Psychological Research And Music Therapy - Essay Example

?Running Head: PSYCHOLOGICAL RESEARCH AND MUSIC THERAPY How Psychological Research has influenced the Development of Music Therapy Practice? [University] How Psychological Research has influenced the Development of Music Therapy Practice? Introduction Music is an art and good as it’s an alternative treatment to drugs for many disorders. Arts therapists have struggled to find ways to convey the meaning and the significance of their work to other health care professionals through research. Grainger (1999) argued that among major therapeutic approaches, art therapies are the most challenging to articulate, as the very essence of art is malleable and multi-dimensional. In their article Nightingale and Scott (2007) also emphasised that a scientific paradigm of measurement is limiting when we are trying to understand those things that are difficult to measure. Jevne (1991) noted that science lacks objective definitions of suffering and hope, and no developed language for human meaning. Indeed, it seems that many things in the modern world remain unquantifiable by science. Remen (2000) supports this belief, arguing that there are many things that remain only observed and tangentially understood. Although music has been used in conjunction with therapeutic practices throughout history, the formal development of the profession of music therapy is still relatively new. The field of music therapy is broadening and developing as more music therapists gain clinical experience and complete advanced education. In addition, there is an increasing awareness for the need to define clinical work in theoretical models that are arts-centred, rather than accommodating music therapy to the predominantly verbal language of traditional psychological therapeutic approaches, or the objectivism of the medical profession (Aigen, 1996; Kenny, 1989). It is, however, necessary for music therapists to maintain a relationship to and an awareness of these disciplines (Ruud, 1980). Music therapy programs are based on individual assessment, treatment planning, and ongoing evaluation while using activities that are musical in nature (i.e. instrumental and vocal) to generate non-musical changes in the recipient. The music therapist can work independently or as a member of an interdisciplinary team. The music therapist can attend to groups or individuals by providing a service that may reduce pain and anxiety, aid stress management and/or improve communication and emotional expression. The focus of current therapy seems to be shifting away from this medical model. The recent focus of therapy is incorporating a more generalised holistic approach to wellness when treating a patient (Peters, 2000). Increasingly, music therapists in some areas of clinical practice are moving away from activity-based models--rooted in the tenets of behaviourism and recreationally-oriented therapies--and embracing more process and aesthetic models of practice, which are more closely linked to an awareness of music as an ancient source of psychological research. These approaches to psychology have not severed their connection from the original meaning of the word therapy, which is "care of the soul," and lend support to the concept of the arts as one important way of attending to and caring for the soul (McNiff, 1981). In contrast to Freudian theoretical views (which have had far-reaching influence on the practice of psychology) of the arts as a flight from reality, or as a manifestation of pathological conditions, a healing view of the arts is grounded in a recognition of more observable and recordable human suffering. The process and depth-oriented approaches to music therapy are particularly effective in the clinical areas of music therapy in dementia care (Spiro, 2010; Summers, 1999), palliative/oncology care (Nicholson, 1999,2001; Salmon, 2001), and the combined use of imagery and music in the treatment of trauma, pain and abuse (Nicholson, 2001; Purdon & Ostertag, 1999). Still, psychological research has reinforced the validity of music therapy within the health care field. However, in many respects, music therapy practice is ahead of its research and literature. The therapeutic use of music has been taking place for centuries all over the world and will continue to change and grow as time passes. The research advances with an understanding that music has been implemented as a therapeutic tool since its inception, yet within the last century has become articulated in scientific and therapeutic terminology. The research begins by establishing the originary contributions historians and researchers made during the pre-paradigm period of music therapy. The main models in music therapy are then examined as they demonstrate the dynamic interaction between psychological research models and music therapy practice; as in the historical examples, some are not empirical. Finally, suggestions for further research are advanced. History of Music as Therapy In understanding music as therapeutic, one need consider the history of medium because it is ignorant to assume that the origin of music therapy is directly linked to the origin of modern psychological research. Historically music can be traced back to the most ancient times where it was used for a number of reasons. Not only was it used therapeutically, (Peters, 2000) but it was also used for entertainment and communication. Although it's purpose may have changed and evolved through time, music continues to remain an integral part in the lives of all who listen to it. Music has often been associated with healing throughout history. In primitive tribal cultures healing was often connected to a ritual or rituals. In African tribes the shaman functioned not only as the priest but also as the chief musician and medicine man using songs, instruments, dances and costumes in order to heal the members of his tribe (Peters, 2000). The medicine men of the Native American tribes had particular uses for individual songs. The songs and music were used as tools to heal specific ailments or conditions (Apel, 1972). The use of music as part of the healing process changed through time as society continued to develop and become more civilised. Music as a therapeutic modality was first used to treat those believed to have mental illness (Peters, 2000). The Greeks were the first to apply the controlled use of music without magic or religious implications (Benenzon, 1997). In contrast to this, increasing technological advancements led to the creation of tools that allowed listeners to hear prerecorded music. This created a renewed interest and increase in the exposure of people to music who would not otherwise be able to hear it (Peters, 2000). The use of music therapy as a treatment modality continued to increase in the second half of the 19th century. Positive results such as an increase in morale and a more rapid recovery rate were viewed in response to treatment of World War II veterans. (Peters, 2000) These results from Psychological research reinforced the validity of music therapy within the health care field. Although the first curriculum designed specifically for training music therapists was established in 1944, the first meeting of a professional music therapy organisation was not held until 1950 (Peters, 2000). It was the need to make music applicable to medicine that prompted the organisation of the field to reach more measurable goals and purposes (Peters, 2000). As the value of music spread it was used with different populations, some of the more prominent being pediatrics, psychiatry and geriatric. The diversity of music as a therapeutic tool, along with the generalist training of those who obtain music therapy degrees, lends itself to adaptation and clinical work in a wide range of settings. In these instances one comes to recognize the diversity of contexts wherein psychological research has contributed to the establishment of a music therapy paradigm. The successful use of music therapy has now been documented for the elderly (Bright, 1988), for persons with psychiatric illnesses (Priestley, 1994), for mentally and physically challenged adults (Bruscia, 1991), and for persons living with life-threatening and terminal illnesses (Salmon, 2001). The literature on the use of music therapy in palliative care reflects how music has been used effectively in pain management (Magill, 2001), anxiety management (Gross & Swartz, 1982), and to enhance patient communication and self-expression (Aldridge, 1999). Throughout the literature, one also finds references to the importance of music in spiritual care for those who are terminally ill (Salmon, 2001). The effective use of music therapy has also been documented with special needs children in a variety of educational and therapeutic settings, and for children living with chronic, life ­threatening and terminal illnesses (Aasgaard, 2001; Daveson & Kennelly, 2001). Ultimately, these categorical distinctions established through research function as the overarching paradigm through which further research contributions have been made. Limitations in Music Therapy During the past 61 years, since the National Music Therapy Association was founded in 1950 in the United States, music therapy profession has developed rapidly (Abrams, 2011). The United Kingdom witnessed considerable adoption of music therapy curriculum approaches following Priestley’s (1975) text Music Therapy in Action. Supported by psychological research from many studies, many people agree that music can influence human behaviour as well as emotion, and music therapists have worked with other professionals as team members (Priestly, 1975; Magill, 2001). However, there are few formal assessment tools in music therapy (Maranto, 1991; Wilson & Smith, 2000) although they have an important role in the music therapy process. Furthermore, the lack of formal tools which can be obstacles to communication between interdisciplinary team members and increased reliance on informally designed music therapy assessments have resulted in the diminished respect, approval, and credibility of the profession (Cole, 2002). Differences in approaches One of the prominent ways that research has contributed to music therapy has been through the establishment of assessment mechanisms. Still, a relevance gap existence, as in spite of the agreement that assessment is an important process in music therapy, it is difficult to agree upon the format or the system of the assessment tool. Because there are several differences between not only work settings but also music therapists' viewpoints, therapists assess their clients differently and with different methods (Barbara & Felicity, 2010). Probably the most distinct approaches are the behavioural approach and psychodynamic approach, as well as or quantitative and qualitative assessment (Ruud 1980). Loewy (2000) insists that the majority of assessment tools currently being utilised by music therapists appear oriented to specific behavioural tasks that are seemingly unrelated to the dynamic musical relationship that naturally occurs between client and therapist. a. Behavioural approach vs. Psychodynamic approach One prominent contribution research has made occurs in terms of the fusion of psychological models with music therapy. According to Taylor (1997), a behavioural approach suggests that music is used as a reinforcer or as an operant to modify behaviour of a client by conditioning. Although it continues to be used effectively as an intervention strategy in music therapy practice, he also insists that an inherent problem of this approach is that the musical stimulus is emphasised as a reinforcer after a target response has been elicited; therefore, it is very difficult to explain the therapeutic effects of music. Standley, Johnson, Robb, Brownell, & Kim (2004). They explain this approach in the context of four important behavioural principles. This is psychological research that contributes to the advancement of music therapy. The first step is to identify, modify, count, or otherwise observe a behaviour or behavioural indicator of a cognitive or affective process. Once a target behaviour is identified, observation is utilised to document related information. The next step is to introduce contingencies into the environment to influence the client into modifying the behaviour in a positive direction. The final step in a behavioural therapy program is the evaluation of the treatment result through continued or post observation of the targeted behaviour. They add that the reason why behavioural techniques have been adopted by early music therapists was because these techniques fit easily or effectively recordable psychological research. when objective evidence of treatment effectiveness is required for reimbursement of health costs. Ultimately, as reading this section demonstrates, psychological research greatly contributed to establishing the means that such behavioural practices can be implemented in music therapy. On the other hand, a psychodynamic approach uses music experiences to facilitate the interpersonal process between therapist and client as well as the therapeutic change process itself (Bruscia, 1998). In this approach, unconscious psychic confusions are emphasised to describe the process. Isenberg-Grzeda, Goldberg, & Dvorkin (2004) state that the goal of the psychodynamic therapy is resolve past unconscious conflicts as a means of improving present functioning. In contrast to the behavioural approach, there are little objective research models that help the music therapist understand how to describe the psychoanalytic music therapy experience. Existing assessment tools seem to focus on the technical aspects of music or other disciplines' measurements (Loewy, 2000). Isenberg-Grzeda (1988) asserts that the theoretical framework and world view of the therapist strongly influences the manner of assessment. Isenberg-Grzeda (1988) divides these perspectives in that the behavioural approach is linked more heavily to observable and quantifiable responses to music, whereas the psychodynamic approach would seek to interpret musical projections. Of course the ultimately challenge is that the psychodynamic approach is largely contingent on the therapist and in-depth knowledge of psychoanalytic practice and terminology. Such ‘unscientific’ processes seem to resists articulation in research. b. Quantitative assessment vs. Qualitative assessment Another prominent contribution psychological research has made to music therapy is through quantitative and qualitative assessment models. The differences between philosophical approaches are brought about by the differences of assessment style. When music therapists get patient information, the data can be evaluated quantitatively or/and qualitatively. For example, the frequency and duration of musical events which take place while therapist and client are improvising music together can be examined using quantitative analysis. On the other hand, therapist can qualitatively assess interaction within the context of their music-making during an activity (Wigram, 2000). Loewy (2000) argues for interpreting the music therapy experience to understand an event. The more such interpretive data is gathered, the greater progress and contributions it makes to music therapy. Taylor (1997) indicates a limitation resulting from the lack of specific variables identified by other related clinical disciplines, and insists that it is difficult to predict therapeutic outcomes of music therapy and justify the inclusion of music therapy in a clinical setting. It seems the predominant challenge is determining direct correlation between the musical elements and the areas of psychological progress. To achieve reliability, a therapist must organise and control the methods of obtaining data and independent variables so that the client's responses cannot be attributed to extraneous influences or chance. To be valid, an assessment must produce and provide the kinds of data needed to draw the desired conclusions (Hintz, 2000). Taylor (1997) insists that the best type of research for the use of music as therapy is still being debated among researchers, and suggests future studies should yield replicable and reliable results. Research Issues and what needs to be done In its initial development as a profession in the United States in the 1940s, music therapy aligned itself closely with the behavioural sciences in order to gain validity, recognition and acceptance into the mainstream clinical and research practices of the day. The United Kingdom followed this lead and was one of the early Western implementers of music therapy in educational curriculums. A review of the music therapy literature reveals a historical reliance on quantitative research approaches (Kenny, 1989). Kenny's music therapy text, The Mythic Artery, published in 1982, was dismissed and savagely critiqued by some current pioneers in the field at that time, precisely because it spoke in poetic and artistic language about subjectivity, culture, and the ancient connections between music and healing. Kenny's text presented a vision of music therapy practice that was in direct opposition to the perspective being promoted by many of the behaviourally-based training programs in the United States, which were trying to link themselves to the perceived scientific validity of the field of psychology. In doing so, these programs minimised the long-standing cultural link between music and healing, replaced the language of healing and the arts with the popular language of psychological systems, and emphasised the importance of observable, measurable results. This research used to be philosophical, thus it’s relevant to society. The challenge becomes changing the perspective from philosophy to psychology. In addition to the philosophical problems with the assumption of objectivity in human interactions, music therapy research which emerged from the failure to capture the meaning and richness of music therapy experiences (Valle 1998). Some music therapists became dissatisfied with this focus on applying research methods designed for science to the human and social science fields. A dialogue thus began to emerge in the research literature which not only questioned this dominant approach, but which also began to offer alternatives rooted in the qualitative tradition. This shift of paradigms has involved a radical questioning of basic presuppositions about what can and cannot be "proved" and "measured" in musical therapy related work (Kuhn, 1962). The struggle and the search to find a language which conveys the depth of music therapy clinical experiences has therefore been taken up by a number of prominent music therapy educators, clinicians, and researchers (Aigen, 1993; Langenberg et al, 1996). In addition, some United Kingdom graduate programs in music therapy are now specialising in qualitative research methods, and a body of literature and research on qualitative studies in music therapy is beginning to develop. According to Bonny (1989) music therapy practice has gradually shifted away from a strict reliance on behavioural models to a reliance on uncertainty in search of new paradigms. It does not mean to imply here that there is no place for quantitative research in music therapy; in certain settings and in relation to certain research questions, it can clearly be justified (Wheeler, 1995). Kenny (1989) urged music therapists to seek ways to balance the 'art and the science' of research, and to search for harmony between logic and intuition. To an extent such an approach can be linked to mixed method qualitative and quantitative modes of understanding. There is a concern among music therapists who express a sense of frustration and difficulty in being able to communicate to others what music therapy is and how it works (Kenny 1989). One recognizes the relevance gap in research has broached in many ways. Among prominent steps have been the describing and naming the experiences of music therapy. Certainly, the most central of these is translating the language of sound and music into words (Kenny 1989). In trying to explain this work to people outside of the field, turning to the stories and descriptions of the clinical work is a key to helping people gain more understanding of the power of the arts in healing. Building a repertoire of descriptive, phenomenological accounts of work seems particularly important for a field which is still struggling to establish and maintain itself within and among the mainstream disciplines of medicine, psychology, rehabilitation and education. McNiff (1989) pointed out that there is a need to explore research approaches that acknowledge the ambiguity of creative processes. In fact, a similar call has been made by qualitative researchers in the bereavement field, a call for a new language in which to talk about loss (Mcferran et al., 2010). Traditional grief models have largely evolved out of a positivistic scientific methodology and world view that many have argued has not adequately considered the impact of culture, has tended to pathologise the experience of patients, and thus has failed to capture the complexity of human suffering and healing (Klass, Silverman & Nickman, 1996; Mcferran et al., 2010). Conclusion and Need of Further Research Despite much evidence to the contrary, people still tends to view the arts in general, and music specifically, as entertainment, something to be performed on a stage by skilled experts, rather than something which can be an integral part of the health of individuals and communities. This view is supported by many school arts programs and by arts educators who focus only on developing the technical artistic skills and expertise of their students. This narrow view of the role of the arts in society and in education separates and removes the arts from everyday life and from everyday people. It also suggests that creativity and imagination are special talents, limited to "professionals in the arts", rather than more universal aspects of human experience and character. In health care settings, music therapy is often on the edge, frequently misunderstood as in-house entertainment, and frequently undervalued in the funding hierarchy. Many music therapists feel a sense of alienation and isolation in their work sites which is due not only to the newness as a profession, but also due to the fact that what music therapists offer and value is not widely valued by the larger societal systems; particularly in a health care system which is dominated by the tenets of objectivism and the medical model (Bonny 1986). According to Bonny (1986) many medical practitioners do not believe music fits into scientific paradigms that have embraced left-brain mentality over right-brained intuitive facilities. The cultural propensity for binary thinking makes it difficult for many in the medical profession to see the value in the co-existence of the creative with the technical, the abstract with the concrete, the artistic with the scientific, and the intuitive with the rational. Yet, in a holistic analysis, these things are very important to healing. Music therapy research has contributed to the understanding of specifically quantifiable element. The historical considerations demonstrate that the evolution of music is in-turn the evolution of music therapy. The establishment of psychological practice has contributed to music therapy through the increasing establishment of art-centered models over the traditional verbal language of traditional psychological therapeutic approaches. From these foundations music therapy programs have been developed based on individual assessment, treatment planning, and ongoing evaluations that were previously established in psychological research. Further music therapy approaches have not so much directly incorporated psychological research, but have been influenced by it through consciously rejecting it in favor of more holistic approaches. Although music has been used in conjunction with healing practices throughout history, the formal development of the profession of music therapy is still relatively new. Music therapists in training and in practice are trying to learn about a field of study that is still trying to find out about itself. It is a young field still in the process of becoming. There is a need, not only to increase the quantity and quality of music therapy research, but also to find a language and a research approach that can embrace and communicate to others the ambiguity and complexity of artistic, therapeutic processes. References Aasgaard, T. (2001). An ecology of love: Aspects of music therapy in the pediatric oncology environment. Journal of Palliative Care, 17(3), 177-181. Abrams, B. (2011). Understanding music as a temporal-aesthetic way of being: Implications for a general theory of music therapy. The Arts in Psychotherapy 38 ,114–119 Aigen, K. (1993). The music therapist as qualitative researcher. Music Therapy, 12, (1), 16-39. Aigen, K. (1996). The role of values in qualitative music therapy research. In M. Langenberg, K. Aigen, & Frommer (Eds.), Qualitative research in music therapy: Beginning dialogues (pp. 9-33). Gilsum, NH: Barcelona Publishers. Aldridge, D. (Ed.). (1999). Music therapy in palliative care: New voices. London: Jessica Kingsley Publishers. Apel, W. (1972). Harvard Dictionary of music (2nd ed.). Cambridge, MA: Harvard University Press. In Peters, J.S. (2000). Music Therapy an Introduction. Springfield, IL: Charles C. Thomas. Barbara L. Wheeler, Felicity A. Baker, (2010). Influences of music therapists’ worldviews on work in different countries. The Arts in Psychotherapy 37, 215–227. Benenzon, R. (1997). Music Therapy Theory and Manual Contributions to the knowledge of Nonverbal Contexts. Springfield, IL: Charles C. Thomas. Bonny, H. (1989). Sound as symbol: Guided imagery and music in clinical practice. Music Therapy Perspectives, 6(1), 7-28. Bright, R. (1988). Music therapy and the dementias. St. Louis, MO: MMB Publications. Bruscia, K. (Ed.). (1991). Case studies in music therapy. Phoenixville, PA: Barcelona Publishers. Bruscia, K. E. (1998). An introduction to music psychotherapy. In K. E. Bruscia (Ed.), The dynamics of music psychotherapy (pp. 1-15). Gilsum. NH: Barcelona Publishers. Cole, K. M. (2002). The music therapy assessment handbook. Columbus, MS: SouthemPen Publishing. Daveson, B., & Kennelly, J. (2000). Music therapy in palliative care for hospitalized children and adolescents. Journal of Palliative Care, 16(1), 35-38. Grainger, R. (1999). Researching the arts therapies: A drama therapist's perspective. London: Jessica Kingsley Publishers Ltd. Gross, J. & Swartz, R. (1982). The effects of music therapy on anxiety in chronically ill patients. Music Therapy, 2(1), 43-52. Hintz, M. R. (2000). Geriatric music therapy clinical assessment: Assessment of music skills. Music Therapy Perspectives, 18, 31-40. Isenberg-Grzeda, C. (1988). Music therapy assessment: A reflection of professional identity. Journal of Music Therapy, 25, 156-169. Isenberg-Grzeda, C., Goldberg, F. S., & Dvorkin, J. M. (2004). Psychodynamic approach to music therapy. In A. A. Darrow (Ed.), Introduction to approaches in music therapy. Silver Spring, MD: The American Music Therapy Association, Inc. Jevne, R. F. (1991). It all begins with hope: Patients, caregivers, and the bereaved speak out. San Diego, CA: LuraMedia, Inc. Kenny, C. (1989). The field of play: A guide for the theory and practice of music therapy. Atascadero, CA: Ridgeview Publishing Co. Kenny, C. (1989). The field of play: A guide for the theory and practice of music therapy. Atascadero, CA: Ridgeview Publishing Co. Klass, D., Silverman, P.R., & Nickman, S. (Eds.). (1996). Continuing bonds: New understandings of grief. Washington, DC: Taylor & Francis. Kuhn, T. (1962). The structure of scientific revolutions. Chicago: University of Chicago Press. Langenberg, M., Aigen, K., & Frommer, J. (Eds.). (1996). Qualitative music therapy research: Beginning dialogues. Gilsum, NH: Barcelona Publishers. Loewy, J. (2000). Music psychotherapy assessment. Music Therapy Perspectives, 18, 47-58. Magill, L. (2001). The use of music therapy to address the suffering of advanced cancer pain. Journal of Palliative Care, 17 (3), 167-172. Maranto & K. Bruscia (Eds.), Perspectives on music therapy education and training. Philadelphia, PA: Temple University, EstherBoyer College of Music. Mcferran, K., Roberts, M. & O’grady, L. (2010). Music Therapy with Bereaved Teenagers: A Mixed Methods Perspective. Death Studies, 34: 541–565, 2010 McNiff, S. (1989). Depth psychology of art. Springfield, Illinois: Charles C. Thomas, Publishers. McNiff, S. (1992). Art as medicine: Creating a therapy of the imagination. Boston, Massachusetts: Shambala Publications, Inc. Nicholson, K. (1999). Music therapy in cancer care: A study of the music therapy program at the British Columbia cancer agency. Burnaby, BC: Open University. Nicholson, K. (2001). Weaving a circle: A relaxation program using imagery and music. Journal of Palliative Care, 17(3), 173-176. Nightingale, P. and Scott, A. (2007). Peer review and the relevance gap: ten suggestions for policy-makers, Science and Public Policy, 34(8), 543–553. Peters, J.S. (2000). Music Therapy an Introduction. Springfield, IL: Charles C. Thomas Prinsley, D.M. Priestley, M. (1994). Essays on analytical music therapy. Phoenixville, PA: Barcelona Publishers. Purdon, C. & Ostertag, J. (1999). Understanding abuse: Clinical and training implications for music therapists. Canadian Journal of Music Therapy, 6(2),9-23. Remen, N. (1996). Kitchen table wisdom: Stories that heal. New York, NY: The Berkeley Publishing Group. Ruud, E. (1980). Music therapy and its relationship to current treatment theories. St. Louis, MO: Magnamusic-Baton, Inc. Salmon, D. (2001). Music therapy as psycho spiritual process in palliative care. Journal of Palliative Care, 17 (3), 142-146. Spiro, Neta (2010). Music and dementia: Observing effects and searching for underlying theories. Centre for Music and Science. 14(8), 891–899. Standley, J., Jonson, C., M., Robb, S., L., Brownell, M. D., & Kim, S. H. (2004). Behavioural approach to music therapy. In A. A. Darrow (Ed.), Introduction to approaches in music therapy (pp. 103-123). Silver Spring, MD: The American Music Therapy Association, Inc. Taylor, D. B. (1997). Biomedical foundations of music as therapy. Saint Louis, MO: MMB Music, Inc. Valle, R. (Ed.) (1998). Phenomenological inquiry in psychology: Existential and transpersonal dimensions. NY: Plenum Press. Wheeler, B. (Ed.). (1995). Music therapy research: Quantitative and qualitative perspectives. Phoenixville, P A: Barcelona Publishers. Wigram, T. (2000). A method of music therapy assessment of the diagnosis of autism and communication disorders in children. Music Therapy Perspectives, 18, 13-22. Wilson, B. L., & Smith, D. S. (2000). Music therapy assessment in school setting: A preliminary investigation. Journal of Music Therapy, 37, 95-117. Read More