiment with emerging themes over a series of sessions or days, and notice how it
takes on a sense of structure so that you can utilize it at will (or as a situation in therapy
dictates); at this point, notate it;
• Record it for your own review to uncover its strengths and potentials, or use it in a
setting in which you may not have access to the necessary equipment and instruments,
ultimately providing a listening experience for your clients;
• Write about this experience.
2. Look again at the self-assessment that you did in the assignment in Level II. For each type of
musical experience (improvising, performing and re-creating, composing, and listening),
evaluate how your personal experience and your experience as a beginning music therapist
have changed over time. What have you done to become more familiar with and comfortable
using each type of experience? Write out a plan to develop the areas in which you would like
to make greater progress.
Working With
Groups
Much music therapy takes place with groups of people. There are a number of reasons for this.
Some of them are economic-it is less expensive to treat people in groups, and one music
therapist can see more people when they are seen together. But there are reasons unrelated to
economics why music therapy is done in groups. The most important reason for treating people
in groups is that, since we lead much of our lives in social situations, many of the problems that
we encounter occur in social situations. So what better way to work on problems than in the same
arena in which we have the problems?
Of course, the other members of a music therapy group are probably not the people with
whom a client has a problem in real life. (An exception to this would be in a family music
therapy group, which typically includes some of the people with whom real problems are
encountered.) Here lies one of the most potent reasons that groups can be effective: They create
the safety and support necessary to help clients work through problems they encounter outside of
the group, thus helping them become healthier and more effective in real life. Many music
therapy groups are set up to do this.
Working with groups of a similar chronological age, such as we find in most schools, has
the benefit of presenting similar developmental challenges, which can help the music therapist
plan and work more effectively. In some special education settings, level of functioning is a
primary consideration, although age is also taken into account.
Various institutional settings may also consider age when placing people in groups. In
many inpatient and outpatient treatment settings for people with emotional difficulties, a person's
age is a primary consideration in the program to which he or she is admitted. It is quite usual to
have a treatment facility or unit for adolescents, one for adults, and one for older adults. And we
are all familiar with nursing homes, where most people are older, although some younger people
requiring extensive care (such as survivors of severe traumatic brain injury) may be admitted. As
with children in schools, age grouping brings people of similar socio-cultural backgrounds
together, while clients of similar ages are also more likely to be working on similar life tasks, for
example, groups of older adults dealing with aging and loss.
Sometimes people who function at similar levels are placed together. The consideration
may be what they are able to do or their developmental level. Sometimes, for instance, people
who need a high level of care stay in one part of a facility, while those who need less intensive
care are placed in another part.
In some settings, age and level of functioning are not the determining factors; people are
placed together when they have similar needs or characteristics. In schools, again, it is not
unusual for children with emotional difficulties to be placed together, those with communication
problems to be placed together, those with intellectual deficits to be placed together, and so forth.
(Such homogenous placement has decreased markedly in recent years with the belief that it is
better for children to be educated with children who are not classified as having problems-in
other words, in the mainstream or, as it is referred to most often, in an inclusion setting.)
Similarly, rehabilitation centers will often place people with spinal cord injuries in one area and
those with head injuries in another area. Finally, adults with addictions or with emotional
problems are often placed together. Even though people placed in groups have similar
characteristics, it is important to remember that within those groupings there will be different
needs and levels of functioning. Maslow (1999) devotes attention to this issue, saying:
To place a person in a system takes less energy than to know him in his own
right, since in the former instance, all that has to be perceived is that one
abstracted characteristic which indicates his belongingness in a class .... What
is stressed in rubricizing is the category in which the person belongs, of which he
is a sample, not the person as such-similarities rather than differences. (p. 141)
Two points should be made as we discuss separating people by age, level of functioning,
and type of problem. First is that all labels are potentially damaging and must be used with great
care. When we say that one person is "high functioning" while another is "low functioning," we
are using a label that may have a negative connotation and lead to results that we did not intend.
We must, therefore, use labels for the purpose for which they are intended but be very careful not
to rely too much on them. The second point is that more than one category or label can be
applied to all of us. If people are placed in categories by labels, it is important to realize that such
placement will only be partly accurate. A child placed in a group because of emotional
difficulties, for instance, may also have communication difficulties or be very gifted. Always
strive to remember that clients are complex individuals and not their labels or diagnoses.
Forming Music Therapy Groups

People will often be assigned to a music therapy group based on their participation in other
groups. For example, children who share a classroom for their educational activities may be
assigned to music therapy together, or a group of clients with psychiatric difficulties may have
music therapy scheduled at a particular time in their day. For reasons we've already discussed,
this can be a very effective division. An additional benefit is that the clients will already know
each other and may, as a result, be more comfortable working together.
Instead of grouping by age and characteristics, a music therapist may have the freedom to
identify people to include in a music therapy group. In such a situation, the music therapist
decides the basis for the grouping, then assesses the potential group members (often in
consultation with others who work with them) to determine group membership. This allows
people to be grouped for various reasons-perhaps because they are dealing with similar issues
or function at similar levels.
Other music therapy groups are formed based on who expresses an interest in music or
music therapy. This is how groups are often formed in treatment facilities for adults with
emotional difficulties and in nursing homes and other facilities for older adults. The advantage of
this method is that those who attend music therapy do so by choice.
Music therapists who work in community settings are likely to work with configurations
of people who are already part of a group. One of the advantages here is that working with
people in their natural environment enriches and builds on their community ties. Although music
therapists have worked in community settings for many years, a recent movement labeled
Community Music Therapy (Ansdell, 2002; Pavlicevic & Ansdell, 2004; Stige, 2002) is defining,
developing, and popularizing this work and helping music therapists to understand their role and
the role of music therapy in the community.
Chapter 15 Working With Groups D 159
Short-Term Treatment
Another consideration in forming music therapy groups is whether the setting is long- or short-
term. This is not normally an issue in school settings for children, since most schools placements
are for at least a year, although it may be in other children's treatment settings. And it is not
generally an issue in nursing home placements or some other placements for older adults, since
these tend to be long-term placements. In rehabilitation, medical, and mental health settings,
though, many clients will be in the treatment facility for very short periods of time. Due to
philosophical, insurance, and other reasons, some clients may stay only a day or two, while even
those whose stays are relatively lengthy may be in treatment for only 3 or 4 weeks. The
philosophical reason for shorter stays is the belief that people are better off living in their normal
environment and receiving ongoing treatment there than living in an institution. The insurance
reason is that, with attempts being made to cut health care costs, institutional stays are closely
monitored and limited. The result of these shorter stays in certain treatment settings is that clients
are seen only briefly in music therapy.
Music therapy can be tailored for people with short-term stays. Music therapists can
often schedule clients more times per week than they might if the clients were there longer. In a
single week, for instance, music therapy might meet three or five times, thus accomplishing goals
in a more compact form. The goals of short-term treatment may be quite different from goals in
long-term treatment, often focusing on crisis intervention, restoration of functioning, and helping
clients access resources in the community for further treatment and support.
Methods and expectations must also be adapted to short-term treatment. What is to be
accomplished must be accomplished more quickly, at times within a single session. This changes
much of the process of therapy, with assessment needing to occur very quickly within the
session, methods being easily comprehensible, and evaluation occurring on an ongoing basis.
Music therapists working in short-term settings become skillful at adapting to new
clients. With turnover occurring so quickly, people often attend the music therapy session
without the therapist being acquainted with their problems, history, and interests, all of which
would be available in a long-term setting. Students who work in short-term treatment settings,
often spending only a few hours or days at the facility, find special challenges in working with
clients about whom they have limited previous knowledge. In these settings, it becomes
imperative for the student to maintain ongoing communication with the on-site supervisor in
order to provide music therapy experiences that are meaningful and appropriate for the clients.
Level of Structure
Music therapy groups may be organized in various ways. To clarify some of the differences, it
can be helpful to view music therapy groups according to the level of structure and extent of the
direction provided by the therapist. A leader who uses a directive style leads (or directs) the
group, establishing the type of music therapy experience and leading group members through the
planned activity. One who uses a nondirective style provides little direction to the group but
allows and encourages the direction to emerge from the group itself.
Although it can be useful to consider group leadership in terms of how directive or
nondirective it is, there are also difficulties with doing this. One is that many groups include
elements of both leadership styles. Another is that sometimes a person uses elements of one style
on one occasion and the other style on another, making it impossible to classify the leadership
style as directive or nondirective.
Groups with leaders who use a directive style of leadership will often fall into the
categories of activity therapy (Wheeler, 1983) or supportive, activities-oriented music therapy
(Unkefer & Thaut, 2002). Some of these concepts are related to material that was presented in
Chapter 12, Further Considerations in Planning.
Much of the literature on working with older adults refers to groups with directive
leadership. Clair (1996), citing literature indicating that social activity, personal control, and
opportunities to increase their knowledge and skills are helpful in promoting a sense of well
being in older adults, recommends activities that
(1) Promote social interaction with others, (2) offer opportunities to make
decisions and manage choices, (3) present occasions to learn or relearn
information or skills, and (4) provide opportunities to discover novel ways to use
personal resources. (p. 33)
Clair goes on to suggest that participation in music offers all of these and more. These goals and
ways of thinking about therapy lend themselves to an activity therapy style of working. Chavin
(1991), writing about the use of music to reach people with dementia, also cites goals and ways
of working within an activity therapy approach to music therapy.
Another example of a group in which the music therapist took a directive role in
leadership is by M. Cassity (1976), who studied the influence on peer acceptance, group
cohesiveness, and interpersonal relationships of a music therapy group in which clients with
psychiatric difficulties learned to play the guitar. The therapist, who was teaching participants to
play the guitar, no doubt used a directive leadership style.
While some groups can benefit from planned activities and strong guidance, keep in
mind that, with a directive style, the group comes to depend upon the therapist to keep the group
going and make group decisions. If the therapist is trying to get group members to take increasing
responsibility for what occurs in the group, a less directive approach should be used.
Many music therapy groups follow procedures planned by the leader or facilitator, with
the purpose of this sequence being to elicit musical and nonmusical responses from the group
members. The procedures are intended to facilitate the work of the group. This style of group
leadership is not as directive as those described above in that the leader does not typically direct
everything. However, it may be quite directive in how the group is structured, leading the group
to be a combination of directive and nondirective. The groups described in the next paragraphs
are examples of this type of group, where several experiences are structured to assist the group
members in working on their goals.
Plach (1980) uses this format, incorporating a sequence of experiences, in The Creative
Use of Music in Group Therapy when he describes a group in which a song is used to stimulate
discussion, personal work, or group process. Wolfe, Bums, Stoll, and Wichmann (1975) use the
same format in a collection of procedures for eliciting discussion on various themes in music
therapy groups.
The group vignettes described by Borczon (1997) in Music Therapy: Group Vignettes
include elements of this format, with the musical activity providing a focus for the later
development of the group. Borczon describes a number of vignettes, which give a sense of the
richness of material that can be a part of a music therapy group. He also makes the point that
group sessions are comprised of an opening, a main portion (the one that most writers speak of),
and a closing.
Many music therapy groups are based on improvisation. As described by Dvorkin
(1998), these groups utilize music improvisation and clients' reactions to the improvisation. The
Chapter 15 Working With Groups D 161
therapist in these groups has an important role in facilitating the improvisation and verbal
processing of the experience (when that occurs). Facilitators of groups that utilize improvisation
may be directive or nondirective or use elements of both. Analytical Music Therapy (Priestley,
1975, 1994) may also use group improvisation and may employ a less directive approach.
A leaderless group is the most nondirective type of group experience. Although this is
not a typical music therapy format, it is theoretically possible. Even in a leaderless group, leaders
tend to emerge in order to help the group function.
Stages of Development
Groups evolve through various stages over time. These stages have been identified in various
ways but generally include the same basic sequence. The four stages, as identified by Corey,
Corey, Callanan, and Russell (1992), are: the initial stage, the transition stage, the working stage,
and the final stage.
During the initial stage, trust is developing and members (as well as the leader) are
dealing with anxiety over what the group will entail. Members wonder how to get involved, may
be concerned about outcomes, and begin developing roles, forming power structures, and testing
the leader and other members. During the transition stage, group members learn to recognize and
deal with anxiety, resistance, and conflict. Members must learn to monitor their feelings and
reactions and to express them. The leader at this stage must develop interventions that help a
group become a cohesive unit. During the working stage, the work of the group, or the purpose
for which it has been formed, is accomplished. Characteristics of this stage are that members are
usually eager to initiate work or to bring up themes and are willing to interact with one another,
including having confrontations. This stage is characterized by a here-and-now focus. Members
can usually identify their goals and concerns and take responsibility for them. Group cohesion
increases during this stage. Termination occurs during the final stage. During this time, members
complete any unfinished business and prepare for the ending of the group. They also make plans
to continue to deal with issues and receive support when the group no longer exists.
The Corey et al. (1992) model deals with termination as an important part of therapy.
This significant phase of the therapy process is often neglected but is important and should be
given consideration. McGuire and Smeltekop (1994a, 1994b) did a review of the literature on
termination of therapy and developed a model that is appropriate for termination in both group
and individual music therapy. It includes the following sequence: (a) termination announcement,
(b) review and evaluation, (c) expression of feelings, (d) projections into the future, and (e)
saying goodbye. Music therapy students are encouraged to pay attention to this stage, which can
sometimes be difficult to deal with because of our own feelings, as well as those of our clients,
about ending therapy. It is precisely because of these feelings that the termination of therapy
should be acknowledged and addressed.
Stages of music therapy groups have been dealt with only occasionally in the music
therapy literature. Hibben's (1991) group followed a similar progression to the one above. She
describes the stages of development of a group of 6- through 8-year-old children with attention
deficit hyperactivity disorder, utilizing three stages of group development posited by Garland,
Jones, and Kolodny (1976). The group began in the pre-affiliation stage, during which children
were acting as individuals but not yet functioning as a group. When they moved into the power
and control stage, they began to jockey for positions in the group; during this stage, the therapist
gave control to the children as much as possible. In the third stage, the intimacy stage, the
children began using the group to practice new behaviors. During this latter stage, "the
therapist's aim was to move the children to take more responsibility for the group activities, to
urge them to make the rules, to be the leaders, and to share their intimate selves" (Hibben, p.
183). Hibben's description of group process and stages is significant in that it follows the typical
progression described in the literature. This occurred because she was nondirective enough to
allow the group to develop as it needed to and also aware enough of group development that she
allowed and facilitated the needs of the members at each stage.
James and Freed (1989) proposed a five-stage model to develop group cohesion in music
therapy:
Stage 1: Goal-setting activities,
Stage 2: Individual/parallel activities,
Stage 3: Cooperative group activities,
Stage 4: Self-disclosure activities,
Stage 5: Group problem-solving activities.
Their model is different from the others in that they appear to be providing a directive approach
to moving the group through stages rather than facilitating the group's own movement through
the stages. Although there is no report of this model having been tested, it might prove useful for
music therapists who work in a structured manner to help their groups move through various
stages of group development.
Others who have dealt with the progression of groups through stages have done it
theoretically but without detailed case examples from their practice. The models that they have
presented include one with five stages of development by Apprey and Apprey (1975), which may
apply to either individual or group therapy, and one with three stages by Plach (1980). Sandness
(1991) reviewed theoretical models of developmental sequences in music therapy groups.
Therapeutic Factors
Yalom (1985, Chapters 1-4) describes the primary factors that make the group expenence
therapeutic. The factors are listed below, with brief explanations of each.
1. Instillation of hope: Because people in a therapy group are at different points in the
process of becoming healthy, a new member (or one who is struggling) can often be
encouraged by seeing the progress that others have made.
2. Universality: People often assume that they are the only person who has a particular
problem or trait; learning that others have similar concerns can be helpful.
3. Imparting of information: This includes didactic information about the illness or
resources for assistance, or information and advice that is often given by other
group members.
4. Altruism: People are able to help others in a therapy group and may benefit by being
helpful.
5. The corrective recapitulation of the primary family group: Many people have had
problems in their primary family group, and the therapy group offers an opportunity
to reenact some of these experiences and relationships in a healthier manner.
6. Development of socializing techniques: The social learning that occurs in therapy
groups can take place at many levels, allowing people to benefit at their level of
need.
7. Imitative behavior: Group members model their behavior after the behaviors of both
the therapist and other clients.
Chapter /5 Working With Groups D /63
8. Interpersonal learning: The relationships that develop through the therapy group,
the emotional experiences that are often a part of the group experience, and the fact
that the group can serve as a social microcosm all lead to unique opportunities for
social learning.
9. Group cohesiveness: The cohesiveness of the group influences and motivates
members to be accepted by others in the group, leading to behaviors and emotions
that are acceptable within the group culture.
10. Catharsis: The opportunity to experience intense feelings in a supportive
environment, to learn to express them, and for this expression to be acceptable, can
be valuable.
11. Existential factors: These include gaining awareness that life is sometimes unjust,
facing issues of life and death, and recognizing that pain is a part of life.
These factors describe qualities that might exist as a part of the group process or as a
characteristic of the therapist's approach to the clients. For example, instillation of hope may be
the result of interaction between and among group members or may come from the approach and
attitude of the therapist.
These are important factors. Some may be more be relevant to groups with relatively
nondirective leaders than to groups where the leader takes a very directive role. Some of the
factors, though, apply to all groups.
Principles of Working With Groups

Some elements of group work are similar to individual work while others are quite different. One
thing that students often find confusing is that, although the group will have group goals, it is
also necessary to work toward the goals of individuals within the group. Most of the primary
goals will usually be similar for the majority of the members, but the therapist must also be
aware of individual goals, since it is individuals that come to the group for help. Therapists have
various ways of determining and documenting these individual goals along with the group goals.
Plach (1980) suggests the following guidelines for planning and implementing music in
group therapy:
1. The chosen activity should be appropriately in tune with individual
symptomotology [sic], individual and group needs, and within whatever
conceptual, integrative, or physical limitations are existent within the group.
2. Music chosen for a session must take into consideration the cultural and age
factors existent within the group.
3. The amount of structure contained in the activity is contingent upon the
level of functioning of the group and its individual members.
4. The level of participation by the leader in the music activity is determined
by what the group needs to experience the activity to its fullest potential.
5. All individual and group responses to a music activity are valid responses.
6. Whenever appropriate, communicate immediate observations of behavior in
the music activity to the group and/or individuals in the group.
7. Whenever appropriate, refer back to the initial activity and group or
individual responses to the activity.
8. Whenever appropriate, explore within the group ways of integrating

newfound insights, behaviors, or skills into situations outside of the group.
(p. 12)
For Further Reading

Davies, A., & Richards, E. (2002). Music Therapy and Group Work: Sound Company. London:
Jessica Kingsley Publishers.
Friedlander, L. H. (1994). Group music psychotherapy in an inpatient psychiatric setting for
children: A developmental approach. Music Therapy Perspectives, 12, 92-97.
Murphy, M. E. (1992). Coping in the short term: The impact of acute care on music therapy
practice. Music Therapy, 11, 99-119.
Pavlicevic, M. (2003). Groups in Music: Strategies From Music Therapy. London: Jessica
Kingsley Publishers.
Summer, L. (1990). Guided Imagery and Music in the Institutional Setting (2nd Ed.). St. Louis,
MO: MMB Music.
Waldon, E. G. (2001). The effects of group music therapy on mood states and cohesiveness in
adult oncology patients. Journal of Music Therapy, 38, 212-238.
Wheeler, B. L., Shifflet, S. c., & Nayak, S. (2003). Effects of number of sessions and group or
individual music therapy on the mood and behavior of people who have had strokes or
traumatic brain injuries. Nordic Journal of Music Therapy, 12, 139-151.
Wilson, B. L. (Ed.). (2002). Models of Music Therapy Interventions in School Settings (2 nd Ed.).
Silver Spring, MD: American Music Therapy Association.
Wolfe, D. E. (2000). Group music therapy in acute mental health care: Meeting the demands of
effectiveness and efficiency. In Effectiveness of Music Therapy Procedures: Documentation
of Research and Clinical Practice (3 rd Ed.; pp. 265-296). Silver Spring, MD: American
Music Therapy Association.
Assignments-Working With Groups

1. If you are observing or assisting with a group, how was it formed? What or who determined
who would be a member of the group? If you do not already know this, speak with the music
therapist who is responsible for the group to explore the answers.
2. Is the person leading the group using a directive style, a combination of directive and
nondirective, or a nondirective style? Give your reasons for labeling the style as you have.
3. Go through the guidelines described by Plach and speak of those that you have seen in the
group. Discuss the observed effects on the group.
Chapter /5 Working With Groups 0 /65

1. How was the group that you are co-leading formed? What or who determined who would be
a member of the group? If you do not already know this, speak with the music therapist who
is responsible for the group to explore the answers.
2. Are you using a directive style, a combination of directive and nondirective, or a
nondirective style? State why you have chosen the style and why you have labeled the style
as you have.
3. Examine the group stages of your group using several of the frameworks outlined in the
chapter. Specifically, place it in the initial stage, the transition stage, the working stage, and
the final stage (Corey et a1.); you may use the stages described by Hibben if they seem to fit
your group better. Then look at the group according to the stages suggested by James and
Freed.
Level III-Leading
1. How was the group that you are leading formed? What or who determined who would be a
member of the group? If you do not already know this, speak with the music therapist who is
responsible for the group to explore the answers.
2. Are you using a directive style, a combination of directive and nondirective, or a
nondirective style? State why you have chosen the style and why you have labeled the style
as you have.
3. Go through the guidelines described by Plach and speak of how you have or have not
followed each in the group. If appropriate, look at the effects of following or not following
each guideline.
4. If appropriate to your group, describe the therapeutic factors (as described by Yalom) as they
apply.
Working With
Individuals
Music therapy can be done individually as well as in groups. The decision to assign a client to a
group treatment setting or an individual setting is based on a number of factors. First, consider
which setting will most effectively address the client's goals. Second, think about the kinds of
interventions you plan to use and how the structure of an individual setting will contribute to
those interventions as compared with the structure of a group. Most importantly, keep in mind
the disposition of the client-will he or she function better with individual attention, or will the
interaction and dynamics of a group setting be more conducive to growth?
Bruscia (1987) reports that certain models of improvisational music therapy employ only
an individual or only a group format, whereas other models implement the two formats at
different stages of therapeutic growth, and still others include clients in both individual and
group settings simultaneously. Whether in an individual or group setting, much of what happens
in therapy is similar. However, there are also important differences to consider when making the
choice of individual or group sessions. This chapter examines these considerations, focusing on
the use of music therapy with individuals.
Individual music therapy is indicated when a person has needs that can be worked
through more easily in an individual setting. These may be emotional needs; for example, a
person is too emotionally distressed over a major life change to attend a group right away. In this
case, individual work can build rapport and decrease the client's distress, leading to participation
in groups. In other cases, a person may require individual therapy prior to beginning group music
therapy-perhaps a child's behavior is too disturbed to allow participation in a group, but after a
period of individual music therapy, he or she is ready to join a group. Sometimes, it is simply the
case that the client cannot leave his or her room and so must be treated there.
There are times when it may be useful for a person to be seen in both individual and
group music therapy. In these cases, the therapist should consider whether to introduce the client
to an existing group or to develop a new group. Frequently, the familiarity of certain experiences
in individual therapy (for example, certain songs for greetings and goodbyes, the use of
dependable prompt sequences, the learning of pre-composed instrumental pieces) can allow
clients to feel a sense of commonality with other group members, even in their first group
seSSIOn.
Determining whether a client should be placed in individual or group music therapy is
one of the most important decisions a therapist makes. As a student music therapist, you may not
have the luxury of making these determinations, but you should certainly be sensitive to the fact
that a particular client may progress at a faster or slower rate depending on the therapeutic format
used. "Individual or one-to-one sessions are most appropriate: when the client is too withdrawn
or aggressive for working with other clients; when a relationship with the therapist is a priority
for treatment; and when the client needs privacy to work through problems" (Bruscia 1987, p.
510).
Therapists often find that individual therapy greatly increases the level of participation
for both the client and therapist. Additionally, it is often the case that the role assumed by the
music in the individual session takes on much greater importance, since there is less opportunity
for social conversation to occur as it naturally does in group therapy.
It is important for the therapist to consider adaptations to his or her style of leading when
working in individual therapy. In individual therapy, some clients may feel that there is a great
deal of pressure to perform or produce, as he or she is the only person there. Others may
welcome the opportunity for the individualized support and guidance; for them it is a freeing
experience, allowing greater opportunities for exploration and creativity.
Working with clients in individual sessions also raises the issue of establishing
appropriate boundaries, which are necessary for developing a successful therapeutic relationship.
Therapists must remember that the client is a client, not a friend. The client is in therapy to
address specific problems, work toward goals, and develop the skills to live more effectively in
daily life. Therapists must use caution when revealing personal information to clients, must not
accept valuable gifts from clients, and must not have contact with clients beyond the scope of the
therapeutic relationship. The AMTA Code of Ethics (American Music Therapy Association,
2003) outlines important boundaries for client relationships and serves as a guide for music
therapists.
In some clinical settings, a student music therapist may be assigned to work with an
individual early in the experience. This may be done so that the student can focus on the needs of
just one client before trying to accommodate the needs of an entire group.1
Some of the same considerations that are found in working with groups also apply to
individuals. One of these, level of structure, was discussed in Chapter 12, Further Considerations
in Planning, and in Chapter 15, Working With Groups. Another area, stages of development, is
discussed here in relation to individual therapy.
Stages of Development
Individual therapy goes through stages of development that are similar to the stages discussed for
groups in the previous chapter. There are many ways to conceive of stages of development in the
therapy relationship. Most of these take into account both natural development through stages
and the role of the therapist in helping to achieve what needs to be done at each successive stage.
A four-stage model of the helping process, with tasks to be accomplished in each stage,
is provided by Corey and Corey (1998). In the first stage, identifying clients' problems, therapists
help clients to define and clarify the problems that they would like to address in the context of
the therapeutic relationship. In the second stage, helping clients create goals, clients are helped
to devise new approaches to dealing with their problems. In the third stage, encouraging clients
to take action, therapists help clients plan and carry out action strategies for achieving their
goals. Finally, in the fourth stage, termination, the goal is to help the client to terminate the
professional relationship and continue to make the changes on his or her own.
Following is an example of applying this four-stage process. Sam, a medical patient, is
referred for assistance in coping with a lengthy hospital stay. The first stage, identifying the
problems, begins early in the first session when, as a part of assessment, Sam describes his
lengthy disability from a slip on the ice, which caused back problems. This injury led to surgery
1 Summer (2001) discusses supervising students working with individuals in a first practicum. Although her chapter is
aimed at supervisors, her presentation of the material might provide students with insights into clinical work with
individuals.
Chapter 16 Working With Individuals 0 169
that has now resulted in a need for painful rehabilitation to enable him to resume his normal
activity. The second stage, helping to create goals, is accomplished as Sam identifies his goal as
managing the pain of his rehabilitation exercises and coping with being confined in the hospital.
In the third stage, encouraging client action, Sam is taught to use music-based relaxation for
managing pain. He is also engaged in a songwriting experience in which he writes a verse about
what is happening to him, followed by a verse that describes his strengths for coping with the
realities of his hospital stay. Sam is encouraged to continue creating lyrics for use in future
sessions and given music to support his pain management practices. After several sessions, Sam
has developed the ability to create lyrics and melodies to express his feelings about his hospital
stay and to use music-based relaxation exercises to manage his pain. In the fourth stage,
termination, Sam processes the meaning of his hospital and music therapy experience and is
encouraged to continue using his new coping skills after discharge.
Bruscia (1987) suggests four main stages in the interpersonal process. In the first stage,
developing a relationship, the therapist and client find ways to work together. This includes the
therapist's work to develop trust and fulfill the client's immediate needs and the client's efforts
to find a comfortable way of expressing him- or herself and communicating with the therapist.
Conscious thoughts and feelings are explored at a surface level while unconscious thoughts are
explored after a trusting relationship has been established. In the second stage, conflict
resolution, the relationship that was established in the first stage is used as a means of exploring
and working through problems that are at the center of the client's being. During this stage, the
client works to bring these problems into awareness. Unconscious material is examined in depth
and new role behaviors are explored but not adopted. In the third stage, internalization, the client
masters and internalizes the insights and skills that were discovered in the previous stage. Role
behaviors are adopted and integrated into the personality. The client is able to make more active,
independent choices for his or her life, and the therapist is less active as a helper and serves more
as a supportive witness. In the fourth stage, autonomy, the client prepares for termination of
therapy. Relationships with significant others begin to supplant the need for the therapist. A
follow-up plan is agreed upon, and closure is achieved.
The musical process also unfolds through stages. The client first discovers and learns the
sensorimotor schemes of improvising and selects a sound vocabulary for playing and organizing
sounds in an intentional way. The sounds being explored become associated with events,
feelings, and people in the improviser's experience, leading the improviser to discover how
sounds can symbolize both inner experiences and aspects of the external environment. As the
improviser develops and repeats short patterns, he or she eventually needs to experience a more
complete expression of thoughts and feelings. While musical support from others is initially
needed, the improviser later gains control over his or her improvising and the music making
becomes less self-centered. With the increased ability to express him- or herself musically, the
improviser begins to desire to share music with others, leading to the need for greater
communicativeness. "Music becomes an effective satisfying means of expressing various aspects
of the self, meeting psychological and physical needs, and resolving emotional conflicts. Musical
interactions with others become a desirable way of learning role behaviors and developing
relationships" (Bruscia, 1987, pp. 571-572). Finally, as musical autonomy emerges and the
individual gains the ability to maintain his or her musical identity within a group, a personal
lifelong relationship with music is established.
Bruscia (1987) describes the stages of improvisational models, applied to both individual
and group music therapy. His book, Improvisational Models of Music Therapy, can be consulted
for help in understanding the developmental process of individual (and group) music therapy. In
his summary and synthesis of all of the models, Bruscia suggests that stages of growth in
improvisational music therapy can be seen in both the interpersonal and the musical process.
Principles of Facilitating
Individual Music Therapy Sessions
Although facilitating individual and group music therapy sessions have many things in common,
some principles that apply particularly to individual sessions are described below:
1. Base individual work on a comprehensive assessment that includes medical and
diagnostic information; family, job, educational, and social history; psychological
history and current state; musical history and preferences; current problems;
prognosis; team treatment goals; and anticipated length of treatment.
2. Use music that reflects the client's preferences and musical and social history or
cultural background.
3. Have a plan that addresses steps toward established goals but remains open to the
possibilities of emerging needs or changes in response patterns.
4. Monitor progress toward goals and collect data as appropriate to the setting.
5. Evaluate progress toward goals and revise at pre-established target dates.
6. Include other team members or family as is appropriate to the setting.
7. Be sensitive to needs which may be identified in music therapy but could more
effectively be addressed by another professional and make appropriate referrals.
8. When possible, include the client in treatment planning, evaluation, and goal
reVISIOn.
For Further Reading

Bruscia, K. E. (Ed.) (1991). Case Studies in Music Therapy. Gilsum, NH: Barcelona Publishers.
Hadley, S. (Ed.) (2003). Psychodynamic Music Therapy: Case Studies. Gilsum, NH: Barcelona
Publishers.
Hibben, J. (Ed.) (1999). Inside Music Therapy: Client Experiences. Gilsum, NH: Barcelona
Publishers.
Pavlicevic, M. (1999). Music Therapy Intimate Notes. London: Jessica Kingsley Publishers.
Tyson, F. (2004). Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson
(M. G. McGuire, Ed.). Gilsum, NH: Barcelona Publishers.
Wheeler, B. L., Shifflet, S. C., & Nayak, S. (2003). Effects of number of sessions and group or
traumatic brain injuries. Nordic Journal ofMusic Therapy, 12, 139-151.
Chapter 16 Working With Individuals D 171
Assignments-Working With Individuals

1. Consider the clients in your clinical placement. If a client is being seen individually, why
was the decision for individual therapy made? How do you think that he or she would
progress in a group? Write out your answers.
If your placement is with a group, choose one client and think about how the music
therapy would be different if he or she was receiving individual therapy. What would the
goals be? Do you think he or she would be showing different progress?
2. Consider the person selected in Question 1 in terms of the Principles of Facilitating
Individual Music Therapy Sessions presented above. How do they apply or, if you are
observing a group, how would they apply to the work with this client if you were seeing him
or her individually?

1. If you are working with an individual, use the stages described by Corey and Corey and
discussed earlier in this chapter (identifying clients' problems, helping clients create goals,
encouraging clients to take action, termination). Describe the stage your client is currently in
as well as previous stages through which the therapeutic relationship has progressed. If the
stages do not match the stages described by Corey and Corey, consider why they are
different.
If you are working with a group, consider how the therapeutic process might be
progressing if one of the members were being seen individually. Do this for a specific client.
Discuss why you chose this member and what you might have done in the sessions.
2. If you are working with an individual, apply the stages described by Bruscia (developing a
relationship, conflict resolution, internalization, autonomy) and discussed earlier in this
chapter. Describe the stage your client is currently in as well as previous stages through
which the therapeutic relationship has progressed. If the stages do not match the stages
described by Bruscia, consider why they are different.
3. Discuss the application of the Principles of Facilitating Individual Music Therapy Sessions
for an individual with whom you are working, or, if you are not working with an individual,
for a person from your group whom you might select for individual treatment. Which of the
principles are you following or would you follow? Discuss their applicability, either in
reality or as you think they would be if you were working with an individual.
Level III-Leading
1. If you are working with an individual, use the stages described by Corey and Corey and
discussed earlier in this chapter (identifying clients' problems, helping clients create goals,
encouraging clients to take action, termination). Describe the stage your client is currently in
as well as previous stages through which the therapeutic relationship has progressed. If the
stages do not match the stages described by Corey and Corey, consider why they are
different.
2. If you are working with an individual, apply the stages described by Bruscia (developing a
relationship, conflict resolution, internalization, autonomy) and discussed earlier in this
chapter. Describe the stage your client is currently in as well as previous stages through
which the therapeutic relationship has progressed. If the stages do not match the stages
described by Bruscia, consider why they are different.
3. Discuss the application of the Principles of Facilitating Individual Music Therapy Sessions
for an individual with whom you are working or, if you are not working with an individual,
for a person from your group whom you might select for individual treatment. Which of the
principles are you following, or would you follow? Discuss their applicability, either in
reality or as you think they would be if you were working with this individual.
Documentation
Strategies
It is important for music therapists to be able to document and communicate what occurs in
music therapy. Assessment and evaluation both rely on being able to keep accurate records of
how the client is doing. Tallying, duration and latency recording, checklists, rating scales, and
interval recording may be used to document client behavior. When using any of these methods,
an operational definition-an exact description of the behavior under consideration-will be
needed. After we have documented what has taken place, we share this information by writing
progress notes. This chapter describes these aspects of documenting and communicating
progress.
Measurement Systems
In tallying, also called frequency or event recording, the observer marks every time that a
discrete behavior occurs. This may be done with pencil and paper or a mechanical counter. The
important thing is that each incidence of the behavior under consideration is recorded.
In duration recording, the length of time during which something occurs is recorded.
This is most accurately done with a stopwatch. Latency recording, which measures the length of
time before a behavior occurs, is similar to duration recording.
A checklist is a list of behaviors to be checked off when they occur. Cartwright and
Cartwright (1984) suggest that the use of a checklist is appropriate when the behaviors of interest
are known in advance and when there is no need to indicate their frequency or quality. Checklists
provide information about specific observable behaviors but do not require the therapist to keep
count. This is useful when working independently with a group, as it allows the therapist to
collect meaningful data over time when counting instances of specific behaviors would not be
possible.
A rating scale may be used when the degree or quality of the behavior, trait, or attitude is
of interest. One type of rating scale, a Likert scale, is numerical, with numbers corresponding to
the degree that the behavior or trait is manifested. Rating scales are by nature less objective than
many other forms of measurement because they measure the degree or quality of something, and
qualities are not as objective as behaviors.
With interval recording, the time for observation is divided into small intervals (for
instance, 15 seconds). Within these intervals, the observer is normally instructed (often via
earphones audible only to that person) to observe and to record whether or not the behavior of
interest occurred. Hall and Van Houten (1983) divide interval recording systems into whole or
partial interval recording. In whole interval recording, the behavior of interest must occur during
the entire interval in order to be counted; in partial interval recording, it is scored if it occurs at
all during the interval. Madsen and Madsen (1983) suggest that behavior be observed during an
initial interval and recorded during the next interval (10-second intervals are recommended).
More complex interval recording techniques have been utilized in classroom observations to
gather information on teachers and students (Madsen & Madsen; Medley, 1982). These systems
utilize codes so that observers can record many different teacher and student behaviors. Interval
recording can only be used when a person is available exclusively to observe.
A consideration with any of these measurement systems is the reliability of your
measures. You want to have measures that are the same or similar when the data are gathered by
several people, or at several different points in time (assuming there are no changes in the actual
behavior between the two times). A measure of reliability is the correlation between two
measures that are taken, and you want the reliability to be high. When the reliability is high, you
can trust that the measures would be similar no matter who made them.
Operational Definitions
An operational definitionoutlines a construct (concept) in observable terms. McGuigan (1968)
says, "an operational definition is one that indicates that a certain phenomenon exists and does so
by specifying precisely how (and preferably in what units) the phenomenon is measured" (p. 27).
Sometimes an operational definition is a verbal specification of exactly what behaviors
will be considered examples of the construct. For example, agitation may be operationally
defined as "getting out of chair at inappropriate times, pacing around the room, body movements
outside of the norm, interrupting the speaker, verbal statements concerning anxiety." Even in this
operational definition, there is room for interpretation by the observer. To minimize this, the first
step is to make the operational definition as concrete and specific as possible. The second step is
to train the observer to bring his or her observations into agreement with what you have in mind
a large percentage of the time (that is, until you have high reliability).
Another type of operational definition is performance on a test or other measure. For
example, musical ability may be operationally defined as performance on a test of musical
ability.
Writing Progress Notes

Following music therapy sessions, it is important to be able to convey what was accomplished.
This is generally done in the form of a progress note. Facilities may require progress notes to be
written within a specific timeframe, or you may get to determine the interval. Many people write
progress notes after each session, while at other times, they are done quarterly or at some other
selected interval.
There are many formats for writing progress notes; some are dictated by a system for
planning and documenting sessions that is in effect at the facility. Table 17.l contains a sample
of what needs to be included in a progress note.
Chapter 17 Documentation Strategies 0 175
Table 17.1
Music Therapy Progress Note
Suggested Format
Client Information
Name (may be coded in some learning situations to protect confidentiality)
Facility
Age or date of birth
Diagnoses (list in order of importance; if they are numerous, may select the most pertinent)
Number of sessions attended out of number available
Initial behavior (describe how client behaved when sessions began)
Overview of Music Therapy

Goals
Objectives
Sample procedures (intended to make it clear to anyone who reads the note how the sample
procedures are designed to work on the goals and objectives)
Progress (toward each goal)
Signature and Title
Table 17.2 provides an example of this progress note format as it might be written for an
actual client. The goals and objectives are taken from Chapter 5, Goals and Objectives.
In reviewing progress toward goals, you want to include information that describes the
quality of the client's level of participation in the music therapy experiences as well as any
interventions used to motivate that participation, such as encouraging, cueing, or assisting.
Be sure to describe what the client did in the session such as: singing; verbalizing about
memories, feelings, or ideas; playing instruments; imitating rhythms; creating melody or
rhythms; improvising; interacting with others; or contributing to group projects such as
songwriting.
A progress note also includes how the client responded to the therapist. Be sure to note if
the client made eye contact, was verbal or nonverbal, initiated interaction, sought attention,
offered assistance, and was cooperative or enthusiastic about the experience. Additionally, you
will want to make note of any other factors that influenced the client's participation and
responses, or anything that distinguishes the client's participation. If you are dealing with a client
who exhibits inappropriate behaviors in the session, make note of what you did in response to
these behaviors and what was successful or not successful. If the client was agitated, distressed,
or withdrawn, what do you know about the source of this response and what were you able to do
to draw him or her into the music therapy experience?
It is often useful to distinguish between objective and subjective information when
writing progress notes. These are sometimes separated in assignments or in writing the notes; at
other times, it may be sufficient to be aware of the distinction.
Progress notes may be of varying lengths, depending upon the requirements of your
setting and the needs of your clients. The most important function of a progress note is to
document what the client did, how the therapist intervened, and how the client responded to
intervention. A progress note should be clear and concise but include enough detail that another
staff member can get a picture of how the client is progressing in music therapy and what has
worked or not worked thus far.
Table 17.2
Sample Music Therapy Progress Note
Clieut Information
Name: J. Jones
Facility: Nursing Home in Mytown
Date of birth: DOB: 12/01124
Diagnoses: Dementia, cause unknown; Depression (dysthemia)
Number of sessions attended out of number available: 10 out of 12
Initial behavior: When the sessions began, Mrs. Jones tended to be lethargic. She did not
interact with the therapist or any of the other residents. She seldom initiated
any kind of response and had to be cajoled to participate. She seemed quite
confused and did not know the day of the week or where she was. She was
willing to remain in the session but did little else.
Overview of Music Therapy
Goal: Increase verbal interaction
Sample objective: During planned break in lyrics of song, client will face another client and
answer the question posed by the song with a maximum of one prompt.
Goal: Increase reality orientation
Sample objective: When therapist asks client to name the day of the week, client will state the
correct day 3 out of 4 times.
Goal: Improve range of motion
Sample objective: During music and movement activity, client will move arms in direction up
or down as modeled by therapist, with at least 12" movement between the
two directions.
Sample procedures: All music therapy sessions followed a similar format and included an
opening experience intended to encourage verbal interaction and increase
reality orientation. The main part of the session consisted of one or more
musical strategies such as singing, playing simple instruments, and/or
composing a song, and always included some movement. All procedures
built upon the social aspects of music and included a focus on reality
orientation. Sessions concluded with a brief recapitulation of what had been
done in the session and a closing song.
Progress: Mrs. Jones made progress toward the first goal, increase verbal interaction.
In 8 of the 10 sessions that she attended, she faced another client and
answered the question posed by the song with a maximum of one prompt.
On two occasions, she spontaneously spoke with the music therapist. The
second goal, increase reality orientation, was more difficult to achieve. Her
condition seemed to be declining quite steadily; only two times in the 10
sessions was she able to name the correct day of the week. She was
similarly unable to state where she was consistently, although she was able
to do it on two occasions. She made substantial progress toward the third
goal, improve range of motion, being able to accurately imitate the
therapists' movement on 7 out of 10 sessions within the targeted range.
1!ucg Smltft. ,Mu.,k gfwtap" Studmt

Signature and Title
Chapter 17 Documentation Strategies D I 77
For Further Reading

th
Fraenkel, J. R, & Wallen, N. E. (2003). How to Design and Evaluate Research in Education (5
Ed.). New York: McGraw-Hill Higher Education.
Oldfield, A. (1993). A study of the way music therapists analyse their work. Journal of British
Ryback, R S. (1974). The Problem Oriented Record in Psychiatry and Mental Health Care. New
York: Grune & Stratton.
and benefits of a music therapy program for early intervention: A behavioral analysis. Music
Zaro, J. S., Barach, R, Nedelman, D. J., & Dreiblatt, I. S. (1977). A Guide for Beginning
Psychotherapists. Cambridge, UK: Cambridge University Press.
Assignments-
Documentation Strategies

1. Determine what measurement system would be appropriate to measure the sample objectives
that you prepared in Chapter 5. Go through each objective, picturing the situation in your
mind, and write down how your measurement recording would look.
2. Describe a hypothetical situation (related to your clinical sessions, if possible) in which each
type of measurement system described in this chapter (tallying, duration recording, checklist,
rating scale, interval recording) might be used. After describing the situation clearly, devise
the measurement system, including any forms that are necessary, that you would use in this
situation.
3. For the group or individual that you are observing, devise two real observation methods
using the measurement systems described in this chapter. Use them in the session and report
the results in a way that is comprehensible to someone who did not attend the session.

1. Devise two real observation methods using the measurement systems described in this
chapter. Use these measurement systems in the session. If you are able to record the data
yourself, you should do so. If you need assistance from someone else, find a way to get that
assistance. Report the results in a way that is comprehensible to someone who did not attend
the session.
2. Look at the goals that you have selected for your session. Are there words or phrases for
which the meanings are not completely clear (perhaps reality orientation or range of
motion)? Even if you think that all are clear, it will be useful as an exercise to select three.
Write operational definitions for these three words or phrases. Ask several people to read the
operational definitions and see if they have the same idea that you do. An operational
definition is acceptable only when the words are clear and understood the same by everyone
involved.
3. Write a progress note for one of the clients in your clinical setting.
Level III-Leading
1. Write an operational definition for each of your goals.
2. Devise a measurement system for each of your objectives and use them in your sessions.
3. Write progress notes for each of the clients in your clinical setting.
Self-Assessment for
the Music Therapist
This chapter focuses on the music therapist rather than on the client. It will offer some ideas
about the importance of continuous growth, some directions for growth, and some tools to
continue your growth throughout your career. "It is possible for you to become an effective,
intentional therapist. Helping can be a way of life, but it requires the ability to change, grow and
develop with your clients" (Ivey & Simek-Downing, 1980, p. 14). How does a therapist change,
grow, and develop with his or her clients? The first step is self-assessment. We begin the process
of self-assessment as music therapy students and will continue it throughout our professional
lives.
The Importance of Self-Assessment

Bright (1995, p. 310) describes the skills necessary to do music therapy as including knowledge
about the diseases and disabilities of our clients, the specific difficulties being experienced at the
time of treatment, counseling and therapy skills, and music skills. Bright separates these and
defines therapy skills as the following:
1. An understanding of illness, disability, and death and dying,
2. An understanding of the client's view ofthese issues,
3. What the present illness, disability, or weakness means to the client,
4. What the probable outcome or prognosis is for the problem,
5. How the illness or disability affects the client's life and relationships,
6. How the illness or disability affects those with whom the client shares life.
Bright (1995) further describes the music skills necessary for effective treatment:
1. Appropriate practical skills on our own instrument,
2. Ability to play a portable instrument that can be taken to the bedside when
necessary,
3. Knowledge of the repertoire that is appropriate for the people with whom we work,
4. Ability to select items that will fit the total therapeutic aims of the intervention,
5. Ability to improvise and to help the client develop his or her own ability to
improvise in order to express feelings that are verbally inexpressible, and so forth,
6. Ability to transpose at sight and on paper (for example, to accommodate a person
with limited vocal range or who plays a transposing instrument such as the hom or
clarinet).
Bright also reminds us that music therapy requires many skills that combine music and
therapy, although she does not attempt to define these. Such skills might best be understood from
Pennebaker's (1997) view of music therapy:
Dance, art, and music therapies can be powerful in getting individuals to

experience emotions related to relevant upheavals in their lives .... Indeed, most
dance, art, and music therapists go far beyond encouraging self-expression.
During or after dancing, drawing, or singing, clients are strongly encouraged to
talk about their emotional experiences. In other words, non-language-based
therapies rely heavily on language once the clients' inhibitions are lifted. (p.
101)
Music therapists need to develop verbal therapy skills in addition to their music skills.
As you continue to grow as a therapist, you will want to monitor your own development in this
area. In order to do so, you will need to self-assess specific skills. Ivey and Simek-Downing
(1980) list the following general categories of qualities as essential to good counseling
technique: (a) positive regard; (b) respect and warmth; (c) concreteness; (d) immediacy; (e)
confrontation; (f) congruence, genuineness, and authenticity; and (g) empathy and the empathic
response. They further divide them into the micro-skills of attending and influencing, which
include open versus closed questions, encouragement, paraphrasing, reflection of feeling,
summary, directive comments, interpretation, self-disclosure, expression of content or feelings,
and direct mutual communication.
Sperry, Carlson, and Kjor (2003) also define factors needed in therapy to include (a)
empathy; (b) engagement of the client, which is broken into component parts such as attending,
active listening, empathic response, and encouragement; (c) negotiating goals and treatment; (d)
seeding hope; and (e) triggering the placebo effect, which is a reflection of the client's faith in
the therapist and/or treatment process (p. 34).
How can you as a music therapist in training (and later as a music therapist in practice)
learn about yourself? What tools and resources do you have to help you to assess the skills and
knowledge necessary for effective clinical work? While you are a student, you have instructors
and clinical supervisors to offer you feedback. Once you are a practicing therapist, you can seek
supervision or a mentor to help you examine your work, support you as you develop a better
understanding of your work, and help you settle into the beginnings of your therapeutic style.
The value of a supervisor or mentor cannot be stated too strongly. This person can cheer you on
when discouraged, hold you up when tired, smile with you in the joy of your successes, and hold
you accountable for your needed changes and growth. This valued professional can mean the
difference between staying in the field and working with a healthy attitude or leaving music
therapy because of burnout.
In addition to external help, you can take responsibility for your own growth by
developing the habit of looking at yourself and your work in a systematic manner. Bruscia (2001)
offers a five-level model for supervision that might be adapted to your self-assessment as
follows:
1. Action-oriented: Do you need to do something differently?
2. Learning-oriented: Do you need to acquire knowledge, skill, or insight in order to
address a problem or weakness in your work?
3. Client-oriented: Do you need to understand your client differently?
4. Experience-oriented: Can you reframe the way you experience the therapy process
with the client?
5. Countertransference-oriented: Are there personal issues involved in your work with
this client or group?
As a self-reflective music therapy student, you can ask yourself these questions and seek
assistance from teachers and supervisors as needed. This will help you to develop the habit of
Chapter 18 Self-Assessment D 181
examining yourself and your work, a habit that will serve you well in your development and
growth as a therapist throughout your career.
Thinking About Self-Assessment

In order to make self-assessment meaningful, you may want to begin to think about it as soon as
you start to assist with sessions. Keeping a log or journal that catalogs and gives a chronology of
your experiences and also includes your reactions, responses, questions, and concerns is the
foundation for self-assessment. You may find that you naturally begin to identify specific skills
that you need to develop. You can take responsibility for making a plan to develop those skills,
including seeking out classes, lessons, practice sessions, or readings that will help you to address
these needs. In the following example, a music therapy student is assisting with groups in her
clinical practicum. She identifies a weakness in her skills and plans to address it:
I'm assisting with sessions at a daycare center for frail older adults with both
physical and cognitive dysfunction. My piano skills are good enough to
accompany group singing, and I'm really excited that I've been asked by the
supervising therapist, Jane, to plan to accompany the sing-along portion of the
session. Jane provided me with a list of four songs to be used in the next session
and told me that I should be sure the music I use to accompany the songs does
not have any melody notes that are higher than C. I've searched for music at
school and found that one of the songs is too high and has to be transposed. I
didn't really have enough time in my schedule to write out the transposition, so I
penciled in the melody notes and wrote the chords above, hoping I would be able
to play it for my clinical assignment. When I played the song for the group to
sing, I kind of stumbled along and the group didn't sing as much on this song as
on the others. They weren't as animated, and I had to work really hard just to get
through the song. I've decided to set aside an hour each week to practice playing
songs in different keys, beginning by transposing down a third, fourth, or fifth in
order to improve my skills.
Consider how you think about yourself as a therapist. What role do you see yourself
playing in your therapeutic relationship with clients? Do you see yourself as a facilitator, helper,
and guide, or are you caught up in a need to save people who need your help? Do you see
yourself as the person with the knowledge or right answers? Do you know what is best for the
clients and make all the decisions? Recognizing the differing advantages of both directive and
nondirective approaches can provide a more balanced and effective process. Be sensitive to the
timing of what occurs in sessions, to the flow of the music, and to the pace of growth. Ivey and
Simek-Downing (1980) suggest that, if we can understand the world from the client's point of
view, we are more likely to make effective choices in our therapeutic interactions. Maslow
(1999) proposes getting into the Weltanschauung (a German term meaning worldview) of the
client-in essence, seeing the world through the eyes of your client.
How do you see your actions? How do you decide what to do when? This book is filled
with information about how to think about, plan for, and implement music therapy sessions.
Reflect on how your work compares to the suggestions made in this book. Take time to review
your own work and attitudes toward your work and allow yourself to grow. Be conscious of
doing so on a regular basis, not engaging in this kind of self-reflection only when it is assigned
by your instructor or clinical supervisor. Be curious and exploratory in what you want to know
about yourself as a musician and as a therapist.
How do you think about your clients? How do you understand them and the behaviors
they exhibit? Be sensitive to the typical characteristics of each illness or disability. Be
knowledgeable about the steps of normal development, and develop your observation skills and
clinical intuitions so that you recognize developmentally appropriate changes in behavior as they
occur. Be alert to recognizing when your perceptions of the client or the therapy process are
affected by your own life experiences and understanding. Take time to become familiar with who
you are and what experiences have influenced and formed you.
Tools for Self-Assessment

Journaling
This conscious effort to write about your experiences can be most helpful. Pennebaker (1997)
suggests that to write about content in the context of your own feelings, thoughts, hopes, and
other subjective experiences in relation to what happens during sessions is more powerful than
talking or writing about the content alone. Thus, journaling about clinical experiences can be an
effective way to learn about the clinical therapy process and to grow as a therapist and as a
person. In order for journaling to be effective, the journal needs to address some specific topics.
Your instructor may choose a specific model for journaling that is used for class assignments, but
you may find another format more effective for your own use.
Journals may include: (a) an objective chronology of the experience; (b) a subjective
summary of your responses to the experience; (c) an observational focus on client response; (d) a
focus on a particular theme or topic, for instance, use of music skills in a particular session or
what my client might have been thinking as the session progressed; (e) an evaluation of the
effectiveness of the session; (f) a post-session review of the plan as compared to the actual
session process; (g) ideas for future interventions; and (h) comparison to a specific model or
theory of music therapy.
Journals are also more useful if we return to them after a period of time and, as we re-
read them, look for growth and learning. You may find it useful to read a semester's worth of
entries and summarize your own learning. You might also include unresolved issues, questions,
and skills that you have not yet developed. This unfinished business may become a part of your
journaling process in the next semester.
Journaling is not something that should stop when classes are over. Continue journaling
during your breaks, during the summer, and, perhaps even more importantly, during your
internship and on into your life as a professional music therapist. It can be an invaluable tool to
aid you in continuing your own self-assessment and reflection.
Worksheets
Some people find it useful to have a form to fill out to help them think about their work. You
may find the format suggested below for self-reflective exercises to be easier to use than
journaling and reflecting on the questions found above. Use those that are most helpful to you at
this time in your growth, recognizing that some questions may be more relevant later on or that
some may not apply to you.
Many students will want to transfer these worksheets to their computer and to answer the
questions using the computer. You are encouraged to do this if it will help you to take full
advantage of the worksheets. Two examples of the worksheet format for self-reflective exercises
follow:
"That Client"
Some clients stir emotional responses in us as we work with them. This may be a result
of our lack of understanding about the nature of the illness or disability, it may be that
we have expectations that are mismatched to the capacities of the client, or it may be that
this client stirs some personal issues in us (countertransference). We can learn from this
experience by taking the time to examine our own responses.
When in the session did I notice myself reacting or responding to the client in a
manner that was inconsistent with good therapy? What was the client doing? What
was happening musically? What was I doing?
2 Do I understand what behaviors or responses are within normal limits for this
particular client? How does his or her diagnosis or challenge affect the responses I
see in music therapy? What is developmentally appropriate for this client?
3 What goals were set for this client? Did I set them alone or with input from other
professionals, or did the client have a role in setting them? Did I get enough
information at assessment to be clear about what this client needs and what he or she
is capable of doing?
4 Does this client want to be in music therapy? Is this client motivated to change? Did
the client make the decision to seek treatment or was the decision made by a parent
or guardian, and how does that affect the client's motivation to participate in the
therapy experience?
5 Are there qualities about this client or my perception of this client that remind me of
someone from my own life? What is my relationship with that person? Do I have any
unresolved issues in that relationship? Am I projecting aspects of that relationship
onto this client?
Post-Session Review
It is always useful to spend some time following a music therapy session reviewing the
session. The steps outlined here may help in this process but are just one way to do a
review. You may find other ways that are more effective for you.
1. Describe the flow of your session. What form or structure did you use? Was there a
beginning, middle, and end to the session? How did you open the session? How did
you introduce the focus of the session? How did you close? Did it serve as closure to
the experience?
2. Describe your work as the facilitator/leader. How directive were you in the group
process? When directions for an experience were required, were you clear about
what the clients were to do? Did you use as few words as possible so the clients
could process without extra words? How clear was your role to clients? How clear
were the clients' roles to themselves? How well did you incorporate the factors that
encourage therapy to progress-empathy, engagement, including the clients in goal
planning, and seeding hope that change is possible?
3. How did the clients respond to the session? Were they easily engaged in the music
experiences? Did they interact freely with the therapist? Did they interact with one
another in a group setting? When applicable, were clients able to articulate some
benefit they received from participating?
4. Where do you go from here? What does this client or group need to do next to work
toward the established goals? Are there materials you need to incorporate? Are there
skills you need to acquire?
5. Write about your session. What stands out in your mind? What is it about that
particular experience that draws your attention? Can you write about the emotional,
cognitive or physical responses you have to the experience? What might this be
related to in your life?
Personal Therapy
Undergoing your own personal therapy is one of the best ways to continue growing. Many
campuses provide access to psychotherapy, so this may be something that you can pursue while
you are still studying. Some music therapy students and music therapists begin their own therapy
because they feel that this is a good way to learn what therapy is about. This is certainly true.
However, most people who begin therapy with this in mind find as they go through the process
that they also have legitimate problems and issues that they are able to deal with in therapy.
Of course, there are many different models of therapy. Keep these in mind when
choosing a therapist, and follow a model of therapy that is congruent with your personal beliefs
and one that will meet your needs.
Music therapy students and music therapists often decide to engage in music therapy as
clients. This may be psychotherapeutically oriented music therapy. Music therapy may also be
accessed in addition to traditional psychotherapy. Some music therapy training programs include
an experiential music therapy component (see Murphy & Wheeler, in press), and students in
these programs may have had a music therapy experience that was therapeutic in addition to
being educational. This should not be considered a substitute for either music therapy or
psychotherapy but may provide a good opportunity for growth as well as a model for music therapy.
Competency-Based Skills Assessment

Music therapy education in the U. S., including clinical training, is based on the AMTA
Professional Competencies (American Music Therapy Association, 2003), a set of 146
competencies divided into three areas of knowledge and skill: Music Foundations, Clinical
Foundations, and Music Therapy. While you must be competent in each of these areas in order to
graduate in music therapy, there will always be more information to learn as you progress
through your career. You might do an annual progress review by checking the list of
competencies to see if you have grown in these areas.
Chapter 18 Self-Assessment 0 185
Music Foundations
1. Music Theory and History
2. Composition and Arranging Skills
3. Major Performance Medium Skills
4. Keyboard Skills
5. Guitar Skills
6. Voice Skills
7. Nonsymphonic Instrumental Skills
8. Improvisation Skills
9. Conducting Skills
10. Movement Skills
Clinical Foundations
11. Exceptionality
12. Principles of Therapy
13. The Therapeutic Relationship
Music Therapy Foundations and Principles

14. Client Assessment
15. Treatment Planning
16. Therapy Implementation
17. Therapy Evaluation
18. Documentation
19. Termination/Discharge Planning
20. Professional Role/Ethics
21. Interdisciplinary Collaboration
22. Supervision and Administration
23. Research Methods
Using Music for Self-Assessment

Since music is the primary tool in our therapy work, it is appropriate and desirable to use music
as a tool for self-growth. Music might be used improvisationally, re-creatively, compositionally,
or receptively.
Improvisational Tools
1. Think about a client relationship that you wish to understand more deeply. Choose
an instrument that will allow you to metaphorically describe the client through
sound. You might want to tape yourself in order to more effectively listen to what
you create when you are expressing the client through your own music. Listen
reflectively, allowing yourself to hear the music from different perspectives.
Describe the music, your response to it, the qualities that it has. How do these relate
to your understanding of the client? How do these relate to your understanding of

yourself?
2. You might also create a dialogue between the client and yourself by choosing two
instruments, one to represent the client and one to represent yourself, then playing.
Reflective listening to a tape recording of this music may help you to gain insight
into the relationship. Describe the qualities of the music, your responses to it, and the
interaction between the sounds. What does this reveal about the relationship, the
client, and you?
Re-Creative Tools
1. Choose a song or piece you love to perform, then perform it with enthusiasm. When
you finish, journal about the experience of performing. Reconnect with why you love
music, and write about why you believe in the power of music to change others. How
does this reflection affect your view of your clinical work?
2. Join a community performance group and participate with a dual intention. While
participating in the rehearsals and performances, be aware of how you are
responding to the music, to the group, to the conductor, to the audience. What can
you learn about yourself and your relationship to music? How does this affect your
skills in the clinical environment?
Compositional Tools
1. Write a song about your client, group, the session experience, or the particular issue
that you are struggling with in your growth. You might use lyrics or not, you might
write for only one instrument or perhaps more than one. If you are reflecting on a
group experience, lyrics or multiple instruments might be more effective than a
single line melody. Tap into your musical selfto gain a deeper understanding of your
therapist self.
2. Write a poem about your therapy work and then orchestrate it with sounds or music.
Perform it for yourself. Consider taping it and doing some reflective listening when
you are done.
Receptive Tools
1. Take time away from your academic and clinical work to listen to music that you
especially enjoy. Allow yourself to be as completely involved in the music as you
can, using the musical experience as a respite from the hard work of learning and
becoming. Return to your work and notice how you are now approaching it. Has
your perspective changed? Do you notice changes in your energy level? Do you have
the motivation to continue your work?
2. Practice relaxation exercises with music. If you have not yet learned to do this, find a
taped version and use it. (Your instructor may make a recommendation.) In this
relaxed state, revisit your clinical experience to see if your perceptions have
changed.
3. Choose a recording that reflects how you are feeling and listen to it. Allow yourself
to experience the emotion in the music. After listening, take time to write about the
experience, identifying any insights you may gain.
For Further Reading

Alter, c., & Evens, W. (1990). Evaluating Your Practice: A Guide to Self Assessment. New
York: Springer Publishing Co.
Austin, D. S. (1998). When the psyche sings: Transference and countertransference in
improvised singing with individual adults. In K. E. Bruscia (Ed.), The Dynamics of Music
Psychotherapy (pp. 315-333). Gilsum, NH: Barcelona Publishers.
Brammer, L. M., & MacDonald, G. (1999). The Helping Relationship: Process and Skills (i h
Ed.). Boston: Allyn & Bacon.
Camilleri, V. A. (2001). Therapist self-awareness: An essential tool in music therapy. The Arts in
Psychotherapy, 28,79-85.
Cozolino, L. (2004). The Making of a Therapist: A Practical Guide to the Inner Journey. New
York: W. W. Norton Co.
Dass, R, & Gorman, P. (1985). How Can I Help? Stories and Reflections on Service. New York:
Alfred A. Knopf.
Goldfried, M. R (2001). How Therapists Change: Personal and Professional Reflections.
Washington, D.C.: American Psychological Association.
Kramer, C. H. (2000). Therapeutic Mastery: Becoming a More Creative and Effective Therapist.
Phoeniz, AZ: Zeig, Tucker.
Montello, L. (2003). Protect this child: Psychodynamic music therapy with a gifted musician. In
S. Hadley (Ed.), Psychodynamic Music Therapy: Case Studies (pp. 299-318). Gilsum, NH:
Nolan, P. (2003). Through music to therapeutic attachment: Psychodynamic music
psychotherapy with a musician with dysthemic disorder. In S. Hadley (Ed.), Psychodynamic
Music Therapy: Case Studies (pp. 319-338). Gilsum, NH: Barcelona Publishers.
Sperry, L., Carlson, J., & Kjor, D. (2003). Becoming an Effective Therapist. Boston: Allyn & Bacon.
Assignments-Self-Assessment
1. Select a worksheet question that is relevant to the sessions that you are observing,
participating in, or assisting with. Write out the answers and discuss your responses with a
classmate, supervisor, teacher, or friend.
2. Select one of the tools under Using Music for Self-Assessment, then carry out one of the
exercises under that tool. Write about your experience.
3. Use the AMTA Professional Competencies to assess your current level of competence.

1. Select a worksheet question that is relevant to the sessions that you are planning and co-
leading. Use a different question than you did at the earlier level. Write out the answers and
discuss your responses with someone else involved in music therapy-a classmate,
supervisor, or teacher.
2. Select a different tool under Using Music for Self-Assessment than you used in Level I, then
carry out one of the exercises under that tool.
3. Use the AMTA Professional Competencies to assess your current level of competence.
Compare it with your competence when you did the same in LevelL Focus on areas in which
you are still in need of work and devise a plan for improvement.
Level III-Leading
Self-assessment is an ongoing process. It is essential to all therapists' growth and development.
We continue to grow and develop throughout our careers.
As you near the completion of your training to be a music therapist, begin to make self-
assessment part of your own process. Discover the tools that are most useful for you. Use several
of them as you lead your music therapy sessions.
Continue to revisit this chapter after your formal academic work is completed and you are a
practicing music therapist.
References
Adams, N. (1996). Piano Lessons: Music, Love & True Adventures. New York: Delacorte Press.
Adler, R. (2001). Musical Assessment of Gerontologic Needs and Treatment: The MAGNET
Survey. St. Louis, MO: MMB Music.
Aigen, K. (1991a). Creative fantasy, music and lyric improvisation with a gifted acting-out boy.
In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 109-126). Gilsum, NH:
Aigen, K. (1991b). The roots of music therapy: Towards an indigenous research paradigm.
(Doctoral Dissertation, New York University, 1990). Dissertation Abstracts International,
52(6),1933A.
Aigen, K. (1995) An aesthetic foundation of clinical theory: An underlying basis of creative
music therapy. In C. Kenny (Ed.), Listening, Playing, Creating: Essays on the Power of
Sound (pp. 233-257). Albany, NY: State University of NY Press.
Aigen, K. (1998). Paths of Development in Nordoff-Robbins Music Therapy. Gilsum, NH:
Aigen, K. S. (2001). Popular musical styles in Nordoff-Robbins clinical improvisation. Music
Aigen, K. (2002). Playin' in the Band: A Qualitative Study of Popular Music Styles as Clinical
Improvisation. New York: Nordoff-Robbins Center for Music Therapy, New York
University.
Aigen, K. (2005). Music-Centered Music Therapy. Gilsum, NH: Barcelona Publishers.
Aldridge, D. (1996). Music Therapy Research and Practice in Medicine: From Out of the
Silence. Philadelphia: Jessica Kingsley Publishers.
Aldridge, G. (1996). "A walk through Paris": The development of melodic expression in music
therapy with a breast-cancer patient. The Arts in Psychotherapy, 23, 207-223.
Alter, c., & Evens, W. (1990). Evaluating Your Practice: A Guide to Self Assessment. New
York: Springer Publishing Co.
American Music Therapy Association. (2002). AMTA Standards of Clinical Practice.
http://www .musictherapy.orglstandards.html
American Music Therapy Association. (2003). AMTA Code of Ethics. http://www.musictherapy
.org/ethics.html
American Music Therapy Association. (2003). AMTA Professional Competencies. http://www
.musictherapy.org/competencies.html
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental
Disorders (4 th Ed., Text Revision; DSM-IV-TR). Washington, DC: Author.
Amir, D. (1996). Music therapy-Holistic model. Music Therapy, 14,44-60.
Amir, D. (1999). Tales from the therapy room. In J. Hibben (Ed.), Inside Music Therapy: Client
Experiences (pp. 267-275). Gilsum, NH: Barcelona Publishers.
Amir, D. (2001, June). How do we nurture ourselves? My personal journal with music. Voices: A
World Forum for Music Therapy. http://www.voices.no/columnist/colamir040601.html
Amir, D. (2001, July). Sometimes, it is our task to find out how much music we can still make
with what we have left. Voices: A World Forum for Music Therapy.
http://www.voices.no/columnist/colamir300701.html.ReprintedinC.Kenny&B.Stige
(Eds.; 2002), Contemporary Voices in Music Therapy: Communication, Culture, and
Community (pp. 242-243). Oslo, Norway: Unipub Forlag.
Ansdell, G. (1995). Music for Life: Aspects of Creative Music Therapy With Adult Clients.
London: Jessica Kingsley Publishers.
Ansdell, G. (2002). Community music therapy & the winds of change. Voices: A World Forum
for Music Therapy. http://www.voices.no/mainissuesNoices2(2)ansdell.html
Apprey, Z. R, & Apprey, M. (1975). Applied Music Therapy: Collected Papers on a Technique
and a Point of View. London: Institute of Music Therapy and Humanistic Psychology, The
International University.
Asmus, E. P. (1985). The development of a multidimensional instrument for the measurement of
affective responses to music. Psychology ofMusic, 13(1), 19-30.
Austin, D. S. (1998). When the psyche sings: Transference and countertransference in
improvised singing with individual adults. In K. E. Bruscia (Ed.), The Dynamics of Music
Psychotherapy (pp. 315-333). Gilsum, NH: Barcelona Publishers.
Austin, D. (1999). Vocal improvisation in analytically oriented music therapy with adults. In T.
Wigram & J. De Backer (Eds.), Clinical Applications of Music Therapy in Psychiatry (pp.
141-157). Philadelphia: Jessica Kingsley Publishers.
Ball, T. S., & Bernadoni, L. C. (1953). The application of an auditory apperception test to
clinical diagnosis. Journal of Clinical Psychology, 9, 54-58.
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International
Universities Press.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4,561-571.
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press.
Benjamin, A. (1987). The Helping Interview (3 rd Ed.). Boston: Houghton-Mifflin.
Berman, I. (1981). Musical functioning, speech lateralization and the amusias. South African
Medical Journal, 59, 78-81.
Birkenshaw-Fleming, L. (1989). Come On Everybody Let's Sing! Toronto, Canada: Gordon V.
Thompson Music.
Bitcon, C. H. (2000). Alike and Different (2 nd Ed.). Gilsum, NH: Barcelona Publishers.
Bolton, R. (1979). People Skills. New York: Simon & Schuster.
Bonny, H. (1980). GIM Therapy: Past, Present and Future Implications. Salina, KS: The Bonny
Foundation.
Bonny, H. (2002). Music Consciousness: The Evolution of Guided Imagery and Music. Gilsum,
Boone, P. (1980). DAMREB: Diagnostic Assessment of Music Related Expression and Behavior.
Unpublished manuscript.
Boone, P. (1991). Composition, improvisation and poetry in the psychiatric treatment of a
forensic patient. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 433--449).
Borczon, R M. (1997). Music Therapy: Group Vignettes. Gilsum, NH: Barcelona Publishers.
Borczon, R M. (2004). Music Therapy: A Fieldwork Primer. Gilsum, NH: Barcelona Publishers.
Boxill, E. H. (1985). Music Therapy for the Developmentally Disabled. Rockville, MD: Aspen
Systems Corporation.
Boxill, E. H. (1997). The Miracle of Music Therapy. Gilsum, NH: Barcelona Publishers.
Boyle, M. E., & Krout, R (1987). Music Therapy Clinical Training Manual. St. Louis, MO:
MMB Music.
Bradt, J. (2002). The effects of music entrainment on postoperative pain perception in pediatric
patients. (Doctoral Dissertation, Temple University, 2001). Dissertation Abstracts
International, 62, 5073.
References 0 191
Brammer, L. M., & MacDonald, G. (1999). The Helping Relationship: Process and Skills (7th
Ed.). Boston: Allyn & Bacon.
Braswell, c., Brooks, D. M., DeCuir, A., Humphrey, T., Jacobs, K. W., & Sutton, K. (1983).
Development and implementation of a music/activity therapy intake assessment for
psychiatric patients. Part I: Initial standardization procedures on data from university
students. Journal ofMusic Therapy, 20, 88-100.
Braswell, c., Brooks, D. M., DeCuir, A., Humphrey, T., Jacobs, K. W., & Sutton, K. (1986).
Development and implementation of a music/activity therapy intake assessment for
psychiatric patients. Part II: Standardization procedures on data from psychiatric patients.
Braverman, S., & Chevigny, H. (1964). The Braverman Chevigny Auditory Projective Test. New
York: American Foundation for the Blind.
Briggs, C. (1991). A model for understanding musical development. Music Therapy, 10, 1-21.
Bright, R. (1988). Music Therapy and the Dementias: Improving the Quality of Life. St. Louis,
MO: MMB Music.
Bright, R. (1991). Music in Geriatric Care: A Second Look. Wahroonga, NSW, AU: Music
Therapy Enterprises.
Bright, R. (1995). Music therapy as a facilitator in grief counseling. In T. Wigram, B. Saperston,
& R. West (Eds.) The Art and Science of Music Therapy: A Handbook (pp. 309-323).
Chur, Switzerland: Harwood Academic Publishers.
Brodsky, W., & Sloboda, J. A. (1997). Clinical trial of a music generated vibrotactile therapeutic
environment for musicians: Main effects and outcome differences between therapy
subgroups. Journal of Music Therapy, 34, 2-32.
Broucek, M. (1987). An Interpersonal Model of Music Therapy Improvisation. Unpublished
master's thesis, Hahnemann University, Philadelpha.
Brunk, B. (1997). Songwritingfor Music Therapists. Grapevine, TX: Prelude Music Therapy.
Brunk, B., & Coleman, K. (2000). Development of a special education music therapy assessment
process. Music Therapy Perspectives, 18, 59-68.
Bruscia, K. E. (1987). Improvisational Models of Music Therapy. Springfield, IL: Charles C.
Thomas.
Bruscia, K. (1988). Standards for clinical assessment in the arts therapies. The Arts in
Bruscia, K. E. (Ed.) (1991). Case Studies in Music Therapy. Gilsum, NH: Barcelona Publishers.
Bruscia, K. E. (1993). Client Assessment in Music Therapy. Unpublished manuscript.
Bruscia, K. E. (1998a). Defining Music Therapy (2 nd Ed.). Gilsum, NH: Barcelona Publishers.
Bruscia, K. E. (Ed.). (1998b). The Dynamics of Music Psychotherapy. Gilsum, NH: Barcelona
Publishers.
Bruscia, K. (2000a). A scale for assessing responsiveness to Guided Imagery and Music. Journal
of the Association of Music and Imagery, 7, 1-7.
Bruscia, K. (2000b). The nature of meaning in music therapy: Kenneth Bruscia interviewed by
Brynjulf Stige. Nordic Journal ofMusic Therapy, 9(2), 84-96.
Bruscia, K. (2001). A model of supervision derived from apprenticeship training. In M. Forinash
(Ed.), Music Therapy Supervision (pp. 281-295). Gilsum, NH: Barcelona Publishers.
Bruscia, K. E. (2002). Client assessment in the Bonny Method of Guided Imagery and Music
(BMGIM). In K. E. Bruscia & D. E. Grocke (Eds.), Guided Imagery and Music: The
Bruscia, K. E. (2003, November). Client Assessment in Music Therapy. Presentation at the
conference of the American Music Therapy Association, St. Louis, MO.
Bruscia, K. E. (2005). Developing theory. In B. L. Wheeler (Ed.), Music Therapy Research (2 nd

Ed.; pp. 540-551). Gilsum, NH: Barcelona Publishers.
Bruscia, K. E., & Grocke, D. E. (Eds.) (2002). Guided Imagery and Music: The Bonny Method
and Beyond. Gilsum, NH: Barcelona Publishers.
Bruscia, K. E., & Maranto, C. D. (1985, November). The Bruscia-Maranto Projective Music
Listening Test. Presentation at the conference of the National Coalition of Arts Therapy
Associations, New York.
Cameron, J., with Bryan, M. (1992). The Artist's Way: A Spiritual Path to Higher Creativity.
New York: G. P. Putnam's Sons.
Camilleri, V. A (2001). Therapist self-awareness: An essential tool in music therapy. The Arts in
Carkhuff, R. R. (2000). The Art of Helping in the 21 st Century (8 th Ed.). Amherst, MA: Human
Carter, E., & Oldfield, A (2002). A music therapy group to assist clinical diagnoses in child and
family psychiatry. In A Davies & E. Richards (Eds.), Music Therapy and Group Work:
Sound Company (pp. 149-163). Philadelphia: Jessica Kingsley Publishers.
nd
Cartwright, C. A, & Cartwright, G. P. (1984). Developing Observation Skills (2 Ed.). New
York: McGraw-Hill.
Cassity, M. D. (1976). The influence of a music therapy activity upon peer acceptance, group
cohesiveness, and interpersonal relationships of adult psychiatric patients. Journal of
Music Therapy, 13,66-76.
Cassity, M. D. (1985). Techniques, Procedures, and Practices of Adaptive and Music Behaviors
of Trainable Mentally Retarded Children. Unpublished master's thesis, University of Iowa,
Iowa City.
Cassity, M. D., & Cassity, J. E. (1998). Multimodal Psychiatric Music Therapy for Adults,
Adolescents, and Children: A Clinical Manual (3rd Ed.). St. Louis, MO: MMB Music.
Cattell, R. B., & Anderson, J. C. (1953). The measurement of personality and behavior disorders
by the IPAT Music Preference Test. Journal ofApplied Psychology, 37, 446-454.
Cattell, R. B., & McMichael, R. E. (1960). Clinical diagnosis by the IPAT Music Preference
Test. Journal of Consulting Psychology, 24,333-341.
Certification Board for Music Therapists. (2001) Code of Professional Practice.
http://www.cbmt.org
Chase, K. M. (2002). The Music Therapy Assessment Handbook. Columbus, MS: SouthemPen
Publishing.
Chase, K. M. (2003). The Multicultural Music Therapy Handbook. Columbus, MS: SouthemPen
Publishing.
Chase, M. P. (1974). Just Being at the Piano. Culver City, CA: Peace Press.
Chavin, M. (1991). The Lost Chord. Mt. Airy, MD: ElderSong Publications.
Chesky, K. S., & Michel, D. E. (1991). The music vibration table (MVT): Developing a
technology and conceptual model for pain relief. Music Therapy Perspectives, 9, 32-38.
Clair, A A (1996). Therapeutic Uses of Music With Older Adults. Baltimore: Health Professions
Press.
Clark, C., & Chadwick, D. (1979). Clinically Adapted Instruments for the Multiply Handicapped.
St. Louis, MO: Magnamusic-Baton.
Clarkson, G. (1991). Music therapy for a nonverbal autistic adult. In K. E. Bruscia (Ed.), Case
Studies in Music Therapy (pp. 373-385). Gilsum, NH: Barcelona Publishers.
Cohen, G., & Gericke, O. L. (1972). Music therapy assessment: Prime requisite for determining
patient objectives. Journal ofMusic Therapy, 9, 161-189.
References D 193
Coleman, K., & Brunk, B. (1997). Prelude: Music Therapy Assessment Kit: Special Education
Edition (1997 Revision). Grapevine, TX: Prelude Music Therapy.
Coleman, K. A., & Brunk, B. K. (2003). SEMTAP: Special Education Music Therapy Assessment
Process Handbook (2 nd Ed.). Grapevine, TX: Prelude Music Therapy.
Come Join the Geritones. (n.d.). Lake Forest, IL: The Geri-Tones.
Cordrey, C. (1994). Hidden Treasures: Music and Memory Activities for People With
Alzheimer's. Mt. Airy, MD: ElderSong Publications, Inc.
Corey, G., Corey, M. S., & Callanan, P. (1988). Issues and Ethics in the Helping Professions (3 Td
Corey, G., Corey, M. S., Callanan, P., & Russell, J. M. (1992). Group Techniques (2 nd Ed.).
Pacific Grove, CA: Brooks/Cole.
Corey, M. S., & Corey, G. (1998). Becoming a Helper (3 Td Ed.). Pacific Grove, CA: Brooks/Cole.
Cozolino, L. (2004). The Making of a Therapist: A Practical Guide to the Inner Journey. New
York: W. W. Norton Co.
Critchley, M. (1977). Musicogenic epilepsy. I. The beginnings. In M. Critchley & R. Henson
(Eds.), Music and the Brain (pp. 344-353). London: William Heineman Medical Books
Limited.
Crocker, D. B. (1956). Music as a projective technique. In E. T. Gaston (Ed.), Music Therapy
1955 (pp. 86-97). Lawrence, KS: National Association for Music Therapy.
Crocker, D. B. (1958). Music as a therapeutic experience for the emotionally disturbed child. In
E. T. Gaston (Ed.), Music Therapy 1957 (pp. 114-119). Lawrence, KS: National
Association for Music Therapy.
MD: Scarecrow Press.
Dalton, T. A., & Krout, R. E. (2005). Development of the Grief Process Scale through music
therapy songwriting with bereaved adolescents. The Arts in Psychotherapy, 32, 131-143.
Darrow, A-.A. (2004). Introduction to Approaches in Music Therapy. Silver Spring, MD:
Dass, R., & Gorman, P. (1985). How Can I Help? Stories and Reflections on Service. New York:
Alfred A. Knopf.
Davies, A., & Richards, E. (2002). Music Therapy and Group Work: Sound Company. London:
Jessica Kingsley Publishers.
De Backer, J., & Van Camp, J. (1999). Specific aspects of the music therapy relationship to
psychiatry. In T. Wi gram & J. De Backer (Eds.), Clinical Applications of Music Therapy in
Psychiatry (pp. 11-23). Philadelphia: Jessica Kingsley Publishers.
Dileo, C. (1999). (Ed.). Music Therapy & Medicine: Theoretical and Clinical Applications.
Dileo, C. (2000). Ethical Thinking in Music Therapy. Cherry Hill, NJ: Jeffrey Books.
Dileo, c., & Bradt, J. (1999). Entrainment, resonance, and pain-related suffering. In C. Dileo
(Ed.), Music Therapy and Medicine: Theoretical and Clinical Applications (pp. 181-188).
Dobson, K. (Ed.) (1988). Handbook of Cognitive-Behavioral Therapies. New York: Guilford
Press.
Dolan, Y. (1991). Resolving Sexual Abuse: Solutions-Focused Therapy and Ericksonian
Hypnosis for Adult Survivors. New York: Norton.
Dvorkin, J. (1982). Piano improvisation: A therapeutic tool in acceptance and resolution of
emotions in a schizo-affective personality. Music Therapy, 2, 52-62.
Dvorkin, J. (1998). Transference and countertransference in group improvisation therapy. In K

E. Bruscia (Ed.), The Dynamics of Music Psychotherapy (pp. 287-298). Gilsum, NH:
Edwards, J. (1998). Music therapy for children with severe burn injury. Music Therapy
Egan, G. (1975). The Skilled Helper: A Model for Systematic Helping and Interpersonal
Relating. Monterey, CA: Brooks/Cole Publishing Co.
Egan, G. (1998). The Skilled Helper: A Problem-Management Approach to Helping (6 th Ed.).
Pacific Grove, CA: Brooks/Cole Publishing Co.
Erikson, E. (1963). Childhood and Society (2nd Ed.; first published, 1950). New York: W. W.
Norton & Co.
Eschen, J. T. (Ed.) (2002). Analytical Music Therapy. Philadelphia: Jessica Kingsley Publishers.
Farnan, L. A. (2001). Competency-based approach to intern supervision. In M. Forinash (Ed.),
Music Therapy Supervision (pp. 117-134). Gilsum, NH: Barcelona Publishers.
Farnan, L., & Johnson, F. (1988a) Everyone Can Move. New Berlin, WI: Jenson Publications.
Farnan, L., & Johnson, F. (1988b). Music Isfor Everyone. New Berlin, WI: Jenson Publications.
Ficken, T. (1976). The use of songwriting in a psychiatric setting. Journal of Music Therapy, 13,
163-172.
Fischer, R. (1991). Original song drawings in the treatment of a developmentally disabled,
autistic adult. In K E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 359-371).
Forano, S. (1979). Hawaii Early Learning Profile: Activity Guide. Palo Alto, CA: VORT.
Fraenkel, J. R., & Wallen, N. E. (2003). How to Design and Evaluate Research in Education (5 th
Ed.). New York: McGraw-Hill Higher Education.
Frank, J. D. (1974). Persuasion and Healing (Rev. Ed.). New York: Schocken Books.
Freud, S. (1938). The Basic Writings of Sigmund Freud (A. A. Brill, trans.). New York: Random
House.
Friedlander, L. H. (1994). Group music psychotherapy in an inpatient psychiatric setting for
children: A developmental approach. Music Therapy Perspectives, 12, 92-97.
Gagne, R. M., & Briggs, L. J. (1974). Principles of Instructional Design (2 nd Ed.). Holt, Rinehart,
and Winston.
Gallagher, L. M., & Steele, A. L. (2002). Music therapy with offenders in a substance
abuse/mental illness treatment program. Music Therapy Perspectives, 20, 117-122.
Gardstrom, S. C. (2001). Practical techniques for the development of complementary skills in
musical improvisation. Music Therapy Perspectives, 19, 82-87.
Garland, J., Jones, H., & Kolodny, R. L. (1976). A model for stages of development in social
work groups. In S. Bernstein (Ed.), Explorations in Group Work: Essays in Theory and
Practice (pp. 17-71). Boston: Charles River Books.
Gfeller, K. (1987). Songwriting as a tool for reading and language remediation. Music Therapy,
6,28-38.
Gfeller, K, & Hanson, N. (1995). Music Therapy Programming for Individuals With Alzheimer's
Disease and Related Disorders. Iowa City, IA: Univ. of Iowa.
Glassman, L. (1983). The talent show: Meeting the needs of the healthy elderly. Music Therapy,
3,82-93.
Goldberg, F. S. (1989). Music psychotherapy in acute psychiatric inpatient and private practice
settings. Music Therapy Perspectives, 6, 40-43.
Goldfried, M. R. (2001). How Therapists Change: Personal and Professional Reflections.
Washington, DC: American Psychological Association.
References D 195
Goodman, K. D. (1989). Music therapy assessment of emotionally disturbed children. The Arts in
Grant, R. (1973). Sing Along Senior Citizens. Springfield, IL: Charles C. Thomas.
Grant, R. (1995). Music therapy assessment for developmentally disabled clients. In T. Wigram,
B. Saperston, & R. West (Eds.), The Art and Science of Music Therapy: A Handbook (pp.
273-287). Chur, Switzerland: Harwood Academic Publishers.
Greenspan, S. I. (1992). Infancy and Early Childhood: The Practice of Clinical Assessment and
Intervention With Emotional and Developmental Challenges. Madison, CT: International
Universities Press.
Greenspan, S. I., & Wieder, S. (1998). The Child With Special Needs: Encouraging Intellectual
and Emotional Growth. Reading, MA: Addison-Wesley.
Gregory, D. (2000). Test instruments used by Journal of Music Therapy authors from 1984-
1997. Journal ofMusic Therapy, 37, 79-94.
Gustorff, D. (2001). Beyond words: Music therapy with comatose patients and those with
impaired consciousness in intensive care. In D. Aldridge, G. DiFranco, E. Ruud, & T.
Wi gram (Eds.), Music Therapy in Europe (pp. 61-72). Rome: ISMEZ.
Hadley, S. (1996). A rationale for the use of songs with children undergoing bone marrow
transplantation. Australian Journal of Music Therapy, 7, 16-27.
Hadley, S. (Ed.) (2003). Psychodynamic Music Therapy: Case Studies. Gilsum, NH: Barcelona
Publishers.
Hadsell, N. A. (1993). Levels of external structure in music therapy. Music Therapy
Hall, R. V., & Van Houten, R. (1983). Managing Behavior 1: Behavior Modification: The
Measurement of Behavior. Austin, TX: Pro-Ed.
Hanser, S. B. (1985). Music therapy and stress reduction research. Journal of Music Therapy, 22,
193-206.
Hanser, S. B. (1987). Observation and feedback techniques for student practica. In C. D. Maranto
& K. Bruscia (Eds.), Perspectives on Music Therapy Education and Training (pp. 149-
157). Philadelphia: Esther Boyer College of Music, Temple University.
Hanser, S. B. (1990). A music therapy strategy for depressed older adults in the community.
Journal ofApplied Gerontology, 9, 283-298.
Hanser, S. B. (1999). The New Music Therapist's Handbook (2 nd Ed.). Boston, MA: Berklee
Press.
Hanser, S. B., & Thompson, L. W. (1994). Effects of a music therapy strategy on depressed older
adults. Journal of Gerontology: Psychological Sciences, 49, P265-P269.
Heimlich, E. P. (1965). The specialized use of music as a mode of communication in the
treatment of disturbed children. Journal of the American Academy of Child Psychiatry, 4,
86-122.
Heimlich, E. P. (1972). Paraverbal techniques in the therapy of childhood communication
disorders. International Journal of Child Psychotherapy, 1(1),65-83.
Herman, F. (1991). The boy that nobody wanted: Creative experiences for a boy with severe
emotional problems. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 99-108).
Hesser, B. (2001). The transformative power of music in our lives: A personal perspective. Music
Hibben, J. (1991). Group music therapy with a classroom of 6-8 year-old hyperactive-learning
disabled children. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 175-189).
Hibben, J. (Ed.). (1999). Inside Music Therapy: Client Experiences. Gilsum, NH: Barcelona
Publishers.
Hintz, M. (2000). Geriatric music therapy clinical assessment: assessment of music skills and
related behaviors. Music Therapy Perspectives, 18, 31-37.
Hoffren, J. (1964). A test of musical expression. Council for Research in Music Education, 2,
32-35.
Homme, L. (1970). How to Use Contingency Contracting in the Classroom. Champaign, IL:
Research Press Co.
Horikoshi, T., Asari, Y., Watanabe, A., Nagaseki, Y., Nukui, H., Sasaki, H., & Komiya, K.
(1997). Music alexia in a patient with mild pure alexia: distorted visual perception of
nonverbal meaningful figures. Cortex, 33, 187-194.
Hough, S. (1982). The Nature of Musical Communication, Group Interaction and Social
Independence Among Preschool Children. Unpublished master's thesis, Southern
Methodist University, Dallas, TX.
Hurt, C. P., Rice, R R, McIntosh, G. C., & Thaut, M. H. (1998). Rhythmic Auditory Stimulation
in gait training for patients with traumatic brain injury. Journal ofMusic Therapy, 35, 228-
241.
Hurt-Thaut, C., & Johnson, S. (2003). Neurologic Music Therapy with children: Scientific
foundations and clinical application. In S. L. Robb (Ed.), Music Therapy in Pediatric
Healthcare: Research and Evidence-Based Practice (pp. 81-100). Silver Spring, MD:
Husni-Palacios, M., & Palacios, J. R (1964). Auditory perception and personality patterns in
blind adults. Journal of Projective Techniques and Personality Assessment, 28, 284-292.
Isenberg-Grzeda, C. (1988). Music therapy assessment: A reflection of professional identity.
Ivey, A. E., & Simek-Downing, L. (1980). Counseling and Psychotherapy: Skills, Theories, and
Practice. Englewood Cliffs, NJ: Prentice-Hall.
James, M. R, & Freed, B. S. (1989). A sequential model for developing group cohesion in music
therapy. Music Therapy Perspectives, 7,28-34.
Katsh, S., & Merle-Fishman, C. (1998). The Music Within You (2 nd Ed.). Gilsum, NH: Barcelona
Publishers.
Kenny, C. B. (1985). Music: A whole systems approach. Music Therapy, 5,3-11.
Kenny, C. B. (1989). The Field of Play: A Guide for the Theory and Practice of Music Therapy.
Atascadero, CA: Ridgeview Publishing Co.
Kenny, C. B. (1995). Listening, Playing, Creating: Essays of the Power of Sound. Albany, NY:
State University of New York Press.
Koga, M., & Tims, F. (2001, OctoberlNovember). The Music Making and Wellness Project.
American Music Teacher, 51 (2), 18-22.
Kramer, C. H. (2000). Therapeutic Mastery: Becoming a More Creative and Effective Therapist.
Phoeniz, AZ: Zeig, Tucker.
Krout, R (1986). Music Therapy in Special Education. St. Louis, MO: MMB Music.
Krout, R (1987). Music therapy with multi-handicapped students: Individualizing treatment
within a group setting. Journal of Music Therapy, 24, 2-13.
Lane, D. (1991). The effect of a single music therapy session on hospitalized children as
measured by salivary immunoglobulin a, speech pause time, and patient opinion Likert
scale. Pediatric Research, 29 (Pt. 2), 119-125.
References 0 197
Layman, D. L., Hussey, D. L., & Laing, S. J. (2002). Music therapy assessment for severely
emotionally disturbed children: A pilot study. Journal ofMusic Therapy, 34, 164-187.
Lazarus, A. A. (1976). Multimodal Behavior Therapy. New York: Springer.
Lazarus, A. A. (1989). The Practice of Multimodal Therapy. Baltimore: John Hopkins University
Press.
Lee, C. (1996). Music at the Edge. London: Routledge.
Levin, H., & Levin, G. (1977). A Garden of Bell Flowers. Bryn Mawr, PA: Theodore Presser.
Levin, H., & Levin, G. (1997). Learning Through Songs. Gilsum, NH: Barcelona Publishers.
Levin, H., & Levin, G. (1998). Learning Through Music. Gilsum, NH: Barcelona Publishers.
Levin, H., & Levin, G. (2004). Distant Bells: 12 Delightful Melodies from Distant Lands
Arranged for Resonator Bells & Piano. Gilsum, NH: Barcelona Publishers.
Lewinsohn, P. M., & Talkington, 1. (1979). Studies on the measurement of unpleasant events and
relations with depression. Applied Psychological Measurement, 3, 83-101.
Liberatore, A. M., & Layman, D. L. (1999). The Cleveland Music Therapy Assessment of Infants
and Toddlers: A Practical Guide to Assessment and Developing Intervention. Cleveland,
OH: Cleveland Music School Settlement.
Lipe, A. (1995). The use of music performance tasks in the assessment of cognitive functioning
among older adults with dementia. Journal of Music Therapy, 32, 137-151.
Loewy, J. V. (1995). The musical stages of speech: A developmental model of pre-verbal sound
making. Music Therapy, 13,47-73.
Loewy, J. (1999). The use of music psychotherapy in the treatment of pediatric pain. In C. Dileo
(Ed.), Music Therapy and Medicine: Theoretical and Clinical Applications (pp. 189-206).
Loewy, J. (2000). Music psychotherapy assessment. Music Therapy Perspectives, 18,47-58.
Loewy, J., MacGregor, B., Richards, K., & Rodriguez, J. (1997). Music therapy in pediatric pain
management: Attending to the sounds of hurt, fear and anxiety. In J. Loewy (Ed.), Music
Therapy and Pediatric Pain (pp. 45-56). Cherry Hill, NJ: Jeffrey Books.
Logis, M., & Turry, Alan. (1999). Singing my way through it: Facing the cancer, the darkness,
and the fear. In J. Hibben (Ed.), Inside Music Therapy: Client Experiences (pp. 97-117).
Loveszy, R. (1991). The use of Latin music, puppetry, and visualization in reducing the physical
and emotional pain of a child with severe bums. In K. E. Bruscia (Ed.), Case Studies in
Music Therapy (pp. 153-161). Gilsum, NH: Barcelona Publishers.
Mack, G. (1999). Adventures in Modes and Keys. Miami, FL: Warner Bros. Publications.
Madsen, C. H., Jr., & Madsen, C. K. (1983). Teaching/Discipline: A Positive Approach for
Educational Development (3Td Ed.). Raleigh, NC: Contemporary Publishing Co.
Madsen, C. K. (1980). Behavior Modification and Music Therapy: A Guidefor Working With the
Mentally Retarded. Washington, DC: National Association for Music Therapy.
Magee, W. (1999) "Singing my life, playing my self': Song based and improvisatory methods of
music therapy with individuals with neurological impairments. In T. Wigram & J. De
Backer (Eds.), Clinical Applications of Music Therapy in Developmental Disability,
Paediatrics and Neurology (pp. 201-223). London: Jessica Kingsley Publishers.
Maranto, C. D. (1993a). Applications of music in medicine. In M. Heal & T. Wi gram (Eds.),
Music Therapy in Health and Education (pp. 153-174). London: Jessica Kingsley
Publishers.
Maranto, C. D. (Ed.) (1993b). Music Therapy: International Perspectives. Pipersville, PA:
Jeffrey Books.
Maranto, C. (1996). Research in music and medicine: The state of the art. In M. A. Froehlich
(Ed.), Music Therapy With Hospitalized Children (pp. 39-66). Cherry Hill, NJ: Jeffrey
Books.
Marley, L. (1996). Music therapy with hospitalized infants and toddlers in a child life program.
In M. A. R. Froelich (Ed.), Music Therapy With Hospitalized Children (pp. 77-86). Cherry
Hill, NJ: Jeffrey Books.
Maslow, A. H. (1999). Toward a Psychology of Being (3 rd Ed.). New York, NY: John Wiley &
Sons.
Matthews, G., Jones, D. M., & Chamberlain, A. G. (1990). Refining the measurement of mood:
The UWIST Mood Adjective Check List. British Journal of Psychology, 81, 1-26.
Mazzagatti, N. (1975). The Mazzagatti Auditory Perception Technique (MAAT). The New
Jersey Psychologist, 26(1), 10-12.
McDonnell, L. (1983). Music therapy: Meeting the psychosocial needs of hospitalized children.
Journal of the Associationfor the Care of Children 's Health, 12(1), 29-33.
McGuigan, F. J. (1968). Experimental Psychology (2 nd Ed.). Englewood Cliffs, NJ: Prentice-
Hall.
McGuire, M. G., & Smeltekop, R. A. (1994a). The termination process in music therapy: Part 1-
Theory and clinical implementations. Music Therapy Perspectives, 12, 20-27.
McGuire, M. G., & Smeltekop, R. A. (1994b). The termination process in music therapy: Part
II-A model and clinical applications. Music Therapy Perspectives, 12, 28-34.
Meadows, A. (2000). The validity and reliability of the Guided Imagery and Music
Responsiveness Scale. Journal of the Association for Music and Imagery, 7, 8-33.
Medley, D. M. (1982). Systematic observation. In H. E. Mitzel (Ed.), Encyclopedia of
Educational Research (5 th Ed., pp. 1841-1851). New York: Free Press.
Merle-Fishman, C., & Marcus, M. (1982). Musical behaviors and preferences of emotionally
disturbed and normal children: An exploratory study. Music Therapy, 2, 1-12.
Merriam-Webster's Collegiate Dictionary (1oth Ed.). (2002). Springfield, MA: Merriam-
Webster, Inc.
Montello, L. (2003). Protect this child: Psychodynamic music therapy with a gifted musician. In
S. Hadley (Ed.), Psychodynamic Music Therapy: Case Studies (pp. 299-318). Gilsum, NH:
Morris, K. T., & Cinnamon, K. M. (1975). A Handbook of Non-Verbal Group Exercises.
Springfield, IL: Charles C. Thomas.
Murphy, K. M., & Wheeler, B. L. (in press). Symposium on Experiential Learning in Music
Therapy: Report of the Symposium Sponsored by the World Federation of Music Therapy
Commission on Education, Training, and Accreditation. Music Therapy Perspectives.
Murphy, M. E. (1992). Coping in the short term: The impact of acute care on music therapy
practice. Music Therapy, 11,99-119.
Nolan, P. (2003). Through music to therapeutic attachment: Psychodynamic music
psychotherapy with a musician with dysthemic disorder. In S. Hadley (Ed.),
Psychodynamic Music Therapy: Case Studies (pp. 319-338). Gilsum, NH: Barcelona
Publishers.
Nordoff, P., & Robbins, C. (1962). The First Book of Children's Play Songs. Bryn Mawr, PA:
Theodore Presser.
Nordoff, P., & Robbins, C. (1966). The Three Bears. Bryn Mawr, PA: Theodore Presser.
Nordoff, P., & Robbins, C. (1968a). Funfor Four Drums. Bryn Mawr, PA: Theodore Presser.
Nordoff, P., & Robbins, C. (1968b). The Second Book of Children's Play Songs. Bryn Mawr,
PA: Theodore Presser.
Nordoff, P., & Robbins, C. (1969). Pif-PafPoltrie. Bryn Mawr, PA: Theodore Presser.
References D 199
Nordoff, P., & Robbins, C. (1971). Therapy in Musicfor Handicapped Children. New York: St.
Martin's Press.
Nordoff, P., & Robbins, C. (1972). Spirituals. Bryn Mawr, PA: Theodore Presser.
Nordoff, P., & Robbins, C. (1977). Creative Music Therapy. New York: John Day.
Nordoff, P., & Robbins, C. (1979). Fanfares and Dances. Bryn Mawr, PA: Theodore Presser.
Nordoff, P., & Robbins, C. (1980a). The Fifth Book of Children's Play Songs. Bryn Mawr, PA:
Theodore Presser.
Nordoff, P., & Robbins, C. (1980b). The Fourth Book of Children 's Play Songs. Bryn Mawr, PA:
Theodore Presser.
Nordoff, P., & Robbins, C. (1980c). The Third Book of Children 's Play Songs. Bryn Mawr, PA:
Theodore Presser.
Nordoff, P., & Robbins, C. (1983). Music Therapy in Special Education (2 nd Ed.). St. Louis, MO:
MMB Music.
Nordoff, P., & Robbins, C. (1995). Greetings and Goodbyes. Bryn Mawr, PA: Theodore Presser.
o 'Callaghan, C. (1995). Songs written by palliative care patients in music therapy. In C. Lee
(Ed.), Lonely Waters (pp. 31-39). Oxford, UK: Sobell Publications.
Oldfield, A. (1993). A study of the way music therapists analyse their work. Journal of British
Oldfield, A., & Bunce, L. (2001). "Mummy can play too ... " Short-term music therapy with
mothers and young children. British Journal ofMusic Therapy, 15(1), 27-36.
Palmer, H. (1981). Hap Palmer Favorites. Sherman Oaks, CA: Alfred Publishing Co.
Pattison, P. (1991). Songwriting: Essential Guide to Lyric Form and Structure. Boston: Berklee
Press.
Pavlicevic, M. (1997). Music Therapy in Context. London: Jessica Kingsley Publishers.
Pavlicevic, M. (1999). Music Therapy Intimate Notes. London: Jessica Kingsley Publishers.
Pavlicevic, M. (2003). Groups in Music: Strategies From Music Therapy. London: Jessica
Pavlicevic, M., & Ansdell, G. (Eds.). (2004). Community Music Therapy. London: Jessica
Pavlicevic, M., & Trevarthen, C. (1989). A musical assessment of psychiatric states in adults.
Psychopathology, 22, 325-334.
Pennebaker,1. W. (1997). Opening Up: The Healing Power of Expressing Emotions (Rev. Ed.).
New York: Guilford Press.
Perilli, G. (1991). Integrated music therapy with a schizophrenic woman. In K. E. Bruscia (Ed.),
Case Studies in Music Therapy (pp. 403-416). Gilsum, NH: Barcelona Publishers.
Persoons, J., & De Backer, J. (1997) Vibroacoustic music therapy with handicapped and autistic
adolescents. In T. Wigram & C. Dileo (Eds.), Music Vibration (pp. 143-148). Cherry Hill,
NJ: Jeffrey Books.
Pierce, W. D., & Cheney, C. D. (2004). Behavior Analysis and Learning (3 rd Ed.). Mahwah, NJ:
Lawrence Erlbaum.
Plach, T. (1980). The Creative Use of Music in Group Therapy. Springfield, IL: Charles C.
Thomas.
Polen, D. W. (1985). Music Therapy Assessment for Adults With Developmental Disabilities.
Unpublished manuscript.
Priestley, M. (1975). Music Therapy in Action. London: Constable.
Priestley, M. (1994). Essays on Analytical Music Therapy. Gilsum, NH: Barcelona Publishers.
Prochaska, J. 0., & Norcross, J. C. (1999). Systems of Psychotherapy: A Transtheoretical
Analysis (4 th Ed.). Pacific Grove, CA: Brooks/Cole Publishing Co.
Purvis, J., & Samet, S. (1976) Music in Developmental Therapy. Baltimore, MD: University Park
Press.
Reed, K. J. (2002). Music therapy treatment groups for mentally disordered offenders (MDO) in
a state hospital setting. Music Therapy Perspectives, 20, 98-104.
Reuer, B. (2005). Music Therapy Toolbox: Medical Settings: Strategies, Applications, and
Sample Formsfor Therapists. San Diego, CA: MusicWorx of California.
Reuer, B. L., Crowe, B., & Bernstein, B. (1999). Best Practice in Music Therapy: Utilizing
Group Percussion Strategies for Promoting Volunteerism in Well Older Adults (2 nd Ed.).
Rider, M. (1981). The assessment of cognitive functioning level through musical perception.
Rider, M. (1997). The Rhythmic Language of Health and Disease. St. Louis, MO: MMB Music.
Rio, R. E., & Tenney, K. S. (2002). Music therapy for juvenile offenders in residential treatment.
Music Therapy Perspectives, 20, 89-97.
Ristad, E. (1982). A Soprano on Her Head: Right-Side-Up Reflections on Life and Other
Performances. Moab, UT: Real People's Press.
Ritholz, M. S., & Robbins, C. (1999). Themesfor Therapy. New York: Carl Fischer.
Ritholz, M. S., & Robbins, C. (2002). More Themesfor Therapy. New York: Carl Fischer
Robazza, C., Macaluso, c., & D'Urso, V. (1994). Emotional reactions to music by gender, age,
and expertise. Perceptual and Motor Skills, 79, 939-944.
Robb, S. (1996). Techniques in song writing: Restoring emotional and physical well being in
adolescents who have been traumatically injured. Music Therapy Perspectives, 14, 30-37.
Robbins, Carol, & Robbins, Clive. (1980). Music for the Hearing Impaired and Other Special
Populations. St. Louis, MO: MMB Music.
Robbins, Clive, & Robbins, Carol (1998). Healing Heritage: Paul NordofJ Exploring the Tonal
Language of Music. Gilsum, NH: Barcelona Publishers.
Rubin, B. (1976). Handbells in therapy. Journal of Music Therapy, 13,49-53.
Ruud, E. (1980). Music Therapy and Its Relationship to Current Treatment Theories. St. Louis,
MO: MMB Music.
Ruud, E. (1998). Music Therapy: Improvisation, Communication, and Culture. Gilsum, NH:
Ryback, R. S. (1974). The Problem Oriented Record in Psychiatry and Mental Health Care. New
York: Grune & Stratton.
Rykov, M. (1999). Sometimes there are no reasons: Marco's Song. In J. Hibben (Ed.), Inside
Music Therapy: Client Experiences (pp. 203-207). Gilsum, NH: Barcelona Publishers.
Salas, J., & Gonzalez, D. (1991). Like singing with a bird: Improvisational music therapy with a
blind four-year-old. In K. Bruscia (Ed.), Case Studies in Music Therapy (pp. 17-27).
Sandness, M. I. (1991). Developmental sequence in music therapy groups: A review of
theoretical models. Music Therapy Perspectives, 9, 66-72.
Sandrock, D., & James, M. R. (1989). Assessment instruments for music-assisted relaxation
training. Music Therapy Perspectives, 7,44-50.
Saperston, B. M., Chan, R., Morphew, C., & Carsrud, K. B. (1980). Music listening versus juice
as a reinforcement for learning in profoundly mentally retarded individuals. Journal of
Music Therapy, 17,174-183.
Scalenghe, R., & Murphy, K. M. (2000). Music therapy assessment in the managed care
environment. Music Therapy Perspectives, 18, 23-30.
Scartelli, J. P. (1989). Music and Self-Management Methods. St Louis, MO: MMB Music.
References 0 20 I
Scheiby, B. B. (1999). Music as symbolic expression: Analytical Music Therapy. In D. J. Wiener

(Ed.), Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical
Practice (pp. 263-285). Washington, DC: American Psychological Association.
Schmidt, J. A. (1983). Songwriting as a therapeutic procedure. Music Therapy Perspectives, 1(2),
4-7.
Shakow, D., & Rosenzweig, S. (1940). The use of the tautophone ("Verbal Summator") as an
auditory apperceptive test for the study of personality. Character and Personality, 8, 216-
226.
Shaw, J. (1993). The Joy of Music in Maturity. St. Louis, MO: MMB Music.
Shippen, M. E., Simpson, R. G., & Crites, S. A. (2003). A practical guide to functional
behavioral assessment. Teaching Exceptional Children, 35(5),36-45.
Shultis, C. (1995). Music Therapy Assessment and Initial Treatment Plan. Unpublished
manuscript.
Shultis, C. L. (1997). A Manual for Music Therapy-Based Stress Management Training for
Adults in Psychiatric Treatment. Unpublished master's thesis, Pennsylvania State
University, State College, P A.
Shultis, C. (1999). Music therapy inpatient psychiatric treatment in the 1990s. Psychiatric Times,
16(2). http://www.psychiatrictimes.com/p990246.html
Silber, F., & Hes, J. P. (1995). The use of songwriting with patients diagnosed with Alzheimer's
disease. Music Therapy Perspectives, 13, 31-34.
Skille, O. (1997). Potential applications of vibroacoustic therapy. In T. Wigram & C. Dileo
(Eds.). Music Vibration (pp. 49-53). Cherry Hill, NJ: Jeffrey Books.
Skille, 0., & Wigram, T. (1995). The effect of music, vocalisation and vibration on brain and
muscle tissue: Studies in vibroacoustic therapy. In T. Wi gram, B. Saperston, & R. West
(Eds.), The Art & Science of Music Therapy: A Handbook (pp. 23-57). Chur, Switzerland:
Harwood Academic Publishers.
Small, C. (1998). Musicking: The Meanings of Performing and Listening. Hanover, NH:
Wesleyan University Press.
Smith, G. H. (1991). The song-writing process: A woman's struggle against depression and
suicide. In K. E. Bruscia (Ed.), Case Studies in Music Therapy (pp. 479-496). Gilsum, NH:
Speilberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA:
Consulting Psychologists Press.
Sperry, L., Carlson, J. & Kjor, D. (2003). Becoming an Effective Therapist. Boston: Allyn &
Bacon.
Spintge, R. K. W. (1989). The anxiolytic effects of music. In M. H. M. Lee (Ed.), Rehabilitation,
Music and Human Well-Being (pp. 82-97). St. Louis, MO: MMB Music.
MO: MMB Music.
Standley, J. M. (1992). Clinical applications of music and chemotherapy: The effects on nausea
and emesis. Music Therapy Perspectives, 10, 27-35.
Standley, J. (2000). Music research in medical treatment. In Effectiveness of Music Therapy
Procedures: Documentation of Research and Clinical Practice (3 Td Ed., pp. 1-64). Silver
Spring, MD: American Music Therapy Association.
and benefits of a music therapy program for early intervention: A behavioral analysis.
Steinberg, R., & Raith, L. (1985). Music psychopathology: II. Assessment of musical expression.
Psychopathology, 18, 265-273.
Stige, B. (2002). Culture-Centered Music Therapy. Gilsum, NH: Barcelona Publishers.

Stratton, V. N., & Zalonowski, A. H. (1984). The relationship between music, degree of liking,
and self-reported relaxation. Journal ofMusic Therapy, 21, 184-192.
Sulzer-Azaroff, B., & Mayer, G. R. (1991). Behavior Analysis for Lasting Changes. Ft. Worth,
TX: Holt, Rinehart & Winston.
Summer, L. (1990). Guided Imagery and Music in the Institutional Setting (2 nd Ed). St. Louis,
MO: MMB Music.
Summer, L. (2001). Group supervision in first-time music therapy practicum. In M. Forinash
(Ed.), Music Therapy Supervision (pp. 69-86). Gilsum, NH: Barcelona Publishers.
Summer, L. (2002). Group music and imagery therapy: Emergent receptive techniques in music
therapy practice. In K. E. Bruscia & D. E. Grocke (Eds.), Guided Imagery and Music: The
Thaut, M. (2000). A Scientific Model of Music in Therapy and Medicine. San Antonio, TX: IMR
Press, University of Texas.
Theurer, K. (2003). The Bells Are Ringing: The Magic of Using Handchimes in Music Therapy
for People Living With Dementia. Vancouver, BC, Canada: Author.
Thompson, A. B., Arnold, J. C. & Murray, S. E. (1990). Music therapy assessment of the
cerebrovascular accident patient. Music Therapy Perspectives, 8, 23-29.
Trevarthen, C., Aitken, K., Papoudi, D., & Robarts, J. (1998). Children With Autism (2 nd Ed.; pp.
172-202). London: Jessica Kingsley Publishers.
Turry, Alan, & Marcus, D. (2003). Using the Nordoff-Robbins approach to music therapy with
adults diagnosed with autism. In D. Wiener & L. Oxford (Eds.), Action Therapy With
Families and Groups (pp. 197-228). Washington, DC: American Psychological
Association.
Turry, Ann E. (1997). The use of clinical improvisation to alleviate procedural distress in young
children. In J. V. Loewy (Ed.), Music Therapy and Pediatric Pain (pp. 89-96). Cherry
Hill, NJ: Jeffrey Books.
Tyson, F. (2004). Psychiatric Music Therapy in the Community: The Legacy of Florence Tyson
(M. G. McGuire, Ed.). Gilsum, NH: Barcelona Publishers.
Unkefer, R. F., & Thaut, M. H. (Eds.). (2002). Music Therapy in the Treatment of Adults with
Mental Disorders (2 nd Ed.). st. Louis, MO: MMB Music.
Van Den Daele, L. (1967). A music projective technique. Journal of Projective Techniques and
Personality Assessment, 31(5),47-57.
Wadsworth, B. J. (1989). Piaget's Theory of Cognitive and Affective Development (4 th Ed.).
White Plains, NY: Longman.
Waldon, E. G. (2001). The effects of group music therapy on mood states and cohesiveness in
adult oncology patients. Journal of Music Therapy, 38, 212-238
Walters, C. L. (1996). The psychological and physiological effects of vibrotactile stimulation, via
a Somatron, on patients awaiting scheduled gynecological surgery. Journal of Music
Therapy, 33, 261-287
Watson, D. E., & Wilson, S. E. (2003). Task Analysis: An Individual and Population Approach
nd
(2 Ed.). Bethesda, MD: American Occupational Therapy Association.
Watson, T. (2002). Music therapy with adults with learning disabilities. In L. Bunt & S. Hoskyns
(Eds.), The Handbook of Music Therapy (pp. 86-114). London: Jessica Kingsley
Publishers.
Werner, K. (1996). Effortless Mastery: Liberating the Master Musician Within. New Albany, IN:
Jamey Aebersold Jazz.
Wheeler, A. H., & Fox, W. L. (1972). A Teacher's Guide to Writing Instructional Objectives.
Lawrence, KS: H & H Enterprises.
References D 203
Wheeler, B. (1981). The relationship between music therapy and theories of psychotherapy.
Music Therapy, 1, 9-16.
Wheeler, B. L. (1983). A psychotherapeutic classification of music therapy practices: A
continuum of procedures. Music Therapy Perspectives, 1 (2), 8-12.
Wheeler, B. L. (1987a). Levels of therapy: The classification of music therapy goals. Music
Therapy, 6(2),39-49.
Wheeler, B. L. (1987b). The use of paraverbal therapy in treating an abused child. The Arts in
Wheeler, B. L. (1999). Experiencing pleasure in working with severely disabled children.
Wheeler, B. L. (2000). Music therapy practicum practices: A survey of music therapy educators.
Wheeler, B. L., Shifflet, S. c., & Nayak, S. (2003). Effects of number of sessions and group or
traumatic brain injuries. Nordic Journal of Music Therapy, 12, 139-151.
Wheeler, B. L., & Stultz, S. (April, 2001). The development of communication: Developmental
levels of children with and without disabilities. European Music Therapy Congress,
Naples, Italy. Available on Info-CD Rom IV, University ofWitten-Herdecke (2002) and at
http://www.musictherapyworld.net/
Wheeler, B. L., & Stultz, S. (July, 2002). Musical relatedness in infancy as a resource in
understanding children with disabilities. 10th World Congress of Music Therapy. Oxford,
UK. Available on Info-CD ROM V, University of Witten-Herdecke (2004) and at
http://www.musictherapyworld.net/modules/wfmt/stuff/oxford2002.pdf
Wigram, T. (1995). A model of assessment and differential diagnosis of handicap in children
through the medium of music therapy. In T. Wigram, B. Saperston, & R. West (Eds.), The
Art & Science of Music Therapy: A Handbook (pp. 181-193). Chur, Switzerland: Harwood
Academic Publishers.
Wigram, T. (1997). The measurement of mood and physiological responses to vibroacoustic
therapy in non-clinical subjects. In Wi gram, T. & Dileo, C. (Eds.) Music Vibration (pp.
87-97). Cherry Hill, NJ: Jeffrey Books.
Wi gram, T. (2000a). A method of music therapy assessment for the diagnosis of autism and
communication disorders in children. Music Therapy Perspectives, 18, 13-22.
Wi gram, T. (2000b). A model of diagnostic assessment and analysis of musical data in music
therapy. In T. Wigram (Ed.), Assessment and Evaluation in the Arts Therapies: Art
Therapy, Music Therapy & Dramatherapy (pp. 77-91). Hertfordshire, UK: Harper House
Publications.
Wigram, T. (2004). Improvisation. Methods and Techniques for Music Therapy Clinicians,
Educators and Students. London: Jessica Kingsley Publishers.
Wi gram, T., & Dileo, C. (Eds.). (1997). Music Vibration. Cherry Hill, NJ: Jeffrey Books.
Wilmer, H. A., & Husni, M. (1953). The use of sounds in a projective test. Journal of Consulting
Psychology, 17,377-383.
Wilson, B. L. (Ed.). (2002). Models of Music Therapy Interventions in School Settings (2nd Ed.).
Wolberg, L. R. (1977). The Technique of Psychotherapy (3 rd Ed., Pt. 1). New York: Grune &
Stratton.
Wolfe, D. E. (1980). The effect of automated interrupted music on head posturing of cerebral
palsied individuals. Journal ofMusic Therapy, 17, 184-206.
Wolfe, D. E. (2000). Group music therapy in acute mental health care: Meeting the demands of
effectiveness and efficiency. In Effectiveness of Music Therapy Procedures:
Documentation of Research and Clinical Practice (3 rd Ed.; pp. 26S-296). Silver Spring,
MD: American Music Therapy Association.
Wolfe, D. E., Bums, S., Stoll, M., & Wichmann, K. (197S). Analysis of Music Therapy Group
Procedures. Minneapolis, MN: Golden Valley Health Center.
Wolfe, D. E., & O'Connell, A (1999). Specifying and recording treatment objectives within a
group music therapy setting. Music Therapy Perspectives, 17, 37-41.
Wolpe, J. (1990). The Practice ofBehavior Therapy (4 th Ed.). Elmsford, NY: Pergammon.
Wood, M. M. (197S). Developmental Therapy. Baltimore, MD: University Park Press.
Wood, M. M., Quirk, C. A, & Swindle, F. H. (in press). Teaching Responsible Behavior:
Developmental Therapy-Developmental Teaching. Austin, TX: Pro. Ed Publishers.
Wright, L. M. (1992). A levels system approach to structuring and sequencing pre-practica
musical and clinical competencies in a university music therapy clinic. Music Therapy
Wyatt, J. G. (2002). From the field: Clinical resources for music therapy with juvenile offenders.
Yalom, I. D. (198S). The Theory and Practice of Group Psychotherapy (3rd Ed.). New York:
Basic Books.
York, E. (1994). The development of a quantitative music skills test for patients with
Alzheimer's disease. Journal ofMusic Therapy, 31, 280-297.
Zabin, A H. (200S). Lessons learned from the dying: Stories from a music therapist. Music
Therapy Perspectives, 23, 70-7S.
Zaro, J. S., Barach, R., Nedelman, D. J., & Dreiblatt, I. S. (1977). A Guide for Beginning
Psychotherapists. Cambridge, UK: Cambridge University Press.
Author Index
Adams, N., 154 67n, 68, 78, 81, 84, 89,91,96,101,109,

Adler, R, 52 115, 125, 129, 130, 137, 143, 150-152,
Aigen,K., 5,6, 85, 89,107,129,148,154 167, 169, 170, 180
Aitken, K., 84 Bryan, M., 11
Aldridge, D., 86, 147 Bunce, L., 84
Aldridge, G., 86 Bums, S., 160
Alter, C., 187 Callanan, P., 25, 132, 160
American Music Therapy Association, 4, 28, Cameron, J., 11
119,131,168,185 Camilleri, V. A., 11, 187
American Psychiatric Association, 120 Carkhuff, R. R, 25, 131, 144
Amir, D., 107, 129, 154 Carlson, J., 180, 187
Anderson, J. c., 37 Carsrud, K. B., 112
Ansdell, G., 89, 158 Carter, E., 84
Apprey, M., 162 Cartwright, C. A., 173
Apprey, Z. R., 162 Cartwright, G. P., 173
Arnold, J. c., 53 Cassidy, J. E., 52, 62, 120
Asari, Y., 53 Cassity, M. D., 35, 52, 62, 120, 160
Asmus, E. P., 38 Cattell, R. B., 37, 40
Austin, D., 85, 150, 187 Certification Board for Music Therapists,
Ball, T. S., 37 131
Barach, R, 177 Chadwick, D., 77n
Beck, A. T., 34, 144 Chamberlain, A. G., 34
Beck, J. S., 144 Chan, R., 112
Benjamin, A., 11, 144 Chase, K. M., 11, 33
Berman, I., 53 Chase, M. P., 151-153
Bernadoni, L. C., 37 Chavin, M., 78, 94, 95, 104, 113
Bernstein, B., 86, 95 Cheney, C. D., 145
Birkenshaw-Fleming, L., 78 Chesky, K. S., 113
Bitcon, C. R., 35, 97 Chevigny, R., 37
Bolton, R., 141 Cinnamon, K. M., 145
Bonny, R., 33, 115 Clair, A. A., 94, 95, 113, 147, 160
Boone, P., 35, 37, 107 Clark, c., 77n
Borczon, R M., 71, 85, 112, 160 Clarkson, G., 84
Boxill, E. R., 35,85,93, 104, 112, 147 Cohen, G., 52
Boyle, M. E., 62, 70 Coleman, K., 29, 33, 34,45,46
Bradt, J., 34, 53 Cordrey, c., 97, 113
Brammer, L. M., 23, 144, 187 Corey, G., 25, 132, 144, 160, 168
Braswell, c., 52 Corey, M. S., 25, 132, 144, 160, 168
Braverman, S., 37 Cozolino, L., 187
Briggs, C., 131 Critchley, M., 53
Briggs, L. J., 69 Crites, S. A., 54
Bright, R., 86, 97, 113, 179 Crocker, D. B., 84
Brodsky, W., 115 Crowe, B. J., 11,86,95, 132
Brooks, D. M., 52 Dalton, T. A., 54
Broucek, M., 38 Darrow, A-.A., 129
Brunk,B.,29,33,34,45,46, 96,105 Dass, R, 11, 187
Bruscia, K. E., 5, 11,27--41,44,45,54,66, Davies, A., 87, 164
De Backer, J., 111, 147, 149-151 Hintz, M., 52

DeCuir, A., 52 Hoffren, J., 38
Dileo, C., 25, 53, 113, see also Maranto Homme, L., 144
Dobson, K., 4 Horikoshi, T., 53
Dolan, Y, 111 Hough, S., 38
Dreiblatt, 1. S., 177 Hughes, J. E., 62, 177
D'Urso, Y., 38 Humphrey, T., 52
Dvorkin, J., 89, 160 Hunter, L. L., 89, 107
Edwards, J., 105 Hurt, C. P., 113, see also Hurt-Thaut
Egan, G., 4, 132, 144 Hurt-Thaut, C., 115, see also Hurt
Erbaugh, J., 34 Husni, M., 37, see also Husni-Palacios
Erikson, E., 121 Husni-Palacios, M., 37, see also Husni
Eschen, J. T., 85, 137 Hussey, D. L., 45, 49, 50
Evens, W., 187 Isenberg-Grzeda, c., 54
Farnan, L., 17, 78, 94 Ivey, A. E., 4, 179-181
Ficken, T., 104 Jacobs, K. W., 52
Fischer, R, 104 James, M. R, 34, 53, 162
Forano, S., 121 Johnson, F., 78, 94
Fox, W. L., 62 Johnson, S., 115
Fraenkel, J. R, 177 Jones, D. M., 34
Frank, J. D., 11 Jones, H., 160
Freed, B. S., 162 Katsh, S., 25
Freud, S., 121 Kenny,C.B.,5,6, 129, 130, 148, 149, 154
Friedlander, L. H., 164 Kjor, D., 180, 187
Gagne, R M., 69 Koga, M., 95
Gallagher, L. M., 107 Kolodny, R L., 160
Gardstrom, S. C., 89 Komiya, K., 53
Garland, J., 160 Kramer, C. H., 187
Gericke, O. L., 52 Krout, R E., 54, 62, 70
Gfeller, K., 94, 95, 103, 113 Laing, S. J., 45, 49, 50
Glassman, L., 95 Lane, D., 53
Goldberg, F. S., 112 Layman, D. L., 33,37,41,44,49,50
Goldfried, M. R, 187 Lazarus, A. A., 120
Gonzalez, D., 84 Lee, C., 89
Goodman, K. D., 38 Levin, G., 92, 93
Gorman, P., 11, 187 Levin, H., 92, 93
Grant, R., 54, 96 Lewinsohn, P. M., 34
Greenspan, S. 1., 121, 122 Liberatore, A. M., 33, 37,41,44
Gregory, D., 54 Lipe, A., 52
Grocke, D. E., 115, 137 Loewy, J., 53, 54, 132
Gustorff, D., 86 Logis, M., 89
Hadley, S., 104, 170 Loveszy, R, 107
Hadsell, N. A., 71, 125, 127 Macaluso, c., 38
Hall, R Y., 173 MacDonald, G., 23, 144, 187
Hanser, S. B., 17,35,62, 70, 113, 141 Mack, G., 89
Hanson, N., 94, 95, 113 Madsen, C. H., Jr., 62, 173
Heimlich, E. P., 84 Madsen, C. K., 62, 129, 173
Herman, F., 111 Magee, W., 95
Hes, J. P., 104 Maranto, C. D., 37
Hesser, B., 154 Marcus, D., 89
Hibben, J., 161, 162, 170 Marcus, M., 35
Author Index D 207
MacGregor, B., 53 Reuer, B. L., 8, 86, 95, 105, 113

Marley, L., 95, 158 Rice, R R, 113
Maslow, A. H., 4, 152, 181 Richards, E., 87, 164
Matthews, G., 34 Richards, K., 53
Mayer, G. R, 145 Rider, M., 32, 145
Mazzagatti, N., 40 Rio, R E., 103
McDonnell, L., 84 Ristad, E., 154
McGuigan, F. J., 174 Ritholz, M. S., 93
McGuire, M. G., 161, 170 Robarts, J., 84
McIntosh, G. C., 113 Robazza, c., 38
McMichael, R E., 40 Robb, S., 103
Meadows, A., 45 Robbins, Carol, 78, 89, 93, 96
Medley, D. M., 173 Robbins, Clive, 37, 38, 78, 84, 89,92,93,
Mendelson, M., 34 96
Merle-Fishman, c., 25, 35 Rodriguez, J., 37, 53
Michel, D. E., 113 Rosenzweig, S., 37
Mock, J., 34 Rubin, B., 94
Montello, L., 187 Russell, J. M., 160
Morphew, C., 112 Ruud,E.,6, 89,129,147-150
Morris, K. T., 145 Ryback, R. S., 177
Murphy, K. M., 29, 32, 53, 184 Rykov, M., 107
Murphy, M. E., 164 Salas, J., 84
Murray, S. E., 53 Samet, S., 123, 125
Nagaseki, Y., 53 Sandness, M. I., 162
Nayak, S., 164, 170 Sandrock, D., 34, 53
Nedelman, D. J., 177 Saperston, B. M., 112
Nolan, P., 187 Sasaki, H., 53
Norcross, J. C., 145 Scalenghe, R, 29, 32, 53
Nordoff, P., 37, 38, 78, 84, 92, 93 Scartelli, J. P., 34, 141
Nukui, H., 53 Scheiby, B. B., 86
O'Callaghan, C., 105 Schmidt, J. A., 105
O'Connell, A., 62, 71 Shakow, D., 37
Oldfield, A., 54, 84, 177 Shaw, J., 94, 95, 97, 113
Palacios, J. R, 37 Shifflet, S. c., 164, 170
Palmer, H., 97 Shippen, M. E., 54
Papoudi, D., 84 Shultis, C., 42, 85, 94, 112, 141
Pattison, P., 107 Silber, F., 104
Pavlicevic, M., 11,38,52,158,164,170 Simek-Downing, L., 4,179-181
Pennebaker, J. W., 179, 182 Simpson, R G., 54
Perilli, G., 107 Skille, 0., 34, 113, 115
Persoons, J., 111 Sloboda, J. A., 115
Piaget, J., 121 Small, c., 154
Pierce, W. D., 145 Smeltekop, 161
Plach, T., 160, 162, 163 Smith, G. H., 104
Polen, D., 50, 51, 89, 107 Speilberger, C. D., 34
Priestley, M., 32, 34, 38,41,85, 137, 161 Sperry, L., 180, 187
Prochaska, J. 0., 145 Spintge, R K. W., 114
Purvis, J., 123, 1125 Standley, J. M., 17,62,71,78,113,177
Quirk, C. A., 123 Steele, A. L., 104
Raith, L., 38 Steinberg, R, 38
Reed, K. J., 94, 112 Stige, B., 6, 147, 149, 158
Stoll, M., 160 Zaro, J. S., 177

Stratton, V. N., 145
Stultz, S., 132
Sulzer-Azaroff, B., 145
Summer, L., 115, 116, 164, 168n
Sutton,K,52
Swindle, F. R., 123
Talkington, J., 34
Tenney, K. S., 104
Thaut, M. R., 6, 113, 1120, 125, 126, 128,
148, 160
Theurer, K, 97
Thompson, A B., 53
Thompson, L. W., 113
Tims, F., 95
Trevarthen, C., 38, 39, 52, 84
Turry, Alan, 89
Turry, Ann E., 86
Tyson, F., 170
Unkefer, R F., 120, 125, 126, 128, 160
Van Camp, J., 147, 149-151
Van Den Daele, L., 37,40
Van Routen, R, 173
Wadsworth, B. J., 121
Waldon, E. G., 164
Wallen, N. E., 177
Walters, C. L., 116
Ward, C. R., 34
Watanabe, A, 53
Watson, D. E., 71
Watson, T., 84
Werner, K, 154
Wheeler, A R., 62
Wheeler, B. L., 18,25,84,125, 126, 128,
129,132, 160, 164, 170, 184
Wichmann, K, 160
Wieder, S., 121, 122
Wi gram, T., 31, 34,41,43,54,88,113,115
Wilmer, R. A, 37
Wilson, B. L., 164
Wilson, S. E., 71
Wolberg, L. R, 126
Wolfe, D. E., 62, 71, 112, 160, 164
Wolpe, J., 145
Wood, M. M., 123, 124
Wright, L. M., 18
Wyatt, J. G., 111
Yalom,1. D., 162
York, E., 52
Zabin, A R., 53
Zalonowski, A R., 114
Subject Index
Accompanying instrument, 75 Gathering background information,
Active experiencing, Maslow, 4 29-30
Adaptive instruments, materials, 77 Projective, 37
Adults Purposes,27,30-33
With developmental disabilities, 50-51, Diagnostic, 27, 31
82,84-85,91,93-94,102,110,112 Prescriptive, 27, 32-33
With psychiatric disorders, 52, 82, 85, Descriptive, 32
91-92,94, 103, 110, 112 Evaluative, 33
Aesthetic, 5-6, 148 Interpretive, 32
Alzheimer's/dementia, 43, 52, 86, 90, 94, Quantitative, 44--45
104, 110, 113 Qualitative, 44--45
Analytical Music Therapy, Priestley, 32, 38, Reliability, 45
41,85,86, 137, 161 Sources of musical information, 30-31,
Assessment, client, 8,27-56 39--40
Benefits of music therapy assessment, Improvising, 39
29 Performing or re-creating, 39--40
Conducting, 40--43 Composing, 40
Gathering data, 41 Listening, 40
Summarizing and/or interpreting, Standards, AMTA Standards of Clinical
41--42 Practice, 28
Reporting findings, 43 Validity,45
Not recommending music therapy, Assessment, music therapist, see Self-
43 assessment
Criterion referenced, 45 Assisting, level of involvement in sessions,
Domains 16
Biographical,33-34 Attention, 35,49, 66, 70, 110, 152
Somatic, 34 Attention deficit disorder, 119, 162
Behavioral,34-35 Autism/autistic, 31, 81, 84-85
Skill,35 Avoidance of the other's concerns, verbal
Personality or sense of self, 37-38 facilitation technique, not helpful, 142
Affective, 38 Beech Brook Music Therapy Assessment for
Interactional, 38-39 Severely Emotionally Disturbed
Gathering information, 27, 29-30,41 Children, Layman, Hussey, & Laing,
Norm-referenced, 45 49-50
Populations, 46-53 Behavior modification, 139-140
Children, with special needs, 46-50 Behavior therapy, 139-141
Adults, with developmental Belief system of therapist, 9
disabilities, 50-51 Beliefs of therapist
Adults, with psychiatric disorders, About health and wellness, 22-23
52 Bipolar disorder, 119-120
Medical settings, people in, 53 Boundaries, 168
Older adults with age-related needs, Cancer, 86, 113
52 Cerebral vascular accident (CVA), 7, 53, 76,
Presentation of information, 27-28 103
Process of, 28, 29-31 Changing behavior, verbal facilitation
Referral, 29 technique, 139-141
Characteristics of client, 119-121
Charts, 78 Diagnosis, 31, 119-121

Checklist, 173 Professionals qualified to diagnose, 31
Children, with special needs, 81, 84, 91, 93, Directive leadership, 159-161
101,103, 109, 111 Directive-nondirective continuum, 125,
Chordal instruments, 75 159-161
Classification, in special education, 121-121 Documentation, 173-178
Client Drums, 75-76
Characteristics, 119-121 Diagnostic and Statistical Manual ofMental
Needs, 7, 123-128 Disorders, DSM-IV-TR, 120
Perspective of, 21-22 Duration recording, 173
Wishes/desires, role in setting goals, 61- Electronic instruments, 77
62 Encouraging communication, verbal
Client-driven outcomes and skills, 61-62 facilitation technique, 136
Clinical foundations, competencies for, 185 Environment (clinical), setting up, 74-78
Closing or wrap-up experience, of session, Equipment and instruments, for sessions,
73 74-77
Code of Ethics, AMTA, 167 Ethics/ethical considerations, 24-25, 131
Cognitive therapy, 138 Evaluation of music therapy procedures, 71
Co-leading, level of involvement in External structure, level of, 125, 127
sessions, 16-17 Extinction, 139
Community, 6, 158 Facilitating client responses, 135-146
Competencies Verbal facilitation, 135-142
Competency-based skills assessment, Musical facilitation, 143-144
184-185 Field of Play, Kenny, 6, 130
Professional Competencies, AMTA, Functioning level, 158
184-185 General Behavior Checklist, Bruscia, 35-36,
Composing, 10 41
Composing experiences, 101-108, 152-153 Giving feedback, confronting, and changing
Tool for self-assessment, 186 cognitions, verbal facilitation
Considerations techniques, 137-138
For improvisation, 86-87 Goals
For performing and re-creating, 95-96 Client's role in setting, 9
For composing, 105 Definition, 67
For listening, 114 Establishing, 57-58
Constructions, 6 Generic, 9
Contracting, 140 In setting that focuses on client's
Counterconditioning, 140 wishes, 61-62
Countertransference, 183 Long-term, 57-58
Culture, 6 Sample, 58
Definitions of music therapy 3 Short-term, 57-58
Bruscia's, 5 Specific, 9
Therapist's, 9 Goals and objectives, 57-64
Dementia, see Alzheimer's Group therapy, 157-165
Depression, 9, 39, 52, 86, 149 Formation, 157-158
Desensitization, 140 In conjunction with individual therapy,
Development, Greenspan's approach, 121- 167
123 Principles of, 163-164
Developmental disabilities, adults with, see Rationale, 157
Adults, with developmental disabilities Group cohesion, 162
Development, level of, 71, 121-123 Growth
Developmental Therapy, Wood, 123, 124 Musical,3
Subject Index 0 2 I I
Self,3 Measurement systems, 173-174

Guided Imagery and Music (GIM), 45, 109, Medical settings, people in, 53, 83-84, 86,
137 93,95, 102-105, 111, 113-114
Guidelines for Activity Planning, Bruscia, Model, Thaut's, 6
68 Modeling, 139
Healthlhealthy, 3, 4, 22-23 Moving/movement, 10,39-40,94
Hospice, 8, 53 Music
Identity, 149-150 As therapy/in therapy, 150-151
Improvisation, 160-161 For self-assessment, 185-187
Developing skills, 152 Foundations, competence in, 185
Nonreferential, 83 Relationship with, 24, 151
Piano, 151-152 Role of, 147-155
Referential, 83 Uses in music therapy, Clair, 147-148
Improvisation Assessment Profiles (lAPs), Music Therapy Assessment and Initial
Bruscia, 38,44 Treatment Plan, Shultis, 42
Improvisational music therapy, 149, 167 Music Therapy Assessment for Adults With
Improvising experiences, 81-90, 151-152 Developmental Disabilities, Polen, 50-
Tool for self-assessment, 185-186 51
Individual therapy, 167-172 Music therapy
Indications, 167 Foundations and principles, competence
In conjunction with group therapy, 167 in, 185
Adaptations ofleadership style for, 168 Practice, levels of, 126, 128
Principles of facilitation, 170 Clients appropriate for each level,
Inpatient setting, 8 128
Instruments, choice of, 150 Theoretical framework, 129-130
Interpreting, verbal facilitation technique, Musicianship, clinical, 151-153
137 Needs
Interval recording, 173 Of client, 7, 123-128
Joumal/joumaling, log, for self-assessment, Neurologic Music Therapy, 113-114
181-182 Nondirective leadership, 159-161
Judgment, verbal facilitation technique, not Nordoff-Robbins Music Therapy, 37, 38, 77,
helpful, 142 84-85,86,93-94
Keyboard, in session, 75 Normalization, 6
Latency recording, 173 Objectives, 58-60
Leadership style, 159-161 Definition, 185
Adaptations for individual therapy, 168 Sample objectives, 58-60
Leading, level of involvement, 17 Observing, level of involvement in sessions,
Levels of student involvement, 15-19 15
Listening and understanding, verbal Older adults, with age-related needs, 52, 83,
facilitation technique, 135-136 86,92,94-95,102,104,110,113
Listening experiences, 10-11, 109-117, 153 Operational definition, 174
Tool for self-assessment, 186-187 Opening experience, of session, 73
Main portion, of session, 73 Organizing/organization, session, 73-79
Mallets, 76 Outpatient setting, 8
Materials Participating, level of involvement in
For composing, 105-106 sessions, 16
For improvisation, 87 Percussion instruments, 75-76
For performing and re-creating, 96 Additional,76
For listening, 114-115 Drums, 75-76
For sessions, 77-78 Melodic, 76
Meaning, 6
Performing or re-creating experiences, 91- Understanding of, 9

99, 152 Sending solutions, verbal facilitation
Tool for self-assessment, 186 technique, not helpful, 142
Personal listening journal, 153 Setting, 8
Personal theory of helping, 23-24, 129 Sharing information, verbal facilitation
Piano, in session, 75 technique, 139
Planning, 65-72, 119-133 Short-term treatment, 159
Level of involvement in sessions, 16-17 Sing-alongs, 92, 94-96
Process of, 21-26 Singing, 10, 150
Playing, 10 Skill analysis, 70
Post-session review, 183-184 Skills
Professional Competencies, AMTA, 4, 184- Assessment, competency-based, 184-
185 185
Progress notes, 174-176 Music, 179
Progressive desensitization, 140-141 Required to do music therapy, 179-180
Psychosis/psychotic, 42, 82, 92, 94, 120, Verbal, 180
149 Socialization skills, 9
Punishment, 140 Somatron®,61, 109, 110, 113
Purpose statements, 57, see Goals Song sheets, 77-78
Psychiatric disorders, adults with, see Special Education Music Therapy
Adults, with psychiatric disorders Assessment Process (SEMTAP),
Psychotherapeutic framework, 129 Coleman & Brunk, 33, 46-48
Psychotherapy, levels of, 125 Stages of development
Rating scale, 173 Group
Reality orientation, 35-36, 52, 59, 177 Corey, Corey, Callanan, & Russell,
Receptive tools for self-assessment, 186- 161
187 Garland, Jones, & Kolodny, 161
Recording, own playing, 153 Group cohesion, James & Freed, 162
Re-creative tools for self-assessment, 186 Improvisational models, group and
Reflecting and sharing, verbal facilitation individual, 169
technique, 136 Individual therapy, 168-169
Reinforcement, 13 9-140 Interpersonal process, Bruscia, 169
Relationship(s), 149 Music therapy group, applied to, 161-
Relaxation, 109, 110, Ill, 112, 114, 140, 162
141 Relationship, Corey & Corey, 168
Relaxation training, verbal facilitation Standards of Clinical Practice, AMTA, 28,
technique, 141 119
Reliability Sticks, 76
Of assessment, 45 Strategy/Activity Form, Bruscia, 66-67
Of measures, 174 Stroke, see Cerebral vascular accident
Reminiscence, 92, 109-110, 113-114, 153 Structure, level of, 128-128
Research-based music therapy, 6 Supervision, supervisor, 180
Residential facility, 8-9 Supervision model, applied to self-
Ritual, 6 assessment, 180-181
Room arrangement, for session, 74 Systematic desensitization, 140-141
Schizophrenia, 39, 52, 120, 128 Tallying, frequency, or event recording, 173
Self-assessment, for music therapist, 179- Task analysis, 69-70
188 Termination, 119, 161, 168-169
Importance of, 179-181 Theoretical framework
Self Music therapy, 129-130
Therapeutic use of, 3, 9 Psychotherapy, 129
Subject Index 0 2 13
Theory
Of helping, personal, 23-24, 129
Of music therapy, 3, 5-6
Theory development in music therapy,
overview, Bruscia, 130
Therapeutic factors, Yalom, 162-163
Therapist
Attitudes and beliefs, 22-23
Perspective of, 22-24
Role of, 8-9
Therapy, 4-5
Importance of, 3
Personal, 184
Process of, 3, 7-8
Tips for using
Improvisation, 88
Performing and re-creating, 97
Composing, 106-107
Listening, 115
Traumatic brain injury (TBI), 113
Treatment, rationale for, 130-131
Treatment team, 3, 9
Validity, of assessment, 45
Vibroacoustic, 34, 110, 111, 113
Vocal techniques, 150
Wellness,3
Wind instruments, 76--77
Worksheets, for self-assessment, 182-184
"That client," 183
Post-session review, 183-184

Barbara L. Wheeler, Carol L. Shultis, Donna W. Polen - Clinical Training Guide For The Student Music Therapist-Barcelona Publishers (NH) (2005) PDF

Uploaded by

Copyright:

Available Formats

Barbara L. Wheeler, Carol L. Shultis, Donna W. Polen - Clinical Training Guide For The Student Music Therapist-Barcelona Publishers (NH) (2005) PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Barbara L. Wheeler, Carol L. Shultis, Donna W. Polen - Clinical Training Guide For The Student Music Therapist-Barcelona Publishers (NH) (2005) PDF

Uploaded by

Copyright:

Available Formats

Clinical

All rights reserved. No part of this book may be reproduced

Distributed throughout the world by:

Kenneth E. Bruscia for pennission to reprint:

Introduction: How to Use This Book

* Anthony Meadows is the first author of Chapter 4, Client Assessment.

Understanding Music Therapy

Understanding the Therapy Process

Defining Client Needs

Understanding a client's needs requires a thorough assessment of that person. During

Understanding the Therapist's Role

Working With the Music

For Further Reading

Assignments-Doing Music Therapy

Level II-Planning and Co-Leading

Level III-Lead ing

Observing the Session

Participating and Assisting

Planning and Co-Leading

For Further Reading

Level II-Planning and Co-Leading

The Client's Perspective

What Is Important for the Client?

What Can the Client Gain From Music Therapy?

The Music Therapist's Perspective

How Do I Feel About the Client?

What Is My Personal Theory of Helping?

How Do I Find Music Helpful?

For Further Reading

Level I-Observing, Participating, and Assisting

Level II-Planning and Co-Leading

Reviewing the Assessment Process

Why Music Therapy Assessment?

The Process of Assessment

Gathering Background Information

1. Reading the client's chart or file;

Determining the Purpose and Type of Assessment

Overall Purpose of the Assessment

to stimulation, or interaction with the environment that can be seen, heard, or

Personality or Sense of Self

Sources of Musical Information

Performing or Re-Creating Assessments

Conducting the Assessment

Gathering the Data

Summarizing and/or Interpreting the Findings

_ will demonstrate a decrease in symptoms of anxiety by U anxiety)

Reporting the Findings

If Music Therapy Is Not Recommended

Reviewing the Assessment Process

Issues in Music Therapy Assessment

Taking a Quantitative or Qualitative Approach

Reliability and Validity Issues

Assessment for Various Populations

Children With Special Needs

Student Name: Judy Jones

Review of IEP and IEP Goals

Music Therapy Assessment Results

Suggested goals and objectives

Assessment report submitted by: