Music Therapy

An Introduction with Case Studies for Mental Illness Recovery

Alfredo Zotti

• Publisher: Loving Healing Press
• Year: 2020
• ISBN:
  9781615995325
• Topic: Media & Performing Arts
• Subtopic: Music Theory & Appreciation

Alfredo Zotti, a professional musician and bipolar survivor with a university degree in social anthropology and three years study of psychology, provides an introduction to music theory with specific case studies of applications for Alzheimer's, bipolar disorder, autism spectrum disorder (ASD), schizophrenia, anxiety, depression and other issues. Working primarily as a peer support counselor, his person-centered methods are respectful of client's needs, abilities and responses to music therapy. Strategies explored include both active listening of recorded music as well as instruction in playing musical instruments. Using patience and listening skills, you can -- with Zotti's book -- begin your own journey of music therapy. "I congratulate Alfredo on this terrific summary of the ways in which music therapy can serve a complementary role in the treatment of a range of psychological difficulties. Anyone who is interested in promoting his or her wellbeing, or the wellbeing of loved ones, will enjoy Music Therapy: An Introduction with Case Studies for Mental Illness Recovery."
--Paul Corcoran, psychologist, Moving Forward, NSW "Alfredo Zotti's Music Therapy: An Introduction with Case Studies for Mental Illness Recovery shows that recovering through music can be an extremely powerful and wonderful journey of self-healing and positive discoveries. I highly recommend this book to anyone who wishes to enhance their knowledge of music therapy and the influence of music on their health and, consequently, on their lives."
--Krystyna C. Laycraft, Ph.D, physicist, educator and artist "Through his own experience of positive outcome by therapeutic use of music, Alfredo Zotti shares the supplemental, holistic method to improving mental health issues and dementia. Music Therapy: An Introduction with Case Studies for Mental Illness Recovery promises to assist in the recovery process and help sufferers regain a happier life."
-- Rie Matsuura

1	An Introduction to Music Therapy

In this book, I hope to illuminate the topic of music therapy as it is used in a practical, common sense and powerful way to help people who suffer with mental illness and other mental challenges. Unfortunately, governments here in Australia, as in many countries of the world, do not subsidize music therapy in terms of providing mental health insurance for those who cannot afford to pay for it. While this book does not aim to offer therapy that is specifically tailored to a person, it nevertheless offers some elements that can be used by the sufferer to alleviate symptoms. Given that we are all unique, there is always the need for a therapist to guide the sufferer.

Although I am not certified as a music therapist, practitioners of that profession often consult me, because I am a qualified pianist, composer and sound engineer and have recorded many CDs for a variety of artists. Since 1993, as a composer, I have been a member of the Australian Performing Rights Association (APRA) and the Australian Mechanical Copyright Owners Society Limited (AMCO). Recently, I completed my own jazz CD to raise funds for the Kidman Centre. It is particularly relevant that my wife and I also suffer with bipolar disorder, and I have collaborated with psychologists and psychiatrists on various issues. I have also written three books, including this one, on mental illness, and one on art therapy in collaboration with other writers. I have a university degree at honors level, majoring in sociology, anthropology and three years of psychology.

In the following chapters, we will discuss practical ways in which I have been able to help people, of all ages, with Alzheimer’s, autism, anxiety, depression, bipolar disorder and schizophrenia. Music therapy can be powerful, either in combination with medical interventions or as a sole therapy, where medical interventions fail, because not all people respond to medication. Over the years, I have developed my own unique methods of helping people and this has also been possible because of my tertiary studies in sociology, anthropology and psychology. When possible, the chapters are supported by research, and I indicate issues in which there is need of more research.

What is Music Therapy?

Music therapy is defined by Bruscia (2014, p.12) as:

A systematic process of interventions wherein the therapist helps the client to promote health, using musical experiences, and the relationships that develop through them, as dynamic forces of change.

Alvin (1966, p 11) offers a somewhat deeper definition, although complementary to Bruscia’s:

Music therapy is the controlled use of music in the treatment, rehabilitation, education and training of adults and children suffering from physical, mental and emotional disorder. Since it is a function of music in which music is not an end in itself, its therapeutic value is not necessarily related to the kind of music used, nor to the standard of musical achievement. Its effect is primarily due to the influence of sound on man, of which music was born, and whose curative, harmful or negative value will become apparent… throughout history.

Koelsch (2009) proposed that five factors contribute to the effects of music therapy: modulation of attention, modulation of emotions, modulation of cognition, modulation of behaviors and modulation of communication. Koelsh (2009, pp. 26-27) writes:

These processes can have beneficial effects on psychological and physiological health. Music can evoke strong emotions and reliably affect mood... Music-evoked emotions can modulate activity in all limbic and paralimbic brain structures.

I will now, in turn, discuss each of these effects of music.

Attention Modulation

This is a complicated area of the music therapy. For example, according to Koelsch, when music captures our attention, we can become distracted from any stimulus that can lead to negative thoughts or experiences. For example, suppose a person is constantly worried about personal problems; for example, finances. A song or a nice tune comes on the radio, and the person begins to focus on the music and temporarily puts aside his/her financial problems. However, it is not always this simple. For example, some depressed or anxious people do not like listening to any music at all. They may be completely locked in their negativity and not want to listen to any music, unless they force themselves to do so and then let the therapeutic process begin.

For people with a mental disorder, there must be an initial struggle for music therapy to work. Songs, or some music, can worsen the worries, rumination, anxiety or depression. When one engages in any therapy process, one has to struggle and this is so for any person with mental illness. The struggle is the decision to accept that the person will give therapy a go, that they will attempt to work with the therapist and that they are ready to change. Change always comes at a cost—it is not something that happens naturally. In mental illness, changing is extremely difficult because one must admit that one has problems and that one will work with the therapist to attempt to solve the problems or at least reach a plateau where the problems are less disruptive in their life.

Modulation of attention is an important factor in music therapy, but a therapist must know how to use it and the sufferer must be prepared to do some work. A therapist cannot do the work for the patient.

To recap, modulation of attention happens when the person in question begins to attentively listen to the right music, which helps to distract from negative thoughts that may lead to negative experiences. The right songs or music is subjective, and therefore it is up to each person to find the kind of music that is helpful, either alone or with the aid of a music therapist.

Emotion Modulation

According to Koelsch (2009), some studies have shown that music can be used to regulate certain activities in the brain, which have to do with modulation, generation, termination, initiation and maintenance of emotions. For example, think of a person who has lost a loved one but is unable to cry. Simply listening to an appropriate song, let’s say for example, “Danny Boy” (Frederic Weatherly, 1913), can trigger tears, therefore opening that tap of emotions that need to be released. Many studies clearly show that there are enormous benefits in crying, particularly for people in distress (Becht, & Vingerhoets 2002; Cornelius 1997).

Koelsch and Jancke (2015) write that recent findings suggest that music evokes effects on the activity of the heart, as reflected in electrocardiogram amplitude patterns. This indicates that, when listening to music that has a calming effect, patients with heart disease show a reduction of pain and anxiety associated with a lower heart rate and lower blood pressure. Additionally, heart rate (HR) and respiratory rate (RR) are higher in response to exciting music compared with tranquilizing music. Koelsch and Jancke (2015) call for more research into the effects of music on wellbeing and health, particularly for heart and respiratory related problems.

Music can affect physiological changes regarding heart activity, blood pressure and breathing. For example, because anxiety is a disorder that has largely to do with breathing, some music can be particularly efficient in relieving anxiety and regulating breathing (ibid). Tranquil music, as opposed to exciting music, can control heart rhythm, particularly if at 60 beats per second, which is roughly the rate of a normal heart. A tune that has a 60 beats per second, coupled with beautiful harmonies and interesting melodies, appeal to many people and can be used to relieve anxiety.

Cognition Modulation

Music modulates thinking (Koelsch, 2009; Khalfa, et al., 2008; Nilsson 2009); for example, memory processes, such as the encoding and decoding of musical information. This is particularly notable in Alzheimer’s disorder and dementia, where music and songs can stimulate memories (Blackburn & Bradshaw 2014; Johnson & Chow 2015). Modulation of cognition has also to do with syntax and musical meaning.

Behavior Modulation

Modulation of behavior, according to Koelsch (2009), happens when music affects behavior, such as a runner who wears headphones and runs in synchrony to the beat of the music, or a dancer who dances to the music. Music can aid in rehabilitation of body movements and can also modulate speaking behavior. We can breathe to the music, as is the case when we do guided relaxation with music. More radical changes are noted in autism, where children, if helped early, can dramatically change their behavior with the aid of music. One obvious change is socializing through music activity, which then progresses to personal socialization. Coordination of movements, such as the ability to control one’s distorted thinking or emotions, as in bipolar disorder, are all dramatic changes induced by music.

Communication Modulation

Music is a means of communication, and language and music often work together. Music improvisation is a non-verbal language, but can also be a pre-verbal language, as suggested by Geretsegger et al., (2004). Classical musicians can communicate emotions without words and sometimes musical expression can go much further than words to express certain feelings; for example, when jazz musicians play together and improvise. In addition, communication through music alone can happen at a much more emotional level, allowing a struggling person to better process their personal struggles. We all know the power of music in expressing love. Or think of how a film scene is enhanced by the score and how the music makes what is communicated to the viewer so much more powerful. Animals also use sounds to communicate emotions, feelings and needs.

There is little research to better understand music as a language and a means to communicate what the spoken word may gloss over. When I choose the right musicians for one of my recordings, I always ensure that I can communicate musically with them. Music phrases and drum fills or improvisations really depend on the quality of musical communication that happens among the musicians and how well they synchronize their performance. This is not like a verbal language, but it is a communication that relies on expression of emotions, timing and skills of the musicians in presenting and performing musical phrases and rhythms. When I sit at the piano, I can communicate my emotional and sometimes intellectual state of mind: I can communicate a mental state of calmness and reflection or confusion and upset.

Music is, above all, a universal language, but it is unique in that it does not have a fixed meaning. The same song, in the same society, in different contexts, can have very different meanings. As Blacking (1995, p. 237) argues, “Not only can the ‘same’ patterns of sound have different meanings in different societies, they can also have different meaning within the same society because of different social contexts.” Music gives us comfort when we have problems. Also, when a society has problems, music is affected. I would argue with Blacking that even verbal language can have similar problems; for example, when we write to another person online and are, therefore, unable to see the recipient’s facial expressions. Talking face-to-face helps in defining meaning, and, without it, we can misinterpret the intention of the communicator. Expressing ideas digitally, using symbols and words alone, has its problems, and the meaning of the words can be misinterpreted, or interpreted in various ways.

Looking back at history, we can note how the Charleston Dance suddenly died out at the end of the 1920s, and, by 1930s, it was gone. Some factors affected this, including the arrival of the Great Depression. And we also note the increased output of creativity after World War II, with music suddenly flourishing (e.g., Glen Miller’s big band music; Gershwin). We also note that from the tension of the1960s during the Vietnam War, a new musical expression marked the beginning of a special era in pop, country, jazz rock and blues music. Indeed, the 1960s were a great time for music. Today again, I suspect, we are going to have music help us to alleviate all the tension generated by many problems that give rise to great uncertainty.

Due to climate change, pandemics, economic collapses and more generally a world in trouble, we will rely on music a lot more. Particularly, the younger generation will rely on music to cope with a difficult world, and I predict a new era in music as a new critical consciousness emerges due to suffering and uncertainty. Music is, after all, part of the way humans communicate. While some research has attempted to shed light on the communicative powers of music, more is urgently needed, because music as communication is a very complex enquiry. For example, Cross and Woodruff (2009, p. 23) propose that:

Music is a communicative medium with features that are optimized for the management of situations of social uncertainty, and that music and language constitute complementary components of the human communicative toolkit. It presents a theory of meaning in music, and compares its implications with those of a recent theory of prosodic features of language.

Prosodic is an important word that is seldom used but which has an important meaning in music therapy. According to Vocabulary.com:

Prosody is the rhythm and sounds used in poetry. Kids who can freestyle rap fit the prosody of their words to a rhythm that's already laid down. Prosody can also mean the study of the rhythms and sounds of language, and sometimes you can talk about the prosody of prose. It's about where the emphasis falls in the words and how those work together. When you read great writers like Alice Munro aloud, you will see that their prosody, as much as anything, is what carries the story forward.

That music is a universal language was an idea supported by Charles Darwin (1872), who suggested that “music captures the relationship between affective state and sound that are found across a wide range of species, embodying in the musical signal clues as to the emotional state of its producer.” (Cross and Woodruff, 2009) Darwin also noted that, “This leaves unexplained the more subtle and more specific effects that we might call the musical expression of the song.”(1872, p.34) It also means, and I agree with Darwin, that we are ignorant of just how powerful music is because of lack of knowledge. When it comes to mental illness, which is a very mixed bag, we should always use as many interventions as possible toward better health, and music therapy is certainly powerful.

There are two fundamental kinds of approaches in music therapy, namely the receptive method (based on listening to music) and the active method (based on playing an instrument). In this book, we will deal mainly with the receptive method.

Problems that Music Therapists Face

Because music is so personal, we likely forget that not everyone likes music and that only a handful of people like every type of music. The reality is that most people prefer certain genres, songs or artists. When they come across a song that they dislike, some people can become anxious. It is of the utmost importance to remember that music therapists use music as a complementary tool to the therapy that they are providing, and that it doesn’t matter what music works as long as the patient likes it and as long as it is of benefit to the patient, even if this is to be loud heavy metal music that makes the therapist uncomfortable. Unfortunately, the therapist, in this circumstance, must struggle to show agreement with the sufferer if it is of benefit to the sufferer.

Another problem that music therapists often come across is that music is not a cure for everything, and there are times when it simply does not work for some people. We have to accept this fact; indeed, there are rare cases where music can create problem...

Table of contents

• Cover Page
• Praise for Zotti’s Music Therapy
• Title Page
• Copyright
• Contents
• Foreword by Bob Rich, Ph.D.
• Foreword by Paul Corcoran
• Chapter 1 - An Introduction to Music Therapy
• Chapter 2 - How Can Music Help People with Alzheimer's?
• Chapter 3 - Defining Mental Illness
• Chapter 4 - Bipolar Disorder and Music Therapy
• Chapter 5 - Autism Spectrum Disorder and Music Therapy
• Chapter 6 - Schizophrenia and Music Therapy
• Chapter 7 - Anxiety, Depression, and Music Therapy
• References
• About the Author
• Index
• Also by Alfredo Zotti