Music Therapy Today, Vol. 11, No. 1 by World Federation of Music Therapy

Spring 2015

MUSICTHERAPYTODAY Spring 2015, Volume 11, No. 1

Suggested Citation of this Publication Author A. A., Author B. B., & Author C. C. (2015). Title of article. Music Therapy Today 11(1), ppâ&#x20AC;&#x201C;pp. Retrieved from http://musictherapytoday.wfmt.info.

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Music Therapy Today Spring 2015 Editor Melissa Mercadal-Brotons, Ph.D., MT-BC, REMTA

Business Manager Amy Clements-CortĂŠs, Ph.D., MT-BC, MTA, RP, FAMI

Editorial Board Anita Gadberry, Ph.D., MT-BC Joy Allen, Ph.D., MT-BC Kana Okazaki-Sakaue, DA, MT-BC, NRMT, ARAM Katrina McFerran, Ph.D., RMT Michael Silverman, Ph.D., MT-BC Nancy Jackson, Ph.D., MT-BC Patricia L. Sabbatella, Ph.D., EMTR-Supervisor, MTAE-Spain Sooji Kim, Ph.D., MT-BC, KCMT Sumathy Sundar, Ph.D. Giorgos Tsiris, Ph.D. Candidate, MMT-NR, BA (Hons) Renato Sampaio, Ph.D. Candidate, MT Helen Oosthuizen, MMus (Music Therapy)

Abstract Translations Cristina Zamani, MM, MT-BC

Graphic Design Petra Kern, Ph.D., MT-BC, MTA, DMtG

Published by World Federation of Music Therapy (WFMT) www.wfmt.info

Music Therapy Today ISSN 1610-191X

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PRESIDENTALNOTE

President of WFMT Dr. Amy ClementsCortés 2014-2017

Welcome

Disseminating Knowledge about Music Therapy Worldwide By Amy Clements-Cortés

In this edition of Music Therapy Today you will find articles on: entry level requirements for music therapy education around the globe; the status of music therapy in Africa, and Central America; and clinical applications of music therapy with pediatric patients, and persons diagnosed with autism. Alongside these papers, you will find a review of the film “Conducting Hope,” three papers that were absent from the 2014 world congress proceedings, and articles written by 2014 WFMT award winners: Dr. Amelia Oldfield, and Dr. Jayne Standley, and an interview with award winner Dr. Petra Kern.

The WFMT journal is a peer reviewed publication, which is made possible through the outstanding editorial leadership of Dr. Melissa Mercadal-Brotons and the dedicated Music Therapy Today editorial board comprised of reviewers from around the globe. The purpose of the journal is to disseminate current knowledge and information about music therapy education, clinical practice, and research worldwide. I am delighted that in this edition, we have papers that are authored by persons in 6 of the 8 WFMT Regions including: Australia/New Zealand, Africa, Eastern Mediterranean,

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Europe, Latin America, and North America; and that the overall edition highlights education, clinical practice and research. The journalâ&#x20AC;&#x2122;s main reading audience is: educators, clinicians, students and allied health care practitioners. Our aim is to attract authors from around the globe to share their clinical work and research in order to grow the body of knowledge on music therapy. The WFMT strives to produce a publication that is accessible to everyone who endeavors to continue to learn and develop their practice as music therapists and health care practitioners. The positive response to the call for papers for this issue indicates a real desire by authors to contribute to the knowledge base of music therapy and grow our profession internationally. I trust you will enjoy this edition and hope that it inspires you to consider submitting an article for publication in future editions. As President of the WFMT I am honored to serve as the Business Manager for this important publication, and am so pleased that this is the first of two editions of in 2015: the 30th Anniversary of the WFMT. Regards,

Amy Clements-CortĂŠs, PhD, MT-BC, MTA, RP, FAMI President, WFMT

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EDITORâ&#x20AC;&#x2122;SMESSAGE

Chair, WFMT Publications Commission Melissa Mercadal-Brotons 2014-2017

New Edition Renewed Commitment to Excellence By Melissa Mercadal-Brotons

I am delighted to present the new edition of Music Therapy Today published by the World Federation for Music Therapy (WFMT).

priority and benefit to our membership. The commission is committed to providing a quality publication that not only demonstrates continuity, but a long life as well.

As Chair of the publications commission of the WFMT and editor of the online journal Music Therapy Today, I am excited to present this Spring 2015 issue. The publications commission has identified the journal as a top

The objective of this peer-reviewed journal is to disseminate and inform about music therapy practice, research, training, and professional issues worldwide, as well as

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WFMT related topics. We envision this professional journal to be a platform for information exchange between our worldwide members (clinicians, researchers, educators, and students) as well as colleagues who are interested in our field. It is our aim, therefore, to include different perspectives on clinical practice, training, and research with a richness of reflecting the cultural differences. Learning about and acknowledging how diversity helps us develop and grow professionally and personally. Our goal is to publish two issues a year of Music Therapy Today. In addition, we will be adding the Spanish translation of all the abstracts, and progressively include the Spanish translation of some of the articles. We are also adding a review section to the journal to present and comment on new audiovisual material in the field of music therapy: books, CDs, DVDs, movies, etc. I feel very honored and privileged to work with a group of highly competent and motivated professionals from around the globe, who have generously accepted and committed to be part of the editorial board and advance the mission of Music Therapy Today. We hope you reading the issue and that you will consider submitting your future publications to Music Therapy Today. Sincerely,

Melissa Mercadal-Brotons, Ph.D., MT-BC, REMTA Chair, WFMT Publications Commission

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CONTENTS 4

PRESIDENTIALNOTE Welcome: Disseminating Knowledge about Music Therapy Worldwide Amy Clements-Cortés

EDITOR’SMESSAGE New edition: Renewed Commitment to Excellence Melissa Mercadal-Brotons

11 PROCEEDINGS2014ADDENDUM APPLICATION OF NEUROBIOLOGY RESEARCH TO A MUSIC THERAPY FRAMEWORK FOR TRAUMA TREATMENT Gene Ann Behrens MUSIC THERAPY RESEARCH AND PRACTICE IN CONTEXT: CONTEMPORARY MENTAL HEALTH REHABILITATION Jeanette Milford MAXIMIZING THE MOMENT: MUSIC THERAPY WITH SCHOOL-AGE INDIVIDUALS AND GROUPS Anita L. Gadberry

19 CLINICALAPPLICATIONS PEDIATRIC PALLIATIVE CARE: PROGRAM REPORT ON THE ROLE OF TECHNOLOGY-ASSISTED MUSIC THERAPY Beth A. Clark, Harold Siden, and Lynn Straatman MUSIC THERAPY AND PLAY THERAPY: COTREATMENT WITH A BOY DIAGNOSED WITH AUTISM SPECTRUM DISORDER Anita L. Gadberry

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49 MUSICTHERAPYWORLDWIDE THE CURRENT STATUS OF MUSIC THERAPY IN AFRICA Katie Myers MUSIC THERAPY IN COSTA RICA AND CENTRAL AMERICA Roy Kennedy MUSIC THERAPY EDUCATION WORLDWIDE: REPORT ON ENTRY-LEVEL REQUIREMENTS Aksana Kavaliova-Moussi

141 AWARDWINNERS2014 MUSIC THERAPY IN THE 21st CENTURY: AN INTERVIEW WITH DR. PETRA KERN Roy Kennedy THIRTY FIVE YEARS AS A MUSIC THERAPIST: THE BEST JOB IN THE WORLD... Amelia Oldfield HISTORY AND EVOLUTION OF NICU-MT: RESEARCH AND SPECIALIZED TRAINING IN EVIDENCE-BASED MUSIC THERAPY FOR PREMATURE INFANTS Jayne M. Standley

171 GLOBALREVIEWS CONDUCTING HOPE: A FILM REVIEW Vanya Green

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PROCEEDINGS2014 ADDENDUM 11

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Proceedings of the 14 WFMT World Congress of Music Therapy July 7-12, 2014 in Vienna/Krems, Austria!

APPLICATION OF NEUROBIOLOGY RESEARCH TO A MUSIC THERAPY FRAMEWORK FOR TRAUMA TREATMENT Gene Ann Behrens Elizabethtown College, USA

Never before has it been more important to become trauma-informed as music therapists. The incidence of disasters, wars, acts of violence, and abuse across the world continues to escalate each year; therapists are observing an increase in the comorbidity of trauma with other diagnoses; and recent conclusions from research on the neurobiology of trauma are challenging how treatment is provided (Perry, 2009; Sutton, 2002; van der Kolk, McFarlane, & Weisaeth, 1996; van der Kolk, 2006).

Weisaeth, 1996). Neurobiological changes, thus, are viewed as the body trying to cope. Becoming trauma-informed, therefore, necessitates understanding recent research on the neurobiology of stress trauma. For example, research suggests the left hemisphere tends to be less active; orbital frontal cortex functioning is disrupted; abnormal levels of norepinephrine from the amygdala inhibit memory integration in the hippocampus; and high toxic levels of glucocorticoids eventually reduce the size of the hippocampus and amygdala—just to name a few (Solomon & Heide, 2005; van der Kolk, McFarlane, & Weisaeth, 1996). A trauma-informed therapist also uses treatment approaches and protocol suggested by the neurobiological research to facilitate positive changes in brain functioning while refraining from retraumatizing clients.

Despite the increasing incidence of trauma and the potentially unique benefits of music therapy, limited outcome data and treatment recommendations exist linking the neurobiology research to methods and protocol for music therapists working with clients experiencing trauma. This workshop will focus on these two needs, understanding the neurobiology of trauma research and linking the research outcomes to the components of a new framework for developing music therapy experiences in the treatment of unresolved trauma.

Applying the neurobiology research and treatment outcomes, Behrens formulated a new framework for music therapy treatment that involves the intersection of four components: (a) treatment steps, such as the establishment of safety and trust, assessment of clients, and unlearning of dysfunctional responses and development of coping skills to eventually facilitate deconditioning trauma responses (Blaustein & Kinniburgh, 2010; Steele & Malchiodi;

Recent research now suggests that trauma symptoms previously associated with psychological explanations are due to neurobiological changes that become disruptive to the brain and body’s ability to function (van der Kolk, McFarlane, &

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Proceedings of the 14 WFMT World Congress of Music Therapy July 7-12, 2014 in Vienna/Krems, Austria! Ziegler, 2011); (b) neurobiological goals for facilitating changes in the brain (Ziegler, 2011; Steele & Malchiodi, 2012); (c) key strategies suggested by research (Isaacs, 2009; Solomon & Heide, 2005; van der Kolk, 2006; van der Kolk, McFarlane, Weisaeth, 1996) and (d) main domains for trauma work (Ziegler, 2011; Blaustein & Kinniburgh, 2010; Steele & Malchiodi, 2012). As limited research exists on the use of music therapy in trauma-informed treatment, music and brain research can be used to support the unique, potential benefits of music as the medium of experiences within the Behrens Music Therapy Trauma Framework. Through experiences and discussions, participants will be introduced to research on the neurobiology of trauma, the implications for treatment, and the interactive Behrensâ&#x20AC;&#x2122; framework for using music as a medium in trauma treatment. As the framework is based on neurobiological research, it can be applied across psychological approaches, cultures, and ages of clients. References Blaustein, M. E., & Kinniburgh, K. M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York, NY: Guildford Press. Isaacs, N. (2009). The cutting edge of trauma treatment: Healing through the body. Retrieved from http://www.kripalu.org/article/648 Perry, B. D. (2009) Examining child maltreatment through a neurodevelopmental lens: clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14, 240-255. Perry, B. D. (2006). Applying principles of

neurodevelopment to clinical work with maltreated and traumatized children: The Neurosequential Model of Therapeutics. In N. B. Webb (Eds.), Traumatized youth in child welfare, (pp. 27-51). New York, NY: Guilford Press. Solomon, E. P., & Heide, K. M. (2005). The biology of trauma: Implications for treatment. Journal of Interpersonal Violence, 20(1), 51-60. doi: 10.1177/0886260504268119 Steele, W., & Malchiodi, C. A. (2012) Trauma-Informed practices with children and adolescents. New York, NY: Routledge. Sutton, J. (Ed.) (2002) Music, music therapy and trauma: International perspectives. New York, NY: Jessica Kingsley. van der Kolk, B. (2006). Clinical implications of neuroscience research in PTSD. Annals New York Academy Sciences, 1071, 277-293. van der Kolk, B., McFarlane, A., & Weisaeth, L. (Eds). (1996). Traumatic stress. New York, NY: Guilford Press. Ziegler, D. L. (2011). Traumatic experience and the brain: A handbook for understanding and treating those traumatized as children, (2nd ed.), Phoenix, AZ: Acacia. About the Authors Gene Ann Behrens, Ph.D., MT-BC, Professor/Director of music therapy, Elizabethtown College; chair WFMT Global Crises Intervention Commission; MTP editorial board; presents on research, music and emotions, neurobiology of trauma. Contact: behrenga@etown.edu

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Proceedings of the 14 WFMT World Congress of Music Therapy July 7-12, 2014 in Vienna/Krems, Austria!

MUSIC THERAPY RESEARCH AND PRACTICE IN CONTEXT: CONTEMPORARY MENTAL HEALTH REHABILITATION Jeanette Milford Glenside Health Service, Inpatient Rehabilitation, South Australia Australian national health policies now clearly state that all mental health services should be recovery oriented, supporting each personâ&#x20AC;&#x2122;s unique and personal journey to create a fulfilling, hopeful and contributing life and achieve his or her own aspirations. This positive focus on wellbeing is a challenge in the context of the difficulties and limitations presented by mental illness. People with schizophrenia for example experience delusions, hallucinations, disorganized thinking, disturbed behavior and negative symptoms, leading to high rates of social isolation, unemployment, substance misuse, imprisonment and suicide. Major cognitive deficits are common, including impaired attention, memory, language and executive function. Brain changes have been mapped in adolescents with schizophrenia, demonstrating accelerated grey matter loss enveloping increasing amounts of the cortex (Thompson 2001). Australian mental health services adopt a biopsychosocial approach to recovery, with medication providing significant symptom relief, in spite of challenging side-effects. Psychosocial approaches like music therapy are then able to focus on individual resources rather than illness, providing opportunities for restoring hope, identity, achievement, social connections and cultural engagement. In an inpatient rehabilitation setting, the author investigated

the impact of individualized music therapy on recovery from chronic schizophrenia (Milford 2007). A case series design with mixed methods was used with a resourceoriented approach based on individual strengths and interests Interventions included improvising, composing, learning to play an instrument and song discussion to explore recovery-related issues. Pre and post observational behavioral measures, self-reports and a standardized test were used to systematically record any changes in motivation, engagement, communication, mood and affect, as well as any value or meaning ascribed to music therapy by participants. Individual music therapy appeared to provide participants with a meaningful expressive outlet, as demonstrated by high levels of motivation, active participation and reported satisfaction. Music therapy had an immediate impact on negative symptoms with brighter affect and higher levels of engagement, spontaneity, verbal and nonverbal expression during sessions than in the ward. Participants reported higher levels of happiness and energy after music therapy sessions. A community music therapy approach (Stige 2002) was later used to connect individual strengths and interests into group programs and sustainable creative networks. This broader, collaborative approach addressed needs of consumers, carers, health facilities

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Proceedings of the 14 WFMT World Congress of Music Therapy July 7-12, 2014 in Vienna/Krems, Austria!

and communities simultaneously to promote wellbeing and resilience. The Bach to Blues project brought together hospitalized and community musicians, including streetwise blues singers and professional classical players. Band members were committed to reducing stigma while celebrating and showcasing the talents of musicians with mental illness. Arts department funding enabled video and sound recordings and performances in mainstream and disadvantaged settings.

adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early onset schizophrenia. Proc Natl Acad Sci USA 98(20):11650–11655. [PMC free article] [PubMed]. About the Author Jeanette Milford studied in Adelaide, Philadelphia and Melbourne (Research Master’s Degree), has extensive experience as a music therapist in mental health and is World Federation of Music Therapy Regional Liaison for Australia/New Zealand.

Music therapy can play a unique role in contemporary mental health rehabilitation programs, which recognize the importance of social inclusion, community capacity building and cultural connectedness. A broad approach to music as an everyday health resource, a positive focus for engagement and a source of enjoyment, hope and social connection helps reduce institutional barriers and promote mental health recovery.

Contact: australianewzealand@wfmt.info

References A national framework for recovery-oriented mental health services - PDF 2099 KB South Australia Health 2013 Bach to Blues, making music for wellbeing CD/DVD South Australia Health 2009 http://youtu.be/0wkBGCC7_yQ Milford, J (2007) Individual music therapy in rehabilitation and recovery from schizophrenia Melbourne Uni Masters thesis. Rolvsjord, R. (2004). Therapy as empowerment.. Nordic Journal of Music Therapy, 13(2), 99-111. Stige, B. (2002) Culture-centred music therapy. Gilsum NH: Barcelona Publishers. Thompson, PM et al (2001) Mapping

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Proceedings of the 14 WFMT World Congress of Music Therapy July 7-12, 2014 in Vienna/Krems, Austria!

MAXIMIZING THE MOMENT: MUSIC THERAPY WITH SCHOOL-AGE INDIVIDUALS AND GROUPS Anita L. Gadberry Marywood University, USA David L. Gadberry Clients and therapists alike benefit from a seamless session that capitalizes on every second of interaction. A cohesive music therapy session reduces distracting or unwanted off-task behaviors and facilitates more on-task work toward positive functional outcomes. Planning aesthetic moments in between music therapy interventions keeps clients’ attention and prevents off-task behavior in groups (Gadberry & Gadberry, 2013). Transitions may be facilitated with music, verbalizations, movement, or a combination of the aforementioned modes. Musical transitions can be tonal or rhythmic (Gadberry & Gadberry, 2013; Klinger, 1991). In addition to thoughtful transitions, planning, preparation, and practice will assist the therapist in making the most of every moment of the session. Thinking about the upcoming session and potential experiences allows one to formulate possible responses so that the therapist may effectively react to client behavior (Gadberry, 2014). Preparation and practice allows the therapist to be fully present in the moment and maximize opportunities for growth. By creating seamless sessions, the therapist may increase engagement and success of the client(s) (Gadberry & Gadberry, 2013).

References Gadberry, A. L. (2014). Skills for students: Making a good impression in fieldwork placements. In K. Cornelius (Ed.), The West Music professional success course. Three-hour continuing education course available at musictherapyed.com. Gadberry, D. L., & Gadberry, A. L. (2013, November). Tying it all together with transitions. Presentation at the American Music Therapy Association Conference, Jacksonville, FL. Klinger, R. (1991). A Guide to Lesson Planning in a Kodály Setting. Author. About the Authors Anita L. Gadberry, Ph.D., MT-BC is the Director of Music Therapy at Marywood University, Scranton, PA, USA. Contact: agadberry@marywood.edu David L. Gadberry, Ph.D. is a music education expert with interests in pedagogical repertoire and behavior management.

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Getting Involved Looking for other ways to get involved with the WFMT? The WFMT is currently building our library of music and folk papers. What a wonderful way to build our growing WFMT community in our 30th year. Is your country/region represented on the website? If you don't see song selections from your country, or a folk music paper, we invite you to submit a contribution! The WFMT believes that it is important for music therapists to understand the musical histories from multiple cultures around the world, in order to lead to a better understanding of the many clinical applications of music in different cultures and in therapy settings. The Folk Music Project is a working platform for music therapists to stimulate further studies, experiences and dialogues for developing new contributions and approaches to our work. Check on http://www.wfmt.info/folk-music/... The International Library of Songs is also a thriving platform which houses music in several categories including: lullabies, rhythms, folk and pop music. Songs are available at http://www.wfmt.info/resource-centers/publication-center/international-library-of-music/ We’re waiting for more musical histories, and music from all over the world! For more information or to submit a song idea or paper, please contact Dr. Daniel Tague, Chair of the Commission for Clinical Practice. Contact: practice@wfmt.info

http://www.wfmt.info/resource-centers/publication-center/international-library-of-music/

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CLINICALAPPLICATIONS 19

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Pediatric Palliative Care:

Program Report on the Role of Technology-Assisted Music Therapy By Beth A. Clark, Harold Siden, and Lynn Straatman

Abstract The use of technology in music therapy practice has been documented in many settings, as has music therapy with pediatric palliative care populations. However there has been little discussion of the integration of music technologies into pediatric palliative care music therapy practice. This retrospective program description summarizes the application of technologyassisted music therapy in a free-standing children’s hospice over a twelve-month period. The participants in the music therapy program were 100 children and youth, ages 0-19, with life-limiting conditions. Music therapy technologies used regularly include Somatron® vibroacoustic equipment, Snoezelen® multisensory environment, Soundbeam®, GarageBand®, YouTube™ and handheld devices such as iPod® and iPad®. The primary clinical needs addressed through the program include pain and symptom management, sensory stimulation, social interaction, normalization, selfexpression, choice, motivation, mood, coping, and legacy making. Benefits of technologyassisted music therapy in this Setting Canuck Place setting include enhanced selfChildren’s expression, motivation, Hospice is a freestanding accessibility, relationshippediatric hospice, which building and legacy creation. serves the Challenges related to needs of children aged 0 integrating technology in music to 19 years with progressive lifetherapy programs include cost limiting diseases of equipment and training of for the province of British therapists.

Resumen El uso de la tecnología en la práctica musicoterapéutica ha sido documentada en muchos entornos, al igual que la musicoterapia lo ha sido en la población de pacientes pediátricos en cuidados paliativos. Sin embargo ha habido poca discusión acerca de la integración de las tecnologías de la música en la práctica musicoterapéutica de los cuidados paliativos pediátricos. Esta descripción del programa retrospectivo resume la aplicación de la musicoterapia y la tecnología asistida en un hospicio para niños durante un período de doce meses. Los participantes en el programa de musicoterapia fueron 100 niños y jóvenes, de edades 0-19, con condiciones de vida limitantes. Las tecnologías que generalmente se utilizan en Musicoterapia incluyen los siguientes equipamientos: Somatron® vibro acústicos Snoezelen® ambiente multisensorial, Soundbeam®, GarageBand, YouTube ™ y dispositivos portátiles como iPod® y iPad®. A través del programa, las necesidades clínicas principales incluyen el manejo del los síntomas y del dolor, la estimulación sensorial, la interacción social, la normalización, la autoexpresión, la elección, la motivación, el estado de ánimo, el afrontamiento, y la toma de decisiones. Los beneficios de la musicoterapia asistida por la tecnología en este contexto incluyen la expresión de uno mismo, la motivación, la accesibilidad, la construcción de relaciones y el legado. Los desafíos relacionados con la integración de la tecnología en los programas de musicoterapia involucran el costo de los equipos y la formación de los terapeutas.

Columbia, Canada.

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Introduction A relatively small body of literature highlights the potential benefits of utilizing a range of technologies in music therapy practice. As Magee (2006) reported, music therapists are not in agreement about the integration of music therapy technologies in clinical practice, indicating a need for further research in this area. Music therapy in pediatric palliative or hospice care is also an emerging area, in which research is needed to document the applications of this modality (Lindenfelser, 2005). The purpose of this paper is to address both of these areas through description of clinical applications of technology-assisted music therapy within a pediatric palliative care setting. Pediatric Palliative Care The World Health Organization (WHO) has defined pediatric palliative care as â&#x20AC;&#x153;the active total care of the childâ&#x20AC;&#x2122;s body, mind and spirit, and also involves giving support to the familyâ&#x20AC;? (World Health Organization, 2015). The definition also states that palliative care should begin when the life-limiting illness is diagnosed and continue throughout the illness, regardless of whether the child receives therapy directed at cure of the disease (World Health Organization, 2015). The terms hospice and palliative care are used differently around the world. In this paper, hospice is used to refer to the physical center where care is provided, and pediatric palliative care refers to care provided to children and youth, ages 0-19, diagnosed with a life-limiting condition, with a life-expectancy of 19 years or less. Pediatric palliative care is unique in several ways. The number of children dying is small compared to the adult population. Many of the conditions are extremely rare or specific to childhood, or may be genetic in nature, and therefore there may be more than one affected child in a family (National Hospice and Palliative Care Organization, 2001). Childhood is also a time of continuing change in the physical, emotional and cognitive

development of the child. These changes are reflected in their communication skills and ability to understand their disease and death (Stevens, 1998). In 2000, the American Academy of Pediatrics stated that the minimum standards for pediatric palliative care must include an interdisciplinary team with sufficient expertise to address the psychosocial, emotional and spiritual needs of the family and child (American Academy of Pediatrics, 2000). In addition to nursing and physician care, an integral component of the interdisciplinary team is counseling and support services provided by individuals such as social workers, pastoral counselors, play, and music and recreational therapists. One of the primary goals of pediatric palliative care is to enhance quality of life (Steele, 2005; Wood, 2009). The use of expressive therapies in working with children and families can be powerful methods in fostering awareness, emotional growth and enhancing relationships with others (Lindenfelser, 2005; Van Breeman, 2009). Music Therapy in Pediatric Palliative Care Music therapy can address a broad range of needs within pediatric palliative care, including pain, fear, anxiety, relationships (Lindenfelser, 2005), self-expression, choice and control, trust, conflict resolution, safe environment (Daveson, 2001), comfort, family support, coping skills and meaningful experiences (Hilliard, 2003). Pawuk and Schumacher (2010) highlighted the benefits of music therapy as a noninvasive and patient-centered modality through which many domains can be addressed concurrently: physiological, psychological, cognitive, spiritual and family. Further, music therapy can be integrated into bereavement support for families following the death of their child. Regardless of the specific need addressed, the overarching focus is on utilizing music therapy as a tool to improve quality of life for children and their families (Amadoru & McFerran, 2007; Clark, Siden, &

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Straatman, 2014; Daveson, 2001; Hilliard, 2003; Lindenfelser, 2005).

may require a high level of physical activity for a youth with a physical disability.

In the extant music therapy literature, focus is placed on live, acoustic music therapy interventions to address the complex range of needs presented in pediatric palliative care. Singing, songwriting, instrumental playing, improvisation, listening, lyric analysis, song parody, and reminiscence are all examples of these live music therapy interventions (Daveson & Kennelly, 2000; Hilliard, 2003). Clark, Siden, and Straatman (2014) wrote about a broader range of receptive, active and analytical interventions, including multimodal stimulation, vibroacoutic music therapy, multisensory environments. Eaves (2010) discussed the role of recording technology in music therapy for adolescents with muscular dystrophy within a pediatric hospice setting, and while some technology may be incorporated in playing instruments (e.g., electric guitar, digital drumset) or listening to music (e.g., iPod® or compact disc recording), the employment of technology tools in music therapy to intentionally address pediatric palliative care goals remains largely unaddressed.

In a recent study, youth with severe physical disabilities were provided with computers, assistive technology, tutors, and internet connection in their homes (Schreuer, Keter, & Sachs, 2014). The provision of information and communication technologies resulted in increased engagement in age-normative social and leisure activities. In a similar application of technologies, Raghavendra, Grace and Wood (2013) explored the impact of providing youth with disabilities support in learning how to use the internet for social networking. Findings included increases in independent use, strengthening existing relationships, forming new social connections, and improved self-esteem and confidence in the area of social communication. Assistive technologies and facilitated access to technologies typically used by youth may allow youth with disabilities to engage in normative social and leisure activities, and to increase their independence in the world. Music Therapy Technologies With increased availability of portable electronic devices, such as laptops, smart phones, iPods®, and assistivecommunication devices, there is potential to use these technologies to increase the benefits of music therapy. However, an argument can also be made that technology should not be used just because it is available, but only when it provides a unique benefit. A study in the United Kingdom identified several points of interest (Magee, 2006). The majority of music therapists (69%) were not using music technologies in their practice, and concerns regarding whether “electronic technologies inhibit rather than enable the therapeutic relationship and process” (p. 145) were identified. However, the majority of those surveyed wanted more information about how music technologies were used in clinical work, and cited lack of skills, access and funding as barriers to using music therapy technologies in practice. In

Assistive Technologies A substantial body of literature is devoted to the application of assistive technologies with children and youth who have a broad range of disabilities. While a comprehensive review is not within the scope of this paper, the following examples serve to highlight the breadth of application as well as specific examples of relevance to music therapy practice. Lancioni, et al (2010) worked with children who had severe to profound intellectual disabilities, successfully reducing in appropriate stereotypic behavior and increasing object manipulation through a technology-assisted program using microswitches. King et al. (2014) wrote about the importance of examining activities differently for youth with disabilities, specifically activities typically classified as passive (e.g., video games) that

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contrast to Magee’s 2006 study, Cevasco and Hong (2011) found higher rates of technology use in music therapy practice, in a more recent survey of American Music Therapy Association members (professionals, interns, and students). For example, about 60% of respondents used technology in songwriting interventions. Over 40% of the MT-BCs responding to the survey strongly agreed that, “they and their clients would benefit from using technology every day of the work week” (Cevasco & Hong, 2011, p. 70).

a variety of mats, chairs, and other devices. Research with vibroacoustic therapy has demonstrated effectiveness for reduction of pain, anxiety, muscle tension and other symptoms (Boyd-Brewer & McCaffrey, 2003), as well as reduction in challenging behaviors of individuals with autism spectrum disorders (Lundqvist, Andersson & Viding, 2009). Bergström-Isacson, Julu and Witt-Engerstrom (2007) examined brainstem autonomic functioning, and found vibracoustic therapy to increase parasympathetic response in individuals with Rett Syndrome.

Over the last decade there has been increasing debate in the music therapy literature about the benefits music technologies, as well as the barriers to successful integration. Whitehead-Pleaux, Clark, and Spall (2011) stated that with effective clinical assessment, taking into account factors such as developmental stage, coordination, concentration and dexterity, technology can be integrated into pediatric music therapy practice to effectively address coping and pain management skills, identity, mastery and empowerment. Magee and Burland (2008) investigated applications of Musical Instrument Digital Interface (MIDI) technologies with children who have complex needs, and found that clinicians use these technologies to motivate clients who are otherwise difficult to engage, expand opportunities for self-expression and foster identity development. Magee (2006) identified future areas for research, including barriers to use of technology and how technologies may inhibit or enhance the therapeutic process. This paper seeks to address these issues, primarily the latter, through exploration of six specific technology applications of particular relevance to music therapy practice in pediatric palliative care: vibroacoustic, multisensory environments, Soundbeam®, karaoke, composition and recording software, and handheld digital devices.

Multi-sensory Environment: Snoezelen®. Multi-sensory environments (MSEs), such as those designed by Snoezelen®, provide a wide range of visual, auditory, tactile, aromatic and movement-based sensory experiences (Snoezelen®, n.d.). MSEs have been used to reduce heart rate, muscle tone and agitation in children with traumatic brain injury (Hotz et al., 2006). In a meta-analysis of MSEs studies for individuals with intellectual and developmental disabilities, Lotan and Gold (2009) found a significant impact on adaptive behaviors. Soundbeam®. The Soundbeam® system uses sensors to translate movement into digitally generated sounds (Soundbeam® Project, n.d.). A conical beam is emitted from a sensor that is similar in shape and size to a microphone. The child can move fingers, hands, legs, head or whole body to break the beam. This triggers a MIDI keyboard, which can be programmed to play preferred sounds. These gestural sensors can meet the needs of many clients who have profound disabilities (Swingler & Brockhouse, 2009) and allow individuals with physical limitations to create music independently (McCord, 2004). Karaoke: YouTube™. The use of karaoke in therapeutic settings has been documented in the literature. Magee et al. (2011) highlight the benefits of iTunes® and YouTube™ in accessing music that is personally meaningful to clients. Benefits of karaoke singing have

Vibroacoustic: Somatron®. Vibroacoustic products convert music to tactile sensations (Somatron®, 2010), which are transmitted via

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been documented for individuals with quadriplegia; these include active recreation, respiratory benefits, personal satisfaction, enjoyment and opportunities to improve speech and cognitive functioning (Batavia & Batavia, 2003). Music that is preferred by children and youth is commonly available on iTunes® or for free on YouTube™. YouTube™ postings of song lyrics along with the audio track provide a highly accessible way to create a karaoke-style experience without special equipment.

technology for children and youth with disabilities, technology in pediatric music therapy, and applications of specific technologies in general music therapy settings. No studies were identified that specifically addressed the integration of music therapy technologies in pediatric palliative care practice. We seek to address this gap through a program description giving a picture of one year of pediatric palliative care music therapy practice integrative six specific music therapy technologies.

Composition and Recording Software: GarageBand®. GarageBand® is a software program available on Mac® computers and iPad® which allows the user to create musical compositions from prerecorded loops, record original music and share the music easily through a variety of formats (Apple®, 2012). Benefits of computer-based recording for hospitalized children include pain management, anxiety reduction, selfexpression, and creating gifts of recorded music or messages for family members and friends (Whitehead-Pleaux, Clark & Spall, 2011). Magee et al. (2011) found that recording software makes professional quality recording and editing not only accessible to music therapists, but also user-friendly enough to enable entire process to be completed within a single session.

Program Description Settings Canuck Place Children’s Hospice is a freestanding pediatric hospice, which serves the needs of children aged 0 to 19 years with progressive life-limiting diseases for the province of British Columbia, Canada. The Canuck Place inpatient program offers four types of care: respite and family support, pain and symptom management, end of life care and bereavement. Music therapy sessions primarily take place in a music therapy room within the hospice. The room is large enough to accommodate five individuals in wheelchairs and up to eight people in total. When children are unable to utilize the music therapy room due to the severity of their medical symptoms, sessions are conducted in patient rooms or in an alcove next to the nursing station. Other spaces available for music therapy include a multisensory (Snoezelen®) room, art room, schoolroom, recreation room, great room (for large groups and special events), play therapy/sand tray room, volcano room (gross motor play), and outdoor gardens. The therapeutic environment is selected based primarily on the needs and preferences of the children, youth and families.

Handheld Digital Devices: iPod®. Digital hand-held music devices offer music therapists a portable tool that can perform a v a r i e t y o f f u n c t i o n s ( N a g l e r, 2 0 11 ) . Opportunities to decrease patient isolation by sharing original musical compositions via social networking have emerged. The iPod® makes interventions to reduce pain through preferred music listening and to reduce anxiety before surgery through music applications more accessible in healthcare settings (Whitehead-Pleaux, Clark & Spall, 2011).

Populations Children and youth, ages 0-19, receive inpatient music therapy services at the hospice while admitted for respite, symptom management, transition to home or end-of life care. The life-limiting diagnoses of most of

The literature includes research on music therapy in pediatric palliative care, assistive

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these children fall into one of six categories: neuromuscular diseases, congenital multiorgan syndromes, central nervous system conditions (CNS), cancer, metabolic/ biochemical disorders, or cardiac/pulmonary conditions.

integrate electronic technology, and (2) could not be implemented without the use of the technology. For example, use of a digital piano, when an acoustic piano could serve the same function, would not qualify as TAMT. Conversely, using music-recording software to compose music via prerecorded loops could not be achieved without the electronic technology and would therefore be described as TAMT.

Personnel This program was facilitated by a music therapist with Canadian accreditation (MTA), United States board certification (MT-BC) and British Columbia counselor registration (RCC). Trained hospice volunteers were available to assist with music therapy sessions, and staff such as physicians, nurses and counselors, occasionally participated.

Assessment Goals of care for each child and youth were determined by the interdisciplinary team, as part of their care plan. The music therapist’s role was to address these goals of care through music interventions. Prior to participation in TAMT, children and youth were assessed by the music therapist to determine which interventions were clinically appropriate. Information from medical records, interdisciplinary team member, and family members, as well as observation in the hospice milieu and during music interventions provided the basis for assessments. Children w e r e c o n s i d e r e d a p p r o p r i a t e TA M T candidates if TAMT interventions were likely to be as, or more, effective than nontechnology interventions in meeting goals of care. TAMT was deemed inappropriate if adverse effects were likely to occur (e.g. overstimulation).

Equipment The following music therapy technologies were available at the hospice: Somatron® (Snugums™, wedge and recliner cushion), Snoezelen® multisensory environment (MSE), SoundBeam® 2 (with MIDI keyboard), iPod®, and Mac® computer with iTunes®, YouTube™ and GarageBand® applications. Some children brought their own iPods® and iPads® to the hospice for communication and recreation purposes. The music therapy room at the hospice housed all of the music therapy technology equipment, with the exception of the MSE which was a separate room. The music room was also equipped with a Firewire® mixer and audio interface, allowing easy recording of the SoundBeam®, digital drumset, digital piano, electric guitar, electric bass and microphones.

Each TAMT intervention can address multiple goals, however some require minimum levels of intellectual, motor, or communication functioning. For example, the Soundbeam® intervention requires independent movement of some part of the body and an understanding of cause and effect. Karaoke

For the purposes of this paper, TechnologyAssisted Music Therapy (TAMT) will be used to describe clinical interventions that (1)

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is designed for those with verbal language skills. Composing and recording music can be pursued by youth with any level of motor ability, but require moderate to high cognitive functioning. Vibroacoustic and multisensory environments are the lowest barrier interventions, requiring no specific motor, cognitive or communication skills, however care must be taken to assess tolerance for sensory stimulation.

ethical approval by the University of British Columbia Childrenâ&#x20AC;&#x2122;s and Womenâ&#x20AC;&#x2122;s Research Ethics Board. Descriptive statistics and qualitative summaries of the applications of music therapy technologies were generated from this data. Results Descriptive Statistics Over the course of 2011, 153 children were admitted for respite, symptom management or end-or-life care, for 399 total admissions. The average length of stay was six days. In 2011, 40 children on the program died, 19 of them while admitted to the hospice. The music therapist provided direct services at the hospice two afternoons per week for a total of eight hours.Typically, a child or youth received individual or group music therapy services during each admission; reasons for not receiving services during a given admission included admission during nonmusic therapy days, conflicting medical appointments, contraindicative acute symptom presentation, spending time with family, and choosing to engage in an alternate activity. During 2011, the music therapist provided services to 100 of the 153 children who were admitted (65%). These children were all assessed by the music therapist, and for the vast majority of children (92%), a combination of TAMT and nontechnology interventions were determined to be appropriate. TAMT was assessed as inappropriate for 8% of children, due to either potential for overstimulation or behavioral challenges making use of the TAMT equipment a safety risk. Figure 1 shows the percentage of children and youth served through the music therapy program (n=100) who received, or were assessed as appropriate to receive, specific TAMT during the 12-month study period.

Therapeutic Approach The music therapy program was developed using a client-centered, strengths-based approach to care. Emphasis was placed on empowering children and youth to identify and pursue goals, capitalizing on their existing strengths and building new skills that could be of benefit within and beyond the music therapy session. Due to the broad range of ages, developmental levels, functioning levels, and goals of care, interventions drawn from medical (i.e., neurologic, NICU), developmental, and cognitive-behavioral music therapy approaches were utilized to meet specific needs. Data Collection Over a one-year period, a database was maintained to document each music therapy session, using Bento software. Basic demographic data were recorded, including name, date of birth, diagnostic category, and level of hearing. The length of each session, individual or group format, goals of care, interventions used, and responses were also documented. Descriptions of responses included therapist observation, client selfreport, and other data such as song lyrics. Audio and video recordings were stored separately and references in the database notes. Following the year of data collection, a review of records was conducted to explore the needs, goals, and outcomes of clients who accessed music therapy while admitted to the childrenâ&#x20AC;&#x2122;s hospice from January through December of 2011. This review was granted

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Consistencies were noted between specific TAMT interventions and goals of care addressed through the interventions. Somatron®, Snoezelen® and Soundbeam® interventions selected to target one or more physiological goals (i.e. pain reduction and sensory stimulation). Snoezelen®, Soundbeam®, GarageBand® and YouTube™ were selected to address social and e m o t i o n a l / b e h a v i o r a l g o a l s . Ta b l e 2 summarizes specific goals of care commonly addressed through each of the TAMT modalities.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Characteristics, Goals of Care, and Interventions Three individual client characteristics were key in assessing appropriateness for TAMT: intellectual, motor and communication functioning levels. Specific presenting symptoms, goals of care, and client preferences were also important in selecting interventions for each session. Table 1 summarizes the common characteristics of clients who were assessed as appropriate for specific interventions.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

Understanding the intellectual, motor, and communication functioning levels of each client are essential in assessing which TAMT interventions are appropriate. The following intervention descriptions are provided to describe both the applications of TAMT interventions and typical responses observed and recorded in the music therapy database. TAMT Interventions Somatron®. Three different sized Somatron® products are available at the hospice: Snugums™, “wedge” and “recliner cushion”. The Snugums™ is the size of a small pillow

CNS: Central Nervous System Conditions

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and primarily used with children under two years of age, the wedge is a small mat used with children two to five years of age, and the recliner cushion is a mat large enough for a typical adult. Children who were listless, agitated, or showed signs of pain or discomfort were most frequently provided with vibroacoutic music therapy sessions. Positive responses were frequently documented, including reduced muscle tone, relaxed facial muscles, smiling, opening eyes, eye contact, orienting to sound source, and increased nonagitated vocalizations. For some, no observable responses occurred; however no children displayed adverse reactions to this therapy. The responses indicate that vibroacoustic music therapy can be used to provide an appropriate level of music-based sensory stimulation for children with severe to profound intellectual, motor and communication impairments.

Soundbeam®. The Soundbeam® was used with two different cohorts of children and youth. The first, with moderate intellectual impairment, moderate to severe motor impairments, and significant communication challenges, used the device to experience choice and have control over the environment. When a motor impairment ruled out playing most traditional instruments, even slight movements could be captured with the Soundbeam®, creating vast opportunities for self-expression. Engagement in this process was observed to increase motivation to interaction with others and increase engagement in music therapy sessions. The second cohort of Soundbeam® users were cognitively high functioning (at most a mild impairment), were verbal, and had moderate to severe motor impairments; these individuals were most often youth with neuromuscular conditions. For these youth, the ability to play traditional instruments was highly compromised, and the Soundbeam® offered new possibilities for engaging in the normal teen activity of music making. Choice of soundscapes, combined with live instruments (played by therapist, volunteer or youth) and loops from GarageBand® or MIDI keyboard, resulted in creation of music in the styles/genres preferred by the youth. Youth were observed to have high levels of social interaction, collaborative engagement in group activities, and improved affect.

Snoezelen® with Live Music. At the hospice, a Snoezelen® multi-sensory room provides many opportunities visual and tactile stimulation, and also has a CD player. Nurses frequently referred children who were listless, and sometimes agitated, to the music therapist for sensory stimulation. The music therapist used the visual and tactile elements of the multisensory environment in combination with live music (guitar, singing and percussion) to address these needs. One benefit of the diverse range of stimuli were the opportunities to adapt the MSE for children whose levels of visual and auditory functioning were undetermined. Stimuli can be presented individually, allowing children to indicate preferences through eye gaze, reaching and vocalizing, and in various sequences and combinations to elicit and maintain attention while avoiding overstimulation. Shifts in attention, vocalization, social interactions and falling asleep were all considered to be positive outcomes, depending on the presenting needs of the child.

GarageBand®. The GarageBand® software program was used in two primary ways. The first was to record improvised music that was sung or played on acoustic instruments, digital/MIDI instruments or the Soundbeam®. Depending on the level of cognitive functioning and attention span, the music therapist either mixed the recording with the client or completed that step following the session. Either way, the child or youth received a CD recording to share at the hospice and at home. Recording improvised music involved making choices, being in

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control of the creative process and fostering an identity as a musician.

Handheld Digital Devices: iPod® and iPad®. A new area within TAMT involved the use of mobile digital devices such as iPod® and iPad®. The hospice has installed several iPod® listening stations to improve access to music for relaxation, stimulation and entertainment when the music therapist is not available. Personalized playlists have also been developed and loaded onto iPods® to assist youth with relaxation and sleep hygiene. Several of the children and youth used an iPad® to aid in communication and for recreation. For children with extremely limited motor function an iPad® can be plugged into speakers, apps that simulated music instrument playing allowed them to play and be heard within a group jam session.

The second application of GarageBand® was with youth with high levels of cognitive functioning, mild to severe motor impairments and strong communication skills. Composition of songs began in many ways, including writing lyrics, improvising on instruments and experimenting with recorded loops. Youth learned to independently use the software, most frequently layering loops and adding vocals before mixing their songs. For some, frustration was evident when the song did not match their expectations; however these situations offered opportunities for exploring coping skills, useful in music and generalizable to their daily lives. With encouragement, most youth were able to work through their frustrations and complete a composition within a single session. Over multiple admissions, youth accumulated tracks and each time left with a longer album. Listening to previously composed songs, especially those with lyrics, allowed for reflections by youth on their own maturity, both personal and musical, and the legacy that is captured through their music.

No TAMT. For a small percentage of children (8%), TAMT was assessed as inappropriate. For most this was due to acute and complex symptom presentation, often at the end of life. Due to a possibility of overstimulation, ongoing and urgent medical interventions, and needs of the family, use of TAMT equipment was deemed inappropriate. In these cases, simple live music (vocals and/or guitar) was offered if appropriate.

YouTube™. The participants who accessed YouTube™ karaoke sessions typically had mild global developmental delays and a broad range of motor abilities. These children and youth wanted to perform, to be on stage, have an audience, be a star. Sessions sometimes involved costumes, dancing, music video recording, and concerts within the hospice. Children and youth were eager to share about themselves through their musical preferences and would sometime engage in lyric analysis. S i n g i n g a l o n g w i t h Yo u T u b e ™ o n microphones in a group setting elicited positive social behaviors, including encouragement of peers, positive selfstatements and high levels of motivation. YouTube™ karaoke groups facilitated rapportbuilding with the music therapist that in some cases lead to future engagement in individual songwriting and recording sessions.

In examining the question of how TAMT is being applied in clinical work, we found that a broad range of technologies were used to address diverse physiological, social and emotional/behavioral goals for children and youth in pediatric palliative care. For the majority of clients, inclusion of one or more TAMT, frequently in combination with nontechnology-based interventions, was assessed to be appropriate. For the small minority who were assessed an inappropriate to receive TAMT due to acute symptom presentation, it is important to note that TAMT might have been indicated for some of these children and youth prior to end-of life medical crises.

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Discussion The WHO (2005) definition of pediatric palliative care as total care of a child’s body, mind and spirit is highly relevant in this work. Our program review reflects this definition and other published literature in its focus on the physical, social, and emotional/behavioral needs of the children in our care. While we did not specifically address the domain of spiritual care, this was interwoven throughout the music that children and youth selected and created across all interventions. Similar to other pediatric music therapy settings, we incorporated TAMT into our work in pediatric palliative care, finding five key benefits for our children and youth: self-expression, motivation, accessibility, relationship, and legacy.

r e c r e a t i o n . TA M T u s i n g a n a l o g o u s technologies (e.g., computer) were used by youth because of physical accessibility level and their comfort with these platforms. All of the TAMT described were adaptable based on the unique characteristics of a child or youth. Somatron® products were available in a range of sizes. A key element in accessibility was keeping as much equipment as possible set up and ready for use when needed. Minimal wait-time for TAMT was important in order to capitalize on interest, energy and willingness to engage in therapy. TAMT offers expanded opportunities for social connection and rapport building with peers, staff and volunteers. Relationship building requires some form of communication, be it verbal or nonverbal, musical or nonmusical. When children have difficulty expressing themselves, either due to their communication abilities or emotionally-based reticence, TAMT frequently opened up the channels of communication and self-expression. This created opportunities to strengthen relationships where otherwise barriers would have remained. While Magee (2006) found that some music therapists surveyed were concerned that use of electronic technologies in music therapy might impede rather than foster therapeutic relationships, we found the opposite to be true. Utilizing a strengthsbased and client/family centered approach, we worked with the child or youth’s strengths to address their needs. Interest in and ability to use technology was often a strength used in other areas of their lives, such as school and recreation, making it a natural element of music therapy practice with this population.

Some children and youth had limited opportunities to actively engage in music prior to the integration of TAMT. Despite a range of physical, neurological, communication and social challenges, many children and youth transformed from quiet observers to excited participants within music therapy sessions with these technology-based opportunities for self-expression. A subset of youth with extremely limited mobility, often due to neurodegenerative disorders, rejected playing acoustic instruments as it represented a loss of previous abilities. Providing an accessible, new instrument (e.g., Soundbeam®) or other accessible TAMT (e.g., GarageBand®) that quickly facilitated music making in their preferred genre was highly motivating. Lastly, children with severe global developmental delays who presented with limited social interaction were more motivated to engage and interact when using vibroacoustic equipment or in a music therapy session in a multisensory environment.

F i n a l l y, r e c o r d i n g t e c h n o l o g i e s h a v e progressed significantly from the tape recorders to the accessible personal computer software for recording, mixing and sharing media of today. The lowering costs and increasingly user-friendly interfaces make recording technologies easier than ever to integrate into clinical practice. No application is more poignant than recording a child’s

Children and youth with limited motor capacities often utilized computers, iPad®, video game systems and adaptive technologies for communication and

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original songs or music videos to share with their family and friends, and to leave as a legacy after they pass away.

can have a positive impact on the quality of life of children, youth and families. Copyright of all songs created in music therapy sessions belong to the child or youth. The material is treated as a confidential product of a therapy session, though children and youth often choose to share their creations with family, friends and hospice staff and volunteers.

The role of the music therapist is important to consider in the context of providing TAMT. Music therapy is the application of music interventions by a trained professional in order to facilitate progress toward therapeutic goals. TAMT equipment ranges from simple (i.e., iPod®) to complex (i.e. Soundbeam®) to use. Regardless of the skills needed to use the equipment, it is the training of a music therapist that allows these technologies to be translated into therapeutic tools. A music therapist is uniquely qualified to assess and target music-based interventions to address specific goals of care, through training in psychology, physiology, communication, counseling, music, assessment, intervention, and evaluation. Following assessment and implementation of TAMT interventions, the music therapist may be able to train family members or other care providers on how to use the technology to benefit an individual client. Within the hospice setting, however, we found that staff had limited time to learn to use equipment, so any intervention to be performed by someone other that the music therapist needed to be simple and clearly documented within the interdisciplinary team notes.

One of the interesting findings from the review of assessments and services provided was the difference between numbers of children assessed as appropriate to receive specific TAMT and the numbers of children who actually received them (see Figure 1). The greatest differences were seen in the numbers of children who received the Somatron® (30%), Snoezelen® (25%) and Soundbeam® (41%) interventions, while all children assessed for YouTube™ (100%) and the majority of those for GarageBand® (58%) received the intervention over the course of the year. The reasons for children not receiving an intervention include lack of admissions during music therapy days, attending medical appointments and choosing different activities. When the census was high, music therapy groups were offered, making interventions that primarily take place in individual sessions (i.e., Somatron® and Snoezelen®) less accessible. Interventions that could be provided with no additional setup within the music room (YouTube™ and GarageBand®) had the least difference, while those that required additional set-up or transportation of equipment had the greatest. For example, the two Somatron® mats are large, require a full stereo system for operation and are typically transported to a child’s room or common area of the nursing floor. In addition to the time needed to transport, set up and clean up equipment, assistance from nursing or other care staff is needed to safely transfer children between bed or wheelchair and the mat. In contrast, instruments in the music room remain ready to use and interfaced with the computer via

The use of this technology also presents some challenges. Cost, training and space for equipment are all potential challenges in using TAMT in practice. Fortunately our freestanding hospice has space to accommodate this equipment and the music therapist has received training through self-tutorials, colleague consultation, and conference workshops. In our experience, private donors and granting foundations have been very generous in providing funds for the purchase of TAMT equipment requested by the music therapist. Many organizations are attracted to opportunities to donate tangible items that

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the Firewire® mixer, allowing for karaoke and music recording with no set-up. It is a priority to reach as many children as possible through the music therapy program during a small number of hours each week; taking time for equipment set-up may be a key factor in implementing TAMT in practice.

could also provide accessible continuing education opportunities to therapists in a timely manner. Therapists should also be prepared to allow their clients to be the experts in technology and to learn from them. This allows for modeling of being open to learning and to new experiences and can build the self-esteem of youth while strengthening the therapeutic relationship.

In our work, TAMT is integral to the music therapy process. With regard to implications and future directions, it is important for music therapists to stay apprised of developments in music-related technologies, whether through conferences, courses or independent study. This is essential for keeping music therapy practice relevant to the lives of children and youth who use adaptive technologies in daily life for communication, recreation and other purposes. We strongly encourage music therapists to integrate TAMT, such as the ones outlined in this article, into practice with children and youth with life-limiting conditions. Similarly, we believe that children with a range of non-progressive developmental challenges can similarly benefit from TAMT, as the treatment goals targeted in this program are not unique to palliative care. We recommend dedicated music therapy treatment space where TAMT equipment can remain prepared. This allows the therapist to maximize time spent working with clients and to quickly capitalize on client interest. In the case of itinerant services, equipment continues to become more compact and easy to transport. For example, a home-visit with a child or youth can be greatly enhanced with TAMT using only an iPad®, with its internal microphone and speakers, GarageBand® application, and iTunes® or YouTube™, via wireless internet connection.

Clinical research is needed to build the evidence base for integration of music therapy technologies into programs for pediatric palliative care and other populations. For example, studies investigating the comparative efficacy of technology-based interventions and live acoustic interventions could guide music therapy treatment planning. Investigating music therapists’ perceptions of the appropriateness of TAMT before and after receiving training in implementing TAMT would address questions of how much a lack of knowledge, skills and confidence impacts clinical decision-making around TAMT. This will be an evolving area of research and education, as technologies continue to evolve. The children, and in our children’s hospice, experience physical, emotional, cognitive, social and spiritual challenges over the course of their illnesses and diseases. Music therapy, enhanced through TAMT and research, is one of the tools of the interdisciplinary team uses to meet the needs of families throughout their journeys. We continue to search for innovative ways to help the children, youth and families on our program embrace life. References Amadoru, A., & McFerran, K. (2007). The role of music therapy in children’s hospices. Complementary therapy, 14(3), 124-127. American Academy of Pediatrics (2000). Palliative care for children: Committee on

To address the challenges of TAMT skill building among practicing music therapist, clinicians experienced in clinical applications of specific technologies should be encouraged to offer conference presentations and workshops. Online tutorials or podcasts

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Bioethics and Committee on Hospital Care. Pediatrics, 106(2), 351-357. Apple®. (2012). GarageBand® ’11. Retrieved f r o m h t t p : / / w w w. a p p l e . c o m / i l i f e / garageband/what-is.html Batavia, A. I., & Batavia, M. (2003). Karaoke for quads: A new application of an old recreation with potential therapeutic benefits for people with disabilities. Disability and Rehabilitation: An International, Multidisciplinary Journal, 26(6), 297-300. doi: 10.1080/0963828021000031025 Bergström-Isacson, M., Julu, P. O. O, & WittEngerstrom, I. (2007). Autonomic responses to music and vibroacoustic therapy in Rett syndrome. Nordic Journal of Music Therapy, 16(1), 42-59. Boyd-Brewer, C., & McCaffrey, M. (2003). Vibroacoustic sound therapy improves pain management and more. Holistic Nursing Practice, 18(3), 111-118. Cevasco, A. & Hong, A. (2011). Utilizing technology in clinical practice: A comparison of board-certified music therapists and music therapy students. Music Therapy Perspectives, 29(1), 65-73. Clark, B. A., Siden, H., & Straatman, L. (2014). An integrative approach to music therapy in pediatric palliative care. Journal of Palliative Care, 30(3), 181-189. Daveson, B. A. & Kennelly, J. (2000). Music therapy in palliative care for hospitalized adolescents. Journal of Palliative Care, 16(1), 35-38. Eaves, N. (2010). ‘A Bohemian Rhapsody’: Using music technology to fulfill the aspirations of teenage lads with muscular dystrophy. In M. Pavlicevic (Ed.), Music Therapy in Children’s Hospices, (pp. 95-109). London: Jessica Kingsley. Hilliard, R. E. (2003). Music therapy in pediatric palliative care: Complementing the interdisciplinary approach. Journal of Palliative Care, 19(2), 127-132.

Hotz, G. A., Castelblanco, A., Lara, I. M., Weiss, A. D., Duncan, R., & Kuluz, J. W. (2006). Snoezelen®: a controlled multisensory stimulation therapy for children recovering from severe brain injury. Brain I n j u r y, 2 ( 8 ) , 8 7 9 - 8 8 8 . d o i : 10.1080/02699050600832635 King, G., Gibson, B. E., Mistry, B., Pinto, M., Goh, F., Teachman, G., & Thompson, L. (2014). An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: The importance of belonging, fund, and control and choice. Disability and Rehabilitation, 36(19), 1626-1635. doi: 10.3109/09638288.2013.863389 Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Didden, R., Olivia, D., & Campodonico, F. (2010). Two children with multiple disabilities increase adaptive object manipulation and reduce inappropriate behavior via a technologyassisted program. Journal of Visual Impairment and Blindness, 104(11), 714-719. Lindenfelser, K. (2005). Parents' voices supporting music therapy within pediatric palliative care. Voices: A world forum for music therapy, 5(3). Retrieved on January 6, 2012 from https://normt.uib.no/ index.php/voices/article/viewArticle/233 Lotan, M, & Gold, C. (2009). Meta-analysis of the effectiveness of individual intervention in the controlled multisensory environment (Snoezelen®) for individuals with intellectual disability. Journal of Intellectual & Developmental Disability, 34(3), 207-215. doi: 10.1080/13668250903080106 Lundqvist, L-O, Andersson, G., & Viding, J. (2009). Effects of vibroacoustic music on challenging behaviors in individuals with autism and developmental disabilities. Research in Autism Spectrum Disorders, 3, 390-400. Magee, W. L., Bertolami, M., Kubicek, L., LaJoie, M., Martino, L., Sankowski, A.,…

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Z i g o , J . B . ( 2 0 11 ) . U s i n g M u s i c Technology in Music Therapy With Populations Across the Life Span in Medical and Educational Programs. Music and Medicine, 3(3), 146-153. doi: 10.1177/1943862111403005 Magee, W. L., & Burland, K. (2008). An Exploratory Study of the Use of Electronic Music Technologies in Clinical Music Therapy. Nordic Journal of Music Therapy, 17(2), 124-141. Magee, W. L. (2006). Electronic technologies in clinical music therapy: A survey of practice and attitudes. Technology & Disability, 18(3), 139-146. McCord, K. A. (2004). Moving beyond 'That's all I can do': Encouraging musical creativity in children with learning disabilities. Bulletin of the Council for Research in Music Education, 159, 23-32. Nagler, J. C. (2011). Music therapy methods with hand-held music devices in contemporary clinical practice: A commentary. Music and Medicine 3(3), 196-199. doi:10.1177/1943862111407512 National Hospice and Palliative Care Organization. (2001). A call for change: Recommendations to improve the life of children with life-threatening conditions. Retrieved from www.nhpco.org/files/ public/ChiPPSCallforChange.pdf Pawuk, L. G., & Schumacher, J. E. (2010). Introducing music therapy in hospice and palliative care: An overview of one hospice’s experience. Home Health Nurse, 28(1), 37-44. Raghavendra, P., Newman, L., Grace, E., & Wood, D. (2013). ‘I could never do that before’: Effectiveness of a tailored internet support intervention to increase the social participation of youth with disabilities. Child: Care, Health and Development, 39(4), 552-561. doi: 10.1111/cch.12048

Schreuer, N., Keter, A., & Sachs, D. (2014). Accessibility to information an communication technology for the social participation of youths with disabilities: A two-way street. Behavioral Sciecnes and the Law, 32(1), 76-93. doi:10.1002/bsl. 2014 Somatron®. (2010). About us: What is vibroacoustic therapy? Retrieved from http://www.somatron.com/about.html Snoezelen®. (n.d.) What is Snoezelen® MSE? Retrieved from http:// www.snoezeleninfo.com/ whatIsSnoezelen.asp Soundbeam®. (n.d.). Soundbeam®: The invisible, expanding keyboard in space. Retrieved from http:// www.soundbeam.co.uk/ Steele, R. (2005). Strategies Used by Families to Navigate Uncharted Territory When a Child Is Dying. Journal of Palliative Care, 21(2), 103-110. Stevens M. M. (1998). Psychological adaptation of the dying child. In D. Doyle, G. W. C. Hanke & N. MacDonald (Eds.), Oxford Textbook of Palliative Medicine 2nd Ed. (pp. 1107-1117). New York: Oxford University Press. Swingler, T., & Brockhouse, J. (2009). Getting better all the time: Using music technology for learners with special needs. Australian Journal of Music Education, 2, 49-57. Van Breeman, C. (2009). Using play therapy in pediatric palliative care: Listening to the s t o r y a n d c a r i n g f o r t h e b o d y. International Journal of Palliative Nursing, 15(10), 510-514. Whitehead-Pleaux, A., Clark, S. L., & Spall, L. E . ( 2 0 11 ) . I n d i c a t i o n s a n d counterindications for electronic music technologies in a pediatric medical setting. Music and Medicine, 3(3), 154-162. doi:10.1177/1943862111409241

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World Health Organization. (2015). Cancer: WHO definition of palliative care. Retrieved from http://www.who.int/cancer/ palliative/definition/en Wood, I. (2009). An educational program in a pediatric hospice setting. The American Journal of Hospice and Palliative Care, 26(3), 209-212. doi: 10.1177/1049909108328608

Dr. Siden is Medical Director, Canuck Place Children’s Hospice, Vancouver, Canada. He also a Clinical Professor, Dept. of Pediatrics, University of British Columbia and Senior Associate Clinician Scientist, the Child & Family Research Institute. In addition to his clinical work in pediatrics, palliative medicine and complex pain, Dr. Siden’s recent research has focused on pain and other symptom management in pediatrics and palliative and end-of-life care. He is specifically interested in new and emerging areas in biological markers of pain in children, psycho-social care of families, and the epidemiology of children with life-threatening conditions.

About the Authors Beth Clark, MM, RCC, MT-BC, MTA, is a music therapist and doctoral student based in Vancouver, British Columbia, Canada. She completed training in music education at The University of Maine (1999, 2000) and in music therapy at Western Michigan University (2007). Clark is currently pursuing a PhD in interdisciplinary studies at The University of British Columbia and is a Vanier Canada Graduate Scholar. Her research focuses on healthcare, education, arts, and ethics. Clark’s clinical practice specialized in pediatrics and mental health, with a priority on working with nonprofit organizations to provide access to music therapy for those who could otherwise not afford services. She was music therapist at Canuck Place Children’s Hospice for six years, and in 2011 she was awarded the Arthur Flagler Fultz Award for research in pediatric palliative care music therapy. Clark has published and presented on her research and clinical work in Canada and the United States.

Dr. Straatman is a pediatric and adult trained cardiologist in Vancouver, British Columbia. She has received training in Ann Arbor Michigan and in Toronto, Ontario. She is currently a member of the Vancouver General Hospital Cardiac Function and Cardiooncology clinics as well as a consultant at Canuck Place Children's Hospice and the British Columbia Children's Hospital. In addition to her clinical responsibilities she is currently the cardiology lead for the transition of adolescents with cardiac conditions to adult healthcare. Her research interests include the transition of adolescents with chronic medical conditions to adult health care and end of life care for individuals with end stage cardiac disease.

Contact: musictherapy.bc@gmail.com

From left to right Beth A. Clark, Harold Siden, and Lynn Straatman

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Music Therapy and Play Therapy:

Co-treatment with a Boy Diagnosed with Autism Spectrum Disorder By Anita L. Gadberry

Abstract The prevalence of autism spectrum disorder (ASD) in children around the world is rising and has reached epidemic proportions in several countries. Though there is no known cure for ASD, the search remains for efficient and cost-effective means for treatment of the disorder. The purpose of this study was to examine the experience of co-treatment using music therapy and play therapy with a sevenyear old boy diagnosed with ASD. Six 45minute combined music and play therapy sessions were conducted by a board certified music therapist (MT-BC) and a registered play therapist supervisor (RPT-S). Each session was videotaped. Session transcripts, session notes, and therapist journal entries were segmented and coded using the qualitative research software program, HyperRESEARCH 2.6. Separate interviews with the play therapist and the child’s mother were also transcribed and coded in a similar fashion. Trustworthiness was ensured by member checking, triangulation, and reflexive journaling. Emerging themes from data analysis included: (a) music provides structure, (b) music engages, (c) music Note facilitates meaningful This article was interaction, and (d) music accepted for publication in facilitates a “group effect.” The 2011. Due to the journal results demonstrated that publication music was an integral being suspended, it is component of the co-treatment published now at the first experience.

Resumen La prevalencia del trastorno del espectro autista (TEA) en los niños de todo el mundo va en aumento y ha alcanzado proporciones epidémicas en varios países. A pesar de que aún no existe una cura conocida para los TEA, se continúa buscando medios eficaces y costo-efectivos para el tratamiento de este trastorno. El objetivo de este estudio ha sido examinar la experiencia de co-tratamiento en musicoterapia y terapia de juego con un niño de siete años de edad con un diagnóstico de TEA. Seis sesiones combinadas de musicoterapia y terapia de juego, de 45 minutos de duración, se llevaron a cabo por una musicoterapeuta certificada (MT-BC) y un supervisor y terapeuta de juego registrada (RPT-S). Cada sesión fue grabada en video. Las transcripciones de las sesiones, las notas de la sesión y el registro diario de la terapeuta fueron segmentados y codificados utilizando el programa de software de investigación cualitativa, HyperRESEARCH 2.6. Las entrevistas realizadas por separado, con la terapeuta de juego y la madre del niño también fueron transcritas y codificadas de manera similar. La confiabilidad del estudio se aseguró mediante el control profesional, la triangulación y recopilación de información reflexiva recabadas en un diario. Los temas emergentes del análisis de los datos incluyen: (a) la música proporciona estructura, (b) la música promueve la relación, (c) la música facilita la interacción significativa, y (d) la música facilita el ¨efecto grupal¨. Los resultados demostraron que la música fue una parte integral de la experiencia de co-tratamiento.

opportunity. This article was based on the author’s masters’ thesis.

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Introduction Autism spectrum disorder (ASD) affects an average of 1 in 68 children in the United States (Centers for Disease Control and Prevention, 2015) with similar prevalence rates worldwide. No cure is currently available and since treatment is so extensive, the cost associated with ASD is substantial. Many families struggle to pay for the therapy their child needs. The cost of lifetime treatment and care for a child with ASD may be as much as $2.4 million (Autism Society of America, 2014). More efficacious treatments are needed to decrease the cost of treatment as well as the time devoted to treatment. Many children with ASD are in therapy sessions for a significant portion of each day and parents often transport their child directly from one therapy session to another. One possible solution might be the combination of therapeutic modalities to reduce the amount of time a child spends in therapy and the costs associated with multiple treatments. This study was designed to examine the possibility of simultaneous co-treatment of a child with ASD with music therapy and play therapy.

music therapy may be particularly effective for persons with ASD is communication skills (Gold, Wigram, & Elefant, 2010). In addition, Wigram and Gold (2006) stated that music therapy “is most notable in promoting interpersonal communication, reciprocity and the development of relationship building skills” (p. 541) in children with ASD. Play Therapy for Children with Autism Spectrum Disorder Play therapy is often utilized for the reduction of maladaptive behavior and augmentation of communication and social interaction for children with ASD (Bundy-Myrow, 1999/2000; Kenny & Winick, 2000; Mastrangelo, 2009; Reiff & Booth, 1994). In a case study using non-directive play therapy with a five-year-old boy with ASD, results indicated that the boy “gained a sense of self both in the physical and emotional sense” (Mittledorf, Hendricks, & Landreth, 2001, p. 268). The results of another case study involving a six-year-old boy with ASD implied that social and emotional development of children with severe ASD might be improved and accelerated in non-directive play therapy (Josefi & Ryan, 2004). These studies suggest that child-centered play therapy can be effective in achieving therapeutic gains with young children with ASD.

Music Therapy for Children with Autism Spectrum Disorder For decades, music has been supported as a treatment modality for children with ASD. As cited in Stevens and Clark (1969), “Rimland concludes that musical interest and ability were ‘almost universal in autistic children’” (p. 98). Pioneers of child-directed music therapy, Nordoff and Robbins (1985) have documented several case studies where persons with ASD have made significant progress in social behavior and communication through music therapy. Continuing research by Trevarthen, Aitken, Papoudi, and Robarts (1998) documented progress in increases in prosocial behaviors, environmental awareness, vocalizations, attention span, and vocal imitation.

Practicality of Co-treatment Music therapy and play therapy share qualities that might make them ideal when combined in concurrent treatment. Music, in itself, is an inherently playful medium and is a part of many children’s play routines and environments. In fact, music therapists Kern and Aldridge (2006) utilized music therapy to support play for children with ASD. Play therapists can also use the appeal of music in their sessions. The fields of music therapy and play therapy have much in common with regard to the therapeutic goals pursued, the clients with whom they work, and the importance of creativity and playfulness within the therapeutic context. Thus, it would seem

Music therapists can use a variety of approaches to treat persons with ASD in various goal areas. One goal area in which

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sensible to combine music therapy and play therapy.

ASD, a search for more efficacious treatments warrants the investigation of the possibility of simultaneous co-treatment. To begin this line of research, the first area of exploration is to analyze the experience of cotreatment for the client(s) and therapists.

Currently, both therapeutic approaches have been discussed as separate entities in their respective bodies of literature. Some authors state that they have compared the effects of music therapy and play therapy; however, these studies do not utilize a professional registered play therapist. For example, Froehlich (1984) compared the effects of music therapy and medical play therapy on the verbalization of pediatric patients. One child life specialist conducted individual sessions and participants were assigned either the music therapy treatment or the medical play therapy treatment. Froehlich conducted content analysis on the 30-minute sessions and found that the pediatric patients verbalized more in music therapy than in medical play therapy. Other researchers accessed mood differences of hospitalized children during music therapy sessions in comparison with play therapy sessions (Hendon & Bohon, 2007). In this study, more smiles were elicited during the music therapy sessions than play therapy sessions and led the authors to advocate for the increased implementation of music therapy in hospitals. Yet, the sessions designated as play therapy sessions were conducted by a volunteer who was not a professional play therapist.

Method The author examined the experience of cotreatment of a seven-year-old boy with ASD by a board certified music therapist and a registered play therapy supervisor. A board certified music therapist and a licensed play therapist conducted six sessions of combined music therapy and play therapy with the child. Though each intervention was planned from a music therapy or play therapy foundation, the therapists worked together to provide simultaneous play therapy and music therapy experiences. The researcher used phenomenology as a research method to examine an entire experience so that the findings would allow as full an understanding of its multiple aspects as possible. Forinash (1995) described phenomenology as a search for meaning. In this case, meaning and understanding of the co-treatment experience in regard to the treatment goals of social interaction and communication was examined. Participants After receiving Institutional Review Board approval, the author recruited participants. Each adult participant was fully informed of the purpose and procedures of the study, and each adult provided informed, written consent. The child’s mother consented to his participation on his behalf. The participants included the play therapist (whose name was changed to “Don”) who had practiced play therapy for 20 years, the child with ASD (whose name was changed to “Nick”), the child’s mother (who remains unnamed), and myself, the music therapist who had practiced music therapy for five years. The specific participants were chosen for several reasons. First, this child had appeared to benefit from

Music therapy and play therapy have been concurrently discussed as appropriate treatment modalities within articles as they share common therapeutic goals and clientele (Anderson, 1991; Dempsey & Foreman, 2001; Thomas, Ellis, McLaurin, Daniels & Morrissey, 2007). In fact, they have both been labeled as useful educational approaches for persons with ASD (Dempsey & Foreman, 2001). Yet a comprehensive review of the available literature in music therapy and play therapy yielded no research that documents the effects of simultaneous co-treatment of clients using both music therapy and play therapy methods. Since both therapeutic modalities can be utilized in the treatment of children with

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both therapeutic interventions when they were implemented separately. Second, scheduling his therapy sessions to include everyone involved was feasible because (a) the play therapist and I shared an office, (b) the child’s mother was willing to travel to the therapists’ office for sessions, and (c) co-treatment sessions could be scheduled during normal business hours because the child was homeschooled. Finally, both therapists shared a child-centered philosophy, which it was believed would facilitate the process of cotreatment with a child with ASD.

half. He was home-schooled and primarily cared for by his mother. When his mother was not available, his father, grandmother, or other close family members cared for him. Nick did not have a competent communication system in place. He occasionally used a few spoken words; however, most of his communication consisted of taking a person’s hand to the object he wanted. Nick learned to use eye contact when he desired something. Nick also lacked peer relationships as his scarce communication and minimal reciprocity inhibited his ability to interact with others. C o n s e q u e n t l y, c o m m u n i c a t i o n a n d interpersonal interaction were the treatment goal areas.

The child chosen for participation in this study, Nick, had already demonstrated an intense positive response to music therapy. Eighteen months ago, the child’s mother witnessed music therapy sessions between her son and me over a period of several months from behind a two-way mirror. These music therapy sessions focused on interpersonal interaction, improved eye contact, and initiation of speech. During the music therapy sessions, Nick was highly responsive to the treatment modality and Nick and I experienced an intense connection through the music. I was the first recipient of consistent speech from Nick since he had developed ASD and lost these abilities at the age of two years. In fact, the child’s mother commented on this connection and later told me that watching the music therapy sessions and hearing her son’s meaningful communication gave her hope that he would speak again.

Therapeutic Experiences As the music therapist, I co-treated the child using a child-centered approach. I sang, used musical instruments, and employed movement interventions to engage the child in musical interactions. In addition to operating from the child-centered perspective, the play therapist employed Theraplay® play therapy techniques (Reiff & Booth, 1994). Therapeutic interventions involved the music therapy and play therapy strategies listed in Table 1. Theraplay® activities included one nurturing intervention and several structure and engagement interventions. The play therapist and I discussed at length how the study would progress.Operating from the child-centered perspective, we took each session week by week. We debriefed after each session and then planned for the next session in light of what had transpired. We planned various interventions to introduce to Nick; however, we were consistently flexible in adapting our plans to what Nick showed us in the treatment room. Each of the six 45minute sessions was held in the music therapy room of our office.

Nick had also received play therapy sessions from the play therapist involved in this study eighteen months prior to the current study. Play therapy sessions had focused on interpersonal interaction and improved eye contact. Nick responded well to the highenergy play interventions, such as swinging and piggyback rides, as evidenced by his increased eye contact and elevated positive affect. Prior to this study, Nick had not received therapy outside of his home for a year and a

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Data Analysis Colaizzi’s protocol analysis (1978) was used to analyze the data from this study. In this study, the protocols consisted of: (a) the written transcriptions of the sessions; (b) the written transcriptions of the interviews; (c) both therapists’ Subjective-ObjectiveAssessment-Plan (SOAP) session notes; and (d) both therapists’ reflective journals. Once the themes emerged through the coding procedure, I produced an exhaustive description of the co-treatment experience that was then given to the child’s mother and the play therapist for verification; thus member checking, triangulation, and reflexive journaling ensured trustworthiness of the study. Additional measures of trustworthiness were honesty of participants, debriefing of the therapists, and provision of a thick description.

Table 1. Therapeutic Strategies used in the Co-treatment Sessions

Data Collection In an attempt to capture the essence of the c o - t r e a t m e n t e x p e r i e n c e a c c u r a t e l y, triangulation was used in gathering data. Triangulation involves acquiring information about the same phenomena from several sources. The sources for this study included: (a) session videotapes, notes, and therapist journals; (b) an audio taped interview with Nick’s mother, and (c) a written interview with the play therapist, who responded to a series of specific questions using a word-processing program.

Results As I reread the session transcriptions, interview transcriptions, session notes, it became evident that music was of paramount importance in the co-treatment experience. The themes that emerged from the data analysis were: (a) music provides structure, (b) music engages, (c) music facilitates meaningful interaction, and (d) music facilitates a group effect. This group effect was an outgrowth of the synergism among all the elements and individuals involved in the therapy experience.

From the videotapes, I transcribed events, communications, and actions of the music therapist, the play therapist, and the child. The session videotapes were duplicated so both Don and Nick’s mother could view them while they read the session transcripts. After their viewing and verification of the transcripts, I segmented and coded the transcripts using the qualitative research software program, HyperRESEARCH 2.6. The interviews were also segmented and coded into HyperRESEARCH 2.6.

Music Provides Structure Music provided the structure for opening and closing each session. The same opening and closing songs were used for all sessions. Music also provided structure when a redirection was needed, such as when Nick handled an object in a way that might have compromised his physical safety. An example of music providing structure occurred in session four: (D=Don; A=Anita; N=Nick; quotation marks indicate sung material, italics indicate chanted material).

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D: I see you looking around. I see you. Thanks for looking at me! Nick walks around the room. Anita is getting her guitar. Nick picks up Anita's business bag and opens it. D: Oh, you'll try that. Nick sets the bag back. Anita kneels facing Nick. A: "Nick is here to make music." N: Oo. A: "Nick is here to make music." [(Pinson, 2000)] Nick looks at Don and smiles enthusiastically. Don returns a smile with enthusiasm. Nick jumps onto the child-size couch. Don sits on the floor by Nick. Anita moves over towards Nick and kneels. A: "Nick is here! Let's give him a great big cheer!" [(Pinson, 2000)] All three cheer simultaneously. A: Hooray! D: Yeah! N: Yaee! A: "Nick, we're glad you're here." Anita moves close to Nick and offers him the guitar. A: Do you want to play today? N: Yea. A: "Play the guitar." Nick strums loudly. A: Wow! Don is leaning back, resting his hand on the floor. He smiles and nods his head as Nick plays. A: "Play, play, play. Play the guitar." Nick plays. A: There you go! "Play, play, play. Play the guitar, play, play, play.” Nick pulls the guitar towards him. A: Oh, my goodness I like that look! Nick looks directly at Anita smiling. Don laughs lightly and smiles. Nick, smiling, looks at Don.

Nick entered the room and was wandering from one object to another. Once “Big Cheer Welcome” (Pinson, 2000) began, Nick immediately focused, responded verbally, and continued to interact with the therapists.

swing and when Don gave him a piggyback ride. Throughout the sessions, Nick taught us that he engages and interacts through a musical medium. As his mother stated in her interview, “I noticed most, I think I have to go back to interaction with music. I noticed that more than interaction with play. It seemed like he responded really well when any music instrument was taken out. You’d always take two out and he’d always grab at least one and interacted. That’s what I noticed the most.”

Music Engages Music provided a means through which Nick could become engaged with the therapists and the musical instruments, singing, and intervention strategies. Whereas much of the music interventions I initiated were playoriented, the music is usually what grasped Nick’s attention, built the interaction, and subsequently increased the interaction. It became evident early in the course of treatment that Nick responded best to sung or rhythmic material. The only non-music interventions in which Nick engaged, provided eye contact, and interacted during the blanket

One of many examples of music fostering Nick’s engagement occurred in session six: (D=Don; A=Anita; N=Nick; quotation marks indicate sung material, italics indicate chanted material).

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A: “See how I’m jumping, jumping, jumping, See how I’m bouncing like a ball. You didn’t know I could jump so high. You didn’t know I could stand so still.” Don has been bouncing up and down in a corner, smiling, and moving the red ocean drum. Everyone is smiling. Nick stops as Anita stops to stand so still. Then he picks up the red ocean drum. Don kneels on his knees on the floor, still playing the other red ocean drum. A: “See how I’m jumping, jumping, jumping. When I am tired, down I plop.” Plop. Plop. Anita wraps her arm around Nick’s waist and gently pulls him to the floor with her. A: Plop! Nick giggles happily. Don sets his drum down. A: We went straight to the ground. Nick and Anita laugh. Nick vocalizes. A: [unintelligible reply to Nick’s vocalization] Nick and Anita laugh. Nick kneels on the floor, looking into Anita’s eyes. A: Hickory dickory dock, the mouse squeezed up the clock. The clock struck one (clap), the mouse squeezed down. Nick laughs. A: Does that tickle? A: Hickory dickory dock. The mouse tapped up the clock, the clock struck two (clap, clap). The mouse said Whoo! N: Hmm. A: Hmm. Hickory dickory dock. The mouse slapped up the clock. Nick laughs and stands up. Anita stands up and continues the game. She playfully chases/follows Nick around the room. A: The clock struck three. Nick stops and looks at her. She claps three times. Nick starts jumping around the room in a circle. Anita “chases” after him. N: Eeee! A: The mouse said “Whee!” [(Gilbert, 2003)] N: Wheee! Don plays quarter notes on the red ocean drum. N: Whee. A: You like to jump around. N: Hmmm. A: Hmmm. A: “See how I’m jumping, jumping, jumping. See how I’m bouncing like a ball. You didn’t know I can jump so high. You didn’t know I can stand so still.” Don continues to play quarter notes on the red ocean drum. Nick has been jumping and following the directions of the song. However once Anita stands still, she reaches her hand out to him to encourage him to stand still. He takes it and then runs around her as he lets go, laughing and giggling. Anita laughs. Nick continues to run in circles around her as she sings. A: “See how I’m jumping, jumping, jumping. When I am tired.” Nick stops behind Anita holding her hands behind her back. Then he dashes out. She corners him by the chair, both smiling and laughing. A: “Down I plop.” Anita tries to get Nick to plop down on the floor; however he quickly darts away and seems to want to jump and run some more. Nick laughs. Anita laughs. Don smiles.

Music engaged Nick and kept his attention and energy for a significant period of time. In addition to providing structure and encouraging engagement, music facilitated meaningful interaction. As Nick responded best to music interventions and he was engaged by either melody, rhythm or both, interaction naturally came more easily within the music interventions and the therapeutic relationships developed through the music interventions.

Music Facilitates Meaningful Interaction In session three, Don was attempting to facilitate interaction through Theraplay® activities. However, Nick did not appear to be interested. At various times, he ignored the activity, turned away from it, or participated at a minimal level. The introduction of music produced more interaction during the Theraplay® activities as illustrated by the following session transcript. (D=Don; A=Anita; N=Nick; quotation marks indicate sung material, italics indicate chanted material).

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Nick resumes playing his drum. Don puts the frog on Nick’s head. D: Oh, can you put it on your head? Don takes the frog and moves it down to the drum as if it were falling. D: Here it comes. He puts the frog back on Nick’s head and again moves it down to the drum as if it were falling there. Nick seems to not pay attention to it. D: Here it comes. Nick tips his drum so that the frog falls on the ground. N: Aah. D: You made the frog fall! Anita continues to accompany with the drum, playing louder as the frog falls. Nick continues to watch his drum, not paying attention to the frog. Don puts it on Nick’s head two more times and has it fall. D: Here it comes. Then Don puts in back on his own head. Anita continues to play quarter notes on the drum. D: I’m gonna make it fall from my head. Don puts it back on Nick’s head. D: There, now off of your head. The frog falls onto the drum. D: Now make it fall into my hands. Nick tips the drum and the frog falls. D: Thank you. He puts it back on Nick’s head. D: Going up. The frog falls on the floor off to the side. D: Uh, oh! Nick vocalizes. At first he sounds slightly irritated, and then his tone ascends as he turns away from Don. Nick continues to play his drum, swishing, and vocalizes in a singing manner. D: Put it on mine. Don puts the frog on his head. Nick rocks on his feet a couple of times then walks past him. D: Yes. Anita stands up, still playing her drum. D: Okay. Anita goes over to the instrument box. Nick continues to move around the room. Anita looks into the box of instruments. D: Let’s get one of those. Don gets an ocean drum. He moves over to Nick. Anita trades her drum for an ocean drum. Nick goes back to sit on the child-size couch. Nick holds onto Don’s ocean drum as they both sit down together. Anita joins them on the floor. Nick vocalizes as in song. Then he begins to rock as he watches Anita play her drum. A: Back and forth. Around and around.Nick continues to sing. Anita then begins to play quarter notes by tapping on the drum. Nick watches intently and does not play his drum. A: “This is the way we play the drum, play the drum, play the drum. This is the way we play the drum, when we’re making music.” Nick begins to tap his drum. A: Ah! You’re gonna play! Nick continues to watch and play. A: “This is the way we play the drum, Play the drum, play the drum.” N: Aaahh, o, o. Nick continues to vocalize. Anita stops singing and begins to play faster quarter notes as Don taps the tops of Nick’s hand which is playing the drum and begins Patty-cake, a Structure Theraplay® activity. D: Pattycake, patty-cake baker’s men. Bake me a cake as fast as you can. Roll up and toss it up and mark it with an N. Nick stops tapping the drum. Don continues to tap his hand. N: Ooe. D: Bake it in the oven for Nick and me! Don touches Nick’s chest and points to himself. Don giggles and begins the rhyme again. This time he pats the drum. D: Patty-cake, patty-cake baker’s men. Bake me a cake as fast as you can. Roll it up and toss it up and mark it with an N. Roll it in the oven for Nick and me! He touches Nick’s chest again as he says his name. Don points to himself again when he says me. Nick turns away. Nick continues to play the red ocean drum. He had started to swirl it during patty-cake. Anita joins him by swirling the other red ocean drum. Nick reaches for Anita’s drum and says Ma. He takes the drum so he has one in each hand. A: You wanted mine. N: Oh. D: Two of them.

As music engaged and facilitated interaction, it was central to the interaction of all participants in each session. In the earlier sessions, Don and Nick interacted

meaningfully very little. However, as Don began to become more comfortable and involved musically in the later sessions, Nick interacted with him more.

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Music Facilitates a Group Effect Music seemed to be the unifier for all persons involved in the study. As time went on it appeared that Don grew more comfortable adding his own singing and instrument playing to the interactions. He then benefited from singing and playing instruments more as Nick began to interact more readily with him.

session. And I think he responded real well to that. I liked to see that. Discussion The therapeutic goals, which Don and I developed for Nick for these six sessions, were to increase his interaction with others and to increase his verbal communication. Nick did meet his objectives during the six sessions. According to Merriam (1964), music is a natural way to encourage two behaviors that our society values deeply: social interaction and communication. These two abilities were not highly developed in Nick, and these deficits were significant in the determination of his diagnosis of ASD. However, in this study Nick clearly showed us that music is a pathway to increasing his communicative and interactive abilities.

The presence of music created the opportunity for Don, Nick, and myself to become a small group. The presence of two therapists in the room provided multiple opportunities for constant engagement and interaction. When one therapist was collecting supplies, the other therapist could continue doing therapy with Nick. Besides the obvious advantage of being able to do activities that require two adults, such as swinging Nick in a blanket, two therapists and one child became a group, and this sense of group cohesion was noticed and acknowledged by Nick’s m o t h e r i n h e r i n t e r v i e w. T h i s g r o u p atmosphere gave Nick the opportunity to witness others interacting and to have a model for activities in which the directions or intent may have been confusing for him. The synergism which occurred among the three of us and the music and Theraplay® interventions brought about a greater cohesiveness and shared experience than would have been possible with fewer people and/or only one therapeutic modality. Nick’s mother noticed this and mentioned it in her interview. She stated:

Music may have facilitated Nick’s communication since it provides a unique basis for therapy for children with ASD due to its ability to be both predictable and flexible (Brunk, 1999). A consistent environment can be created through music while a music therapist is able to adapt the music to reflect the child’s current mood state and meet his present needs. Brunk (1999) stated that music provides a structure for time, while Gaston (1968) indicated that music is predictable and orderly. These attributes of music allowed the therapists in this study to provide predictable interactions with flexibility in regard to the child’s responses and also the other therapist’s responses. Structure was particularly helpful in session closure. By the fifth session, Nick recognized the music indicating that the end of the fifth session was approaching. Don commented after this session that Nick stood up immediately to leave when it was time to go. In previous sessions, either Nick’s mother had had to retrieve him out of the therapy room, or Nick had required much encouragement to leave the room.

The difference in co-treatment [as opposed to individual treatment] that I liked is that I think it exposed Nick to be able to interact with two human beings, and be included in more of a group, than just a one-on-one. It seemed to me that he wasn’t jumping in your lap and wanting to put pressure on his forehead, as he would if it were a one-on-one sometimes. So he was sort of able to take that group atmosphere. So I thought it was really nice because it turned what he’s always known as one-on-one into a group

In addition, the music in music therapy often gives children with ASD both freedom and

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security (Trevarthen, Aitken, Papoudi, & Robarts, 1998). These characteristics of music may have assisted Nick in the presence of two therapists. A child may be intimidated being in a treatment room with two adults, yet Nick did not demonstrate behaviors indicative of anxiety or intimidation. The dichotomy of both freedom and security is likely due to the previously mentioned structure and flexibility of music. Though children with ASD often resist change, music can provide a predictable structure that is malleable during the clienttherapist interaction.

the sessions together and discussed findings of previous sessions, and yet music played such a surprisingly dominant role in the cotreatment experience. Music provided the means for both therapists and client to interact, communicate, and generate therapeutic gains. A challenge in facilitating therapeutic gains was that each therapist had to continually assess responses of the other therapist in addition to the needs and responses of the client. With time, a stronger therapeutic alliance would most likely be established between the two therapists and two corresponding treatments could be delivered with greater ease. Recommendations for future studies include more time or sessions for therapists to work together so that the therapists may more easily anticipate each other’s behavior. Anticipation of the actions of the other therapist would facilitate more fluid sessions.

Results demonstrated that music was a crucial component in the co-treatment experience. Through participation in music, the individuals involved in the sessions became a small group. Within this small group, music facilitated therapeutic gains in meaningful engagement and interaction. In accordance with Merriam’s functions of music (1964), music served as a unifier among the participants just as it does in other social situations. It provided a sense of unity and a feeling of belonging.

In regard to another factor impacting therapeutic alliance, Nick’s mother mentioned her perception that Don’s and my personalities seemed conducive to a collaborative working relationship. If this were so, research focused on discovering therapist traits that contribute to successful cotreatment would be warranted. If certain key personality traits or a specific combination of personality traits are needed to facilitate the co-treatment process, identifying these would be necessary to determine whether cotreatment endeavors might be successful.

Addressing the other therapeutic modality in this study, research in play therapy with children with ASD has shown that therapeutic gains are most likely when the client-therapist ratio is low (i.e., in individual or small group sessions), when the child is young (i.e., ideally 3-6 years old), and when a phenomenological approach is used to enter the child’s world (Mittledorf, Hendricks, & Landreth, 2001). Considering that the play therapy treatment parameters were indicative of this literature, it is interesting that no themes emerged from the play therapy interventions. One impacting variable could be that Theraplay® is typically a directed therapeutic modality. However, since Don had implemented it in his child-centered work, he believed it could function well in a cotreatment setting. In addition, play therapy research literature indicates that play therapy for children with ASD is most successful when structure and flexibility are balanced (Mastrangelo, 2009). Both therapists planned

The play therapist recognized the successful engagement precipitated by music and as he became more comfortable singing while in cotreatment, the client interacted with him more. Perhaps with more sessions, play therapy interventions may have yielded greater outcomes. The themes that emerged from this study may serve to unite the participants, which with more time could allow both therapy modalities to serve more balanced roles in the treatment. In addition, future

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research is warranted to determine if the use of music in play therapy sessions could decrease the amount of time needed to establish a firm therapeutic relationship. Based on the themes from the present study, music may establish a therapeutic alliance that would then allow the play therapist to work with the client within a reduced number of sessions, thus providing a cost savings to clients and third-party payers.

w w w. t h e r a p l a y. o r g / a r t i c l e s / 00_win_bundy_lindaman.htm Centers for Disease Control and Prevention. (2015, February). Autism spectrum disorder: Data and statistics. Retrieved from http://www.cdc.gov/ncbddd/autism/ data.html Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.), Existentialphenomenological alternatives for psychology (pp. 48-71). New York: Oxford University Press. Dempsey, I., & Foreman, P. (2001). A review of educational approaches for individuals with autism. International Journal of Disability, Development and Education, 48(1), 103-116. Forinash, M. (1995). Phenomenological research. In B. L. Wheeler (Ed.), Music therapy research: Quantitative and qualitative perspectives (pp. 367-387). Phoenixville, PA: Barcelona. Froehlich, M. A. (1984). A comparison of the effect of music therapy and medical play therapy on the verbalization behavior of pediatric patients. Journal of Music Therapy, 21(1), 2-15. Gaston, E. T. (1968). Man and music. In E. T. Gaston (Ed.), Music in therapy (pp. 7-29). New York: MacMillan. Gilbert, A. G. (2003). “Hickory Dickory.” BrainDance: Variations for infants through seniors [Motion picture]. Seattle, WA: Creative Dance Center. Gold, C., Wigram, T., & Elefant, C. (2010). Music therapy for autistic spectrum d i s o r d e r. C o c h r a n e D a t a b a s e o f Systematic Reviews 2006, 2. doi: 10.1002/14651858.CD004381.pub2. Hendon, C., & Bohon, L. M. (2007). Hospitalized children’s mood differences during play and music therapy. Child: Care, Health and Development, 34, 141-144. doi: 1 0 . 1111 / j . 1365-2214.2007.00746.x Josefi, O., & Ryan, V. (2004). Non-directive play therapy for young children with autism: A case study. Clinical Child

In a similar fashion, research investigating the effectiveness of interventions by a music therapist trained in play therapy techniques would be beneficial to determine the relative effectiveness of having two treatment modalities delivered by one therapist versus having two therapists each delivering a specific treatment modality. Co-training as opposed to co-treatment may be a more costeffective solution to offering clientele the best treatment possible. Future research might address co-treatment and co-training with larger sample sizes and a diversity of music therapists and play therapists. Limitations for the present study included a small sample size of one client with only one team of therapists. Investigation of simultaneous co-treatment of music therapy and other therapeutic modalities is also warranted. References Anderson, S. C. (1991). Therapeutic recreation: Meeting the challenge of new demands. Journal of Physical Education, Recreation and Dance, 62(4), 25-55. Autism Society of America. (2014). About autism. Retrieved from http://www.autismsociety.org/what-is/ Brunk, B. K. (1999). Music therapy: Another path to learning and communication for children in the autism spectrum. Arlington, TX: Future Horizons. Bundy-Myrow, S. (1999/2000, Winter). Theraplay for children with autistic spectrum disorders. The Theraplay® Institute Newsletter. Retrieved from http://

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Psychology and Psychiatry, 9(4), 533-551. Kenny, M. C., & Winick, C. B. (2000). An integrative approach to play therapy with an autistic girl. International Journal of Play Therapy, 9(1), 11-33. Kern, P., & Aldridge, D. (2006). Using embedded music therapy interventions to support outdoor play of young children with autism in an inclusive communitybased child care program. Journal of Music Therapy, 43(4), 270-294. Mastrangelo, S. (2009). Play and the child with autism spectrum disorder: From possibilities to practice. International Journal of Play Therapy, 18(1), 13-30. Merriam, A. P. (1964). Uses and functions. In The anthropology of music (pp. 209-228). Evanston, IL: Northwestern University Press. Mittledorf, W., Hendricks, S., & Landreth, G. L. (2001). Play therapy with autistic children. In G. L. Landreth (Ed.), Innovations in play therapy: Issues, process, and special populations (pp. 257-269). New York: Brunner-Routledge. Nordoff, P. & Robbins, C. (1985). Therapy in music for handicapped children. London: Gollancz. Pinson, J. (2000). Big cheer welcome. Score. Reiff, M., & Booth, P. (1994, Spring). Theraplay for children with PDD/autism. The TheraplayÂŽ Institute Newsletter. Retrieved from http://www.theraplay.org/ articles/94_sp_reiff_booth.htm Stevens, E., & Clark, F. (1969). Music therapy in the treatment of autistic children. Journal of Music Therapy, 6(4), 98-104. Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disabilities, 37, 1902-1912. doi: 10.1007/ s10803-006-0323-7

Trevarthen, C., Aitken, K., Papoudi, D., & Robarts, J. (1998). Music therapy for children with autism. In Children with autism: Diagnosis and interventions to meet their needs (2nd ed.). (pp. 172-202). London: Jessica Kingsley. Wigram, T., & Gold, C. (2006). Music therapy in the assessment and treatment of autistic spectrum disorder: Clinical application and research evidence. Child: care, health, and development, 32(5), 535-542.

About the Author Anita L. Gadberry, Ph.D., MT-BC is passionate about assisting future and current music therapists as the Director of Music Therapy at Marywood University (Scranton, PA, USA). She also enjoys promoting global music therapy connections as she serves as the North American Regional Liaison for the World Federation of Music Therapy. Anita holds the following degrees in music therapy: Ph.D., University of Kansas; MA, Texas Womanâ&#x20AC;&#x2122;s University; BM, Southwestern Oklahoma State University. She has been in private practice as a board certified music therapist for fifteen years and loves working with individuals with ASD. She is a frequent speaker and workshop facilitator; her book Treatment Planning for Music Therapy Cases is available from Sarsen Publishing. Contact: northamerica@wfmt.info

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The Current Status of Music Therapy Services in Africa By Katie Myers

Abstract The purpose of this study was to obtain demographic information on practicing, boardcertified music therapists in Africa, and determine what services they provide. Music therapists were sent a survey that sought to determine a) the geographic location in Africa they practice, b) the number of music therapists that provide services in the country, c) their highest level of music therapy education, d) the music therapy credentials they possess, e) the status of their professional music therapy membership, f) employment details such as: average hours worked, salary, and session rates g) reimbursement information, h) the type of setting or facility they provide services in, i) the type of clients they provide services to, j) the theoretical orientation from which they practice music therapy, k) the types of interventions and techniques they use with their clients, l) whether or not they collaborate with other healthcare professionals in the provision of client services, and m) perceptions of music therapy services in general. Results indicated growing acceptance of music therapy, but confirmed that music therapy is still in the developmental stages, and requires a more in depth knowledge of the therapeutic value of music.

Resumen El objetivo de este estudio fue obtener información demográfica en relación a la práctica de los musicoterapeutas acreditados en África, y determinar cuáles son los servicios que proporcionan. Se envió una encuesta a los musicoterapeutas que buscaba determinar: a) la localización geográfica en África donde practican, b) el número de musicoterapeutas que prestan servicios en el país, c) nivel de formación alcanzado en musicoterapia, d) las credenciales en musicoterapia que poseen, e) el estado de su membresía profesional en musicoterapia, f) detalles de empleo, tales como: el promedio de horas trabajadas, salario y arancel de las sesiones g) información sobre reintegro por la prestación, h) el tipo de lugar o institución en la que brindan servicios, i) el tipo de usuarios a los que prestan servicios a, j) la orientación teórica en la musicoterapia que practican, k) los tipos de intervenciones y técnicas que utilizan con sus usuarios, l) si colaboran o no con otros profesionales de la salud en la prestación de servicios, y m) las percepciones sobre los servicios de musicoterapia en general. Los resultados indicaron una creciente aceptación de la musicoterapia, pero confirmaron que la musicoterapia se encuentra todavía en proceso de desarrollo, y requiere un conocimiento más profundo sobre el valor terapéutico de la música.

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Review of Literature In Africa, many different socio-economic, geographic, and psychosocial factors present reasons why African people choose or do not choose to seek healthcare (Nikiema, Haddad, & Potvin, 2012). Not only is the existence of barriers to obtaining healthcare significant, but it is the degree to which potential patients perceive that they have the ability to overcome these barriers that appear to influence the decision to pursue care (Nikiema et al., 2012). Understanding the factors that motivate healthcare seeking behaviors in Africans is a significant step in discovering what prevents them from searching for and obtaining such resources for preventative and medical treatment. Working from a “culturally competent” perspective, healthcare professionals may have the ability to influence not only individuals’ motivations for looking for healthcare resources, but also each individual’s perceived ability to overcome any necessary barriers to the process (Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003). In order for this to be a success, healthcare professionals must first comprehend the scope of factors that precede healthcare seeking behavior, and what aspects of the behaviors are caused by these factors.

frequently prevented patients from utilizing resources involved lack of professional advice regarding restorative measures, personal lack of understanding about restorative care, neglect of scheduling regular preventative check-ups, the inconvenience that resulted from restorative care, and previous experiences with medical experiences (Kikwilu et al., 2008). Africans often waited until medical situations were out of control or creating an emergency before seeking care (Kikwuli et al., 2008). “Gender-related constraints” influence the impetus to acquire healthcare services in the sense that they determine the cultural appropriateness of behavior for men and women who seek care (Nikiema, et al., 2012). The factors that stimulate women’s pursuit of healthcare can be largely categorized into socio-economic, geographical, and psychosocial influences, but are additionally dependent on household mechanics and family structure (Nikiema et al., 2012). Additionally, men have been identified as less inclined to search for healthcare, obtain healthcare resources within a suitable time frame, attain complete information for proper treatment through questions, follow medical advice, or participate in preventative care (Griffith et al., 2011).

The type or function of healthcare that is sought in Africa seems to influence the initiative that is taken by potential patients to receive such care. Perception plays a significant role in the process, and often determines how patients approach healthcare professionals, the precise moment when healthcare is pursued, where patients will travel for care, and the reason for which care is obtained (Kikwuli, Frencken, Mulder, & Masalu, 2008). Preventative care is often neglected due to economic concerns, inconvenience, cultural doubts about the necessity of pursuing care when an individual is healthy or not becoming progressively ill, and skepticism of available medical knowledge (Griffith, Allen, & Gunter, 2011). In terms of restorative care, the factors that most

According to Anderson, Scrimshaw, Fullilove, Fielding, and Normand (2003), an individual’s culture influence a predisposition to particular beliefs about the concepts of health and illness. Regarding healthcare, these beliefs and perceptions directly relate to “how symptoms are recognized, to what they are attributed, and how they are interpreted and affects how and when health services are sought” (Anderson et al., 2003). With a basic understanding of and concern for the cultural background of their patients, healthcare professionals can use this “cultural competency” to influence positive healthcare seeking behaviors in their patients, and possibly even motivate them to overcome

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some of barriers that prevent them from doing so, in service of advocating for their best care.

“music has the potential to encourage people to commit to routine and necessary preventative care” (Wolf & Wolfbrown, 2011).

The American Music Therapy Association (AMTA) defines music therapy as, “an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals” (American Music Therapy Association, 2012). Music therapists’ are often part of “an interdisciplinary team of healthcare professionals who work collaboratively to address clients’ treatment needs” (American Medical Association, 2009). Music therapy is becoming an essential part of healthcare services because music provides a versatile alternative for accomplishing specific treatment goals and objectives.

Music therapy services in Africa are still in the developmental stages, however, the field is dynamic and is growing alongside the healthcare system. Since music is an integral part of Africa’s culture, music therapy could present cost-effective strategies to improve the healthcare seeking behaviors that prevent many Africans from receiving the medical treatment they need. As evidenced in the previous paragraph, music therapy creates a positive environment for clients, increases motivation for pursuing preventative services, and alleviates many psychological and physiological symptoms and side-effects of illness. Because music therapy is grounded in the therapeutic relationship between the client and therapist, music therapy may be the solution to encouraging positive healthcare seeking behaviors.

The AMTA has identified the numerous benefits of music therapy with medical patients, including “improved respiration, lower blood pressure, improved cardiac output, reduced heart rate, relaxed muscle tension… significant effect on a patient’s perceived effectiveness of treatment, self reports of pain reduction, relaxation, respiration rate, behaviorally observed and self-reported anxiety levels, and patients choice of anesthesia and amount of analgesic medication” (AMTA, 2012). Music therapy can successfully address many of the psychosocial, physiological, and psychological concerns of patients in addition to alleviating the symptoms of illnesses and conditions. There is increasing empirical support for the benefits of music therapy, as stated by Carnegie Hall’s Weill Music Institute, “The clinical use of music is now an evidence-based Music Therapy in practice that has been proven Africa Music therapy both to satisfy patients, and, services in Africa are still in the very significantly, to lower the developmental stages, however, the cost of care” (Wolf & field is dynamic and is growing alongside Wolfbrown, 2011). Additionally,

Method The participants for this study (N=13) were board-certified music therapists that are currently employed as music therapists in various countries in Africa. A demographic profile of board-certified music therapists (n=51) who are currently practicing music therapy in Africa was obtained for the 2012-2013 year. Participants were acquired through the World Federation of Music Therapy African Student Delegate, Tanya Brown (1tanyabrown@gmail.com). Survey Instrument African music therapists were sent a link to a survey questionnaire by email, which inquired about the demographics of music therapy services available, and the music therapy services that they provided. The survey was modeled after select categories from the American Music Therapy Association’s 2012 Member Survey and Workforce Analysis. For the purposes of this study, participants were considered a “board-certified music therapist” if they completed academic training in an

the healthcare system.

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accredited music therapy program and passed a certification exam in Africa or another country with a music therapy board certification exam.

with other healthcare professionals in the provision of client services, and m) perceptions of music therapy services in general (see Table 1). Question types included text entry, multiple answer, multiple choice, and questions using skip logic. Parameters included only interviewing those music therapists that are “board-certified” and provide services on the African continent. Limitations were not placed on any of the other questionnaire contents, as the study is designed to discover what types of services are available.

The clinicians that were found to provide music therapy services were examined to discover a) the geographic location in Africa they practice, b) the number of music therapists that provide services in the country, c) their highest level of music therapy education, d) the music therapy credentials they possess, e) the status of their professional music therapy membership, f) employment details such as: average hours worked, salary, and session rates g) reimbursement information, h) the type of setting or facility they provide services in, i) the type of clients they provide services to, j) the theoretical orientation from which they practice music therapy, k) the types of interventions and techniques they use with their clients, l) whether or not they collaborate

Procedure The survey was created using The Florida State University’s survey creation program, Qualtrics, and emailed to 52 board-certified music therapists in Africa. The email contained a message requesting participation and a link to complete the survey online. The online survey format allowed the participants to complete the survey at their convenience and return it anonymously. The original email was returned from three email addresses with the message “delivery to the following recipient failed permanently”, and one of these appeared to be a duplicate address. Therefore, these three email addresses were removed from the total number of participants, bringing the total possible participant sample size to 49. The researcher contacted the participants on two separate occasions; once with the initial email, and a second time with a follow up email before recording the results two weeks later. Two respondents emailed the researcher with questions regarding two of the survey questions; this resulted in the researcher adding an answer choice to one question. Additionally, the two music therapists requested clarification of a survey question regarding medical services.

Table 1. Client Populations Served by South African Music Therapists

Results Board-certified music therapists in Africa (N=51) were sent an email requesting their participation in a survey to provide demographic information on music therapy

Notes. Percentages based on N=13. The population survey question allowed respondents to select more than one choice, so the sum of percentages exceeds 100%. All percentages are rounded to the nearest whole number.

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services in Africa. Three emails out of the 52 were returned with the message “delivery to the following recipient failed permanently”, one of which appeared to be a duplicate. Additionally, one recipient sent a message explaining that she was no longer a practicing music therapist. Of the 49 music therapists whose participation was requested, 16 music therapists returned the survey. However, only 13 of the surveys were complete, representing six African cities in two countries (range 1-12, M = 6.5), and providing a 27% return rate. Demographic results displayed respondents from limited locations, educational backgrounds, professional organizations, salary, training backgrounds, and theoretical orientations. However, respondents indicated a large variety in average hours worked, hourly rates for music therapy sessions, reimbursement methods, facilities, client populations, music therapy interventions, and professional collaborations.

collaborated with a nurse, 62% collaborated with an occupational therapist, 8% collaborated with other therapy staff, 23% collaborated with a physical therapist, 31% collaborated with a psychologist or psychiatrist, 31% collaborated with a speechlanguage pathologist, and 15% collaborated with a social worker. Additional collaborations included “carers” (8%), “teachers” (8%), and a “play therapist” (8%). No respondents reported that they collaborated with a recreation therapist. Location The majority of respondents are currently practicing in South Africa (92%), while one respondent is currently practicing in Namibia (8%). Respondents in South Africa were located in Johannesburg (15%), Cape Town, Western Cape (8%), Pretoria (23%), Cape Town (15%), Stellenbosch (8%), Port Elizabeth (8%) and unidentified cities (15%). Respondents in South Africa indicated that there were other music therapists in the country (range 20-50+, M=36).

Medical Services Nearly all of the respondents indicated that medical services are frequently sought (85%), but that there are many barriers (socio-economic, political, psychosocial) that prevent people from seeking medical services (92%). Fewer respondents stated that medical services are provided in a culturally sensitive manner (46%), patients are trusting of medical professionals (53%), and that medical professionals are perceived well (61%). The least number of respondents reported that medical services are perceived well (38%), medical services are frequently sought (15%), and that medical services are widely understood (15%).

Education, Training, and Certification All of the respondents (100%) stated that they received a master’s level post-graduate degree. One respondent reported receiving additional educational training in Guided Imagery in Music through Level 3 with a German primary trainer and fellow. 100% of the respondents completed their educational training in South Africa.Professional certifications held by the respondents include Music Therapist-Board Certified (15%), Registered Music Therapist (54%), GIM Fellow and Associate Trainer – Association for Music and Imagery (8%), and MMus Music Therapy (23%). Additional responses included “awaiting registration to become RMT as MT has been formally announced a health profession by the HPCNA by law recently” (8%), “Music Therapist” (8%), “I’m not sure how it works in SA” (8%), and “MMus (MT) (8%).”

A significant percentage of respondents (85%) replied that they collaborated with other healthcare professionals, while the remaining (15%) respondents did not. Of the respondents that participated in collaborative relationships, 15% collaborated with an art therapist, 23% collaborated with a counselor, 15% collaborated with a doctor, 31%

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Professional Licensure and Organization Membership The majority of respondents (85%) affirmed that there was an agency for professional licensure in the country that they practiced music therapy in, while the remaining 15% denied the existence of such an organization. Of the 85% that confirmed the presence of a licensing organization in their country, 8% cited the Health Professions Council of Namibia, and the remaining 78% cited the Health Professions Council of South Africa or the Association of Professional Music Therapists in South Africa. Of the total respondents, 54% indicated that they were currently members of professional music therapy organizations, while the remaining 46% were not. Of the 54% who maintained professional membership in a music therapy organization, 15% were members of the South African National Arts Therapies Organization, 38% were members of the Association of Professional Music Therapists of South Africa, which is being reconstituted as the South African Music Therapy Association (8%).

was in U.S. dollars. In terms of reimbursement for music therapy services, donations (38%), endowments (8%), facility budget (30%), grants (8%), government funds (30%), private insurance (15%), and private pay (54%) were cited as methods of payment. One respondent added, “once registered with the board and ministry, MT clients will be able to claim from medical aid.” No respondents reported reimbursement of music therapy services through medical waivers or 3rd party reimbursement. Facility/Organizational Statistics Respondents provide music therapy services under several types of organizations, including governmental (15%), not-for-profit (38%), or private/non-governmental (80%). No respondents classified the type of organization they provide services in as a “facility.” Respondents indicated that they worked in multiple facilities to provide music therapy services. The majority of respondents work in private practice, contract with other facilities, or are self-employed (62%), a hospital or clinic (54%), or a school or children’s facility (46%). Other respondents worked in a community center (15%), geriatric care facility or nursing home (23%), a “place of safety” (8%), or an “institution for intellectually disabled” (8%). No respondents reported that they worked in a prison or psychiatric facility/mental health setting.

Occupational Statistics All of the respondents (100%) indicated that they worked an average of zero to 39 hours per week. 30% of respondents worked less than 10 hours a week, 23% worked between 10 and 19 hours per week, 30% worked between 20 and 29 hours per week, and 15% worked between 30 and 39 hours on a weekly basis. No respondents reported working 40 or more hours a week. Ten out of the 13 respondents provided numerical data regarding their annual salary in U.S. dollars, creating a return rate of 80%. Of this 80%, 70% stated that they earned between $0 and $19,000. The remaining respondents indicated their salary was between $20,000 and $39,000. Regarding hourly rates for a music therapy session, 30% stated that they charge less than $20, 46% charged between $20 and $39, 8% charged between $40 and $59, and 8% charged $100 or more. One respondent indicated that they did not know what their rate for a music therapy session

Clientele Respondents provide music therapy services to a variety of client populations, ranging from young children to elderly adults. Results are listed in Table 1. Music Therapy Theory and Techniques Feedback received from respondents indicates that music therapists in Africa integrate many theoretical orientations into their practice. All of the respondents reported using Nordoff-Robbins (100%), in addition to psychodynamic (23%), the Bonny Method of Guided Imagery in Music (15%), humanistic (8%), neurologic music therapy (8%),

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“Community music therapy” (8%), and eclectic or integrative (8%). No respondents incorporate the behavioral, cognitivebehavioral, Dalcroze, Kodaly, Orff-Schulwerk, or rational-scientific mediating models into their music therapy practice. Music therapy techniques used by African music therapists include chant (8%), drumming (100%), improvisation (100%), instrument playing (92%), lyric analysis (4%), movement to music (85%), music-assisted relaxation (23%), music and imagery (38%), music instruction or therapeutic lessons (15%), music listening (69%), song-writing (77%), song-singing (77%), and “creative arts therapies” combined (8%). Music therapy techniques that were not used by African music therapists include progressive muscle relaxation and vibroacoustic therapy.

may be a result of the currently developing healthcare system in Africa, and the lack of medical supplies available. However, survey results also indicated that aside from a limited understanding of medical services, these services are still highly sought after. This could potentially be due to the fact that a Table 2. African Music Therapist Perceptions of Music Therapy’s Limited Acceptance

Client and Community Perceptions of Music Therapy Respondents expressed varying acceptance of music therapy in Africa, stating that music therapy is not understood or widely accepted (8%), music therapy is not understood, but widely accepted (30%), music therapy is understood, but not widely accepted (0%), music therapy is somewhat understood and somewhat accepted (62%), and music therapy is understood and widely accepted (0%). Music therapists in Africa report that music therapy is most commonly labeled music therapy (92%), as opposed to “musical therapist” (8%), music teacher 98%), music healing (0%), traditional healer (0%), or healer (0%).

discrepancy exists between the public and private healthcare systems in certain African countries. One additional consideration to be made regarding these results is that the question was presented to music therapists, who were invited to share their perceptions of the frequency with which healthcare services are sought. The resulting data could be a misconception of how frequently services are sought, or may be skewed in the sense that music therapists may come into more frequent contact with clients who require more healthcare services. Discovering the motivations to seek healthcare services in Africa would be an excellent study for future research.

Discussion The purpose of this study was to obtain demographic information on practicing, boardcertified music therapists in Africa and determine what services they provide. The demographic information received from music therapists in Africa demonstrated a perceived limited understanding of medical services and limited use of preventative services. This, as research and the survey feedback suggests,

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Music therapists who reported that they collaborated with other healthcare professionals most often worked with other therapeutic staff (occupational therapy, art therapy, counseling, psychology, speechlanguage pathology, and physical therapy), as opposed to medical staff. Few music therapists collaborated with doctors and nurses, which may be related to the developing status of healthcare and music therapy, or it may be a function of the facilities in which most therapists are employed. However, more than half of the respondents indicated that they do provide music therapy services in a hospital or clinic setting. Examining the perceptions of African doctors on music therapy services would be an excellent question for further study.

Some of the music therapy organizations in existence appear to be going through structural changes, due to the growing nature of the music therapy profession in Africa. The credentialing process also seemed to be a source of confusion for some music therapists, whom communicated that recent credentials were connected to the recent acceptance of music therapy as an allied health profession. Hours worked by African music therapists were almost proportionally equal between the first three survey categories (1-9,10-19, and 20-29). However, most music therapists stated that their salary was less than $20,000. Possible explanations for the salary incongruity include differences in the facility music therapists are employed in, different sources of funding or reimbursement, duties of the music therapist, and currency conversions. Considering the participant feedback, this may also be caused by the limited understanding of music therapists’ ability level, training requirements, and the value placed on educational training of a certain level. The researcher would be interested to know whether music therapists have supplemental employment or consider their music therapy employment “full time.” Finally, the hourly rates reported by African music therapists vary greatly, ranging from less than $20 per hour to over $100 per hour. Although the question requested “hourly rates,” variations in session length and type, facility guidelines, and funding or reimbursement sources should be considered. Funding sources cited most often were private pay and donations, which implies that the government, facilities, and insurance companies may not be as willing to provide support for music therapy, or do not have such services allotted in their budget. One respondent did indicate that once registration with the board and the ministry are complete, clients may receive medical aid for services. Given the developmental nature of the music

The majority of music therapists in Africa are practicing in various areas of South Africa. This is almost certainly due to the fact that Africa’s only University with a music therapy training program is located in South Africa. All of the respondents indicated that they received a post-graduate degree in music therapy, which implies that they had not received any music therapy training as an undergraduate. This is most likely a function of the existing training opportunities; as the University music therapy program provides the degree only at the secondary, postgraduate level. Research regarding the types of undergraduate or pre post-graduate degree programs music therapists pursue before training would provide beneficial insight into the influences that shape music therapy practice. A significant percentage of African music therapists express awareness of the professional licensure organization in their country, which exhibits positive involvement in the development of the music therapy profession. Conversely, only about half of the music therapists in Africa hold membership in a professional music therapy organization.

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therapy profession and the current lack of medical resources, funding may not be as readily available for music therapy services.

social contexts. As noted in Table 2, music is already perceived as a healing entity, so it is seen as “superfluous” to emphasize music as “therapy.” Given the importance of music in African culture and the current understanding of music’s healing properties, this last statement is both logical and perplexing. Africa’s acceptance of music’s healing properties would seem to create more widespread recognition of the value of music therapy. However, considering the developing state of Africa and its healthcare system, music therapy may be subject to the same skepticism for the time being.

The organizations that provided music therapy services were almost entirely private, and a significant portion of services were provided in the private practice or contract setting. Conversely, music therapy services were provided equally as often in public facilities such as hospitals, schools, and other institutions. This is likely due to the vast diversity in client populations that are served by African music therapists, or the varied understanding of how music therapy functions. Survey responses indicated that African music therapists serve both several and varied groups of client populations in their work. This is likely due to the fact that African music therapists work in multiple facilities, but is significant in the sense that music therapists are reaching a large amount of clients. Further, it may also reveal that the facilities in which these clients reside are beginning to realize the effectiveness of music therapy services for all people.

Conclusion This study sought to obtain demographic information on practicing, board-certified music therapists in Africa, and determine what services they provide. Survey responses indicated growing acceptance and understanding of music therapy and its healing value. However, results confirmed that music therapy is still in the developmental stage in African countries. Music is already recognized as significant in the cultural and healing traditions of the African people, but a more in depth knowledge of the therapeutic value of music and the education and training of music therapists is needed for acceptance to increase. Lack of resources, both medical and monetary are likely significant c o n t r i b u t i n g f a c t o r s . H o w e v e r, t h e advancement of professional music therapy organizations may be able to provide solutions to some of these issues. The cultural significance of music and the parallel development of the music therapy and healthcare fields makes music therapy a probable solution to the lack of healthcare needs. Further investigation into the positive influences of receiving music therapy services on encouraging healthcare seeking behaviors would be beneficial to both fields.

Responses to the survey question regarding theoretical orientation of African music therapists suggested that all music therapists practiced Nordoff-Robbins music therapy, which is based in creative improvisation. While respondents reported that they also practiced other types of music therapy, all respondents included Nordoff-Robbins as one of the therapeutic models they used in practice. The shared training respondents received at the University in South Africa may influence this finding. Additionally, creative improvisation-based music therapy may be indicative of how music functions in African culture in general. Of the music therapy interventions that were chosen, interventions that involve playing instruments, singing, and movement to music were identified as most used by music therapists. This is likely due to how closely music is integrated into African culture, as Africans use music in many cultural events, healing rituals, and in many

References American Medical Association. (2009). Music therapist. Health Care Careers Directory 2008-2009. Retrieved from h t t p : / /

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www.amaassn.org/ama1/pub/upload/mm/ 40/musicther0809.pdf American Music Therapy Association. (2012). A descriptive statistical profile of the AMTA membership. AMTA Member Survey & Workforce Analysis 2012. Retrieved from http:// w w w. m u s i c t h e r a p y. o r g / a s s e t s / 1/7/12WorkforceAnalysis.pdf American Music Therapy Association. (2012). What is music therapy. Retrieved from http://www.musictherapy.org/about/ musictherapy/ American Music Therapy Association. (2012). Music therapy and medicine. Music Therapy Fact Sheets. Retrieved from http://www.musictherapy.org/assets/1/7/ MT_Medicine_2006.pdf Anderson, A. M., Scrimshaw, S. C., Fullilove, M. T., Fielding, J. E., & Normand, J. (2003). Culturally competent healthcare systems: A systematic review. American Journal of Preventative Medicine, 24(3S), 68-79. Fouche, Sunelle. (2009). Fact page about music therapy in South Africa. World Federation of Music Therapy Fact Pages. Retrieved from http://www.wfmt.info/ WFMT/Regional_Information_files/Fact %20Page_South% 20Africa%202009.pdf Fouche, Sunelle (2010). Africa. World Federation of Music Therapy Regional Liaisons Paper. Retrieved from http:// w w w . w f m t . i n f o / W F M T / WFMT_Publications_files/Anniversary %20Paper_ Region a l % 2 0 L i a i s o n s %202010.pdf Griffith, D. M., Allen, J. O., & Gunter, K. (2011). Social and cultural factors influence A f r i c a n A m e r i c a n m e n ’s medical help seeking. Research on Social Work Practice, 21(3), 337-347. Irani, L., Kabalimu, T. K., & Kasesela, S. (2007). Knowledge and healthcare seeking behaviour of pulmonary tuberculosis patients attending Ilala District Hospital, Tanzania. Tanzania Health Research Bulletin, 9(3), 169-173.

Kikwulu, E. N., Frencken, J. E., Mulder, J., & Masalu, J. R. (2008). Barriers to restorative care as perceived by dental patients attending government hospitals in Tanzania. Community Dentistry and Oral Epidemiology, 37(1), 35-44. Nikiema, B., Haddad, S., & Potvin, L. (2012). Measuring women’s perceived ability to overcome barriers to healthcare seeking in Burkina Faso. BMC Public Health, 12(147), 1-12. Wolf, L. and Wolfbrown, T. (2011). Music and health care. Carnegie Hall’s Weill Music Institute. Retrieved from http:// www.carnegiehall.org/uploadedFiles/ Resources_and_Components/PDF/WMI/ Music_and_Health_Care_Final%20Aug %202011(1).pdf World Federation of Music Therapy. (2012). Regional Information. Retrieved from http://www.wfmt.info/WFMT/ Regional_Information.html About the Author Katie Myers received her Bachelor's degree in Music Therapy, with a c o n c e n t r a t i o n i n p s y c h o l o g y, f r o m Duquesne University, and a Master's in Music Therapy from The Florida S t a t e U n i v e r s i t y. S h e e a r n e d h e r certification as a NICU music therapist and completed the first music therapy study in an ambulance, as she is a certified emergency medical technician. Katie completed her music therapy internship at the world-renowned University of Pittsburgh Medical Center. She is now the chair of the Professional Development Committee of the Maryland Association of Music Therapists, and presents regularly at regional and national conferences. Katie joined the music therapy team at Levine Music in Washington, D.C. in 2013, and also contracts for The Creative Arts Therapy Studio, LLC. in Northern Virginia.

Contact klmyers11 89@gmail .com

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Music Therapy

in Costa Rica and Central America By Roy Kennedy

Abstract The purpose of this paper was to interview a professor of music education, 2 music therapists, and a practicing music educator about the status of the music therapy profession in Costa Rica. In addition, I describe the interest in music therapy that I experienced among professionals, students, and lay people during 2 presentations I delivered in Costa Rica. In order to investigate the overall status of the music therapy profession in Costa Rica, I conducted an interview with each of the interviewees via email. With regard to the methodology of this project, I simply asked each respondent to describe their job and to send any information they had about the practice of music therapy in Costa Rica. I concluded from the interviewees’ responses that the challenges they experienced towards establishing the music therapy profession in Costa Rica were similar to challenges faced by the pioneers of music therapy during the first half of the 20th century in the U.S. Recognition of music therapy as a legitimate healthcare profession, the establishment of a national and/or regional music therapy organization, and the use of music therapy in both healthcare and educational settings were identified as important issues to the development of music therapy as a profession in Costa Rica. In addition, some of the interviewees’ applications of music therapy and music education were unique and interesting. Dr. Rosabal-Coto’s creation of the “Observatory of Formal and Informal Learning of Music,” and Fabian Rodriguez Garro’s use of music education in a children’s hospital were certainly groundbreaking innovations for the use of music therapy and music education in Costa Rica.

Resumen El objetivo de este trabajo fue realizar entrevistas a un profesor de educación musical, a 2 musicoterapeutas, y a un pedagogo musical acerca del estado de la profesión de musicoterapia en Costa Rica. Además, describo el interés que he experimentado en relación a la Musicoterapia entre profesionales, estudiantes y laicos durante 2 presentaciones que realicé en Costa Rica. Con el fin de investigar la situación general de la profesión de la musicoterapia en Costa Rica, llevé a cabo una entrevista con cada uno de los entrevistados vía e-mail. Con respecto a la metodología de este proyecto, simplemente le pregunté a cada encuestado que describiera su trabajo y que enviase cualquier información que tuviera sobre la práctica de la musicoterapia en Costa Rica. Llegué a la conclusión, por medio de las respuestas de los entrevistados, que los desafíos que experimentaron en establecer la profesión de la musicoterapia en Costa Rica fueron similares a los desafíos que enfrentaron los pioneros de la musicoterapia en los Estados Unidos durante la primera mitad del siglo 20. El reconocimiento de la Musicoterapia como una profesión legítima de la salud, la creación de una organización nacional y / o regional de musicoterapia, y el uso de la musicoterapia, tanto en la asistencia sanitaria y los centros educativos fueron identificados como temas importantes para el desarrollo de la Musicoterapia como profesión en Costa Rica. Además, algunas de las aplicaciones de la musicoterapia y la educación musical de los entrevistados han sido particulares e interesantes. La creación del Dr. Rosabal-Coto del "Observatorio de aprendizaje formal e informal de la Música", y el uso de la educación musical de Fabián Rodríguez Garro en un hospital de niños, sin duda fueron innovaciones pioneras para el uso de la musicoterapia y la educación musical en Costa Rica.

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Introduction During an incidental conversation with a colleague about research interests, I learned about the Cloud Forest School, a bi-lingual English/Spanish school located in Santa Elena, a small town in the Monteverdi region (mountains) of Costa Rica. The colleague encouraged me to visit the Cloud Forest School to give some presentations and collaborate with the teachers about teaching second languages. After an exhilarating visit to the Cloud Forest School in 2007, I began to wonder if the profession of music therapy existed in Costa Rica and in 2009 I contacted the School of Music at The University of Costa Rica (UCR) to set up a visit to their campus. I met with the Director of the School of Music and the Director of Music Education, Dr. Guillermo Rosabal-Coto. During this visit I had an informal talk with about half a dozen students that seemed interested in music therapy, met a music psychologist that was studying music at UCR, and met a music therapist from Costa Rica that had graduated from The Florida State University but was not practicing music therapy at the time. At the conclusion of this visit, Dr. Rosabal-Coto invited me to visit again in May of 2010 to give a three-day lecture/workshop on the use of music therapy with exceptional children. A Music Therapy Workshop at The University of Costa Rica When I arrived in May for the lecture/ workshop I was overwhelmed with the interest, enthusiasm, and number of people that attended the event. The meetings for the lectures/workshops took place in a recital hall which seated about 100 people. During each of my presentations the recital hall overflowed with attendees that consisted of students in the School of Music, professionals in related disciplines, and people from the general public. So many people attended each lecture/ workshop that a big screen television monitor

was set up in the lobby of the School of Music with chairs so that more people could hear the lectures. With Dr. Rosabal-Coto’s expert assistance as interpreter, I lectured and demonstrated music therapy activities for about 2 hours each day. The audience was so enthusiastic, however, that the lectures and demonstrations gave way to spirited discussions that lasted for over an hour each day. Most of the questions asked by the attendees were about how music therapy with exceptional children could be integrated into the public schools and community services. An Innovative Music Education Degree Since the lecture/workshops in 2010, Dr. Rosabal-Coto has introduced a new music education degree at UCR, which he described as an “Observatory of Formal and Informal Musical Learning” (G. Rosabal-Coto, personal communication, February 1, 2012). His description continues…. I can now share with you that we expect to open an entirely new program at our university, based on the mediation of musical learning in intercultural contexts. One of these contexts is that which includes hospitals and other health service-related centers, among other venues, specific to Costa Rica: municipal music schools, music academies, church, and amateur and community musicmaking. This will be a major breakthrough for Costa Rica and perhaps worldwide. We are at the stage of selling the idea to our Faculty Council, and setting up the coursework, in which music therapy will be an important component (G. RosabalCoto, personal communication, February 1, 2012). Music Therapy in an Educational Setting During the spring of 2010, I met Laura Mésen Méndez, a music therapy student from Costa Rica that was studying at Georgia College and State University (GCSU) in the U.S. Laura graduated in 2011 with a Master’s

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Degree in Music Therapy from GCSU and moved back to her hometown where she became the Academic Coordinator of the Music School of Pérez Zeledón. Among other accomplishments, Laura, attended and gave two presentations at the first Latin American Symposium on Music Therapy during 2012 that was held in conjunction with the Latin American Jazz Festival in Panama City, Panama. Laura wrote the following account of her role as a music teacher in her hometown of Pérez Zeledón and her attendance at the Symposium on Music Therapy: I am the academic coordinator of the Music School of Pérez Zeledón, Universidad Nacional de Costa Rica, which is located 136 km south of San Jose, the capital of Costa Rica. The school has 177 students of different ages and social and economical backgrounds. These students come to the school twice or t h r e e t i m e s per week to have music reading classes, orchestra, instruments lessons (the one they choose), and music theory, among others. Our school has almost 20 professors, most of them live in San Jose and come to Peréz Zeledón once a week. They all have attended universities in Costa Rica and overseas. Students enjoy coming to the school and learning. There are some students that have difficulty learning and need more individual attention when learning how to play the recorder or read music. I work with these students in individual sessions to help them learn in a non-threatening environment so that they can learn at their own pace. I frequently use music therapy techniques with them to provide structure and comfort (L. M. Méndez, personal communication, M a y 31, 2013).

The First Latin American Symposium on Music Therapy Laura, then wrote about her experience at the First Latin American Symposium on Music Therapy that was held at the Latin American Jazz Festival in Panama City, Panama in 2012: Regarding my experience at the First Latin American Symposium on Music Therapy in Panama, I can say that it was an amazing experience. The conference lasted for one week and we had presentations of music therapists from Panama, Mexico, Costa Rica, South Africa, Chile, among others. Every professional presented a different and interesting topic about the development of music therapy in their countries. They also presented strategies and activities to work with different populations. The audience included psychologists, elementary and preschool teachers, therapists, and other professionals who actively participated in the activities and presentations. I had the opportunity to give two presentations, the first one was: Music Therapy in Costa Rica. In this presentation I talked about some of the isolated efforts by the pioneers of music therapy many years ago (L. M. Méndez, personal communication, May 31, 2013). Laura then described the efforts of some pioneers in music therapy in Costa Rica and South America and their attempts to establish music therapy as a profession. Her description of these individuals and their writings reminded me of some of the innovators of music therapy during the first half of the 20th century in the U.S such as Eva Vescelius, Margaret Anderton, Isa Maud Ilsen, and Harriet Ayer Seymour. Some of the music therapy pioneers were Bolivian. For example, Mario Bustamante and Lilliana Valerio worked with children with autism at the National Children's

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Hospital in San Jose. Some time ago, a music therapist, Katarzyna Bartoszek, began a program called Creativity Connections to offer artistic experiences to patients of different health institutions; this program did not offer therapy but was one of the first steps to offer people with disabilities artistic involvement. Recently, there are other music therapists such as Randy Steinkoler who graduated from Argentina and is working privately in institutions with clients that have special needs. For the future, I propose opening centers for people of different ages and disabilities to offer them opportunities for a better quality of life through music therapy services (L. M. Méndez, personal communication, May 31, 2013).

Figure 1. Laura Mésen Méndez had them up and dancing the Hokey Pokey during this independent part of the Panama Jazz Festival. Photo of the First Latin American Music Therapy Symposium by Eric Jackson

Music Therapy in Argentina José Pablo Valverde Villar, another music therapist from Costa Rica, recently graduated from The Universidad del Salvador in Buenos Aires, Argentina, where he studied music therapy. José described his journey to become a music therapist and contributed some historical information about the development of music therapy as a profession in Argentina. This was the first university in all of Latin America which offered music therapy

training more than 50 years ago. The psychiatrist Rolando O. Benenzon promoted music therapy in Latin America and today he has one of the most widespread music therapy practices among Spanish-speaking countries. In Argentina I observed that there are many music therapy services offered in hospitals, private universities, and in community health care settings. I have an image of music therapy as a discipline that requires specific training and research, and is combined with interdisciplinary work. The Development of Music Therapy in Costa Rica José Pablo Valverde Villar then discussed his research interests while studying at the Universidad del Salvador in Buenos Aires. They included some interesting historical information about the development of the music therapy profession in Costa Rica. I was struck by how recently the term “music therapy” was first mentioned in the media in Costa Rica. I was interested in doing my dissertation research on "the image of music therapy in health care settings in Costa Rica.” I was amazed that many professionals in health care settings said that they did music therapy just for the sake of using music in their sessions. This shows great ignorance on the subject. On the other hand, there were professionals who knew about music therapy and mentioned that they expected professional music therapy to develop which would facilitate their referrals to music therapy. I also gave myself the task of investigating the evolution of the image of music therapy in the media. I checked the various files of newspapers, magazines and television interviews. The first article in which the word "music therapy" appeared was in 1997 in a newspaper called “La Nación.” The statement read as follows: “Music therapy is a method that helps, by the use of

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sounds, to improve physical, emotional, and mental disabilities”. After that other articles were published portraying an incorrect image of that discipline reducing it to the superfluous use of music in relaxation. But a few articles were published that portrayed music therapy as a real intervention for many diseases. At that time many articles also appeared that linked the concept of music therapy to using music, but without any therapeutic purpose or under the control of a professional music therapist (J. P. V. Villar, personal communication, June, 5, 2013). Music Therapy in Costa Rica Today José Pablo Valverde Villar then talked about his use of social media to promote the profession of music therapy in Costa Rica, the importance of creating a national music therapy organization, and his practice of music therapy in hospital settings: In 2012, together with my colleague Max Teran, we opened a Facebook page called "Musicoterapia Costa Rica" in order to inform people about this discipline and to present our clinical services and eradicate some myths that obstruct the actual scope of music therapy practice. In addition, we seek to promote music therapy research in Costa Rica and offer workshops where people can approach this discipline through their own experiences with music. We also provide clinical care for individuals and groups of patients in community health settings. We were also invited to join the Latin American Musuc Therapy Committee (CLAM) and represent Costa Rica. This is the most important organization for music therapy professionals in Latin America. Every four years they organize a congress with the purpose of updating the knowledge of music therapy. Our goal is to open the way for music therapy in Costa Rica. We have worked at the National Children's Hospital with patients that have autism and Asperger’s

syndrome, in the Asociación Lucha contra el Cáncer Infantil (Fight Childhood Cancer Association), with leukemia patients, and with adult patients at the Hospital CIMA who have suffered strokes and other serious medical conditions. We constantly provide workshops for musicians, music teachers, psychologists, doctors, nurses, and other professionals with the main objective to educate them about music therapy (J. P. V. Villar, personal communication, June, 5, 2013). Music Education in a Children’s Hospital In addition to José Pablo Valverde Villar’s efforts at beginning music therapy in Costa Rica, a music educator, Fabian Rodriguez Garro, described his use of music education in the National Children’s Hospital School in San Jose, Costa Rica. His account of the use of music education in a children’s healthcare setting reminded me of the collaboration between music educators and music therapists that began in the public schools of the U.S. during the 1970s (Davis, Gfeller, & Thaut, 2008). Fabian gives the following account of his efforts to use music education in the National Children’s Hospital: Lilia Valerio previously worked at the institution as a music therapist specializing in children with autism. The number of children she provided music therapy services for was very low in comparison to the total population the hospital served. She only cared for children with autism as outpatients in her office on the fifth floor of the hospital. Over time the institution needed a new pedagogical approach for the school, and after Lilia retired the director decided that the best thing for the institution was to hire a music educator. Upon my arrival, the program has made the following changes: • Music is used in an educational environment that facilitates adaptation, socialization, and relaxation for the hospitalized child.

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•

• •

•

Students are referred by teachers for specific music education activities in the hospital rooms. We organize and implement special events (civic events and concerts). We develop recreational workshops in the hospital rooms in order to achieve an emotional bond between the students and the music class. The music teaching is divided into two areas: (1) Pedagogy in the hospital rooms: This is the first time in the history of the school that a music teacher has worked directly with children taking into account each child’s health characteristics and mood. Music education activities take place in the various departments of the hospital, including Medicine, Surgery, Burn Unit, Palliative Care, I m m u n o l o g y, N e p h r o l o g y, a n d Neurology. (2) Groups of Preschool and Multiple Disabilities: Preschool children and groups of children with multiple disabilities are treated in the hospital classrooms located on the fifth floor of the Children's Hospital. The children are taught using various special techniques that are related to their health conditions. Some children have problems with fine motor or gross motor skills, and other children have difficulties with language skills. The children’s age is between 2 and 5 years, and I work directly with 5 to 6 groups of children. The music activities are planned jointly with the teachers in charge of the groups. With students who maintain a medium or long hospital stay, the music teacher must coordinate with the music teacher of the institution where the child attended school before becoming hospitalized. Various educational activities which are required to give continuity to the child’s educational process are then included, to the maximum extent, in the Children’s Hospital in San Jose. I am the first music educator that has

worked in the Children’s Hospital in San Jose. There are no suitable curricula for music education classes in hospitals and there are no specialized classes offered at the universities in Costa Rica for using music in hospitals. In addition, most children do not stay in the hospital for a long period of time, and I see many children only once during their stay at the hospital. This hinders me the task to implement an effective program with them. In order to create a viable music education position in the National Children’s Hospital in San Jose I need to answer the following questions: • What is the work of the music teacher in a hospital? • How can I implement a music education program in the National Children's Hospital? • How can I create an emotional link between hospitalized children and the music classes? These questions concern me with regard to justifying my work in the hospital. So, I decided to design a music education curriculum to work with hospitalized children. I will make this new music program so that other music teachers that work in hospitals with children do not have to start from scratch as I had to do (F. R. Garro, personal communication, June 12, 2013). Discussion I was struck by the similarities of the challenges the pioneers of music therapy in Costa Rica are facing today, as very much like the challenges faced by the innovators of music therapy as a profession in the United States during the first half of the 20th century. Recognition of music therapy as a formal healthcare profession, the formation of a national and/or regional music therapy organization, the collaboration of music

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therapists and music educators, and the development of college degree programs, all seem important components of the development of music therapy as a profession (Davis, Gfeller & Thaut, 2008). The challenges of developing music therapy as a profession seem especially poignant, however, in developing countries such as Costa Rica where funding for such programs remains a challenge. With regard to the music education degree program with a music therapy component, in February of 2013 Dr. Rosabal-Coto wrote: In 2011 I founded the "Observatory of Formal and Informal Musical Learning" as a research program sponsored by the Vice-Rectorship of Research at the University of Costa Rica. In these two preliminary years of work with very few resources and no staff, we held conferences and some training sessions related to the issues you tackled in your workshops. In addition, Karla Abarca, who you met in Costa Rica, wrote two small books about the therapeutic use of music for children with emotional problems in the schools. And we are still trying to succeed in convincing our university authorities to endorse a brand new music education Bachelor's Degree operated solely by the Music School (as opposed to our music education programs, which are jointly operated by the m u s i c a n d e d u c a t i o n schools). This program will include music therapy as an important component. We expect in the coming years to offer more continuous and substantial workshops i n m u s i c therapy, and in the long term, a music therapy program. The program website is now under construction so there's no evidence on the web, yet (G. Rosabal-Coto, personal communication, February, 16, 2013).

Conclusions I found evidence that the profession of music therapy exists in 2 other countries in Central America but support for the profession is sparse at best. For example, music therapy has existed in Mexico since 1983 when Victor Mu単oz Polit created the Humanistic Music Therapy Model. This model of music therapy, h o w e v e r, i s u s e d e x c l u s i v e l y w i t h psychotherapy patients. Two other music therapists in Mexico, Esther Murow and Ginger Clarksson, have expanded the practice of music therapy to other populations and use other methods of practice such as Guided Imagery and Music (GIM). There is no academic music therapy degree offering in Mexico, however, music therapy is offered as a post-degree course for psychology graduates. In fact, music therapy is not recognized as a profession by any official education institution in Mexico (Campos, 2003). In addition, an Internet search revealed that no academic music therapy degree programs exist in any of the Central American countries. Local musicians do attempt, however, to practice music therapy in countries such as Honduras. Teresa Devlin wrote: There is no music therapy university degree in Honduras. This fact has not prevented us from hoping that some day Honduras will have a wide range of information and techniques applied to this new discipline. Meanwhile, we keep on incorporating the techniques taught by music therapists that visit our country, the readings made by our professors, and the perseverance to maintain the communication with the music therapists that have visited our country (Devlin, 2005, para. 7). Music Therapy in Costa Rica The significant parts of the population that benefited from music therapy in Costa Rica

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were described in responses from the interviewees as children with autism, Asperger’s syndrome, and leukemia patients, and adult patients that suffered from strokes and other medical conditions. The populations served by music therapists in Costa Rica were no different than populations served by music therapists in other parts of the world. The way that music therapy and music education services were delivered in Costa Rica, however, were somewhat unique. For example, Fabian Rodriquez Garro’s use of music education as individualized educational interventions in children’s hospital rooms was a groundbreaking strategy in Costa Rica, if not the world. In addition, Dr. Rosabal-Coto’s plans to focus on formal and informal musical learning in intercultural contexts which included hospital and healthcare settings specific to Costa Rica such as municipal schools of music, music academies, churches, and amateur and community music-making venues was a major breakthrough in Costa Rica. I think that Central America is a new frontier in which music therapy may be established. I hope this article will serve as recognition of the valiant efforts of our colleagues in Costa Rica that are championing the development of music therapy as a profession in their country. Hopefully, the use of social media such as Facebook and other technologies, combined with the strong will, determination, and creativity of such dedicated professionals will hasten the progress of music therapy in Costa Rica and the larger region of Central America in the near future. References Campos, Ezequiel González (2003). Music Therapy in Mexico. Voices Resources. Retrieved January 15, 2015, from http:// testvoices.uib.no/community/?q=country/ monthmexico_august2003. Davis, Gfeller, & Thaut (2008). An introduction to music therapy: Theory and practice.

Silverspring, MD: The American Music Therapy Association. Devlin, T. (2005). Music Therapy in Honduras. Voices Resources. Retrieved March 6, 2015, from https://voices.no/community/? q=country/monthhonduras_april2005. Jackson, E. (2012). Music therapy advances as one of Latin America’s healing professions. The Panama News. Retrieved from http:// www.thepanamanews.com/pn/v_19/ issue_01/nature_01.html. About the Author Roy Kennedy, Ph.D., MTBC, is an associate professor of music therapy at the University of Georgia, USA. While previously providing music therapy services to various populations, his primary research interests include guitar pedagogy for music therapists, music therapy for Englishas-Second Language learners, adults with substance abuse problems, and skill generalization of students with developmental disabilities. Dr. Kennedy has presented his work in the USA, Brazil, South Korea, and Costa Rica. He continues having an interest in the international development of the profession and is eager to make future contributions. Photograph: Eric Jackson

Contact: rkennedy@uga.edu

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Music Therapy Education Worldwide: Report on Entry-Level Requirements By Aksana Kavaliova-Moussi

Abstract Ever since the author became an Accredited Music Therapist (MTA, Canada) and began working in the Kingdom of Bahrain, she was interested in the diversity of educational standards of music therapy programs around the world. Becoming an Eastern Mediterranean Regional Liaison for the World Federation of Music Therapy in 2011 allowed the author to get involved in the worldwide projects, and to work with prominent professionals from many parts of the world. The more international music therapists the author met, the more her interest was fueled, and resulted in the following review of entry-level educational requirements in the field of music therapy around the globe. This review is an independent study project for a Master's degree in Music Therapy, which the author received in May 2014. Curricula from the music therapy training programs worldwide were obtained using various sources. First, English-language curricula were collected from the universities' websites. When the plans of studies were not available in English, the online Google translation feature and some help from music therapists-native speakers were used. In cases where no information was available online, the author contacted programs' directors to obtain their curricula. The curricula from 100 training programs in 37 countries outside of the U.S. were included in the current report. Three types of entry-levels currently exist across the globe. Those are the Bachelor, Postgraduate Diploma/Certificate, and Master's degree. There is a diversity of entry-level music therapy educational requirements between the regions, as well as within some countries.

Resumen A partir de haber recibido su acreditación profesional como Musicoterapeuta ( en Canada) y comenzado a trabajar en el Reino de Baréin, la autora se interesó en la diversidad de los estándares educacionales de los programas de Musicoterapia alrededor del mundo. Para la autora, ser desde el 2011 el enlace de la Región del Este del Mediterráneo para la Federación Mundial de Musicoterapia, le permitió involucrarse en proyectos internacionales y a la vez trabajar con distinguidos profesionales de diferentes partes del mundo. Asimismo, incrementó su interés al relacionacionarse con musicoterapeutas a nivel internacional lo cual le brindó como resultado la revisión de los procesos de admisión a nivel educativo del campo de la Musicoterapia. Esta revisión es un proyecto de investigación independiente para la Maestría en Musicoterapia que la autora concluyó en Mayo de 2014. El currículo de programas en Musicoterapia a nivel mundial, fue recopilado a través de diferentes fuentes. Primeramente, el currículo en idioma inglés, fue extraído de las paginas web de las Universidades. Cuando los planes de estudio no se encontraban en inglés, la autora utilizó la traducción provista en internet por Google y también recibió la ayuda de musicoterapeutas que dominaban diferentes idiomas. En aquellos casos en los cuales no se encontró información disponible en la web, la autora contactó con los directores de los programas para obtener los planes de estudio. En este trabajo se incluyeron un total de 100 planes de estudio (o currículo) en 37 países fuera de los Estados Unidos. Tres tipos de niveles de ingreso o admisión se evidencian alrededor del mundo. Estos son: Grado, Post grado/Certificación, y Programa de Maestría. Existe una diversidad tanto en las regiones como dentro de algunos países en relación a los requisitos educacionales que se necesitan para ingreso o admisión en la carrera de Musicoterapia.

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The World Federation of Music Therapy was founded in 1985 in Genoa, Italy. It is the only professional music therapy organization that represents music therapy worldwide. Among numerous commissions, the Education and Training Commission was formed at the 6th World Congress in Rio De Janeiro, Brazil, in 1990. Nine years later, in 1999 in Washington, DC, Dr. D. Grocke, then Chair of the Education and Training Commission for the WFMT, organized an Education Symposium. The aim was to establish worldwide standards for the music therapy training (Wheeler & Grocke, 2001). As Dr. Grocke shared later (Kern, 2010), â&#x20AC;&#x153;we all agreed it would be too difficult to determine specific hours of education and training in all aspects of music therapy, so the final document was quite succinct.â&#x20AC;? This document, WFMT Guidelines for Music Therapy Education and Training, described standards of training, proposed for the implementation worldwide (Wheeler, & Grocke, 2001). According to these Guidelines, the educational system of each country was to determine the most appropriate entry-level taking into consideration their cultural contexts. However, any program of study should be intensive, with a supervised clinical training over an extended period. The program of study should have a set curriculum, being offered on a regular basis and recognized by the professional organizations of a given country. Selection process would include assessing prospective students' music skills, academic qualifications and suitability of personal qualities. The program should be taught by a person educated and trained in music therapy, with clinical experience in various aspects of the field. Intensive studies should consist of musical skills and knowledge, biological, psychological and social studies, music therapy knowledge and skills. Clinical training had to include a variety of populations in different settings and be supervised by an experienced music therapist. The program of study might be specialized or general. A

specialized program could focus on one or more models or philosophies of music therapy. A general program had to cover active and receptive methods of music therapy, music therapy application with a variety of populations in various settings, different theories and philosophies of music therapy, research and ethics, and current models of music therapy practice (World Federation of Music Therapy, 1999). According to the Symposium Proceedings (Grocke, 1999), there were three different entry levels around the world. Undergraduate/Bachelor's degrees took three to four years to complete; Graduate diplomas took one to two years; and Master's degrees by coursework and research could last two to three years. These levels may have had a specialization in one client group (e.g., children), in one theoretical approach (e.g., Benenzon Model of Music Therapy, NordoffRobbins Music Therapy, Analytic Music Therapy, Guided Imagery and Music, Behavioral, or Neurologic Music Therapy), or representing an eclectic approach, with a range of theoretical models and client applications being taught during the course of studies. The Proceedings provided an extensive report on music therapy standards of education from the various parts of the world. However, to date no documents have been published listing detailed programs of studies/curricula from different universities. The purpose of this report was to provide a description of music therapy curricula from various training programs in all eight regions as defined by the World Federation of Music Therapy. These regions were as follows: Latin and North America, Europe, Africa, Eastern Mediterranean, Southeast Asia, Western Pacific, and Australia/ New Zealand. The author did not include the U.S. schools in the current report. There were more than 70 entry-level programs in the United States, with their curricula following the standards set by the American Music Therapy Association (AMTA). Of course, some differences existed

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among many schools in the U.S, perhaps due to their various philosophical orientations. However, the standards for the Bachelor's degree were the same across the country, as s p e c i f i e d i n t h e A M TA P r o f e s s i o n a l Competencies (American Music Therapy Association, 2013, November 23, pp. 1-2). According to the Master’s-level entry: moving forward (n.d.), academic coursework included the following: • Music Foundations: music theory; music history and literature; composition and arranging; applied music; ensembles; conducting; functional piano, guitar, percussion and voice; and improvisation. • Music Therapy: foundations and principles; assessment and evaluation; methods and techniques; psychology of music; music therapy research; influence of music on behavior; music therapy with various populations; and pre-internship clinical training and internship (1,200 hours in total). • Clinical Foundations: exceptionality and psychopathology; normal human development; principles of therapy; and the therapeutic relationship.

About this Report The report provides readers with a document, where they can quickly find required information that has been categorized and translated into English. It may be of a particular interest to the music therapy educators and new programs founders, as well as professional music therapy associations worldwide.

Another reason for not including the U.S. schools in this report was the fact that, during the past years, the AMTA has been discussing plans to move towards the Master's-level entry education in music therapy (Master’s-level entry: moving forward, n.d.). Thus, the current report could be a valuable source for the American Education and Training Advisory Board. The report provides readers with a document, where they can quickly find required information that has been categorized and translated into English. It may be of a particular interest to the music therapy educators and new programs founders, as well as professional music therapy associations worldwide.

Methods of Data Collection and Organization The author first examined the Regional Information and Fact Pages on the World Federation of Music Therapy website (2014). The regional sites of the European Music Therapy Confederation (2015), the Australian Music Therapy Association (2012), and the British Association for Music Therapy (2012) provided more details about their training. Many universities listed by the sources mentioned above presented detailed descriptions of their curricula/plans of studies. However, many other universities had no such information on their websites. Therefore, the data collection became a three-level process. Level 1 included finding programs’ curricula in English on their websites and inputting details into the Tables 1-12. Level 2 involved translating website pages, finding curricula, and translating them into English to include into the Tables. Level 3 comprised of sending emails to program coordinators, or finding former students, who replied by sending curricula or descriptions of the study plans. The author included only the programs approved by the countries’ professional associations (when available) or with music therapy faculty members. This report listed curricula that were obtained between October 2013 and March 2015. The author used the online Google translation feature, and also received translations from music therapists who were native speakers of Korean, Japanese, Chinese and Arabic languages. Microsoft Excel 2011 computer program was used to organize all curricula into the tables. The top columns include training programs, their locations and indications of whether the author obtained the information from the universities’ websites or the program directors. The rows represent degree levels and theoretical approaches (when specified), entry requirements, and categories/ subcategories of disciplines.

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After reviewing the WFMT Guidelines (1999), the author created a list of categories to organize the requirements, such as Music Therapy, Music, Psychology/Medical Science, and Other disciplines. Each category contained common subjects as well as rare and unique ones. The author examined available descriptions of the requirements and assigned them to the appropriate categories and subcategories. To make the Tables as compact as possible and to avoid them being very large, the author included additional subcategories. They were as follows: “Other topics/seminars/workshops” (in the Music Therapy category), “Other psychology disciplines”, “Other disciplines”, “Other therapies” (occupational, speech and language, physical therapy, arts), and “Elective/ Optional studies” in the Psychology/ Medical Science/Other disciplines. These subcategories included requirements that were either unique to a program or listed in the curricula as seminars/ workshops and did not fall into any existing subcategory. Report by the Regions The author collected details from 100 entrylevel training programs in 37 countries (excluding the U.S.A.). The country from which it was difficult to obtain more information was Japan. The author included only two programs in this report, the links to which she received from a Japanese music therapy student. The Japanese Music Therapy Association listed general training descriptions on its website, and they were translated and included in the Tables. In China, there were several Bachelor-level trainings, but the author received curricula from three only. Another challenging task was to find any information about the program in Jordan. The author decided to include a study plan that had been sent by a former student and was in place in 2012. A similar issue arose with some European programs, as their directors were not responsive to the numerous attempts to obtain necessary information.

The results indicated that music therapy training was offered in at least 37 countries outside the United States. The majority of them were in Europe, North and South America, and Far East (Korea, China, Japan). Again, it would be worth to note that this report and corresponding tables included only those programs, information on which was available online or from private correspondences between the author and the programs coordinators. North America (Canada) Bachelor’s degree is the entry level in both USA and Canada. A majority of colleges and universities offered four-year programs with 1,000 hours of internship, which is required to apply for accreditation (MTA, Canada) or certification (MT-BC, USA). In Canada there are five universities with music therapy programs: the Acadia in Nova Scotia, the Capilano University in British Columbia, the Canadian Mennonite University in Manitoba, the Wilfrid-Laurier University in Ontario, and the Concordia University in Quebec. The latter has only a Graduate program, offering Master’s degree. It also offers a Graduate Certificate in music therapy for people with the non-music therapy undergraduate degrees. At the Acadia University, in addition to a four-years Bachelor’s degree (without an internship), there is a two-years Certificate in music therapy for those with the undergraduate degrees in related fields. Overall, graduates cannot apply for a professional accreditation unless they complete 1,000 hours of supervised internships after graduating with the Bachelor’s degrees. Theoretical approaches in these programs are mostly eclectic, but the Capilano University provides Music Psychotherapy teachings, and the WilfridLaurier University has music-centered, improvisational and Analytical orientations. Recommended competency areas (Canadian Association for Music Therapy, n.d.) are similar to those outlined in the AMTA Professional Competencies and include the following:

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•

Music skills (history and theory of music; performance skills on a primary instrument, keyboard, guitar, percussion, and voice; songwriting and arranging; and conducting). Clinical competencies (psychology and psychopathology, biology, and physiology; theories and processes in therapy; research; multicultural issues; and interdisciplinary interaction).

Table 1. Canada, South Africa, Jordan, Austria

•

Music therapy competencies (music therapy theory, principles, and methods; clinical skills). Professional practice competencies (standards and ethics; professional conduct; supervision; and advocacy). For more details on the Canadian training programs, please see Table 1.

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Table 1. cont.

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Table 1. cont.

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Table 1. cont.

Latin America Benenzon Model of Music Therapy, developed in the 1960s in Argentina, is a dominating theoretical approach in the Latin American countries. Argentina, Brazil, Colombia, and Chile have established music therapy trainings. Music therapy in Argentina is a government-approved profession in many provinces (Loureiro, 2013, August). In Brazil, music therapists get credentialed by the Brazilian Code of Occupations (Loureiro, 2013, May), while Chile and Colombia do not have professional credentials. Argentina. There were four programs mentioned on the WFMT Regional Information (2014). The Music Therapy Association of Argentina (http://asamdifusion.wix.com/ musicoterapia - !quienes-somos1/cfw8) listed the following approved trainings: the University of Buenos Aires, the University of Salvador, the University Maimonides, and the Universidad Abierta Interamericana. The entry level is a Bachelor’s degree, which takes four to five years to complete. Studies comprise all categories of subjects, with research and music classes, as well as psychology (including group psychology), psychoanalysis, and medical science. For more details, please see Table 2.

Brazil. The author collected information about five programs: Faculdade de Artes do Paraná, Universidade Federal de Minas Gerais (with thesis), FAMMETIG-Faculdades Integradas Olga Mettig, Faculdade EST (São Leopoldo) Rio Grande Do Sul, and Faculdades Metropolitanas Undas (UNIFMU) in São Paolo (with thesis). The FAMMETIG offers a Graduate Diploma in music therapy; all others have four-year Bachelor ’s programs, with the length of internships varying between 60 and 350 hours. The programs of studies include some music disciplines, core music therapy subjects, the orientation towards psychiatry with a few psychology disciplines, some courses from a medical field, and a research methodology (Table 2). Colombia, Chile. There is one Master’s level program in each of these countries: Universidad Nacional de Colombia and Universidad de Chile. Both require high music skills prior to admission. The curricula have a few disciplines from music, psychology, and medical/other categories, with more time allotted to music therapy subjects in Chile. Students in both programs have to complete graduation projects. For more details on these countries, please see Table 2.

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Table 2. Argentina, Brazil, Chile, Colombia

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Table 2. cont.

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Table 2. cont.

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Table 2. cont.

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Table 2. cont.

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Table 2. cont.

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Table 2. cont.

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Africa South Africa is the only country with a professional music therapy organization and training on the entire continent. South Africa. In order to practice in South Africa, music therapists have to be registered with the Health Professions Council (Fouché, 2013, February). The only approved training program on the continent is at the University of Pretoria: a two-years Master’s program, with a 1,000-hours internship in a second year. There are many psychology disciplines pre-requisites together with music skills demonstration, and the studies cover music therapy core modules, psychology modules, introductions to other therapies, and a minidissertation. For more details, please see Table 1. Eastern Mediterranean This part of the world, comprised of 22 countries, differed from other seven listed in this report. The region has no professional music therapy organizations, very little or no communication between countries and no government regulations or certifications. Jordan. The sole training program in the region exists at the National Music Conservatory in Amman. As mentioned before, the author was unable to obtain the most recent curriculum, thus including the one from the year 2012. It was a four-years Bachelor’s program, with a supervised clinical practice. The curriculum includes core music therapy and music subjects, introductory-level psychology classes, a few medical science and general college subjects. Until 2012, the program’s orientation was mostly Behavioristic. For more information, see Table 1. Europe The author succeeded in collecting curricula from 21 countries. As stated earlier, some universities do not have their curricula online, and numerous attempts to reach their program directors failed. Therefore, this report

includes most, but not all, of the European training programs. Austria. Professional credentials were regulated by the State since the introduction of the Music Therapy Law in 2009 (Harrison, 2013, May). There is one Bachelor’s level program at the University of Applied Sciences in Krems, which offers a part-time, three years, Bachelor of Science in Health Studies. A Diploma program at the University of Music and Performing Arts in Vienna provides another entry-level training, taking four years to complete. Both programs include music psychotherapy foundations, experiential music therapy studies (as a self-discovery and self-awareness in a group), and classes from all other categories. The program in Krems also requires scientific work and a completion of a thesis (Table 1). Belgium. The College for Science and Arts, campus Lemmensinstituu, offers a Bachelor of Music Therapy program, which has been recognized by the government of Belgium. Students have to complete experiential group music therapy studies, many music subjects. The program focuses on the acquisition of knowledge in the fields of psychotherapy and psychiatry, and a theoretical foundation is psychoanalytically oriented (Table 7). Denmark. Aalborg University offers a combined Bachelor-Master’s degree (three plus two years of studies), approved by the Danish Society for Music Therapy. Training follows the Psychodynamic/ Analytic Music Therapy approaches (those of Mary Priestley and Guided Music Imagery-GIM). It emphasizes clinical improvisation, experiential individual and group music therapy studies (more at the Master’s level), and core music subjects. Master’s degree requires a thesis completion. Clinical practice lasts for one semester in both the Bachelor and Master’s programs (Table 7). England. Music therapists who have completed one of the approved Master's-

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level training programs are eligible to register with the Health and Care Professions Council (HCPC). Music therapy trainers in the United Kingdom wrote a core syllabus, which all courses follow (Watson, n.d.). The author succeeded in obtaining the curricula from the following programs: Anglia Ruskin University (Cambridge), Guildhall School of Music and Drama (London), Nordoff-Robbins Music Therapy (London, Manchester), University of Roehampton (London), and the University of South Wales. All programs require a two-years study, except the latter training, which lasts three years. Trainings follow analytic or psychoanalytic orientations except the music-centered

Table 3. England, Estonia, Finland

Nordoff-Robbins training. The programs in England have specific entry requirements: a musicianship at the Grade 8 level, some experience working with various populations, and the maturity of the applicants. All programs begin studentsâ&#x20AC;&#x2122; clinical placements in their first semester of studies; observational studies and self-experiential music therapy studies are mandatory. Students have to undergo personal psychotherapy, the length of which varies between 40 to 60 hours (Guildhall and Nordoff-Robbins center) and weekly sessions during the entire program (South Wales). All programs except NordoffRobbins Music Therapy require a completion of a thesis/dissertation (Table 3).

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Table 3. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Table 3. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Table 3. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Estonia. Tallinn University offers a Bachelor of Health Science in Art Therapies. Its curriculum consists of a few core music therapy subjects, including clinical placements, some psychology and psychotherapy disciplines, research, and a thesis. The program follows the ECTS- European Credit Transfer System (Table 3). Finland. Although there are at least four training programs in Finland (University of Jyväskylä, Pirkanmaa Polytechnic, The North Karelia Polytechnic, and Eino Roiha Institute), the only curriculum obtained for this report came from the University of Jyväskylä. It is a two-years Master ’s program, with the emphasis on music psychotherapy and music therapy in medicine. Applicants have to have basic knowledge of music theory and show practical music skills. Students begin their clinical practice in their first semester. Among other subjects are psychotherapy and psychiatry; a thesis is required (Table 3). France. It was difficult to determine the professional entry level for music therapists in France. The programs vary from Certificates (as in the “Atelier de Musicothérapie” of Table 4. France

Bourgogne and Bordeaux, Centre International de Musicotherapie of Paris), to Diplomas (University of Nantes, University Paul-Valery Montpellier), to a Master of Art Therapies (University Paris Descartes). Diplomas take three years to obtain, and a Master’s program lasts two years. Prior music training is required from those entering the Diploma and Master’s programs. Vocal music therapy is the emphasis of all Certificates’ trainings. Individual relaxation sessions are being taught in two programs, and movement/ dance in therapy is part of the curriculum in four of them. All curricula include clinical practice and/or internship, as well as knowledge of psychotherapy and psychoanalysis. The Centre International de Musicotherapie (Paris) differs from all other programs in its specializations: Relaxation Music Therapy, Musical creativity, and Art Therapy. Among the subjects are harmonic chant, creative music meditation, energy and meditation, body and mind, to name a few. Research methods are taught only at the Master’s level; however, a thesis is required only at the University Paul-Valery Montpellier (Table 4).

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Table 4. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Table 4. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Table 4. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Germany. There are many training programs in Germany, including eight private schools. However, for this study the focus was on the entry-level, government-supported programs (Voigt, n.d.). The author collected curricula from the following schools: University of Applied Sciences in Heidelberg (Bachelor of Music Therapy), Westfälische WilhelmsUniversität Münster, University of Augsburg, Universität der Künste Berlin, University of Applied Sciences in Würzburg-Schweinfurt, Table 5. Germany, Ireland, Israel

and Hochschule für Musik und Theater Hamburg (Master of Music Therapy). All programs include clinical practice, individual or group experiential music therapy studies, psychoanalytic theory of psychotherapy and its application, and psychiatry. All schools, except the Westfälische Wilhelms-Universität Münster, require the completion of a research or a thesis. The latter program has a Morphologic music therapy orientation (Table 5).

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Table 5. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Table 5. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 5. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

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Table 5. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

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Table 5. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Table 1. Characteristics of Children Assessed as Appropriate for TAMT

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Ireland. The University of Limerick offers a two-years Master’s degree program. Among the entry requirements are high-level performance music skills and an assessment interview with a psychotherapist. The observational practice is required in every semester, followed by the supervised clinical training. Group and individual experiential music therapy studies are mandatory, as well as personal psychotherapy. A completion of a Figure 1. Percentage children and in hospice care final ofproject isyouth necessary to graduate (Table who were assessed and participated in TAMT. 5).

whose levels varied from a Qualified Technician in Music Therapy and Certificate trainings, to Diplomas and Bachelor ’s programs. They take about three years to complete. All programs have become more coordinated in terms of educational requirements and curricula in recent years, however certification standards have not been completely established yet (Scarlata, n.d.). The focus here is going to be on the following ten programs: “Apollon” institute of music therapy and musicology; Cesfor – Centro Studi e Formazione, Florence School of Israel. Three programs are offering music Dynamic Music Therapy, Conservatorio therapy training: David Yellin College, Statale di Musica E.R. Duni (Matera), Table 2. Goals of Care Commonly Addressed through TAMT Levinsky College, and the Bar Ilan University. Conservatorio Ferrara, Conservatorio Chedini This report includes the curricula of the last Cuneo, Stratos: Scuola di Formazione two programs. Master of Music Therapy is the Triennale in Musicoterapia, Conservatorio entry level in Israel and takes two years to Evaristo Felice Dall'Abaco (Verona), and complete. Both programs require a Conservatorio Luisa D’Anunzio (Pescara). demonstration of music skills on two Among the theoretical orientations are instruments prior to the admission. Among Benenzon model of music therapy, Dynamic music therapy subjects are clinical practice music therapy, and Psychoanalytic approach. (two years), various experiential therapeutic All programs have extensive music therapy studies (at the Bar Ilan University), and sound trainings, with clinical practice and/ or therapy. Music subjects are being taught at internships, and provide trainings in the Bar Ilan University. Both programs require psychiatry and psychotherapy. Most of them the completion of various classes from the cover medical subjects including anatomy and Table 1. Characteristics of Children Assessed as Appropriate psychology and psychotherapy category, as physiology, neurology and neuropsychiatry, as for TAMT well as research methods and statistics (Table well as music pedagogy and research 5). methods. Three programs require the completion of a final project/thesis (Table 6). Italy. There seemed to be a large number of music therapy trainings available in Italy,

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Table 6. Italy

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Table 6. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 6. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 6. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 6. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

Latvia. Two schools offer Master’s level studies: Liepaja University (Master in Health Care, three years), and Riga Stradins University, (Master in Art Therapy, five semesters). Both curricula consist of music therapy subjects, including extensive clinical practice and clinical improvisation, psychology and psychotherapy subjects, medical subjects, research methods and a thesis. Students at the Riga Stradins University have to undergo personal Table 1. Characteristics of Children Assessed as Appropriate psychotherapy; Liepaja University offers for TAMT choices of studying other therapeutic fields (Table 7). Netherlands. Bachelor of Music Therapy/ Creative Arts Therapies is the entry level and takes four years to complete. Three schools offer training: HAN University of Applied Sciences (Nijmegen), Zuyd University of Applied Sciences, and ArtEZ Conservatory (Enschede). All three provide students with clinical practice, research methods classes; internship is a requirement in the first two programs. ArtEZ Conservatory students have

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to undergo an experiential study and take core music studies. Zuyd University requires students to complete psychology and psychodiagnostic courses, as well as a graduation thesis (Table 7). Norway. Music therapy as a profession has been government-approved since 1992. There are two Master’s level programs: at the Norwegian Academy of Music (two years), and the University of Bergen (five-year integrated program). According to Erdal (n.d.), Norwegian theoretical foundation is eclectic, based on humanistic psychology, special education, psychotherapy and music as Cultural Engagement. Their curricula includes the following: theory and methods of music therapy, improvisation, composition, drama, clinical music therapy, neuropsychology, psychology, special education, as well as musical and personal development, including self-experience (Erdal, n.d.). Both programs require completion of a Master’s theses (Table 7).

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Table 7. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 7. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 7. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Poland. The current report includes four Master of Music Therapy (four semesters). programs: at the Karol Szymanowski Both programs include music therapy selfAcademy of Music (Katowice), Maria Curieexperiential studies, and either a clinical Sklodowska University (Lublin), Karol Lipinski practice (Porto) or an internship (Lisbon). Music Academy (Wroclaw) and Music Completion of a dissertation or a thesis with Academy of Krakow. These schools offer an oral defense is required to graduate (see either five-years, combined undergraduate Table 8). and postgraduate degrees, like those in Katowice and Wroclaw or postgraduate Scotland. The Queen Margaret University in degrees, like those in Lublin and Krakow. Edinburgh has a two-years Master of Science Figure 1. Percentage childrenschools and youth inrequire hospice care The oflatter a certain level of in Music Therapy program, following the who were assessed and participated in TAMT. musicianship from the applicants. The Nordoff-Robbins approach. Applicants have to programs in Katowice and Wroclaw provide show strong music skills, be mature, and two to three years of clinical practice and complete an observation of a preschool child require extensive music training. There are prior to the admission. Alongside the Nordoff2. Goals of Care Commonly Addressed through TAMT v a r i o u s s u b j e c t s i n t h e c a t e g oTable ry o f Robbins approach, GIM and Analytic music psychology/ psychotherapy, with all programs therapy are introduced. All students take part covering psychiatry and psychopathology. in the experiential music therapy groups and The program in Wroclaw has a Balint personal psychotherapy. They have two psychoanalytic orientation. Arts therapies clinical placements and extensive clinical include dance, art, and theatrical therapy improvisation training. Graduates have a techniques. Among other disciplines are choice between a dissertation, composition, intellectual property and copyrights, audio or additional clinical work (see Table 8). phonology, speech, and physiotherapy, to name a few. Graduation project/thesis is also Serbia. Music therapy is a recognized healthrequired to graduate (see Table 8 for more care profession and supported by the information). Republic Fund of Health Insurance (Radulovic, 2013). The Hatorum Center for Table 1. Characteristics of Children Assessed as Appropriate Portugal. Two major theoretical orientations in Education and Counseling of Music Therapy for TAMT teaching and practice of music therapy in in Belgrade offers the only program in this Portugal include developmental and didactic country. Its founder, Ranka Radulovic, approach in the area of special education and developed the following methods of music rehabilitation, and a psychodynamic approach therapy that are taught there: analytical (Leite, n.d.). Two schools are offering music listening-guided fantasies, integrative and art therapy training: the Lusiada University of music therapy methods. The music therapy Lisbon (two-years Masterâ&#x20AC;&#x2122;s degree) and a subjects include extensive training in various joint Portuguese/Spanish program of the methods and techniques, clinical practice, as Instituto Politecnico do Porto and the well as group and individual experiential University of Cadiz. The latter offers a analytic listening studies (about 260 hours). combination of on-site and online learning, for Students also learn about psychotherapy and a Postgraduate Diploma (three semesters) or diagnostics (Table 8).

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Table 8. Poland, Portugal, Scotland, Serbia, Switzerland

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 8. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 8. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 8. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 8. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Spain. The entry level in Spain is a Postgraduate/Master’s degree. However, the length of training and the amount of European Transfer Credits (ECTS) varies among the programs. The author obtained information about eight programs. Catholic University of Valencia, University of Barcelona and Universidad Pontificia de Salamanca require between 60 and 69 ECTS. A joint program of ISEP (Instituto Figure 1. Percentage of childrende and Estudios youth in hospice care Superior Psicológicos) and the who were assessed and participated in TAMT. Universidad de Vic provide a dual Master's degree (no ECTS mentioned). Casa Baubo International School of Music and Music Therapy requires a completion of 240 ECTS

while Institute MAP, Vitoria-Gasteiz requires 180 credits. Musitando School of music therapy in Madrid is a three years program, and training at the University Ramon Llull in Barcelona takes two years. All programs offer an extensive training in theories, history and practical application of music therapy with various populations. Among the other requirements are clinical practice and experiential studies, as well as numerous music and psychology/psychotherapy subjects. Research methods and final projects with defense are mandatory in all programs except the Musitando in Madrid (see details in Table 9).

Table 2. Goals of Care Commonly Addressed through TAMT

Table 9. Spain

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Table 9. cont.

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Table 9. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 9. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 9. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 9. cont.

Sweden. There are three music therapy programs in Sweden, and they differ in their teaching approaches. While the Expressive Arts only offers a three-years Bonny Method of GIM training, the Royal College of Music has a Master program in Music Education (Music Therapy profile), which takes two years to complete. The Musikhögskolan Figure 1. Percentage of children and youth in hospice care Ingesund in Arvica has a three-years who were assessed and participated in TAMT. Professional Diploma in Functional Music Therapy. The first two schools require their Table 10. Sweden, New Zealand, Australia

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students to undergo self-discovery and Intertherapy. All three provide students with clinical practice training. However, Master’s level students learn much more about theories and foundations of music therapy and complete a Graduation essay.The curriculum of the Musikhögskolan Ingesund consists of psychological and medical subjects, and also requires a completion of the independent written work (see Table 10).

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Table 10. cont.

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Table 10. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 10. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 10. cont.

Switzerland. The only government recognized India. Three programs offer internationally training program that leads to a federal level accepted training in music therapy: the title of â&#x20AC;&#x153;MAS ZFH in Klinischer Musiktherapieâ&#x20AC;? Chennai School of Music Therapy, the Music is housed at the Zurich University of the Arts Therapy Trust in New Delhi, and the Mahatma (Kande-Staehelin, 2013). It offers a Master of Gandhi Medical College and Research Advanced Studies in Clinical Music Therapy Institute. The Chennai School offers a degree, which is a four-year, part-time Postgraduate Diploma in Music Therapy, with program. The fifth year can be added to six months of online training, and six months become a certified music therapy instructor. on-campus. Its curriculum consists of the core Figure 1. Percentage of children and youth in hospice care who were assessed and participated The programin TAMT. follows a psychodynamic music therapy subjects and disciplines from a approach. Entrance requirements include psychology category. It emphasizes traditional base modules in music, medicine, and Indian medical/ healing methods and includes psychology. All students have to undergo a research class on the integration of twenty hours of continuous individual healing systems into music therapy. Table 2. Goals of traditional Care Commonly Addressed through TAMT psychotherapy and forty hours of group T h e M u s i c T h e r a p y Tr u s t o ff e r s a experiential music therapy. Students have an Postgraduate Diploma in Clinical Music extensive training in music therapy Therapy, which takes two years (part-time) to foundations, methods, and their applications. complete. Its curriculum follows European They also have three years of clinical practice programs, has a psychoanalytic/ and one year of internship (150 hours). psychodynamic orientation and requires the Among the other requirements there are completion of music therapy experiential subjects from the categories of music, studies and personal psychotherapy. The medicine, and psychology/psychotherapy, as Mahatma Gandhi Medical College and well as research methods and a thesis (Table Research Institute started as a Postgraduate 8). Diploma program in 2014 and is in a process of transitioning into a first Master's degree in Southeast Asia India in March 2015. The new curriculum is India, Thailand and Indonesia are the only not yet available at the time of writing this countries offering music therapy training at report; therefore a Postgraduate study plan various entry levels. has been included here (Table 11).

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Table 11. India, Thailand, Indonesia, China

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 11. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 11. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 11. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 11. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Thailand. The Mahidol University opened its Master’s program in July 2013. The studies take two years to complete, with an internship in the second year. At the end, students are required to present a graduation thesis. Curriculum includes core music therapy courses with clinical techniques and skills, as well as research seminars (Table 11).

it difficult to obtain their curricula and instead included general requirements in Table 8, translated from the Japanese Music Therapy Association website. Additionally, the author received the curricula of the Nagoya College and Showa University from the WFMT Student Delegate for Western Pacific. To obtain a professional accreditation in Japan, one has to complete an approved program Indonesia. The Pelita Harapan University’s and pass the exam. The entrance Figure 1. Percentage of children and youth program in hospice care requires eight music therapy requirements include a music skills exam and who were assessed and participated in TAMT. semesters (four years) of training and working experience in music teaching/ includes a one-semester internship. Its recreation. Core courses include psychology, curriculum consists of courses from all music therapy, medicine, social welfare categories, with a variety of music and studies, and education. However, the length Table 2. Goals of Care Commonly Addressed through TAMT psychology disciplines (Table 11). of clinical practice varies from two-three semesters in Showa University to six Western Pacific semesters at Nagoya College (Table 12). China. Among many schools offering music therapy training, only five have professional Hong Kong. The Hong Kong University offers music therapists as faculty members. They a Foundation Certificate (62 hours) as well as are as follows: Central Conservatory of Music a Postgraduate Diploma (PGD) in Music (Beijing), Shanghai Conservatory of Music, therapy (18 months). Upon the completion of Sichuan Conservatory of Music, Jiangxi the Postgraduate program, students can enter University of Traditional Chinese Medicine, a Master’s program at the Melbourne and Yunan Arts University (T. Gao, personal University (Australia) with an exemption of communication, October 31, 2013). All of four modules (25% of classes). Students at them offer Bachelor’s degrees, with curricula the HKU learn foundations of music therapy, Table 1. Characteristics of Children Assessed as Appropriate closely following the one of the Central including behavioral and psychodynamic for TAMT Conservatory of Music. The latter was the first approaches. Postgraduate level also includes training program in China and followed the clinical training (Table 12). course of studies established by the American Music Therapy Association, in particular by South Korea. A graduate degree is the entry Temple University. A five-years training level in Korea, being offered in about ten includes music therapy courses with eight schools. The major music therapy programs semesters of clinical practice and an are as follows: Ewha Women University, internship. It consists of core music and Myong-Ji University, Sungshin and Jeonju psychology courses, with a music Universities, and SookMyung Women’s psychotherapy/ counseling orientation. University (J. Lee, personal communication, Students are also required to complete a final April 18, 2014). Training covers a large graduation thesis. Two other programs number of music therapy disciplines, including mentioned in this report are at the Sichuan music psychotherapy, neurologic music and Shanghai Conservatories, with three- and therapy, and medical music therapy. Clinical four-years Bachelor's degrees, respectively practice lasts two to three semesters. All (Table 11). programs require the completion of an internship. The curricula also include some Japan. There are around 15 schools offering disciplines from categories of music, undergraduate music therapy training (Kwan, psychology and research/statistics (Table 12). 2013, February). However, the author found

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Table 12. Japan, Hong Kong, South Korea

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 12. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Table 12. cont.

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Table 12. cont.

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

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Australia/ New Zealand Australia. There were three Master’s level programs, at the Universities of Melbourne, Western Sydney, and Queensland. The latter, unfortunately, had its last admission in 2013. All programs took two years to complete, and the University of Melbourne offered a blended-learning model, with some classes being hosted online. Prospective students have to demonstrate a musicianship at the Bachelor’s level, and the University of Sydney requires music improvisation skills. The latter program had a creative music therapy emphasis of the Nordoff-Robbins approach. All three programs covered many disciplines from a category of music therapy (including clinical practice). University of Queensland required extensive instrumental and vocal music training. Both Melbourne and Queensland universities taught research methods and required a thesis completion (see Table 10 for more details). New Zealand. The only program, at the University of Wellington, offers a two-year Master ’s degree. Among the entry requirements are strong music skills at the Bachelor’s level and psychology-related courses. The training includes clinical practice and an internship, music therapy classes and research (Table 10). Discussion and Conclusion A primary purpose of the current report was to collect available curricula from various countries, categorize disciplines, and combine this information into easy-to-read tables. The project took more than a year to complete. As mentioned throughout the report, there were some programs that could not be included due to the unavailability of their curricula. The report showed that the principles of music therapy training vary between and within the regions. While some countries try to standardize their curricula, others have more diverse educational requirements. The entry levels range from the Undergraduate/

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Bachelor degrees to the Postgraduate Diplomas/Certificate to the Master’s degrees. These entry levels differ between and in some cases, within the countries. Although many programs offer extensive training in all categories of subjects (music, music therapy, psychology/psychotherapy, medicine/science/ other disciplines, and research methods), some others require only a limited number of courses. For instance, introductory/ general psychology has been offered in 39 programs, and anatomy and physiology in 32 programs, according to the findings (see Table 13). Music knowledge and skills requirements also vary significantly. While many programs provide extensive training in instrumental and vocal skills, only a third of programs teach improvisation/clinical improvisation to its students. Some programs have very limited theory and history of music requirements. Clinical practice requirements also differ among the programs. Some schools follow requirements similar to those in the United States, which is 1,200 hours of extensive supervised practice and internship (American Music Therapy Association, 2015). However, many other programs do not require such an intensive clinical training. Table 13 provides readers with total numbers for each discipline. The current status of music therapy as an allied health profession varies from one country to another. As this report shows, the educational requirements are not consistent. It can be a difficult task to achieve a certain level of standardization worldwide. Cultural contexts and traditional influences need to be considered in every part of the world (World Federation of Music Therapy, 1999). In the author’s opinion, to reach a worldwide recognition of our profession, we should strive to further systematize and regulate our educational requirements, including the most current research and evidence-based practice into the training of future music therapists around the globe.

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Table 13. Summary

Figure 1. Percentage of children and youth in hospice care who were assessed and participated in TAMT.

Table 2. Goals of Care Commonly Addressed through TAMT

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References American Music Therapy Association. (2013, November 23). AMTA professional competencies. Retrieved March 8, 2015, from http://www.musictherapy.org/about/ competencies/ Masterâ&#x20AC;&#x2122;s-level entry: moving forward (n.d.). Retrieved on March 9, 2015, from http:// w w w. m u s i c t h e r a p y. o r g / a s s e t s / 1 / 7 / Masters_Entry-Moving_Forward.pdf Figure 1. Percentage of childrenMusic and youth in hospice care American Therapy Association (2015). who were assessed and participated in TAMT. Professional requirements for music therapists. Retrieved March 11, 2015, from http://www.musictherapy.org/about/ requirements/ American Music Therapy Association (2014). Strategic priority on research. Overview. Retrieved December 4, 2014, from http:// w w w. m u s i c t h e r a p y. o r g / r e s e a r c h / strategic_priority_on_research/overview/ Australian Music Therapy Association (2012). How to become an RMT. Retrieved April 15, 2014, from http://www.austmta.org.au/ about/how-to-become-a-rmt British Association for Music Therapy (2012). MT training. Retrieved April 20, 2014, from http://www.bamt.org/training-inmusic-therapy.html Canadian Association for Music Therapy (n.d.). Recommended competency areas. Retrieved March 9, 2015, from http:// www.musictherapy.ca/documents/official/ Competencies.pdf Erdal, K.D. (n.d.). Music therapy in Norway. European Music Therapy Confederation. Retrieved March 11, 2015, from http:// emtc-eu.com/country-reports/norway/ European Music Therapy Confederation (2015). Training Courses. Retrieved March 9, 2015, from http://emtc-eu.com/ courses/ FouchĂŠ, S. (2013, February). Music therapy in the South Africa [Fact Page]. World Federation of Music Therapy. Retrieved March 10, 2015, from http:// www.wfmt.info/newsite/wp-content/ uploads/2014/05/Fact-Page_SouthAfrica-2013.pdf

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Grocke, D. E. (1999). Introductory comments: Setting the scene. 9th World Congress for Music Therapy, Washington, DC. Retrieved from https://www.yumpu.com/ en/document/view/4764493/ symposium-1999-washington-dc-pdfworld-federation-ofHarrison, A. (2013, May). Music therapy in Austria [Fact Page]. World Federation of Music Therapy. Retrieved March 10, 2015, from http://www.wfmt.info/newsite/ wp-content/uploads/2014/05/FactPage_Austria-2013.pdf Kande-Staehelin, B. (2013). Music therapy in Switzerland. European Music Therapy Confederation. Retrieved March 11, 2015, from http://emtc-eu.com/country-reports/ switzerland/ Kern, P. (2010). Historical aspects of WFMT: Three core questions for seven presidents. Retrieved April 22, 2014, f r o m h t t p : / / w w w. w f m t . i n f o / W F M T / 25._Anniversary_Events.html. Kwan, M. (2013, February). Music therapy in Japan [Fact Page]. World Federation of Music Therapy. Retrieved March 11, 2015, from http://www.wfmt.info/newsite/ wp-content/uploads/2014/05/FactPage_Japan-2013.pdf Leite, T.P. (n.d.). Music therapy in Portugal. European Music Therapy Confederation. Retrieved March 11, 2015, from http:// emtc-eu.com/country-reports/portugal/ Loureiro, C.V. (2013, August). Music therapy i n A r g e n t i n a [ F a c t P a g e ] . Wo r l d Federation of Music Therapy. Retrieved March 9, 2015, from http://www.wfmt.info/ newsite/wp-content/uploads/2014/05/ Fact-Page_Argentina-2013.pdf Loureiro, C.V. (2013, May). Music therapy in Brazil [Fact Page]. World Federation of Music Therapy. Retrieved March 9, 2015, from http://www.wfmt.info/newsite/wpcontent/uploads/2014/05/FactPage_Brazil-2013.pdf Radulovic, R. (2013). Music therapy in Serbia. European Music Therapy Confederation. Retrieved March 11, 2015, from http:// emtc-eu.com/country-reports/serbia/

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Scarlata, E. (n.d.). Music therapy in Italy. European Music Therapy Confederation. Retrieved March 11, 2015, from http:// emtc-eu.com/country-reports/italy/ Voigt, M. (n.d.). Music therapy in Germany. European Music Therapy Confederation. Retrieved March 11, 2015, from http:// emtc-eu.com/country-reports/germany/ Watson, T. (n.d.). Country report-United Kingdom. European Music Therapy Confederation. Retrieved March 10, 2015, from http://emtc-eu.com/countryreports/united-kingdom/ Wheeler, B. L., & Grocke, D. E. (2001). Information sharing: Report from the World Federation of Music Therapy Commission on education, training, and accreditation education symposium. Music Therapy Perspectives, 19(1), 63-67. doi: 10.1093/mtp/19.1.63 World Federation of Music Therapy (1999). Guidelines for Music Therapy Education a n d Tr a i n i n g . Wa s h i n g t o n , D . C . : Education Symposium, World Congress of Music Therapy. Retrieved December 4, 2014, from https://normt.uib.no/ index.php/voices/article/ downloadSuppFile/637/155 World Federation of Music Therapy (2014). Regional Information. Retrieved March 9, 2015, from http://www.wfmt.info/resourcecenters/publication-center/regionalinformation/

About the Author Aksana Kavaliova-Moussi, MTA, Neurologic Music Therapist, currently resides in the Kingdom of Bahrain, where she works with individuals with special needs. She completed her Master of Music in Music Therapy degree at the Colorado State University, Honor Bachelor of Music Therapy at the University of Windsor, Canada. She also holds Bachelor of Arts in Cultural Studies and Bachelor of Music (Theory and History) from Republic of Belarus. She has been the Eastern Mediterranean Regional Liaison for the World Federation of Music Therapy (WFMT) since July 2011.Aksana is a professional member of the Canadian Association for Music Therapy (CAMT), the American Music Therapy Association (AMTA), a n d t h e Wo r l d F e d e r a t i o n o f M u s i c Therapy. She has been a Co-Chair of the OCMT- Online Conference for Music Therapy since 2013. Contact: moussiaksana@hotmail.com

Acknowledgements The author would like to thank Dr. Yanyi Yang (Shanghai Conservatory of music), Dr. Hyun Ju Chong (Ewha women's University), Dr. Dena Register (Mahidol University), Helen Loth, Dr. Helen Odell-Miller (Anglia Ruskin University), MingMing Liu (Beijing Central Conservatory of Music), Mirdza Paipare (Latvia), Kwok Win Sam (Hong Kong University), Dr. Sumathy Sundar (Chennai School of Music Therapy and Mahatma Gandhi Medical College and Research Institute), Nicki Zhang (Sichuan Conservatory of music) and Ruth Oreschnick (The Music Therapy Trust, New Delhi) for sending their programs' curricula. The author would also like to thank Junko Shimomura, Karam Chakkour, Jin Lee, Kumi Sato and Hana Kang for their help with translations.

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30th Anniversary Song Writing Contest The WFMT Call for Songwriters is open to everyone. We are excited to co-create the musical aspects of our 30th anniversary with you. Put your songwriting skills to good use, and write an anniversary song celebrating 30 Years of WFMT. The chosen song will be featured on the WFMT website, and the winner will receive an individual membership to the WFMT (2014-2017 for nonmembers; 2017-2020 for current members)! Submission Guidelines • 2-4 minutes (mp3 sample) • Lyrics (PDF) • Sheet Music (PDF) Please submit your song to Rose Fienman (publicrelations@wfmt.info) no later than June 30, 2015.

#WFMT30Rocks

AWARDWINNERS 2014

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Music Therapy in the 21st Century: An Interview with Dr. Petra Kern By Roy Kennedy

Introduction As a professor in the United States of America (U.S.A.), I had the privilege to present and hold workshops in Brazil, Korea, and Costa Rica over the past ten years. In 2004, I was invited to attend an international music therapy conference in Goiania, Brazil where I gave a 3-day workshop about the different populations that music therapists serve. I also sat on an international panel with a focus on “music therapy perspectives” as the topic of discussion. I learned that there are many music therapists in Brazil. The Universidad de Goiania alone had 80 music therapy students. Many music therapists that I met in Brazil seemed to prefer improvisational Dr. Petra Kern is the recipient of the music therapy First International Service Award of the t e c h n i q u e s . D r . World Federation of Music Therapy. Kenneth Bruscia, a professor at Temple University, U.S.A., was mentioned frequently in conversations with regards to the philosophy of music therapy practiced in Brazil.

In 2005, I was approached by a former classmate, Byungchuel Choi, of Sookmyung Women’s University in Seoul, Korea about hosting the 8th Korean Music Therapy Workshop at the University of Georgia. A year later, Dr. Choi brought 50 music therapy students and/or practicing music therapists from Korea to attend 2 weeks of professional presentations given by music therapists from up and down the eastern seaboard of the United States. One year later, our collaboration continued at the 10th Year Korean Music Therapy International Conference in Seoul, Korea. I was especially impressed with the music skills of the music therapists in Korea and the spirituality that was infused into the music therapy presentations at this conference. Inspired by a colleague, I also visited in 2007 The Cloud Forest School, a bilingual school in the Monteverde mountain region of Costa Rica. I learned that the Cloud Forest School had an itinerant music teacher that gave general music lessons and conducted group sing-a-longs in English and Spanish once a week in a huge

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open-air building on the campus. I gave two presentations about the use of music as a supplementary strategy for teaching Englishas-a-Second Language to the teachers and sat in on several of the English instruction classes offered to learn about their methods of language instruction. My experience at the Cloud Forest School left me to wonder if the profession of music therapy existed in Costa Rica. During my following visit at The University of Costa Rica in 2010, I gave three Â˝ day workshops about music therapy and met one Board-Certified (MT-BC) music therapist in the country. Since then, three other students from Costa Rica returned to their country after studying music therapy at The Universidad del Salvador in Buenos Aires, Argentina, and the Georgia College and State University in the United States. I interviewed all three of these music therapists and found out that music therapists in Costa Rica are facing many of the same challenges that the pioneers of music therapy in the United States faced during the first half of the 20th century. These challenges include a) creating a national organization of music therapy, b) developing recognition of music therapy as a legitimate profession, and c) educating the general public in Costa Rica about the benefits of music therapy for different client populations. After learning about the practices and challenges music therapists experience in these countries, my curiosity about the worldwide development of the profession and contemporary topics and issues arouse. To find answers to my questions, I turned to Dr. Petra Kern, a well-known music therapist with an international reputation as a scholar, clinician, professor, and leader in the field.

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About the Interviewee Petra Kern, Ph.D., MT-BC, MTA, DMtG, business owner of Music Therapy Consulting, has a clinical and research focus on young children with autism spectrum disorder, inclusion, and coaching caregivers. She is a recipient of the AMTA 2008 Research/ Publications Award, editor-in-chief of imagine, and author of over 50 publications. A former research scholar at the University of North Carolina at Chapel Hill, Dr. Kern has taught at the University of Windsor, State University of New York at New Paltz, and Marylhurst University in Oregon, where she received the 2013 Faculty Innovation and Excellence Grant. Currently she is an online professor at the University of Louisville, Kentucky and Augsburg College in Minnesota. A former President of the World Federation of Music Therapy (WFMT) and recipient of the first International Service Award of the World Federation of Music Therapy, Dr. Kern continues to serve on various editorial boards and is an active international speaker and guest lecturer. As a board-certified music therapist in three countries, Dr. Petra Kern brings a wealth of knowledge and international experiences to the table. Her responses to my questions provide the readership of Music Therapy Today an international perspective, which may lead to cultural awareness and a better understanding of the global development of the profession. For more details, please visit her website at www.musictherapy.biz.

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KENNEDY: In July 2014, the 14th World Congress of Music Therapy was held in Vienna/Krems, Austria. What was the driving theme and in which way was this World Congress unique compared to previous ones? KERN: With the globalization of our profession, cultural awareness and crosscultural understanding have become more prominent and need to be considered when working with a cultural diverse clientele or studying abroad. Thus, the 14th World Congress of Music Therapy invited professionals and students from over 40 countries to discuss the impact of “Cultural Diversity in Music Therapy Practice, Research, and Education.” This theme was reflected in nine pre-congress seminars, four spotlight sessions featuring 21 content experts, 212 concurrent sessions, 30 roundtables, 49 workshops, and 125 posters. The 2014 congress proceedings (available online at http://www.wfmt.info/music-therapytoday-2014-special-issue/) provide insights into specific topics shared by 170 presenters.

The Interview Conducted in December 2014 via email and phone.

The combination of offering pre-congress seminars at the prestigious University of Music and Performing Arts in Vienna and staying in Krems, home of the hosting organization Ethno Music Therapy Austria and IMC University of Applied Science – both world cultural heritage cities of UNESCO – made the 2014 World Congress of Music Therapy unique. The cultural program accompanying the congress (e.g., the Opening Ceremony, a Danube River Cruise, a general rehearsal by the world famous Tonkuenstler at the Castle Grafenegg, and a typical Austrian Heurigen wine-tasting) contributed to cultural-oriented learning for congress participants, especially spotlighting the host country. The live stream videos and picture gallery accessible (until July 2017) at www.musictherapy2014.org give readers a glimpse of the unique event. It should be mentioned that this world congress utilized state-of-the-art technology, including an

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interactive congress app, and attracted social media attention. The reader might have seen Wolfi, the congress mascot in various tweets, blogs, or Facebook Groups. Additionally, the Wo r l d F e d e r a t i o n o f M u s i c T h e r a p y acknowledged outstanding contributions of music therapy experts around the world by initiating awards (see http://www.wfmt.info/ newsite/wp-content/uploads/2014/05/WFMTAwards.jpg). Overall, the 14th World Congress of Music Therapy embraced diversity and understanding of differences and offered many cultural perspectives that hopefully enriched participants’ professional and personal lives. KENNEDY: As a former President of the World Federation of Music Therapy, you have witnessed the development and implementation of music therapy programs in established and developing countries around the world. What do you think are some of the most prominent challenges to the development of music therapy around the globe during the 21st century? KERN: Over the past seven decades, the field has made great gains in establishing music therapy degree programs and services in many regions of the world, especially in Asia. Meaning, music therapy is not a new profession anymore. However, the following remain ongoing challenges for many countries in various regions of the world: • Recognition of music therapy as an evidence-based health profession; • Board-certification of music therapists to assure professional standards of practices, competences, and ethical conducts; • Regular funding of music therapy services and competitive salaries; • Expanding the number of degree programs and jobs; and • Keeping professionals in the field and offering opportunities for professional leadership and growth.

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While music therapy has received some attention throughout the world, the industry is still small. If every hospital, school, or community agency would request a music therapist on staff today, the field would not be ready to provide these services. The small number of universities offering music therapy degree programs (outside the U.S.A., Japan, and Korea) and professional membership of their respective organizations is concerning. For instance, Australia has only two training programs and 500 professional members; Indonesia has one training program and 5 professional members; and Denmark reports having one training program and 130 professional members (see WFMT Regionals Fact Pages 2013-2014 at http:// www.wfmt.info/resource-centers/publicationcenter/regional-information/). Therefore, it is no surprise that building research-based knowledge that supports evidence-based music therapy practice is a slow process. KENNEDY: Music therapy emerged in the U.S.A as an organized profession in the early 1940. Do you see any similarities or differences in the way that music therapy is developing in other countries compared to how the profession started in the U.S.A.? KERN: Similarities can be drawn to the pioneering spirit of individuals who demonstrated a passion and strong commitment in developing music therapy as a profession in their home country. It still seems to be rather a â&#x20AC;&#x153;grass rootsâ&#x20AC;? movement of clinicians than an organizational or political healthcare decision to bring music therapy services, training, and research endeavors to a country. In the past, many international students received training in North America or Europe. After returning to their home country, they have been the driving force for starting a music therapy clinical or degree program in their country (e.g., Korea, China, and Indonesia). However, over the past few years, university programs have started to partner with universities abroad (e.g., University of

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Kansas, U.S.A. with Mahidol University, Thailand) and a few foundations have asked for consultation in bringing music therapy programs to their country (e.g., Music Academyâ&#x20AC;&#x201C;Qatar Foundation). Nowadays individuals, universities, or foundations do not need to start from scratch. Successful models for clinical music therapy and degree programs are available. Additionally, clinicians, educators, and scholars travel or engage in online means to offer services, guest lectures, or research collaborations worldwide. Therefore, a wealth of expertise, knowledge, and support are available to countries that are interested in offering music therapy services to their citizens. The advancement of technology and social media also has enhanced information sharing and access to resources necessary to build new music therapy programs around the world. Yet, it still seems to be a matter of individuals convincing administrative decisionmakers to implement music therapy programs. KENNEDY: In the U.S.A., music therapists apply music therapy approaches based on theoretical frameworks from related fields. Which approaches are music therapists using around the world and is there an emerging trend? KERN: At present, we do not have any available statistical data to give a solid answer to this question. However, it appears that music therapists apply theoretical frameworks that are rooted in the culture and tradition of the country in which they work. For example, many European colleagues are applying a psychoanalytic or psychodynamic approach to music therapy, which has its origin in Western Europe (e.g., Freud, Jung, and Adler), whereas many American colleagues apply a behavioral or humanistic approach to music therapy, which emerged in U.S.A. (e.g., Skinner, Rogers). Furthermore, the numerous international music therapy students trained in both regions of the world, most likely carry over to their home country the theoretical

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frameworks they have been taught in their degree programs. There are also countryspecific approaches based on the work of specific music therapy pioneers (e.g., Orff Music Therapy by Gertrud Orff in Germany, Benenzon Model of Music Therapy by Rolando Benezon in Argentina), which are prominent in these countries and beyond. It should also be mentioned that countryspecific values (e.g., the value of music), traditions (e.g., Ayurveda), and music (e.g., instruments, scales, modes, and rhythms) play a role in developing an intervention/ treatment plan. In the 21st century, prominent U.S.-based music therapy certificate programs such as Neonatal Intensive Care Unit Music Therapy (NICU-MT), Nordoff and Robbins Music Therapy (NRMT), Neurologic Music Therapy (NMT), and Guided Imagery and Music (GIM) have spread around the world. For many colleagues who do not have an official boardcertification process in their home countries in place yet, these short-term programs that offer a designation seem to be very attractive as they bring value and merit to their original degree. While many music therapy practitioners and educators still identify themselves with a specific theoretical framework, there seems to be an emerging understanding that the approach applied depends on the population served and the evidence behind it. Consequently, music therapists working with a variety of populations and across cultures need to be fluent in various approaches despite their preferred theoretical framework and values. KENNEDY: As you mentioned, music therapists work with a variety of populations. What is the most frequently served population today and have there been any new client populations emerging?

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KERN: Music therapists around the globe are working with clients from the beginning to the end of life. Yet, it seems like country-specific demographics, governmental regulations, and support systems influence which population music therapists mostly serve. Presently, descriptive data that provides a solid profile of specific countries is only published by a few music therapy organizations and individuals. In 2014 the American Music Therapy Association reported that their members served mainly people with mental health issues (20%) followed by development disabilities (14.7%), and medical/surgical conditions (11.2%). A 2012 report by Sabbatella and Mercadal-Brotons indicated that music therapists in Spain work mainly with people with Intellectual Disabilities (16%), Depression (12%), and Autism Spectrum Disorder (9%). And, in 2011 The Japanese Association for Music Therapy reported that most members work with the elderly (45%) followed by adults (20%) and children (28%). Furthermore, for this interview, several organization leaders in music therapy provided some anecdotal information. In Australia, music therapists seem to work mainly in aged care, hospitals, and early childhood agencies. In Singapore, colleagues primarily provide music therapy services in special education settings, medical institutes, and mental health care facilities. Updates may be found at the WFMTâ&#x20AC;&#x2122;s Regional Liaisons Blog at http://www.wfmt.info/leadership/ regional-liaisons-blog/. New or renewed focus on specific populations seems to emerge based on needs, prevalence, or public awareness. For instance, music therapy crisis intervention became prevalent when the massive 2008 earthquake happened in Chengdu, China. With the increasing worldwide prevalence rate of Autism Spectrum Disorder, more music therapists may see this population on their caseload. Over the past decade, the military

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population has also given music therapy some attention in the U.S.A.; President Obama recently acknowledged the profession i n h i s 2 0 1 4 Ve t e r a n ’s D a y s p e e c h . Additionally, due to film documentaries such as “Alive Inside” more attention to Alzheimer’s patients can be expected. Looking into the DSM-5™, recognition of new populations (e.g., Internet Gaming Disorder) are on the horizon; music therapists might see these on their caseloads in years to come. It is therefore advisable to stay informed and be ready to serve current and future populations. Continuing to build the knowledge base on the effectiveness of music therapy interventions for specific populations remains equally important to sustain and advance the field. KENNEDY: You are the owner of a music therapy consulting business. Would you please describe your services and identify some of the challenges private practice music therapists face in the 21st century? KERN: Music Therapy Consulting serves national and international foundations (such as the Qatar Foundation mentioned above), institutes, organizations, and federal agencies who want to include music in their existing programs or start a brand new music therapy program that will enhance the lives of their clients or citizens. Applying a family-centered practice model, Music Therapy Consulting also supports parents, especially those of young children with Autism Spectrum Disorder, in using music intentionally in their home environment for encouraging social communication and daily functioning. Exemplifying a passion for teaching, Music Therapy Consulting offers university-based online and hybrid courses worldwide, including course development and faculty training in “excellence of online teaching.” In addition to providing clinical supervision to alumni, Music Therapy Consulting also offers short-term professional development

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opportunities for various healthcare professionals (see h t t p s : / / w w w. y o u t u b e . c o m / w a t c h ? v=rqG6bdbmFW0&list=UUGir2uomx3UxZyqrQI2HHg0). Music therapists working in private practice have great job opportunities, but also face challenges that confront every entrepreneur. Examples of these are the constant acquisition of clients, negotiation of fees or finding funding, and the daily operation of the business. Another issue is maintaining a worklife balance, which is especially important when providing health services. Nowadays, music therapists entering the private business sector do need to have basic knowledge of business administration, advertisement and marketing, and a solid understanding of business ethics. In a globalized world, it is also important to have cultural awareness and reflect on one’s own values, beliefs and attitudes to meet the needs of diverse client groups, collaborate with international colleagues, and to compete with the overall health sector. However, the most important skill to have may still be an ongoing passion for the profession, a clear understanding of ones competences and boundaries, and willingness to embrace change and innovation. KENNEDY: You are the editor-in-chief of the highly successful early childhood online magazine imagine. What are highlights of the current issue and which topics will be featured in the next one? KERN: imagine is the primary online magazine dedicated to enhancing the lives of young children and their families by sharing evidence-based information and trends related to early childhood music therapy with colleagues and parents worldwide. The 2014 issue focused on family-centered practice – a trend observed in music therapy practice and research circles worldwide. In family-centered practices, music therapists embrace strengthbased, collaborative, enhancing, and

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empowering strategies that provide families confidence and competence in parenting children with disabilities. imagine 2014 reached out to 1.5 million potential readers via email and social media featuring 44 textbased articles, including 15 videos, 13 audio files, 9 audio podcasts, 4 photo stories, and numerous hyperlinks that invited to additional exploration. imagine 2015 is re-visiting inclusion â&#x20AC;&#x201C; an ongoing hot topic around the world that deserves ongoing attention from music therapists and related professions. imagine 2015 also invites authors to share strategies utilized in early childhood music therapy that support generalization of skills across settings, people, subjects, behaviors, materials, and time. In general, imagine publishes articles that are directly related to early childhood music therapy (ages: zero to five) and grounded in evidence-based practice. The submission deadline is May 15 each year. imagine is currently free and accessible worldwide. However, to keep this evidence-based resource available to everyone, advertisements and sponsorships are needed to cover the editing, production, and website costs (see http://imagine.musictherapy.biz/Imagine/ home.html).

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K E N N E D Y: Yo u a r e a n e x p e r t o f international music therapy. In your opinion, what are three key strategies of moving music therapy forward in the 21st century? KERN: First, the profession needs to tackle the ongoing challenges mentioned under your second question. Second, the field may benefit from looking at the industry through a business lens, seeking support from experienced CEOs, and following a step-bystep plan. Thirdly, it might be advantageous to collaborate with major players in the health sector (such as the World Health Organization) and lead a worldwide campaign that includes politicians and celebrities. However, this is not a small undertaking; it will require major collaborations with various stakeholders. This could be a future focus of the WFMT Council or an international task force. Meanwhile, the profession will continue to grow at its own pace through the efforts of dedicated individuals and advocacy groups around the world. KENNEDY: Thank you Dr. Kern for sharing your global perspective and opinion about music therapy in the 21st century with the Music Therapy Today readers and me. While my reference point is the USA (as reflected in my questions), I acknowledge the diversity of music therapy research, education, and practice worldwide. Bringing awareness to the current status of music therapy worldwide may spark discussion about future directions.

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Resources Mentioned in this Interview Kern, P. (2015, January 24). Music therapy consulting. Innovation through creativity and knowledge. [Web log post] Retrieved f r o m w w w. m u s i c t h e r a p y. b i z / Dr._Petra_Kern/Home.html Kern, P. (Producer). (2015). Music Therapy Consulting [Video]. Available from https:// www.youtube.com/watch? v=rqG6bdbmFW0&list=UUGir2uomx3UxZyqrQI2HHg0 Kern, P. (Ed.). imagine.magazine: Early childhood music therapy. Retrieved from http://imagine.musictherapy.biz/Imagine/ home.html [Photographs of WFMT Awards] (2014). Trieannual award winners. World Federation of Music Therapy. http://www.wfmt.info/ newsite/wp-content/uploads/2014/05/ WFMT-Awards.jpg World Congress of Music Therapy (2014). Cultural diversity in music therapy practice, research, and education. Proceedings of the World Congress of Music Therapy. Vienna/Krems, Ausria. Retrieved from http://www.wfmt.info/ music-therapy-today-2014-special-issue/ Wo r l d F e d e r a t i o n o f M u s i c T h e r a p y (Producer). (2014). Opening ceremony. [Live stream videos and picture gallery]

Available from www.musictherapy2014.org Wo r l d F e d e r a t i o n o f M u s i c T h e r a p y (Producer). (2015). WFMT Regionals Fact Pages 2013-2014 [Video]. Available from http://www.wfmt.info/resource-centers/ publication-center/regional-information/ World Federation of Music Therapy (2015, January, 24). World Federation of Music Therapy: Regional liaisonâ&#x20AC;&#x2122;s blog [Web log post]. Retrieved from http://www.wfmt.info/ leadership/regional-liaisons-blog/ About the Author Roy Kennedy, Ph.D., MT-BC, is an associate professor of music therapy at the University of Georgia, U.S.A. While previously providing music therapy services to various populations, his primary research interests include guitar pedagogy for music therapists, music therapy for English-as-Second Language learners, adults with substance abuse problems, and skill generalization of students with developmental disabilities. Dr. Kennedy has presented his work in the USA, Brazil, South Korea, and Costa Rica. He continues having an interest in the international development of the profession and is eager to make future contributions. Contact: rkennedy@uga.edu

Roy Kennedy Photo courtesy of Eric Jackson

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Thirty Five Years as a Music Therapist: The Best Job in the World… By Amelia Oldfield

Introduction I started working as a music therapist 35 years ago in 1980. It was a full-time post at a residential unit for around 250 people with a wide range of learning disabilities and ages. The thrill and excitement I felt at becoming a music therapy clinician was very similar to the enthusiasm I see in my emerging music therapy students today. The elation I felt then when I was able to make contact through improvised musical dialogues with clients who were usually withdrawn and noncommunicative, is the same as I felt a few days ago when working with a four-year-old boy with autistic spectrum disorder and his mother. After being completely silent for 18 months he has Ms. Amelia Oldfield is the recipient of suddenly started using the First International Clinical Impact vocalizations and Award of the World Federation for words and marched Music Therapy. around the room with me and his mother excitedly shouting ‘start!’ and ‘stop!’ as I matched his movements through my improvised clarinet playing.

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Nevertheless, in many other ways, the setting within which I work, the National Health Service itself, the way society views people with special needs, and the recognition and development of music therapy as a profession both nationally and internationally have all changed hugely over the past 35 years. Of course, I have also changed and evolved both personally and professionally. In this article I will reflect on some of these changes as well as describing some of my current music therapy work, and where I feel I have arrived now. How it All Started When I was five years old I remember dancing in front of a full-length mirror in the bathroom and singing improvised gobbledygook at the top of my voice with huge conviction and enjoyment. The following year I begged my parents to let me have piano lessons, which they eventually agreed to a few years later. I always enjoyed my piano lessons and playing

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but in my teens I wanted to play an instrument which would allow me to play with others so I started learning the clarinet. Gradually this took over as my first instrument, but I am very grateful to have learnt the piano early on as it has been invaluable in my work as a music therapist. As a child, I also loved figure skating to music which I was able to do frequently as we lived very near to a large ice rink. I can still remember the excitement and impatience to get onto the ice and move to the music, as I laced up my skating boots as quickly as I could. Looking back I realize that I have always liked being actively involved in playing music, singing or moving to music rather than just listening – although I also enjoy going to concerts or the opera and allowing the music to transport me to other worlds. I decided to study music at the University because I loved music more than anything else, but I didn’t really have any idea what these studies would lead to. I first heard about music therapy between the second and third year of my music degree. A physiotherapist, who was a family friend, described to me how she had worked with a child with cerebral palsy, alongside a music therapist in London, helping the child to move while the music therapist improvised music to support and accompany the movements. I think I knew at once that this was what I wanted to do. It really was a revelation, suddenly here was a profession where I might be able to use music actively and creatively, and at the same time perhaps help others through my playing. Music Therapy in the UK in the 80s When I trained with Juliette Alvin at the Guildhall School of Music And Drama in London in 1979 this was one of only two possible music therapy training courses in the UK. The other course was the Nordoff and Robbins training course set up a few years previously by Sybil Beresford Pierce. Both courses were one year full-time post-

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graduate courses based in London, leading to music therapy diplomas. At that time there were approximately 70 music therapists working in the UK who seemed to be dominated by these two talented, charismatic and determined older ladies, Juliette Alvin and Sybil Beresford Pierce. Unfortunately, they could not stand one another. I remember attending music therapy conferences in London where the two women sat in separate parts of the hall surrounded by their followers, with arguments about ‘what is music therapy’ raging between the two groups. Today, there are ten times as many music therapists working in the UK, the profession has become state-registered and there are seven music therapy training courses all leading to MA qualifications. While there are still different views amongst trainers of music therapists in the UK, we regularly meet, exchange views and support one another in an amicable way. We advise potential students to look around and make their own decisions about where they would like to train. Perhaps new fields such as music therapy need strong singleminded and independent characters to initially launch the profession, but following generations can then become more openminded and conciliatory. In the early 80s, a relatively high proportion of music therapists worked full-time in large institutions and were expected to treat huge numbers of clients every week. In my first job it would not be unusual for me to see four groups of six to eight clients as well as four individuals in one day. Often I worked on my own although I tried to organize groups where I worked jointly with other therapists and nurses. I had to pull a trolley full of instruments from one ward to the next in between the groups, and I remember being physically as well as mentally exhausted and drained by the end of most weeks. I tried to write effective notes and reflect on each of my clients, but I don’t think the quality of this reflection is what I would now expect of myself or other music therapists. One big advantage of this music therapy job was that I shared an office with a speech and

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language therapist and the neighboring office housed the clinical psychologist and several physiotherapists. As a result we all cooperated and worked in an effective multidisciplinary team which was a great advantage for many of our clients. It was a wonderful way for me to learn and expand my knowledge and led to my first publications which were a series of three articles written with a speech therapist, a physiotherapist and an occupational therapist exploring links between these professions and music therapy (Oldfield & Parry 1985; Oldfield & Pierson 1985; Oldfield & Feuerhahn 1986). This multi-disciplinary exchange is sometimes difficult to re-create now that many larger institutions and hospitals have closed down and large groups of different professionals no longer work geographically close together. It was conversations with the clinical psychologist, Malcom Adams, which spurred me on to set up a research investigation in 1983. I wanted to investigate the effects of music therapy with groups of profoundly learning disabled adults and he suggested a cross-over design comparing music therapy with play. Together we elaborated a video analysis method which involved coding behaviors of individual clients every five seconds. This video analysis system has now been successfully used in at least five other major music therapy research investigations, two of my own and three of music therapy research students whose investigations I have supervised. I finished this research investigation in 1986 and was excited to present my results in various music therapy conferences in the UK. Unfortunately, at the time, quantitative outcome research was not in fashion in the arts therapies community in this country. Many arts therapists resisted any attempts to quantify their work and felt that to do so resulted in losing the creative side of the intervention. Although disappointed, I was not too discouraged. I knew, deep-down, that the

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research had been thorough and of high quality and I was able to publish the results of the investigation (Oldfield & Adams 1990; 1995; Oldfield 1993). I also felt that I had learnt a huge amount about my own clinical work through hours of detailed video analysis. Now I attend conferences where qualitative research is no longer considered of value, and some music therapists are under pressure do undertake more randomized control trials (RCTs). Although I am currently involved in several RCTs, I find myself arguing the opposite way to what I was saying in the 80s, urging researchers to remain interested in the quality of the musical interactions rather than focusing only on behavioral outcomes. Perhaps I have a tendency always to defend the minority opinion, or perhaps experience has taught me that many different points of view can be valid, particularly in a field as varied and wide as music therapy. This openness to different ways of viewing or thinking about music therapy also came about because of experiences of teaching abroad, which started in Nantes and Paris in 1983. As a child I was very fortunate to be brought up speaking three languages, French, German and English, which meant that I could give workshops in French about the music therapy work I was doing in the UK. Of course it was great fun for me to travel in this way, but it also meant that I had to learn to adapt to different views and expectations and be able to explain and justify to a wide audience why I was working in the way I was. 1985 was the year of the World Music Therapy Conference in Genoa, Italy. The combination of my knowledge of languages, music therapy qualifications and experiences teaching abroad meant that I was invited to attend this conference as a member of the World Federation of Music Therapy Working Party, a group which had been set up at a World Music Therapy Conference in Paris in July 1983. Before the Genoa conference my colleague Tony Wigram and I had put together a draft proposal for this Federation and rather to our

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surprise we found that during the conference this document was used at an official televised congregation to actually formerly create the World Federation of Music Therapy. I was excited to be part of an event that I hoped would promote further exchange and debate amongst music therapists internationally, however, I realized then that meetings and policy making were not my main sphere of interest. I was happy to let others continue this work while I remained more focused on my clinical practice. Workshops and Videos As there were relatively few practicing music therapists when I started my career, a significant portion of my time (and the time of most of my music therapy colleagues) was spent running workshops about music therapy both at the institution where I worked and at other institutions across the country. More recently I have written about these types of music therapy workshops and suggested a specific format which combines talking, case presentations and practical music making (Oldfield, 2006b). During workshops I found that there would be frequent requests from participants for ideas of musical activities that they could use, and it was in response to this demand that my music therapy colleague John Bean and I decided to put together a book of such activities (Bean & Oldfield, 1991). This book has been very successful and was re-printed by Jessica Kingsley publishers in 2001. It has been translated into Russian (two editions), Japanese and Greek. At the time the book first came out I remember that some music therapy colleagues were skeptical about this publication, expressing concern that if we made suggestions of musical activities for non-music therapists to use, then this would stop people employing qualified music therapists. Actually in my experience the opposite occurs, the more our non-music therapy colleagues experiment with music making, the more keen they become to employ specialists who will be able to provide

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expert advice and a wide range of possibilities. Anyway, we can’t claim, as music therapists, that we are the only people who can make music with others – this would be like saying to a mother that she wasn’t qualified to sing a lullaby to her baby… However, what we can say is that we, as qualified music therapists, are the only people who can practice music therapy. I quickly realized that one of the best ways of conveying to others how I worked as a music therapist was not so much to talk about my work but to show video excerpts of my sessions. I mentioned earlier that I learnt a great deal about my own work through the video analysis I had to do in my initial research. I analyzed 40 half-hour video tapes, watching them all several times in order to code behaviors that occurred every five seconds. I think this experience must have sparked an interest in creating music therapy training videos, and given me the patience to spend many hours deciding exactly where the best starting and ending points of clips should be. Over the years I have been lucky enough to work with excellent professional documentary film makers, and together we have created six music therapy training videos, two of which have won Royal Television Society Awards. (I have included a list of these videos at the end of the article). I still enjoy editing videos of my clinical sessions, my main difficulty is deciding which bits I am willing to cut. Today, I cannot imagine teaching about music therapy without video examples. I think that one of the main reasons I have been invited to give so many lectures and workshops both in the UK and all over the world is because of all the DVD excerpts of a wide range of clinical work that I can show, which now span 35 years of music therapy practice. Of course I always gain written consent before videoing sessions or showing excerpts of these sessions. Even if I have this permission I won’t video or show videos if I think the clients or their families will be adversely affected in any way. So many families I have worked with have been grateful to have video-evidence of their child’s progress

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and delight in music therapy sessions. I remember one mother telling me that she was moved and elated every time she watched the video, and another explaining that watching the DVD had made her proud of her son in a way she had not been before. Parents also often enjoy showing the videos to the wider family and this can be a way for grandparents to gain a better understanding of their grandchild’s special needs. On other occasions parents show the videos to nursery teachers or other professionals, thereby helping progress in music therapy to become generalized to other settings. I also use video feedback as part of my music therapy treatment. Watching excerpts of music therapy sessions can be useful for children and parents to gain insight into their own strengths and difficulties. Sometimes parents who struggle to see beyond their children’s difficulties, will be able to recognize how creative their child is when watching a video of a musical interaction. Other carers who don’t believe that they are effective parents can be helped to recognize that they are kind and warm towards their child when observing action songs or improvised musical games they are involved in together.

Video Recordings I also use video feedback as part of my music therapy treatment. Watching excerpts of music therapy sessions can be useful for children and parents to gain insight into their own strengths and difficulties.

Having Children, and Family-Focused Music Therapy My four children were born in 1988, 1990 and 1992 (twins). By this time I had moved to a different part-time (three days a week) music therapy post in child and family psychiatry. I found it worked well to combine part-time music therapy work with being a mother. Actually, I think the experience of being a parent was helpful in my clinical work where I could easily empathize with mothers who had sleepless nights, or with the difficulties of managing a rebellious toddler. Equally my experiences at work were useful at home. For example, the strategies I used to communicate non-verbally through music making with non-verbal children in my music therapy sessions, made it easy for me to engage with my own pre-verbal babies.

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With part of my world now focused on my own children perhaps it is not surprising that it became clear to me around this time that it was a great advantage to work jointly with both the carer and the child in the music therapy room. Actually this realization initially occurred when two-year-old John, a boy with an early autistic spectrum diagnosis refused to come into the room without his mother. The joint work that the three of us did together over 18 months, was so successful that his mother and I wrote a book chapter together (Jones & Oldfield, 1999). Today, I struggle to imagine working with preschool children without at least one of their carers in the room. A part of me focuses on the child, another part on the carer, and a third part on what is happening between the two of them, which is perhaps the most important aspect. I have come to realize that there are many reasons why it is important to work with parents in the room. Initially, children will be reassured to have their parent present and may be physically supported and guided by the parent. I will be able to find out as we work what the child can or can’t do and sometimes parents will be able to explain what a non-verbal child (or a child whose speech is unclear) might be trying to say to me. It is important for parents to share and witness their child’s enjoyment of music making and to be able to see a child who usually fails succeeding. Music therapy sessions can help parents to become playful themselves develop new ways of communicating with their children and feel that they can contribute in a positive way. Parents may see some of their children’s behaviors in a new light, and will also come to expect their child to succeed outside music therapy sessions as well as in the sessions, thereby ensuring that progress achieved in music therapy becomes generalized to other situations. Of course there will be exceptional circumstances where it is not helpful to have the parent there, perhaps if the parent is exhausted and needs a break, or perhaps if there is a history of abuse which needs to first

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be worked through. However, overall the advantages of working with the parent almost always out way the possible disadvantages. In 1998, Anglia Ruskin University, Cambridge provided me with some funding to set up a research investigation into working with small groups of mothers and young children in the child and family psychiatric unit where I was working. Families attending the unit were considered at risk and parents were referred for a number of reasons such as: post-natal depression, previous alcohol or drug abuse, history of sexual abuse, extreme neglect and poor parenting, history of previous children being taken into care. I studied three different groups: 1) a mothers and toddlers group attending six play sessions followed by six music therapy sessions; 2) a group of mothers and babies who took part in three ‘one-off’ music therapy sessions which were videoed and followed by a discussion group a week later with the same mothers and 3) a group of ‘non-clinical’ parents and children who attended six weekly music groups in a mainstream nursery. All the sessions were videotaped and analyzed using the same system as in my previous research which I described earlier (in the ‘Music in the UK in the 80s section) and parents filled out questionnaires after each session. Results were positive and showed that aims and objectives set out for parents and children were achieved in both play sessions and music therapy sessions. All the children were engaged, however the ‘clinical’ parents were not able to recognize their own children’s achievements, whereas the ‘non-clinical’ parents were. This indicates how important it is for music therapists to work closely with parents and support them to enjoy music making with their children (Oldfield & Bunce, 2001; Oldfield, Bunce, & Adams, 2003). A few years ago I really enjoyed jointly editing a book about Music Therapy with Children and their Families with my colleague Claire Flower (Oldfield & Flower, 2008) and gathering together chapters from a number of

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different music therapists working with families in the UK. Internationally, the interest in family music therapy work has grown considerably since the time of this publication leading to another book, (Edwards, 2011), and regular symposiums and round tables organized on this topic at all major recent international music therapy conferences. In 2014 our Family book (Oldfield & Flower, 2008) was translated and published in Korea. Today, I received a contract to write a chapter in a future book entitled: Models of Music Therapy with Families, edited by Lindahl Jacobsen and Thompson (expected publication in 2016), which shows how far this area has developed in a relatively short space of time. Training Music Therapists In 1994, my colleague, Helen Odell-Miller and I jointly set up a music therapy training course at Anglia Ruskin University, Cambridge. This course has now been running for 21 years and has gradually become a two year, full-time postgraduate MA course. We audition and interview applicants thoroughly and almost all our students are mature, motivated and talented, and a complete joy to teach. Early on I decided that I would continue my clinical work for three days a week and lecture for the two remaining days, happily leaving my colleagues to organize and manage the training course itself. Apart from the fact that I loved the music therapy work and didn’t want to stop, I also felt that I needed to keep it going in order to be an effective trainer of music therapists. My lectures invariably refer to my ongoing clinical practice, I always show DVD excerpts of my work and reflect with the students on what is happening. I am certain that this teaching has greatly improved and sharpened my clinical practice. Having to explain why I am playing and acting in the way that I am on the DVDs, means that I have to be clear about my aims and my objectives. I have to be able to explain why I am singing a particular song or improvising on the clarinet or the piano in a specific way. I sometimes have to acknowledge that I may not have done something very well

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and reflect openly about how it could be improved. However, as my teaching is so heavily dependent on my own clinical practice I also have to be clear that there may be many ways to help a client through music therapy and that â&#x20AC;&#x2DC;myâ&#x20AC;&#x2122; way is certainly not the only way. Although students can use ideas and techniques from my practice, in the end they have to find their own ways of improvising and using their first instruments, and discover their own styles of interacting through music making. Whenever possible I encourage students to video their own music therapy sessions on their placements. I suggest that they view these videos several times and choose excerpts to bring to group supervision sessions with specific questions to ask the group. As explained earlier, even just viewing oneâ&#x20AC;&#x2122;s own music therapy work is an invaluable learning experience. Students need to first recognize their own specific musical and interactive strengths, and then build on these strengths to improve weaker areas. I think it is important to encourage students to nurture their own love of music and their enjoyment of playing their first (and sometimes second and even third) instrument. I know that my passion for clarinet playing comes through in my clinical work and that it is important for me to maintain my standard of playing and my own excitement about playing through practice and chamber music outside music therapy. As musicians most of us will have spent more time with our first instrument than with anyone or anything else and therefore, this is a special and intense relationship which can be used to great benefit in our music therapy work. We are more likely to be able to communicate and relate to someone through this instrument than through a different instrument which we may not master so well and do not feel a strong affinity for. In a few months I am delighted to say that a new book will appear about the use of different instruments in music therapy. With two other colleagues, I have gathered together over 50

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case studies where music therapists from all over the world describe how they have used their first instruments to great advantage with a wide range of clients (Oldfield, Tomlinson, & Loombe, 2015). One of the recent developments on our Music Therapy MA training course has been that in 2011 we created a dramatherapy training course which runs alongside the music therapy training. Students share some core lectures, and lecturers also teach jointly for some combined workshops. This creates new possibilities and ideas as there are clearly many overlaps between the two professions. In December 2012 I organized a successful joint music therapy and drama therapy conference encouraging drama therapists and music therapists to co-present and explore. Ph.D. Research, Focus on Autistic Spectrum Disorder In 2000, I was fortunate to receive a Millennium Research Fellowship from the Music Therapy Charity which enabled me to investigate two aspects of my clinical practice with children with autistic spectrum disorder: individual music therapy with pre-school children with autistic spectrum disorder and their parents; and music therapy diagnostic assessments with primary aged children suspected of being on the autistic spectrum. I studied ten dyads who each received individual weekly music therapy sessions for approximately 22 weeks. We videoed all the sessions and analyzed the tapes. The parents were interviewed and asked to fill in questionnaires both pre- and post-treatment. Nine out of the ten dyads achieved some or all of the individual aims set out before treatment began. The parents all felt that music therapy had been effective. I was also able to look at how I spent my time in music therapy sessions across the ten children and found that I was generally very active and spent a high proportion of my time vocalizing. Carrying out this research taught me a huge amount about my own practice and helped me to define the

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characteristics of my approach with this client group (Oldfield, 2006a). Today, I would say that my main working tool is live, improvised music making. I like to use my first instrument, the clarinet, but also use the piano and my voice, sometimes with guitar or percussion accompaniment. After a couple of initial assessment sessions I establish clear objectives in my work which I determine and discuss with parents and the multi-disciplinary team. I have a positive stance where I consciously focus of what the child and the parent can do, and as their confidence increases, we address the weaker areas and the difficulties. I have found that there are eight further points that appear to characterize my approach with young children with autistic spectrum disorder and their parents: motivation, structure, basic exchanges, balance (between following and initiating), control, playfulness / drama, movement, and involving parents. Children will initially engage because they are motivated by the musical instruments and music-making. From the very beginning I establish a clear structure where the room is uncluttered and one or two instruments are taken out, played with and then put away, having established an ending to our improvisation by saying: ’one, two, three…. finish.’ There is also a clear Hello song at the beginning and a familiar ending on the bongos at the end of each session. Throughout the session I will look out for often non-verbal basic exchanges and in our musical improvisation I will constantly be aware of the importance of the balance between following the child and initiating myself. With most dyads there will be issues of control which will need to be addressed but I will try to do this playfully, using humor and drama. Many young children with autism enjoy moving around as well as focusing on playing so I usually incorporate musical improvisations and games which involve moving around the room. As mentioned previously I involve parents in my sessions

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whenever possible and in many cases the work becomes a partnership between the three of us (Oldfield, 2006a). For the last couple of years I have been involved in the large world-wide Time-A R a n d o m i z e d C o n t r o l Tr i a l r e s e a r c h investigation for young children with autistic spectrum disorder led by Christian Gold in Bergen, Norway. Clinical trials are taking place in around ten different sites all over the world with the music therapy being carried out by many different music therapists. I have been involved in setting up the research at two sites in the UK and am currently providing clinical supervision for the music therapists working on the trial here. The research protocol has defined the approach to be used as improvisational music therapy and has listed some essential features as well as some desirable features the work should have. When examining my own approach I have found that it fits with the required criteria, but that I would, in addition, be seeking a wider range of musical repertoire and improvisation from the music therapist (in order to motivate the child); I’d use a more clearly structured approach, incorporating the geography of the room for specific activities; I’d advocate the use of movement; I’d more consciously shift between following and initiating in our improvisations; and I’d work with parents as a support for the child but also considering the parent’s own needs. The other part of my Ph.D. investigation involved comparing Music Therapy Diagnostic Assessments (MTDA), which I had developed in my clinical practice, with Autistic Diagnostic Observation Schedules (ADOS) carried out on 30 children suspected of being on the autistic spectrum. A scoring system similar to that used for the ADOS was devised for the MTDA. Children were interviewed after the MTDA and the ADOS and the testers filled in questionnaires about their perception of the assessment tool after every test. Results indicated that the two assessments showed high levels of agreement between diagnostic

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categories, indicating that the MTDA was providing similar information as a recognized and established diagnostic tool. However, the two assessments also showed significant differences in scores of individual questions, indicating that the MTDA could serve a distinct purpose in helping the psychiatric team to diagnose children with autism (Oldfield, 2006b). The MTDA is now routinely used in my clinical practice in child and family psychiatry. Although the section I researched in my Ph.D. was about autism spectrum disorder, there are also sections on hyperactivity, emotional disorders and learning disabilities. The test has been refined and improved over the years and continues to be adapted as colleagues use it in slightly different clinical settings. It has been helpful and sometimes invaluable in highlighting strengths and sometimes difficulties that have not been apparent through other tests or in other settings. However, it is important to remember that it can only be used within the context of a multi-disciplinary team and does not stand alone as a diagnostic test that can be used independently. One of the activities that form part of the MTDAs but that I also use in music therapy treatment are what I call â&#x20AC;&#x2DC;song stories.â&#x20AC;&#x2122; I have elaborated a system which involves improvised joint story telling combined with improvised music making. Children create stories which I mirror and / or contribute to and we improvise music at the same time. When reflecting on these stories I consider the music, the non-verbal communication between us and the verbal content of the story (Oldfield & Franke, 2005). In some ways this is similar to the way drama therapists create stories in their work. Perhaps there will be opportunities to explore these links and other connections between the two professions in the future. When reflecting on the four music therapy research investigations I have instigated over

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the years it is clear that there are common points to all these projects. All projects arose out of music therapy practice and investigated music therapy in a clinical setting, as it occurred naturally without attempting to make changes for the sake of the research. In all four investigations I was both the researcher and the music therapist being investigated and I combined both qualitative and quantitative approaches. Three out of the four projects depended on the music therapist setting clear goals for her clients and used detailed videoanalysis. This doesnâ&#x20AC;&#x2122;t mean I think that this is the only way for music therapists to carry out research. However, experience of supervising music therapy Ph.D. investigations indicates that researchers find it easier if the initial drive and research questions come out of clinical practice and experience, and results are then directly relevant to working music therapists. What I am Doing Now I currently continue to work two and a half days a week as a clinical music therapist in child and family psychiatry and child development, and the remaining two and a half days as a professor on the MA music therapy training at Anglia Ruskin University. I have already mentioned some aspects of my clinical work in this article, but not the weekly music therapy group that I run for all the children, or the short-term intensive work I do with children and families. The group is a challenge because the children vary hugely in age (usually from 5 to 13 years old) and ability and we have children arriving and leaving every two weeks or so. I work very closely with the multi-disciplinary team and corun the group with one of the psychiatric nurses on the unit. Together we plan and review the group every week, focusing on specific aims for those children who have been on the unit for more than two weeks and using the session as an assessment tool for those who have just arrived. We prepare arrivals and departures and have a specific familiar beginning and ending activity. Group music making and

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improvisation will follow but may take different forms and be more or less structured depending on the strengths and weaknesses of the children attending. Sometimes we make up quite elaborate pieces with leitmotivs and subgroups playing at specific times. At other times I may simply attempt to stop and start together and feel a sense of achievement if the children all remain in the room. I alternate between familiar and more demanding activities, activities which require everyone to play together with activities where we listen to a soloist, energetic lively activities with quiet and thoughtful activities. All the time I am looking out for each of the children, aware of their strengths and difficulties, and trying to anticipate and pre-empt situations which will be too hard for individual children to bear. At times I will openly address difficulties between children and ask the group to help find solutions. At others, I diffuse issues before a conflict develops, often using diversion tactics. At the end of the week when we feedback what has happened to the multi-disciplinary team it is astounding to discover how often the children’s behavior is different in this music therapy group to the rest of the week. I think the music group is particularly exciting and motivating for many of the children, and a welcome non-verbal social forum for many of the children who struggle with verbal communication (Carter & Oldfield, 2002; Oldfield, 2006b).

Annie Annie (9) and her family were admitted to the child and family psychiatric unit in crisis. Annie had a diagnosis of autistic spectrum disorder and learning difficulties. Over the past year she had become very disturbed, screaming, crying and frequently attacking her parents and her brother. She had been excluded from the special school she was attending. During her first week at the unit she attacked all the members of staff and nothing seemed to help her. The team were wondering whether the unit was the right place for this family. In her first music therapy session Annie tried to shut me out of the music therapy room. I put my foot in the door and gently hummed along to her swaying movements. Very gradually I entered the room, swaying and humming in synchrony with both Annie and her mother. After about 20 minutes, I introduced some clapping games, and after a further 20 minutes was able to accompany Annie on the piano. At the end of the session both Annie and her mother spontaneously hugged me causing both me and the nursing team observing the session through a video to fight back tears. From then on the whole team rocked and hummed with Annie at every opportunity and a window of possibility was opened to work with this family on the unit.

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Lisa Lisa (8) was referred to the unit with her mother, Gina, who believed that she had autistic spectrum disorder and attention deficit disorder. In her second Music Therapy Diagnostic Assessment (MTDA) session Lisa improvises a song story while accompanying herself on percussion, I sing and improvise on the piano to support her. Lisa is engaged and free in her playing, and able to pick up my musical cues as well as initiating her own. In the test, she did not score above the cut-off point for either autism spectrum or attention deficit disorder. While playing, Lisa tells a story about a baby crocodile who is not as scary as it looks and wants to have friends. The crocodile’s mother is very present in the story and the baby crocodile keeps repeating to its mother that it is not what it seems, it is a friendly crocodile. With Lisa’s permission I show the DVD of the session to her mother, Gina, who is delighted and moved to see her daughter so engaged in this creative story. I am able to steer her away from looking for symptoms of autism or attention difficulties, and instead appreciate her daughter’s creativity. The following week Gina takes the DVD to a parenting group run by the clinical psychologist at the unit. They use this video excerpt to begin to change Gina’s view of her daughter’s difficulties, and acknowledge possible attachment issues between the two of them.

Ben Ben (12) comes willingly to his third individual music therapy session. He was admitted because of severe behaviour difficulties at school and at home, low self esteem, and difficulties with peers. It has been agreed by the team that he would benefit from four individual music therapy sessions to increase his self confidence and give him a chance to express his feelings non-verbally, as he has been unwilling to engage in any talking therapies. During a joint improvisation on the xylophone, he plays and repeats a sequence of notes which I recognise as a sequence that one of the other children at the unit invented the previous day. When questioned, Ben tells me that his mate taught it to him during the music group the day before. They go on improvising together and gradually another theme emerges which we repeat together several times. I write the notes down on a score, clearly identifying Ben as the composer. He leaves the music therapy room whistling. Later in the week the two boys continue exploring ‘riffs’ together in the music room in the evening. At the end of the week in the management review meeting the team identify that Ben’s self esteem has improved and that he is making a friend on the unit.

Here are a few snapshots of very recent shortterm work. All the names and details have been changed for confidential reasons. In my two single-authored books I have written more extensive case studies and have also attempted to describe my 'emerging theoretical methods by explaining what I do in my music therapy sessions, and why I do it (Oldfield 2006a; 2006b).

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In my teaching job at the University I share my on-going clinical work with music therapy students and give lectures about my practice and about music therapy research. I also provide clinical supervision for the students’ own clinical work on their placements and run instrumental clinical improvisation classes.

outstanding and excellent it might be – as highly as management skills or research income generation (for example). As a result I have seen many of my excellent music therapy colleagues leave music therapy and in some cases become less fulfilled and excited about their work than previously.

In addition to the work at Anglia Ruskin University in Cambridge I am on the teaching team of the music therapy training course at Montpellier University, France, where I run yearly intensive lectures and workshops (in French). Similarly, I regularly teach on the Würzburg Music therapy training course in Germany (in German). In April 2015 I fly to Philadelphia for a few days where I will speak at a one day music therapy conference and attend an international music therapy research consortium meeting. The following week I will teach music therapy students in Katowice, Poland.

I am grateful to Anglia Ruskin University for recognizing the importance of continued clinical practice by giving me a professorship even though I only teach there on a part-time basis. I am honored and delighted to have received the first Clinical Impact Award from the World Federation of Music Therapists in 2014, which is evidence that this organization also recognizes the central importance of clinical practice.

Over the next six months I will be completing the editing of the book I mentioned earlier (Oldfield, Tomlinson, & Loombe, 2015) and I will be writing two chapters for future music therapy textbooks. It is a busy schedule, but I hope to manage it, there have been other years when I have had even more commitments. I know I can’t take any more on just now, or my clinical work will suffer – and I always have to leave space for my clarinet playing which takes up around three evenings a week – in addition to concerts which occur about once a month. Coda When I started working as a music therapist I never dreamt that this work would lead to research investigations, running workshops all over the world, making training videos or writing books. I have greatly enjoyed all these activities, but know that the root of everything remains in the clinical work, without which everything else becomes meaningless. Sadly, most organizations do not value the work ‘on the ground,’ in other words clinical practice or direct teaching – however ,

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I feel privileged to be able to do work that is both creative and rewarding. It is also a privilege to then take this work to the University to share with music therapy students. I truly do feel that being a music therapist is the best job in the world…. References Bean, J., & Oldfield, A. (1991). Pied Piper Musical Activities to Develop Basic Skills. Cambridge, UK: Cambridge University Press. Re-printed by Jessica Kingsley publishers in 2001.Translated into Russian (two editions), Japanese and Greek. Carter, C., & Oldfield, A. (2002). A Music therapy group to assist clinical diagnoses in Child and Family Psychiatry. In A. Davies & E. Richards (Eds), Group work in Music Therapy (pp. 149-163). London, UK: Jessica Kingsley Publications. Edwards, J. (2011). Music in parent-infant programmes. Oxford, UK: Oxford University Press. Jones, A., & Oldfield, A. (1999). Sharing sessions with John. In J. Hibben (Ed.), Inside Music therapy: Client perspectives (pp. 165-171). New Braunfels, TX: Barcelona Publishers. Lindahl Jacobsen, S., & Thompson, G. (in press). Models of Music therapy with

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About the Author Professor Amelia Oldfield, Ph.D., has worked as a music therapist with children and families for 35 years. She currently works half the week as a clinician in Child and Family Psychiatry. During the rest of the week, she lectures at Anglia Ruskin University, Cambridge, UK, where she co-initiated the MA Music Therapy Training in 1994. She has presented papers and run workshops at Conferences and Universities all over the world. She has completed four music therapy research investigations and has published seven books and many articles in referred journals. She has also produced six music therapy training DVDs. In July 2014, she was the first recipient of the World Federation of Music Therapy “Clinical Impact Award” given for long-term impact on advancing the knowledge and practice of music therapy. Amelia is married and has four children. She is an enthusiastic clarinetist who performs regularly in various local chamber music ensembles. Contact: amelia.oldfield@angli a.ac.uk

families. London, UK: Jessica Kingsley Publishers. Oldfield, A. (1992). Teaching Music therapy students on clinical placements - Some observations. Journal of British Music Therapy, 6 (1), 13-17. Oldfield, A. (1993). A study of the way music therapists analyse their work. Journal of British Music Therapy, 7 (1), 14-22. Oldfield, A. (2006a). Interactive Music therapy, a positive approach–Music therapy at a Child Development Centre. London, UK: Jessica Kingsley Publishers. [French Translation was published by l’Harmatan in 2012]. Oldfield, A. (2006b). Interactive Music therapy in child and family psychiatry – Clinical practice, research and teaching. London, UK: Jessica Kingsley Publishers. Oldfield, A., & Adams, M. (1990). The effects of Music therapy on a group of profoundly handicapped adults. Journal of Mental Deficiency Research, 34, 107-125. Oldfield, A., & Adams, M. (1995). The effects of Music therapy on a group of adults with profound learning disabilities. In A. Gilroy and C. Lee (Eds.), Art and Music Therapy research (pp. 164-182). London, UK: Routledge. Oldfield, A. & Bunce, L. (2001). Mummy can play too… - Short term Music therapy with mothers and young children. British Journal of Music Therapy, 15, (1), 27-36. Oldfield, A., & Feuerhahn, C. (1986). Using music in mental handicap: 3 - Helping young children with handicaps and providing support for their parents. Mental Handicap, 14, 10-14. Oldfield, A., & Parry, C. (1985). Using music in Mental Handicap: 1 - Overcoming communication difficulties. Mental Handicap,13, 117-119. Oldfield, A., & Pierson, J. (1985). Using music in mental handicap: 2 – Facilitating movement. Mental Handicap,13, 156-158. Oldfield, A., Bunce, L., & Adams, M. (2003). An investigation into short-term Music

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therapy with mothers and young children. British Journal of Music Therapy, 17(1), 26-45. Oldfield, A., & Flower, C. (Eds.). (2008). Music therapy with children and their families. London, UK: Jessica Kingsley Publishers. [Korean translation completed in 2014]. Oldfield, A., & Franke C. (2005). Improvised aongs and atories in Music therapy diagnostic ssessments at a Unit for Child and Family Psychiatry – A music therapist’s and a psychotherapist’s perspective. In T. Wigram and F. Baker (Eds), Songwriting, methods, techniques and clinical plications for Music therapy clinicians, Educators and Students (PP. 24-44). London, UK: Jessica Kingsley Publishers. Oldfield, A., Tomlinson, J., & Loombe, D. (2015). Flute, accordion or clarinet? Using the characteristics of our instruments in Music therapy. London, UK: Jessica Kingsley Publishers. List of Music Therapy Training Videos •

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Music Therapy at the Child Development Centre, Cambridge. Made in 1992 by Amelia Oldfield and Richard Cramp. Length: 38 minutes. Timothy: Music Therapy with a Little Boy who has Asperger Syndrome. Made in 1994 by Amelia Oldfield and Richard Cramp. Length: 32 minutes. Training as a Music Therapist: the MA in Music Therapy at Anglia Ruskin University. Made in 1999 by Amelia Oldfield, Rod Macdonald and Joy Nudds. Length: 26 minutes. (updated 2011) Received a Commendation from the Royal Television Society, East Anglia, NonBroadcast Video of the Year 1999-2000 Award. Music Therapy for Children on the Autistic Spectrum. Made in 2000 by Amelia Oldfield, Rod Macdonald and Joy Nudds. Length: 34 minutes. Joshua and Barry – Music Therapy with a Partially Sighted Little Boy with Cerebral Palsy. Made in 2002 by Amelia Oldfield and Joy Nudds. Length: 29 minutes. Winner of the Royal Television Society, East Anglia, Non-Broadcast Video of the Year 2002-03 Award. The Croft – A Unit for child and Family Psychiatry in Cambridge. Made in 2005 by Amelia Oldfield and Joy Nudds. Length: 55 minutes.

ia str Au em s, Kr IM C of sy rte ou to c Ph o

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History and Evolution of NICU-MT: Research and Specialized Training in Evidence-Based Music Therapy Interventions For Premature Infants By Jayne M. Standley

Abstract Research in music therapy for premature infants in the Neonatal Intensive Care Unit began in 1989 with a Florida State University Master’s thesis conducted by Janel Caine. Her study was published in the Journal of Music Therapy in 1991 and provided the impetus for extensive further research leading to development of specialized clinical services for vulnerable and fragile premature infants. In 2003, the National Institute for Infant and Child Medical Music Therapy was formed to conduct Dr. Jayne Standley is the recipient of research and provide the First International Research and evidence-based Special Projects Award of the World training to music Federation of Music Therapy. therapists and medical personnel worldwide. It awards the certificate, Neonatal Intensive Care Unit-Music Therapist (NICU-MT), to professional music therapists who complete

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the innovative academic and in vitro training in evidence-based music therapy for premature infants while in critical care. Currently, the certificate in NICU-MT is widely acknowledged as a newly developed standard of care for premature infants in the U.S. with extensive interest throughout the world’s medical community. Resumen La investigación en musicoterapia para los bebés prematuros en la Unidad de Cuidados Intensivos Neonatales comenzó en 1989 con la tesis realizada por Janel Caine para la obtención de su titulo de Maestría de la Florida State University. Su estudio fue publicado en el Journal of Music Therapy en 1991 e impulsó el desarrollo de servicios clínicos especializados para bebés nacidos prematuros, siendo vulnerables y frágiles. En 2003, se formó el National Institute for Infant

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and Child Medical Music Therapy [Instituto Nacional de Musicoterapia y Medicina para el Bebé y el Niño] con el objeto de realizar investigaciones y proporcionar capacitación y formación a musicoterapeutas y a personal médico a nivel internacional en el tratamiento musicoterapéutico basado en la evidencia. Esta institución otorga el certificado de Musicoterapeuta-en Unidad de Cuidados I n t e n s i v o s N e o n a t a l ( M T- U C I N ) a musicoterapeutas profesionales que han completado la innovadora formación académica y capacitación de entrenamiento en in-vitro, teniendo en cuenta la musicoterapia basada en la evidencia para bebés prematuros que se encuentran en situación critica y reciben cuidados intensivos. Actualmente, el certificado en MT-UCIN es ampliamente reconocido como un nuevo estándar desarrollado para el cuidado y atención de bebé s prematuros en los EE.UU., sumándose así, al interés de la comunidad médica mundial. e

History Though practice in general hospitals was rare until the 1980s, medical music therapy is now an integral part of healthcare in America. At the current time 4.9% of the 6307 members of the Certification Board of Music Therapy report they work with medical populations (Dalsimer, 2015). There is also a strong body of research and many contemporary textbooks for student training in this area. In 1986, Standley published a meta-analysis of research in music in medical treatment that identified evidence-based clinical uses of medical music therapy. The meta-analysis was updated in subsequent years (1988, 1993) providing a direct link between research and cutting-edge clinical practice for the next 14 years. A survey in 1994 identified it as one of the five articles with the most impact on the field to that point (Standley & Prickett, 1994, p. 1). Prior to this publication, medical music therapy in the U.S.A. had received little publication attention. A subject index of the Journal of Music Therapy (Miller, 1997)

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included only 10 articles from inception (1964) to 1985 in this topic area. These 10 articles consisted of: two studies on the effect of music on physiological variables; one on preoperative anxiety; one on labor and delivery; three on verbal behavior or crying of pediatric infants/toddlers, one on hemodialysis, one on pain rehabilitation, and one clinical description of music therapy use during burn treatment. Medical MT was not widely practiced nor were clinical descriptions of its use included in the commonly used textbooks of the time (Gaston, 1968; Munro, 1984; Michel, 1985). In the 1980s, the growing interest in medical MT led to innovative research with new medical populations. One of the more innovative areas was use of music therapy to enhance care of fragile infants born too early. In 1989, Janel Caine conducted the first premature infant music therapy research on a Neonatal Intensive Care Unit. Her Florida State University master’s thesis, The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates on a newborn intensive care unit (1989), was later published in the Journal of Music Therapy (1991) and found dramatic benefits of music on premature infant growth, development, and progress toward discharge. It also identified issues for future research inquiry. Further NICU-MT clinical research grew out of a Florida State University (FSU)/Tallahassee Memorial HealthCare (TMH) partnership for an evidence-based Medical Music Therapy/ Arts in Medicine Clinical Demonstration Program. Established in March, 1999 by Jayne Standley, Ph.D., MT-BC, Director of the FSU Music Therapy Program, it consisted of two distinct clinical services supervised by one Music Therapy position entitled, Coordinator of Medical Music Therapy and AIM Programs (Standley et al., 2005). Training components of the TMH Medical Music Therapy program were designed in accordance with guidelines of the American

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Music Therapy Association so that internships could be initiated. The master’s level, MT-BC coordinator position was funded by the College of Music and assigned full-time to the local hospital. The founding Coordinator was Jennifer Whipple, PhD, MT-BC. Originally, all equipment, supplies, internship stipends, expenses, and office space/clerical support were provided by the TMH Foundation. Five years later, in 2004, the hospital Foundation funded a second MT-BC position and increased its annual budget contribution. This year the hospital is adding an additional half time clinical MT position. Currently, the purposes of the Medical MT program are five fold: 1. to provide clinical music therapy services to TMH patients in accordance with established evidence-based medical music therapy practices and approved hospital protocols; 2. to serve as a national training site for music therapy interns who are completing a bachelor’s or equivalency/master’s degree in music therapy; 3. to provide training and supervision for FSU music therapy majors in clinical practica at the graduate and undergraduate levels; 4. to conduct research on innovative uses of medical music therapy; 5. to provide a national model for training allied health professionals in the medical uses of music therapy. Clinical privileges for the Medical Music Therapy staff are approved by the hospital Medical Director with daily supervision/ coordination initiated through the Director of the Neuroscience Department who was a Registered Nurse. Today, the clinical services consist of a priori MT protocols dictated by specific diagnoses and medical/social problems which use proven music therapy treatment options with predictable outcomes. Medical music therapy services are accessed

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through a combination of staff, interdisciplinary team, and patient self-referrals. Additionally, it is standard procedure for the hospital’s unit nurse to complete a social functional assessment of each patient over 60 years of age upon admission. Selected items on that assessment trigger an automatic referral to music therapy. Patients or relatives of patients can also request music therapy. On some units, MT is paid for by the patient’s insurance. On other units, it is funded by the hospital and is free to patients. The Arts in Medicine Program uses the arts to enhance the aesthetic environment of the hospital and participation with course credit is available to any FSU university student. It has grown to approximately 150 FSU students/ year enrolled with Professor Dianne Gregory, MT-BC (Gregory, 2005). All services are provided free of charge to patients of TMH. This partnership between FSU and TMH has resulted in the development of the most comprehensive and progressive use of evidence-based music therapy in the medical treatment of children. By 2003, 47 medical MT research studies had been completed by FSU students and faculty. Twenty-five utilized procedures for infants and children and 20 of those were published in refereed nursing and music therapy journals. By this point, the author and the clinical MTs were answering so many questions about how the research-linked clinical NICU services were developed, that the FSU/TMH partnership was expanded by establishing an institute to train music therapists and medical personnel in NICU-MT. In 2003, the first refereed MT book for premature infants was published (Standley, 2003) and the first institute training was attended by more than 100 people at the November, AMTA conference in Minneapolis (AMTA, 2003). This innovative program incorporated research, text book, and lecture learning with hands on NICU training for a certificate indicating specialized training in NICU-MT. In 2007 FSU formally established the National Institute for Infant and Child

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Medical Music Therapy as a center for research and training. The Institute has to date trained hundreds of persons with over 200 having been awarded the special certificate. Additionally, we have trained NICU neonatologists, occupational and physical therapists and nurses from the U.S., Spain, United Kingdom, Japan, Korea, Australia, Canada, Argentina, Venezuela, Puerto Rico, Germany, Austria, Barcelona, Denmark, Finland, and Belgium. In 2010, the Institute expanded into a research/training network of 4 university music therapy programs and 10 affiliated hospitals, including the Florida State University affiliated with Tallahassee Memorial HealthCare, Florida Hospital in Orlando, Wolfson’s Childrens Hospital in Jacksonville, and Yale-New Haven Children’s Hospital in Connecticut; the University of Alabama affiliated with DCH Regional Medical Center; the University of Louisville affiliated with Norton Healthcare, U. Louisville Hospital, and Kosair Children’s Hospital; and the University of Kentucky affiliated with the U. Kentucky Medical Center. The Fellows of the Institute each are highly specialized in an area of research or clinical NICU experience and include Dr. Andrea Cevasco-Trotter, MTBC, Director of Music Therapy at the University of Alabama; Dr. Darcy DeLoach, MT-BC, Director of MT at the University of Louisville; Judy Nguyen Engel, MM, MT-BC, Director of MT at Yale-New Haven Children’s Hospital; Dr. Lori Gooding, MT-BC, Director of MT at the University of Kentucky; Ellyn Hamm, MM, MT-BC, a Neonatal ICU Research Associate at Vanderbilt University; Brianna Negrete, MM, MT-BC, Music Therapist at TMH; Jennifer Jarred Peyton, MM, MT-BC, Music Therapist at U. Kentucky Medical Center; Amy Robertson, MM, MTBC, Former Director of MT at Florida Hospital, Jessy Rushing, MM, MT-BC, Director of MT at U. Kentucky Medical Center; Dr. Natalie Wlodarczyk, MT-BC, Director of MT at Drury University, and Dr. Olivia Yinger, MT-BC, Assistant Professor of

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MT at University of Kentucky. Future expansion of the network is planned for programs and hospitals in the U.K. and in Barcelona. Current Status Institute sponsored research has continued. To date, there have been two editions of the Premature Infant book (Standley, 2003; Standley & Walworth, 2010) with translation into Japanese (2009). A Spanish translation is in process. There is also a developmental MT curriculum for preterm infants following discharge from the Neonatal Intensive Care Unit (Walworth, 2013). On this topic alone, Standley has published 7 invited and refereed book chapters, and 28 refereed journal articles. Her premature infant research was reviewed in the Journal of the American Medical Association (Marwick, 2000). In 2000, Standley invented and documented the effectiveness of the PAL, an FDA approved medical device that uses music reinforcement for non-nutritive sucking that teaches feeding skills to premature infants. This equipment is produced and sold by Powers Device Technologies. In 2014, Standley’s research was replicated using the mother’s voice to deliver the music reinforcement and showed similar very positive results (Chorna et al., 2014). The device is currently used in the U.S.A. to teach feeding skills to premature infants and results in improved patient care and earlier discharge (Standley, 2003). Others are currently investigating the use of the PAL for consoling children with Neonatal Abstinance Syndrome and to treat older infants and toddlers with oral aversion and failure to eat. A meta-analysis in 2012 showed that evidence-based music therapy techniques had significant positive impact on care and treatment of premature infants (Standley, 2012). World-wide interest in music therapy with premature infants has flourished. At the 2014 World Congress of Music Therapy conference, the program showed more than 8

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sessions on this topic and, additionally, a preconference institute and 3 posters (WCMT, 2014). Music therapists from Germany, France, Brazil, the US, the UK, Austria, Japan, Switzerland, Singapore, Korea, Colombia, and Rio de Janeiro presented their research and experience with premature and young, medically fragile infants.

Research Outcomes A meta-analysis in 2012 showed that evidence-based music therapy techniques had significant positive impact on care and treatment of premature infants (Standley, 2012).

Many NICU-MTs are employed in this specialty area in the U.S.A. We recently surveyed 191 MTs identified by the U.S.A. Certification Board for Music Therapy as working in medical settings with children (Standley & Riley, 2014). One hundred six people responded to some portion of the survey for a response rate of 78.3%. Of the 100 people responding to specific NICU-MT clinical questions, 86% reported they were trained in NICU-MT with another 3% reporting being in the process of completing training. Ninety eight percent were MT-BCs, most of whom were female (93%). Fifty-one per cent were providing NICU-MT clinical services. Thirteen per cent had initiated procedures for reimbursement from medical insurance companies for NICU-MT clinical services. The average amount of time working in the NICU was 2.2 years and the salary range was $35,000 to over $55,000 annually. These music therapists reported that neonatologists were the hospital personnel who most often assisted them in starting new NICU programs. The most common clinical procedures practiced were multi-modal stimulation to reduce hyper-responsiveness and enhance neurologic development, parent training in infant interactions to increase attachment and reduce over-stimulation, use of PAL to teach feeding skills, recorded music listening to stabilize physiological measures or mask ambient noise, live singing by the incubator to soothe infants, parent counseling for stress, and hospice/bereavement assistance upon the death of an infant. Future Development of NICU-MT Due to the wide diversity of clinical areas in which MTs practice and the difficulty in

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training everyone to practice across this broad spectrum, there has been discussion in the U.S.A. for development of specialized training for certain critical populations, including premature infants. The following possibilities are suggested for improving the training of MT students and promoting improved care for premature infants through specialized, advanced techniques: • Include instruction about premature infants as a clinical population during MT student training with emphasis on fetal development characteristics by gestational age and medical care of premature infant needs. • Require specialized training for working with vulnerable populations such as premature infants in order to assure that no harm is done by inexperienced or unqualified music therapists. Research has shown that such training has resulted in improved quality of care and higher salaries for other professions (PeczeniukHoffman, 2012). • Promulgate standards of NICU music therapy care for premature infants within the medical community that specify services seven days/week with adequate staffing ratios for quality service provision. Based on clinical experience a ratio of 1 therapist for each 20 babies is suggested. • Promulgate NICU standards of care that fully incorporate NICU-MTs into the interdisciplinary treatment team, fund MT as are other therapy services such as speech or physical therapy, and identify MTs as the experts who determine uses of music in the NICU. The next endeavor of the National Institute for Infant and Child Medical Music Therapy is to establish a website hub for expanded collaborations. We intend to maintain a network for research to identify and disseminate therapeutic uses of music to improve children’s lives within healthcare, early intervention, developmental care and the family. This collaborative will create, maintain and offer consultation according to

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our members’ expertise, provide various certificates in specialized training, and develop print material and trainings related to MT with young children. We will have an annual symposium for leading researchers to share new findings, generate cutting edge clinical methodology, stimulate thinking about new avenues of research, and propose solutions to children’s problems using MT. It is timely that this MT specialty area be more widely recognized for its powerful and multiple benefits for children of the world. References American Music Therapy Association (2003). Annual Conference Program, Minneapolis, MN. Caine, J. (1989). The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates on a newborn intensive care unit. Master’s Thesis, Florida State University, Tallahassee, FL. Caine, J. (1991). The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates In a newborn intensive care unit. Journal of Music Therapy, 28, 180-192. Chorna, O., Slaughter, J., Wang, L., Stark, S., & Maitre, N. (2014). A pacifier-activated music player with mother’s voice improves oral feeding in preterm infants. Pediatrics, 133(3), 462-468. Dalsimer, B. (2015). Personal communication with staff member of Certification Board for Music Therapists, Downingtown, PA, Jan. 8, 2015. Gaston, E. (Ed.) (1968). Music in Therapy. New York, NY: The MacMillan Co. Gregory, D. (2005). Arts in medicine service learning course: Design and university student perceptions. In Standley, J., et al. (Eds), Medical Music Therapy: A Model Program for Clinical Practice, Education, Training, and Research. Silver Spring,

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MD: American Music Therapy Association. Marwick, C. (2000). Music hath charms for care of preemies. Journal of the American Medical Association, Jan. 26, 468-469. Michel, D. (1985). Music Therapy. Springfield, IL: Charles C. Thomas. Miller, S. (1997). A subject index to the Journal of Music Therapy 1964-1996. Unpublished student project, Florida State University, Tallahassee, FL. Munro, S. (1984). Music Therapy in Palliative/ Hospice Care. Magnamusic Baton: St. Louis, MO. Peczeniuk-Hoffman, S. (2012). MT in the NICU: Interventions and techniques in current practice and a survey of experience and designation implications. Unpublished Master’s Thesis. Western Michigan University, Kalamazoo. Standley, J. M. (1986). Music research in medical/dental treatment: Meta-analysis and clinical applications. Journal of Music Therapy, 23(2), 56-122. Above article reprinted In: CE. Furman (Ed.) (1988; 1993). Effectiveness of music therapy procedures: Documentation of research and clinical practice. Washington, D.C.: National Association for Music Therapy, p. 9-61. Above article reprinted In: J. M. Standley and C.A. Prickett (Eds.) (1994). Research in Music Therapy: A Tradition of Excellence. Silver Spring, MD: National Association for Music Therapy. Standley, J., & Prickett, C. (Eds.) (1994). Research in Music Therapy: A Tradition of Excellence. Silver Spring, MD: National Association for Music Therapy. Standley, J. M. (2000). The effect of contingent music to increase non-nutritive sucking of premature infants. Pediatric Nursing, 26(5), 493-495, 498-499. Standley, J. M. (2003). Music Therapy with Premature Infants: Research and Developmental Interventions. Silver Spring, MD: American Music Therapy Association.

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Standley, J. M. (2003). The effect of musicreinforced non-nutritive sucking on feeding rate of premature infants. Journal of Pediatric Nursing, 18(3), 169-173. Standley, J. M., & Walworth, D. (2010). Music Therapy with Premature Infants: Research and Developmental Interventions (2nd ed). Silver Spring, MD: American Music Therapy Association, 248 pp. Standley, J. M. (2009). Japanese Translation: Music Therapy with Premature Infants: Research and Developmental Interventions. Tokyo, Japan: The English Agency (Japan) Ltd. Standley, J. (2012). Music therapy research in the NICU: An Updated meta-analysis. Neonatal Network. The Journal of Neonatal Nursing, 31(5), 311-316. Standley, J., Gregory, D., Whipple, J., Walworth, D., Nguyen, J., Jarred, J., Adams, K., Procelli, D., & Cevasco, A. (2005). Medical Music Therapy: A Model Program for Clinical Practice, Education, Training, and Research. Silver Spring, MD: American Music Therapy Association. Standley, J., & Riley, J. (2014). A survey of NICU-MTs. Unpublished study, Florida State University, Tallahassee, FL. Walworth, D. (2013). Bright Start Music: A Developmental Program for Music Therapists, Parents, and Teachers of Young Children. Silver Spring, MD: American Music Therapy Association. World Congress of Music Therapy (2014). Tri-Annual Conference Program, Krems, Austria, July.

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About the Author Jayne M. Standley, Ph.D., MT-BC is a Robert O. Lawton Distinguished Professor at Florida State University with appointments in the Colleges of Music and Medicine. Her research emphases are medical music therapy and MT in the Neonatal Intensive Care Unit. Standley is Director of the National Institute for Infant and Child Medical Music Therapy, a network affiliation of universities and medical centers to promote research and training in NICU-MT. The Institute has trained hundreds of music therapists, neonatologists and neonatal nurses from around the world in the clinical specialty of evidence-based NICU-MT for premature infants. She is widely published in international MT and medical journals. Standley is author of over 30 refereed research articles on Medical MT for premature infants and co-author of the book, Music Therapy for Premature Infants: Research and Developmental Interventions, 2nd ed. She was honored as the first recipient of the World Congress of Music Therapy Research and Special Projects Award. Contact: JStandley@music.fsu.edu

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Music Therapy Today (ISSN 1610-191X) publishes articles that are related to music therapy education, practice, and research. Only original work of authors will be published. The editor maintains the right to reject articles not in compliance with the goals of the WFMT online journal. Categories may include, but are not limited to: Categories may include, but are not limited to • Position Statements • Curriculum Reports • Clinical Case Studies • Research Reports • Service Projects • World Congress Proceedings • Conference Reports • Interviews • Book Reviews • Online Resources Format & Style. APA Publication Manual (2010, 6th edition), Arial, 12-point font, no markups, no formatting. Exception: one space after periods for the purpose of online publication layout. Submissions should include a title, author(s)’ name(s), credentials and affiliations, an email address, and a reference list or website links if appropriate. Preferred article length is 2,000-10,000 words (research reports maximum 10,000 words; case studies maximum 5,000 words). Podcast submissions (audio and videos) are also considered. All manuscripts need to be prepared in English. Authors whose first language is not English are strongly advised to have a native English speaker proofread the manuscript before submitting it or to consider using professional editing services. Multimedia & Releases. Inclusion of images, audio, and video recordings of clients and authors that are in compliance with the WFMT Ethical Practice Guidelines and relevant to the topic of the manuscript are encouraged. Clear images (jpg file, maximum of 1 MB), audio (mp3 file; maximum of 10 MB), and videos (mp4, maximum of 50 MB) must be submitted separately. Please indicate where the multimedia should be placed in your manuscript by saying [INSERT XX ABOUT HERE]. Authors are solely responsible for the content and release of any media and must sign the WFMT Multimedia License. Submission Deadline. The online journal is published biannually, and submissions are accepted year round. Review Process. Receipt of the submission will be acknowledged electronically. All submissions will undergo a blind peer review. The reviewing period is 4-6 weeks. Authorship & Copyrights. Authorship and copyrights are reserved to those who make contributions. Contributors will be responsible for the content and clearance on media and must signed the WFMT Multimedia License Agreement. Authors are not financially compensated. The online journal does, however, provide authors with international exposure and a wide range of readership. Disclaimer. The opinions and information contained in this publication are those of the authors of the respective articles and not necessarily those of the editor(s), proofreaders, or the World Federation of Music Therapy (WFMT). Consequently, we assume no liability or risk that may be incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this publication.

Submissions We encourage you to submit to the WFMT online journal, Music Therapy Today, by clicking the “Submit Article” button available at

Subscription. WFMT members and others interested in music therapy education, practice, and research may subscribe to be notified about new uploads on this WFMT website.

http://www.wfmt.info/ music-therapy-todaysubmit-article/

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CONDUCTING HOPE A Film Review By Vanya Green

Conducting Hope, a film created by Margie Friedman, is a moving portrayal of the power of music to change the lives of men incarcerated at Lansing Correctional Facility in Lansing, Kansas. The men are all in the correctional institution for different reasons, ranging from theft to violent felonies -- offenses which define them in prison and risk defining them beyond the length of their sentences. What Friedman so eloquently shows here is that the opportunity to sing in a choir and perform outside the prison walls creates community and empathy in a way that very little else could. As a skilled filmmaker, Friedman crafts a meaningful story that humanizes the choir members, without being overly saccharine or forced. We see them for what they

Visit the project's website at http://conductinghope.com/

are -- former criminals trying to better themselves and their chances for a better future. A good film, like a good piece of music, makes us feel that we have a window into someone else's world. By creating an honest and

About the Author Vanya Green, MA, LPCC, MT-BC is working with individuals, groups, and organizations in Enico, California to maximize creativity and improve well-being.

Contact: vanya@melodyworks.org

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moving documentary, Friedman reminds us that the process of creating music and the opportunity to share and perform it can bring joy, fulfillment and hopefully have the power of redemption.

MUSICTHERAPYTODAY Spring 2015, Volume 11, No. 1

Disclaimer The opinions and information contained in this publication are those of the authors of the respective articles and not necessarily those of the editor, editorial board, or the World Federation of Music Therapy (WFMT). Consequently, we assume no liability or risk that may be incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this publication.

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SUPPORTING

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