Music Therapy Readings PDF

Preview

Summary

Music Therapy ReadingsPg. 167-180  Excerpts from: Music Therapy Treatment ProcessPart 1: The clinical process  Cohen & Gericke (1972)  cornerstone to develop responsible & meaningful treatment-rehabilitation program is the accumulation & synthesis of accurate & sig...

Description

Music Therapy Readings Pg. 167-180  Excerpts from: Music Therapy Treatment Process Part 1: The clinical process  Cohen & Gericke (1972)  cornerstone to develop responsible & meaningful treatment-rehabilitation program is the accumulation & synthesis of accurate & significant patient data  After this info collected & analyzed  used to formulate treatment goals, objectives & strategies  Assessment of client needs also assists therapist in evaluating & documenting clinical changes that occur during treatment Client  Donna  Donna, 68-years old, lower back pain, back injury tissue has healed, still has pain, no interventions have worked, has changed her life, recluse, stays inside, become depressed, negative impact on relationship with husband, personal physician referred her to Backpain Clinic at Roseville Rehab Centre for 4-week program to provide intensive transdisciplinary approach to address physical, emotional & social functioning Referral  o First step in treatment process = referral; facilitates access to health care providers o Requests for services may come from  physicians, psychologists, OT’s, PT’s, SLP’s, teachers, parents, social workers, clients themselves o Hospital setting – referral for MT; by physician o School setting – referral for MT; parents, school psychologist, interdisciplinary team (IEP) o Nursing home – referral for MT; staff member, physician, family member, activity director Donna cont’d   Physician administers medical exam to see if any tissue damage  Psychologist conducts evaluation to identify psychological factors (depression/personality traits)  PT assesses functional movements  OT reviews assessment of everyday activities  Social worker interviews her to learn about lifestyle/interests prior to onset of back pain  Assessments identify  dance & music have had important role in Donna’s life therefore music therapy is identified as important treatment Assessment 

       

Initial assessment  prior to start of treatment Provides overall view of client’s history and present condition AMTA standard of clinical practice  assessment should be included as a general procedure prior to commencing services w/ a client Assessment=analysis of person’s abilities, needs, problems Assessment info. Can be acquired by interviews w/ client/family, testing, observing, documenting how client does in cognitive, physical/other tasks, viewing interactions w/ others, reviewing records Assessment data should be gathered in multiple ways Format & content of assessment tools vary – depend on age/type of population served, policies of facility, state/federal requirements, length of treatment, time available Three primary types of assessment currently used by music therapists  o 1. Initial assessment- completed at beginning of therapeutic process to identify client strengths & weaknesses, help formulate treatment goals o 2. Comprehensive assessments – completed when a client is referred for music therapy services only o 3. Ongoing assessment – tracks functional levels and progress through treatment process

Why is Assessment Important?  The info learned from initial assessment helps determine nature & scope of treatment; e.g., if client is suited for music therapy/what treatment goals and techniques are appropriate  Assessing client needs is to provide a reference against which progress during treatment can be measured (ongoing assessment) o Can’t tell how far we’ve come if we don’t know where we started o Can moderate treatment plan o Final evaluation at end of treatment – determines improvement  Continued growth and development of music therapy profession is dependent upon ability to assess, monitor, and evaluate treatment Areas of assessment  to determine a treatment plan, the team will assess strengths & needs of client in these areas; 1. Medical (past med. History, current health) 2. Physical (range of motion, gross & fine motor coordination, strength, endurance) 3. Cognitive (comprehension, concentration, attention span, memory, problem-solving skills) 4. Emotional (appropriateness of affect, emotional responses) 5. Social (self-expression, self-control, quality & quantity of interpersonal interaction 6. Communication (expressive and receptive language skills) 7. Family (assess family relationships & needs)

8. Vocational/education (adequacy of work skills/preparation for workplace) 9. Leisure skills (awareness of recreational needs, interests, participation in activities/community resources) Donna Cont’d ; initial assessment  Medical  record of dosage/frequency for pain & sleep medications, xrays, tests. No physiological abnormality found  Physical  self-protective walk, fills out several pain scales  Cognitive  normal intelligence, difficulty concentrating  Emotional  MMPI, Beck Depression Inventory, medical outcomes survey; sig. level of depression, resentment, anger, helplessness, dependent  Social withdrawn from activities, lonely  Communication  NA  Family  life revolves around back pain, relationship toll  Vocational/education  OT met w/ donna to plan how to re-establish capabilities  Leisure skills  used to participate in activities, now home-bodies  Music therapy assessment  questionnaire to determine fav music styles, identify musical selections for relaxation sessions/exercise Assessment Tools  Good assessments = reliable and valid  Reliability  consistency with which test measures behaviour/behaviours  Validity  how well a test measures what it is supposed to measure  Music therapy assessments have been published for use with variety of pops  o Developmental disabilities o Children in spec. ed. o Behavioural-emotional disorders o Hospitalized children o Hospice patients o Older adults  Drawbacks  o Reliability and validity have not been fully established Treatment Plan  Once initial assessment data is gathered & analyzed, next step = establish treatment plan  Multidisciplinary  each team member focuses on & reports in team meetings on particular aspects of client’s needs closest to their disciplinary scope of practice

 

Interdisciplinary approach  each team member takes primary responsibility for particular treatment goals, with collaboration in development of treatment goals & how they will be attained Transdisciplinary approach  several specialists collaborate on particular goals & objectives

Therapeutic Goals & objectives  Goal=broad statement of desired outcome of treatment  Objectives= more specific and short-term  Goal is broken down into series of short-term objectives  Each objective describes an immediate goal; measurable  Specific music therapy interventions can be used to help meet objectives o Music=excellent for exploring/expression emotions, strong social component, effective for use in cognitive pain management, promotes efficient movements & persistence in exercise  Music as a stimulus to reduce discomfort  Music to promote efficient movements & persistence  Music in group therapy  Music and leisure skills Treatment goals for Donna   Reduce experience of pain (including psych components)  Decrease/eliminate use of meds for pain  Improve physical/lifestyle functioning  Enhance social support Documentation of Progress  Monitoring progress through therapeutic process=most important thing  Objectives= what client needs to do to meet the treatment goal  Baseline measure= important to maintain; indicates severity & is reference point  Organization must maintain accurate & complete records on diagnosis, treatment, and care of clients (legal document)  Submission of regular & accurate written reports is a fundamental responsibility of ALL music therapists o Contain: assessment data, goals, objectives, treatment plans, progress notes, final report @ discharge o Must be non-judgemental, objective terminology Evaluation & Termination of Treatment  When client has met treatment goals/when treatment team decides client has achieved greatest benefit from therapy; treatment is discontinued



@ time of discharge/discontinuation  MT writes an evaluation of entire music therapy process (initial goals, progress made, recommendations)

Pg. 1-8  Music Therapy: Historical Perspective Music Therapy in Preliterate Cultures  Preliterate societies: no system of written communication  Members of preliterate cultures generally believe in the power of music to affect mental and physical well-being  Music often connected w/ supernatural forces  Most instances  tribal musician/healer holds place of importance within society o They determine cause of disease, apply appropriate treatment to drive spirit/demon from body o Sometimes music functions as prelude to actual healing ceremony o Drums, rattles, chants, and songs – used in preliminary ritual & throughout ceremony o Musician/healer usually does not act alone Music and healing in early civilizations  Music played important part in “rationale” medicine during this time (5000 and 6000 BC) as well in magical and religious healing ceremonies Use of music in antiquity: healing rituals  Egyptian music healers enjoyed privileged existence, due to close relationship with priests/government  Egyptian-priest-physicians referred to music as medicine for the soul and included chant therapies as part of medical practice

 



Babylonian culture  treatment of sick people consisted of religious ceremonies, healing included music Music = special force over thought, emotion, and physical health in ancient Greece o Music prescribed for emotionally disturbed individuals o People who subscribed to power of music  Aristotle, Plato, Caelius Aurelianus Predominant explanation of health/disease became theory of 4 cardinal humors  blood, phlegm, yellow bile, black bile (each had unique quality) o Good health = balance of the 4

Music and Healing in the Middle ages and Renaissance  Christian beliefs influenced attitudes towards disease; practice of medicine still based on theory of 4 humours  This framework provided basis for role of music in treating illness  Renaissance advances in anatomy, physiology and clinical medicine = marked beginning of scientific approach to medicine o Some integration of music, medicine, and art o Music during renaissance was used as remedy for melancholy, despair, madness, and prescribed by physicians as preventative medicine o Enhance emotional health o Helped to maintain positive outlook on life  Baroque period  o Music continued to be linked with medical practice o Theory of temperaments and affections by Kircher provided fresh viewpoint on use of music in treatment of disease o Kircher  believed that personality characteristics were coupled with certain style of music  E.g., depressed would Listen to melancholy music  Thus, healer would choose correct style of music for treatment o Burton  Anatomy of Melancholy; supports use of music to treat depression



Late 18th century  music still advocated by European physicians in treatment of disease o Increased emphasis on scientific medicine o Use of music to soothe the gods= no longer consisted with views on illness/healing o Music was relegated to special cases, applied by only few physicians who used holistic framework

Music Therapy in the United States  MT as a profession became organized in 20 th century 18th century writings on music therapy  Earliest known reference to MT in USA  unsigned article in Columbian Magazine in 1789; o “Music Physically Considered” – basic principles of music therapy still used today o Influence and regulate emotional conditions o Person’s mental state may affect physical health o Music was a proven therapeutic agent o Advised that the skilled use of music in treatment of disease required properly trained practitioner  Another article; “Remarkable Cure of a fever by music: an attested fact” 1796 NY Weekly Magazine; o French teacher with severe fever lasted 2 weeks, went to a concert, symptoms disappeared during performance, returned upon conclusion o Music repeated; suspension of illness, 2 weeks later recovered completely Pg. 141-147  The Development of the Music Therapy Profession  Traditionally – music’s role as a healing power has been assumed to be the profession’s foundation o Ignores 2 details   1. Music has historically served other purposes pertinent to current music therapy practice  While music has always had a healing role, was not until 1940s that music therapy evolved as distinct profession The Roots of Music Therapy: Music’s Historical Roles  Music therapy mirrors this usage of music (various roles)

 













Ancient societies; music fulfilled spiritual, religious, healing and social roles Ancient preliterate societies; used music as means to connect to gods o In palliative care, connection to higher being is made when patients sing/meditate/etc. Ancient Greeks introduced concept that music is an integral part of the cosmos, affect character development and health through “right” kind of music and balancing one’s passions Ancient beliefs  music is essential to human development, can influence health, character and relaxation – concepts integral to music therapy approaches today Iso-principle  involves matching particular music to person’s mood o Elements of music are gradually changed, altering client’s emotions or energy levels Middle ages  development of music’s role in religion; emergence in Renaissance and Baroque periods  de-emphasized music’s use as a healing power Divisions found in various roles that music fulfills in life  o Ritual and ceremonial purposes o Integral part of spiritual, religious, h o ealing and social aspects of life o Provides connection to that which is meaningful o Affects behaviours and emotions These roles are all found in the music therapy practice

The Development of Modern-Day Music Therapy  From ancient Greeks to modern times, physicians have written about music as form of medical treatment  Nearchus (Alexander the Great’s physician) used music as antidote for viper and scorpion bites  Roman Aulus Gellius believed music could relieve pain of gout  Theophrastus thought music could relieve epilepsy  1600s – physicians recommended music for treatment of melancholy  Columbian magazine article  1789; earliest written reference to music therapy o Highlighted basic principles of music therapy still used today o Document stems from writings of ancient Greeks; music and its effect on regulation of emotions o Author asserted that music is proven therapeutic agent, requires application by trained practitioner

  





Doctorial thesis by Edwin Augustus; 1804 expanded these beliefs Next 100 years; number of articles referring to music therapy were published sporadically in medical journals 1832; US educational facilities such as Boston’s Perkin’s school for the Blind; began to integrate music into curriculum to assist blind population 1880; 14 training schools had been established in US for people with mental impairments; each school integrated music into curriculum (for socialization and physical well-being) Late 1800’s and early 1900’s; number of individuals who worked to establish music therapy as a profession o Eva Vescelius, isa Maud Ilsen, Harriet Ayer Seymour o Music should be used to facilitate health

The Development of Music Therapy in the United States  Formation of the profession of music therapy is accepted as having begun during World War 2 with the US Army’s establishment of music programs for wounded servicemen  Music had been used to entertain troops and support mental and physical abilities  Program developed during ww2; first to systematically implement and evaluate music to boost morale and improve health outcomes  Special Services Music Officer  The success of the music recreation service led to development of US Army’s Reconditioning Program  Surgeon general of US requested a national survey be completed looking at use of music in mental hospitals  Program= based on belief that music is effective in bringing people together, releasing emotions, and creating a feeling of community. 3 Programs: o Active participation  Play specific instrument/sing to heal that part of the body o Passive participation  Listening and discussing music, appreciate it o Audio reception  Listen without necessary response required, entertainment  Army was VERY careful to avoid using term; music therapy o Lack of supporting scientific evidence o This led to start of 3.5 year study looking at efficacy of Army’s program





o Results 74% of patients within programs attained improved health outcomes through involvement with music End of WW2; 122 veterans hospitals engaging with services of music therapy personnel o After war ended, led to development of numerous University programs, and founding of national association for music therapy in 1950 Since then; developments in US include establishment of Registered Music Therapist (RMT) qualification, institution of an examination based certification process, degree programs and requirements, journal of music therapy & music therapy perspectives, and the gradual expansion of scope of practice to include various client pops.

The Development of Music Therapy in the United Kingdom and Europe  Music was used in WW2 in European hospitals like US, music therapy did not formally develop in Europe until 1950s  Juliette Alvin; being primary pioneer responsible for developing music therapy in Britain o Worked with autistic children, mentally impaired, and/or physically impaired o 1958; founded the society for music therapy and remedial music therapy  10 years later; founding the first training program at Guildhall school of music and drama  1976; field was officially recognized by British government with formation of the Association of Professional Music Therapy o 2005; 6 established training programs  In UK; music therapy was largely based on improvised music and existence of 2 primary theories: o First considers music as a medium through which therapy occurs o Second is based on psychodynamic theories and emphasizes therapeutic relationship  End of 1970’s; music therapy could be found in Netherlands, Norway, Sweden, Denmark, Germany, Austria, France, Switzerland, Yugoslavia, Belgium  1989; formation of the European Music Therapy Confederation  2005; membership included countries listed above and Italy, Spain, Cyprus, Estonia, Finland, Greece, Hungary, Israel, Lithuania, Malta, Poland, Portugal, Switzerland, and Republic of San Marino

The Development of Music Therapy Worldwide  Began in the US, soon spread across the globe  Therapists trained in either US or England, then would return to home country  Music therapy approaches within each country depended on initial pioneers whom therapists trained  Specific country approaches; pg. 145-146  In past 20 years; music therapy has gained a foothold in the Far East  As music therapy grew around the world, the organization of an international conference was inevitable o First occurred in Buenos Aires in 1974 o American Association for Music Therapy began to publish an international music therapy journal; music therapy international report Music Therapy Within the Context of Modern History  Music therapy’s development in the US was clearly affected by 2 professions: medicine and music education  Interactions between music education and music therapy began in early 1800s  Various schools incorporated music into curriculum w/ the belief that students would benefit from the integration of music with studies  National music council  conducted the survey upon which Army’s program was based and sponsored committee that resulted in formation of National Association for Music Therapy  Before establishment of the association & regulatory qualification; music therapists were often music educators/professional musicians who worked with people w/ mental health needs  Medical community influenced development of musi...