What is Music Therapy?
Music therapy is an allied health profession in which a credentialed music therapist uses developmentally appropriate music-based interventions to address nonmusical goals in the areas of communication, academic, motor, emotional, social, and sensory (Humpal & Tweedle, 2006). Music therapists use a variety of music therapy techniques such as singing, playing instruments, listening to music, and moving to music to promote change. Music therapists also pair music with other modalities like art, drama, and literature (Humpal & Kern, 2012). Regardless of the specific intervention, music therapists employ music, which is both natural for children and socially appropriate, to meet global, individual, curricular, and/or Individualized Education Program (IEP) goals and objectives (Humpal, 2015).
The Music Therapy Treatment Process
The music therapy treatment process is systematic, providing structured experiences that meet identified goals efficiently and effectively (Hanser, 1999). Children are first referred to music therapy services by parents, teachers, interdisciplinary team members, physicians, or IEP teams. After Referral, music therapists then a) assess client needs and formulate goals (Assessment), b) plan and implement music therapy intervention (Intervention), c) evaluate and document clinical change (Evaluation), and d) terminate (Termination) (Davis, Gfeller, & Thaut, 2008). Both the client’s diagnosis and history are considered, as are the individual’s level of functioning and needs across multiple domains (American Music Therapy Association & Certification Board for Music Therapists, 2015).
Depending upon facility protocols, music therapy referral may occur in a number of ways. In some facilities, children may be referred by teachers, parents, therapists, or other specialists for music therapy evaluation. In this model, children must be determined eligible for services before moving forward with the treatment process. Evaluation is typically associated with IEP-based service delivery and children must meet pre-established criteria. Other models may forgo evaluation and move directly into the assessment process. Again, children may be referred by a wide range of individuals. Finally, formal referrals may not be necessary in programmatic or consultative models. Instead music therapists address global developmental needs or work with teachers or specialists to adapt classroom instructional strategies for entire classes. Individualization may still occur, although it is typically more informal. For more information on the referral aspect of the treatment process see the corresponding video.
The Scope of Music Therapy Practice mandates that music therapists collect systematic, comprehensive, and accurate information to determine if and what type of music therapy services should be provided for clients and evaluate individuals’ responses to interventions (American Music Therapy Association & Certification Board for Music Therapists, 2015). This process of collecting information is known as assessment. Assessment generally falls into one of three categories: a) initial assessment, which is used to determine baseline functioning (i.e., functioning without intervention), b) comprehensive assessment, which is used to determine if services are warranted, and c) ongoing assessment, which is used to evaluate music therapy effectiveness over the course of treatment (Hanser, 1999). During assessment, data are collected using surveys, tests, or other assessment tools, some of which are adapted for use in music therapy and others which are specifically developed to meet site and/or individual needs. Areas assessed typically include a) motor, b) communication, c) social-emotional, d) academic, and e) responsiveness to music (Chase, 2004), and music therapists are particularly interested in responses related to target behaviors as well as responses that impact how a client will respond to music therapy (Hanser, 1999).
One of the primary functions of assessment is to determine relevant and appropriate goals for music therapy intervention. Goals can be both long and short term and are frequently SMART in nature (Specific, Measurable, Attainable, Relevant, and Time based). Music therapists may work as part of multidisciplinary (independent), interdisciplinary (independent with info exchange), or transdisciplinary (integrated and collaborative) teams to design goals that are functional, understandable, developmentally appropriate, and behavioral (i.e., observable). Often, the level of collaboration between the music therapist and the educational team is determined by her or his relationship with the facility (i.e., contract employee, part time, or full time employee). Ultimately, music therapists should be fully integrated into the educational team to ensure maximum input and appropriate goal development (Kern, 2012).
In addition to goal development, data collected during assessment are used to plan music therapy intervention. Music therapists must determine appropriate therapeutic strategies, which includes selecting appropriate service delivery models (e.g., direct services) and music therapy experiences that target specific, nonmusical goals and objectives in a developmentally appropriate manner (Wellman, 2011). Strategies selected must a) encourage participation, b) address multiple needs, and c) promote success (Humpal, 2015).
Music therapy sessions often follow a structured format based on familiar routines. Sessions are approximately 30 minutes in length and typically start and end with hello and goodbye songs. Most sessions include 9-12 different activities; these activities incorporate various music therapy techniques such as singing and playing instruments and are designed with developmental level, musical abilities, and children’s interests in mind (Barrickman, 1989; Gooding, 2013). Interventions are also chosen based on programmatic, thematic, or individual goals and objectives, and specific activities are ordered to promote engagement. The therapist uses behavioral techniques like modeling, cueing, and reinforcement to improve learning (Gooding, 2013; Humpal & Kern, 2012).
Group music therapy sessions are common, and the research suggests that group-based early childhood music therapy can promote the development of meaningful communication skills, motor skills and academic/pre-academic skills, and inclusion (Gooding, 2013; Humpal, 2015; Humpal & Tweedle, 2006; Standley & Hughes, 1997). Groups may be inclusive (children with and without disabilities), integrated (one class of children with special needs combined with one class of typically developing children), reverse mainstream (majority of children with special needs and a few children with no disabilities), parent/caregiver and child-based, or specialized (classes specifically for children with special needs) (Humpal, 2004; Kern, 2015). Though group sessions are common, music therapy is also easily adaptable to an individual format, which allows for greater flexibility in meeting individual needs.
Once implementation begins, the music therapist evaluates treatment effectiveness and uses the data to make future treatment decisions or recommendations. Music therapists also communicate with other team members and families as well as document progress to support funding for services (Kern, 2012).
Using the goals identified during the assessment phase, music therapists observe and measure progress related to each goal. Music experiences are structured to facilitate data collection, and progress is tracked quantitatively (e.g., number of occurrences, percentages) when possible. More formal evaluation may also occur in the form of annual or bi-annual evaluations. In this case, the initial evaluation used to determine service eligibility may be repeated to determine broader progress.
The above evaluation process may be referred to as ongoing assessment. It involves systematic observation of the frequency and duration of target behaviors, a functional analysis of the surrounding conditions, and clinical interpretation (subjective analysis) of the data (Hanser, 1999). Previous music therapy research has identified several formats used for collecting data in early childhood settings including a) checklists, b) behavioral observations, and c) use of standardized assessment tools (Hanser, 1999; Register, 2001; Martin, Snell, Walworth, & Humpal, 2012; Standley & Hughes, 1996). Please see the Evaluation video for an example of how evaluation may be incorporated into music therapy intervention.
The final phase of music therapy can have a large impact on therapy outcomes. Termination planning and discharge should, whenever feasible, be an essential part of the music therapy process (Hudgins, 2013). Music therapy services end for a variety of reasons ranging from curricular or schedule changes to personnel changes, but ideally termination occurs when the goal has been met (Kern, 2012). The decision to terminate music therapy services may be reached by the music therapist alone or by an interdisciplinary team. Providing opportunities to reflect on progress is also important, as is incorporating music and providing the opportunity to say “goodbye” (Hanser, 1999; Hudgins, 2013). See the Termination video for more information on the final stage of the music therapy treatment process.
Music therapy is highly compatible with a play-based approach; it is collaborative, developmentally appropriate, and designed to meet a wide range of needs simultaneously. Music therapy is also adaptable to group or individual formats and addresses client’s IEP based goals. The music therapy treatment process is both systematic and robust; it encompasses assessment, planning, implementation, evaluation, and termination planning. Music therapy can be a valuable part of an early childhood education curriculum and support children’s learning in all developmental domains.
American Music Therapy Association & Certification Board for Music Therapists. (2015). Scope of music therapy practice. Retrieved from file:///C:/Users/ldg07c.FSU/Downloads/CBMT-AMTA_SoMTP_V6%20(2).pdf
Barrickman, J. (1989). A developmental music therapy approach for preschool hospitalized children. Music Therapy Perspectives, 7, 10-16.
Chase, K. M. (2004). Music therapy assessment for children with developmental disabilities: A survey study. Journal of Music Therapy, 41, 28-54. doi: 10.1093/jmt/41.1.28
Davis, W. B., Gfeller, K. E., & Thaut, M. H. (2008). An introduction to music therapy theory and practice (3rd ed.). Silver Spring: American Music Therapy Association.
Gooding, L. F. (2013). Structuring early childhood music therapy groups. imagine, 4, 54-57. Retrieved from http://imagine.musictherapy.biz/Imagine/archive.html
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Hudgins, L. (2013). Closing time: Clients’ shared experiences of termination of a music therapy group in community mental health. Qualitative Inquiries in Music Therapy, 8, 51-78. Retrieved from http://www.barcelonapublishers.com/resources/QIMTV8/QIMT8-3_Hudgins.pdf
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Gooding, L. F. (2016). Music therapy: An overview of the therapeutic process. imagine 7(1), 30-35.