Music to Our Ears: Teaching Music Therapy

Martin Bowra/Shutterstock

Martin Bowra/Shutterstock

Music therapy is a field that few people know about, but makes a large impact in the lives of the people it benefits. In this month's interview, Andrew Hibel of HigherEdJobs spoke to Kathleen Howland, a professor of music therapy at Berklee College of Music. Howard discusses what drew her to the field of music therapy, why music therapy is so important, and best practices in music education.

READ THE COMPLETE INTERVIEW HERE 

Dr. Oliver Sacks- the inspiration for Music Therapy Tales

Dr. Sacks, the inspiration for Music Therapy Tales

 

On August 30, 2015, Dr. Oliver Sacks passed away from an earlier cancer that only had a 5-percent chance of returning. With such low odds, it was inconceivable that we could lose our great champion, friend and advocate of music therapy!

 

Since his first books were published in the 1970s, Dr. Sacks’ clinical stories have meant the world to me personally and to my development as a music therapist and educator. I was impressed and deeply touched by his early writings that described the capacity for ability to be nested in disability. Young readers have to understand, and we all should appreciate, that this was a revolutionary idea at the time. Honoring the inherent worth and dignity of every individual was completely novel in the world of the diseased and disordered. His clinical descriptions came well before the use of Person First Language and cultural aspirations for political correctness. Back in the day, people were labeled in reductionist ways. There was an emphasis on describing them by what they couldn’t do and devaluing them accordingly. For example, “he can’t talk, can’t walk, and can’t see,” therefore “he’s deaf, dumb and blind.” Dr. Sacks’ writings focused on and emphasized his subjects’ strengths and gifts. He elevated and honored their humanity with his warm and humanistic narratives.

 

In many of the cases that Dr. Sacks wrote about, music or art was the strength that shone like diamond in the rough of a disease or disorder. In the well-known story and book, The Man Who Mistook His Wife for a Hat, he wrote of “Dr. P.,” whose life was threaded from one moment to the next through song. If his song for dressing was interrupted, he was utterly lost. Music was the glue that held him together in his daily functioning.

 

Dr. Sacks wrote eloquently of how music remained alive in patients with dementia, notably Woody Geist, described in MusicophiliaWoody’s ability to sing long into the progression of this disease is astounding. Check out the wonderful HBO documentary series The Alzheimer’s Project: Memory Loss Tapes and listen to his music and how much it contested with his functioning in daily activities. I also recommend Measures of the Heartthe touching book by Woody’s daughter, Mary Ellen Geist.

 

Dr. Sacks was portrayed by the late, great Robin Williams in the film Awakenings, which beautifully showed Dr. Sacks’ devotion and efforts to solve problems of patients long forgotten in the back wards of dreary hospitals. With the invention of the drug L-dopa and his determination to use it on this population, patients became enlivened, awakened and brought back to life. They could voluntarily move again, communicate and engage in life, even if only for a while. Before the drugs were available, he observed and wrote about music’s power to enliven them beyond their frozen states.

 

The website Music Therapy Tales (www.musictherapytales.com) is my way to pay homage to

the “poet laureate” of medicine, Dr. Oliver Sacks. I feel that we must carry on this legacy of storytelling as a means of informing and transforming people’s opinions and understanding of our beloved field. The website will feature interviews with music therapists and all those who are moved and inspired to record and share their stories about the beauty and power of music: clients, physicians, therapists, parents, family members and others. You will find new stories uploaded at the website as we collect them, mainly in the “Clinical Stories” and “Power of Music Therapy” sections.

 

With this project, and all of my endeavors as a clinician, teacher, researcher and lecturer, I very much hope to do Dr. Oliver Sacks proud and honor his legacy with respect for the power of story as a light to shine on the inherited dignity of all.

What do ‘Hamilton’ and ‘School House Rock!’ have in common?

I recently picked up Thomas Fleming’s book Duel at a kiosk in Boston’s historic Fanueil Hall. As I read its account of the parallel lives of Alexander Hamilton and Aaron Burr, I found that I already knew many of the details of their lives and their relationship. That’s because my husband, daughter and I have been listening to the soundtrack of the smash Broadway production Hamilton (and also yearning to see it live). With its compelling rhythms, lush melodies and clever rhymes, Lin-Manuel Miranda’s musical makes the facts of Hamilton’s life easy to remember:

  • That he was “a bastard, orphan, son of a whore and a Scotsman dropped in the middle of a forgotten spot in the Caribbean.”
  • That the Federalist papers were a series of essays defending the new United States Constitution. And Hamilton wrote 51 of these 85 essays.
  • That Hamilton’s wife Eliza raised money for the Washington monument and began the first private orphanage in New York City in her husband’s honor.

This reminds me of “School House Rock!,” the fabulous Saturday-morning television series of animated shorts that used music to help children remember lessons about grammar (“Conjunction Junction”), math (“Three is the Magic Number”) and social studies (“I’m Just a Bill”). The show aired on ABC-TV from 1973 to 1985 and again from 1993 to 1999.

 

Music has the ability to enhance memory for facts and figures. As linguists would say, rhythm and melody help to “chunk” information for recall. We learn our ABCs much younger than we learn our numbers because there is a song for one and not the other. The song helps us organize the letters in chunks of 3, 4 and 5: ABCD EFG HIJK LMNOP QRS TUV WXYZ. 

 

Years ago, I did research for the Metropolitan Opera on the creation of original operas in schools. Children from kindergarten through high school collaborated on these productions based on their curriculum. In Brooklyn, I observed a fourth-grade production on “New York City Moments.” It imagined conversations about building and celebrating the Brooklyn Bridge. Facts and figures were embedded into songs and the dialogue that framed the songs. I would wager that if I could locate those children today, their recall of all this information would be just as their teachers hoped it would be: as solid as that bridge. They could engage in a discussion about it, answer questions about it in a trivia contest and consider its rightful place in the history of their city. If I were to interview those same students about other history lessons, not organized into original arts productions, I would further wager that those facts and figures would have waned with time – not because they were less interesting but because there was no music to facilitate its recall. I hypothesize this would be true even if the students had given equal study time to each topic.

 

Advertisers keenly understand the power of music and memory in promoting products. I have yet to meet someone who has bought products from the national Empire Carpet chain. And in New England – one region where the company advertises – I have yet to meet someone who does not know the company’s phone number, featured in its musical advertising tag: “800-588-2300, Empire!”

 

Music is a powerful asset in memory. In music therapy, we use music to promote healthy memory functioning. Children with Down’s syndrome might learn to tie their shoes because of a song that instructs them of the sequence. An adult with a brain injury might relearn biographical information in a song, such as address and phone number. And the act of singing may do more than enhance recall. It builds up brain structures related to the process of memory storage and retrieval. That can help a person learn both new and old information. Therapeutically, music is used as a brain-based treatment for a brain-based skill, such as memory, speech or language.

 

The next time you need to remember something important, take a cue from Hamilton and School House Rock: set it to a song and feel the power.

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The effect of the Mozart Effect

In 1993, an article in the prestigious academic journal Nature created massive public interest in the power of music on the brain. The study reported that college students who listened to a Mozart piano concerto before taking a test that measured visual-spatial abilities did better than those who received relaxation instructions or silence. Authors Frances H. Rauscher, a psychologist and cellist, and Gordon L. Shaw, a physicist, never claimed that “music makes you smarter.” In fact, they noted that music’s cognitive benefit to subjects dissipated after 10 minutes.

 

No matter. The “Mozart Effect” got widespread popular media coverage and parents thought they had found a way to enhance their children’s IQ by passive listening to music. In the late 1990’s, every child born in Georgia under the governorship of Zell Miller received a cassette tape or compact disc of classical music. There was tremendous enthusiasm for the possibility that music could make you smarter. In 1999, the effect was given a requiem, also in Nature: The study could not be replicated. Nonetheless, the commercialization of Mozart’s music for children continued to spread like wildfire. Many erroneous claims about improved IQs were made in books and recordings. 

 

I watched with fascination as this unfolded. Without a doubt, there were some wonderfully positive effects from this. Subscription rates for symphony orchestras increased. More families were listening to classical music both live and in the home. But there were negative effects, too. Music educators began to advocate curricula with the “music makes you smarter” slogan. Worse yet, some educators wanted to use music education to improve test scores in grades K through 12 – as if studying music for the sake of its art was not enough. Why, I thought, should we ask music teachers, “What did you do to improve students’ history scores?” I couldn’t imagine history teachers facing a similar expectation to improve students’ understanding of music.

 

Another negative effect was the elevation of Mozart above other composers. If Mozart’s music could have had a priming effect on cognition, perhaps it was due to the style of composition common at that time in history. His music features melodies that are played and then slightly varied with each repetition, in “assumable patterns.” This writing style enhances familiarity, even during a first listening. The pieces progress in a steady fashion. There are no changes in loudness (dynamics), and no quickening or slowing of the beat (tempo). The brain likes repetition and identifiable patterns, but also some variation to avoid boredom. Those elements combine to create music that could perhaps prime cognition. Mozart was not the only composer who wrote in this style. The music of Haydn and Bach,and some of Mendelssohn’s are similar. 

 

So, there continue to be lingering effects of the Mozart non-Effect. If we were to focus on musical elements that might have nonmusical effects – even the effect of improving cognition – we perhaps would be heading down a better path of discovery. 

-- Kathleen M. Howland

 

Kathleen M. Howland, Ph.D.,  is a certified music therapist (MT-BC, NMT/F) and speech therapist (CCC-SLP). She teaches undergraduate and graduate courses at Berklee College of Music and the Boston Conservatory of Music.

Let’s stop bashing ‘Alive Inside’

Perhaps you have seen Alive Inside, the film about music’s ability to counteract memory loss. Alive Inside is controversial among music therapists because it shows people listening to recordings and not experiencing music actively with a therapist. I understand why some therapists object. But the film is valuable, and so is recorded music as part of therapy when handled properly. Let me explain.

 

Like so many people, I was deeply moved by Alive Inside. I saw the film with friends and family and took part in two panels that screened it for the Massachusetts Alzheimer’s Association and the Reel Abilities Film Festival in Boston. Filmmaker Michael Rossato-Bennett was present for both. All of these viewings have brought me deeper into the beauty of the case studies the film presents. They show the power of music to reach across the divide of pathology.

 

Leaders of the American Music Therapy Association have offered a strong critique of Alive Inside, emphasizing that the film does not depict music therapy. As our professional association, they are the stewards of the integrity of our work. I support their position that passive music listening programs are not comparable to engaged, active music making with therapeutic outcomes. 

 

The controversy around this film reminds me of what happened after the publication of a 1993 “Mozart effect” study. It claimed that listening to music could improve certain kinds of brain function. It got a lot of media coverage and was accompanied by a remarkable surge in subscriptions to symphony orchestras and purchases of classical music recordings for family life. This was a positive outcome for music, even when the research was refuted. We have the same opportunity with Alive Inside. We as a profession can leverage this beautiful film and the wonderfully warm interest of the general public in the power of music toward a deeper understanding and reliance on music therapy. 

 

Here’s my hope. People in assisted living residencies and in skilled nursing homes have lots and lots of time on their hands. In an ideal world, each resident would have access to a private music therapy session and a group session daily, if indicated by clinical assessment. Even with these resources, residents would still have lots of idle time. As depicted in the film, when they are not stimulated and engaged, they become detached and vacant. They become less and less of themselves. 

 

The opportunity for passive listening experiences could help fill those hours. And a music therapist is ideally suited to arrange the playlists for each individual. The playlists would be based on a clinical assessment that identifies preferences (and non-preferences), styles and genres.

 

As music can do harm, it is important that music therapists be involved in choosing playlists. By harm, I mean the emotional distress that can come when music awakens certain memories. An example is the “Anniversary Waltz” that was ubiquitously played during World War II and for decades afterwards. A song with that power can disrupt the well being of persons with cognitive impairments. The confusion they already have can turn into distress if a song triggers memories and they do not see their loved ones or anything familiar in their surroundings. This is an example of why a skilled music therapist would benefit these listening programs. As Michael Rossato-Bennett said in Boston, he wants to see these tools put in the hands of music therapists. It is the ideal opportunity for music to be of service throughout the long days of people living in skilled nursing facilities.

-- Kathleen M. Howland

 

Kathleen M. Howland, Ph.D.,  is a certified music therapist (MT-BC, NMT/F) and speech therapist (CCC-SLP). She teaches undergraduate and graduate courses at Berklee College of

When all that's left is the music, 'I'll be me'

When I was a young girl in the 1970s, Glen Campbell was the artist of the day. His playing mesmerized me. I was captivated by his ease with the guitar, his warmth with fellow artists and his musical sensitivities and sensibilities. He was versatile, making music with stars as diverse as Johnny Cash, Neil Diamond, Willie Nelson and Stevie Wonder. This 1969 TV segment featuring Glen and Stevie is my favorite.

Even after he was diagnosed with Alzheimer’s disease in June 2011, Glen kept performing for a time. The film I’ll Be Me follows his final tour. I saw the film in 2014 at a screening for the Berklee College of Music faculty. Among the speakers at the screening, hosted by Massachusetts Sen. Ed Markey, were Glen’s wife and children and researchers from the Boston area who are investigating the causes of and possible treatments for Alzheimer’s. Sen. Markey, who lost his mother to Alzheimer’s disease, has become a champion for this cause in Congress. He has authored legislation to create a national strategy to address an Alzheimer’s epidemic that researchers believe is coming.

I was delighted to see and hear Glen again in I’ll Be Me. After all those years, my musical tastes had changed but my respect for and admiration of his musicianship hadn’t. In fact, they grew as the movie went on. It was an engaging evening that still has me thinking. In the film, Glen appears vulnerable and confused when offstage. He is very resistive to taking showers, and he wanders out of a hotel room when his wife is taking her shower. Onstage, he is very different. He banters congenially with the audience, improvising, reading song lyrics from the teleprompter, playing sensitively with his grown children in the band and being that remarkable musician I remember from so long ago.

I have developed a theory about Glen’s dementia, having reflected on I’ll Be Me as well as his long-running CBS-TV show, “The Glen Campbell Goodtime Hour” (many episodes can be viewed online), and his 1994 autobiography, Rhinestone Cowboy. Glen had been exhibiting signs of Alzheimer’s disease for 10 years before his 2011 diagnosis. Most people move through early-stage Alzheimer’s faster than that. I believe that his extraordinary capacity as a musician built dense neural circuitry that offered resistance and resilience to the cell death that dementia causes. With extensive networks built over years of music learning and performance, Glen was able to continue playing and improvising, even with early- to mid-stage Alzheimer’s, throughout his final tour – 151 shows over 425 days. As Bruce Springsteen said, “it’s a rough, rough disease. To be out there rolling the dice was pretty brave.” It was that indeed.

Research on dementia and occupation has shown that it is most prevalent among people whose careers have been in “realistic” work, such as skilled trades, technical and some service occupations (see this 1998 article by Anthony F. Jorm, Bryan Rodgers and others in the British journal Age and Ageing). These occupations tend to emphasize manual skills. Jobs that place more emphasis on literary or intellectual work – the kind done by professors, writers and researchers, for example – have lower incidences of dementia, it would seem, because of the dense neural networks that are developed to accommodate those pursuits. In Glen, I see the possibility that his tremendous capacity as a musical prodigy may have given him the same advantage. Music training and experiences shielded him from the rapid rate of decline that one would expect with Alzheimer’s. Well into the mid-stages of the disease, he was musically functional. But he needed lots of support to be functional offstage.

I have recently read that Glen is no longer verbal and no longer able to sing or play music. Although his ability to produce music is no longer available, his ability to perceive music may be. His daughter, Ashley, says Glen will walk away at the sound of an out-of-tune guitar. I would wager that if we could image Glen's brain activity (with an EEG cap), we would see his music perception skills online when his production skills are clearly offline. 


I am most grateful to the Campbell family for allowing us to see Glen at this time in his life. The film is a wonderful advocacy tool for the ravages of Alzheimer’s disease and a testament to the power of music in the face of it. It has also helped me see the possibility that being a musician is an advantage to aging well. 

 

Music therapy assessment of communication abilities

Recently the American Speech Hearing Association (ASHA) has expressed concerns about music therapists assessing communication.  As a speech-language pathologist myself, I know well  the skills required to perform comprehensive evaluations for both pediatric and adult clients. We use norm referenced, standardized batteries of tests that provide highly detailed, statistical information about communication, to include assessment of syntax, semantics, articulation, pragmatics and phonology. Often testing requires more than one session to complete, depending on the age and presenting issues.  

Music therapists (MTs) are trained to assess communication through music. The tasks are less comprehensive than SLP assessments but still provide important information as to how a client functions and identifies possible abilities that can be leveraged toward disabilities.  The following are examples of a music therapists assessment of expressive skills: 

  1. evaluate if a client can complete the last word or words of a phrase in a known or familiar song demonstrating recall, anticipation, timing and production abilities
  2. evaluate if a client can vary vocalizations or verbalizations demonstrating auditory perceptual skills, imitation, repetitions and production abilities
  3. evaluate if a client can generate original words and/or ideas for songwriting activities demonstrating word finding (divergent and convergent), concentration, ability to initiate and develop an idea to completion
  4. evaluate if a client is able to take turns vocally or with musical instruments demonstrating pre-conversational and pragmatic abilities 

Music therapists assess receptive skills as follows:

  1. evaluate whether clients respond better to sung than spoken cues. Positive responses to sung cues demonstrate cognitive priming, leveraging the right hemisphere's capacity for melody perception. In addition to cognitive priming, sung cues can improve  success of comprehension because of decreased rate of syllable production in sung phrases versus spoken ones
  2. evaluate the client’s ability to follow directions in musical tasks (e.g. play this, then play that this way, etc.) demonstrating comprehension, sequencing abilities. Music may provide compelling activities that motivate a client to perform at their best

The music therapist benefits greatly from SLP assessments that identify needs and establish goals, some of which can be addressed by music-based interventions. SLPs can benefit from the identification of abilities in music that can be used to motivate a client and to provide another entry point into communication development or recovery.

Speech therapists use word lists, games, books and conversations to address communication goals. Music therapists use songwriting, improvised music, and familiar songs to address some of these same goals. By working together, we have the opportunity to serve clients to reach their optimal functioning. 

Here are references to studies that are relevant to this discussion. It is my hope that speech-language pathologists and music therapists will continue to share their skill sets for the betterment of the clients we mutually serve. 

Thompson WF, Schlaug G. The Healing Power of Music. New therapies are using rhythm, beat, and melody to help patients with brain disorders recover language, hearing, motion, and emotion Scientific American Mind; March/April 2015, pp 33-40. [PDF]

Wan CY, Bazen L, Baars R, Libenson A, Zipse L, Zuk J, Norton A, Schlaug G. Auditory-Motor Mapping Training as an Intervention to Facilitate Speech Output in Non-Verbal Children with Autism: A Proof of Concept Study PLoS ONE 2011;6(9):e25505; doi:10.1371/journal.pone.0025505. [PDF]

Wan CY, Schlaug G. Neural pathways for language in autism: the potential for music-based treatments.Future Neurol 2010;5(6):797-805. [PDF]

Schlaug G, Norton A, Marchina S, Zipse L, Wan CY. From singing to speaking: facilitating recovery from nonfluent aphasia. Future Neurol. 2010;5(5):657-665. [PDF]

Music and speech therapy: a winning combination

As a young music therapist, I found myself drawn to addressing clinical goals in speech, language and cognition. In order to advance my skill set in this area, I later sought and was awarded a Master’s degree  and then a Ph.D. in Speech-Language Pathology. In this training, I got to ask all of the pressing questions that I had from years of clinical experience in music:

how is music (melody, rhythm) neurally perceived? how is speech perceived?  

how does articulation differ in speech and in music? how are they similar?

how does cognition, the hallmark of our humanity, develop optimally? And how could music could support this cognitive development and inform cognitive rehabilitation?

 

Some of the things that I have come to learn is that music and speech share the same neural network. This explains the overlap of pitch and rhythm in music and speech. And they differ in important ways- speech perception and production are predominantly left hemispheric activities while melody perception and production are predominantly right. This explains why people who stutter don't when they sing. Because of these shared networks, we have an opportunity to use music to treat speech disorders because:

the rate of production can be slowed naturally in music to facilitate motor ability

music is compelling and motivating 

repetition of targeted sounds and phrases is generally more acceptable and natural in music  than it is in speech

people with speech disorders can often sing when they can't talk which can be an important asset in repairing elements of speech

I have come to find the combination of my training as a speech and music therapist to be a significant asset in my work as both a clinician and as an educator. It has truly been a winning combination in problem solving, treatment planning and clinical services for a wide variety of clients who have congenital or acquired diseases and disorders. It is my hope that this winning collaboration of services will be available to all who could benefit from it. 

To find a music therapist in your area, go to http://www.musictherapy.org/about/find/

To find a Neurologic Music Therapist in your area with specialized skills in speech/language protocols, go to: http://cbrm.colostate.edu/academy/registry-of-members/