MUSIC 2MT3 - Exam

What is music therapy? 

* A discipline in which an MTA uses music purposefully within a therapeutic relationship to support the development, health and well-being of an individual 
* MTs use music to address human needs within cognitive, communicative, emotional, musical, physical, social, and spiritual domains 

MTA

music therapist accredited

CAMT

* Canadian association of music therapists
* Canada's self-regulating body for music therapy  
* Purpose:
* to create strong certified music therapists and bring awareness about the profession of music therapy 
* MTs must provide proof every year that they are engaging in continual education, etc
* Need to maintain their membership with the CAMT in order to be recognized as a music a MT 

Is music therapy new? 

* In Canada? Yes
* Has been recognized as a healthcare profession in the 1970's (over 40 years) 
* The use of music in healthcare is NOT a new concept 
* Professional term of being self regualted in canada begain in the 1970s 

When was MT first regulated in the US

* 1950s


* The National regulating body for music therapy was established in the USA in the 1950s, however, the first MT training program in the USA was established in the 1940s. 

Why music?

* Music therapists tap into how humans respond to music and using that response to help facilitate a healthcare goal 
* Because of its ^^flexibility^^ (music) music therapists as healthcare practitioners can change how they're using music in the moment to respond to the client  

Universal Phenomenon

* Used globally  
* Used for social interactions to support wellness and recognize aspects of traditional and cultural connections 

Music as a tool

* Music is used as a tool within a therapeutic context to achieve a variety of healthcare goals 
* The use of music affects our mood, emotions, acts as a distraction, evokes memories, elicits movement 

What is not music therapy? 

* MT is not entertainment
* Does not refer to musical lessons
* Not special music education

Becoming a MTA

* Must complete one of the MT programs at their an undergrad or post graduate level
* 6 unis in Canada that offer a degree in MT 
* Complete 1000 hrs internship
* complete supervision hours
* complete board certification exam (CBMT - Certification Board of Music Therapists)

Skills needed to be accepted into MTA training programs

* Must already be proficient in musical skills 
* Broad knowledge and execution of different musical styles 
* Needs to be able to improvise music (important for flexibility and creativity) 
* Needs to have a sincere interest in helping others  
* Need to be patient and understanding 
* Need to be reliable, genuine and ethical  

MT + ACT of psychotherapy

* If one is a music therapist in Ontario and they want to work towards mental health, they might draw upon the psychotherapy act  
* In addition to meeting the mandates of the CAMT one must also meet the mandates of the CRPO (College of Registered Psychotherapists of Ontario  

Who do MTAs work with?

* Work with all ages (newborn or premature babies to the elderly) 
* Work with all diagnoses  
* i.e. injury, pain, mental illness, disability, etc

Where do MTAs work? 

* They work in hospital settings, long term care facilities, day programs, private practice, schools, rehabilitation programs, very diverse 

MT interventions

* Pre-composed music 
* Listening to music 
* Singing 
* Improvisation 
* Lyric analysis  
* Song writing 

Pre- composed music 

* Any song that already exists and we can replicate it 
* Have to be cognizant of how we use precomposed music because not only can it evoke positive memories but also negative memories 
* Can be used in a positive way if the individual is cognitively able to process this emotions 
* Something with dementia is not cognitively able to process a traumatic experience 

Group MT session - Pre-composed music

* MTA may repeat certain parts over again in order to facilitate the healthcare goals 
* Ex. Someone with a cognitive decline starting to remember the lyrics, MTA will repeat it bc. The client is cognitively starting to engage an getting more benefit by singing that song a few times 
* Why is it so beneficial? 
* Feelings may be difficult, and that’s okay if we can cognitively process those emotions and have the support in a therapy session 
* Familiar and predictable 
* Almost always we can engage in the chorus 
* When memories are evoked it can stimulate dialogue  
* In a group session, people will learn things about each other that they didn’t know before 
* When you feel connected to other ppl in the group, you have a shared experience 


*  Alleviate feelings of loneliness

How its implemented

* Live music 
* MTA can play the piece of music as a live piece of music  
* Pre-recorded 
* Benefit – client hears the music in the form that they're used to hearing it  
* Listening to it in its original format may be more powerful for a client  
* Singing 
* Increasing oxygen saturation 
* Working on vocals 
* Working on muscles for speech  
* Listening 
* Can be to live or pre-recorded music 
* Playing instruments 
* Could be motivated to play along on an instrument 
* Moving  
* Might be moving to the beat of the music 
* Can evoke the memories of how to move 

Precomposed music and cognitive goals 

* Memory 
* Precomposed music evoke memories 
* Trying to bring memories back around their own identity and previous experiences 
* Ex. Dementia, post-stroke 
* Speech 
* Can be a way to work on aspects of speech and to communicate (while singing)
* Keeping areas used related to speech strong 

Physical rehabilitation - precomposed music

* Post-stroke, acquired brain injury 
* Lost the ability to walk independently, can use music to facilitate walking, range of motion with arms, etc 
* Muscles get primed
* Know they're getting ready for a specific movement with precomposed music 
* Gate
* Increased balance or coordination 
* Stride  
* Using precomposed music with a strong beat, can help an individual to align their movements with the beat 
* Motor cortex starts to fire more readily when it hears music with a strong beat 
* Can help to facilitate movement and support physiotherapy goals 
* Increased range of motion 

Bell choir example 

* MT session – goals of working on fine motor skills, dexterity, working on evoking memories, facilitating meaningful discussions 
* Long term care facility – specific health care goals of elevating mood, physical goals, building connections between the members of the group  

iPod project 

* Not MT 
* Saw healthcare workers + family creating a playlist 
* More happening in MT sessions listening to the playlist would be directed to specific healthcare goals 
* Very important to sit with the individual with the headphones 
* If left alone and a song that evokes a negative memory, you may be causing them harm 
* May not realize that all they need to do is remove the headphones because of their cognitive decline 
* May not have the vocal capacity to call out for help 

Listening

* Can help to developed cognitive skills such as attention and memory  
* Its about listening meaningfully with intent  

Singing

* Can assist with the development of articulation  
* Helps with rhythm – important aspect of speech rehabilitation 
* Breath control – helps with aspects of anxiety  
* Group setting  
* Singing together can help with social skills, listen out and respond to our environment  
* Individuals with dementia
* facilitate engaging in reminiscence
* boots self esteem
* highlights ability rather than disability

Song writing 

* Song writing can help an individual make sense of their inner world, thoughts, feelings
* Provides a tangible product that can be shared with others
* BUT the product is not as important as the process
* Terminal illness
* Use songwriting as a way to express and share with others words and feelings they want to convey after they leave
* can replicate it
* Intent of the song is the most important part

Song writing as a MT intervention

* Tends to be used mostly in achieving goals having to do with wellness 
* Working with individuals who
* have symptoms of anxiety, depression, addiction 
* Clients who have had a stroke (post-stroke), accident, etc
* What if the client is non-verbal? 
* Can use images to help facilitate the songwriting process (next slide) 

Example of song writing

* Client's reaction 
* Idea of engaging in MT seemed like it wasn't going to be his thing 
* Having a song to work on gave him a distraction 
* Was able to say thank you to her for all of her support (wife) 
* Gave him purpose and meaning, something to motivate him with 
* Had autonomy and self-control over his environment  

When to introduce songwriting?

* Depends on the client 
* Engaging in songwriting requires a bit of cognitive ability  
* If one's cognitive processes are impaired it might not be applicable 
* Dementia care? 
* If the client is quite progressed in their dementia they likely will not be able to communicate verbally or with any kinds of pictures 

brainstorming (songwriting technique)

* Throwing out every word coming to your mind at the moment 


* Might use a whiteboard to write words 

Rhyming (songwriting technique)

* Taking the words from brainstorming exercise and seeing if any of them rhyme 

Fill in the blanks (songwriting technique)

* Technique where we take the melody of a song that the client likes and is drawn to  
* Client can cross out the lyrics they don't want to keep and those will be the words that will be replaced with the lyrics they're brainstorming 

Song parody (songwriting technique)

* Take a precomposed piece of music but instead of taking out some of the words, we take out all of the words 
* Replacing the lyrics with ones used to express ourselves yet still keeping with the pre-existing melody  

Song collage/medley (songwriting technique)

* Where the client resonates with several songs and instead of writing their own lyrics to several different songs, they want to make one song that brings together a couple of different melodies and mix them into one song  
* Drawing from these different pieces of music  


* Maybe add a bit of fill in the blank so that the song is further individualized 

Mother + daughter - songwriting

* Mother wrote song for her child 
* Gracie also wrote a song for her mom 
* Idea of intent 
* Mother had words to share and empower her daughter 
* Gracie had words she wanted to share with her mother  
* Point: not only the client can write songs but the parents can too and participate collaboratively  

Case example - songwriting

* At first he wasn't interested but she noticed a box of cassettes of recordings of him reading his poetry 
* Eyesight had been getting worse and was concerned he wouldn't be able to read anymore 
* Importance of autonomy  
* This opportunity to engage in giving someone Greek lessons (all his poetry was in Greek) was very empowering for him  
* He was in control and was important for his overall health and wellbeing 
* Was burned on a CD and given to client's family members 

Lyric analysis 

* By looking at the song or the lyrics it can be revealing for the individual to recognize maybe there's something in the song that they want to say, hear, or share with somebody  
* Sometimes finding the words of what we want to say or convey is difficult but maybe those feelings and thoughts have already been said in a song we've heard  

Improvising

* In MT, when the client is improving their creating sounds on an instrument or vocally to express themselves
* Purpose of improvising is to provide the client with a space to self-express themselves without any concerns about if they're getting it right or not bc it's their own creation
* Nordiff Robins – approach likely to use improvisation 
* About creating music in the moment 

When would a MTA implement improvisation? 

* When clients are working toward goals in relation to self-expression, building self-confidence, alleviating or managing stress and anxiety  
* Could have had a stroke or acquired brain injury 
* Creating something freely in the music could be a way to communicate feelings and emotions 
* Creativity to have autonomy in their day to day life 

Clients - improvising

* Anyone can engage in improvising 
* Except infants 
* What is the intent? 
* Is it to manage anxiety? Enhance self-confidence? Give the client a voice? 
* Need to think about this 
* What are we going to do with this? 
* Creating something in the moment? 
* Maybe it’s a tool to facilitate discussion or self-reflection 
* Recorded and used as a tool to listen back to and reflect on? 
* Do they have the cognitive ability and emotional stability in order to do that? 

Mirroring - improvising technique

* Therapist is going to support their improvisation and play along with them 
* Empathic technique 
* Trying to musically reflect the same music that the client has 
* Doing the exact same thing at the same time of the client  
* Idea is that the client can see themselves in the therapist
* Video
*  Client and the MT are at the keyboard 
* MT is mirroring with the same timing as the client  
* Client is in control and directing the therapist  

Matching - improvising technique

* MT is creating something simialr but not doing th esame thing at the same time 
* Doing something compatible with what the client is doing 
* Not the same thing at the same time 
* Compliments what the client is doing  
* Idea is that the client feels the MT is with them even though they're not doing the exact same thing at the same time 

Grounding - improvising technique

* Client is free expressing themselves 
* Way for the MT to bring an anchor to the improvisation 
* Plays the same notes repeatedly in order to create something of predictability  
* Client is still expressing but the MT is providing grounding support for the client 

Holding - improvising technique

* Similar to grounding 
* Used for the same purpose – in order to provide some stability/container for this free expression, the therapist will play a pattern 
* Musical pattern (grounding was repetitive, stable) 
* Creates a container around the improvisation 

Dialoguing - improvising technique

* Therapist and client speaking to one another through improvisation 
* Going back and forth/turn taking 
* Video 
* Dialoguing is helping with his social interactions (has autism) 
* Could be helpful if that's one of his healthcare goals 
* Can see how he responds to the music 
* Can promote social skills 

Process to receive MT

* Referral 
* Music therapist will meet with the individuals and conduct an assessment  
* From there they'll determine goals and objectives of the session and put together a treatment plan to best reach those goals etc 

Referral process

* Anyone can make one doesn't have to be a healthcare practitioner  
* The referral isn't based on the fact that they have diagnoses 
* Individual doesn't have to have any background in music or know how to play an instrument/music theory, etc 

Evidence of music overtime 

* Bone flute (45 000 yr old) 
* Couldn't record music to share it till the 1800s 
* Evidence of rattles, whistles, percussion instruments 
* Dating back over 30 000 years ago 
* Images of rock engravings as old as 16 000 years prior 
* Showed dancers 
* Can infer that there was music  
* Wooden pipes (4000 years ago) 
* Oldest music instrument that can still be played is 9000 yrs old 
* Flute found in China 
* Proof that music notation was occurring during circa 2500 B.C 
* From cuneiform tablets in the Sumerian culture  

The role of music  

* Post literate times
* healing traditions
* Used to motivate and bring ppl together during battles 
* Facilitate bonding during groups 
* Emotional catharsis 

Preliterate cultures 

* Since there was no written communication, we don't have any evidence remaining from this time 
* Can only speculate

Densmore (1954) 

* Reported that healing songs by Native Americans are characterized by irregular rhythms and different classes of songs and dances are associated with different types of healing requirements from different illnesses 
* healthcare goal in regards to healing  


* In certain preliterate societies its postulated that healing songs originated directly from superhuman sources to the members of society  

Ancient Egypt (5000 BC) 

* Still see aspects of magic in regards to medicine and health + religion 
* Aspects of magic, medicine, religion and music are intertwined  
* Egyptian priests were similar to Egyptian physicians and referred to music as medicine for the soul 
* In the Babylonian culture (circa 1850 BC), music was included in healing ceremonies as to appease the gods as illness was viewed as punishment from the gods  

Ancient Greece (600 BC) 

* Believed that music could influence one's character 
* it had a force over thought emotions, and could impact physical health 
* Aligns with views of using music today 
* Healing shrines and temples had hymn specialists 
* Recognizes the importance of music in prayer  
* Music was prescribed to the mentally ill 
* Used as a prescription to manage symptoms of mental illness  

Pythagorus Circa 500 BC 

* Considered music as a model for the harmonic proportions of the universe 
* Studied physics and recognized there were parallels in how music was constructed to the physics of the universe 
* Had a preference for string instruments (area he studied) and warned against flutes and cymbals as they would potentially unbalance the mind 

Plato circa 400 BC 

* Emphasized the ethical and educational dimensions of music which he considered important especially for young adults and young ppl for keeping the soul clean and pure 

Aristotle circa 400 BC 

* Held a therapeutic concept of music based on the notion that music can create an emotional katharsis in terms of mental states that need release from unhealthy inner tension or dysfunctional hyper reactive mood states 
* Believed that music could change character

Ascelpiades (124-40 BC) 

* Moved away from the idea that someone who is ill is being punished by the gods or brought it upon themselves 
* Recognizing that there's actually a physiological illness in that person that's not a result of the gods, etc 
* Referred to using greek modal scales for healing 
* Such as phrygian and dorian mode to encourage changed from somber and melancholic  

Caelius Audrelianus 500 AD 

* Recommended massage, bed rest, heat, dietary alterations and music 
* Warned against the indiscriminate use of music as this could cause madness 

The middle ages (C 500 – 1450 AD) 

* Now we have the theory of the 4 humors: 
* Black bile 
* Yellow bile 
* Phlegm 
* Blood 
* Illnesses were thought to be caused by imbalances between these 4 elements 
* St Basil  
* believed that music was a powerful vehicle for sacred emotion and it was though that music could help balance these 4 humors  
* Music = preventative 
* Hymns could be effective against certain respiratory diseases 

Boethius middle ages - circa 480 - 524

Through this book, there were sections that divided the use of music into 3 levels 

* Highest level - Musica Mundana 
* considers music as a mathematical concept of harmony in proportions and numbers  
* Second level - Musica humana 
* Music as a reflection of the harmony of the human body 
* Lowest level – musica instrumentalis  
* Listening to music as performed by singers and instrumentalist

Music and education - 6th century 

Music has made it officially into the most influential medieval treatises on education as part of the quadrivium 

* Four major subjects 
* Math 
* Geometry 
* Astronomy 
* Music  
* Being seen as the most important together with the more practical disciplines 
* Grammar 
* Rhetoric 
* Logic 

The renaissance (1300-1600)

* Advances in anatomy, physiology and clinical medicine  
* Four humors are still seen as the basis of medicine at this time 
* Physicians are still prescribing music as a preventative medicine  

Baroque period (1580-1750)

* Medicine is still informed by the 4 humors 
* Use of latromusik created by Athanasius Kircher 
* based on the vibrations 
* The bad humors (black and yellow bile) are shaken lose by the vibrations and can escape through the pores of the skin  
* Figured bass 
* Musicians would improvise upon the base, choosing dif times of tempos, rhythms, expressions, dynamics, etc to math appropriately the music to specific states of illness  
* Theory of treating illness through the 4 humors is no longer a concept 

Ernst Anton Nicolai - Circa 1745 

* Psychological experiences of music would exert physiological effects on the rest of the body 
* Recognizes that music works therapeutically primarely on the psyche which in turn will effect the physiological states of the body 

Richard Brocklesby  - Circa 1749 

* School of thought - ordering the school of thought can be an important therapeutic tool to treat mania and other acute disorders 
* Revisiting the idea that the kind of music is going to influence your character as well as how music can help to reorder the passions 

18th century writing about MT 

Columbian magazine (1789) 

* Unknown author wrote an article called "music physically considered" 
* Discusses principles that are currently being used in MT 
* Importance of a trained practitioner 
* Use of it has been trained (priest, shaman, etc) 

Modern medicine – 1800s to now 

* Importance of scientific methodology of being able to replicate results and have a research question 
* Became difficult to prove the efficacy of music in medicine 
* As a result modern medicine got rid of music science and music psychology 
* Medicine became re-active rather than preventative

Medicine tends to be re-active  

* Music programs in schools for the blind/with disabilities  
* Recognizing how helpful it can be to engage in music beyond just learning an instrument 

James Whittaker - 1874

* Article music as medicine 

Advances of studying the brain 

* 1990's FMRI
* Once we were able to see the brain, we could actually study the effects of music on the brain 
* Can now measure the impact of engaging in music or music therapy through measuring changes in hormones 
* Other examples
* Computerized tomography (CT) 
* Used around 1972 
* Magnetic resonance imaging (MRI) 
* 1980's 
* Allowed us to see the brain  
* FMRI 
* See where the oxygen is in higher concentrations and indicates that's the area of the brain being used at the time  
* EEG 
* Look at the electrical activity through the surface of the brain 

WW2 soldiers

* Engaging in music had an impact on managing PTSD symptoms 
* Soldier project where research was conducted 
* Published works and were able to hare findings to heathcare teams about how engaging in music was having a positive impact on their symptoms 

History of MT in Canada 

* Mid 1950s, Fran Herman was one of the founders of MT in Canada
* 1960's Norma Sharpe conducted a survey across Canada to find out if there were other ppl using music in hospital settings 
* 1970's, Sharpe invited these individuals to come together for the first conference of MTAs 
* Formed collaboratively the Canadian Music Therapy Association in 1974 
* BEFORE 1974, it wasn't an established healthcare profession in Canada 
* Name change – Canadian association of therapists  

Music therapy in Europe 

* Juliette Alvin
* Worked with children with autism and children with developmental differences 
* Through her work, that the society of music therapy for remedial therapy was established in 1958 which was renamed to the british society of music therapy 
* First training program was established at Guild Hall in 1968 
* European association of music therapy was established in 1989 

The European association of music therapy 

* 1970’s
* Programs in Netherlands, Norway, Sweden, etc were a part of the European association of MT 
* 2005
* Further grew to include Italy, Spain, etc 

Human voice

* At least 530 000 yrs old  
* Hominids a couple species prior to us developed the modern human speech box 
* Descendent voice box 
* Gives your voice a lot more control + versatile range to produce sounds 

Prehistoric instruments

* Oldest known instrument is a bone flute in Germany  
* Dates back 42000 yrs 
* Some archeologists debate there's an older bone (43-60 thousand yrs ago) 
* Whistles – date back 50 thousand yrs 
* Hollow gourds, drums 
* Harder to track

Why did music evolve? 

* Don’t know
* Possible explanations
* Would evolve for rituals and religious purposes  
* To woo people  
* Method of communication  
* Evolved as a biproduct of dance 
* Catharsis or way of healing 

Why did rhythmic music evolve?

* Cohesion, group coordination and cooperation 
* Seen in rituals which would have preceded a war venture or social bonding ritual that requires people to come together 
* Rhythmic music evolved in that sense to strengthen the bonds between early societies 

Why did music evolve culturally? 

* Storytelling and singing promotes those social bonds 
* Neolithic period 
* Societies are becoming more larger and complex 
* Seeing a division on labour and social hierarchy  
* Start seeing ivory flutes  
* Great indicator of developed social hierarchy 

Ancient Egypt 

* Music is depicted in the lives of the elite class 
* In their rituals 
* Religious scenes 
* Court scenes 
* Military scenes 
* Sexual scenes 
* Obvious in the elite class that music was very prominent 

Ancient Greece and Rome 

* In Greece we know that there were professional musicians, competitive musicians and everyone else who were still considered musicians  
* Everyone else who wasn’t a professional musician  
* Expected to have knowledge of all of the folk and drinking songs
* Musical activities in all of the social classes of ancient Greece  
* Theater events 
* Festivals 
* Private parties 
* Domestic work 
* Manual labour 
* Military activities 
* Education, etc
* Have records of music being a big part of the medicine of ancient Greek and roman life  

Music as therapy (role of music)

* When the approach uses music as therapy, music is seen as what facilitates the change


* The engagement in the music, the creation, listening, participation of music that supports the goal
* Creates change
* The facilitatory of change/centre of what is moving change

Music in therapy (role of music)

* Some approaches where music is seen in the therapy


* Music is a tool facilitating the change but it's not the end all
* Change doesn’t happen all in the music
* The music is facilitating the change but there's other things contributing
* Therapeutic relationship
* Verbal facilitation
* Reflection
* Images, other creative tools
* Music is a piece of the puzzle
* Supports change

Nordoff Robbins Music Therapy (Creative music therapy)

* Developed by Paul Nordoff and Clive Robbins
* Their work focused specifically on children with disabilities 
* has since grown and ppl trained in this model work with people all ages and diagnoses
* They saw how there was a healthy music child in every person and this healthy music child could be reached through engaging in music together 
* This model involves 2 music therapists  
* One on the piano and one with the client  
* Example of ^^music centered^^ 

Guided imagery method (GIM) 

* Developed in the 1970s  
* Training one would do after becoming a MT 
* Part time over a 3 year period
* In this model is about listening to recoded music and facilitating discussions around the images that come to the forefront as a result of listening to the music  
* Helen Bonny (1980s) 
* Based on the idea that we can have an outer source that can facilitate images and facilitate inner reflection  
* Example of ^^music in therapy^^ 

Behavioural approach 

* Using music as a reinforcement stimulus and to modify behaviour  
* Providing an experience with the client that is positive to reinforce that behaviour or doing something to deter a behaviour  
* Ex. Neonatal units (positive) 
* Where an infact sucks on a pacifier its hooked up to a machine that plays music 
* Positive reinforcement 
* When they stop sucking on the pacifier the music stops 
* Lack of music (negative) 

Cognitive behavioural model 

* Type of therapy that aims at shifting how we perceive something 
* MT has adopted this approach in using music to help the client shift the lenses around an irrational belief 

Psychotherapy approach 

* Based on psychodynamic theory 
* Brought forward by Sigmund Freud and further developed by Jung and Adler  
* Based on the idea of unconscious thought 
* Example - songwriting 
* Can invite a client to brainstorm different words that come to mind 
* This is like free association 

Biomedical models 

* Neurobiology, what's happening in the brain, how is music impacting the brain, how can it increase endorphins to manage pain perception, etc 
* How can there be an increased release in dopamine (happiness endorphins) 
* Examples of a biomedical model 
* Using music to impact physiological and neurological changes 
* Seen in pain management and symptoms of mental illness 

Neurologic music therapy (NMT) 

* Newer model in music therapy  
* The therapeutic application of music to cognitive sensory and motor dysfunctions due to neurologic disease 
* There are standardized evidence based interventions 
* Outcomes are measurable
* Video example
* When the client began his sessions he was walking at 65 bpm (playing the guitar) 
* By the end of the treatment the client was able to walk at 120 bpm 
* Gradually increased the speed of the walking and that was measured with the bpm with the guitar 
* 3 domains that it focuses on
* 1) example of sensorimotor rehabilitation
* 2) speech and language rehabilitation
* 3) cognitive rehabilitation 

Eclectic model 

* The music therapist draws upon any of the approaches that they have training and expertise in to best meet the needs of the client 
* Client centered approach 
* Most important 
* MTA is using the different approaches + models within the scope of their ability 
* MTA must always work within their limitations and recognized their strengths and limitations to best meet the needs of their client 

What is community MT

* Not fully embraced by MTA's because it doesn’t follow a typical clinical format 


* The approach involves awareness of the system MT are working within 
* MT is not only directed to the individual but often aims at changing that system that is part of the situation of the client 
* Happens in a group context 
* Music listening, instrumental playing, improvising, song writing, lyric analysis, almost any MT intervention can be implemented 
* Super flexible  

System theory 

* CMT has its roots in system theory  
* Suggests an alternative to the traditional cause and effect model within science 

Typical MT goals 

* Provider of vitality 
* Emotional stimulation and expression 
* Tool for developing agency and empowerment  
* Resource in building social networks 
* Way of providing meaning and coherence in life 

Coffee house study

* Purpose of coffee house: 
* Build skills to overcome anxieties  
* engaging in risk taking and having positive results 
* Participatory ethos  
* Means that coming to the coffee house was about participating 
* Judgement had no place 
* Outcomes 
* Clients reported feeling increased agency outside of the coffee house 
* Provided opportunities for staff to see clients in a different way 
* Shows a side of someone outside of a clinical setting 
* Challenges the system to make a change and embrace another way in engaging with clients 
* Very few opportunities of normalcy in healthcare settings 
* Coffeehouse allowed clients to forget they were in a hospital or institution 

Neurological Music Therapy 

* Neuro science approach to music theory based on scientific knowledge in music perception, music production and the effects of nonmusical brain and behaviour functions 
* 20 Standardized clinical techniques 
* Come under 3 topics 
* Sensory motor training 
* Speech and language training 
* Cognitive training 

NMT Training 

* In order to use neurological music therapy techniques or be recognized as a MT with the credentials of an MT, one must complete training through the Neurologic music therapy academy 
* 3 day training – intensive 
* Goes through techniques, implementation of the standardized way of working as an NMT 
* Allows a credential music therapist to practice the use of designation of NMT for 3 years 
* After that time an individual can become a neurological music therapy fellow 

NMT fellowship 

* For the credentialed MTA's  
* Intensive course that begins with a review and update of current research and clinical practice 
* Must present video examples demonstrating current clinical work using 3 dif neurologic music therapy techniques 
* At the end they are evaluating and if they receive more than a 70% majority then they will receive their fellowship credential 

Background of NMT

* Formally established in 1999/2000 (over 20 yrs ago) 
* Medically recognized as an evidence based therapy 
* World federation of neurorehabilitation is represented in over 60 countries by certified NMT therapists   
* Rhythmic auditory stimulation (RAS) 
* Beocme porminant for gait rehabilitation  
* Facilitating walking often after a stroke or brain injury 
* RAS is included in the official clinical stroke care guidelines in the US and Canada 

Dr. Michael Thaut 

* Founder of neurological music therapy  
* Currently a prof of music at UofT with ross appointment sin rehabilitation science and neuroscience  
* Director of the music and health science research center and music and health sciences graduate programs at UofT 

20 NMT techniques 

* 3 umbrellas that summarizes the goals  
* 1) Sensory motor 
* Mostly talking about movement  
* e.g. gait, range of motion, dexterity, coordination 
* Most used technique: 
* ^^Rhythmic auditory stimulation (RAS)^^ 
* ^^Therapeutic instrumental music performance (TIMP)^^ 
* 2) Speech and language 
* Developing vocab, speech, sentences, sentence structure, facilitating communication, developing vocal strength 
* Most used technique:  
* ^^Melodic intonation therapy (MIT)^^ 
* 3) cognition 
* Attention (attending go the environment or objects), perceive the environment/orient it,  
* Music and psychosocial training under cognition 
* e.g. CBT – requires change in cognition, how we perceive  
* Most used technique: 
* ^^Musical neglect training (MNT)^^