Harmony june 2014

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.

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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