Taking Forward Musi c Therapy : Shaping The Future
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the HARMoNY Bulletin
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH Volume : III
Issue : I
June 2014
the HARMoNY Volume : III
Issue : I
June 2014
EDITOR’S DESK The focus of the current issue of "The Harmony" is on clearing common myths and misconceptions that clouds the field of music therapy in India. Though music therapy is an established academic discipline and an insurance reimbursable allied health care profession in many western countries, the field is yet to develop fully in India. CMTER is a pioneering initiative from Sri Balaji Vidyapeeth dedicated to promote music therapy in the areas of clinical practice, research and professional training. The goal of the bulletin is to share information on the activities of the center to expand professional music therapy knowledge by reporting
empirical studies, clinical cases, patient stories, photo stories and many interesting music
therapy information to benefit practitioners from diverse specialties. In this issue, the featured article “Understanding Music Therapy: Clearing Misconceptions by Dr. Sumathy Sundar clarifies all the myths, distinguish between healing and music therapy, discusses various methods and procedures adopted during the music therapy process and also clearly explains the distinction between music medicine and music therapy approaches. Also, often, the clinicians wonder as to what are the appropriate referral areas for which they could recommend music therapy services and so a chart of referral areas for various clinical specialties is provided in this issue. But, this chart is only illustrative and not exhaustive. The clinicians are encouraged to use this chart for recommending music therapy services to CMTER. The CMTER team which comprises of trained music therapists who not only work with patients who come for OPD services but also go to bed-side and support patients who experience emotional difficulties, have Quality of Life issues and communication deficits and also be part of adjunct non-pharmacological pain management services all offered as a part of integrative care in Mahatma Gandhi Medical College and Research Institute.
Inside this issue Editorial Featured article Music therapy information Photo stories Global music therapy events Referral areas for music therapy services Recent publications from CMTER
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UNDERSTANDING MUSIC THERAPY : CLEARING MISCONCEPTIONS Dr. Sumathy Sundar, Head, Center for Music Therapy Education and Research, Sri Balaji Vidyapeeth Introduction
groups, families or communities who seek to
While there is a growing interest in the field of
optimize their quality of life and improve their physical, social, communicative, emotional,
music therapy among medical professionals, allied
intellectual, and spiritual health and well being.
health care and mental health professionals and
Research, practice, education and clinical training
students in India, there is also a deep rooted
in music therapy are based on professional
misconception and lack of clarity around this field.
standards according to cultural, social and political
It is a matter of concern that though there is a lot of
contexts.1 Another definition of music therapy is
interest shown by these people in learning about
that music therapy is an interpersonal process in
how to offer clinical music therapy services, their
which the therapist uses music and all of its facets-
knowledge is limited to the existence of music
physical, emotional, mental, social, aesthetic, and
healing practices across Indian history and culture
spiritual-to help clients to improve or maintain their
and they struggle to integrate these practices in
health. In some instances, the client's needs are
clinical services. The confusion is about identifying
addressed directly through music; in others they
what is healing and what is music therapy and
are addressed through the relationships that
understanding the difference that exists between
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healing and music therapy. Also there is a strong
develop between the client and therapist.
belief that there are ready made general
Healing and Music Therapy
prescriptions of music available for curing various
What is a healing practice? Healing is deepened
diseases. There is also an enigma around music
and inherited not so much with words but by
medicine (music being used as therapy by medical
"feeling in one's body, heart and soul" and "belief“.
3
professionals) and music therapy in which music is
and music therapy is something observable and
being used in therapy. The practices are based on
measurable. It is an evidence based practice as
belief systems using history as a tool. The various
indicated by many Cochrane reviews. In some
music therapy techniques apart from the receptive
cultures “the drive for theory is not so intense.
listening experiences are not still known due to lack
Things are just known. Explanations are not always
of training. This article attempts to clear all these
required for
misconceptions and also explain what is music
practices to be accepted.
Understandings are transferred across the
therapy, the theoretical background and the
generations through action. Indeed, in some
therapeutic processes involved in clinical music
societies in which traditional healing practices are
therapy sessions.
maintained, healing is contingent on not
What is Music Therapy?
questioning the how's, why's, what's, when's,
According to World Federation of Music Therapy,
where's of the experience. In these societies, the value is on belief more than description or
the definition of music therapy is as follows. Music
explanation.”3 This situation holds true for Indian
therapy is the professional use of music and its
situations. The local resources by way of healing
elements as an intervention in medical, educational
practices like Raga Chikitsa, Vedic Chanting and
and everyday environments with individuals,
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June 2014
Chakra activation exist as a strong belief system as
ways and means to integrate these resources
a curative solution and the last decade of
become primarily important in practice, education
development in the music therapy field was based
and research. The unquestionable is questioned,
only on this premise. Now, new horizons have
also at the same time keeping in mind that the local
emerged. The unquestionable is being questioned.
resources should be transferred wherever possible
There is a shift from using the static-history as a
with a need for explaining the processes involved.5
tool for explaining the practice of art of healing to
Methods and Responses
the dynamic music therapy workings which explain
Also, the musical experiences that the therapists
how music, therapy, cultural, spiritual and social
use in the music therapy sessions range widely
context work in a clinical set up are rationalized. 4, 5
from the methods of
Further, we can question now how traditional
improvisation, playing of musical instruments and
can be transposed in time to the present.6
engaging in verbal discussion methods.
However, there is another understanding that
Sometimes, the therapist sings
music therapy in general is a art with irrational aspects and anthropological, cultural and personal dispositions playing an important role in r e c e p ti o n
of
m us i c
complicates development further.
7
the By
culture, we mean belief s ystems,
phil os ophical
to the
active re-creative experiences, song writing,
practices located in a past that has its own validity
rational science as well as an
passive listening
and at other times, the Do you know that Music Therapy is not.............
clients sing. The therapist play both tuned and un-
Taking Music Lessons
tuned musical instruments
Learning to Play a Musical Instrument
and also engage the clients
Appreciating Music
with
Performing Ragas Promoting Classical Music
baseline, prompted,
collaborative
and
A Cure for Diseases
independent musical tasks
Just Listen To Music Through Headphones
in singing, moving, rhythmic
Prescribing CDs And Cassettes as Cure for
and
Specific Diseases
playing
mu sic a l
instruments activities. The
orientations, tradition,
mu si c al
religion, art, values and
r es p o ns es
for
engagement, pleasure, self confidence and
societal norms for behavior. In a country like India
creativity levels are recorded during initial
where there is a rich tradition and culture and
assessment to find out the musical profile of the
philosophy of life is linked strongly to religion and
client and for planning the therapy protocol. The
spirituality, during the therapy process, when we
therapist selects musical experiences depending on
want to connect to the client, the musical
the needs of the clients and also the goals set for
experiences which are closer to these aspects play
therapy. Playing instruments can help physically
a more important role than the drive for theory. The
disabled clients to develop gross and fine motor
local healing resources which are available
coordination.1
throughout the history cannot be ignored
The responses range from developing sensorimotor
completely as they strongly form the basis for the
skills, learn adaptive behaviours, develop
clients' actual needs. The principle function of
spontaneity, creativity and freedom of expression
music in these healing practices is at times healing,
and also develop communication and interpersonal
at times spiritual, at times religious, and sometimes
skills. Individual singing Exercises can help
a combination of these three elements.5 Hence, 4
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individuals who have speech impairments to help
communication or the behavior, emotions,
improve their articulation or fluency and group
attention or cognition. The neuro biological
singing
builds reality orientation in elderly
outcome of the therapeutic musical dialoging
individuals, or help mentally retarded people
depends on 1) the therapist recognizing the needs
develop adaptive behavior, or build cohesiveness in
of the client and the client recognizing the intention
a dysfunctional family or group. Playing
of the therapist to help him 2) the therapist's ability
instruments can help physically disabled clients to
to get into emotional resonance with the client 3)
develop gross and fine motor coordination. 1
engaging in musical activities that result in shared
Music Therapy Process and Outcome
attention between the therapist and the client 4) the therapist understanding the motivation and the
The different stages of music therapy, a systematic
intention of the client and 5) the cooperative action
process of intervention are 1) Referral, 2) A first
between the therapist and the client.9 The mind, a
session: Building Rapport, 3) Assessment, 4.
product of the brain, influences physical health
Setting up Goals, Objectives and Targets, 5)
through three brain-body information transfer
Observation, 6) Music Therapy Strategies, 7) MT
systems namely the autonomic nervous system
Treatment plan, 8) Implementation 9) Evaluation
( A N S ),
and 10)Termination8 During these stages the
and
pathways.10
MIND/ MENTAL HEALTH (Emotions, stress etc.)
Information transfer system/ pathways ANS Pathway
p a t hwa y s
neuroimmune pathways and the health behavior
therapist works on modulating either the client's
BRAIN
n e ur o e n d oc r i n e
Immune Pathway
Endocrine Pathway
Health Behavior Pathway
PHYSICAL HEALTH Music therapy being a mind body medicine,
the
major computational centres for processing music
therapeutic musical dialoguing outcome during the
in the brain which get influenced by appropriate
music therapy process
depend on how the brain
musical inputs to transfer positive information to
transfers the information to the ANS, Endocrine
the ANS, Endocrine and Immune pathways to
and Immune pathways and the Health Behaviour
achieve physical health.
pathway influencing the physical health.
Music as Medicine Versus Music Therapy
Researchers have indicated that there are many 5
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Use of recorded music by medical professionals
approach which has an interpersonal component
who may not be skilled musicians or music
working as a dynamic force within the therapeutic
therapists in order to achieve desired biological
process between the therapist and the client. The
effects is a regulatory approach called music
following table indicates the difference and the
medicine approach. This approach depends on the
research designs between music in medicine and
inherent quality of music to reach the desired goal.
music therapy approaches. 11
Music therapy is both a regulatory and a relational Table 1. Therapeutic Concepts and their Research Designs Music Medicine
Music therapy in medicine
Positivistic Scientific Tradition
Hermeneutic scientific tradition
Biomedical Concept
Relational-medical concept
Music has Therapeutic Potential by Itself
Emphasis on relation: therapist-client; music-client
Symptom Orientation
Health orientation
Starting - Point : Illness
Starting-point: health (resources)
Music as Medicine
Artistic-creative activity
Desired Biological Effects
Improved quality of life through creative expression of self
Conclusion
development of music therapy as a profession and
Music therapy is both an art and science of healing
an academic discipline
and an evidenced based practice. The scientific aspect of this field is yet to be established firmly in Global Music Therapy Events
India due to lack of adequate training facilities across the country and pioneering efforts have
World Congress of Music Therapy July 8 – 12 2014
been taken by medical universities like Sri Balaji Vidyapeeth to launch professional training programs and introduce music therapy
Theme : Cultural Diversity in Music Therapy Practice, Research and Education
as a
medical discipline not only to create awareness on
Venue : IMC University of Applied Sciences, Krems, Austria
the field but also to integrate music therapy clinical practice based on education and research. The a unit of Mahatma Gandhi Medical College and
III International Conference on Music and Medicine June 24-27 2014
Research Institute, Sri Balaji Vidyapeeth has
Theme : Music Medicine through the LIfespan
commenced a one year Post Graduate Diploma
Venue : University of Toronto
Centre for Music Therapy Education and Research,
Program on March 25, 2014. This initiative is surely an important milestone in India for the 6
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References 1.
Bruscia,
K E (1993). Music Therapy Brief. Barcelona Publishers. Available from
www.temple.edu/musictherapy/home/program/faq/htm 2.
Definition of music therapy. Available at www.musictherapyworld.net/WFMT/About_WFMT.html
3.
Kenny, C. B. (2001). Review of: Constructing Musical Healing: The Wounds That Sing, by June BoyceTilman. The Arts in Psychotherapy, 28, 265- 269.
4.
Sundar, S. (2012). Music Therapy Training in India: New Horizons. Proceedings of International Seminar on Current Trends in Music Therapy Practices: Methodology, Techniques and Implementation. Benares Hindu University. Page 57-58
5.
Sundar, S. (2014). In press. (Ed) Goodman, KD. Music Therapy Education in India: Developmental Perspectives in International Perspectives in Music Therapy Education and Training: Adapting to a Changing World. Charles C Thomas Ltd. Illinois. US.
6.
Aldridge, D. (2006) Performative Health - a commentary on Traditional Oriental Music Therapy. Music Therapy Today (Online) Vol.VII (1) 65-69. available at http://musictherapyworld.net
7.
Tucek et al. (2006). The revival of Traditional Oriental Music Therapy discussed by cross cultural reflections and a pilot scheme of a quantitative EEG-analysis for patients in Minimally Responsive State. Music Therapy Today (online) Vol. VII (1), (March) 39-64. available at http://musictherapyworld.net.
8.
Hanser SB. (2000). The New Music Therapist's Hand book. Berkeley Press. US.
9.
Tucek, G. (2006) Traditional oriental music therapy – a regulatory and relational approach. Music Therapy Today (Online 1st October) Vol.VII (3) 623-647.
10. Sivaprakash, B. (2014). (Ed) Mind & Medicine. Newsletter. Department of Psychiatry. Mahatma Gandhi Medical College. Pondicherry. Volume 1 Issue 1 July-Sep 2013 11. Krautschick (2003)
Relationship between music in medicine and music therapy in medicine.
http://www.hisf.no/sts/Musikkterapi/hovudfag/semv01_Krautschick.html
Levels of Evidence in Music Therapy Practice What is Evidence-Based Music Therapy
Meta Analysis
Practice?
Randomized Control Trial
“Evidence-based music therapy practice
Controlled Trials No Randomization
integrates the best available research, the music therapists' expertise, and the needs,
Cohort or Case Control
values and preferences of the individual(s) served”
Case Series and Case Report
Source: American Music Therapy Association
Qualitative
(2010)
Expert Opinion
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Photo story 31 01 2014 The new premise for CMTER was inaugurated by the Vice Chancellor. A Drum Circle was conducted for burnout among doctors of MGMC &RI. All the doctors present were screened for Burnout and participated in the Drum Circle. Dr. sumathy Sundar highlighted the benefits of participating in a Drum Circle which included de-stressing, alleviating anxiety, enhancing mood and relaxation, increasing performance and team spirit
16 02 2014 CMTER organized a stress management program for hospital staff. The program trained the participants to relax and engaged them musically for about an hour by making them play a variety of melodic and rhythmic musical instruments.
25 03 2014 The first Post Graduate Diploma in Music Therapy as a medical course in India was introduced by CMTER. This is an important mile stone in the development of music therapy as a clinical profession and academic discipline in the country. SBV is the first university to have introduced this innovative course as there are only a few courses available right now through private institutions.
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Referral Areas For Music Therapy Services In Hospitals For Various Clinical Specialities Dentistry Pre-Procedural Anxiety and Stress Cooperation Level During Procedures Post-Operative Pain Provide a Positive Means for Coping Induce Sleeping Elevate Mood Provide Emotional Support
Neurology
Psychiatry Reduce of Stress and Anxiety Reduce Symptoms of Depression Improve Sleep Quality Improve Attention and Focus Emotional Support
Expressive and Receptive communication Cognitive and Sensory Stimulation Increasing Motor Activity, strength and Endurance Improving Range of Motion
Anger Management
Increasing Reorientation
Provide a Positive means to Coping
Normalizing Hospital Environment
Enhance Self Expression
Emotional Support
Anaesthesiology
Obstetrics and Gynaecology
Pulmonary Rehabilitation
Antenatal Anxiety
Pre-Operative Stress
Optimize Breathing
Intrapartum Cooperation
Peri-Operative Anxiety
Improve Peak Expiratory Flow Rates
Postpartum Depression
Eliminating Sedation During Minor Procedures
Menopausal Depression
Post Operative Pain
Emotional Support
Normalizing Sterile Operating Environment
Providing a Positive Means to Coping
Providing a Positive Means for Coping
Improve Voice Intensity Alleviate Anxiety Psychological Distress in COPD Support Stress Management Enhance Quality of Life
Cardiology
Surgery
Paediatrics Reduce distress levels (Child and Mother)
Pre-Operative Anxiety
Pre-operative Anxiety and Stress
Fear of Needle
Reduce Restlessness
Reduce Systolic and Diastolic Blood Pressure
Cooperation Level During Painful Diagnostic procedures
Reduce Heart Rate
Post-Operative Pain
Cooperation Level During Diagnostic Procedures
Normalize Hospital Environment
Post-operative Pain
Normalizing Hospital Environment
Induce Sleep
Induce Sleep
Provide a Positive means for Coping
Reduced demand for Post Operative Analgesics
Reduced Demand for Post Operative Analgesics
Reduce Pain Perception Reduction of Crying Spells
Dermatology
Reduce Symptoms of Depression in Chronic Patients Pre Procedural Anxiety Improve Cooperation Levels during the Procedures Anxiety and Stress Reduction Provide a Positive means for Coping
Radiology and imagery Pre Procedural Aanxiety Cooperation Levels During the Procedure Anxiety and Stress Reduction Providing a Positive Means for Coping Decreasing Symptoms of Depression Elevate Mood Normalize Hospital Environment
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Taking Forward Music Therapy : Shaping The Future
CENTER FOR MUSIC THERAPY EDUCATION AND RESEARCH
Editorial Board
Patrons Shri. M.. Rajagopalan, Chairman Prof. Dr. Rajaram Pagadala, Chancellor Editor in Chief : Dr. Sumathy Sundar Advisory Board
Executive Editors
Prof. Dr. K.R. Sethuraman
Prof. Dr. A.R. Srinivasan
Prof. Dr. N. Ananthakrishnan
Prof. Dr. B. Sivaprakash
Prof. Dr. S. Krishnan
Members
Mrs. A.N. Uma
Dr. S. Srirangaraj Dr. V.R. Hemanth Kumar Dr. Sobana Jaiganesh Mrs. Asha Suresh Babu Ms. Vijay Chitra