What is a music therapist?

Not so long ago I watched a TED talk by an American music therapist, Erin Seibert. One minute in and I’m nodding eagerly at the screen in agreement with Erin’s opening to the talk. That is, if told you I was a musician, you’d know roughly what it is I do. Similarly, if I told you I was a therapist, you’d understand to an extent what it is I do. Combine the two into one professional title and there is suddenly a mass of confusion. When I tell people I am a music therapist, they will typically exclaim how “fun” that sounds and envision me in hospitals taking around iPods like “that man they saw on YouTube who came alive when listening to Sammy Davis Jnr”. That, or they visualise me singing the hits of Vera Lynn to the elderly. So what is a music therapist?

I thought a great starting place for this blog would be to tell you a little more about music therapy and perhaps give you some insight into what a music therapist actually does. The profession and training does differ considerably around the world so in relation to my own experience this account will only outline how the profession operates in the UK.

Music therapists typically have a music undergraduate degree or are highly experienced performers with an alternative undergraduate degree. In order to become a music therapist you need a Masters degree in Music Therapy. Upon satisfactory completion of the masters training course you are able to register with the Health and Care Professions Council (HCPC). What on earth is that you might be thinking? The HCPC are a regulating organisation and they exist to protect the public by regulating 16 health and care professions in the UK including Chiropodists, Dieticians, Occupational Therapist, Paramedics, Physiotherapists and Social Workers amongst others. The HCPC set professional standards for these professions, keep a register of professionals and take action if professionals on this register do not meet their standards. Any of the professional titles regulated by the HCPC are protected by law and you must be registered to use them. In essence, regardless of how you may use music to improve health and well-being, you cannot call yourself a music therapist unless you are registered with the HCPC and fulfil all their registration criteria.

I trained on a psychodynamic course which means alongside music making techniques I have studied psychological theory. How does that relate to music you may ask? Basically this is a belief that there are both conscious and unconscious processes going on within a Music Therapy session and that music can aid the expression of both of these processes (google “psychodynamic music therapy” for a more extensive explanation!). However, some training courses in the UK do not follow this approach.

So what does a music therapist do? This is a tricky question to provide a short answer for but my explanation is that we are an alternative psychological therapy who, as skilled musicians, encompass all aspects of the medium of music in order to benefit the clients wellbeing. Part of our skill is to select the appropriate use of music. This is more or less limitless but these are some ways in which the medium of music could be used in a music therapy session:

  • Co-creating improvised music through use of musical instruments and/or voice
  • Exploration of recorded music or “known songs”
  • Writing lyrics and/or creating a song
  • Analysing song lyrics
  • Utilising music technology

What actually happens in a session will depend on the client group, setting and skill set of the music therapist.  For example, a colleague of mine is a flute player. I am a vocalist, pianist and guitarist so likelihood of seeing a flute in one of my sessions is pretty slim. Each music therapist usually has their own specialities and areas of expertise, dependent on their background and what kind of clients they work with. It is also not unheard of to find music therapists leading music activities such as choirs or informal singing groups. We must also take into consideration music therapists who work in areas such as autism or brain injury where a client may not be able to explicitly express a goal for their sessions. This work would be very different than say working with a school aged teenager with anxiety.

Ultimately a music therapist is there to guide and support their clients in determining which use of music will best support them in the session or the setting in which they work. This occurs through development of a relationship between client and therapist: the therapeutic relationship. If you’ve ever seen a therapist or counsellor yourself then you might recall being quite nervous to begin with, unsure what to share or if you should at all. Music therapy could be perceived to be the exact same way. As the therapeutic relationship develops, so do the sessions.

I want to conclude this post with a little description of some of my clinical work in hope this will provide some insight into how music is used in sessions. For confidentiality reasons I do not refer to the clients by any distinguishable details. 

In the first example, the client was living with a terminal diagnosis of cancer. They self referred to music therapy hoping to process and understand their impending death. The client preferred to verbally process a lot of their feelings so we would often spend half of the sessions talking. As our relationship developed, I could sense the client had a lot of inbuilt anger they were uncomfortable expressing to others. The client felt they put on a smile in public to hide their true pain and fear. In the process their unexpressed emotions lay dormant and unresolved. 

In the sessions we used an array of musical instruments and improvised together. The client typically chose things that could make the most noise: drums, rainmaker, piano. In one session I remember the client absolutely bashing the piano but within that there came the revelation: “I’m so angry!” the client said. Valuable discussion erupted from these improvisations. In this example it could be perceived the client was able to express and process an emotion within the music which they otherwise struggled with.

The second example is very different. The client was living with dementia and was refusing almost all social interaction. Day to day the client did their own thing. They usually sat in a chair, isolating themselves from any exterior noise, occasionally stopping a bystander to ask for a drink or a biscuit. I used to envision a snow globe. In the clients world it was as if anything outside of that globe was non existent. They could be in the noisiest room and they’d still be staring into space from their chair like nobody else was there. That is, until they heard my singing voice. 

Our relationship developed from the song ‘She’ll be Coming Round the Mountain’. It was almost our hello. I’d begin singing and before long the client would be tapping their thigh, raising their arm and exclaiming ‘lovely!’ The client would whoop, cheer, laugh and begin joining in themselves. It was like it was a different person. Music connected the client and I with my singing voice seemingly becoming a familiar friend. The client would hold my face and shout in ecstasy “Beautiful!”

In these sessions, a lot of familiar songs would occur between us but for this client, those songs were the tool needed for engagement. As our relationship developed I began bringing instruments which the client would explore. The client would usually continue in an elevated state after the sessions for up to an hour, singing and laughing to themselves, sometimes beckoning others over and engaging with them. In this example, I perceived music as a social instrument. Although, interestingly recorded music never had much impact on this particular client, so there was certainly something about myself and our physical interaction which aided their engagement.

I hope this post has provided some insight into the profession. If anything, I think it helps highlight how the direction of the therapy comes from the dynamics between the music therapist and client. Ultimately there is not one set way in which a music therapist works but certainly where words fail… music speaks 😉

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