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During the past thirty years, concepts in the mental health profession have undergone continuous and dramatic changes. A relatively new type of therapy is musical therapy, which incorporates music into the healing process. Music therapy also is changing, and its concepts, procedures, and practices need constant reevaluation in order to meet new concepts of psychiatric treatment.
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' 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 need 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. 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 music therapist is a competent musician who has received training in the biological and behavioral sciences. Once they have completed one of 69 approved college music therapy curricula including internship involving a period of supervised clinical experience in a psychiatric hospital, they are then 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, and ACMT. These individuals have met accepted educational and clinical training standards and are qualified to practice music therapy.
This broad training allows him or her to assume increasingly varied roles within the psychiatric institutions, and in other areas as well. Imagination, improvisation, and continued learning directed toward community-centered institutions will characterize the successful music therapist. Awareness of the rapid development in the field of mental health will enable the music therapist to demonstrate successfully his or her usefulness in psychiatric endeavors. The clinical settings are all different, but there is a common pattern between them all. The music therapy program represents a movement toward the community and away from institutional isolation.
Music therapists work in psychiatric hospitals, rehabilitative facilities, medical hospitals, outpatient clinics, day care treatment centers, agencies serving developmentally disabled persons, community mental health centers, drug and alcohol
programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools, and private practice. 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. The therapy is used in treating mental disorders including mild to severe mental handicapped, autism, and schizophrenia. This therapy is also useful in treating physical disabilities including vision, hearing, and speech impairments, cerebral palsy, muscular dystrophy, and cleft-palate children. Depending on the ages of the people, the music will have to suit that age of people accordingly.
Music therapists assess the emotional well being, physical health, social functioning, communication abilities, and cognitive skills through musical responses. They 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.
Although much research in the potential of music therapy remains to be done, it is evident that music can play an important role in the rehabilitative process. Music can and does influence human behavior, but it is not a cure-all. It can rarely accomplish treatment aims and goals by itself. In order to be most useful and therapeutic in the hospital setting, music is subordinated to an overall treatment plan designed to meet the specific needs of the patient as prescribed by a physician. Music is administered by a music therapist who, through his personality, knowledge of his medium, skills, examples, and attitudes, provides the experiences necessary to achieve therapeutic results. The therapist uses music as a tool in assisting each patient to reorganize his disorganized and inappropriate patterns of behavior into more acceptable ways of dealing with life's problems. In this way, both the therapist and the music contribute to the positive growth and development of the patient.
Work done in the clinical center (music therapy workshops) stresses participation in individual lessons and practice, in small ensembles (coached and uncoached), and in large choral and instrumental groups. The purposes are to stimulate the interest of the patients in music as a meaningful cultural activity and to direct their energies into making music for enjoyment, satisfaction, and growth toward health. 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. Socialization values lie in the pleasure of being together, doing things of achievement and feelings of self-worth fortify the ego, whereas the discipline of belonging to a group requires personal organization and the recognition and acceptance of reality goals.
Music activities carried on elsewhere in the psychiatric hospital involve performances by patients, and personnel. These are used for entertainment on the wards, parties, and community sings and dances in the auditorium. Background music is supplied for administrative functions and meetings of various professional departments. Suitable music is provided for weekly religious services. Such out-of-clinic activities serve to enhance the prestige of the patients who perform and tend to broaden their interest.
Demonstration programs of music workshop activities are used frequently as an orientation for professional trainee groups in the hospital. These demonstrations describe the program-its goals and its problems-and participation in them affords patients considerable pride. When patients are taken into the community to entertain, they are almost invariably a credit to the hospital in behavior and performance. They illustrate to many kinds of club and church groups that patients are people. Sharing in the social hours at the meetings of these groups increases the patients' ease and security in functioning outside the hospital.
Large group performances for holidays, special patient events, and an annual music and art department show are used to involve patients of many types and levels of skill in music and allied arts. Patients work with staff personnel in planning and coaching these shows. By-products of these activities, both in and out of the workshop, frequently include reduction of bitterness and brooding, improved concentration, better attitudes, a feeling of relationship with other patients in the hospital, and participation in activities typical of the world outside the hospital. The shows serve as a bridge for returning to the community and afford a richer way of life for those who must remain hospitalized.
Music is well suited to the treatment of geriatric patients because of the gratification and socialization that may result from creative experience with it. The nonverbal stimulus of simple rhythm is very effective with patients who have a diminished rapport with reality. Rhythmics, an essential part of the program, was designed to reactivate enjoyment of bodily movement, to provide remedial work for the skeletal and muscular problems so frequent in old age, and to effect reconditioning in motor functions. It also provides an avenue of expression on the nonverbal level.
When group singing has been used with senile incoherent patients, the patients seemed to enjoy most those folk songs with which they were acquainted. Because of the patients' short attention spans, music used occasionally and for only a short time was most effective. It was concluded that the activity was a pleasurable experience and resulted in increasing group cohesiveness. A positive atmosphere of sociability and entertainment was noted, and the cleanliness, morale, and general behavior of the patients seemed to improve.
Music is used in general hospitals to alleviate pain in conjunction with anesthesia or pain medication. It is used elevate patients' mood and counteract depression. Music is used to promote movement for physical rehabilitation. Slow music is used to calm or sedate, or often to induce sleep. The same is used to counteract apprehension or fear, and lesson muscle tension for the purpose of relaxation.
The future of music therapy is promising because state of the art music therapy research in physical rehabilitation, Alzheimer's disease, and psychoneuroimmunology is documenting the effectiveness of music therapy in terms that are important in the context of a biological medical model. Simply said, there is more and more documented research indicating that music therapy works. With proof that this therapy works there is no confusion in whether it will be around in future hospitals, and as more people learn about it's benefits the more widespread it will be used.
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