Handouts Music as a Therapeutic Tool: What? Prepared by Ron D. Kingsley MS, PhD, NCSP Clinical and School Psychologist Arizona License #1441

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1 Handouts Music as a Therapeutic Tool: What? Prepared by Ron D. Kingsley MS, PhD, NCSP Clinical and School Psychologist Arizona License #1441 Music Therapy Talk Highlights Music in childhood: Stepmother woes. 200 th anniversary of the Naval Air Station at Key West Florida: Maybe my stepmother was right. Sing Little Boy Sing: Maybe I m Just Tired: A Reason: 6 th grade girl Free to Dream: Boy in session breaks down Monsters: Whittier: 17 kids in one class with single moms Crocodile Under my Bed: The Truth Is: Eighth grade story. Singing to Mom the day before she passed Connection made with high school kid in Provo Alternative school in Provo Where Do I Go from Here? Sharp school Results of testing in the schools Lost: Maybe Someday: If You Really Want to Know How I Feel? 14-year-old girl Rocks: Or Snowballs depending... Please See All of Me: Freedom s Need: Private practice Choices: Tucson Schools presentation and forgetting the words: The Story of Music Why does every movie have a musical soundtrack? Music intensifies emotions. It can signify a special moment. Music enhances drama, sorrow, fear, anger, yearning, excitement, and hope. Music can also feel emotionally manipulative and intrusive. Much of advertising is set up to exploit the gap between the

2 emotional/vulnerable right and the critical/analytical left hemispheres of the brain. Advertisements that rely solely on visual images are much more likely to influence the right hemisphere and may not be registered at all by the left. Insert the right music into those images and you have a potentially powerful and influential tool. The idea that our behavior may not be rational cannot be tolerated by the brain s left hemisphere. It will instantly begin to rationalize and justify all musically driven behaviors in a desperate attempt to either recover or insure our sanity. As well as sending shivers up the spine, music tells stories, prompts us to dance, makes us happy, aggressive, or sad, hurries us along, or even puts us to sleep. The right sort can actually influence the type of wine we buy at the supermarket. Researchers suggest there is no other human activity as all encompassing as music that can reach into, shape, and influence so much of our behavior. It s also quite clear that music can play different roles for different people and often plays more than one role for the same person. The Origins of Music The actual origins of music and musical behavior are really no more than pure speculation. Various theories are all we have. Now, it is true, that some of these so-called theories are quite a bit more believable than others. For example: Darwinian Theory: Sexual instincts and mating calls. No musiclike mating calls in apes. Theory of Rhythm: Music evolved from its relationship to dance. Correlation is not causation. Work Song Theory: Songs came about to coordinate work efforts. Not

3 universal. Theory of Imitation: Music is man s attempt to imitate the birds. Theory of Expression: Music evolved from emotional speech. Theory of Lalling Melodies of Children: Derivation from children s own melodies. The Communication Theory: Music evolved from trying to communicate from a distance. Early Lullaby Theory: Developed from a mother s efforts to soothe infant. A Special Communication Channel: Speculates we are born with a musical brain because music provides a special channel between parent and child. Along with this, it is pointed out that adults tend to automatically speak, especially to their own children, in singsong musical baby talk. In-Utero Theory: Perhaps our first musical experiences are none other than the constant lub-dub of our mother s heart and swishswish of blood as it courses through her veins throughout the prenatal period. In 1966, Salk s experiments suggested that imprinting occurred in-utero to the sound of the maternal heartbeat. When these sounds were replayed at, about 72 beats per minute babies were more relaxed, able to fall asleep faster, and gained weight more rapidly than controls (Salk, L. Mothers Heartbeat as an Imprinting Stimulus. Trans. New York Acad. Sci., 24: ). Interestingly, the best tempo for falling asleep is usually about 72 beats per minute. Perhaps this is why music is said to soothe the savage beast. Genomic Code Theory: Studies that suggest music is an inherent part of who we are as human beings, woven into our very genomic code, which is why it is evident even in newborn babies. When we connect with music on a deep level, entire parts of the brain are involved in activation and deactivation patterns.

4 Research indicates our neurological system is replicated at the genomic level. It turns out that genes respond to both internal and external conditions. Musical participation turns off genes that stimulate stress alerts to our minds and bodies. Stevens cites research showing that playing music was three times more effective for reducing stress-related gene expression than simply chilling out. According to the research as we engage in making music, we can disengage genomic triggers associated with stress. Thus, it s not only what music does but also what it undoes. Musical Wounds Sir Paul McCartney failed choir auditions in high school twice. Luciano Pavarotti was told he needed to change his sound to be more like the operatic greats. George Gershwin, at age ten, was told it was too late to start studying music. Ron D. Kingsley bought his first drum kit at the age of 18 and within weeks was playing gigs in Key West Florida with some local high school students though he, at the time, was in the army. Soon he also bought his first guitar (a cheap classical of ignominious make) because his band mates wouldn t write music fast enough for the song lyrics that continually flowed from him like water from a fountain. His first complete song lyrically and musically was written before he could change chords quickly enough on the guitar to keep up with the melody. SOMETIMES I WAKE UP LATE AT NIGHT According to Christine Stevens, MSW, MT-BC an internationally acclaimed author, music therapist, and speaker, there are four elements of music used by a therapist in his/her work. These are Rhythm (Medicine for the Body), Melody (Medicine for the

5 Heart), Harmony (Medicine for the Soul), and Silence (Medicine for the Mind). A fifth element also comes into play that is called the Inner Music (Medicine for the Spirit). She points out that music is one of the oldest forms of spiritual medicine known to humanity. The magnetic energy of rhythm draws people in and even without instruments; bodies can become the drums, dancing to the rhythm. Thus, rhythm is the medicine for the body. In rhythm, it has been found that drumming turns off the thinking mind and enables us to experience the primal knowledge already within our bodies. When drumming, if you think too much, you ll screw up. If interested check out youtube.com/ubdrumcircles. The most immediate access to musical expression comes through drumming and singing, probably because these are our biological instruments the drum of our hearts and the song of our voice. Rhythm brings drum medicine, melody brings song medicine, harmony brings ensemble medicine, silence brings resting medicine, and the inner music brings the resonance of your unique spirit. We are incubated in rhythm. Our mother s heartbeat is the soundtrack of our first concert in the womb. Rhythm reaches the inner heartbeat that is the drum within us all, the memory of the sound from a time before birth. We can get lost in the past or the future, but rhythm takes us to the beat of the now, welcoming us into the rich aliveness of every new moment. The heart s longing for freedom may be best expressed in song. Thus, melody is the medicine for the heart. In melody, it has been found that sounding our deep emotions transforms pain and despair and helps heal the heart. From learning information to recalling rich experiences, melody harnesses the power of memory. Melody can also misguide us, be used for propaganda,

6 and, in some extreme cases, cause us to lose our way and forget our own personal tune. Music has been shown to create harmony between conflicting groups and bring hope, peace, and healing to old wounds. Thus, harmony is the medicine for the soul. In harmony, it has been found that harmonizing with others turns off the I and activates the we, surpassing self and charging the soul with unity. The silence found between the breaths, between the beats, and between the notes can lead us to cultivate a silence that quiets the mind and guides us to peace. Thus, silence is the medicine that enriches the mind. In silence, it has been found that quieting the mind deactivates our thinking about the past and the future making possible the establishment of peace and quiet. It is said that before any sound, there is silence. Within silence, there is power. Silence is the absence of sound. Yet, it turns out that absolute silence is nearly impossible other than in a sensory-deprivation booth. Within such a booth, the record length of time a human has endured total silence is around forty-five minutes. Interestingly, while inside the chamber, two distinct sounds always appear: a high pitch and a low pitch, not from outside but from inside it is the human biology singing. Scientists believe that the high pith is the sound of our neurology, and the low pitch is the sound of our blood circulating. The constant hum of our bodies cannot be silenced. External sound, however, can also affect our internal mental symphony. Silence gives music space to breathe and gives listeners time to process. Without spaces, music would be out of breath, exhausted, and unbalanced. The musical notation for silence is literally called a rest, reminding us that music needs its moments

7 of calm as much as we do. Studies demonstrate that fast tempos increase breathing and heart rate, while slower music reduces them. A surprising result of these studies was, however, that it is during the random silences between the music selections that the greatest evidence of relaxation occurs. This has great implications for music therapy sessions. Inner Music (Musical Spirit): According to Christine Stevens, There is internal music within every person. I call it our musical spirit, a unique esprit de corps that lives at the core of our being. Musical spirit is an innate gift that needs to be cultivated and freed. Your musical spirit exists regardless of musical skill; it can be forgotten but never lost. Our heartbeat is a rhythm track pulsing through our veins; our voice is the melody that resonates as we speak; our health is the harmony of our body and mind; and our breath is the silence that allows our bodies to rest. Our brains show that improvisation is an expression of our deepest individual personality. Perhaps more importantly, the jazz of winging it disengages the constant self- monitoring that can bind our creativity. Again, it is the pattern of what music undoes that creates the healing space for the inner musical spirit. The conditions of permission not performance, creativity not complexity, and improvisation not memorization are all part of the formula of the science of inner music. Christine Stevens: Music should be seen as a supplement, a daily vitamin for health and well-being. In music medicine, intention is the key note. Don t think of music as something you have to attain; rather, think of it as something that wants to flow through you. How open we are to music determines how much of its medicinal effect we will receive. When it comes to music, we all have distinct preferences, and it turns out that the music we

8 love is a key to its healing benefits. The music you like facilitates the healing response. Trust the music you love. We all have the capacity for musical expression. Music creates easier access to a child s soul than does talking. Words communicate thoughts, but music communicates energy. Playing music can be another form of active meditation, as can playing drums, improvising, or chanting. When you play music, you become present. Musical skill can enhance our expression, but musical spirit is essential. You are the composer of your own life s song. On a neurochemical level, Goldstein discovered that musical thrills stimulated the release of opioid peptides, which are endorphins that connect to the brain s limbic emotional area and that trigger the neurophysiological chemistry of the natural high. Entrainment: The synchronizing of separate rhythms. The dominant beat draws others in so that ultimately they will begin to move together in concert. Rhythm and Parkinson s disease: The presence of the beat improved patients stride length, distance, and walking tempo. Rhythmic Auditory Stimulation (RAS). According to Navajo elders, The drum is the Creator s favorite instrument. That s why everyone has a heartbeat. Pregnancy after five months gestation. Mothers beware. When Arizona congressional representative Gabrielle Giffords survived a gunshot wound to the left hemisphere of her brain on January 8, A music therapist used singing to successfully retrain her brain back to speaking. Rehabilitation in song is called melodic intonation therapy (MIT).

9 Mirror Neurons: In the last decade, researchers have detected a set of neurons that are now referred to as mirror neurons, which perform much like the principle of sympathetic vibration with stringed instruments. Just by watching the actions of another person these neurons begin to resonate. Even though only observing, parts of our brains respond as if we were performing the very same perceived actions. The existence of mirror neurons has provided scientists insights into how we are prewired for compassion and empathy. As we watch a strong emotional or physical reaction of another, we can literally feel that person s pain. Interestingly, it s not only watching an action that can trigger these neurons to fire. Research reveals that just hearing certain sounds commonly associated with specific actions also triggers this brain sympathetic mirror reaction. Music to treat pain and reduce stress: While music has long been recognized as an effective form of therapy to provide an outlet for emotions, the notion of using song, sound frequencies and rhythm to treat physical ailments is a relatively new domain, says psychologist Daniel J. Levitin, PhD, who studies the neuroscience of music at McGill University in Montreal. A wealth of new studies is touting the benefits of music on mental and physical health. For example, in a meta-analysis of 400 studies, Levitin and his postgraduate research fellow, Mona Lisa Chanda, PhD, found that music improves the body's immune system function and reduces stress. Listening to music was also found to be more effective than prescription drugs in reducing anxiety before surgery (Trends in Cognitive Sciences, April,

10 2013). "We've found compelling evidence that musical interventions can play a health-care role in settings ranging from operating rooms to family clinics," says Levitin, author of the book "This is Your Brain on Music" (Plume/Penguin, 2007). The analysis also points to just how music influences health. The researchers found that listening to and playing music increase the body's production of the antibody immunoglobulin A and natural killer cells the cells that attack invading viruses and boost the immune system's effectiveness. Music also reduces levels of the stress hormone cortisol. "This is one reason why music is associated with relaxation," Levitin says. One recent study on the link between music and stress found that music can help soothe pediatric emergency room patients (JAMA Pediatrics, July, 2013). In the trial with 42 children ages 3 to 11, University of Alberta researchers found that patients who listened to relaxing music while getting an IV inserted reported significantly less pain, and some demonstrated significantly less distress, compared with patients who did not listen to music. In addition, in the music-listening group, more than two-thirds of the health-care providers reported that the IVs were very easy to administer compared with 38 percent of providers treating the group that did not listen to music. "There is growing scientific evidence showing that the brain responds to music in very specific ways," says Lisa Hartling, PhD, professor of pediatrics at the University of Alberta and lead author of the study. "Playing music for kids during painful medical procedures is a simple intervention that can make a big difference." Music can help adult patients, too. Researchers at Khoo Teck

11 Puat Hospital in Singapore found that patients in palliative care who took part in live music therapy sessions reported relief from persistent pain (Progress in Palliative Care, July, 2013). Music therapists worked closely with the patients to individually tailor the intervention, and patients took part in singing, instrument playing, lyric discussion and even song writing as they worked toward accepting an illness or weighed end-of-life issues. "Active music engagement allowed the patients to reconnect with the healthy parts of themselves, even in the face of a debilitating condition or disease-related suffering," says music therapist Melanie Kwan, co-author of the study and president of the Association for Music Therapy, Singapore. "When their acute pain symptoms were relieved, patients were finally able to rest." The beep of ventilators and infusion pumps, the hiss of oxygen, the whir of carts and the murmur of voices as physicians and nurses make rounds these are the typical noises a premature infant hears spending the first days of life in the neonatal intensive care unit (NICU). While the sounds of such life-saving equipment are tough to mute, a new study suggests that some sounds, such as lullabies, may soothe pre-term babies and their parents, and even improve the infants' sleeping and eating patterns, while decreasing parents' stress (Pediatrics, 2013). Researchers at Beth Israel Medical Center's Louis Armstrong Center for Music and Medicine conducted the study, which included 272 premature babies 32 weeks gestation or older in 11 mid-atlantic NICUs. They examined the effects of three types of music: a lullaby selected and sung by the baby's parents; an "ocean disc," a round instrument, invented by the Remo drum company, that mimics the sounds of the womb; and a gato box, a drum-like instrument used to simulate two-tone heartbeat rhythms. The two instruments were played live by certified music

12 therapists, who matched their music to the babies' breathing and heart rhythms. The researchers found that the gato box, the Remo ocean disc and singing all slowed a baby's heart rate, although singing was the most effective. Singing also increased the amount of time babies stayed quietly alert, and sucking behavior improved most with the gato box, while the ocean disc enhanced sleep. The music therapy also lowered the parents' stress, says Joanne Loewy, the study's lead author, director of the Armstrong center and co- editor of the journal Music and Medicine. "There's just something about music particularly live music that excites and activates the body," says Loewy, whose work is part of a growing movement of music therapists and psychologists who are investigating the use of music in medicine to help patients dealing with pain, depression and possibly even Alzheimer's disease. "Music very much has a way of enhancing quality of life and can, in addition, promote recovery." Novotney, Amy, (2013) Music as Medicine, Monitor on Psychology.

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15 What is Music Therapy? Music Therapy is 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 program. (American Music Therapy Association definition, 2005). Kristine Korb, MM, MT-BC, director of music therapy at Pacific University, however, states, There are many definitions of music therapy. She lists one of her favorites as Music therapy is an established healthcare profession that uses the art of music to accomplish nonmusical goals. Another definition is worth considering as well. To the curious checker at the local grocery store she would say, As a music therapist, we use music in a specific way to increase the quality of life. To medical personnel she would provide an answer similar to the first one cited above by the American Music Therapy Association. Finally, she might also simply answer, We use music to help others. What Do Music Therapists Do? Music therapists assess emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses; design music sessions for individuals and groups based on client needs using music improvisation, receptive music listening, song writing, lyric discussion, music and imagery, music performance, and learning through music; participate in interdisciplinary treatment planning, ongoing evaluation, and follow up. Christine Korb again has said, In a typical session, the client and therapist may create engagement through musical experiences such as singing, vocalizing, small rhythm instruments or

16 instrument play, movement to music, and songwriting. These experiences may be focused on speech, occupational, physical, academic, and/or behavioral goals. The bottom line according Christine is a style that emerges from our philosophy for practicing that focuses on another rather than on the performer. Who Benefits From Music Therapy? Children, adolescents, adults, and the elderly with mental health needs, developmental and learning disabilities, Alzheimer's disease and other aging related conditions, substance abuse problems, brain injuries, physical disabilities, and acute and chronic pain, including mothers in labor. Where Do Music Therapists Work? Music therapists work in psychiatric hospitals, rehabilitative facilities, medical hospitals, outpatient clinics, day care treatment centers, agencies serving persons with developmental disabilities, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools (particularly those with special education classrooms), and in private practice. The History of Music Therapy The idea of music as a healing influence which could affect health and behavior is as least as old as the writings of Aristotle and Plato. The 20th century discipline began after World War I and World War II when community musicians of all types, both amateur and professional, went to Veterans hospitals around the country to play for the thousands of veterans suffering both physical and emotional trauma from the wars. The patients'

17 notable physical and emotional responses to music led the doctors and nurses to request the hiring of musicians by the hospitals. It was soon evident that the hospital musicians needed some prior training before entering the facility and so the demand grew for a college curriculum. The first music-therapy degree program in the world, founded at Michigan State University in 1944, celebrated its 50th anniversary in The American Music Therapy Association was founded in 1998 as a union of the National Association for Music Therapy and the American Association for Music therapy. The World Federation of Music Therapy (WFMT) was founded in 1985 in Genoa, Italy. It oversees development of music therapy worldwide and is made up of eight regions: Africa, Australia/New Zealand, North America, Latin America, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific. The WFMT is dedicated to developing and promoting music therapy throughout the world as an art and a science. It also promotes the development of educational programs, clinical practice, and research to demonstrate the contributions of music therapy to humanity. What are the Qualifications Necessary? Persons who complete a curriculum at an approved college or university (including an internship) are eligible to sit for the national examination offered by the Certification Board for Music Therapists. Music therapists who successfully complete the independently administered examination hold the Music Therapist-Board Certified credential (MT-BC). The National Music Therapy Registry (NMTR) serves qualified music therapy professionals with the following designations: RMT, CMT, ACMT. These individuals have met accepted educational

18 and clinical training standards and are qualified to practice music therapy. Does Research Support Music Therapy? AMTA promotes a vast amount of research exploring the benefits of music as therapy through publication of the Journal of Music Therapy, Music Therapy Perspectives and other sources. A substantial body of literature exists to support the effectiveness of music therapy. What are the most Common Misconceptions about Music Therapy? That the client or patient has to have some particular music ability to benefit from music therapy -- they do not. That one particular style of music is more therapeutic than all the rest -- this is not the case. All styles of music can be useful in effecting change in a client or patient's life. The individual's preferences, circumstances and need for treatment, and the client or patient's goals help to determine the types of music a music therapist may use. Can Healthy Individuals Benefit from Music Therapy? Healthy individuals can use music for stress reduction via active music making, such as drumming, as well as passive listening for relaxation. Music is often a vital support for physical exercise. Music therapy assisted labor and delivery may be included in this category since pregnancy is regarded as a normal part of women's life cycles. In Nursing Homes? Music is used with elderly persons to increase or maintain their level of physical, mental, and social/emotional functioning. The sensory and intellectual stimulation of music can help maintain a person's quality of life. In Schools? Music therapists are often hired in schools to

19 provide music therapy services listed on the Individualized Education Plan for special learners. Music learning is used to strengthen nonmusical areas such as communication skills and physical coordination skills, which are important for daily life. Although clearly not functioning as a certified music therapist or doing music therapy as defined by the AMTA, Ron D. Kingsley has nevertheless used music therapeutically in special ED as well as regular classrooms throughout his 17 years as a practicing school psychologist as well as in private practice. Even though no longer working there he will still occasionally present in the schools when given the opportunity. Topics he covers in these musical-talk presentations include the following: Disability awareness Pollution and environment and fears Grief and grieving Loneliness Not giving up on dreams Following rules (don t throw rocks) Peer Pressure Drugs and alcohol Diversity Mindfulness Abuse issues Emotional distress Reaching for the stars Being patient Problem Solving Self-esteem Cultural differences Monsters Parent child relationships ADHD and OCD Inclusion for everyone Understanding all differences Working hard for goals Bullying How is Music Therapy used in Hospitals? Music is used in general hospitals to: alleviate pain in conjunction with anesthesia or pain medication: elevate patients' mood and counteract depression; promote movement for physical rehabilitation; calm or sedate, often to induce sleep; counteract apprehension or fear; and lessen muscle tension for the purpose of relaxation, including the autonomic nervous system. Music is now being used in pre- and postsurgical procedures,

20 cardiac conditions, obstetrics, childbirth, chronic pain, diabetes, headaches, and various other conditions. Research has demonstrated that some of the benefits of music include decreased blood pressure, a reduction in stress hormones such a cortisol (while elevating hormones that have an impact on one s sense of well being). There is also evidence of a decreased need for pain medication, easier rapport building between medical personnel and patients and increased self-esteem. Finally, music therapy s success with patients who may resist other treatment strategies is being documented through clinical experience and research as well. In Psychiatric Facilities? Psychiatry was one of the first professions to realize the value of music therapeutically for patients who would not otherwise respond to talk therapy. Music therapy allows persons with mental health needs to: explore personal feelings, make positive changes in mood and emotional states, have a sense of control over life through successful experiences, practice problem solving, and resolve conflicts leading to stronger family and peer relationships. In Correctional Facilities? A revolution followed Dr. Michael Thaut s groundbreaking work in the 1980s, within the Michigan prison system, published in AMTA s Music Therapy Perspectives. Since then, correctional facilities have been recognizing the ways music therapy can help inmates to improve both their mood and attitude toward incarceration. In Senior Citizen or Retirement Centers? Employing full time music therapists in these settings remains an adventure. In spite of the longstanding awareness of music s benefits in their daily and weekly schedules staff can be resistive in understanding the difference between music therapy and simply play a CD or having

21 a monthly performer come in (not that such couldn t be therapeutic to some). In Hospice Programs? The needs of the hospice population are just beginning to be served by music therapists. To meet such needs the entire family and loved ones are often included. Music therapists can be of great help addressing the spiritual needs of individuals within these settings. In Wellness Programs? A pioneer in this area is Barbara Reuer, PhD, MT-BC. She leads the Resounding Joy agency in San Diego California whose mission is to promote social, emotional, physical, and spiritual well-being through music. One of the main experiences offered since its start in 2004 is drumming with elders. Rhythm Protocols (Procedures) Christine Korb was instrumental in initiating a violence prevention project in the early 1990s titled Drums Not Guns. In Salem Oregon working with David Knott they developed a rhythmic protocol for use with homeless and challenged youth. Weekly creative drumming practice with the youth had the result of increasing attending skills and following directions, a heightened ability to verbally express themselves, and the development of a generally more positive attitude. This led to the projects being used with targeted behaviorally and emotionally challenged youth within special education programs in Portland, Oregon, and Vancouver, Washington. Positive results were reported. In Private Practice? This essentially would be, according to Ms. Korb, the private contractual music therapist. This is actually being done by a limited few music therapists. Although not a music therapist, Dr. Ron D. Kingsley also uses

22 music therapeutically in private practice. He may be one of the few, if not the only, Clinical Psychologist that keeps a guitar hanging on the wall in his office whenever therapy is in session. It s an interesting initial conversation piece to say the least along with the multitude of original drawings and cartoons covering two walls of his office, and an upside-down hanging unicycle. When he takes that guitar off the wall during a session, is he doing music therapy? No, but he is using music for therapeutic purposes no matter what the American Music Therapy Association might think. As counselors, therapists, and psychologists you can use music therapeutically too. You just have to try, and be true to yourself. Always be true to yourself. Whether playing live music in session or sharing recorded music, it can benefit your clients in ways that are sometimes difficult to demonstrate, quantify, or understand. Music often opens the door when nothing else will. It builds and strengthens rapport. Shared music can help create a lasting emotional bond that can cement your psychologist/therapist-client relationship forever and help the client get through difficult times as well as difficult issues. Ron has a channel on YouTube that currently has 79 of his songs. He has made them available for anyone interested in having access to songs he might share in session as well as for other professionals to use therapeutically if so desired. Is Music Therapy Reimbursable? Medicare Since 1994, music therapy has been identified as a reimbursable service under benefits for Partial Hospitalization Programs (PHP). Falling under the heading of Activity Therapy, the interventions cannot be purely recreational or diversionary in nature and must be individualized and based on goals specified in the treatment plan. The current HCPCS Code for PHP is G0176.

23 The music therapy must be considered an active treatment by meeting the following criteria: Be prescribed by a physician; Be reasonable and necessary for the treatment of the individual s illness or injury; Be goal directed and based on a documented treatment plan; The goal of treatment cannot be to merely maintain current level of functioning; the individual must exhibit some level of improvement. Medicaid Currently a few states allow payment for music therapy services through use of Medicaid Home and Community Based Care waivers with certain client groups. In some situations, although music therapy may not be specifically listed within regulatory language, due to functional outcomes achieved, music therapy interventions qualify for coverage under existing treatment categories such as community support, rehabilitation, or habilitation services. Examples of reimbursement situations: Arizona Medicaid coverage for music therapy is provided to individuals with developmental disabilities. Indiana Home and Community-Based Waivers managed by the Division of Disability and Rehabilitation Services includes music therapy as a covered service for the following three waiver programs: Developmental Disability Waiver, Autism Waiver, and Support Services Waiver. Maryland Music therapy is a covered service under the state's Autism Waiver and the Residential Treatment Center Demonstration Waiver. Michigan Music therapy is a covered service under the state's Medicaid Children's Waiver Program. Texas Music therapy is listed as a health service under several in Home and Family Support Program Waivers. Wisconsin Music therapy is a covered service within the Brain Injury Waiver (BIW) and the Children's Long-Term Support Waiver. What Happens in a Typical Music Therapy Session? Since music therapists serve a wide variety of persons with many different types of needs, there is no such thing as an overall typical session. Sessions are designed and music selected based

24 on the individual client's treatment plan. The plan is developed from information gathered during an assessment of the person s areas of functioning or domains. The evaluated domains include communicative, emotional, social, cognitive or academic, physical or motor, sensory, and frequently spiritual. Music therapy can also be used in many other settings. Specific goals are created based on the assessment data. Christine Korb underscores the importance (critical necessity) of using research in designing a music therapy session. The bottom line is that the music therapist is supposed to base a plan of action for a given session on reported results from the journal of music therapy. Using a research base in planning a session enables the therapist to explain to others the scientific basis for their approach. The addition of the music therapist s clinical expertise with the research base in addressing the specific needs of a client is considered evidence-based practice. There are hundreds of examples of music therapy sessions, and no session is typical, says Christine Korb. Is a Common Style Used in Music Therapy? Music therapists utilize music as a therapeutic tool; the genre and type of instrument is tailored to the individual and to the goals that are established between the client and the music therapist. Since music choice/usage is tailored to each client s needs and preferences, there is really no "most common" type of music or instrument. All styles of music have the potential to be useful in effecting change in a client s or a patient's life. The individual's preferences, circumstances and need for treatment, and the goals established will help the trained music therapist determine what music to use. What Instruments Do Music Therapists Play? Music therapists

25 must be trained, accomplished musicians. Common instruments used are guitar, piano, percussion, voice, etc., but a music therapist must be versatile and able to adjust to changing circumstances and use many different instruments within a therapeutic context. There is no one single instrument music therapists need to play in every session, but rather, music therapy students choose one instrument as their major instrument of focus during their educational course of study and are given basic training on a variety of instruments. All music therapy programs require competency in piano, voice, and guitar. Many also require proficiency in percussion. The choice of instrument or musical intervention used in a music therapy session is dependent upon goals and objectives, the client's preferences, and the music therapist's professional judgment. What is the Future of Music Therapy? The future of music therapy is promising because state of the art music therapy research in physical rehabilitation, Alzheimer's disease, and psycho-neuro-immunology is documenting the effectiveness of music therapy in terms that are important in the context of a biological medical model. As of 2015, Kristine Korb reports that there are about six thousand music therapists practicing in the United States and around Eighteen thousand worldwide. What standards and certifications are needed to establish a Career in Music Therapy? The admission process for music therapy students varies among universities. All programs require an assessment of ability on guitar, piano, and voice. They also require a written essay on the reasons you want to become a music therapist in conjunction with a personal interview. To become a music therapist, however, one must earn a

26 bachelor s degree or higher in music therapy from an American Music Therapy Association (AMTA) approved program and have at minimum the entry-level credential, MT-BC (Music Therapist, Board Certified) to ethically practice as a music therapist. The curriculum includes coursework in music, music therapy, biology, psychology, social and behavioral sciences, and general studies. Clinical skills are developed through 1200 hours of required fieldwork, including an internship in healthcare and/or education facilities. These experiences allow students to learn how to assess the needs of clients, develop and implement treatment plans, and evaluate and document clinical changes. Once the music therapy degree is earned and internship is completed, the student is eligible to sit for a board certification exam to earn the entry-level credential, MT-BC, from the credentialing body, the Certification Board For Music Therapists. What Music Therapy Is... And Is Not The American Music Therapy Association (AMTA) supports music for all and applauds the efforts of individuals who share their music-making and time; we say the more music the better! But clinical music therapy is the only professional, research-based discipline that actively applies supportive science to the creative, emotional, and energizing experiences of music for health treatment and educational goals. Below are a few important facts about music therapy and the credentialed music therapists who practice it: Music therapists must have a bachelor s degree or higher in music therapy from one of AMTA s 72 approved colleges and universities, including 1200 hours of clinical training. Music therapists must hold the MT-BC credential, issued through

27 the Certification Board for Music Therapists, which protects the public by ensuring competent practice and requiring continuing education. Some states also require licensure for board certified music therapists. Music Therapy is an evidence-based health profession with a strong research foundation. Music Therapy degrees require knowledge in psychology, medicine, and music. According to the AMTA the following examples of therapeutic music may be noteworthy, but are not clinical music therapy: A person with Alzheimer s listening to an ipod with headphones of his/her favorite songs Groups such as Bedside Musicians, Musicians on Call, Music Practitioners, Sound Healers, and Music Thanatologists. Celebrities performing at hospitals and/or schools A piano player in the lobby of a hospital Nurses playing background music for patients. Artists in residence Arts educators A high school student playing guitar in a nursing home A choir singing on the pediatric floor of a hospital The following are examples of what credentialed music therapists do by AMTA standards: Work with Congresswoman Giffords to regain her speech after surviving a bullet wound to her brain. Work with older adults to lessen the effects of dementia. Work with children and adults to reduce asthma episodes.

28 Work with hospitalized patients to reduce pain. Work with children who have autism to improve communication capabilities. Work with premature infants to improve sleep patterns and increase weight gain. Work with people who have Parkinson s disease to improve motor function. AMTA s mission is to advance public awareness of the benefits of music therapy and increase access to quality music therapy services in a rapidly changing world. In consideration of the diversity of music used in healthcare, special education, and other settings, AMTA unequivocally recommends the unique knowledge and skill of board certified music therapists. Music Therapy Quotes Jodi Picoult (Author of the bestselling book Sing You Home) "Music therapy, to me, is music performance without the ego. It s not about entertainment as much as it s about empathizing. If you can use music to slip past the pain and gather insight into the workings of someone else s mind, you can begin to fix a problem. " Michael Greene, President & CEO of NARAS Grammy Awards: "When we look at the body of evidence that the arts contribute to our society, it's absolutely astounding. Music Therapists are breaking down the walls of silence and affliction of autism, Alzheimer's and Parkinson's disease." Sen. Harry Reid (D-Nev.): "Simply put, music can heal people." Sen. Harry Reid:

29 "Music helps all types of people to remain forever young." He noted that Congress had never before "directly addressed the question of music" as preventive medicine and as "a therapeutic tool for those suffering from Alzheimer's disease and related dementias, strokes and depression." - SUPERIOR, WI Telegram, Aug. 14, Mickey Hart (Grateful Dead): "(Rhythm) is there in the cycles of the seasons, in the migrations of the birds and animals, in 18 the fruiting and withering of plants, and in the birth, maturation and death of ourselves," Hart told a Senate panel studying music therapy. - REUTERS, Aug. 1, Ida Goldman (90-year-old testifying at Senate hearings): "Before I had surgery, they told me I could never walk again. But when I sat and listened to music, I forgot all about the pain," said Goldman, who walked with assistance during the hearing. - REUTERS, Aug. 1, Sen. Harry Reid: "Music therapy is much more complicated than playing records in nursing homes. Therapists are trained in psychology, group interaction, and the special needs of the elderly." Dr. Oliver Sacks ("Awakenings"): Dr. Sacks reports that patients with neurological disorders who cannot talk or move are often able to sing, and sometimes even dance, to music. Its advocates say music therapy also can help ease the trauma of grieving, lessen depression and provide an outlet for people who are otherwise withdrawn. - ST. Louis Post Dispatch.

30 Oliver Sacks, M.D.: "I regard music therapy as a tool of great power in many neurological disorders -- Parkinson's and Alzheimer's -- because of its unique capacity to organize or reorganize cerebral function when it has been damaged." Dr. Clive Robbins (Nordoff-Robbins Music Therapy Clinic): "Almost all children respond to music. Music is an open-sesame, and if you can use it carefully and appropriately, you can reach into that child's potential for development." Nordoff Robbins uses music therapy to help 100s of handicapped children learn and to relate and communicate with others. Mathew Lee (Acting Director, Rusk Institute, New York): "Music therapy has been an invaluable tool with many of our rehabilitation patients. There is no question that the relationship of music and medicine will blossom because of the advent of previously unavailable techniques that can now show the effects of music." Plato: "I would teach children music, physicas and philosophy; but most importantly music, for the patterns in music and all the arts are the keys to learning." Dr. Sanjay Gupta of CNN, Music therapy helps speech, but also motor skills, memory and balance. It is also emotionally uplifting. We do not make music; music makes us. George Leonard, aikido master and pioneer or the human potential movement. Mickey Hart: No culture has existed without music...music makes us human. Anonymous: Music... is the only reason I m still here. Where Words Fail... Music Speaks.

31 Mandatory APA Statement: The information shared during this presentation comes from 35 years of clinical experience as a School and Clinical Psychologist. Research has also been ongoing and compiled from various continuing education and literature sources gathered over the years relative to the possible therapeutic use of music and the specific practice of Music Therapy. Current books and articles are referenced below that are pertinent and have many valuable details for all professionals interested in Music Therapy. Efforts have been made to acknowledge ideas and theoretical viewpoints that are not necessarily consistent with current objectively defined research in the field of clinically applied Music Therapy. A potential limitation is the fact that Dr. Kingsley, although having done training and clinical work with music therapists for many years, is not a credentialed music therapist himself. Attempts to insure the accuracy and content of information presented relative to the actual practice of Music Therapy were made. The speculative elements within the context of this presentation are not meant to critique and/or change current thinking, guidelines, or treatment in relation to Music Therapy as defined by the AMTA. Rather the intent is to broaden perspectives, open creative minds, and expand the possibilities of utilizing music therapeutically as a counselor, therapist, or psychologist. REFERENCES de l Etoile, K, LaGasse, A. B., (2013) Music Therapy and Neuroscience from Parallel Histories to Converging Pathways, Music Therapy Perspectives, 31(1), Gardstrom, S. C., Hiller, J., (2010) Song Discussion as Music Psychotherapy, Music Therapy Perspectives, 28(2), Hanson-Abromeit, D., (2015) A Conceptual Methodology to

32 Define the Therapeutic Function of Music, Music Therapy Perspectives, 33 (1), Korb, Christine (2014) The Music Therapy Profession: Inspiring Health, Wellness, and Joy. Xlibris, pgs Moore, Kimberly Sena, (2013) A Systematic Review on the Neural Effects of Music on Emotion Regulation: Implications for Music Therapy Practice, Journal of Music Therapy, 50 (3): Novotney, Amy, (2013) Music as Medicine, Monitor on Psychology, Vol 44, No. 10 page 46. Pasiali, V., (2014) The Effect of Musical Attention Control Training (MACT) on Attention Skills 20 of Adolescents with Neurodevelopmental Delays: A Pilot Study, Journal Music Therapy, 51() Pasiali, V., LaGasse, A. B., (2015) The Effects of Single-Session Music Therapy Interventions in Comparison with a Cognitive Behavioral Intervention on Mood with Adult Psychiatric Inpatients in an Acute-Care Setting: A Quasi-Experimental Trial, Music Therapy Perspectives, 33(2): MIV030. Reschke-Hernandez, Alaine E., (2012) Music-Based Intervention Reporting for Children with Autism: Implications for Music Therapy Publication Guidelines, Music Therapy Perspectives, 30 (2): Stevens, Christine (2012) The Science and Spirit of Healing Yourself with Sound. Sounds True Inc., pgs

33 Williams, K. E., Berthelsen, D., Nicholson, J.M., Walker, S., Abad, V. (2012) The Effectiveness of a Short-Term Group Music Therapy Intervention for Parents Who Have a Child with a Disability, Journal of Music Therapy, 49(1), REFLECTIONS A Therapeutic Music CD By Ron D. Kingsley, MS, Ph.D., NCSP (An Explanation of Possible Therapeutic Benefits for Parents, Teachers, Counselors, and Psychologists) Nothing s Easy: This was actually written while driving from Mesa to Phoenix in the year It felt like a song condemning the polluting of earth s air (and it is) but what I didn t realize at the time was that the true underlying message is that in life nothing s easy. We must work hard to get what we want. When I listen to this song it acts as a soothing reminder during hard times that nothing is easy. Choices: This is a song that explores choices that we make and how these choices affect our lives. Drugs and alcohol are touched upon but so are lying, not completing work, smoking, and the choice of friends. Depending on the specific emotional area it touches, it affirms these feelings and opens the door for possible further discussion and therapeutic intervention. My mother died in 1991 from lung cancer and my father from the related effects of alcohol and smoking in She was only 56 and he was 63. If You Really Want to Know How I Feel: This was actually written for a 14-yearold young lady experiencing problems with her dad. Practically every adolescent I have ever shared this song with has related to its message. The message is, If you really want to know how I feel then see me and listen to me. Even most adults can relate if they will just think back to their own adolescence. This song can open a window for discussion of how the listener feels in relation to parents and other authority figures. Trapped: This one is for everyone who feels trapped in ways that no one else can see. This would include those who are driven or impacted by symptoms such as ADHD, OCD, Depression, Diabetes, Cancer, and so on. Feeling trapped and misunderstood underlies the meaning of the song.

34 My Teddy Bear is my Best Friend: This one sounds like it was meant for younger children, and indeed they do tend to respond to it though they usually don t understand the underlying implications or meaning. Don be fooled. Like the movie Hook or many of Dr. Seuss s books, which were clearly meant for adults as well as children, the focus of this song has a double-edged message. It s about loneliness and coping. There is a Crocodile Under my Bed: This is a problem solving song. If there were a seventeen-foot crocodile under your bed, how would you get rid of it? I ask those listening how they might do it and we explore their responses. No one has ever guessed before the song is sung how the little boy in the song gets rid of that croc, although it s a way that could conceivably succeed. Use this to teach problem solving through brainstorming. Truly, there are many ways to solve any problem. The Grasshopper and the Ants: I love fables. This is a retelling of the classic The Cricket and the Ant with a few small changes, original music, and one big twist that preserves the moral without requiring the morbidity found in the original tale. There s a place in this world for everyone and for all kinds of work there is room. The Rabbit and the Turtle: Another classic fable retold from a fresh perspective and put into original song without changing the powerful moral lesson. The Red Humbean: While working as a school psychologist in a small district many years ago when integration of the disabled was first beginning to be seriously implemented I was asked by a psychologist colleague to write a song about differences. He was working at a school that was piloting a new integration program that consisted of a full half of the school s student population being diagnosed with some type of disability and in need of special services. They were experiencing some issues especially among the non-disabled students. This song became a part of the effort to turn those students around without threats or lectures. He reported to me that it had made a difference, and that s all that really matters. 10. The Mouse and the Lion: A classic fable retold in song with a few subtle changes to incorporate the ideas of our fluid and world culture. The mouse who saves the King of Beasts is not only a mouse but is also female, which the Lion disdains until, of course, she saves him. The misogynist Lion is forced to concede and redefine his prejudices relative to those weaker than himself being of importance and able to contribute as well as being capable of great things. He

35 is also forced to let go of his stereotyping relative to the female gender. We can all contribute! 11. Only a Chicken: A story song about a dreamer of big dreams who is laughed at and made fun of by his peers. The dreamer ignores the peer driven abuse and continues to proclaim something substantial will come of his dreams even though it appears nothing of the sort could possibly happen. The bottom line message is never give up on your dreams. Many of my dreams that I enthusiastically shared with others while growing up were ridiculed and laughed at by others and have now come true. Some of these include singing, becoming an artist able to draw anything I can see, playing and singing in a restaurant, becoming a songwriter, getting a song on the radio, becoming a psychologist, and an author. I expect many more dreams will yet come true in my life and yours. 12. Please See All of Me: I worked for five years very closely with elementary classrooms serving children diagnosed with Autism. This song was written for them and has since become a standard I share whenever presenting a program on handicap awareness. It took a while but eventually I realized that this song was also written for everyone, and especially for me. 13. Rocks: This is perhaps the most practical and quantifiable song I ve written. Originally, it was called Don t Throw Snowballs written at the request of a principal for an intervention to deal with the snowball throwing epidemic at a school where I was the Psychologist while working on My Ph.D. in Provo, Utah. We played it live in every classroom and over the intercom first thing in the morning for a month. It reduced snowball-throwing incidents that year from about 20 per week to only 1. Years later in my first stint as a School Psychologist in Arizona an elementary Principal asked if I could help do something about the innumerable rock throwing incidents occurring at the school. Children out on the playground continued throwing rocks in spite of the constant warnings and disciplinary measures meted out by the principal. The song Don t throw Snowballs was modified with only a few word changes to Don t Throw Rocks at all and an alternative consequence to the one in the original song was provided to be carried out when a child was caught throwing rocks. The song was played school wide over the intercom every morning after announcements for about two weeks. Teachers were asked to encourage their classes to sing along during the chorus. Finally, anyone caught throwing rocks was disciplined in the exact same way as the child in the song. The peer pressure was tremendous and the rock throwing was virtually eliminated. An added benefit of this song is that it is uptempo with a catchy tune and very funny.

36 14. It Takes Time: I actually wrote this as a reminder to myself because for most of my life I have been so very impatient. The song considers the fact that everything in life takes time to accomplish as well as the idea of accepting and dealing with some of the things that can t be changed and the distress that occurs should we try to change things that are out of our personal control. The bottom line is that everything takes time, and it does. Although all these songs are available for no cost on my YouTube channel, they are randomly mixed within the playlist called Children s Songs. Just go to YouTube and type in - Ron D. Kingsley - and my cartoon self-portrait will come up. Click on that and it will take you to all the songs on my channel. There are currently 79. I plan to add about 25 more in the next year or so. One of the most profound methods of recognizing the impact that music has had is through feedback from clients and others. In accordance with that truth, I offer the following page, which consists of excerpts from a few of the letters I have received over the years. Those that are the most poignant often come from the children I ve had the privileged of presenting to in classrooms and assemblies throughout Arizona and Utah.

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