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TITHE AN OIREACHTAIS AN COMHCHOISTE UM GHNÓTHAÍ EALAÍON, SPÓIRT, Meán Fómhair 2006 HOUSES OF THE OIREACHTAS JOINT COMMITTEE ON ARTS, SPORT, TOURISM, COMMUNITY, Eleventh Report Defining Music Therapy September 2006 ContentsAcknowledgements Chairpersons Forward Executive Summary & Recommendations Chapter One: So What Is Music Therapy? Chapter Two: Music Therapy in Ireland Chapter Three: The Six County Experience Chapter Four: Music Therapy in Action Chapter Five: “An Investigation into the Effectiveness of the Arts Therapies by measuring symptomatic and significant life change for people between the ages of 16-65 with continuing mental health problems” Chapter Six: “Music Therapy with Mothers and Young Children at a Unit for Child and Family Psychiatry: An Investigation” In Conclusion Conclusions & Recommendations of Joint Committee Appendix 1: Quotations from Hospital Settings Appendix 2: Undergraduate Music Students Appendix 3: Letter from Tracey Jones, Music Therapist CheeverstownHse Appendix 4: Membership of the Joint Committee Appendix5: Orders of Reference of the Joint Committee Bibliography AcknowledgementsThis Music Therapy Report could not have been completed without the co-operation of many people. Indeed the response rate was difficult to contend with, given that this is not a consultancy report but an internal one compiled for the Arts Committee by its Chair. Therefore the first acknowledgement to be made is that if all the offers to attend various locations to see what was going on were fulfilled and if there was not a conscious effort to bring the Report to a conclusion, the research could have continued for not only many months but indeed years! However, the goal is to provide information from which others can continue the awareness raising that is undoubtedly started. An initial questionnaire was sent to 240 hospitals / institutions. I am indebted to the 90 people who returned their forms. They gave very frank and informative comments on the topic. A second questionnaire asked music students whether they had been introduced to Music Therapy and whether they would consider it as a career. The responses from 19 Students of NUI Maynooth, who had taken the module on Music Therapy, were most helpful and the thoughts of 12 students in Trinity who had not had the Music Therapy option were most interesting. I thank Professor Gerard Gillen and Grainne Redican respectively for their help in coordinating these responses. For those who gave their names the Committee would like to specifically mention them: Hilary Moss, Arts Officer, Adelaide&Meath Hospital, Dublin My proactive, American intern leant the questionnaires a controversial dimension, as she distributed them prior to being picked up on her use of “Musical Therapy” rather than “Music Therapy”. This was a point of contention with some that responded and just who picked up on the term was of interest in itself. It was a central issue, following on from the physical/physio therapist debate that was part of recent legislation. The information was collated from the Questionnaires by Carol Faulkner, and the initial work was assisted by Hayden Orne both of whom I would like to acknowledge. Expertise in the field was given in a detailed fashion from a core number of people. The first Music Therapist to respond directly was Tracey Jones, of Cheeverstown House Music Therapy Department, Templeogue, Dublin. Her intervention at that point was reassuring. Similarly on a visit to Crumlin Children’s Hospital, it was important to meet Aine Flynn, one of the two Music Therapists working at the Hospital and to hear, first hand the types of clients that avail of the service and the issues that arise. Existing documentation was forwarded from Liam O Callaghan (the Evaluation of the Music in Healthcare Project 2000-04) which was a partnership project between Music Network and the Midland Health Board; from the Eastern Regional Health Authority Arts Council Steering Committee (The Practice of Arts in Healthcare);and the Eastern Regional Arts Committee (The Picture of Health) amongst others. Edel Sullivan, Music Therapist and Lecturer in Music Therapy at the Cork School of Music also gave me encouragement and informative contact. I had a very fortunate, if brief encounter, with Maureen Piggott, Director of MenCap (understanding learning disability) in the North of Ireland who gave me an outline of the significance that was placed on Music Therapy in the North. Had I had more time I would have and should have talked to the many personalities within the region that were leading the way in this regard. I would wish to thank Maureen for forwarding details of the Project carried out, evaluating the role of Music Therapy in Special Schools in the North of Ireland. It was truly another central plank to what could and should be taking place in the rest of the island. Cate Hartigan, Assistant National Director, Planning, Monitoring and Evaluation of the Health Service Executive was very open, helpful and informative in her response to me. Professor Brendan Drumm, guided me to Dr. Hugh Monaghan, Consultant Paediatrician at Crumlin and the National Rehabilitation Hospital in Dun Laoghaire, and active with Enable Ireland, whose interest, expertise and time I valued greatly. I trust that I will have a chance to discuss the topic further with Professor Drumm in his capacity as Chief Executive of the Health Services Executive, subsequent to the publication of this Report and therefore I acknowledge his assistance in advance of this. Finally I mention Dr Jane Edwards. Her attendance at a Joint Oireachtas Committee meeting and responses to various queries both before and after - were essential to the report. She led me to David John, Fulbourn Hospital Cambridge, and Helen Odell-Miller, Anglia Ruskin University, Cambridge, who are two people that do not need introductions to anyone who works in the Music Therapy field. Through them I was facilitated in attending an actual therapy session and would like to thank the clients that allowed me to join them on that occasion. Having experienced a non-verbal intervention first hand it is clear that to do justice to this in a verbal manner will be a challenge that can merely be attempted. In Art (and equally art therapy) they say a picture paints a thousand words, suffice to say that for Music too, it is in participating that you truly gain! Chairpersons ForwardIn choosing Music Therapy I declare both a long time interest in the subject and a blurred understanding of it. This report has grown out of that general confusion. It aims to do a number of things, beginning with defining what music therapy actually is. It dismisses the simplistic notion that Music Therapy is having individuals or groups from the community, visiting a hospital and performing for patients. It responds to the notion that Music Therapy is something passive that any volunteer can offer – playing, or indeed having music piped through the hospital to make patients “feel good”. This is not Music Therapy! Further to the definition there needs to be a broader understanding of the reasons why music is used in hospitals and educational institutions in other countries and the different values that a musical intervention can have generally. It seeks to ascertain if we are missing out, in Ireland from not recognising professionally the Music Therapist and their role in paediatric and geriatric issues. The question thus is, does the Clinical Intervention that Music Therapy is, deserve a higher remuneration and do results to date elsewhere justify such a use of public money and why is it not happening? The writing of this report also aims to raise awareness amongst Health Professionals, Musicians, Patients and Politicians alike as to the benefits that Music Therapy can offer and that are recognised in countries all over the world. In so doing it will clarify why it is important that the profession is given its correct place in our professional standards grading and thus is remunerated in an appropriate manner. In investigating the topic it was clear that throughout the country those who had had an encounter with Music Therapy valued it highly but those exposed to the true form were few. It is time that we took our place on the international stage and put Music into the same level of consciousness and multi-disciplinary team as Speech & Language, Physio, Occupational and other accepted Therapies. It is time, in putting the patients first, to ask for and receive Music Therapy! Cecilia Keaveney, T.D., MPhil, BMus, LTCL, PGCE
Executive SummaryAbroad Ireland is synonymous with the Arts - people everywhere are aware of our music and musicians; our dance and dancers; our writers and their literature. Yet the Arts in Ireland have developed perhaps because of an innate talent within the country rather than due to a particular strategy down the years. The question posed is, if we have achieved so much through a lack of investment and strategy in the past how much better could we be; how much more could we gain, directly and indirectly for our country’s economy, health and reputation both nationally and internationally, were we to examine in a more clinical fashion what the Arts really can offer? The Irish – both its government and its people - historically exude a sense that “anyone could do it” when it comes to Artistic endeavour. The Artist in the pub will be “expected” to perform in the pub in exchange for a few pints as they “enjoy what they do”; the local musician will turn up each week and have a choir perform in Church “because they can” and “singing is twice praying”; the music teacher will produce a show annually and \ or provide the “entertainment” for special guests as they arrive at the school “because there is so much talent available”; the local artist will give time in the hospital settings to perform for the patients “because they all love music”. Seldom is it asked whether any other profession would offer their services in as voluntary a fashion as this. In Ireland there is an acquired sense that artists can give of their talent for nothing or very little financial reward. Artists are not however some inferior beings. They are at the core of selling our country internationally; they are what attract many tourists to our country and similarly give a sense of well-being to our people nationally and locally. They have a social and economic role for those they touch, but for the vast majority the economic reality is that those central to the debate are the least recognised financially. It is time for this fundamental role of the Arts to be questioned as their importance gains momentum in other countries in newer spheres, in social and health contexts through the Arts Therapy evolution. In many countries we see, for example, Music Therapy has an equal place in the hospital team setting beside the physio, speech & language and occupational therapies. The salary for each is the same. There is no pandering to any notion that the musician turned clinician is of a lesser “monetary value” than their counterparts in the other specialities. For Music Therapists in the Republic of Ireland, the story, alas, is that of the Artist outlined above, but it is worse as there is no distinction between the musical volunteer, the professional arts performer and the qualified music therapist, thus none are appropriately paid but one group only is qualified to deal with and able to deliver accountable and effective interventions to vulnerable people who deserve proper clinical support. There is KNOWLEDGE that a Music Therapy intervention can help the burns victim; child who has suffered a trauma; abuse victim; youth presenting with challenging behaviour; child presenting with developmental problems; persons with communication difficulties from the autism spectrum to the Alzheimer’s age profile... Medically too it is accepted that a non-verbal intervention in a setting is most appropriate where the ability / wish to articulate may be the problem. Music Therapy offers huge potential to the Mental Health sector across the age spectrum. Its very nature increases the potential for reducing the use of actual medication replacing these with therapeutic solutions. Thus it is a win / win situation for all. Interesting is the fact that in Chapter 2 “Music Therapy in Ireland” it is shown that this knowledge is with the Health Service Executive at Assistant National Director, Planning, Monitoring and Evaluation level. It is not transcending itself into Professional recognition by the Health Service Executive however which means we have an issue of retention of our qualified personnel. Beyond the Medical and Health benefits are the impacts for society that Music Therapy can offer. There has been a rise recently in the phenomenon of television programmes devoted to addressing the issue of “problem children”. Socially it is emerging that parents presenting with young children with challenging behaviour, can gain significantly in the use of Play plus Music Therapy, especially if the intervention is used when the child is young and still forming its responses. Therapy can help parents begin to understand their child - thus enabling a parent / child bond to be established that may, until then, have been missing and if left unchecked would have serious consequences. Recently in the media we have had the debate about the “hidden generation” – children, for example, who at 13 are presenting drunk and attempting to murder their parents or have been remanded 59 times. Chapter 6 outlines an investigation that has been carried out specifically in the area of mother and child interventions but Chapter 3 (The Six County Experience) also alludes to the importance generally of music to the early childhood development and the role of the parent’s involvement in ensuring the child engages. At a time when society is changing and traditional family patterns and supports are altering greatly in Ireland the issue of parenting skills and early childhood interventions are not only good for the families involved but also have a “cost benefit” for the State, should they reduce the number of youths presenting with delinquent behaviours in the future. Even for those already in trouble with the law the role for a clinical Arts intervention is occurring in other countries. This report includes, in chapter 4, a review of an actual session in a forensic hospital setting where people are availing of Music Therapy, and gaining from it. Studies to date would indicate that Music Therapy has a major role to play in these varied situations. One such study is outlined in this Report and has taken place in the period 2004-2006 in our neighbouring counties in the North of Ireland, where the value of Music Therapy and the financial recognition of the Music Therapist have already been established. The key issue is that Music Therapy in the Republic of Ireland is not being paid for. It is not recognised where it matters, in financial terms. We are finally training people on the island but there is no incentive to employ them and keep them. This incentive is available in the North of Ireland. It is time for the rest of the island to decide that they want to acknowledge the importance of the Arts and specifically Music Therapy. It is time that both the Department of Health and the Health Service Executive decide that they want to go beyond positive words and act to catch up. To do this must, however, be at the same cost as the other established therapies. It must not be, in any sense a poor relation, as even in Cinderella, it was the “poor relation” that was the most successful and was respected eventually - let us learn now before other books are written. Recommendations:
Chapter One: So What Is Music Therapy?Music Therapy is a medical technique that is almost a century old. It began in World War One where veterans benefited physically and emotionally from music in their rehabilitation. If the doctors and nurses were not prepared for the horrors of war neither were the various musicians who crowded into wards to try and help patients, who were eager audiences, deal with the massive levels of pain and suffering. The establishment of the actual profession of musical therapists also came around this time. Training was needed to deal with the treatments and outcomes of their skills on the ill. As success mounted, many American colleges and universities developed a programme of study. It is now an established health profession (the first degree programme was founded in Michigan State University in 1944) similar in stature to occupational therapy and physical therapy. It consists of: “The prescribed use of music by a qualified person to effect changes in the psychological, physical, cognitive [behavioural] or social functioning of individuals with health or educational problems” (American Music Therapy Association, 1999). Because music stimulates all of the senses, and both sides of the brain, it is a powerful and non-threatening medium, and so distinct outcomes are possible. Music is therapeutic but music therapy is a structured intervention so clients are referred to a qualified therapist for clinical assessment and intervention. The types of clients are referred to later in this chapter, but given that it is a non-verbal intervention, it is often utilised where the client has an issue with verbal communication – where they either have an inability to articulate or have suffered a trauma that they do not wish to, or are incapable emotionally of dealing verbally with. Therapists are skilled in eliciting and managing responses. It is generally participative more than passive as the client is encouraged to engage in musical improvisation which is merely facilitated by the therapist. Through their actions or non-actions the therapist forms an impression and reacts, thus bringing the client along a “managed” developmental path. They feed this information back into the overall multi-disciplinary team and so there is a structure to the process. This is quite different to the concept that many people have that you listen to a tape or live performance and “feel better” so that means you have had “music therapy” – this is not what is being discussed in this report. Music Therapy in the true sense aims to clinically change the state of the client and the use of music merely facilitates a therapist’s work. There is always a question when therapy is mentioned of “does it work”. And Dr David Aldridge of the University Witten Herdecke, Germany has reviewed medical literature that supports the fact that: “Music Therapy is widely reported in the medical literature. There has been substantial progress in the establishment of research strategies for supporting clinical practice” (p.2) He concludes however that the quantifying of the progress is difficult (which I expand upon in Chapter Five), but his research has very many and varied links between Music Therapy and Hospital Based Overviews; Psychiatry and Psychotherapy; Schizophrenia; Adolescent Psychiatry (which includes a recommendation that adolescents with drug abuse problems should be exposed to creative therapies as it encourages spontaneous activity; motivates the client’s response and fosters a culture of free expression); Developmental Delay; Culture; Rehabilitation; Psychosomatics; Elderly; Dementia in the Elderly (Research Approaches to New Treatments; Depression; Hearing Impairment; Temporal Coherence; Not Loss of Semantic Memory; Functional Plasticity; Communication); Musical Hallucinations; Heart Rate & Respiration; Coronary Care; Anaesthesia; Cancer Therapy, Pain Management and Hospice Care; Neurological Problems; Mental Handicapped Adults; Hospitalised or Disabled Children and Autism. It is a piece of reading that anyone looking for more detail will not be disappointed in. Another excellent example is Dr. Jane Edward’s: “Music Therapy in the treatment and management of mental disorders” which is published in the Irish Journal of Psychological Medicine, 2006. But similarly, the American Music Therapy Association and others publish substantial bodies of literature (hundreds of research studies) to support the effectiveness of the intervention. It is clear, however, that many of those who have not come into direct contact with Music Therapy can be less than polite in their “assumptions” as to what constitutes Music Therapy. While the clue is in the title for Speech & Language Therapy; Occupational Therapy and Phsyiotherapy there is generally less of an acceptance that Music Therapy is more than what one would get listening to the background “jingles” while shopping. The definitions of Music Therapy that were received from Health Professionals and Music Students alike vary (Appendices 1 and 2) but are wide ranging and interesting. The definition of one of the top people in her field, Dr Jane Edwards, is that: “Music Therapy is an evidence based profession in which university qualified practitioners use music in planned and effective ways to achieve clinical outcomes in domains such as learning, coping, development and participation&Music therapists work as members of multidisciplinary teams in a range of health and education settings to identify, address and ameliorate needs in psychosocial, emotional, developmental, and cognitive domains. Professionals in music therapy have high level skills in 1) assessment of client needs 2) delivery of effective programmes to meet these needs 3) evaluation of the extent to which needs were met through music therapy, as well as 4) skills in reporting the clinical outcomes of their work”. While this definition may be similar to the process and outcomes expected in the other Therapy domains (and Music Therapy is usually a crucial component of the inter-disciplinary service), the fact that there is no professional registration available in Ireland for those who wish to practice leads to a lesser value being placed on the profession and a difficulty for properly trained individuals to attain full time employment at a rate of pay commensurate with their qualification. When there is a gap between qualification and professional recognition, the gap often gets filled by people who mean well and have an interest in “the arts and health” but are not actually qualified Music Therapists and are not offering a “clinical” intervention. Through this the definition of Music Therapy gets drawn back into the realm of blurred misunderstanding as musicians who visit hospitals gain a new, but incorrect title. In this respect I am confused as to what exactly is offered at the hospital that responded to the questionnaire in the manner outlined below: “Our musical therapy is provided by a local musician. He is not qualified in the professional sense but we believe music is a great source of healing to patients and have been planning a music therapy session here for the last four years.” Thus, when undertaking this research, Professor Flusser, of Strasbourg University, a strong exponent of Community Music in Hospital settings advised, that when defining the intervention one must ask what the aim of your activity is. Music Therapy aims to change clinically the patient. Other music interventions can merely be to “decentralise” music into non-regular venues, which is a democratisation of music or there may be neither a therapy nor democracy role but an aim to give both patients and professionals a “humanization” of the institution that they are in. The music intervention in the last case is to have no therapeutic aim but looks at the relationship between and within people. It is more, music for dialogue with people. This Community Music intervention is gaining popularity in itself in many countries in Europe and is officially recognised in Portugal, Germany and Spain currently. Community Music serves a different purpose to Music Therapy. In Ireland too there is a growing, positive momentum in the ‘Arts in Health Practice’ sector supported by groups such as Music Network and the Health Service Executive Eastern Region. That intervention which contributes to staff, patients and families having a “feel good” factor is important but is not the same as Music Therapy. The subtleties in emphasis, and the qualifications/processes involved in the clinical intervention, are quite different as you can see when Dr. Jane Edward’s talks of some of the activities she does with children in hospital: “In my experience, children are very responsive to musical interaction, even those who are not speaking or for some reason not coping particularly well. I have written protest songs with children about hospital food or staff, as well as pain. I have written with children love songs to family members, greetings to family members from children in isolation because of infection control&I used to work with siblings of children with cancer, and they are a particular group in that the family member is going through a cancer treatment that can sometimes take years” The Dean of the Clinical Science Institute, NUI, Galway, Dr. Carney, as a psychiatrist with an interest in music states too that he sees a value in Music Therapy, even if it is qualified praise: “I think your questionnaire is timely – I have no doubt that patients do respond to Music Therapy – but by and large the number of people who are available to provide this therapeutic modality is small in number – and again, because of other priorities, even if they are available the money is probably best spent elsewhere … Again, I think this is a very good interest you have engaged in, and I wish you every success” This feeling that Music Therapy was an “extra” rather than a “core need” was an interesting feature that ran through some of the responses from hospitals (see Appendix 2) but as Dr. Jane Edwards commented when she came before the committee and this point was raised: “The most common response is that Music Therapy is seen as a luxury. It is associated with entertainment and there is an idea that it is the icing on the cake. In that context, I suggest that the icing can sometimes be the best part and that children sometimes only eat the icing. Perhaps we could consider way of broadening our perception of what the health services should do and of what they should bring to a field such as music therapy.” This concept of “luxury” is at odds with the fact that when asked in this report what type of areas benefits from Music Therapy the answers were expansive. The list included: child and adolescent psychiatry, palliative care, intellectual disability, neurological rehabilitation, dementia care, social disadvantage, paediatrics, stroke, head injury, chronic pain, bereavement therapy, autism, coordination/motor skills, behavioural difficulties, mental handicap& Those patients are referred for treatment – that is, they are referred for a clinical intervention. Tracey Jones, MMT at Cheeverstown House, and Secretary for IACAT, was glad that someone was finally exploring what is going on in Music Therapy in Ireland: “Your questionnaire is a first step in seeking to identify existing music therapy practice throughout the country& we anticipate that this valuable work will raise awareness of the role of the profession as an essential part of the inter-disciplinary team” Tracey is convinced about what she is doing as she outlined in her response, how an individual, for example, with an intellectual disability that has been referred for Music Therapy may present with: marked communication deficits, concentration / attention difficulties, marked low self-esteem, reluctance or inability to function in groups, hyper or low activity, socialisation difficulties, coordination or dexterity problems (because music is time ordered it is an ideal stimulus to help coordinate movement), inappropriate mood patterns, change in life events (such as separation from family, recent loss or bereavement etc.,): “As music is a non-verbal communication it can often be an effective tool for establishing initial contact with clients who have difficulty expressing their thoughts and emotions verbally” In this manner instrumental playing can equip a person with the ability, not only to express themselves, but to work through emotions such as frustration and anger. Music Therapy for her, as a practicing professional is equal to the other interventions that may be offered by the Health Services (and for further thoughts from Tracey Jones see Appendix 3). Research results and clinical experiences in Ireland show that Music Therapy can play an important role in the area of dementia even where other treatment approaches have failed (this will be referred to in more detail later). The area of memory recall, awareness of self and environment, the reduction of stress and anxiety, the stimulation or elevation of the patient’s mood that provokes interest in life, the emotional intimacy that is given through music, the opportunities to interact socially are important in themselves but are added to when one realises that music can be a non-pharmacological management of pain and discomfort. A recent study showed even in surgical settings where the playing of live harp music reduced the amount of anaesthetic needed and resulted in the patients recovering faster. Similarly there is ongoing work taking place into the role of Music Therapy in the area of Autism. While it may be too early to be definitive about the absolute role of Music Therapy, those involved in the area see possibilities – and Anglia Ruskin University have already put together a video on some clinical work that they were involved in which is very interesting. The non threatening, non verbal character of music can be a bridge for those who are on the autistic spectrum to get motivated and engaged in a manner that can lead on to the development of verbal communication, speech and language skills. Qualified music therapists are employed in a range of services throughout Ireland including hospice care, adult psychiatry, special education, and community health work. Chapter 3 looks at the area of Special Education and a real investigation that has recently taken place. Subsequent chapters will look to other areas where Music Therapy interventions have been pursued and evaluated in Ireland and other countries. All of them point, however, to the success of Music Therapy and its role in the multi-disciplinary team situation. Thus Music Therapy has a role in the Health Care Sector but also has an increasingly important potential in the addressing of the types of social issues being thrown up by the changing family fabric and the stresses on people as they grapple with the basic pressures of employment and survival in a fast paced world. At her meeting with the Joint Committee Dr. Edward’s was asked: “If we spent more money on developing music therapy for those under six years of age, would we need to spend less on therapy for those over six?” Dr Edward’s response was that Music Therapy worked best at younger ages and with parent / infant interactions. In the past she had been funded by the Australian Government to give ten week music therapy programmes to many vulnerable families throughout Australia called “Sing and Grow”. This is now copied in Limerick in a programme called Suantrai which is offered to refugee and asylum seeking mothers and infants (due to their funding source) and aims to: “offset for vulnerable parents what might happen if they do not bond with their children”. This issue of early intervention is pursued specifically in Chapter 6, where I collate information from an Investigation carried out in the Croft Unit for Child and Family Psychiatry, as it has potential and great significance to any future Childcare and Pre-school government policy in Ireland. Again the paediatric experts such as Dr Hugh Monaghan, know the importance of the 0-6 developmental age range and the openness of children to any clinical therapy at this time. It really is essential that Ireland develop and implement, as a matter of urgency, a strategy to facilitate early interventions. Music Therapy has not gained the significance in Ireland, as yet, that it has in other countries. While we have the Irish Association of Creative Arts Therapies (IACAT), locations such as America (the American Music Therapy Association http://www.musictherapy.org/ and the Florida Association for Music Therapy. http://www.floridamusictherapy.com/); Australia (http://www.austmta.org.au/); Austria; Brazil; Canada (http://www.musictherapy.ca/); Denmark; Korea; New Zealand; Switzerland; Taiwan; United Kingdom (the Association of Professional Music Therapists, http://www.roehampton.ac.uk/artshum/apmt and the British Society for Music Therapy, http://www.roehampton.ac.uk/artshum/bsmt/bsmt.htm) Finland and Germany all have Music Therapy Associations. The European Music Therapy Confederation, founded in 1990, nurtures mutual respect, understanding and professional development. This confederation has Statutes, By Laws and an Ethical Code. It is made up of membership from Austria; Belgium; Bulgaria; Denmark; Estonia; Finland; France; Germany; Greece; Hungary; Iceland; Italy; Latvia; Lithuania; Luxemburg; Netherlands; Norway; Poland; Portugal; San Marino; Spain; Sweden; Switzerland; United Kingdom; Yugoslavia; Israel (non-voting member). There is a coordinator to contact in all these countries but Ireland had no coordinator. It is the great movement of these types of confederations that shows the recognition that exists outside Ireland for the intervention. Thankfully, recently, Dr Jane Edwards has attended a Confederation Meeting in an observer status and keeps in close contact with the Secretary of the European Music Therapy Confederation. It will be important that Ireland make an application to join and the impression to date is that any application will be looked on sympathetically. It remains important that Irish medical personnel, politicians and policy makers generally, learn from other countries experiences and the positive experiences already taking place in the country. The appetite to learn will have to be whetted by the Music Therapists themselves and those who have been in a position to see it work, either as a team member, a patient or a family member. The facts are on their side in respect of research results but the message to be sold is left in the hands of a very busy few. Thus the next chapter looks specifically at Music Therapy in Ireland and that cohort that are trying to deliver an intervention against the odds. Chapter Two: Music Therapy in IrelandThis Chapter does not intend, necessarily, to list every location in Ireland that has “Music Therapy”. It does look at how one qualifies; how that relates to other administrations; how our recognition of the Profession varies; gives examples of some of those involved in the system; outlines why some others have left the profession and ultimately gives a synopsis of the workings of the Music Therapy Unit in Crumlin Children’s Hospital, that links into other chapters which outline activities in other jurisdictions. But it also puts forward the position from Mary Harney, Minister for Health and the Health Service Executive, which makes interesting reading when juxtaposed! While there are two jurisdictions in Ireland, Music Therapy is typically not distinguished between Northern Ireland and the Republic. However, there are differences in how health and education are administered within the United Kingdom as opposed to the Republic of Ireland and therefore that leads to important differences in the governance of the profession and the accreditation process. In the Republic, the Department of Health and Children proposed to regulate Music Therapy through a registration council governing “Complementary and Alternative Medicine” (Massage; Aromatherapy; Indian Head Massage; Rekki…). This is not acceptable to those who are qualified, with a degree and a two year Masters in Music Therapy. In the Six County system, Music Therapy is governed through the Health Professionals Council, so Music Therapists, alongside other creative arts therapists are registered under the same programme as other allied health professionals, since 1999. This is replicated in other countries and is what is needed in the Republic. Qualified practitioners in the Six Counties must be registered with the “Health Professionals Council” and can have a membership of the “Association of Professional Music Therapists” (APMT). In the Republic of Ireland, as of now, anyone can call himself or herself a “music therapist.” This is a serious issue that came to light in the physio versus physical therapist argument of the Health and Social Care Professionals Act that went through the Houses of the Oireachtas recently. Indeed it will be important that Music Therapists are included in the list of professions in that legislation and those current moves to define a registration process are brought to a speedy conclusion. The “Irish Association of Creative Arts Therapists” is developing a system of registration for qualified practitioners. They are very anxious that the title of Music Therapy is established and that this professional title be used correctly to give the service due recognition. The MA in Limerick is recognised internationally and this should be a sound starting point for a definition. It is vital for the reputation of Music Therapy that there is no doubt as to what standard is to be reached before a person can present as a Music Therapist. A Music Therapy e-mail group was set up, by Dr Jane Edwards in November 2001 for qualified music therapists working on the island of Ireland. Music Therapist in Crumlin Children’s Hospital, áine Flynn moderates the group now, which has 32 members. On a visit to the Hospital, Aine was able to outline what happens in Crumlin (the Music Therapy Unit was opened by Chris de Burgh some 12 years ago). Later in this chapter I will abbreviate literature and information received in relation to this facility to give a sense of what ideally happens in our very important Children’s Hospital. I will also outline the thoughts of Dr Hugh Monaghan, the original driving force behind the development of the Music Therapy Unit in Crumlin, as it currently is now. On the bigger picture, the European Parliament now recognises the European Music Therapy Confederation as a professional body. This means the EMYC can lobby the parliament for conditions and training requirement recognition but it also enables the Confederation to develop a procedure for registering Music Therapists on a European level. To qualify to become a Music Therapist generally involves having a music degree or psychology degree or degree in a related discipline. This then enables people interested in the area to take up an MA in Music Therapy (the reason given for the fact that this is not offered as a basic degree but rather as a two year post graduate study is that there is a need for a certain level of maturity to deal with both the actual music requirements but more especially the psycho-analytical/clinical side of the job). Up to recently most music therapists in Ireland have qualified from courses in the United Kingdom. This was due to the fact that up until 1998, when an MA in Music Therapy began at the University of Limerick, there was no Masters programme in Music Therapy on the island. Up until now this MA was run on a two year cycle. As of September 2007 it will have an annual in-take of students and will have another full-time academic appointed to the staff. To be selected for the programme involves, an audition and interview process, with a panel from the fields of psychotherapy, music therapy and music performance. To be successful it is deemed that those who work in the sector be creative, energetic, positive, with strong oral and written communication skills and be ready to work with families and other professionals as a team player. As of August 2006, we have (out of 55 Music Therapists on the island) 29 graduates from the University of Limerick programme run by Dr Jane Edwards. Of those graduates, 6 work full time in Ireland; 8 work in a part time capacity; 3 have moved to other countries, 6 have chosen not to stay in music therapy, 4 work in the North and 2 are looking for employment currently. For only 6 out of 29 (the last 9 are just qualified mid 2006) to be employed in Ireland in a full time capacity is a low percentage and begs the question – why is the Republic of Ireland not conducive for Music Therapists. The answer may be more complex but the lack of Professional Recognition of Music Therapy comes across as the main reason. Edel Sullivan qualified and practiced in London as a Music Therapist (1993-2000) but no longer practices clinically states: “There is enormous interest in music therapy and its effectiveness in both the health and education sectors but the majority of institutions in the Cork area only have the budget to employ you on a sessional and/or temporary basis which means one may have numerous employers and no long term career development opportunities. Financially, this is not very feasible in the current economic climate and a difficult base from which to get a mortgage as well as being unsatisfactory for ones professional development … I strongly feel that both Department of Health and Education have the capacity to facilitate the creation of full time posts by enabling a structure where a therapist may work on a peripatetic basis between a number of institutions but be employed full time by the appropriate Health Authority or School Area. This would enable a proper professional structure to be put in place for the therapist with the more experienced therapists supporting the newly qualified… I strongly feel that it is time for the sporadic funding of short-term, once-off pilot studies to cease (unless it is in new, un-chartered areas) and the creation and development of long-term, permanent work where the clients benefit from a profession with roots, focus and direction & the academic and professional bodies are doing their piece – it is now time for governmental departments to lend their structures and support for the health, education and social development of the country” While she admits to enjoying using her qualification now to teach undergraduate BMus students modules on Music Therapy, in the Cork School of Music, she is clear that she was unable to make an appropriate living as a full-time Music Therapist. This gives one example of what Edel shows as a major problem. The Irish facilities that employ qualified therapists full-time are: Milford Care Centre, Limerick (older adults and hospice); Cheeverstown House, Dublin (children and adults with intellectual disability); Familiscope, Dublin (social exclusion); St Joseph’s Foundation, Charleville, Limerick (a new full time permanent facility) Mayo Mental Health Services, Co Mayo; Tallaght Hospital, Dublin (a new research post for one year). Those who have job share or part-time posts are: Doras Luiminigh, Limerick (refugee and asylum seekers); Our Lady’s Hospital for Sick Children, Crumlin, Dublin (hospitalised children and their families; 2 therapists one day each a week); Bluebox Creative Learning, Limerick (families and young people with social needs); Grove House (2 hours a week on a seasonal basis in the Intellectual Disability Service); St. Mary’s Hospital in the Northern Area (6 hours a week). Dr Jane Edwards too points to the fact that a number of posts have been set up with very low salary scales; lower than a non-degree holding care worker, or classroom assistant, would earn which, she contends explains why at least two posts – one full-time in Dublin and one half-time in Limerick remain unfilled for a qualified Music Therapist. This is not the way to encourage qualified professionals to come or stay in Ireland when they are accepted as “real professionals” outside Ireland. Music Therapy is not fully acknowledged or utilized in the Republic of Ireland. When Music Therapists are acknowledged properly, and are paid the appropriate salary, we would begin to attract a high level of Music Therapists, and the country would benefit from all they have to offer, through the education and the health care system. It is a lesson we must learn soon. It is unclear why there is no Music Therapy recognition in Ireland, as the Department seem to pass responsibility to the Health Service Executive and vice versa. Because there is no award designation music therapists can often be employed under a different title and if they give up the post this can revert to the general pool and the specific intervention is lost again. The Irish Association of Creative Arts Therapists indicated that they have been making submissions to the Department of Health; been involved in reports to various expert groups and have wanted proper recognition with the Departments of Health and Education but it has not happened and yet the Tanaiste in a Parliamentary Question to her and the Department of Health (25/10/2005) was very positive: “Both the Department and the Health Service Executive supports the use of music therapy in the treatment of paediatric and geriatric patients and recognise the positive benefits for patients when music therapy is used in their treatment” In a letter from the Health Service Executive they also value Music Therapy when they say: “Music therapy is efficacious and valid with older persons who have functional deficits in physical, psychological, cognitive or social functioning. Research results and clinical experiences attest to the viability of music therapy even in those who are restrictive to other treatment approaches. Music is a form of sensory stimulation, which provokes responses due to the familiarity, predictability and feelings of security associated with it. International evidence supports the benefits of music therapy provided by a qualified practitioner to a range of patient groups including child and adolescent psychiatry, palliative care, intellectual disability, neurological rehabilitation, dementia care, social disadvantage etc., The HSE recognises the positive benefits for patients when music therapy is used in their treatment…there are difficulties in attracting this staffing group to work in the health care sector” This mutual respect for the profession does not deal with the core issue of “why” people are not attracted into the health care sector, either by the Department or the Executive. The “why” must evolve around the issue of financial recognition. In response to asking the Tanaiste the reason music therapy is not profiled in her Department’s consolidated salary scales booklet thereby leaving it unable to feature as a listed profession in the service delivery and thus ensuring there is no system to enable services to appoint music therapists, Minister Mary Harney said: “The purpose of the consolidated pay scales issued by my Department is to show the nationally approved pay scales for recognised grades within the public health service. The appointment of Health Service Executive staff and their terms and conditions are matters for the Executive itself in the first instance in the overall context of the provisions of the Health Act 2004 and national policies on public pay and employment. The establishment of new grades within the public health service, including the grade of music therapist, is also a human resource management matter for the Health Service Executive which must have regard to service requirements, the extent to which the service concerned can be provided by existing staff or professions, and the distinct qualifications required. The Deputy will wish to know that my Department is writing to the Health Service Executive to clarify the position.”[PQ 32979/05, 25th October 2005] On the same day the Health Service Executive responded with a letter that confirmed that music therapy is not in the Department of Health and Children and Department of Education “Consolidated salary scales” booklet and consequently without this listing music therapy cannot feature as a listed profession in service delivery. The Executive continued by saying: “This in essence means that there is no system to enable services to appoint music therapists. So while music therapy is made reference to in service plans and is a sought after intervention by many health care professionals and parents it is difficult to create positions as the structures to employ music therapists are not in place”. Surely therefore it is time for the sides to come together and cease to abdicate responsibility for making important decisions. By doing this it will enable Irish patients gain from what Cate Hartigan, Assistant National Director, Planning, Monitoring and Evaluation of the Health Service Executive deems to be a successful intervention: “HSE-Mid Western Area has funded a one year study in conjunction with the Music Therapy programme at the University of Limerick examining the effects of music therapy and art therapy on reducing agitation in dementia patients receiving care in a long term ward. The results show that patients show reduction of agitation following regular sessions of music therapy and art therapy offered by qualified practitioners [This was the first such study in Ireland and it proved that Art Therapy intervention works with the most vulnerable in our society. It involved 23 patients on Ward 9b, St Camillus’ Hospital, Limerick from March to October 2005. A decrease in agitation was verified statistically by the Cohen-Mansfield Agitation Inventory – in the number of times the patient called out, the only behaviour not seen to decline was “wandering”]. In dementia care, research conducted in the USA has shown that music therapy can increase communication (including aspects of speech and fluency), improvement in relationship with carers, and reduction of agitation. This is because music skills are often preserved, despite the progression of the disease and its effects in other areas of ability. In the treatment of patients who have psychiatric disorders, research conducted in the UK and the USA has shown that music therapy proves to be beneficial in assisting participation and decreasing social isolation. In treatment of children who are hospitalised, music therapy is used in many countries to assist in psychosocial care and decrease isolation and assist in rehabilitation and pain management. For children who have autism, music therapy is widely used and its benefits are gradually being better researched and understood. Beech Park Services commissioned a pilot report within outreach services for children with autism (2002-2003).”[The difficulty outlined by a consultant to me in relation to this is the ability to get patients admitted to facilities for autism in the first instance as a consultant referral must be accompanied by various psychological and other reports and the time involved in trying to get those professionals to underline a diagnosis that a consultant has made delays interventions significantly]. Through other research and interviews, it is well documented, even in Ireland, that the application of music in child development, and also in the healthcare industry, has vast benefits. The repetitive rhythm of music stimulates the child’s brain at key developmental stages (see Chapter 3). This “multi-modal approach” facilitates many developmental skills, while also facilitating and encouraging socialization, self-expression, communication, and motor development: “The music that makes the foot tap, the fingers snap and the pulse quicken stirs the brain at its most fundamental levels, suggesting that scientists one day may be able to return damaged minds by exploiting rhythm, harmony and melody, according to new research presented (November 1998)… Exploring the neurobiology of music, researchers discovered direct evidence that music stimulates specific regions of the brain responsible for memory, motor control, timing and language. For the first time, researchers also have located specific area of mental activity linked to emotional responses to music”. (Los Angeles Times, November 11, 1998) It has also been shown that music and its distraction may be helpful in handling both acute and chronic pain and stress management, both in children and adults (including women in labour). This recognition is infiltrating some hospital settings as Hilary Moss, Arts Officer, outlined the emphasis that the Adelaide and Meath Hospital have placed on Music Therapy: “We have a number of initiatives that might be of interest to you, including music therapy in the psychiatric wards, a weekly live performance programme for patients and The Irish Chamber Orchestra as our orchestra in residence. We are also preparing to start research in music therapy, and will be conducting a randomised control trial of the effect of music therapy on depression and anxiety following stroke later this year. I myself am the hospital Arts Officer, but am also a music therapist, and have just written a chapter on models of using music in hospital in Ireland and the UK”. Those at the coal face feel / want Music Therapy utilized in the Republic of Ireland - applied in both child development / educational and healthcare aspect to maximize benefits. The St Camillus’ example is one which can be expanded upon as there are other opportunities to develop Irish-specific research studies which can then be published to support a range of initiatives between Health and Education. In that the HSE themselves point to the success of the Music Therapy intervention in St Camillus’ it is all the more disappointing that there is no longer a Music Therapy position in the hospital as it was removed after the research proved successful. Its time for the HSE / Department to deal with the “why not” issue! Leading the field of research, communication, advocacy and particularly educational development in the area of Music Therapy in Ireland at present is Dr. Jane Edwards, who is the Senior Lecturer and course director for the MA in Music Therapy at the Irish World Music Centre at the University of Limerick. An Australian who has worked in Ireland for the past 3 years, Dr Edwards is a qualified music therapist since 1986, who received her PhD from the Faculty of Medicine at the University of Queensland, in 2000. In her contribution to the Joint Committee, one of the most vivid aspects was the discussion of how she, while working in a burns unit in the Royal Children’s Hospital, Brisbane, used Music Therapy to assist young people that had serious burns. The point was made that a two year old with burn injuries may not understand instructions to lift their arm and stretch out (physio-therapy) in their recovery from skin grafting; but if referred to a Music Therapy Unit, did know to reach for the Tambourine which was seen as “fun” for the patient – serving the same purpose but more successfully. What Students Say:There is a Music Therapy module in the undergraduate degree in NUI Maynooth which offers students a taste of what it is about. The Cork School of Music offers an introduction to Music Therapy in Year 2 of their BMus four year course and students can specialize in that topic in years 3 and 4. This offers a real grounding in what to expect in the MA at the Irish World Academy of Music and Dance at the University of Limerick, where a number of students have gone on to train. These, alongside the Cork Institute and Waterford Institute, would seem to be the only such courses that have been brought to my attention. The students who responded to my questionnaires, reflected a real interest in the topic once they were introduced to it but the lack of information is a great drawback as is the understanding that there are few jobs available and the rate of pay is not appropriate to the qualification. In spite of the growing use of Music Therapy in its role in the delivery of medical services, and being described by the Professional Association for Creative Arts Therapists (ICAT) as: “a secure creative space for exploration, expression and development when verbal communication is inadequate or unavailable”; and also; “the primary means of facilitating a therapeutic relationship”, Music Therapy has yet to be placed on the same consciousness as Speech, Physio, Occupational and other such established therapies. All 19 undergraduate music students from the University of Maynooth undertaking the Music Therapy module that responded to the questionnaire had an understanding of what Music Therapy was. They defined it, for example as: “Using music as a medium to meet a persons needs, useful in drawing out and helping people to understand their feelings that they could not express through words”. Others defining it as: “A musical vehicle encouraging the musical experience of an individual, helping in the process of communication verbal/non verbal, as well as the holistic well being of an individual”. 13 out of 19 of these students are also aware of where Music Therapy courses are available, and 17 out of the 19 answered yes when asked if offered would they take up a Music Therapy course. A majority replied in a similar way to: “Yes, it is an interesting subject”. Some believe it could be particularly useful when used for people with disabilities. 14 out of the 19 students also believe Music Therapy to be a career opportunity. They stated both what would encourage them into and discourage them from entering the profession. There were many positive responses as to what factors contributed to encouraging those into the profession. Some stated that it was a good course that could be used: “As a means of helping people” These were positive contributing factors. However despite much of the positive feed back, many of the 19 students cited the limited job opportunities available to Music Therapists in Ireland, as a key factor in discouraging entry into the profession. One student in particular also feels that he or she would be: “Intimidated by the clinical aspect” However: “The major hesitation is being in a position of control of another’s mental well being”. They then went on to say that: “Maybe if I could experience the therapy for myself I would be more confident / interested in the profession”. In comparison Trinity College undergraduate music students were also questioned on the subject of Music Therapy. However unlike that of the University of Maynooth, Music Therapy is not offered as a module within the college. They responded with answers similar to those of the Maynooth students. All 12 Trinity Students defined Music Therapy: “The use of music to treat or alleviate certain mental or physical illnesses” “Music used as an aid to those in suffering” “Use of music to help those using it to cure illnesses” Surprisingly however 11 out of the 12 of theses students were unaware of where Music Therapy was available, despite the same number answering yes, when asked, if offered would they take up a Music Therapy course. Their reason for being positive about the topic was the popular response: “I would find it very interesting” or “I have a keen interest in it” 7 out of these 12 students also believed that it was a potential career opportunity; again stating that the encouraging factor that would lead them into this as a career would be: “An interest in people and helping them” A key factor however in discouraging those students from getting into the profession was citied as a lack of information as to what Music Therapy involved and its effects with comments such as: “Perhaps I might be more encouraged if I knew more about it” “I know nothing about the effectiveness or efficacy of music therapy, and would prefer to find out more before making a decision”. A similar opinion was also voiced by a student from Maynooth. Conclusion of the Student’s Views:Conclusions drawn from the comments of the students’ questionnaires show clearly the growing interest in Music Therapy amongst those surveyed. Despite the growing enthusiasm, the research shows a number of concerns that must be addressed if the current interest is to continue and grow. It is clear that all University Departments should provide students with an optional introductory module on Music Therapy (or at least, information on the full variety of career options available including Music Therapy), which presently happens in the National University at Maynooth, Waterford Institute Cork Institute and the Cork School of Music. It would be of great importance that the option of providing more courses around the country was explored and the concept of a link to actual clinical practice at those locations, similar to the Anglia Ruskin University, Cambridge is considered. Given that the MA is the way to gain a Music Therapy qualification, due to the need for the person to have a certain level of maturity, there may be a need to have a regional spread of the two year MA course so that those moving from employment back to the educational system can be assisted geographically – which in itself is almost equivalent to financially. At the very least, perhaps those interested in a career in Music Therapy should also be given an opportunity to visit such institutions and experience first hand the work undertaken by a Music Therapist, as some students felt that they: “Would like to find out more before getting involved” This is acknowledged as difficult due to client confidentiality; however information packs are available elsewhere on Music Therapy related to specific areas and at least those videos need to be made available. As some students were unaware of a professional association that existed, which embraced Music Therapists, there should be a wider distribution of information regarding www.icat.ie, the Professional Association for the Creative Arts Therapists, formed in 1992. What The Health Professionals Say:A questionnaire was sent to 240 hospitals, ranging from local district to acute hospitals, around the country that serviced a number of different types of patient. 90 responses were returned which contained candid and informative thoughts on Music Therapy. Surprising given the medical background 34 did not have any definition of music therapy – however, 56 defined it in ways such as: “The use of music to address physical, emotional and social needs of individuals of all ages” “Using music as a medium to relate to specific therapies, i.e. dementia, or in use with physical activity or as a part of a group work with older persons in a day care setting” “Music Therapy is the systematic application of music by qualified therapists to bring about desirable changes in persons behaviour, through the use of the various elements of music facilitating self-awareness, self-expression and self-development” 59 out of the 90 hospitals were aware of the circumstances in which Music Therapy would be best received, that is, they knew the patients that could benefit from the intervention. They defined those as: “Clients with communication difficulties, anxiety / depression, cognitive impairment / dementia” “Alzheimer’s, dementia and behavioural problems” In that many talked of the good of Music Therapy for the elderly one hospital in particular said it was beneficial for: “Potentially all patients, irrespective of age”. Surprisingly in this respect therefore was the fact that only 16 of the 90 locations have a Music Therapy programme and only one hospital has an employee who has received their MA in Music Therapy; however, 17 do have employees who have musical training or certifications. Each hospital was asked to rank the importance of Music Therapy in the hospital setting compared with speech & language, physio and occupational therapy, and to state their reason for this ranking. The response was very positive with more than half of the hospitals surveyed giving high rankings. They responded with answers such as: “I would rank Music Therapy as equally important to other allied health service provision. While music therapy is not necessarily required for everyone it should be offered as one of the possible treatment options. As music is a non-verbal communication it can often be an effective tool for establishing initial contact with clients who have difficulty expressing their thoughts and emotions verbally” “It (Music Therapy) would greatly enhance and improve the resident’s everyday life” “Music Therapy is very important within hospital settings; it has very practical benefits for speech and language development” One hospital in particular however felt that: “Speech and language therapy and occupational therapy are not comparable with Music Therapy” This hospital thought that they had different aims and outcomes. This was a feature in some of the feelings of those in the medical field whereby they felt that you could not compare one sector with another – they felt each speciality had a role to serve and thus were of equal merit, but in varied situations. Amongst those 90 Health Service Providers there were a small number of hospitals that found it difficult to answer the questions as they are unfamiliar with Music Therapy and its effects – which indicates an information deficit in an important area. In addition, those partaking in the survey were asked to provide any additional commentary or concerns that they wished to address. Although some hospitals did not wish to comment further those who did, responded with general comments on Music Therapy, particularly within their own settings. Some also pointed out their concerns at associating “Music Therapy” with “Musical Therapy”. It is clear that there is a growing popularity in the role of Music Therapy in the delivery of medical services. Despite the growing enthusiasm among the hospitals for the use of Music Therapy, this research did raise a number of issues and concerns that will need to be addressed if the interest in the use of Music Therapy within the hospital setting is to continue to grow. It is important that a cost benefit analysis of existing full time Music Therapy services be carried out, as some hospitals citied the issue of funding as central in the delivery of Music Therapy within the hospital settings. This relates to the “luxury” as opposed to “core” item sense discussed in page 12 but also two hospitals in particular made a different comment: “We have had a music network in our setting, however it depends hugely on outside funding and we cannot depend on it” “We would love to see money available for Music Therapy for our service” It is clear that the Department of Health noted that “A Vision for Change” (published by the Expert Group on Mental Health Policy, 2006) recommended the inclusion of creative therapies in Mental Health Policy but to do that there needs to be the development of a strategy as a matter of urgency to define Creative Therapy and how service providers in the Health Service Executive can employ creative therapy experts – currently there is no such job title officially in our health service. The facts that there is no professional registration available in Ireland for those persons who wish to practice leads to a lesser value being placed on the profession and a difficulty for properly trained individuals to attain full time employment at a rate of pay commensurate with their qualification. This is compounded by the lack of award conditions that enable health providers to create and develop services that include music therapy. When there is a gap between qualification and professional recognition, the gap, as said before, gets filled by people who are well meaning but are not actually qualified to offer a clinical intervention. The numbers of people qualified and remaining working in our system at this point should be considered worryingly low. The visit to meet Music Therapist Aine Flynn, however, showed what could happen if professionals are given a chance. This next section outlines in detail all the information made available to the Committee and is included in the main body of this report for the very reason of being informative for medical or musical people and / or patients, or families of patients, wanting to know what is possible in this location. It also serves to suggest what should be available in many other locations should our patients be deemed important enough to be offered the full range of therapy supports that exist in other multi-disciplinary teams in locations such as the United Kingdom, United States of America, Australia, Finland, New Zealand… Again, it is vital that those who qualify with their MA be given the potential to have a career that is paid in a manner that equates to the other therapies and is full time. The fact that even after 12 years this great children’s hospital does not have a full time post is a question I turn to at the end of this chapter. Crumlin visit and information courtesy of Aine Flynn, Trudi Carberry and Dr. Julie Sutton, R.M. ThHospital Mission Statement:“Our Lady’s Children’s Hospital Crumlin is committed to providing family-centred health care in a compassionate and supportive environment, where each child receives the highest standards of healthcare” Thus in the provision of Music Therapy too they offer: “A unique service in Ireland” – as there is only one within a children’s hospital anywhere in Ireland. Who Provides Music Therapy?Any sensitive musician can offer therapeutic music making but Music Therapy is a profession allied to medicine. A music therapist is a skilled musician who has been trained to use music to help someone develop their potential, whatever their disability, difficulties or diagnosis. Therapists see children for many different reasons but gear the sessions towards the needs of each individual. Therefore, the qualification involves completing a postgraduate training followed by a probationary period. It is a state registered profession in the UK with its own Code of Ethics. Music Therapists also undergo their own therapy as part of their training. Regular supervision (discussing cases) is also maintained. What is Music Therapy?Everybody is born with the innate ability to appreciate and respond to music. This ability stays with us even if we have experienced injury, handicap or illness. No musical training is necessary to respond to music and yet it is accepted as having significant therapeutic and healing powers. Music Therapy is the use of music – sound, silence, rhythm, melody and harmony – as a means of facilitating self-expression, self-awareness and self-development. It is communication and therapy through music for children and adolescents with emotional and developmental needs. This is achieved by the process of a developing relationship between the client and therapist, based on trust, respect and confidentiality. During Music Therapy the relationship that develops between client and therapist promotes growth and change. Some people may ask whether parents cannot just work on their child at home using musical instruments or toys but Music Therapy is based on the relationship between the client and the therapist and on the use of specialised clinical and musical techniques, so it is not possible to reproduce this situation at home and should, in the interest of the child be avoided. This definition of Music Therapy is an important issue. Musical instruments at home can be used by parents to engage musically with the child. There is a sense of enjoyment and fun when parents interact through even singing a song and while this is good for the well being of both parties involved it is not Music Therapy. Music Therapy is the use of Music as communication. It is psychological therapy and children are not taught an instrument. The expressive aspect of music is explored in a complementary manner to other therapeutic aids – for instance, psychotherapy, physiotherapy, speech and play therapies. Both child and therapist are musically active. The building of a therapeutic relationship is the focus of the work. Music Therapy is spontaneously improvised music making, where the child or adolescent is engaged at fundamental levels of awareness, emotional response and play. Music Therapy is a communication through music between people. It develops a sense of self and creative self-expression within a therapeutic relationship and is a non-verbal means of assessment and treatment of emotional and developmental needs. Music Therapy is a psycho-dynamically-informed creative arts therapy, with the support of additional training and clinical supervision Music Therapy is also an established profession in over thirty countries world-wide. “Music Therapy is an intense form of human communication; there is healing in making music” (Dr David Aldridge, Professor for Clinical Research Methods, University Witten/Herdecke, Germany) “Music Therapy asks no questions and makes no demands; it simply enables the person to be” (Dr Colin Lee, Music Therapist) “I found after a while I could really make my own music… I mean, it’s making a musical conversation together really” (Music Therapy Client) Who can benefit from Music Therapy?Almost everyone can be affected by listening to musical sounds – so music therapy can be beneficial to everyone, from the person who is mentally or physically handicapped to the person who is emotionally or psychologically stressed. Music Therapy is an aid to health available to all, from the very young through to the elderly. Children and adolescents with a wide range of emotional and developmental needs or anyone with the need to communicate where otherwise words are inaccessible or insufficient can gain. It can be particularly effective where verbal communication is impaired or impossible. It can be effective in the areas of: Emotional disorders Who Can Refer?Psychiatrists Music Therapy Unit Covers:
How does it work?Music Therapy does not depend on musical learning or training. It only relies on the innate responses of almost everyone to the sounds and silences in music. Music making is spontaneous; client and therapist create music together in response to the immediate sense of the moment. As a musical relationship develops between child and therapist, the child may begin to express a range of feelings, both positive and negative (or resistive). These reactions and feelings are part of the child’s overall development and are central to the therapy process. While it is a form of treatment which is effective and is often less frightening than other forms of therapy, the principal advantage in the use of music is probably the non-verbal qualities. Music can safely express, through vocal and instrumental sounds, many thoughts, opinions and feelings which may otherwise prove too difficult to verbalise or acknowledge. The music moves along only when and how the client wishes. There is no assessment or judgement of the performance other than to assess whether the process is helpful to the needs of the client. In a way it is an art and a science. Neuroscientists tell us that music has a powerfully stimulating effect on the brain. We feel music in our bodies as an emotion. Developmental psychologists show that early language development relies on the musical aspects of communicating – rhythm, pitch, timing and placing of sounds and expression. Music in communication lets you hear the non-verbal aspects of a conversation. Music also has a structure and form. It can contain or hold emotional experiences. Through the musical relationship that is formed through shared music making, beneficial developments and changes can be encouraged and worked on in a safe and creative way, which, through music constitutes music therapy. At times, some of the more negative responses may be difficult to deal with and then parents/carers and therapists work together to accept the challenges and work towards an ultimate resolution of the problem. All of this however relies on committing time to the relationship. Consistent routine and reliability of regular attendance is essential to ensure that the child trusts and therefore responds freely in the music room. If they are not brought for their session they may well feel that they have done something wrong and therefore even if a session is to be missed for a valid reason the need for people to explain this to the client is important. Music Therapy in Practice for Individual Intervention:Through regular contact and over time the child and therapist establish a creative relationship through “co-improvising”, using their body, voice or a percussion instrument. Via the subtlety and infinite expressive variety of the music, interactions occur that involve the timing and quality of the type found in two-way verbal communication. It aims to meet the child at their level and to understand their view of the world – whether that is a confusing, frightening or uncomfortable place. The therapist looks to deal with the causes of certain behaviour rather than the behaviours themselves and development occurs at the pace of each child. Children use the sessions in a variety of ways but always utilising the powerful expressive properties of improvised music. For the child who hits out when under stress this “hitting out” experience will be different if supported by strong holding music; for the tentative, frightened child, music can create an open, unthreatening atmosphere; for the hyperactive child co-improvised music offers a meaningful channel of physical and emotional expression. In every case, the safe, secure environment that the music and music therapist sets up enables each child to express themselves fully and meaningfully. Even the fact that they are left alone with the therapist can be a signal for the child that the carer / parent trusts the therapist and the sessions are valued which is important for the child to know. Evaluation and continual assessment of each session is carried out by the Music Therapists, in the form of note-keeping and staff feedback. There are basically three types of evaluation used, depending on the therapist’s particular approach:
Music Therapists may use a single approach or a mixture of 2 or more approaches; most important is the unique “musical personality” of each child and the potential they have to develop this. Because it is a therapy and involves the development of a relationship between client and therapist, the length of time involved will vary for each person or situation. The pace of change will vary for each person and this can be difficult to quantify. What seems like a very small change in behaviour or perspective may really be a vital new link, leading to future important developments. In almost every case the effects of music therapy will be of lasting benefit to the client. Some sessions may be taped so that the therapist can review the process over time. This is a vital component as they inform how the relationship develops between client and therapist which, in turn, inform also the reports that are written for the parents. Whether these recordings are audio or video, they remain confidential and with the therapist. Parents are encouraged to watch excerpts so that they too, can monitor and discuss progress. If given permission by parents, these videos can be used as a teaching mechanism for student Music Therapists or information for others about the technique. Such permission involves the signing of a consent form governed by the Code of Ethics of the hospital. Therapists discuss the progress of each child with parents at regular intervals, usually without the child present and outside the therapy session time. The written reports, therapists encourage parents to share, with other professionals that the child deals with, for example, teachers, social workers and so forth. Music Therapists are often asked to participate in reviews of clients. The exchange of information is ideally a two way process where the Music Therapist would receive reports on the child from other professionals also, which helps to develop the overall picture in respect of the child. These written reports are kept for five years after therapy is concluded. Therapy ends when the therapist deems that the reasons for the child having been referred have been addressed. Often both parties feel a loss at the ending of the sessions, due to the core function of the building up of relationships that the therapy entailed. But the good of the intervention remains with the fact that the children for life is actually saying “goodbye” so that they move on with their lives. A Thought - Why Use A Drum?Drums are at the heart of all cultures, but are very important in sub-Saharan African cultures. Drums have a presence in all important aspects of African life – from birth, ancestor worship, rites of passage, healing, storytelling, warrior rites and initiation, at the time of death, as well as an important means of communication over long distances. They still have a role to play in communicating. Extra-Curricular Activities:Music Therapists can offer introductory and educational programmes in addition to clinical presentations for Early Communication and Play Workshops for those already working with children. They can run parent/carer group sessions at sites away from the hospital to either involve them in activities or enable them to discuss their feelings in a supportive environment. They can run sessions to introduce the concept and theory of Clinical Music Therapy and its links with other health professions. They can do conference papers on a variety of Music Therapy subjects or run experiential workshops for healthcare professionals. And So After All these Thoughts From Students & Health Professionals:This all reads very well, so why is such an important paediatric service, as outlined above, available only on a part time basis in such a busy National children’s hospital? This question was addressed to Dr Hugh Monaghan, Consultant Paediatrician, who worked in the Research Section of Our Lady’s Children’s Hospital from the late 1980s and led the way to having Music Therapy established in the hospital. The simple answer is, as always, money! He stressed at the time, Chris De Burgh had championed the concept of having Music Therapy in Crumlin and that he (Dr. Monaghan) had gone to the Nordoff Robbins Music Therapy Centre, London (http://www.nordoff-robbins.org.uk) to investigate further what it was all about. Dr. Monaghan was convinced by what he saw and a Music Therapy Unit was established which was serviced by Dr. Julie Sutton, a Music Therapist from Belfast on a three day a week basis (she subsequently left to work in London). He felt it worked well as the Music Therapist was very much part of the team and regularly presented to case conferences. Referrals were made by a number of the consultants and success was seen with a number of patients. While there was a sense of “team playing”, as soon as any pressure came on the budget for the hospital, the “natural order” set in and the hierarchy within the professions ensured that the weakest / newest / smallest section got hit first and so, with Music Therapy in Crumlin. Given that it was set up without a specific budget it was squeezed as soon as there was a competition for funding. Dr. Monaghan continued to advocate for the retention of the unit but it has become a two day a week service now operated by two different people. The difficulty that that presents logistically, in terms of being available for case conferences, given that either one of the two are only available one day a week and have their patients to see, assess and work with, is obvious. Therefore, the ability to retain and grow a strong position as an essential member of a multi-disciplinary team just gets harder. And, yet, working in isolation will serve a certain purpose for a certain number of patients but militates against the long term success of the Unit on the longer term. To return to the “team player” status that could deliver on all the goals outlined above, would need an investment in the Music Therapy Unit so that it is made more “full-time” than at present. As Dr Monaghan points out, if it was full-time the personnel in the unit would have the ability not only to get through more of a work load but also to sell their message with the other professionals in the hospital and thus build up their reputations and also allies. They would be able to assess people and, in an ideal Health System, work beyond the “fire brigading” that currently takes place to refer patients, with a diagnosis, to community services, where the full range of therapists would be available on a team basis in the community. As it is, as long as there is a competition between Music Therapy and Occupational / Speech and Language / Physio Therapy, the evolution of Music Therapy is challenged. Music Therapy is a small fish in this particular pool and, as it is a contest that each of them is fighting. The others are more established and therefore have a greater clout – not necessarily a greater role in the Health Service [echoes of “all animals are equal but some are more equal than others”]. Dr. Monaghan is a highly respected member of the medical profession in Ireland. He is clear in his belief in Music Therapy. He is also clear that, as was stated by other medical personnel in this chapter, that: there needs to be a clarity brought to what Music Therapy can offer, through promotion of the intervention, so that the level of ignorance is dissipated and other medics / therapists can see Music Therapists as colleagues of equal value; those who are qualified need to be properly remunerated; they need to be part of an overall multidisciplinary team that works as a unit within the hospital and / or the community setting; the overall level of therapists need to be bolstered so that referrals from outpatients can be supported in a more effective manner than the current levels allow and in this manner any suspicion about Music Therapy “taking away from other vital therapies” can be overcome. Currently people who present to Outpatients cannot gain therapy services in Our Lady’s, unless they are brought in as an Inpatient. This takes up a bed unnecessarily. If they are referred to the community service, the waiting list is long and so, particularly with the young patient – a therapy delayed is a therapy denied. He recognises that there is huge potential for Music Therapy interventions in Rehabilitation Centres and locations where longer term work can take place with patients. He recognises too that Enable Ireland are one example of an organisation that will assist those with a physical disability gain access to Music Therapy; that locations such as Cheeverstown support those with serious learning problems but would like to see those with behavioural problems and mild learning difficulties gain easier access to the service. Within all this, remains the problem that just at present there are such a small number of Music Therapists in Ireland and this is compounded by the fact that the Profession is neither defined nor recognised – therefore the challenge to Music Therapy in Ireland is significant but not impossible if the will is there to improve the situation and aspire to what is going on, on the rest of the island. Chapter Three: The Six County ExperienceIn this chapter I wish to share a recent evaluation that has taken place of Music Therapy in the Special Schools environment in the other jurisdiction on this island. I want to focus your attention on items such as the case studies which indicate that Music Therapy does work. I follow that with a look at the importance placed down the years on music, in the “regular” Curriculum in the North of Ireland. Both of these aspects are given to outline the thought that what is “good practice” for the development of all children – both able and less able - in one part of our island should be good for all in the rest of the island. This chapter also links, in emphasis, to the chapter in this Report on the Croft project that looks at the role of Music Therapy in developing relationships between Mothers and Children. Having done a Music Degree, Masters and Teaching qualification in the University of Ulster, Jordanstown; having taught, and having had relations teach in the system there, it is obvious that there has been a huge gap between the concept and respect for music in the six counties versus the twenty six. Music is made up of Listening, Performing and Composing alongside the practical tuition of the Peripatetic teachers right from primary school on one side of the border and it leaves me very jealous as this is not what I experienced growing up on the other side of the border. This is not to say that all children are exposed to the entire experience but the concept that “music is important” is long accepted in the North. Through the course of doing this research I met Maureen Piggott, Director of MenCap (Understanding learning disability), at the opening night of the National Games in Belfast, who informed me of the advanced activities that are taking place in the North of Ireland, in the field of Music Therapy. Similarly, having spoken to teachers in the region, many are au fait with Music Therapy as a Special Needs intervention. There is a “status” attributed to the profession itself. In the previous chapter I indicated that Music Therapists are already respected as akin to all the other allied health professionals in the North. Thus those Music Therapists involved are paid on an equal par and discuss their findings with their team colleagues in the other therapy disciplines – truly a regular occurrence in many places outside the Republic of Ireland. Music as a Therapy in Special Schools:If music is central to the Curriculum, and rightly so, it is of great interest that the Department of Education in the North has seen the importance of it for the Special School Student Sector also. An evaluation of the Northern Ireland Music Therapy Trust (NIMTT) ARRIOSO Project in Special Schools, over the 2004-2006 period, was recently compiled by the Education and Training Inspectorate to inform not only the Department of Education but also the Library Boards; Health and Social Services Boards and the Health and Social Services Trusts of the impact of music therapy in supporting the development, and meeting the social and communication needs of pupils in special schools. The report makes recommendations in relation to how music therapy might be included in the curriculum of special schools as an allied health therapy to enhance the experiences and engagement with learning, of pupils whose behaviour and conditions pose significant challenges for staff. What is the “Northern Ireland Music Therapy Trust”?The NIMTT was founded in 1990 and has a staff of 11 who report to a management board. It was established to facilitate a clinical intervention for people of all ages that experience communication, social, emotional and behavioural difficulties, to take place. It also has role in supporting teachers and health clinicians. What is Music Therapy?Music Therapy is an allied health profession supporting the development of the communication and social interaction of pupils across a wide range of disabilities, particularly in the pre-verbal phases of language development. It aims to encourage self-expression and emotional development through musical activities designed to reflect individual needs. Individual assessment informs the working approach. ARRIOSO Project:The project was funded by the Executive in the North. It involved 17 special schools for serious and profound learning difficulties. The four music therapists worked well as a team supported by the Head of Music and Executive Director of the Music Therapy Trust. Tracking 320 students with autistic spectrum disorder, emotional and behavioural difficulties, communications disorders and significant learning difficulties, over 38 Music Therapy sessions; it also involved interviews with Principals and Staff, therapists and members of the NIMTT in 2004-6. The spectrum was very wide as rural and urban settings that varied from small school to much bigger were all used. Case studies from some of the schools were included. Pupils were given a chance to interact with adults or other pupils, expressing themselves, through musical improvisation in an environment that was both clinical and therapeutic. Most settled well, participated well and showed a sense of enjoyment. This helped many of the sessions to be of a high standard. In a few instances there was a difficulty in motivating or settling the pupil, despite the variety of music therapy strategy employed. There were various objectives including: to improve educational outcomes and access to creative opportunities for disadvantaged and vulnerable groups of children; to support families to care better for their children; to improve their long-term health and well-being. The therapists were seen to have been very professional in their approach. Their Conclusion:There was both an interim and final report. The finding was that the schools, through their responses in their self-evaluation process were very positive about the impact of the Music Therapy intervention. Teachers and/or speech and language therapists completed evaluation forms, based on their observations of pupils immediately prior to, and during the music therapy sessions. They came to the conclusion that pupils participating made improvements in communication, emotional and cognitive development. They also found a reduction in stereo-typical behaviour in those pupils with autism spectrum disorder. Indeed many of the pupils presented with an improved mood and were more relaxed. It seems that all those who took part gained in an important and valued way, with some, this contribution was denoted as significant. There was evidence that some pupils developed their social interaction skills by engaging with music and responding to the therapeutic format that it was set in. Through the systematic and structural nature of the approach in the sessions, the pupils, to varying degrees, made progress in aspects such as initiation of contact; gesture and vocalisation; socialisation and participation; tolerance of change to different sounds; emotional awareness and settling to task; improved use of objects/musical instruments; and reduction in challenging behaviours. In the interview process with the staff and principals there was a consensus that music therapy had had a positive impact. Many teachers had been sceptical at the start about Music Therapy. Their first hand experience changed the perception. They could identify individuals that increased their vocalisation; use of language; improved concentration and eye contact; settled behaviour both in sessions and back in class. They witnessed that many looked forward in anticipation to the session. The most important feature noted by teachers was the chance for teacher and therapist to talk after sessions so that advice was got in relation to how to bring that type of help back into the classroom activities. What was learned?It was felt that schools needed a pre-project briefing to give teachers a sense of what to expect. The half day sessions were not seen to be as effective as the full or two day sessions. It was important that all the written up critiques of the sessions are shared with the teachers and jointly discussed to help with coherent educational planning for the student. There is a need for the Departments of Education and Health and Social Services to work together and develop a policy for Music Therapy in special schools to support the wider curriculum provision for the special needs students. A strategic plan is needed to provide a framework for music therapy to integrate it alongside the other therapies in the schools. It was felt that schools and the Music Therapy Trust need to do awareness forums to let people know and appreciate what it has to offer. However Music Therapy in this study proved what was set out to be proved. It improved the lives of many distressed pupils that participated. Two Case Studies included in the Report:Pupil A at the assessment stage displayed severe communication, emotional and behavioural difficulties. He had no speech and when distressed, banged his head. The home situation is difficult and Pupil A is often placed into residential care. The music therapy aims focused on encouraging eye contact promoting interaction, encouraging turn taking, encouraging self expression. Pupil A was observed over a 3-4 month period and while he remained quite erratic in his responses, there were times when he was more settled and calmer, both during and after the music therapy sessions. In one session, for example, Pupil A was more receptive to learning and was observed turn taking and interacting happily with the music therapist. On return to class, Pupil A went straight to his desk, completed his tasks and remained settled for the rest of the day. The learning support assistant reports that when Pupil A is very stressed, music therapy is the one activity most likely to settle him. Pupil M, aged seven, has a diagnosis of autism, often presents with challenging behaviour and has no speech. He was initially assessed during 2004 and he began an individual half-hour session, once per week, attending the session with a classroom assistant. For the first four weeks, his behaviour was very erratic, showing little engagement with the therapist. He displayed a range of inappropriate behaviours, including biting, pinching, scratching and hitting. After some time, Pupil M began to engage more regularly with music, played on the piano and with the therapist singing. He has since begun to vocalise pre-verbal sounds. He imitates a range of sounds, and his mirroring and modelling activities have increased. His behaviour has improved dramatically and he looks forward to his sessions and will sit and engage with the therapist. Pupil M is now exploring in other instruments and initiating communication using gestures and sounds. It is time that we were looking to the same process and a similar cross departmental integrated strategy for Music Therapy in the Special Needs settings. Music in the Curriculum in the North of Ireland:In the course of looking at the music curriculum in the North of Ireland I encountered the website: www.bbc..co.uk/music/parents/yourchild/northern_ireland.shtml. It re-enforces the central position music should have with all ages. I feel that it is relevant to introduce some information about why music is important generally whether the child/adult is able or less able. The Parent’s Music Room page, on this website, has a by-line of “Motivate your child with music”. This site outlines the development of the child in that, at 20 weeks from conception your unborn baby can hear. From birth your baby may be startled by sudden sound. By one year your baby will discover musical beats. At three months they may respond actively to music, for example by swaying and turning towards the sound and may vocalise vowel sounds like aaah, eee and ooo. By six months babies start to imitate sounds; by nine months they respond to familiar songs; at 18 months babies start to respond to music in a coordinated way. Baby’s song is often recognisable. Therefore the advice is for parents to sing and play to their unborn babies; make music a part of the baby’s routine; when the baby makes a sound the parent should make a sound back; the parent should clap baby’s hands to simple songs; parents and babies should sing and dance together; babies love repetition so favourite songs should be sung over and over to them. It outlines that in the 18 month to 3 year old stage that the child is likely to develop to being able to recognise the difference between fast and slow, loud and soft. They can keep track of a beat and recognise different rhythms; can learn the words of simple songs and are developing the co-ordination that can enable them to play a basic instrument. They are also capable of co-operating with other children. Therefore parents should sing simple rhyming songs together with their child; songs about objects and animals help to build their vocabulary. Parents should combine music and movement and music should be varied to relate to different moods. This musical engagement can be with basic instruments such as drums, bells or shakers, moving on to xylophones or toy pianos or keyboards. In interacting with the child the parent should take turns in singing and dancing, while also encouraging, at times just listening to music. In the 3 to 5 year old phase there is a more steady development in the child. They become more aware of pitch and rhythm, sing more complex songs as language skills grow, and cope with more sophisticated movement to music. They are also able to play and explore new sounds and instruments. Therefore parents should expose children to a broad range of musical experiences from street artists to any events that can be accessed, while keeping the repetition of the favourite songs that they love and giving them independent access to instruments and tapes/compact discs so that they can choose what they listen to themselves. All this is suggested for our youngest children because: “Music helps us to make sense of the world. Through sound we can give an expressive shape to our experience. It is a pleasure and a joy for its own sake. The National Curriculum for music [N of Ireland] says: “As an integral part of culture past and present, it helps pupils understand themselves and relate to others forging important links between the home, school and the wider world”.” The Music Parents Room page continues: “Recent research emphasises the benefits of learning music: Music aids the development of speech. Singing simple songs teaches your child how language is constructed. According to Jessica Pitt from the Pre-School Music Association: “Babies seem to learn best when songs are experienced through their bodies. Movement and music greatly enhance acquisition of language”. Music [particularly piano playing] helps children to learn maths [The Mozart Effect]. “When children learn rhythm, they are learning ratios, fractions and proportions” says Professor Gordan Shaw, University of California, Irvine, after his study of seven year olds in Los Angeles. Music enhances social skills: “Children who take part in music develop higher levels of social cohesion and understanding of themselves and others, and the emotional aspect of musical activities seems to be beneficial for developing social skills like empathy” says Dr Alexandra Lamont, Lecturer in the Psychology of Music at the University of Keele. Music enhances your child’s intellectual development. Dr Frances Rauscher, from the University of Wisconsin, says that music “helps improve children’s ability to reason abstractly, by strengthening neural firing patterns of the brain that are relevant to both musical and spatial cognition” Most music teachers will tell you that music encourages self-expression and self confidence. As a non-verbal language, music can convey a complexity of emotions, and offers a means of expression to a shy or diffident child who finds it hard to communicate through speech” The site continues to give information on the National Curriculum but also offer links to music ideas, games and things to do for every age and ability/disability. The message in all of it is that music can help a child develop. It looks to the child’s imagination, non-verbal communication skills and supports the fact that at whatever ability or disability music is inclusive and can assist in many fields of core development: “Anyone can take up music. There are few activities that are more accessible and more rewarding yet it’s a mind-boggling combination of physical co-ordination, intellectual and expressive activity” Richard Frostick, Music Teacher. The point, in conclusion again is that music is important for a child’s development and Music Therapy has a significant role to play where that child has a disability. There is a recognised need in the North of Ireland to develop a strategy to link the role of the Music Therapist formally into the Special School multi-disciplinary team. The major step of financially recognising the Profession, however, is already taken and there are career opportunities in that jurisdiction for the music therapist. This chapter has themes and resonances with other work that has taken place in other locations. Other examples where music therapy has a role to play will be examined in the next chapters of this report. The consistency of the message does build as you read those other examples even though the type of “client” might seem to vary. Chapter Four: Music Therapy in ActionIt is one thing to write a report on Music Therapy and talk to people and collate information from printed sources. It has been vital to see this work in action. Indeed, should more people see it in action, I would be convinced that Music Therapy would not only be better understood but would be much more sought after. David John is one of the most respected figures in the field of Music Therapy. He operates a service in an Art Therapy Department on the campus of the Fulbourn Hospital, Cambridge. Many of his clients come from a forensic ward in this campus which consists of offenders awaiting trial or sentencing. To witness the session first hand was unusual in the medical confidentiality respect but due to my background in music and my project goal of reporting on Music Therapy the participating clients were anxious that I be facilitated. This I am grateful for. Clients attending Music Therapy sessions come from varied backgrounds and attend for various reasons. They often begin with a hostile attitude and challenge the therapist to: “try and change me”. When it is made clear that this is not a type of “Voodoo” but a participative process that the client controls, the sessions can evolve with much meaning. David John advises that often there can be many silences in a session and if that is what is required he will not be putting on any show for my benefit. This is most welcome. But a show I got, courtesy of the clients. Prior to their arrival I was acquainted with aspects of the group I was to watch. The reasons why some of the clients were in Fulbourn told me one side of a story. The work done to date in the five previous sessions was outlined. This was going to look a little like Community Music, I was warned in response to an earlier question I had raised in respect of what constitutes the difference between people playing for patients in a hospital to “make them feel better” and an actual clinical intervention. The reason they forewarned me was that three of the original group had proposed that they would have a goal of performing for fellow residents at the end of their 6 week session. This was their final rehearsal. The difference, I was assured was, that this rehearsal would be clinically analysed both as it happened and afterwards by both Therapists in the room. Every action or non-action would be a potential reaction from the professional perspective. The session began with three young males and one middle aged female entering the room accompanied by a nurse. They took non assigned seats in a circular form amongst the two therapists and I. The room was full of instruments: a Grand Piano, an electronic Keyboard, Double Bass, several drum kits of varying types, lots of percussion of different sizes and related to many parts of the world - organised chaos of a usual music room. In opening David John asked what happened the third member of the original group, to which one attempted to humorously brush off that he had decided to get alternative therapy lying on his bed studying the ceiling this week; while the other “regular” just said outright that privileges were lost so he was confined to base. There was a moment where the sense of disappointment in the full team not being on hand for the final rehearsal was allowed to sink in, and it did. A rather embarrassed “regular” broke the silence with the news that the new lady had promised to drum for him but quickly revised that to say that she had “nodded agreement rather than saying she would”. This drew the attention to the lady who sat in a huddled manner that clearly showed a “non-involved” status. She didn’t respond to any questioning even regarding her name. The two regulars, however, showed a significant amount of respect for this withdrawn figure. The third young man was also new to the group. From his manner one could relate to what was said before that people enter therapy often in a hostile mode. His body language was almost defiant his answering of questions as to his ability to assist the “regulars” with their performance was negative and dismissive. As time wore on, however, and the session got into full swing I believe that he did want to be forced-but the role of the therapist, especially on a first day was not to force but to let him “come round”. The upcoming performance was discussed - time and venue confirmed and practical issues of who got the instruments and sound system in place by what time& Then it was a question of who sang first; how many songs at a time by the same singer or take it one about; what was a good opener and closing song for each singer; which songs would be the filler. All these issues were part of any concert preparation but they distinguished in this instance that the “regulars” were comfortable with what they had to do; they were working as a team in planning and being very “adult” in their approach – they had come a long distance in this respect I was informed afterwards. Moving out from the circle all clients were asked if they wished to participate. There was a no from the male and no response from the female - who sat with her legs and arms crossed and her head down. The next part of the session was like a regular rehearsal - some words going astray or notes not hit. There was encouragement rather than too much musical advice. This was all in keeping with a feeling of evolving rather than pushing - we were not creating performers but letting individuals express themselves. Frankly I could not understand how the others did not get involved. I was moved by the quality of the performance, the sense of fun, the openness to “try everything out”. My feet were tapping from the off. I wanted to be asked to participate! Thankfully I got my wish by being asked to help out in one of the songs using the other keyboard and thus I was in the group. From the position of being now outside the circle watching in I gained another view of “what was going on”. It was having the competence in instrumental playing that ensured that my “performing” was, like the therapists, on “automatic pilot” which left me free to absorb both those engaged and those who did not engage. In some ways it was reminiscent of my teaching days as I thought about how I would try to bring the other two along - bring them into the “real circle”. I assume that too was what the therapists were doing as they took in the room while appearing to be “facilitating a concert”. The male nurse who had taken over from the female one was even encouraged to perform for the concert and took advice from the “band” as to a suitable song. He was also instructed to sing the song his way not to try and imitate the original singer - this was how the “regulars” had been advised too. The songs were sung. The break for coffee announced and with it the rush outside for the cigarette! I asked the therapists whether smoking was a regular feature with clients, to which the answer was yes - but that’s for a different Report. As in many conferences, the most interesting work can take place in the coffee break. The “regular” clients made a point of telling me that the Music Therapy intervention has been hugely important to them personally. The point was made that, to me and others, the concert on the ward was no big deal but to them it symbolised so much in terms of achievement. Simply to get up and go through all the process that had led to this point had stretched them in many ways and they were aware that the actual day would be nerve wrecking but that they really wanted to have something to show for their effort both internally and externally. Their message was clear - music therapy was serving a function for them! After the clients left there was a discussion between the therapists as to what had being going on with the other two individuals - both in terms of how they related to the rest of the group - the group dynamic - and how their cases were likely to proceed. Personally, I found myself to have formed a lot of “opinions”, particularly in respect of the lady. I was interpreting the times that she had physically turned her body to the music and tried to make a rational for the times that she physically turned from the music. Whether my thoughts were correct or not would have taken more than one session to evaluate, but I understood by my own reaction, the evaluation process involved in Music Therapy. As almost an afterthought I mentioned that the choice of songs had been a little “close to the bone” when you really listened to the words. I asked whether clients selected songs or whether they were prompted in a direction. The answer was that clients are encouraged to look at and try to deal with their darker side. For one such client “Every Breath You Take” by the Police was just a step too close to his darker side as a stalker. It will be too bad if this facility closes. It was under threat while we were there - not because of poor results, but the manner in which the Health system in the area is organised. Given that this is the only such facility in a region covering four other areas, it is seen to be more cost effective to get rid of one than have to replicate it four times in the interest of equal services within the region! This raises the obvious question of where the patient interest lies! Chapter Five: “An Investigation into the Effectiveness of the Arts Therapies (Art Therapy, Drama Therapy, Music Therapy, Dance Movement Therapy) by measuring symptomatic and significant life change for people between the ages of 16-65 with continuing mental health problems” by Helen Odell-Miller, M Westacott, P Hughes, D Mortlock and C Binks, December 2001.Through the course of writing this Report I visited Helen Odell-Miller in her position as Music Therapy Course Leader in the Anglia Ruskin University in Cambridge. This facility has been proclaimed one of the best in its class by the Health Professions Council – having been the only MA in Music Therapy to receive unconditional approval of its course content out of the 100 inspected at the time by the HPC. Helen has been at the forefront of developing the area of Music Therapy for many years now and has managed to keep the academic and practical elements of her interest alive simultaneously. In this respect there is a Music Therapy facility within the Music Department that has a new and unique Music Therapy Clinic within the campus, catering for private individuals with medical or psychological difficulties; local groups, voluntary organisations and charities from the region. It enables real collaboration to take place between the Music Therapy MA, the Academic Staff and the local health and social organisations, while also being a fantastic resource for learning, teaching and researching. Helen Odell-Miller has been involved in many research projects and papers. As mentioned in Chapter One, there is always the question when selling a concept: “have you proof that it works?” In this chapter extracts have been taken from a study by Helen and others, on people in the age bracket from 16 to 65 that presented with mental health problems, to give an outline of its main points in support of the use of Music Therapy. While the emphasis is slightly different to previous chapters, I begin with a definition of Music Therapy, from the Report, that is familiar: What is Music Therapy?Music therapy is a form of treatment where live, mainly improvised, music is used to work towards therapeutic aims. It can help people suffering from autism, learning difficulties, senile dementia, physical disability, schizophrenia and depression, and many other conditions affecting children and adults from all sectors of society. [Bulletin, Anglia Ruskin University, May 2006, p. 3] Why Use Arts Therapies?Arts Therapies treatments offer patients therapy through non-verbal means i.e. art forms such as music, art and drama or dance movement. They are particularly effective where normal communication is absent or has broken down. Why are people referred?Some Patients Request the service What are the presenting problems?Self-harming How successful was the Research?“... The qualitative data reveal interesting facts of the process, for example that the therapist and patients perceptions of the treatment coincide in all treatment cases”. This backs up other studies dealing in the main with the over 65 year old population with dementia type diagnoses that suggested that Arts Therapies in psychiatry are: “effective in reducing symptoms and bringing about significant change, both anecdotally (Odell-Miller 1991, 1995; Payne, H 1993), and in scientific research outcome studies (Hoskyns 1995, Odell-Miller 1995a; Wilkinson et al 1998)” (p.1). The types of questions that were explored in evaluation were: “Does it help me feel better about myself? Does it help me relate better to friends and family? Does it help me get a job? Does it keep me out of hospital?” (p.5) and the messages seem clear, that the patient should be involved in evaluating both the services and the treatments (Shepherd et al 1994 & 1996) p.6. One client referred to in this paper was one who filled in his own referral to say he needed therapy to help: “coming to terms with my personal problems…some problem expressing myself, I would rather leave a situation than deal with it”. His key worker agreed with another issue that he thought music therapy could help with which was an: “underlying rage towards everyone coming into contact with him”. Post music therapy there is a general acceptance that the client: “seems easier to get on with, and less angry … he has improved his access and relationship to his children”. “There is an urgent need to measure outcome in the arts therapies, with the under 65 population with continuing mental health problems, in psychiatry. Clinical evidence shows that arts therapies interventions bring about change in significant areas identified by this population at the start of treatment (such as cutting down the need for admission, increasing quality of life) and that these interventions also reduce symptoms such as depression and anxiety (Odell-Miller 1995b; John 1992; Davies 1995)”. (p.2) The measuring of outcome and quantifying of “improvements” in states of depression was an issue that Aldridge too, was keen to stress was still a matter that needed to be addressed: “The research that has been produced is notably lacking in follow up data, without which it is difficult to make valid statements about clinical value. The assessment instruments are generally lacking by which internal or external validity can be conferred. For example, as ‘depression’ appears to feature in many chronic diseases then clinical rating of depression, using a validated scale, would be appropriate to include in a research design. If this assessment of depression could be combined with an overall assessment of life quality then a significant step forward would be made in establishing a minimal data set for assessing clinical change… That music has been used therapeutically in other cultures cannot be denied, and other perspectives regarding the application of music therapeutically would highlight the limitations of modern Western scientific approaches when used as the sole means of research”.(p.26) “Tang et al (1994) in his study with people with schizophrenia shows that music therapy cut down negative symptoms, increased the ability to converse with others, and an increase in outside events was shown as a result of a randomised trial over a period of one month. This is significant, although both passive listening and active singing of songs is described in the method of music therapy rather than extensive use of improvisation” (p.5). Some quotes from those that undertook the therapy speak for themselves: “I find it easier to paint and chat rather than just chat and look into someone’s eyes I guess” “Sometimes, I can’t believe what I’ve put down. Like one time I put all space and rockets taking off into the future and stuff… So I think it shows how I can be and how I have been… I’m not very good with words. I think in terms of symbols and I find pictures easier to express things sometimes than, well, using words…it expresses my dissatisfaction with myself, I think, my art. It’s quite self-critical…I think it puts thoughts into my head, like I did a drawing of myself at home with my door closed and I put lonely on it and T [therapist] did a neighbouring house with a pathway going up to my door…You know when I feel that I want to go back to hospital, putting it down on paper helps me to see that that’s a dead end…it helps me to discipline myself to keep to a regular appointment and…to confront my feelings about things, like going back to hospital”. “Sometimes you don’t want to say anything about your problems and sometimes you can say it musically, in that way” “Sometimes it was difficult to communicate verbally amongst the group; it was easier to express yourself up on a wall you know” (p.22) “You’re actually taking part in something….And achieving something” “I was getting up through the night, smoking and having a drink… But that’s improved, considerably” From the overall themes that emerged in the study it is clear that the Arts Therapies offer a role in this complex area of mental health and offer a means to access emotions other than through words. They offer a chance for the client to tell the therapist what is going on rather than have health professionals tell the client. There may be still a need for more research into how outcomes are measured and quantified beyond clients’ personal praise but, working with the clients involved in this study it reads that this was a successful intervention. That is in keeping with previous chapters where the importance of Music Therapy was seen to be in the non-threatening, non-verbal approach that it represented. This is but one piece of literature that Helen Odell-Miller has been involved in. She presented it to me as a good example of the ongoing work that is taking place to mark the fact that Music Therapy is an evidence based profession that is proving to be worthy of its place, not superior to, or inferior to, but in the team of, other therapies already accepted. Chapter Six: “Music Therapy with Mothers and Young Children at a Unit for Child and Family Psychiatry: An Investigation” Amelia Oldfield, Lucy Bunce and Malcolm Adams 1996-98Having already pointed out that Music is important to early childhood development, and that Music Therapy has a role to play when the child is faced with a disability there was still the issue beyond medical – the social aspect of child development – the influence of others, especially the relationship with the parent. Therefore when I came across this piece of research (introduced to me by Helen Odell-Miller) I felt that it was very appropriate to the points discussed earlier in this report and has a message for our Childcare Policy into the future, so it is included in some detail. This was an investigation held at the Croft Unit for Child and Family Psychiatry, Cambridge, into the role music therapy could play for both a group of mothers with their very young children on a parenting project and a mothers and toddlers group. Research has been ongoing that looks to the links that exist between the mental health of mothers and how this impacts on their children’s development. There are various reasons why mothers do not engage with their child. Music Therapy has a role to play in trying to intervene with mothers and children both. The aim is to encourage mothers to see what their child is actually like, rather than what they think the child is like and also aims to engender a positive relationship between the mother and child through the use of a non-verbal intervention: “Music Therapy seems to enhance the bond between mother and child, enable mothers to gain new insights about their relationships with their children and in many cases improve the quality of life for the child and the mother” (Oldfield, Bunce, Adams 1998) Mothers with post natal depression:“The strongest determinant of children’s behaviour was the mother’s emotional status” (Bassuk, Weinreb, Dawson, Perloff and Bruckher, 1997) If parents are relating to their child at a pre-school age, that child will, in this way be helped to cope with the move into nursery school and will enhance how they experience school. However the opposite is true: “[An early experience of] insensitive maternal interactions predicted the persistence of poorer cognitive functioning” (Murray, Hipwell, Hooper, Stein and Cooper, 1996) If a mother suffers from postnatal depression, this will impact negatively on the child: “[these mothers have a]difficulty in accepting the restraints of motherhood… showed a general lack of understanding of their children’s needs… were not finding enough satisfaction in looking after their babies… and were unable to adjust and enjoy their new role as mothers” (Chapman and Reynolds). The evidence points to the fact that the child, particularly boys and those from lower socio-economic backgrounds, will not adjust as well to school and will have its impact on the child’s behaviour: “A currently depressed mother is approximately six times more likely to have a child with behavioural problems than a mother who is not depressed” (Mohan, 1998) All this hinges around the inability of the mother to interact with the child. As time goes on the repairing of the damage is unlikely to happen by itself and therefore it is vital that if children present with behavioural problems that the current mental state of the child’s mother is an important aspect in the equation. One obvious means to intervene is through the medium of Music Therapy to educate and support mothers to help them cope and change a potential reality for them and their children. Mother’s internal model of relationship:When children are presented with behavioural problems, it is often assumed that the problem lies with the child. Research would suggest that the parent must be considered also. Mothers have learned through their own childhood a model of relationship that they invariably then employ with their child. The manner that this takes can be classified as ‘detached’; ‘preoccupied’ or ‘secure’ depending on the mother’s experience. Their child will behave and develop in a manner akin to the model of the mother, even when the mother is not present. If the model of relationship is going to stymie the child there needs to be an intervention early on. The earlier it occurs the more likely it is to have a positive impact on a long term basis due to the fact that primary relationships are still forming. Given that the problem is seen to involve both sides, therefore the resolution of the issue works best where parents and children are dealt with together. Therapists would suggest that a mother and child should be encouraged to be involved in an activity together where the child is in charge but that the parent responds. The therapist in this type of session only facilitates and observes so that at a point the therapist can discuss what is going on with the parent, while the child plays on. The information from the discussion is the departure point for the therapist to assist in development of the mother - child relationship. “The therapist’s task is to help the mother develop a capacity to reflect on the meaning of her responses to her child’ behaviour, thus allowing her to understand the effect of those responses on her relationship with the child” (Muir and Thorlaksdottir) As the mother gets less anxious she gets more comfortable with the child and accepts the child’s individuality. If the intervention occurs early in the child’s life it will have a crucial and positive impact on the overall development of the child, while also impacting positively on the parent’s self-worth. Why Music Therapy?Given that the research shows that both the parent and child can benefit from “creative interventions” and that this should happen earlier rather than later to maximise the effect, Music Therapy is an obvious starting point. The way a mother and child interact with each other when engaged is quite similar to the manner in which music therapists work with their client – playful musical interventions. The example given in this research was that of Amelia Oldfield looking after her eight month old twins as a mother and a three year old boy with Asperger’s Syndrome as a clinician: “Both interactions were mainly non-verbal, and relied to some extent on intuitive and spontaneous exchanges. In both situations, the exchanges were playful and included gentle teasing, humor and laughter. Issues of control came up both with the babies and the client. Initiation and leadership would subtly shift between the adult and the child in the non verbal interactions” (Oldfield, Bunce, Adams, 1998) Usually the first experience of musical interaction is the parent “singing” to soothe the crying child. It may be thought that the music is to soothe the child but there is another element: the calming effect might be as much for the parent as the child and in being soothed the parent may well feel closer to the child: “If she is relieving her child’s distress this will boost her confidence and help her to feel positive about her relationship with her baby. The baby may well react to the mother’s heightened sense of well-being and this may in turn help the baby relax and feel at ease” (Oldfield, 1996). For the parent who engages with their child it is found that they initially repeat rhythmically the noise of the child a couple of times before subtly changing the pattern a little which keeps the attention of the child. This is done instinctively, where a parent is in touch with their infant. This is echoed in the work of the Music Therapist: “In the same way a skilled music therapist will often imitate her client’s musical contributions but soon subtly introduce harmonic, melodic or rhythmic changes to maintain and intensify the quality of the improvised musical exchange”. (Oldfield, Bunce, Adams 1998) By reacting to and with the child, the Music Therapist is bringing the client, of whatever age back to the pre-verbal stage which is very effective for anyone with a communication problem. In the case of a mother and child it can reintroduce them to the types of interactions that they may have missed out on to date in a fun way. It can help them explore issues of control and experiment through the therapy – as the very nature of the intervention involves listening, waiting and sharing with others. While interacting in the secure environment that Music Therapy offers, both adult and child can behave in an enjoyable, child-like manner, which facilitates the development of a bond between both parties. By being “equal” in the music therapy environment rather than “adult/child” which is even seen in a “story time” setting (as the adult is always in a superior role to the child), a bond is formed. This bond, whether in the case of babies presenting with extreme feeding or sleeping problems, toddlers with temper tantrums, sibling rivalry, bed-wetting, premature babies or a mother presenting with depression might not have had that chance without a music therapy intervention. Some researchers suggest that the concept of this type of therapy should go beyond mother and child into the family setting: “There is a real need for therapy in the family setting…mothers should have the opportunity to share such a creative experience in sounds and silence, time and space” (Warwick, 1988). This experiencing, by mothers, of Music Therapy, has been seen in other research to have a positive impact in how mothers develop a confidence in themselves and become aware of how to convey their feelings to their children. It is a case of a positive cycle, as they see the child enjoy themselves they too enjoy the sensation and the child picks up on this so the positive effect is reinforced. This was particular to the case of an autistic child where the mother wrote: “I enjoy the music therapy sessions with John very much. I feel as though I am sharing something with him that he really enjoys and that he very much wants me to be there with him” (Jones and Oldfield, 1999). The Croft Investigation:The unit which is based in Cambridge treats, amongst its’ clients children with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD), children with Pervasive Developmental Disorders such as Autism and Aspergers Syndrome, children with Giles de la Tourette Syndrome and children with Eating Disorders. They are referred by their General Practitioner, their school, Social Services or another agency. There are a variety of programmes offered that can be either on an inpatient or outpatient basis. The team involved have expanded to comprise of an occupational therapist, a community psychiatric nurse, a health visitor, a counsellor and a music therapist. For the purpose of this investigation there were three groups. The first group had three “one off”, videoed, music therapy sessions followed by a review the following week, involving discussing the group with the mothers while watching the previous weeks video. The second group had six play sessions followed by six music therapy sessions. The third category acted as a control group which were a group of children and parents attending a mainstream nursery. Like other research projects, the music therapy sessions were videoed as were the play sessions. The tapes were analysed using detailed behavioural observation to monitor progress towards achieving specific aims. The parents filled out questionnaires each week and there were tapes made, and analysed, of the discussions that took place between the parents and therapist each session. Interestingly, in Ireland some people may have knowledge of play therapy and an acceptance that it works. In this investigation the fact that the play therapy preceded the music therapy gave the parents a sense of familiarity and comfort. However the more structured forum of the music therapy session offered new challenges for both child and parent and thereby kept their attention in a more focused manner after the setting of the relaxed scene of the play environment. It was seen that the results of mixing the two were positive. They showed that the goals set for parents and children were achieved in both the music therapy and play sessions as all sets of parents and children engaged in positive activities in both the play and music therapy settings. In terms of negative behaviour the lesson was: “that the treatment package which starts with the more familiar play sessions and moves to the more demanding music therapy sessions may be particularly effective to engage families and then maintain that engagement” (Oldfield, Bunce, Adams 1998 p.35). The sessions allowed parents to interact with their children in a spontaneous manner that, through reflecting on the video afterwards, they could see as very positive. They saw themselves enjoying being child-like. They saw that they enjoyed being with their child. However, the results point to the fact that the Croft parents underestimated their children and the behaviour of their children compared to the mainstream nursery mothers. The mainstream parents saw their children’s behaviour as “exciting and interesting”. The positive behaviour, seen in the high level of engagement and interaction by the children had to be pointed out to the parents of the non-mainstream children. These parents were challenged by their own negative outlook and mood. This indicated that the relationship between the “Croft parents” and their children must be focused upon and that this is best done by watching and discussing the videoed sessions of the parents and children with the parents: “Information gathered from the questionnaires compared to results from the video analyses show that parents’ memory of what their child has done in a session is frequently influenced by how they feel about their child and may not match up with the child’s actual behaviour” (Oldfield, Bunce, Adams 1998). However by working on the positive, this gave those same parents a very important starting point to strengthen the bond: “The structured, non-verbal nature of many musical activities or improvisations can be very reassuring for families who have become entangled in verbal conflicts, and the delicate issues of control can be addressed. Above all, relationships that may have become mainly negative can again be seen in a more positive light as families rediscover the ability to have fun together through music making” (Oldfield, Bunce, Adams 1998 p.29). The fact that the parent did show negative responses in the music therapy setting was important in that this negativity may not have been seen in other settings. This would indicate that the structure and expectations placed on the mothers in Music Therapy has a distinct role. Overall the investigation, as seen through the results of the group discussions, recognised the role of the Music Therapist as “focusing on good parenting skills observed in the group”; “addressing specific aims identified for particular mothers”; “increasing mothers self esteem and sense of self worth” and “recognising difficulties in being a parent”. These various achievements underline important and successful interventions on the part of the Music Therapist when you consider that parents have joined the investigation due to having serious difficulties with their children. At the time of carrying out that investigation it was seen that the area of mothers and young children was not a usual area for Music Therapy intervention. It indicated that there was no research in the field. Logic would say though that Music Therapy certainly has a role in assisting Mothers and Young Children to bond – thereby creating happier mothers and babies of this and future generations. “Unlike more traditional long term music therapy work, this short term approach which relies heavily on close liaison with the rest of the team, is very cost effective” (Oldfield, Bunce, Adams 1998 p.42) Even the Bibliography attached to this particular investigation is a very interesting read as it alludes to other projects but also to training videos that look at specific cases of Music Therapy and Autism and Music Therapy and Aspergers. More and more television programmes are emerging that involve interventions by “super-nannies” or video conferencing supports for parents, to help deal with “difficult children”. This suggests that “problem children” are either becoming more of an issue or it is gaining a greater priority or significance. There is a resonance with reports like this one, that the role of Music Therapy should be considered. In short, Music Therapy has a role to play in helping society generally. It assists bonding between parents and children. In the context of the pressures of the current pace of life, time out to engage in the area of Play and Music can no longer be frowned upon or seen as a luxury – it must be a “core event”. We need to make time for that which is important. As said above, Music Therapy can be a cost effective intervention as well as fun! In Conclusion:Music Therapy is a PROVEN CLINICAL INTERVENTION, respected internationally. Its’ acceptance in Ireland has been stymied by a lack of official professional definition and recognition. The Health Service Executive and Department of Health have tended to blame each other for this while mutually extolling the virtues of Music Therapy for young and for old. The absence of proper pay and working conditions has led to a haemorrhaging of those that are qualifying in the University of Limerick out of the country and out of the system and is a huge disincentive to those coming here from abroad that are used to being accepted as being an equal part of a multi-disciplinary team. It opens doors for those who are not qualified to present themselves as “music therapists” (clinicians) when their role is quite different as “artists in health” (entertainers), thus confusing further the real role of the professional. Because there are so few people within the system that are qualified, their work has not taken on a national importance or recognition that can be achieved in other areas where advocacy works because there are the numbers involved to “sell their own message”. They are therefore squeezed out further by the more established therapies – particularly when there is a tightening of Health Budgets. For those who experience the “real intervention” they value highly Music Therapy but to get the message out needs more people to see it work at first hand. Therefore the challenge is big at this point – in the vicious circle mould: if we had well paid professionals working in the system with their colleagues in the other therapies I would not be writing this report as the intervention would have spoken for itself. To that end, all that can be asked now is that those who can recognise it professionally, do so immediately so that those qualifying will get proper remuneration for a profession that has a lot to offer our young, our young parents and our elderly, whether their needs are at inpatient or outpatient / institutional or community based levels. There has been more fiction than fact associated with Music Therapy in Ireland and it is time the facts were allowed to speak for themselves - the St Camillus’ example proved that. It will be interesting to watch the newly funded project in Tallaght Hospital – the Randomised Controlled Trial of the Effects of Music Therapy in Ireland project – evolve. But where the facts cannot speak for themselves, I trust that this Report will have placed a number of points on record in a single location, and thus whets an appetite for others to follow. Conclusions and Recommendations of the Joint CommitteeThe Joint Committee, mindful of the professional expertise and insight of the Chairman in this field fully endorses her recommendations and consequently recommend the following in line with her findings:
Appendix 1: Quotations from Hospital Settings:“I am aware of the Music Network and the positive feedback from its programmes. Currently we have an “Arts in Health Care” programme with an artist in residence. It would be an achievement to get music therapy as a service to our residents.” “Music therapy draws on the historical, cultural, social and personal experiences of the individual. I would like to see the use of music therapy in care of the elderly but unfortunately we do not have the funds.” “ I think music therapy is very much needed in Ireland particularly in the psychiatric setting but if there is competition for funding then any non-essential (in most people’s view) service gets chopped. Occupational therapy is still seen by many as non-essential after 40 years of ‘home grown’ occupational therapists.” “Patients love it!” “It (music therapy) would enhance and improve the resident’s everyday life.” “Research demonstrates the benefits. Increases social interactions of patients thus increasing mental health. Enjoyment. Help patients express themselves and actualise their talents.” “I haven’t actually seen music therapy in action but think it would be of social benefit to mainstream clients but have a much greater impact with Alzheimer’s clients. I have seen how well most of them respond to music especially to old songs.” “ I haven’t much experience with music therapy but I have found certain patients relax when music is on – often patients who ‘ramble’ will sit and relax to music.” “We would love our patients to benefit from music therapy.” “Complements work of other professional in areas of emotional expression cognitive function and behaviour.” “From experience we have found that the benefit of music therapy is longer lasting and can be carried on during the week by service staff.” “I suppose it will take time for alternative therapies to gain acceptance in the clinical setting. Therapies such as physiotherapy, speech and language therapy and occupational therapy are already widely accepted.” “I have experience of including music in the creative programmes. We have an offer, with musicians, nurses and visual artists all working together. Music Network have been doing projects with us in Mullingar Care of the Elderly Centre since 2000 and all our patients benefited from their involvement in these musician led sessions.” “The ideal would be a full time activity person i.e. 60 hrs per week for this hospital. I have one person working app. 10 hrs/wk.” “I would welcome any type of programme especially in a care of the elderly setting. Our patients love the Morning of Massage (hand), gentle exercises and singing and listening to local singers on CD. It should be part of the budget!” “Our organisation is understaffed in more fundamental areas such as nursing, physiotherapy, and social work. Music therapy by comparison would be seen as desirable but not essential.” “Because this is an acute hospital with 339 beds, there are only 2 speech and language therapists and no occupational therapist, we need these services for more then more therapy despite undoubted benefits of music therapy.” “Music therapy has not been considered by senior managers as something that they would commit financial resources to.” “Our musical therapy is provided by a local musician. He is not qualified in the professional sense but we believe music is a great source of healing to patients and have been planning a music therapy session here for the last four years.” Appendix 2: Undergraduate Music Students“I’m taking part in the Music Therapy Module at NUI Maynooth and it’s very interesting. It shows how music can be used for other purposes than entertainment” 12 Trinity College Undergraduate Music Students12 Define Music Therapy“Using music to give therapy to people” “I’d say it was the use of Music and its aesthetics (i.e. rhythm, harmony etc) to ease difficulties such as different illnesses and learning disabilities” “The use of music, presumably in addition to medical treatment, to treat or alleviate certain mental or physical illnesses” “The use of music as a treatment for rehabilitating and improving the lives with psychological and physical needs” “It is a use of music in adults and children with special needs, physically; mentally and psychologically; to help them through and guide them on the road to recovery or a better way of life” “Music used as an aid to those in suffering” “Using music as an aid for therapy – for example, using music as a means of aiding learning difficulties, or helping develop memory” “The use of music for healing purposes” “Using music to help people overcome fears and problems” “You use music to help people using it to cure illnesses” “Using music together with other psychological / psychoanalytical processes in patient therapy” “The use of music to heal emotional wounds” 11 out of 12 unaware of where Music Therapy is Available One aware of the MA in Music Therapy at the Irish World Academy of Music and Dance - University of Limerick If offered would you take up a Music Therapy Course? 11 out of 12 say yes.“Yes. I would find it a very interesting subject and would be interested in a career in something similar” “I’d consider it; it’d be quite an altruistic and rewarding thing to do” “I wouldn’t. I’m suspicious of the extent to which such therapy is effective” “Yes. I am currently studying for a music degree and am considering doing a post grad in Music Therapy” “Yes – I believe it would be of great benefit to children, adolescents and adults with a wide range of illnesses and conditions; would assist in the recovery after serious accidents, assist in calming the minds of autistic children” “Yes. I think music is highly therapeutic in everyday life. It helps people who are not suffering greatly and therefore may help those who are suffering further” “Yes; I think there’s a very interesting area there for the study of what affects music has on the brain” “Yes because I’m interested in all aspects of music” “If it was a module, definitely yes. If it was a full degree course, no” “I would. I think it would be really interesting” “Yes because I would be interested in it as pure study and as a career option” “Yes. I have a great interest in emotional healing” Would Music Therapy be a career opportunity? 7 Yes / 4 No / 1 wants more info What Would Encourage/Discourage You Into The Profession?“An interest in people and helping them would encourage me” “It’s not so much that I’m discouraged, rather that there are other areas of music that I’m more interested in. Perhaps I might be a bit more encouraged if I knew more about it” “I’m unsure how effective such “therapy” is and to what extent it takes the place of, or is supplemental to, more established therapeutic methods” “The opportunity to help people, both physically and psychologically, through the medium of music” – would encourage. “I have seen music therapy work on a child who has Aspergers and it has calmed him down quite considerably. I have also used it to soothe / relax a terminally ill parent where his favourite music was played and he could listen, therefore giving him a sense of calm and peace. The only discouragement I would have would be that there would probably be those who have no interest in music and they would not see how music therapy would or could help the client” “I would be encouraged into this profession as I have a high personal interest in the matter. However, as of yet, I am unaware of any courses in relation to the subject”. “I’m not very scientific and there would probably be a good bit of science involved” “I know nothing about the effectiveness or efficacy of music therapy, and would prefer to find out more before making a decision” “I would enjoy the diversity and dealing with people. But I am not sure I would be able for the emotional strain” “I would like to work with people and I have heard a lot of good things about music therapy. I don’t know if there would be many job opportunities in it though” “The opportunity to help people with music would encourage me into this profession” “I’m not looking for a career at my age!” 19 Maynooth Undergraduate Music Students Undertaking the Music Therapy ModuleAll 19 Know What Music Therapy Is“Using music to express your feelings at that time ad also using music to communicate and learn” “Music Therapy is a way of using music to provide people with any form of physical disability or psychological problem with alternative tools to communicate – it helps them to gain confidence and to deal with their problem” “A therapy using music as a medium to meet a persons needs. It can be useful in drawing out feelings and helping people understand their feelings that they could not express through words” “Music Therapy helps people define areas in their life and put emphasis on aspects that cannot be controlled by other factors only through music” “It’s a way of helping people of all kinds deal with any problems they may have or may have not dealt with when young. It is done through the use of musical instruments” “A form of therapy that focuses on developing communication skills through various forms of music playing and listening” “A means (medium) of helping people communicate with themselves and with others” “Therapeutic approach suitable for a variety of client’s issues” “A form of psychotherapy and occupational therapy performed through the medium of music” “The prescribed use of music and musical intervention in order to restore, maintain and improve emotional, physical, physiological and spiritual health and well being” “The use of music to promote emotional, physical and spiritual well being” “Using musical techniques to help establish a line of communication that otherwise would remain closed, particularly between people who find it hard to communicate in more conventional ways” “An interpersonal process between a music therapist and client or group, in which the facets of music whether physical, mental, social, aesthetic or spiritual are used to restore or maintain a clients health” “Helping people develop, learn and improve themselves. It helps people with special care needs” “A way of helping people through music through playing music and improvisation the client can be analysed and their behaviour is viewed and then they are helped communicate their problems” “Therapy through music, using music to communicate to heal the entire person” “Music Therapy is a connection between patient / client – a branch of psychiatric healing and a therapeutic approach to aid musical expression (?)” “Helping people of all conditions through the medium of music. It involves a lot of psychology and improvisation”. “I would define Music Therapy as a musical vehicle encouraging the musical expression of an individual. It can help in the process of communication verbal / non verbal as well as holistic well being of an individual” 13 out of 19 aware of where Music Therapy Courses Are AvailableIt’s a subject option in the 3rd Year Course (5 credits) for both BA & BMus Four knew of the University of Limerick offering a Masters Two said that there is no degree available in Music Therapy One said Music Therapy they were aware of was in New Jersey (USA student on exchange) If offered would you take up a Music Therapy Course? 17 out of 19 say yes.“Yes because it is an interesting subject and it could be used much more for people dealing with stress or people with disabilities” “I’m taking part in the Music Therapy Module at NUI Maynooth and it’s very interesting. It shows how music can be used for other purposes than entertainment” “Yes because it is interesting and No because it is hard to be convinced by it completely” “Yes it is a fun way to meet people and express yourself” “Yes. I find it very interesting and I assume one would get great satisfaction through knowing it is of benefit to the client and his/her life outside sessions” “Yes, it would depend though on the comprehensiveness of the course; e.g. are suitable placements and discussion forums available etc” “Yes, because I find it interesting and also has been shown to have considerable results” “Yes because I find this area interesting” “No, as my interest is in performance and composition. I would have no interest in pursing a career in Music Therapy, though I did find the module interesting and beneficial” “Yes, because this therapy has so much potential regardless of the client or context” “Yes, because I find it very interesting and through the knowledge I have learned” “Yes, as I find it very interesting and I think that it can really help people” “Yes – interested in the idea of music as a therapy” “Yes – I am an exchange student from the States to Maynooth” “Yes, I’ve wanted to do Music Therapy since I researched it in Transition Year. I like working with people with special needs, and think it would be a challenging and varied job”. “I would participate in these courses as this area really interests me as I have already studied therapy over a three year period” Would Music Therapy be a career opportunity? 14 Yes / 5 No What Would Encourage/Discourage You Into The Profession?“Working with mentally ill people would be very challenging and would be something that would discourage me. Being able to help people work through their problems by expressing their feelings through music” “A good course would encourage me. Music Therapy seems to me quite a new discipline so the fact that there’s room for improvements and new ideas would encourage me too” “It would encourage me because it is helping people with different dreams & psychological field too. No because it somewhat annoying in the extent that it takes so much to consider it as a proper therapy. “The classes we did in Music Therapy would encourage me to be a Music Therapist because you can make a difference in people’s lives, and help them through a low point in their life” “I would be encouraged by it for the reasons outlined before and discouraged by& well I’m not sure to be honest (this must be a good thing!)” “Interaction with people and way to help them” “Means of helping people” “Encourage though: guidance involving ethics, diversity of e.g. approaches; opportunities for practical experiences (e.g. co-operation with institutions such as schools, hospitals, pre-schools, prisons etc); highly qualified teaching staff from Ireland and abroad; resource materials in the library” “Looking at different case studies and methods” “Encourage through job opportunities, good wages and chance to help others. Discourage through lack of recognition” “I would be discouraged by the limited job opportunities available to Music Therapists in Ireland. I would be encouraged as I think Music Therapy is an extremely effective therapeutic method” “While I appreciate that music is very beneficial and it is, in my opinion it is a very important practice, I really could not be encouraged into this profession. It does not interest me” “An Irish Association for Music Therapy [is needed] I don’t think there is one” “What would encourage me would be more job opportunities” “Don’t think I am suited to any therapy as a profession” “I have taken psychology courses and the clinical aspect does intimidate me a bit – but the major hesitation I would have is being in such a position of control of another’s mental well being. Maybe if I could experience the therapy for myself I would be more confident / interested in the profession” “I like working with people with special needs and a job with a lot of variety etc” “Being a musician I would love to use my skills in this field of work. I am interested in the holistic well being of people as well as encouraging the musical expression of people” Appendix 3
Appendix 4
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An Comhchoiste um |
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Joint Committee on Arts, Sport, |
Martin Brady (FF)
James Breen (Ind)
Michael Collins (Ind)
Jimmy Deenihan (FG)
Jim Glennon (FF) [Vice-Chairman]
Cecilia Keaveney (FF) [Chairman]
Peter Kelly (FF)
Dinny McGinley (FG)
Brian O’Shea (Lab)
Jack Wall (Lab)
G.V. Wright (FF)
Brendan Daly (FF)
Frank Feighan (FG)
Joe McHugh (FG)
Labhrás Ó Murchú (FF)
Joe O’Toole (Ind)
Kieran Phelan (FF)
Music Therapy Research: A review of references in the medical literature by Dr. David Aldridge, Chair of Qualitative Research in Medicine; davida@uni-wh.de
Music Therapy World [online] December 21, 2005, by Aldridge, David from http://www.musictherapyworld.net/index.html
Edwards, Jane & Leslie, Ian (2003) Music Therapy in Ireland [online] Voices: A World Forum for Music Therapy. Retrieved February 2, 2003, from http://www.voices.no/country/monthireland_january2003.html
Early Childhood Music and Movement Association; www.ecmma.org
Sing and Grow Project; vabad@playgroupqld.com.au
Music Intelligence Neural Development Institute (MIND); www.educationthroughmusic.com/brainarticules.htm
Pain Management for Patients with Late-Stage Dementia; http://healthlink.mcw.edu/article/967581724.html
Children and TV Viewing; http://healthlink.mcw.edu/article/915772248.html
Medication is Only One Method of Managing Acute Pain in Children; http://healthlink.mcw.edu/article/965939384.html
MA in Music Therapy; http://www.ul.ie/~iwmc/programmes/mamt/mamt_6.html
Music Therapy and Developmental Delay; http://homepage.eircom.net/~musictherapy/developmentaldelay.html
Bulletin; Anglia Ruskin University, May 2006, Volume 3, No.5; www.anglia.ac.uk
Annual Review 2004>05: from strength to strength; Anglia Ruskin University, May 2006, Volume 3, No.5, p.14; www.anglia.ac.uk
Parents Music Room - Music in the National Curriculum in Northern Ireland; http://www.bbc.co.uk/music/parents/yourchild/northern_ireland.shtml
Irish Association of Creative Arts Therapists: Information Pack; www.iacat.ie
Northern Ireland Music Therapy Trust (NIMTT) ARRIOSO Project in Special Schools in Northern Ireland over the 2004-2006; www.deni.gov.uk
Standards of Education and Training; Health Professions Council; 050/ET/A5 November 2004; www.hpc_uk.org
“About Music Therapy – case studies”: http://www.nordoff-robbins.org.uk
“Music Therapy in the Treatment and Management of Mental Disorders”; Irish Journal of Psychological Medicine, 2006; 23 (1): 33-35.
Music Therapy with Mothers and Young Children at a Unit for Child and Family Psychiatry: An Investigation; Amelia Oldfield, Lucy Bunce and Malcolm Adams; Anglia Polytechnic University; British Journal of Music Therapy, Volume 17, No.1 2003.
Dr. Jane Edwards: Meeting of the Joint Committee on Arts, Sports, Tourism, Community, Rural and Gaeltacht Affairs; Tuesday 11th April, 2006.
An Investigation into the Effectiveness of the Arts Therapies (Art Therapy, Dramatherapy, Music Therapy, Dance Movement Therapy) by measuring symptomatic and significant life change for people between the ages of 16-65 with continuing mental health problems: H. Odell-Miller, M. Westacott, P. Hughes, D. Mortlock and C. Binks; Jointly funded by Addenbrooke’s NHS Trust and Anglia Polytechnic University, December 2001; further copies accessible from Arts Therapies Department, Fulbourn Hospital, Cambridge.
A Vision for Change: Expert Group on Mental Health Policy (2006).
A variety of posters; flyers and information booklets from the Music Therapy Unit, Our Lady’s Children’s Hospital Crumlin
Arts Therapy; Subject Benchmark Statement: Health Care Programmes Phase 2; for Higher Education Institutions in the UK.
Music Works Wonders, Sesame Street Workshop (Music Therapists were part of the advisory board for the original project and some of the footage features an early childhood music therapy session).
“Training as a Music Therapist – The MA in Music Therapy at APU”: Anglia Polytechnic University, East Road, Cambridge, CB1 1PT; Amelia Oldfield, Rod Macdonald and Joy Nudds.
“Music Therapy for Children on the Autistic Spectrum”: Anglia Polytechnic University, East Road, Cambridge, CB1 1PT; 1999.
*by the substitution of ‘6 members’ for ‘4 members’.
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