Music therapy is not a homogenous field. There are lots of different concepts of music therapy which focus on different aspects of how music may result in a client's well-being. Nevertheless the Kassel Theses developed by representatives of eight German music therapeutic associations constitute an effort of consensus about the essential characteristics of music therapy. These theses describe music therapy as psychotherapeutic by nature. They state that in a music therapeutic context music may become an exemplary object to help the patients improve their ability to perceive, experience, symbolize and relate with others. Reception, production and reproduction of music are supposed to trigger intra-psychic and interpersonal processes and therefore to have a diagnostic as well as therapeutic function. Music gives substance to individual experiences making it possible to include them into the therapeutic process. Accordingly, the World Federation of Music Therapy defines music therapy as „the use of music and/or its musical elements (sound, rhythm, melody and harmony) by a qualified music therapist, with a client or group, in a process designed to facilitate and promote communication, relationships , learning, mobilisation, expression, organisation and other relevant therapeutic objectives in order to meet physical, emotional, mental, social and cognitive needs“.
Forms of Music Therapy
Music can be applied functionallay, using just the direct effects of music - mostly on a person's autonomous nervous system - without the mediating therapeutic conversation. In contrast, in receptive as well as active music therapy, the effects of music are pointed out and amplified by the therapeutic conversation and the communicative function of music is mirrored by the development of a therapeutic relationship as is characteristic for psychotherapeutic interventions. Receptive music therapy involves listening to music, whereas active music therapy requires patients to reproduce or improvize music themselves. The therapist can accompany the patient's play to rassure or to provoke. The music thus produced is often taped so that patient and therapist can listen to the music afterwards and analyze it with respect to the therapeutic objectives. Moreover, it can be differentiated between individual and group therapy. The experience of being part of a group in a way that becomes audible in the concerted musical improvizations helps patients to acquire more refined perceptive, communicative and social skills.
Even though it can much depend on subjective experiences what kind of associations music excites and thus what kind of emotions it aroused, it is possible to specify characteristics of music which predominantly cause certain autonomous responses of the body. This is how music can be described as either ergotropic or trophotropic. Ergotropic music leads to activation of the sympathetic part of the autonomous nervous system meaning that listening to it may result in increased blood pressure, accelerated respiration, higher incidence of muscular contractions, pupil dilatation, heightened cutaneous electrical resistance and excitation. Its characteristics are: rigid rhythms, accelerations, major key, dissonance and greater sound intensity. Tropotrophic music leads to activation of rather the parasympathetic part of the autonomous nervous system meaning the opposite reactions as described for ergotropic music. It therefore has a secative effect. Its characteristics are: floating, less accentuated rhythms, minor key, consonance and lower sound intensity.
Receptive Music Therapy
Listening to music may lead to the arousal of emotions. These emotions mostly have their origin in past situations or are related to persons that we associate with this or just similar music. Associations, emotions and their connections can become the topic of a therapeutic conversation which helps to consolidate this form of self-experience, to work on it and get new insights and perspectives. Moreover music can have certain characteristics which correspond to traits of personality. For example songs in 2/4-time can be perceived as having a „down-to-earth“ character and thus correspond to the part of a person's personality which wants things to stay the same. In contrast, a song in 3/4-time has a rather elevating movement (think about the Vienna Waltz) and appeals more to an inventive and adventurous temper. According to the idea that no person has just one dominating trait of character but rather comprises all kinds of tempers some of them more dominating than others, listening to music may call forth new yet undiscovered sides to someone's personality which may consequently unclose a new way of coping. It may reestablish an equilibrium when a character trait has become so dominant that it causes a person's distress. In conclusion music in receptive therapy can be effective in both ways: It can function as a canvas or a mirror for the soul so that a person can discover his or her own qualities in it. Or the qualities of the music can be mirrored by a person who is moved (or altered) by listening to it.
Conditions of trance induced by sound
Trance can be defined as a state of consciousness with extremely restricted, focussed attention and reduced vigilance. Sound is used to focus attention which elevates the intensity but not the extent of perception. Monotonous sounds and rhythms such as produced by gongs or singing bowls are especially capable of inducing such states. The unfamiliar sound which is devoid of meaning and the monotony take away all points of reference. This supports a transformation of thinking, perceiving and experiencing, a hypersuggestible state.
Active Music Therapy
In active music therapy the therapist invites the patient to improvize, either with respect to a given topic or without any guidelines at all. Also, the instrument may either be chosen by the patient or determined beforehand. The therapist may chose to accompany the improvized music with certain therapeutical intentions that arise from the context. It is of course a challenge for the patient to create music out of nothing, to create something new and unforeseen and thus allowing something unpredictable to happen. The way the patients deal with this challenge, the way they react to the new situations may reveal their coping strategies in general allowing to analyze and question them. But also this challenge bears the chance of making new experiences and getting new ideas. It is inspiring. Thus, music serves as a symbol for the patient's situation. Likewise, changing the music may lead to a more general change for the patient. The therpeutic conversation serves to understand and consolidate the experience made with music and to integrate them on a cognitive level in order to profit from them more generally in the future. Music is a nonverbal means of communication. By playing music the patient is enabled to express something without even consciously knowing the meaning of it. Improvizing trains to get in contact with one's own emotions and to heed them properly. Moreover, subconscious conflicts may become audible through musical improvization, making it possible to work on them. This is a psychoanalytic approach. It can be considered as the musical version of free-association. The music can be listened to and interpreted. However, the therapist merely offers possible interpretations to the patient, never states them as certain. The patient is not given a diagnosis but hopefully enabled to develop his or her own self-concept.
The therapeutic effects of music
Thomas K. Hillecke and Friedrich-Wilhelm Wilker have summarized the specific therapeutic effects of music therapy in a heuristic model consisting of five working factors:
- Modulations of attention: Music demands attention and can draw attention to different contents.
- Modulation of emotions: Music can stimulate emotions directly or trigger associations which are charged with emotions. For example, this may open the possibility of experiencing a healing catharsis.
- Modulation of cognition: Music reminds of past situations. It is assigned with meaning by the one who listens to it. Therefore it activates thinking processes which may help identify conflicts and inspire solutions.
- Modulation of motor function and behaviour: Music can serve as a stimulus to condition patterns of behaviour (behaviour therapy). Rhythmic stimulation can lead to entrainment of neurons supporting the acquistion of motor skills, for example in neurological rehabilitation.
- Modulation of communication: Music is a means of nonverbal communication. Music therapy trains patients to express themselves as well as to improve their perception of nonverbal expressions and interpersonal events by interacting with others on a musical level.
Music can als serve as a nonverbal means of communication where verbal communication ist not possible. For example it may have the potential to reach patients suffering from a coma or give autistic patients who cannot speak the opportunity to use the full potential of their communicative skills which might otherwise remain undetected. But music does not only enable to communicate with others, it also helps to understand one's own self better.
Music therapy in psychosomatic medicine - treatment of chronic pain disorder:
A psychosomatic approach of explaining chronic pain is that pain can be an alternative expression of emotional distress. For example the will to control and hide one's emotions may lead to muscular tension which causes pain. This way emotions are associated with pain. Moreover it may be socially unaccepted to show one's emotional distress so that pain turns into a socially accepted way of expressing emotional needs. However this is a learning process which patients are not aware of, not a conscious search for attention. These patients need to learn to express themselves adequately, to substitute pain with emotional reactions. Music as a means of nonverbal communication is yet another alternative of expressing emotions without having to talk about them. In short, pain that has become a substitution for emotional expression is substituted by music. This helps to get in contact with one's own emotions again which in turn helps reduce the pain.
Music therapy in neurological rehabilitation:
Music therapy is also applied in neurological rehabilitation. For examples patients who have had a stroke may benefit from learning to play an instrument with the disabled extremity. Music does not only serve as a strong motivational factor. The auditory feedback may also substitute the possibly disturbed proprioception. Another way that music is assumed to have a positive effect in the rehabilitation of movement is through entrainment or other forms of audio-motor integration.