Music as Therapy / Glazba kao terapija

Author(s): Dunja Degmečić, Ivan Požgain, Pavo Filaković

Source: International Review of the Aesthetics and Sociology of Music, Vol. 36, No. 2 (Dec.,
2005), pp. 287-300
Published by: Croatian Musicological Society
Stable URL: http://www.jstor.org/stable/30032173
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D. DEGMECIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 287

MUSIC AS THERAPY

DUNJA DEGMECI - IVAN POZGAIN UDC:78.05:781.1

- PAVO FILAKOVIC OriginalScientificPaper
Izvorniznanstvenidanak
Received:January24, 2005
Dunja Degmedid,Dr. Med. Primljeno:24. sijecnja2005.
Psychiatric Clinic Accepted:April15,2005
Prihvaeno: 15. travnja2005.
Clinical Hospital Osijek
J. Huttlera 4, 31000 Osijek,Croatia
E-mail:ddegmecic@vip.hr

Abstract- Resume
The article focuses on music as a thera- cally to address physical, psychological, cogni-
peutic option in psychiatry. In the first part of tive, behavioural and social functioning. The
the article the authors have given a review of music therapy experience is related to art and
various comprehensions and definitions of everyday experiences in many different ways.
music itself, as well as the effect of music on In other parts of the article, the authors have tried
the mind. The idea of music as a healing influ- to show the importance of rhythm through life,
ence which could influence health and behav- as well as to show the functions of music
iour is at least as old as the writings of Aristotle therapy, and the favourable experiences that
and Plato. Today, music therapy is a well-estab- they have had with their patients who had mu-
lished allied segment of the health profession, sic therapy as a therapeutic option.
similar to occupational therapy and physical Key Words: music therapy; music and
therapy. It consists of using music therapeuti- art; rhythm in life; functions of music therapy

Introduction:The Power of Music

An old Chinese proverb says: ,Music comes from the heart of the human
being. When emotions are born, they are expressed by sounds and when sounds
are born they give birth to music. Actually this old proverb speaks of the essence
288 D. DEGMEDIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

of music. According to the philosopher Susan Langer,1,2music expresses the forms

of feelings that the individual is not able to express otherwise, experiences that are
not lingual and non-discursive, such as bodily rhythms and other experiences an-
chored to the early childhood of the individual as well as to unconscious and trau-
matic experiences.
According to the Cuban composer Leo Brouwer,3 music is just like telling sto-
ries, and he also says that music should be just like talking. But how could we
verify these arguments? The answer could be found in the symbolic, deep struc-
ture of music. Music is symbolic, but non-discursive, and it could be used to ex-
press the structures of psychic processes rather than the contents of those proc-
esses. According to the Estonian semiotic Carl Leichter,4 the origin of music and
musical expression lies in inner psychic tensions, which seek out their relaxation
through music. According to Leichter, the final intention of expressing, perform-
ing or comprehending music lies in psychic relaxation. The late composer and
modernist John Cage once said in an interview that he had noticed during his
composing work that the final intention of music activities is to gain mental peace.
Music is communication and has been compared to the sacred text, which
contains untold stories, quiet whispers and shouts about mental pictures, memo-
ries, meanings and things that are linked to the psychic processes during the crea-
tive process of composing. Understanding that reality requires an empathetic lis-
tener who is constantly trying to understand music by catching the similar struc-
tures (mental pictures, memories, emotions etc.) presented in a musical composi-
tion from his/her own subjective world of mind. The subject who is creating,
performing or receiving music can thus use meaningful musical structures to build
his or her own world into a meaningful and harmonious entirety.
In this process, the forms of the highly subjective and intimate world of
sounds meet the corresponding forms of experiences of the other human mind.
Musical communication takes place between two highly intimate and subjective
structures of understanding, reacting to and experiencing the world. Central
factors in this process are the internal experiences of the composition, which
mirror the individual's internal world and personality. When music moves
us it means that we can find in it some of our own meaningful structures of expe-
rience. As Tarasti5put it: Music is inside me and I am listening to myself while
listening to music. The empathetic musical communication process could be de-
scribed by using the paradoxical quotation from Marcel Proust6: The world is the

1S. LANGER (1953), Feeling and Form. New York: Charles Scribner's Sons.
2 S.LANGER (1967), Mind. Baltimore: John Hopkins Press.
3 L. BROWER (1984), The Cuba's Composer Virtuoso Leo Brouwer. Guitar Player, 19, 79-85.
4 C. LEICHTER(1984), Musiikki taidemuotona. Synteesi, 3, 1-2, 42-43.
5 E. TARASTI (1983), Tulemisen aika. Synteesi, 2 (3-4) 50-64.
6 M. PROUST (1970), Kadonnuttaaika etsimassa.Helsinki: Ottawa.
D. DEGME(I( ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 289

same but different to everybody. Music is just like an empty mathematical

formula that, for example, the receiving individual could find with his/her own
subjective, non-discursive and non-verbal psychic experiences, memories and
mental pictures. This process is spontaneous and works automatically without the
borders of consciousness or conscious intentions.
Lehtonen7 has shown that music is one of the best ways of activating psychic
processes. Music engulfs us and, at the same time, spontaneously brings to our
minds meaningful memories, mental pictures and experiences from our past, with-
out pain and anxiety. The patterns of music invoke references to the past, and
already forgotten experiential material, and these references intertwine with the
present and lead the listener to anticipate something of the future. In the process of
receiving, performing and creating music there is always a continuous movement
between the past, present and future. A musical experience always also means
both confining in time and space and individualizing. As a result of this confin-
ing, it becomes a dialectic relationship between temporal continuity and disrup-
tion.
According to Igor Stravinsky,8 music is nothing more than a series of tensions
that try to find their relaxation. Maybe this quotation expresses the arrogance of
the angry genius in relation to intellectual studies of music. On the other hand, this
quotation contains a very general and simple theory about music. The tensions
that Stravinsky mentioned become very interesting when they are compared with
the knowledge we have about the inner world of the newborn baby. The archaic
world of the infant is composed of cyclical variations of different states of tension
and relaxation.9,10
Music has its effect directly on our autonomic nervous system, causing dif-
ferent kinds of autonomous bodily reactions. At this level, we don't need intelli-
gence to comprehend or understand music. Music touches a severely mentally
retarded patient or a highly educated professor of philosophy in the same way.
Musical experience in its most general sense seems clearly to have very much
in common with the archaic ways of thinking or coping with the world. Music is a
branch of body language, a certain kind of bodily process that gives meanings to
things in which unconscious bodily experiences of meaning and their symbolic
derivates gain their own abstract forms. According to Rechardt," the structures

7K. LEHTONEN (1987), Creativity, the Symbolic Process and Object Relationships. CreativeChild
and Adult Quarterly, 12, 259-270.
8 I. STRAVINSKI (1973), Musiikin poetiikka.Helsinki: Ottawa.
9 D. STERN (1985), The InterpersonalWorldof the Infant. A View from Psychoanalysis and Develop-
mental Psychology. New York: Basic Books.
10K. LEHTONEN (1991), Music as a Language of Possible Worlds: Music as Psychotherapy. Crea-
tive Child and Adult Quarterly.XVI/3, 133-163.
" E. RECHARDT (1987), Experiencing Music. Psychoanal.Study Child, 42, 11-30.
290 D. DEGME(I1 ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

without content in music actually represent the similar structures of archaic bod-
ily comprehension.
The relationship between music and the unconscious is extremely interesting,
since it seems to show up clearly during clinical music therapy processes.12 The
psychical state during performing or listening to music seems to be in close con-
tact with the symbolic process of the individual. Music seems to promote or speed
up the psychic work and symbolic process of the individual. Music therapy proc-
esses activate the unconscious mind of the therapist and his/her patient and brings
into the light such unconscious material (e.g. in the form of music, fantasy or
mental pictures), which could not be raised to consciousness otherwise. Especially
the temporal creative, but, at the same time, well-controlled regressive state dur-
ing the intensive music therapy process seems to reach back to even the earliest
phases of development. The symbolic material presented during the sessions of
intensive music therapy is in close relationship with dream work and dream pic-
tures, because they have similar unconscious structures; condensation of thoughts,
mirror images, crab movements, pictures instead of thought, and so on.13'14 Analo-
gous to the remark made by the founder of psychoanalysis, Sigmund Freud,'5that
dreams are the royal road to the unconscious may justifiably be completed by
adding music to the definition, because the forms of both dream work and musi-
cal thinking are largely similar ways of approaching and understanding the hu-
man unconscious, which is largely dominated by symbolic processes.

The History of Music Therapy

The idea of music as a healing influence, which could have an effect on health
and behaviour, is at least as old as the writings of Aristotle and Plato.'6 The 20th
century discipline began after World War I and World War II, when community
musicians of all types, both amateur and professional, travelled around to hospi-
tals in different countries to play for the thousands of veterans suffering both physi-
cal and emotional trauma from the wars. The patients' noticeable physical and
emotional responses to music led the doctors and nurses to request the hiring of
musicians by the hospitals. It was soon evident that the hospital musicians needed

12K. LEHTONEN (1989), RelationshipbetweenMusic and Psychotherapy.Publication Series of Turku

University, Dpt. of Education A:138. Cf. also footnote No. 7.
'3 S. FREUD (1925), Some Additional Notes on Dream Interpretation as a Whole, SE:19. Cf. also
footnote No. 10.
14R. FRIDMAN (1980), Proto-rhythms: Non-verbal to Language and Musical Acquisition. In: M.
R. Key (ed.), The Relationshipof Verbaland Non-VerbalCommunication.The Hague: Mouton, 77-91.
15S. FREUD (1900), The Interpretation of Dreams, SE: 4-5. Cf. also footnote No. 13.
'6 D. BROOKS, A History of Music Therapy Journal Articles Published in the English Language,
Journalof Music Therapy.40(2): 151-168, 2003 Sum.
D. DEGMECI ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 291

some prior training before entering the facility and so the demand grew for a col-
lege curriculum. The first music therapy degree program in the world was founded
at Michigan State University in 1944. The American Music Therapy Association
was founded in 1998.17,18 In Norway, music therapy grew as a more or less politi-
cally correct anti-elitist counter-culture.17 An attempt to summarise the values
emphasised in this counter-culture follows:

* Music is a social thing; it is interaction, communication and community.

* Music is heteronymous; it is closely related to our everyday experiences.
* Spontaneous elements are given a high value, although they are simple
and have only a rudimentary musical form.
* Personal expression is more important than technical proficiency. Expecta-
tions on levels of competency should be adjusted to the resources and quali-
fications of each participant.
* Music is for everybody. The split between high and low art is artificial.

Definition

Music therapy is a well-established allied health profession similar to occupa-

tional therapy and physical therapy. It consists of using music therapeutically to
address physical, psychological, cognitive, behavioural and social functioning.19
Because music therapy is a powerful and non-threatening medium, unique outcomes
are possible. In addition to its applications in mental health, music therapy is used
with individuals with AIDS, physical disabilities, Alzheimer's disease, brain inju-
ries, chronic pain, cancer, substance abuse problems and learning disabilities.20-29
In

17S. K. GILBERTSON - D. ALDRIDGE, Searching PubMed/Medline, Ingenta, and the Music

Therapy World Journal Index for Articles Published in the Journal of Music Therapy, Journalof Music
Therapy.40(4): 324-344, 2003.Win.
18W. B. DAVIS, Ira Maximilian Altshuler: Psychiatrist and Pioneer Music Therapist, Journalof
Music Therapy2003, 40(3): 247-263.
'9 E. RUUD, A Comprehensive Guide to Music Therapy. Theory, Clinical Practice, Research and
Training, Musicae Scientiae2003, 7(2):304-306.
20 K. M. CHASE, Music Therapy Assessment for Children with Developmental Disabilities: A
Survey Study, Journalof Music therapy2004, 41(1):28-54.
21 D. J. RICKSON - W. G. WATKINS, Music Therapy to Promote Prosocial Behaviours in Ag-
gressive Adolescent Boys - A Pilot Study, Journalof Music Therapy2003, 40(4): 283-301.
22N. A. JACKSON, A Survey of Music Therapy Methods and Their Role in the Treatment of Early
Elementary School Children with ADHD, Journalof Music Therapy2003, 40(4): 302-323.
23H. KACHELE - U. OERTER,N. SCHEYTT-HOLZER- H. U. SCHMIDT, Music Therapy in
Psychosomatic Medicine. State of Implementation, Training and Research in Germany, Psychotherapeut
2003, 48(3):155-165.
24E. M. TROICE - J.J. S. SOSA, The Musical Experience as a Curative Factor in Music Therapy
with Patients with Chronic Schizophrenia, Salud Mental 2003, 26(4):47-58.
292 D. DEGME(I1 ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

other words, music therapy is the structured use of music to assist people of all
ages in times of need.30Music in music therapy is not used mechanically, as some
kind of medicine, it is more a medium for contact, communication and experience.

Music Therapyand Art

It seems to me that one should neither neglect the relationship between music
therapy and art, nor promote music therapy as a new art form. The music therapy
experience is related to art and everyday experiences in many different ways .31,32
The concept of 'aesthetic practice' thus probably does not help us to answer
many questions related to aesthetics in music therapy. It could rather help us in
developing better questions, and in avoiding unhelpful answers. For instance, we
are not guided to look for universal aesthetic qualities, but for communicative proc-
esses on values and value related to specific contexts and forms of life. Aesthetic
practices in music therapy include negotiations on values and value.33'34It will not
always be helpful to the client if this serves to promote the values of the therapist
on behalf of his/her values. Therefore, an important aspect of a therapist's compe-
tency is to be able to reflect upon his/her own aesthetic values, judgements and
choices. Thus, he/she should be focusing upon i) the preparation of the music
therapy room, ii) the negotiation on values and value through the musical dia-
logues in the therapy sessions and, iii) the process of framing and interpreting the
music. When preparing the physical environment, the music therapist is already

25 M. BROTONS - P. MARTI, Music Therapy with Alzheimer's Patients and Their Family
Caregivers: A Pilot Project, Journalof Music Therapy2003, 40(2):138-150.
26M. J. SILVERMAN, Music Therapy and Clients Who are Chemically Dependent: A Review of
Literature and Pilot Study, Arts in Psychotherapy2003, 30(5):273-281.
27A. TURRY- D. MARCUS, Using the Nordoff-Robbins Approach to Music Therapy with Adults
Diagnosed with Autism. In: Wiener DJ - Oxford LK, Action Therapywith Families and Groups:Using
CreativeArts Improvisationin Clinical Practice2003, 197-228.
28D. ALDRIDGE (1996), Music TherapyResearchand Practicein Medicine.FromOut of Silence.Jessica
Kingsley, London.
29 P. NORDOFF - C. ROBBINS (1971/1992), Therapyin Music for HandicappedChildren.Victor
Gollancz Ltd., London.
30 B.E. HOGAN, Soul Music in the Twilight Years - Music Therapy and the Dying Process, Topics
in GeriatricRehabilitation2003,19(4):275-281.
31K. AIGEN (1995), An Aesthetic Foundation of Clinical Theory: An Underlying Basis of Creative
Music Therapy. In: C. Kenny (ed.), Listening, Playing, Creating.Essays on the Power of Sound. State Uni-
versity of New York Press, Albany. Cf. Also footnote No. 30.
32J. DEWEY (1934), Art as Experience.G. Putnam's Sons, New York.
33S. FELD (1994), Aesthetics as Iconicity of Style (uptown title); or, (downtown title) Lift-up-
over Soundings: Getting into the Kaluli Groove. In: Ch. Keil - S. Feld: Music Grooves.The University of
Chicago Press, Chicago/London.
34 G. L. HAGBERG (1995), Art as Language. Wittgenstein,Meaning and Aesthetic Theory. Cornell
University Press, Ithaca/London.
D. DEGMEIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 293

making many choices: on acoustics, lighting, pictures and room decor, arrange-
ment of instruments and equipment, etc. The physical environment is an impor-
tant context for the moods and communications developed in therapy, and pro-
vides conditions for the activities, roles and relationships of the music therapy
process. Is the therapist preparing the room for contemplation by providing chairs
as the focal point in the room, or is he preparing it for movement by having a lot of
free space and few things to disturb movement? What kind of musical genres and
activities does the choice and arrangement of instruments suggest? Does the room
provide the client with both the space and the boundaries he/she needs? How
well suited is the room for making (easy) changes in activities and roles? These
choices are of course clinical, but they are integrated with values and aesthetic
choices. The questions to ask are: to what degree do I make these choices accord-
ing to my own aesthetic preferences and to what degree do I (and should I) rear-
range the room according to the client's preferences? To what degree do I (and
should I) discuss these aesthetic choices with the client?
To express yourself you need competence and knowledge, as clarified in
Wittgenstein's35 discussion of language and meaning (to learn a language is to
learn a technique). To detach music from genres known by the client therefore
might be to reduce his/her possibilities to express him/herself. Of course genres
could also be used by the client as a defence in the therapy process, just as, for
instance, intellectualisation might be used in verbal therapy. However, this does
not change my argument. Defence is an essential element in the therapy process,
and should be dealt with according to our understanding of the client and the
therapy process. Music made in therapy is always framed in some way or another;
through use of body language (smiles, grimaces, posture, etc.), verbal discussions
and also other media. We might remind ourselves that framing is a major part of
any aesthetic practice.34By framing an object or a phenomenon in a specific way,
we give value to it. Famous examples are John Cage's 4:33 and Duchamp's Fontaine.
Silence and a urinal; a phenomenon and an object that people usually do not de-
fine as art were framed as such by these artists. What happens is that you might
discover new aspects and values in the object or phenomenon. Provided you are
open to it, a process of reflection upon and redefinition of your own values might
start. I therefore think that framing is a very important aesthetic practice in music
therapy.
It seems to me more helpful to adapt some of Bakhtin's ideas about polyphonic
dialogues.36'37 It is no disaster if the client and the therapist have different values and

35L. WITTGENSTEIN (1953/1967), PhilosophicalInvestigations.Blackwell, Oxford.

36M. BAKHTIN (1929/1963/1984), Problemsof Dostoevsky'sPoetics.University of Minnesota Press,
Minneapolis/ London.
37 S. BRYNJULF,Aesthetic Practices in Music Therapy, Nordic Journalof Music Therapy1998, 7(2),
121-134.
294 D. DEGMEI ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

aesthetic perspectives. In many ways this can make the interpersonal communica-
tion richer and more colourful. To be able to stimulate such polyphonic dialogues, by
sharing one's own values and showing respect and interest for those of the client,
must therefore be an important element of the therapist's competence.
If you think there is too much beauty in this conclusion, I think I agree. Poly-
phonic dialogues are hard to establish because power relations tend to make them
monological, and therapy is certainly not automatically a context free from power
relations.

Importanceof Rhythm in Life

Ability to recognise temporally organised patterns of behaviour in another

person, and subsequently to synchronise one's own behaviour with their rhyth-
mic measures has been described in many studies.38,39 The infant studies referred
to show that we are born with a natural orientation towards rhythmically co-
ordinated interpersonal interaction, through which we communicate with those
around us and gain access to the social world. This 'non-verbal' mode of commu-
nication is the infant's primary means of interaction. The communicative nature of
such engagements emanates from a complex interplay of sequences of expressive
movements around a shared intrinsic pulse.
We conceive ourselves scientifically as living in a universe where time moves
linearly from one moment to the next in its dogged pursuit of infinity. But this
physical sense of time is inseparable psychologically from the motives that gener-
ate consciousness. If you wish to move with purpose then you must structure and
co-ordinate your actions in a time you create. Furthermore, by structuring our
behaviour around a common pulse we are able to share the fabrication of time,
and body related space, with other individuals in a mutually beneficial, construc-
tive manner.
A particular rhythm is a recognisable sequence in time. By sharing and co-
ordinating rhythms we show that we appreciate the life impulses of other indi-
viduals. The simple act of co-ordinating or structuring behaviour with reference to
the activity of a separate system manifests an appreciation of that other system
and its behaviour. In this sense the infant is able to influence, as well as appreciate,
the behaviour of the mother, as he or she forms, with her, dynamic interactive
narratives coloured by infectious emotions.40

38E. POPPEL (1994), Temporal Mechanisms in Perception. InternationalReviewof Neurobiology37,

185-202.
39J. A. SLOBODA (1995), The CognitivePsychologyof Music. Oxford: Oxford science publications.
40 D. STERN (1985), The InterpersonalWorldof the Infant. A View from Psychoanalysisand Develop-
mental Psychology. New York: Basic Books.
D. DEGMECIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 295

The production of dynamic interactive narratives needs the participating in-

dividuals to have an understanding of the past, moving through the present, to the
future - a sense of narrative in time. This is an acceptable view of the accom-
plished improvising musician. Remarkably, even a 2-month-old infant possesses
the necessary sensory and cognitive abilities. In studying rhythmic patterning in
infants' expressions, Fridman4 has shown that there are a few common rhythms
displayed by infants. The important factor is the predominance of these rhythmi-
cal patterns in attention-seeking behaviour. The infants use rhythm to gain the
attention of caregiving companions, and so access meaning in the social world.
Kempton41has made microanalysis of both film and audio footage of infants with
their principal caregivers. The results showed the general use of rhythmical
patterning in communicative interactions between infants and caregivers. Rhyth-
mical patterns of behaviour convey a sense of pulse that the caregiver or infant can
use to structure behaviour and co-ordinate it with the partner.41
Infants are born with a vast range of stimulus-seeking behaviour, and they
use this to seek out interaction and to regulate it. Again, microanalysis of film and
sound footage has been used to measure co-ordinated interpersonal timing. Sev-
eral significant observations are made in a study made by Beebe,42which supports
the hypothesis of meaningful interaction between mother and infant. Rhythmical
patterns of movement are directed by the mother to engage the child in a dynamic
interaction of vocal patterns, visible expressions and physical stimulation of the
infant's body. In this interaction, the mother's rhythm co-varies with her level of
emotional engagement. The baby responds through rhythm matching. Studies in-
vestigating a lack of contingent response have shown that irregularity in this inter-
action leads to disinterest in the child and a decrease in positive expression.43The
absence of appropriate contingent responses and feedback from the mother causes
the infant to become distressed, proving the infant's sensitivity to such factors in
its interaction with others.44,45

41 W. KEMPTON (1980), The Rhythmic Basis of Interactional Micro-Synchrony. In Key, M. R.

(ed.), The Relationshipof Verbaland Non-VerbalCommunication.The Hague: Mouton, 67-76.
42B. BEEBE(1982), Micro-Timing in Mother-Infant Communication. In: M.R. Key (ed.), Non-Ver-
bal CommunicationToday.The Hague: Mouton Publishers.
43L. MURRAY - C. TREVARTHEN (1985), Emotional Regulation of Interactions between Two-
Month-Olds and Their Mothers. In: T. Field and N. Fox (eds.), Social Perceptionin Infants. Norwood,
N.J., Ablex. Cf. also footnote No. 38.
44H. PAPOUSEK - M. H. BORNSTEIN (1992), Didactic Interactions: Intuitive Parental Support
of Vocal and Verbal Development in Human Infants. In: H. Papousek - U. Jurgens - M. Papousek
(eds.), Nonverbal Vocal Communication:Comparativeand DevelopmentalAspects. Cambridge: Cambridge
University Press/Paris: Editions de la Maison des Sciences de l'Homme, 209-229.
45M. PAPOUSEK (1992), Early Ontogeny of Vocal Communication in Parent-Infant Interactions.
In: H. Papousek, U. Jurgens - M. Papousek (eds.), Nonverbal Vocal Communication:Comparativeand
DevelopmentalAspects. Cambridge: Cambridge University Press/ Paris: Editions de la Maison des Sci-
ences de l'Homme, 230-261.
296 D. DEGMECIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

Beebe's research42shows that mother and infant track and influence each oth-
er's rhythms, anticipating certain points of mutual synchrony, in both activity (vo-
calisation) and non-activity (silence). Proprioceptive cues, providing information
about an individual's own body states, also contribute to auto-regulation, provid-
ing additional feedback. When bodies are touching as they often are in mother/
infant interaction, the feelings of limb and body acement are part of the communi-
cation - dance with song.
Co-ordinated interpersonal timing is robust in the mother/infant relationship.
A cross-site replication study by Feldstein et. al46found that significant co-ordinated
interpersonal timing occurred at both sites for 90% of comparisons. Co-ordinated
interpersonal timing was also redictive regarding developmental outcomes of in-
dividual infants for up to one year. Infants are able to predict patterns in rhythmi-
cally structured behaviour, and to synchronise the expression of their own behav-
iours with the rhythms of an adult.
The infant is indeed actively seeking out rhythms that it can use to interact
with adults and generate organised sequences of joint action. In further analysis of
such interactions, 'simultaneous improvisation' around a rhythmical structure, that
is, synchronised behaviour in which both mother and infant are 'playing' in uni-
son and not taking turns, is observed to make up a much greater proportion of
mother/infant interaction as compared to polite adult conversation.
While studies such as the above have described important commonalties in
the temporal interaction of infants with their caregivers, 'protoconversations' also
represent highly stylised instances of communication, in which both the mother
and the infant act as individuals, bringing their own personal characteristics out in
the interaction. The detailed patterns of rhythmical behaviour in mother/infant
interaction are a function of the individuals involved. Individual factors are ro-
bust, with personalisation of certain rhythmical patterns evident in the range of
rhythms used by individual infants in later speech patterns. Fridman14reports that
this is most marked in the personalised pronunciation of words. Acceptance of the
principle that infants and mothers already show individuality of expression in
'protoconversations' indicates that the relationship that they are creating together
is a personal one from the start. The studies of mother/infant interaction demon-
strate that the musical qualities of such interactions are robust features, and in the
case of co-ordinated timing they can prove to be predictive of a child's abilities in
co-ordinating its behaviour with that of others in later development. Music psy-
chology has suggested that the further study of musicians and the skills they em-
ploy would provide a greater insight into all forms of human communication.47

46S. FELDSTEIN - J. JAFFE- B. BEEBE- C. J. CROWN - M. JASNOW - H. FOX - N. J.

GORDO (1993), Co-ordinated Interpersonal Timing in Adult-Infant Vocal Interactions: A Cross-Site
Replication. Infant Behaviourand Development,16, 455-470.
47 I. DELIEGE - J. A. SLOBODA (eds.) (1997), Perceptionand Cognition of Music. Philadelphia:
Psychology Press.
D. DEGMEI( ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 297

The fundamental features of mother/infant communication do not disappear

as we develop, but remain as the basis of all our communicative systems. We know
a great deal about the compositional elements of communicative interactions in
infancy, but the functions that such elements perform in communication are still
mysterious. Different receivers usually experience rhythm in a similar way. The
acceleration of rhythm is usually experienced in an increase in tension, which can
lead to losing control and panicking. The accelerating rhythmic movement can
also lead to a total cognitive chaos. Disorganized, irregular movement and restless
rhythmic chaos can represent the most frightening experience we can have.48,49

Functions of Music Therapy

Music therapy is an efficacious and valid treatment for persons who have
psychosocial, affective, cognitive and communicative needs.50 Research results
and clinical experiences attest to the viability of music therapy even in those who
are resistive to other treatment approaches. Music is a form of sensory stimulation
that provokes responses due to the familiarity, predictability and feelings of secu-
rity associated with it.
Music therapy intervention provides opportunities to:
- explore personal feelings and therapeutic issues such as self-esteem or
personal insight;
- make positive changes in mood and emotional states;
- have a sense of control over life through successful experiences;
- enhance awareness of the self and the environment;
- express oneself both verbally and non-verbally;
- develop coping and relaxation skills;
- support healthy feelings and thoughts;
- improve reality testing and problem-solving skills;
- interact socially with others;
- develop independence and decision-making skills;
- improve concentration and attention span;
- adopt positive forms of behaviour;
- resolve conflicts leading to stronger family and peer relationships.

48 K. LEHTONEN (1987), Creativity, the Symbolic Process and Object Relationships. Creative
Child and Adult Quarterly, 12, 259-270.
49E. RECHARDT (1987), Experiencing music. Psychoanal.Study Child, 42, 11-30.
"'E. YORK, A Comprehensive Guide to Music Therapy. Journalof Music Therapy2003, 40(2):171-
175. Cf. also footnote No. 19.
298 D. DEGMEIC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

The work of the American Music Therapy Association - New York City Mu-
sic Therapy Relief Project, combined with over fifty years of practice and research
in music therapy, has demonstrated the impact of music therapy as 'second-wave'
relief in helping to cope with events surrounding a crisis and its aftermath. The
directed use of music and music therapy is highly effective in developing coping
strategies, including understanding and expressing feelings of anxiety and help-
lessness, supporting feelings of self-confidence and security, and providing a safe
or neutral environment for relaxation. Research results and clinical experiences
attest to the viability of music therapy even in situations outside of traditional
therapeutic settings.19
Music therapists assess emotional well-being, physical health, social function-
ing, communication abilities and cognitive skills through musical responses; de-
sign music sessions for individuals and groups based on patient needs using mu-
sic improvisation, receptive music listening, song writing, lyric discussion, music
and imagery, music performance, and learning through music; and, participate in
interdisciplinary treatment planning, ongoing evaluation, and follow up.5'
Children, adolescents, adults and the elderly with mental health needs, de-
velopmental and learning disabilities, Alzheimer's disease and other aging-related
conditions, substance abuse problems, brain injuries, physical disabilities, and acute
and chronic pain, including mothers in labour, can benefit from music therapy.52,53
Patients don't have to have some particular music ability to benefit from mu-
sic therapy. All styles of music can be useful in effecting change in a patient's life.
The individual's preferences, circumstances and need for treatment, and the pa-
tient's goals help to determine the types of music a music therapist may use. Music
therapy sessions are designed and music selected based on the individual patient's
treatment plan.54
Our experiences with music therapy have been very good. Patients at our
clinic are able to choose music repertoire in their treatment plan which gives them
chance to feel they are partners in the therapeutic process. Music therapy sessions
are held once a week with patients who fulfil different diagnostic categories (anxi-
ety disorders, depressive disorders, psychotic disorders, etc.).
Healthy individuals can use music for stress reduction via active music-mak-
ing, such as playing piano or drums, as well as passive listening for relaxation.
Music is often a vital support in physical exercise.55

51 W. SEARS (1968/1996), Processes in Music Therapy. Nordic Journalof Music Therapy,5 (1).
52 C. KORB, Music Therapy and Group Work: Sound Company, Arts in Psychotherapy 2003,
30(3):177-178.
53M. VALENCIA - MoL.RASCON - H. QUIROGA, Research Contributions to Psychosocial
and Familial Treatment of Schizophrenic Patients, Salud Mental 2003, 26(5):1-18.
54 S. ROBB, An Introduction to Music Therapy Theory and Practice, 2nd ed., CollegeMusic Sympo-
sium 2002, 42:155-158. Cf. also footnote No. 50.
55C. KENNY (1989), TheFieldof Play. A Guidefor the Theoryand Practiceof Music Therapy.Ridgeview
Publishing Company, Atascadero.
D. DEGMECI( ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300 299

Conclusion

Music is the special form of flexible abstract thinking, which enables us to use
all kinds of configurations and schemes in our various developmental stages in
the creative and integrative purposes. We must keep in mind that, according to
this theory, the musical integration and working through processes also comple-
ment the psychic integration and working through processes. There is every rea-
son to believe that expressive therapies may be curative. As described by Frank,56'57
there are the same general therapeutic relational and ritual elements. It may there-
fore not be necessary to understand in detail what music is, how music influences
the patient, or how the psyche develops. If it works, it works. This simple pragma-
tism is adopted in many forms of healing activities. On the other hand, the motiva-
tion to choose music therapy must emerge from the music therapist's professional
judgement that it is more effective than mere positive social interaction with any
other randomly assigned activity.58'59
The future of music therapy is promising because state-of-the-art of music
therapy research in physical rehabilitation, Alzheimer's disease and psycho-
neuroimmunology is documenting the effectivevess of music therapy in terms that
are important in the context of a biological medical model.

56 C. JONES - F. BAKER - T. DAY, From Healing Rituals to Music Therapy: Bridging the
Cultural Divide between Therapist and Young Sudanese Refugees, Arts in Psychotherapy 2004,
31(2):89-100.
57J. D. FRANK (1989), Non-specific Aspects of Treatment: The View of a Psychotherapist. In: M.
Shepherd - N. Sartorius (eds.), Non-SpecificAspects of Treatment.Hans Huber Publishers, Toronto.
58E. RUUD (1998), Music Therapy:Improvisation,Communicationand Culture.Barcelona publishers,
Gilsum, N. H.
59 E. RUUD (1980), Music Therapyand its Relationshipto Current TreatmentTheories.Magnamusic-
Baton, St.Louis, MO.
300 D. DEGME(IC ET AL., MUSIC AS THERAPY, IRASM 36 (2005) 2, 287-300

Safetak

GLAZBA KAO TERAPIJA

Stara kineska poslovica ka2e: 'Glazba potjece iz srca ljudskih bica. Kada su emocije
rodene, izraZavaju se zvukovima, a zvukovi radaju glazbu.' Prema Leichteru, konaCni cilj
izvodenja, izrazavanja ili razumijevanja glazbe leZi u psihickoj relaksaciji. Avangardni
skladatelj John Cage u jednom od svojih brojnih intervjua navodi da je konacan cilj njegova
skladanja odnosno glazbenih aktivnosti postizanje mentalnog mira. Glazba djeluje izravno
na naS autonomni Zivcani sustav, dovodeCi do razlicitih autonomnih tjelesnih reakcija.Dakle,
za razumijevanje glazbe na tjelesnoj razini nije potrebna inteligencija. Glazba na isti nacin
dopire do teSko mentalno retardiranog bolesnika kao i do visoko obrazovanog profesora
filozofije.
Glazbeno iskustvo u svojoj osnovi ima mnogo slicnosti s arhaicnim nainom razmisljanja.
Glazba je oblik tjelesnog izricaja, posebna vrsta tjelesnog procesa kojim se daje znacenje
stvarima te u kojem nesvjesna tjelesna iskustva dobivaju svoje znacenje kroz simbole i
apstraktnu formu. Posebno je zanimljiv odnos izmedu glazbe i ljudskog nesvjesnog sto se
jasno vidi tijekom seansa muzikoterapije. Jos su davno Aristotel i Platon u svojim spisima
prikazali ideju da glazba ima ljeeidbeni ucinak. Muzikoterapija je sliena okupacijskoj terapiji,
u njojse koristi glazba u svrhu poboljSanjatjelesnog, psiholoskog, kognitivnog, bihevioralnog
i socijalnog funkcioniranja. Brojnestudije pokazale su sposobnost prepoznavanja temporalno
organiziranih obrazaca ponasanja te posljedieno sinkroniziranje pojedineeva ponasanja u
skladu s ritmickim mjerama. Studije radene na novorodencadi pokazuju da se radamo sa
prirodnom orijentacijom prema ritmicki koordiniranim interpersonalnim interakcijama,
preko kojih komuniciramo sa svojom okolinom.
Muzikoterapija je efikasan nacin lijeCenja osoba s psihosocijalnim, afektivnim,
kognitivnim i komunikacijskim problemima. Rezultati klinickih iskustava pokazuju
vrijednost muzikoterapije cak i u onih bolesnika koji su bili rezistentni na ostale pristupe u
lijecenju. Glazba stimulacijom osjeta navodi na pozitivan odgovor zahvaljujuCi bliskosti,
predvidljivosti i osjeeaju sigurnosti. Bolesnici ne moraju imati posebne glazbene sposobnosti
da bi im glazba koristila, svi glazbeni stilovi kroz muzikoterapiju mogu dovesti do pozitivnih
promjena u bolesnikovu ivotu, premda bolesnikove preferencije, okolnosti i potreba za
lijecenjem kao i postavljeni cilj odreduju vrstu glazbe koju ee muzikoterapeut koristiti u
terapijskom procesu. Seanse muzikoterapije te izabrana glazba temelje se na individualnom
bolesnikovu planu lijeenja.
MoZemo zakljuditida je budunost muzikoterapije obeCavajuCas obzirom na istraZivanja
koja pokazuju njezinu udinkovitost u tjelesnoj rehabilitaciji, Alzheimerovoj bolesti i
psihoneuroimunologiji u kontekstu bioloskog medicinskog modela.