Music has been an integral part of our culture since the beginning of time. Be it Indian classical music that dates back to the multiple eras of rule in India or the evolution of jazz over the last century in America, communities all over the world have turned to music to communicate, express and create an identity for themselves.  And yet, when someone listens to a song from a culture they have never been exposed to, they still seem to be able to understand and connect to the music, the universal language of humanity. 

So, what is it about music that makes it universal? 

Research in the field of music and its effect on the behavior, emotions and most recently, the human brain is beginning to give us relevant information to further understand the impact of music and its ability to initiate and elicit responses that aren’t necessarily musical from the client. 

Given that music therapy is a constantly evolving profession with more research backing it up with every passing day, there are two definitions that stand out which explain both the scope of the profession and the expectations and required standards. 

Definition of Music Therapy 

The first is by Bruscia, who in his book Defining Music Therapy (1998) states; “music therapy is a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of change.1” 

According to the American Music Therapy Association, music therapy is defined as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program2. 

While the first definition captures the essence of the work that goes into music therapy, the second one offers a structure and context to the profession of music therapy. To better understand what these music therapy interventions are and how they can be applied with various populations, being able to differentiate between music education and its musical goals and music therapy with its non-musical goals is vital. 

For example, in a music lesson, if the teacher is teaching a student to play the scales on the piano, the end result of this activity is for the student to be able to play the scale on their own and use that musical knowledge and motor skills to be able to learn and play pieces of music that increase in complexity over time. Now this activity of playing the scales can also be a clinical music intervention used by a music therapist for a client that is working on fine motor skills like finger dexterity. The process of repetition, hand over hand teaching and maybe even using the help of sheet music could be the same but what differentiates the two scenarios is the end goal. Learning the scales and being able to reproduce it is a musical goal that the student is working on but in the second scenario, the end goal is for the client to be able to transfer the fine motor skills that they’re working on in other daily functioning activities in their life. 

Music and the Brain

The auditory system is the first to fully develop in a fetus between the 19th and 25th week of pregnancy while vision is the last sensory system to develop just before birth. Therefore, the way a fetus understands and perceives the world around it is through sound. Over the years, some of the ways neurologists have conducted neuro-musical research include research on animals, fetal and infant research, research on brain-damaged individuals, hemispheric asymmetry research and brain imaging research, neuro-motor research and affective research. 

While “elemental” responses to music, including emotional responses have been associated with the cerebellum and the limbic system, developmental aspects of music and the more complex analysis of it is carried out in the left hemisphere. Humans can entrain to rhythm, meaning that we have a biomusicological sense of synchronizing to an external perceived rhythm. Pitch has been proven to be an in-built property of the brain and absolutely necessary for auditory perception and therefore, damage to the area that processes it can impair one’s ability to assess pitch3. 

Music is the only activity that engages an extensive neural network in the brain involving various regions in the brain as opposed to a single region. It engages motor and cognitive components and is in operation not just during infancy but even the later stages of fetal development4. 

According to Habe, structural differences between musicians and non-musicians can be found in the structural changes in the corpus callosum, motor cortex and the cerebellum. Differences in gray matter volume in motor, auditory and visual-spatial brain regions have also been found in musicians when compared to non-musicians. Research conducted by Gibson, Folley and Park show that musicians who have been trained professionally show a higher level of activity in the left and right sides of their frontal cortex and this carries over to divergent thinking or creative thinking. 

Electroencephalography (EEG) has been a primary instrument that has been used to understand the effects of music on the brain better. Alpha frequencies or waves synchronized and changed with tempos of the music that individuals were exposed to. While non-musicians shows a decrease in the production of alpha waves in the left mid-temporal region of the brain, musicians showed a stronger decrease in the temporal region of the left hemisphere, including the pre-central, frontal and parietal areas.

Magnetic Resonance Imaging (MRI) has proven that the corpus callosum in musicians is larger than those of non-musicians. The planum temporale, which is the cortical area just posterior to the auditory cortex within the Sylvian fissure, is strongly lateralized in the left hemisphere in musicians compared to non-musicians4. 

Brain research involving music has shown that music has a distinct influence on the brain by stimulating physiologically complex cognitive, affective and sensorimotor processes. This research provides evidence that music works best in very different areas of therapeutic applications than was previously imagined or tried. In the late 1990s, the evidence found through research gave birth to a system of therapeutic techniques that are now known as a specialization within the field called Neurologic Music Therapy or now, more popularly known as NMT5.

Implementing music therapy

Similar to other forms of therapy and their processes, assessment is the first step to initiating a relationship with the client. There is an initial assessment where goals and objectives are created, spanning across cognitive, social, behavioral, emotional and physical abilities of the client. Once these goals have been determined, they are prioritized in terms of the client’s baseline. This can be done in the first session through observation of behavior, conversation with the client and/or the family, using previous evaluation information provided to the music therapist and in some cases, using pre-existing assessment tools. While the initial assessment provides the music therapist with information to create a treatment plan and design interventions, it is important to note that an ongoing assessment during the sessions is necessary in order to change and add to the plan as the client progresses. 

Building a therapeutic relationship with the client is the next step. While there is a treatment plan already in place, the first session is important to further define the goals and objectives, observe and also establish the boundaries and responsibilities of the client and therapist. Once these preliminary steps are done, the therapeutic process can begin. 

Designing music interventions revolve around the client’s goal and the ability to achieve it with the use of music. The genre of music is mostly client preferred. Breaking down a piece of music to the elements of music – pitch, rhythm, melody and timbre helps in using the altering and adapting various pieces of music to address the goal at hand. For example, lyric substitution is an intervention where you can replace certain words or phrases in a familiar piece of music to address a communication or emotional expression goal that a client has. Songwriting is also a important tool that works on cognitive and emotional goals in both individual and group settings. Making music using instruments and using techniques like call and response, mirroring (where the therapist plays what the client plays on a different instrument) and improvising are great ways to work on non-verbal communication. 

The Nordoff-Robbins method specializes in improvisation and active music making by developing a musical attitude that recognizes both the potential in everyone, irrespective of their diagnoses, for engagement in active, communicative, expressive music making and the importance of this in developing skills, a sense of self and a capacity for satisfying social interaction6. 

Neurologic Music Therapy is defined as the therapeutic application of music to cognitive, affective, sensory, language and motor dysfunctions due to neurological conditions and disorders. It is a rapidly growing system of music therapy, especially in the medical setting. Created by researchers and clinicians in music therapy, neurology and the brain sciences, there are currently 20 different standardized clinical techniques that are used by neurologic music therapists. Clients recovering from stroke, traumatic brain injury, left neglect, developmental neurologic disorders like autism are just a few of the various populations where NMT has made a mark by providing rapid progress and visible results, supported through research and evidence. 

An example of an NMT would be RAS (Rhythmic Auditory Stimulation) – a neurologic technique used to facilitate the rehabilitation, development and maintenance of movements that are intrinsically biologically rhythmical. RAS uses the physiological effects of auditory rhythm on the motor system to improve the control of movement in rehabilitation of functional, stable and adaptive gait patterns in clients with gait deficits due to neurological impairment.7 

Another technique is MIT (Melodic Intonation Therapy) that uses melodic and rhythmic elements of intoning (singing) phrases and words to assist in speech recovery for clients with aphasia. 

These interventions are only a few in an evolving field. While research and clinical evidence drive the therapy, the creativity and versatility of music allows for new and engaging interventions to be designed in the future. 

In India, there is a rich and vast culture of music being central to our lives. The complex rhythmic structures, the various combinations of notes to form raagas and the use of music as a vehicle to talk about philosophy and spirituality in Indian classical music showcases all the various elements of music discussed earlier that can be used in therapeutic interventions. Creating research studies that experiment and provide clinical evidence backed by research, we have the ability to be able to create music therapy interventions that define Indian Music Therapy while making it available to the global community. Our way ahead is to find a way to bring together our historic arts with neurologic and clinical research to add to and create a mark in the world of music therapy. 

In the words of Billy Joel – “Music in itself is healing. It is an explosive expression of humanity. It is something we are all touched by. No matter what culture we’re from, everyone loves music.”

About the Author

Purvaa Sampath MT-BC, NMT is the founder and director of Mayahs’ Universe and a graduate from Berklee College of Music. She is one of the few CBMT Board-certified music therapists and NMTs (Neurologic Music Therapist) in the country. With a dual-degree in music therapy and performance, Purvaa has had the opportunity to practice as a student music therapist in some of the top institutions like Perkins School for the Blind, Beth Israel Deaconess Medical Center and Boston Children’s Hospital in Massachusetts, USA. In her time with A Place To Be, an award-winning expressive arts therapy organization, she worked with a variety of populations from children and young adults on the Autism spectrum, cerebral palsy, traumatic brain injury, stroke rehabilitation, mental health disorders like depression, anxiety, bipolar and schizophrenia to geriatric care for Alzheimer’s, Parkinson’s, dementia and terminally ill clients. She specialized in working with the mental health population during her time at INOVA’s behavioral health facility in Virginia, USA.

In Bangalore, India, she works as a consulting music therapist with multiple institutions like FAME India which caters to individuals with neurodevelopmental disorders and Sukino Healthcare which is a residential neuro-rehab facility. In addition to this, she also works with clients at Mayahs’ Universe’s therapy space based in central Bangalore. Purvaa teaches music therapy as part of a PG diploma program in Expressive Arts Therapy at Women’s Christian College in Chennai and St. Xaviers College in Mumbai. In 2020, she was a facilitator and speaker for multiple online internships, workshops, events and courses with Youth for Mental Health, Muktha Foundation and Dr.Reddy’s Foundation, to name a few. In the corporate space, Purvaa has collaborated with IndiGo airlines to create learning and development programs with music-based activities.

Purvaa was also recognized for her work in music therapy by the Rotary Downtown chapter’s HR Pratibha Award for Women of Distinctive Vocation, 2019. She currently serves as a member of the Global Reporting Executive Committee for the IAMM (International Association of Music and Medicine). Her aim is to create a clinical standard for music therapy and provide access to education in order to establish and grow the industry of music therapy in India.

Bibliography

  1. Hanser, S. B. (2018). The new music therapists handbook. Boston, MA: Berklee Press.
  2. American Music Therapy Association. (n.d.). Retrieved from https://www.musictherapy.org/about/musictherapy/
  3. Levitin, D. J. (2006). This is your brain on music: The science of a human obsession. New York, NY: Dutton.
  4. Habe, K. (2010). Neuropsychology of music – a rapidly growing branch of psychology. Horizons of Psychology, 19(1), 79-98.
  5. Hoemberg, Volker (st Mauritius Klinik Meerbusch, Germany), Thaut, & McIntosh. (2016). Handbook of neurologic music therapy. Oxford University Press.
  6. What is music therapy? (2018, October 15). Retrieved from https://www.nordoff-robbins.org.uk/what-is-music-therapy
  7. Thaut, M. H. (2005). Rhythm, human temporality, and brain function. Musical Communication,171-192.