©2009 Neuroscienze.

net
Journal of Neuroscience, Psychology and Cognitive Science

On-line date: 2009-01-05

Diagnostic and Therapeutic Updatings

Notes about Music Therapy

di Alfredo Spoto

Keywords: Music, Therapy, Diagnostic, Gestalt

The term music therapy is conventionally used to indicate specific surveys and possible actions on
human suffering. It is possible to state that the essence of music therapy is the positive influence it
can have on psyche through the evocation of pleasant, positive memories. It acts directly on the
neuro-vegetative system (hypothalamus, hypophysis, suprarenal glands) to produce those
substances (neurotransmitters, well being hormones) that can reactivate those functions which, due
to some pathologies, have been altered, giving a balance back to the body and the mind. The
therapy is clearly based on sound, rhythm and the language of music; it makes use of a way of
communication which is not verbal, the language of music, the system of sounds (frequencies from
Hz 16 to 16.000 periods per second - simple vibrations). The sound waves include either the
positive and the negative height of the sinusoid-wave. Music therapy as a science was born within
the art-therapy in the 1920s, 1930s and it was used as an occupational therapy. From 1950s on,
Music therapy spread almost all over Europe and subsequently in Latin America where, thanks to
the efforts of Rolando Benenzon, it has found its specific connotation based on scientific results
and documented with texts, treatises, reports of clinical cases and various publications. In Italy,
from some time, people have started being interested in this type of scientific phenomenon through
the efforts of private associations or the organization of national and international conferences,
seminars, stages and training courses for music therapists and lately even through postgraduate
courses of specialization organized by some faculties of medicine or psychiatry. The aim of music
therapy is the study of the relation "human being-sound-human being" in order to prevent,
rehabilitate and treat. Some scholars have stated that this kind of relation starts even before our
own birth and actually the foetus during the nine months inside the mother's uterus is sensitive to

Pagina 1/5
any sound, rhythm or movement. The cellular anatomic-physiology and the acoustic physics have
given us the opportunity to explore and ascertain a world otherwise unknown. The movement,
according to the acoustic physics, gives origin to the sound; different objects and different
movements give origin to different sounds. In the case of the embryo the cellular physiology needs
micro movements in order to develop and those will clearly give origin to micro sound-rhythm
events. It is possible, therefore, to state that the human body is a complex sound apparatus and that
sound codes of the organs, of the systems of organs and of their functions can exist. It is thought
that probably these codes are used to communicate their own physiologic conditions; they can
establish a motor-rhythmic communication among the organs. Music therapy, moreover, works
together with other disciplines to prevent and therefore to improve life standard. These disciplines
are based on communication, on the various types of languages, on psycho-motor activities, on
creativity, on art. Music therapy is often used, with preventing purposes, for its attention to
prenatal life, to childhood, to teenage, etc. If a sound event (infrasound, sound, ultrasound) can act
on a physiologic level, i.e. eliminating those pathologies as renal calculus, dental plaque, etc., why
could not the same happen at a psychic level? It has been demonstrated that listening to or
producing sound events creates some modifications, or positive alterations, on the neural system in
our brain and indirectly on the endocrine and sympathetic systems which can produce some
substances (neurotransmitters or well being hormones) that positively stimulate and give balance
back to our body. As we know music therapy is just a part of the system of disciplines named as
art therapy which has been developing more and more in the last few years thanks to the success
some specialists have had in the assistance, rehabilitation and special re-education of patients. In
the last twenty years, therefore, art has demonstrated it can contribute to keep us mentally and
physically fit.

First Principles of Music Therapy

While talking about music therapy we will quite frequently refer to the concept of sound identity (I
S O). A deep comprehension of this concept will allow the therapists to act at a higher level to
obtain their own purposes (preventing, rehabilitating and treating). The word I S O derives from
the Greek and means "same". The term "isomorphous", for example, is applied to all those objects
with different chemical composition but same crystalline shape. The term "isochronous" (from the
Greek chronos = time) refers to the same swings of a pendulum which are different in terms of
width and speed but maintain the same regular stressing. In the field of music the term
"isorhythmic" refers to an ancient composition technique which consists of present again and again
the same rhythmic structures with the same melodic phrases. Much used in music is also the term
"isophone" when a sound is the same to another produced by a different instrument. All the non
verbal techniques and mainly music therapy are based on the above concept (I S O). Generally, in
order to "communicate" with another person each of us tries to find a contact, something similar,
the same tastes, the same feelings; therefore, a subject, a sporting, cultural, artistic activity to talk
about is chosen if it is shared among the people who "take part" to the conversation. Actually, two
or more people must have or develop the same affinities to feel good when together. The concept
of I S O, therefore, makes it clear that "to be able to start" a communication with another person it
is necessary that both sides but mainly, in this case, the therapist make the effort to "identify", "to
imitate" the patient to deal with. For example, in the case of a communication with a newborn
baby the parents and all the other people dealing with him/her tend to a "babbling" language or to
imitate the sounds corresponding to specific needs, material, physiological, emotional wishes of
the baby and his/her mysterious world. To communicate with an autistic child it is necessary to
imitate the particular sounds he/she produces and that, as said above, can correspond to different
needs or are just used to communicate. In order to realize a correct communication it is also
necessary to take into account the mental time of the person we are going to deal with. In the case

Pagina 2/5
of depressed patients the mental time is slowed down and, according to some scholars, they have
to be stimulated by listening to or playing some slow music, andante, lento or even with nostalgic,
calm melodies that can recall positive experiences. On the contrary, in the case of patients with
maniacal symptoms allegro, mosso, vivace music is to be used. Therefore, in order to establish a
"way of communication" between the music therapist and his/her patient it is necessary to make
the mental times coincide or at least make them similar to each other. At this stage it becomes
necessary to say that the concept of I S O has got a specific dynamic feature as the term itself
synthesizes the whole system of acoustic phenomena and internal movements which characterize
and individualize each human being. Rolando Benenzon in his book "Theory of Music Therapy"
distinguishes five dynamic structures of the I S O: gestalt, cultural, universal, complementary,
group. The gestalt I S O refers to the concept expressed by Wertheimer in the Gestalt's psychology
(to go back to a perception not polluted by pre-concepts that prevent us from perceiving the
phenomenon in its essence, its reality). This psychological theory talks about the immediate
experience and states that the individual perceives in a global, unified, total way. The cultural I S
O refers to the sound identity of a community or of a certain number of people who share a
musical or sound culture. The universal I S O, on the contrary, is a dynamic sound structure
common to all the human beings independently from their cultural, social, historical and
psycho-physiological contexts. This concept includes the heartbeat, the inspiration and expiration
sounds, the mother's voice, the noises of the uterine walls, the blood flux, the water and many
other sounds coming from nature and from the human being in his/her evolution. The universal I S
O acts in the unconscious and it is part of the gestalt I S O. It is important to bear in mind that
music therapy can be used within a vast range of pathologies belonging to general medicine,
physical, psychological and sense-motor handicaps, communication problems, emotional or
behavioural troubles, relational problems, conditions of drawback, mental retardation or incapacity
and any other common pathology. Another useful application of music therapy is given by the
ability of music to develop self-realization, to improve learning and to allow stressed people to use
the sounds as a source of psycho-physical well being. Music therapy can effectively be used even
in the case of pathologies characterized by pain or in the physical training. In order to get the best
from the music therapy it is necessary that the relationship between the patient and the music
therapist is based on trust. Any type of musical experience is useful within a music therapy
session. It is important to remember that the patient must be put in the condition of accepting, of
being interested in the musical activities (improvisation, listening, composition, re-creation) which
can contribute to improve his/her health conditions through the recalling of memories, images,
sensations having an influence on the emotional sphere so that the organism can release all those
biochemical "substances" (hormones-neurotransmitters) that can create well being, giving back to
the organism those energies it had lost. It is useful to bear in mind that music therapy involves also
other activities, art disciplines like drawing, painting, poetry, dancing, playing, story telling, drama
and so on, even if the centre around which the action of the music therapy has to develop is music.
Various musical activities, as said above, like improvisation, composition, listening and
re-creation can be used according to the different pathologies or illnesses. The aim of
improvisation, for example, is that to develop in the patient his/her ability to create and, at the
same time, his/her self-esteem, through the improvised reproduction (through the voice or a
musical instrument) of a melody which must be the expression of his/her feelings. The activities
based on improvisation try to give room to spontaneity, creativity, sense of identity, ability to
communicate; improvisation allows, moreover, to express feelings or emotions otherwise difficult
to put in words. This therapeutic activity is particularly effective with the following pathologies:
obsessive-compulsive neurosis, personality troubles of Borderline or Narcissistic type, with
autistic patients, inhibited or depressed adults and with patients with mental retardation or
physically disabled. In the re-creative activity, as it is defined by. K.E. Bruscia, the patient is

Pagina 3/5
stimulated to reproduce (again through the voice or a musical instrument) sound events, melodies,
as a soloist or in a chorus, to improve the ability to socialize, to adapt, to be in contact with the
surrounding reality, to better identify with the others' behaviours and feelings. The re-creative
activity is particularly useful with patients who need to develop sense-motor abilities, to learn how
to adapt to the others' behaviours, to identify with others' feelings, to master a particular role, to
collaborate with others to reach common aims. The choral or soloist canto can represent an
excellent therapeutic occasion in the case of patients with language or articulation of sounds
difficulties; at the same time playing an easy instrument in a group can help the patients to develop
a better psycho-motor coordination. It is important to bear in mind that as for children with
learning problems or cognitive difficulties reading the musical notes together with the instrumental
reproduction of a melody can help them to develop the auditive-motor or visual-motor integration.
Finally, the musical activities in groups, the arrangement of a small "orchestra" can help children
with behavioural or emotional problems to control impulsivity or shyness. In the sessions based on
the composition activity the therapist helps the patient to compose melodies, songs, instrumental
pieces with no artistic or technical- esthetical aim. The composition activity is particularly useful
in the case of insecure patients with difficulties in decision making or that need to carry out their
own initiatives. The composition of a simple melody helps them to develop their self-esteem, their
self-confidence in carrying their projects out, to show the inner and the outer thoughts, their own
memories, their sensations. If the patients are staying in a hospital writing songs can help them to
better understand their own anxiousness, the unconscious fears, the feelings and to leave them
there on the paper. In those sessions based on listening the patient is guided to concentrate on the
emotional, intellectual, artistic, esthetical or spiritual sensations that the sound event can produce
in his/her inner world. Generally, in these cases the therapist helps the patient through relaxing
activities, free association, imagination, narration, structured movement, meditation, drawing,
perception of their own corporeity. The activity of listening is more useful in the case of people
who have to be reassured or physically, emotionally, intellectually or spiritually stimulated. It is
known as, in the last few years, pregnant women can take part to some music therapy sessions in
order to help them to relax and to live the birth experience in a positive way. Music, therefore, is
used as a way to bear the pain and to regulate the cardiac activity and the breath. In the case of
patients with learning problems music therapy can be useful to develop perceptive abilities and to
improve the auditive capacity. Listening to musical passages can, moreover, be used to memorize
colours, behavioural sequences, words, numbers, etc. It is important, therefore, that the therapist
has got a clear clinical picture of the patient, the specific pathology on which the therapy will be
centred and the aims to be reached and that will have to be monitored. Another important aspect to
bear in mind when defining a music therapy session are the patient's musical abilities. Studies
recently carried out by several music therapists have shown that each person, independently from
the age or from the musical experience, has got a basic ability to express with and/or recognize the
musical language. This fundamental ability does not require a special attitude and/or the specific
preparation musicians have but it has its origin in the learning and in the general results we get
during the normal human development. Actually, during our own development we all get the
opportunity to become potential musicians or music lovers at a basic level. This normal or basic
ability includes the abilities to learn singing, to play simple instruments, to move following the
music, to react to the musical elements, to perceive the relation among the sounds, to remember
the music, to imagine with the help of the music, to give a meaning to the musical experience. Of
course, in the clinical situations the music therapists often meet patients with physical, emotional
or mental handicaps that can interfere with these musical potentialities. In these cases the
therapists' aim is that of adapting the music therapy to the patient's abilities and avoid those
experiences that can be an obstacle. The music therapists analyse also those patients that can have
negative psychological or psycho- physiological reactions to participate to this type of therapy.

Pagina 4/5
Music therapy is a source of stimulations for the therapeutic change. To be sure this can happen it
is important that the therapist selects and defines the experiences according to the patient's tastes (I
S O), preferences and requires. Important considerations are the patient's tendencies to: 1. Type of
activity (musical or non musical). 2. Type of personal experience ( soloist, duet or group). 3. Type
of musical experience (improvisation or listening). 4. Musical means (voice or instrument). 5.
Instrument ( drum, marimba, metallophonous, other). 6. Role (leader or companion). 7. Style (pop,
rock, classical, etc.).

The Clinical Process

The music therapy process involves three fundamental steps: check, treatment and evaluation.
During the check step the therapist uses any of the musical experiences described above to study
the patient, his/her condition, his/her therapeutic needs, his/her musical abilities and preferences.
During the treatment step the therapist uses the music as a means to specifically treat the patient's
particular condition and state of health. During the evaluation step the therapist determines the
patient's progress as a consequence of the treatment and of the planned aims. Usually the progress
is evaluated through the changes a patient has made during the therapy or comparing the initial
level or the status of the patient's functions to the actual ones.

Summary
The author describes music-therapy in its widest sense, referring to the origin of the term, the
centres where this medical practice has been developed and its medical and scientific fields of
application. The second part deals with the technical aspects of music-therapy (improvisation,
recreation, composition, listening) that are used by the therapists, according to the pathology of the
client and the clinical process on which a correct music therapy practice has to be based.

References

Benenzon R., 1994, Theory of Music therapy, Novastampa Editions, Verona.

Bruscia K., 1991, Clinical cases of music therapy (adults). Barcelona Publishers, USA.
Lorenzetti L.M., 1989, From musical education to music therapy, Ed. Zanibon, Padova.
Rossi Pritoni L., 1994, Applied music therapy, Del Cerro Editions, Tirrenia.
Warren B.: Art therapy in education and rehabilitation. Erickson Editions, Trento,1996.
Various Authors, 1997, Music and Therapy: Italian notes on music therapy, Vol. 5, Boccassi
Editions, Alessandria.

2004- Alfredo Spoto, University of Catania - Psychiatric Institute

Origins, Centres of Development, Surveys carried out in the Acoustic Physics and Cellular
Anatomic-physiology Fields

permalink: http://www.neuroscienze.net/index.asp?pid=idart&cat=3&arid=388

Pagina 5/5