Music Therapy involves the use of collaborative music-based experiences with a credentialed music therapist to facilitate health in a variety of areas. These goals may be musical or non-musical. Music therapy can occur in a one-to-one or group setting. In a music therapy session, a client may engage in music listening, playing an instrument, singing, or writing music.
While the professional field has been around for over 70 years, music therapy is still a novel concept for many people. This article serves as an overview of what is involved in music therapy and who may benefit.
What Is Music Therapy?
Music therapy is a type of experiential therapy that is “a reflexive process wherein the therapist helps the client to optimize the client’s health, using various facets of music experience and the relationship formed through them as the impetus for change.”1 More simply, music therapy involves harnessing the qualities and experience of music in a way that addresses client-specific goals. These goals are determined after an initial assessment and based on the therapist’s observations and input from the client or caregiver when applicable.
Music is a natural part of many people’s lives. A woman listens to the radio during her commute. A teenager chooses specific music to listen to at home to match or change his mood. Children learn and sing songs that teach academic concepts. Music therapists have extensive training in both music and psychology and are able to craft and facilitate music experiences that both resonate with the client and promote growth.
Do You Have to Be Good at Music to Benefit From Music Therapy?
In short, no! While improving musical skill may be a part of music therapy sessions, the focus is typically less on the technical performance aspect and more on the experience of engaging in music. A music therapist has extensive training in order to tailor music experiences for anyone from an experienced professional musician to someone who never sang or played an instrument. No previous musical experience is necessary to benefit from music therapy.
Although music experience is not a requirement, it is recommended that the potential client responds positively to music. Music therapy may not be effective for individuals who actively reject all forms of music or for whom musical sounds cause extensive pain and harm. However, even if someone has a high sensitivity to music, a trained music therapist will be able to find what is most effective and use music in a way that prevents harm.
Techniques Used in Music Therapy
Music therapy sessions include a variety of music-based experiences tailored specifically to the client’s preferences and goal areas. A music therapist may use instruments, live music, and recorded music. The client may engage actively with music through singing or playing an instrument. They may engage receptively through listening to music. The music therapist could employ other non-music techniques such as additional forms of creative expression (visual art, movement, drama, etc.) or verbal processing.
Many music therapists categorize music therapy experiences into four methods:1
- Improvisation: The act of creating music in-the-moment that has not been created before. The music may be vocal, instrumental, or a combination of the two.
- Re-creation: The act of creating music that has already been written. Examples may include singing a favorite song or learning how to play a song on an instrument.
- Composition: The act of writing music. The most common form of composition is songwriting. Even novice musicians can engage in songwriting using a technique in which the music therapist assists the client in changing the words to a pre-written song.
- Receptive: The act of taking in music and responding in some way. The response may be musical or non-musical and can use a variety of creative modalities.
In a group setting, a music therapy session may appear more structured or have a specific focus. In an individual session, there is more flexibility and the therapist and client may engage in one or multiple methods. The exact methods used will depend on the preference of the client and the therapist’s skills and theoretical orientation.
Some common music experiences used in sessions include:
- Expressing emotions through instrument playing
- Songwriting and recording
- Adapted music lesson
- Song discussion
- Adding instruments/music to imaginative play
- Creating playlists for specific moods
- Music-assisted relaxation
- Music and imagery
- Music and mindfulness
- Drawing to music
- Movement to music
What Can Music Therapy Help With?
Although the professional field of music therapy began gaining momentum after World War II to assist veterans experiencing Post-Traumatic Stress Disorder,2 music therapy is used today with a wide variety of individuals. Because music is both specialized and far-reaching, music therapy can help with a variety of needs. Music therapists often address mental, physical, developmental, emotional, social, and spiritual needs. They are trained to use music to meet these needs throughout all stages of life.
Music therapy can provide support in pregnancy, birth, and postpartum,3,4,5 and is also effective in fostering development for premature babies in NICUs.1 As children grow, music therapy can be used to help children reach developmental milestones and improve social and self-regulation skills.7 Research shows that adolescents receiving music therapy experience growth in identity formation, resilience, connectedness, and feelings of competence.8 Music therapy is effective for adults who may experience mental health needs, neurologic disorders, or substance use disorders, and can also assist with general wellness.
Specific areas of need music therapy can address include:
- Physical rehabilitation
- Motivation and engagement
- Emotional support for clients and families
- Cognitive skills
- Social/emotional functioning
Music Therapy Examples
A common question many have about music therapy is: So what does music therapy actually look like? Because music therapy is far-reaching, the answer likely depends on the client and setting.
Music Therapy With a Child on the Autism Spectrum
David, a 5-year-old child on the autism spectrum, sees a music therapist each week at his school. David has difficulty joining other children in play and communicating his wants and needs effectively. David loves playing instruments and listening to music from children’s movies.
The music therapist brings a variety of instruments David can play without much instruction. David explores the instruments and the music therapist follows his lead. She begins singing his favorite songs, often leaving space for David to fill in the next word. Over time, the enjoyable experiences allow David to express his creativity in a fun and engaging way.
He begins allowing the music therapist to choose a music experience and then joins her to play. Because he enjoys singing, the music therapist writes songs for David that use common phrases. As David starts singing these songs on a regular basis, he begins to use these same phrases in relevant settings outside of the music therapy session.
Music Therapy With an Adolescent Who Has Experienced Trauma
Sarah is a 15-year old female who has a history of trauma and abuse. She experiences symptoms of Post-Traumatic Stress Disorder, Anxiety, and Depression. Sarah is resistant to music therapy at first but connects with the music therapist over her preferred songs. Sarah shares her favorite songs with the music therapist and engages in song discussions about the different lyric themes.
Sarah begins drawing connections between the song lyrics and her own personal experiences as a way of processing her trauma. As her treatment continues, the music therapist discovers Sarah writes poetry in her free time. Sarah agrees to try songwriting and the music therapist uses her musical skills to assist Sarah in setting her poems to music. Sarah decides the melodies, harmonies, instruments, and overall structure. The music therapist helps Sarah record and mix the songs using music recording software. Not only was Sarah able to express herself through songwriting, but she also increased her self-esteem and has something tangible that she created.
Music Therapy With an Adult in Hospice Care
Richard is a 70-year-old man diagnosed with lung disease who has recently entered hospice care. He experiences physical health symptoms such as shortness of breath and pain. Richard and his family experience grief as they prepare for end-of-life.
The music therapist asks Richard about his favorite song and Richard names a song from his young adulthood. The music therapist plays the song on his guitar for Richard and Richard appears reflective. The song brought up a specific memory that Richard shares with the music therapist. Richard smiles at this fond memory and engages in verbal discussions about other positive memories from his life. The music therapist invites Richard to sing along as he plays the song again. Richard sings in short phrases and the music therapist adjusts the tempo of his music to match Richard’s breathing.
The music helps Richard regulate his breathing and the singing helps him maintain as much lung capacity as possible. Over the next few months, the music therapist uses Richard’s preferred music to assist Richard and his family in processing their grief and experiencing closure.
How Much Does Music Therapy Cost?
Music therapy is typically funded either through an organization, included by a facility as part of their overall treatment model, or paid for out-of-pocket. A music therapist may charge different rates for individual sessions, group sessions, and assessments. Rates are also determined by factors such as geographical location or the therapist’s education and experience.
The American Music Therapy Association surveys its professional members each year and includes average rates for the United States. The survey findings are broken down by geographical region. According to their 2018 Member Survey & Workforce Analysis, average hourly rates for individual music therapy sessions were between $50-90. Average hourly rates for group music therapy sessions were between $60-90, and average rates for a music therapy assessment were between $65-110.9
Is Music Therapy Covered by Insurance?
Whether or not music therapy is covered by insurance varies state-by-state and often case-by-case. Some states such as Arizona, Indiana, Michigan, and Texas provide reimbursement under Medicaid waiver programs.2 Music therapy has been covered by specific insurance companies such as United Healthcare, Blue Cross Blue Shield, Cigna, and Aetna in certain situations.2 Individuals seeking music therapy should contact their insurance company directly to ask if their coverage includes music therapy.
How to Find a Music Therapist
The Certification Board for Music Therapists keeps an up-to-date directory of board-certified music therapists in the United States that can be searched by name, state, or zip code. Additionally, many music therapists choose to be professional members of the American Music Therapy Association (AMTA). The AMTA online directory provides the ability to search for music therapists by state, zip code, setting, or populations served. Many states also have their own music therapy state association and can provide additional information on music therapists in the area.
There are currently over 9,000 board-certified music therapists in the United States,10 engaged in a variety of specialties and positions. Music therapists are employed in a variety of settings including, but not limited to:
- Private practices
- Medical and psychiatric hospitals
- Nursing homes/long-term care facilities
- Rehabilitation and outpatient facilities
- Substance use recovery programs
- Hospice agencies
- Community mental health agencies
- Adult day care programs
Who Can Offer Music Therapy?
A music therapist practicing in the United States must hold the MT-BC credential (Music Therapist – Board Certified). This credential ensures that the person claiming to practice music therapy has completed rigorous education and training to provide music therapy in a safe, effective, and ethical way. Certain states require additional licenses.
A credentialed music therapist must hold a bachelor’s degree or higher from a music therapy university program approved by the American Music Therapy Association. In addition to coursework in music, psychology, and music therapy foundations, a bachelor’s degree program in music therapy requires 1200 hours of clinical practice, including a supervised internship. There are currently over 80 music therapy degree programs in the United States.11
Once the degree is completed, a person is eligible to sit for the national board certification exam and, upon passing, will receive the MT-BC credential. All people who hold the MT-BC credential must adhere to specific Standards of Practice and a Code of Ethics provided by the American Music Therapy Association.
What to Look For in a Music Therapist
Due to the broad nature of music therapy training and practice, many music therapists, while they may work in multiple areas, will have a few specific areas of focus or interest. It is important to find a music therapist that can best address the needs and goals you have in mind. There are many additional trainings and certifications open to music therapists, and it is worth noting if the therapist’s additional areas of focus meet what you’re looking for.
Key Questions to Ask a Music Therapist When Considering
An important part of what makes music therapy so effective is the relationship between the therapist and client. Therefore, it’s important to make sure that the music therapist is a good fit for you. While this is explored more in the initial assessment, it may be helpful to ask questions ahead of time.
Key questions to ask before beginning music therapy may include:
- What populations/need areas do you have experience with?
- What do you believe about music therapy and why it’s effective?
- What is your main focus during music therapy sessions?
- Are your services covered by insurance?
- What are your rates and do you have a sliding scale?
- What is your theoretical approach and how does that show up in your sessions?
- Do you have any additional training or certifications?
What to Expect at Your First Appointment
The first step to music therapy treatment is always an assessment session. Many music therapists use this assessment to gather basic information and offer a variety of music experiences as an example of what to expect in following sessions. Some music therapists will structure the assessment like a typical session while others may schedule a longer block of time and offer more experiences to see what will be the best fit for the client.
During this first session, if applicable, the therapist may gather background information from you through a simple conversation. The therapist may ask what brought you to music therapy, what goals you have, and other general information such as your interests, your music preferences, and any previous music experience you have. The therapist will likely offer a variety of options for engaging in music. A music therapist is trained to assess various needs through these experiences.
The most important part of the initial music therapy assessment is determining whether this therapist and their approach to music therapy is a good fit for you. The relationship between client and therapist is imperative to effective music therapy treatment and it is important that the client feels comfortable about moving forward with sessions.
Is Music Therapy Effective?
Much research has been done that continues to show the benefits of music therapy with a variety of populations. The National Institutes of Health partnered with music therapists to expand their Sound Health initiative—an effort to continue research on how music impacts the brain and how music therapy can be effective for neurologic disorders.12 The National Autism Center has also named music therapy as an effective emerging modality for individuals on the autism spectrum.13
Music therapy has been shown to:
- Lower stress in pregnant mothers and reduce pain in labor and delivery2
- Provide emotional support and total family bonding support postpartum3,4
- Promote communication, interpersonal skills, and creative play in children14
- Facilitate identity formation, self-esteem, and self-expression in adolescents8
Additionally, research shows music therapy is effective in supporting:15
- Pain management
- Military populations
- Medical procedures
- Alzheimer’s Disease
- Adults in correctional facilities
- Those with neurologic disorders
Criticisms of Music Therapy
One of the biggest criticisms of music therapy is the barrier to access. Many federal and private insurance systems do not yet cover music therapy, so many people that could benefit from services are not able to receive them due to cost. Additionally, the field of music therapy is relatively small and some communities do not always have access to a music therapist. Some who do not have firsthand knowledge of music therapy doubt the efficacy of music to treat various needs and disorders, though countless research has proved that is not the case.
Risks of Music Therapy
As with any therapeutic modality, music therapy carries inherent risks. For those with sensory integration difficulties, music could become overstimulating. Additionally, music often evokes deep internal processes, many of which may be unconscious or subconscious. Deep emotional experiences and vulnerability may cause anxiety or emotional distress. These risks point to the importance of having a board-certified music therapist, as they are specifically trained and held responsible for mitigating these risks as much as possible.16
Music Therapy vs. Sound Therapy
Music therapists are not the only ones who use musical sounds as a treatment modality. There are a variety of sound healing techniques and therapies out there, all of which are distinct from music therapy. The main difference between music therapy and sound therapy is where the change comes from. In music therapy, the change comes from the client, the therapist, and/or the music they engage in together. In sound healing, the change comes from the universal sound, energy, and vibrational properties found in music.1 Sound healing focuses on how the vibrations of specific sound frequencies affect the body and does not typically incorporate the client’s subjective experience or engagement with music.17
The History of Music Therapy
The concept of using music as a healing modality has existed for centuries throughout multiple nationalities. In many Indigenous cultures, healing practices involve ceremonies that utilize music as an integral part of the ritual. Greek philosophers such as Aristotle and Plato wrote about the connections between music and health/illness.2
Musical healing techniques continued through the Middle Ages. By the 1800s, reports of music therapy techniques and uses for groups in institutions began to emerge in western medicine. 19th century psychiatrists Benjamin Rush, Edwin Atlee, and Samuel Matthews wrote about music therapy as a supplement to psychiatry. In the first half of the 20th century, professional musicians began using their music training to assist people with mental health needs; however, the field was not formalized until the 1940s.18
By the end of World War II, music therapy was gaining ground in the United States as a formal treatment for Post-Traumatic Stress Disorder in veterans returning home from the war. Universities began creating training programs in music therapy and the first formal music therapy degree program was established at Michigan State University in 1944. Two national associations were created to formalize the profession and oversee training and clinical practice. In 1988, the two associations merged to form the American Music Therapy Association which remains in effect today setting education and clinical standards for music therapy.2
Final Thoughts on Music Therapy
Music is an incredibly powerful tool that can be harnessed for healing. What you or your loved one is struggling with may feel isolating, but you are not alone. If you are experiencing any mental health, physical, emotional, or developmental needs, music therapy may be effective in supporting you.