by Matt Robert Originally published in the November 14th, 2013, Worcester Magazine.
Just beyond the entrance of Worcester Music Therapy on Elm Street is a quiet and warmly lit waiting room – indistinguishable from any other, with the possible exception of a Dark Side of the Moon coffee mug that sits upon a shelf. As with most waiting rooms, a few adults sit or stand as a child rolls a toy around on the wall-to-wall carpet.
Worcester Music therapy owner Kayla Daly greets me with her characteristic enthusiasm, and ushers me into the therapy room, a small, neat space with white walls and trim and a dropped ceiling, with the same wall-to-wall carpet throughout. The room has been decorated with some kid-friendly furnishings that would not be out of place in a pre-school classroom: a multi-colored interlocking rubber mat and colorful papa san and beanbag chairs on the floor. The rest of the room is empty, save for two keyboards – one modern, one ‘60s-type wooden kid’s organ – two three-quarter-size acoustic guitars mounted on the wall and a nondescript cabinet.
It doesn’t look like much, but during the next hour it will become a living performance space in which Daly will present a concert of sorts. This concert, however, will not be the megalomaniac’s self-obsessed spotlit show. Rather, it will be a spontaneous composition, at times a ballet or Broadway musical, blending elements of music (rhythm, repetition, melody, call and response, vocalizations) with appropriate therapeutic goals and methods. It will be more about the patient than the expressive desires of the performer, and the success will be measured, not by how good it feels to the performer, or even how good it feels to the audience, but how well the methods get inside of the patient and respond to his or her inner workings.
Like any performance, some sessions are better than others, the result an important coalescence of the participants: therapist and patient. An 11-year-old diagnosed with autism (who, here we will call David), has been taking music therapy for three and a half years, and has recently been taken off of strong anti-psychotic medication, which was prescribed, in part, to calm significant muscular tics and spasms. David’s level of comfort and trust with Daly has grown and evolved over hundreds of sessions.
The session gets started with Daly pulling down and strumming one of her guitars, while singing gently in a warm, round tone. David immediately takes hold of the neck of the guitar and, like any child might, begins strumming brusquely upon it. Daly has stressed the importance of active participation. This isn’t awed fans before the master. This is participatory music. To this end, Daly begins singing, with pronounced articulation, the words to a simple song, using gentle redirection to keep David’s attention on the session. David, intense and roaming the room in search of something that ostensibly he cannot request in traditional ways, more often than not, finishes the lyrics. Daly remains fleet-footed and alert, changing her methods according to, it seems, the relative successes of her actions. At times, she will switch to keyboard or drum, or even put the instruments aside and take hold of David, reaching him with the most human of instruments, her voice.
“Ticky-tock,” she sings and strums, “goes the …”
“Clock,” sings David, offhandedly, while opening and closing the cupboard. This they do for several minutes, until, it appears, David grows bored of it and his responses diminish, at which point, Daly swiftly, though relaxedly, tries a different approach.
Throughout the session, David will tap familiar rhythms on a drum, sing lyrics, fill in missing words left hanging in the air, whistle pretty musical patterns in key (despite his mother’s insistence of a non-musical family), and reveal his excitement about a trip to McDonald’s to follow the session. Daly weaves her way through all of these occurrences, working the room like a prizefighter, gently nudging and redirecting, altering the words to the songs, and even the songs themselves, to maintain David’s attention, which seems intent on escaping, like a bird trapped in a tight space.
Daly begins a lilting dialogue about David’s trip to McDonald’s. She sings questions about what he will order, and he replies, “Chicken nuggets.” The call-and-response song is a conversation and is not about music, not about esthetic pleasure. Rather, it is a primordial path to David’s psyche, a means for him to communicate appropriately, with predictable cadence, and can teach social pragmatics, Daly later explains.
Music, she says, is especially effective for a case like this, because of its incorporation of both hemispheres of the brain. Using more areas of the brain means more opportunity for David to connect with it and express himself through it.
Daly is drawing on tested musical patterns, and repetition of familiar, previously effective tunes from past sessions.
BEHIND THE MUSIC
Much like the stereotypical therapist’s session with the leather couch and the pipe-smoking, bearded psychologist that we are quick to mock (“tell me about your, mother….I see….And how did that make you feel?”), there is more going on here than meets the eye.
Daly and another local therapist, Cara Brindisi, who is a member of the local music scene and who works for the Visiting Nurses Association Care Network and Hospice, operating in a variety of care settings throughout Central and Eastern Massachusetts, take their profession as music therapists seriously. Speaking of the nature of their business, both leave a lasting impression of a remarkably defensive posture – two professionals compelled to defend (Brindisi says not defending, but “advocating for”) their profession against accusations, suspicions, and ignorance.
Daly and Brindisi, through their agencies, service as wide a variety of patients as any therapist might, from school-aged children in the local school system to end-of-life hospice care, as is Brindisi’s specialty. The diagnoses, too, are broad, and often overlap with other types of therapy, offering cognitive, social, and physiological benefits, as the music therapists engage the patients in participatory, active music-making. Again, these aren’t performances. Rather, they are treatments made up of carefully choreographed song selections, chosen, either for familiarity of lyric or rhythm, recurrent pattern, or evocative qualities.
Brindisi says that she didn’t play music growing up, instead performing on stages at Calliope Production theatre in West Boylston, with groups like Worcester County Light Opera. When it came time to choose a college, she knew that she wanted to pursue music, though her interest didn’t center on classical arts, nor even on performing.
“All I knew was that I wanted to learn about music – I wanted to know the science of it, find the history of it, learn where it applies in everyday life,” she says.
She chose Berklee, where she fell into the stream of musicians, most of whom were engaged in typical majors, like film scoring, songwriting, recording, composition and performance.
On break from her first semester, Brindisi had a life-changing experience. Aware of the music therapy major, but not yet enrolled in it, a seemingly incidental event affirmed it all for her.
At the time, her grandfather was at the mid- to end-stage of Alzheimer’s. At home during a family gathering, Brindisi sang a traditional Scottish-Irish song in the presence of her grandfather, who expressed what she refers to as “blunt affect, or no connection with anyone in the room, especially not my grandmother.”
The second she began singing the song, however, his whole affect and demeanor changed, she says. “He knew the words and his face brightened,” she recalls. The moment was magical and observed by the whole family, but “almost immediately” upon the song’s end, he returned to his former state of withdrawal and disconnection.
“I just wanted to zoom into that,” Brindisi says. “It was a very emotional, moving experience, and one that had happened before when we would sing Irish songs, or patriotic songs.”
Brindisi notes that social media is replete with videos documenting the remarkable effects of music upon the elderly or disabled, which both confirms music’s potential therapeutic effects, but also “can negate what music therapy is” versus what she says her anecdote describes, which is, she says, just evidence of the human connection to music.
“Anyone you talk to knows that music makes us feel something,” she says. “But I wanted to know why and how I, as a now young musician going into a career path, how do I learn how to make that into something – to do that again – and how to reach … the right goals, the objectives, the clinical goals.”
Distinguishing therapy from the work she does on stage throughout New England, Brindisi says, “I knew that this went beyond just enjoyment.” The main differences, she notes, is that “music therapy is not about you (the performer). It’s never – ever – about me. It’s not what I want to sing. None of these goals are for my benefit.”
In fact, therapists must resist the urge to self-indulge, and Brindisi says that she often has to demur when asked by a client about her original music. “That’s bringing a part of me, my vulnerabilities and personal life, into a therapeutic rapport or a therapeutic setting.”
Therapeutic settings, where one might work, include: mental health clinics, rehabilitation centers, outpatient wellness programs, schools, nursing homes, senior centers, group homes, daycare centers, etc. Notice the list doesn’t include Carnegie Hall, The Dew Drop Inn, or The Lucky Dog Music Hall.
“The clients aren’t joyous and drinking coffee,” Brindisi jokes. They’re not hitting beach balls around and yelling out for “Free Bird,” either. Hence, she says, it isn’t appropriate for her to bring her personal life into a session, and potentially confuse the patient or burden him or her with the therapist’s issues.
And so, while it might seem strange, and often did to Brindisi’s colleagues at Berklee, she could be found heading to anatomy class, while her roommate might have been heading off to Horn Arrangements 101, or Special Topics: The Works of Thelonious Monk. These are not musicians who work in a clinical setting. These are clinicians whose primary tool is music. Kayla points out that the competencies exam required for board certification is only 40 percent music knowledge, while it is 60 percent therapeutic/clinical information, and the coursework associated with the degree is quite rigorous.
Just about everything in today’s society has a proving period. Music therapy isn’t exactly new, though it is still decades newer than its often maligned older sibling, psychoanalysis, which, had its own breaking-in period.
According to the Music Therapy Association, the idea of the therapeutic possibilities within music date back at least to Aristotle and Plato in the third century BCE. Aristotle, more or less, defined our current philosophy of catharsis through art. The late 18th century saw publication of the first music therapy scientific article, entitled “Music Physically Considered,” and references to the medicinal value of music in two medical dissertations, by Edwin Atlee, in 1804, and Samuel Mathews, in 1806. The first use of music in a therapeutic intervention in an institutional setting would follow within decades in Blackwell’s Island, New York. Music therapy gained traction and several associations were formed in the early 20th century, including the National Society of Musical Therapeutics, in 1903, the National Association for Music in Hospitals, in 1926, and the National Foundation of Music therapy, in 1941. None of these, however, led to “an organized clinical profession.”
Music therapy began on a broader scale when performed in community settings on G.I.s returning from World Wars I and II, when clinicians recognized noticeable effects on the physical and psychological well-being of the soldiers. It soon became apparent that more training would be required and beneficial. At the same time, several key figures emerged in promotion of music therapy, including the man that would later be known as “the father of music therapy,” E. Thayer Gatson. The Post-War period saw the creation of the first college training programs, at Michigan State University, and then University of Kansas, Chicago Musical College, College of the Pacific, and Alverno College, in Wisconsin.
It was the National Association for Music Therapy, founded in New York City in June 1950, that cemented the profession, by creating a constitution and bylaws and by laying out academic requirements for university-level music therapy education. A board certification program was established in 1985. Now called the American Music therapy Association, the group oversees 5,000 board-certified music therapists and publishes two research journals.
QUALIFIED TO HELP
Daly and Brindisi both draw on this long history and the rigors of the academic major as they fervently advocate for their profession. It isn’t merely lip service or ego stroking, though – naturally – both express resentment at being taken for little more than pretty girls strumming guitars for a living. Their ardor is cautionary, and when they make distinctions between their work and that of, say, a well-intentioned musician playing in a retirement home, they do so much the way a board-certified doctor might distinguish herself from a well-intentioned neighbor dispensing medical advice.
Daly and Brindisi, both board-certified therapists, have met a range of competencies as defined by the Certified Board Music Therapist (CBMT) organization. Each has been through a five-year undergraduate program and a six-month internship and sat for the board test. The test requires knowledge of music theory and history, composition and arranging skills, major performance medium skills, keyboard, guitar, voice, percussion, and non-symphonic instrument skills, improvisation skills, conducting skills and movement skills. Daly, also, has a Masters degree in Music Therapy and Licensed Mental Health Counseling.
And that is just the musical side of things.
The board also requires knowledge of clinical concepts, like exceptionality, principles of therapy, the therapeutic relationship, foundations and principles of music therapy, client assessment, treatment planning, therapy implementation, therapy evaluation, documentation, termination/discharge planning, professional role/ethics, interdisciplinary collaboration, supervision and administration and research methods.
Both Brindisi and Daly stress that placing a layperson in a therapeutic setting could be worse than simply non-beneficial – it could be downright harmful.
“I know the Bob Marley song says, ‘When the music hits you feel no pain,’ but…” Brindisi jokes before turning serious and describing potential harm that can occur when an untrained individual interacts with vulnerable populations, who might have serious physical, medical and/or psychological diagnoses. She explains that the trained therapist has experience in recognizing patient needs, thorough formal education in physiology and psychology, and works on a team with nurses, case managers, doctors, social workers and clinicians. They know the full history of the client before meeting them and are trained to prepare proper musical accompaniments relative to the goals for the patient. They are equipped with a broad range of tools to manipulate the environment in service of the clinical goals set by a team of health care experts.
While both Daly and Brindisi see widespread potential for music therapy, both recognize its place within a treatment plan and understand that its prescription doesn’t match every case. Brindisi points to scenarios, such as a former professional (or ardent amateur) musician who can no longer play, or one with a potentially high emotional reaction to music as, perhaps, cases in which music therapy might pose problems. This individual might be hurt by the reality of a younger therapist doing what the patient once loved doing, but is now incapable of, like having “lost a real friend” in music. This, she says, could be counter-productive, at least initially.
However, there does seem to be a place for non-certified musicians wishing to help others through sound and rhythm. Rich Leufstedt, or Amazing Dick, as he is known in Worcester as the undisputed ukulele king, takes music beyond the clubs and participates actively in workshops that foster involvement and well-being, both in casual settings, as well as in hospitals. Though he is neither board certified in music therapy, nor technically providing the same therapy as Daly and Brindisi, he nevertheless offers what might be deemed a music experience with therapeutic value.
Aside from his usual performance schedule, Leufstedt leads the Thursday Night Ukulele Club at Union Music on Southbridge Street in Worcester; he participates in the Caring Talents Program at UMass Memorial Medical Center; and he performs in a worship music group at his church. Each, he says, provides a sort of therapy, “or at least a level of enjoyment,” to those in attendance, and altogether, they have changed the way he plays music.
The Thursday Night Ukulele Club, which meets on the last Thursday of each month in a room adjacent to Union Music, brings together, he says, 12-15 people of all ages and skill levels, from guitar players looking to explore the ukulele, to others who perform in senior centers on occasion. The therapeutic value, he says, comes from involvement. Much like Daly and Brindisi, Leufstedt fosters an active, participatory lifestyle for these folks, even catering to new learners, by initially simplifying songs and offering chord charts that are easy to follow along to. With this program, he hopes to encourage everybody to try to play music.
The Caring Talents Program at UMass Memorial Medical Center makes “music and art and literature available for patients and [the] hospital community.” Once a month he plays on the pediatric floor, “going room to room for about a half an hour and playing songs to particular patients.” He seeks out universal songs, in the hopes of engaging the ailing children, who sometimes sing along, and sometimes tap their feet. Nurses occasionally report, to Leufstedt’s pleasure, “That was the first time he smiled today,” or other affirmations of the music’s positive effects.
MOVING US FORWARD
Brindisi and Daly, as well as our health care industry, continue to discover more applications for this emerging practice day-to-day, patient-to-patient.
And for Leufstedt, playing at a variety of music venues with different endeavors has caused him to think differently about his performance and material selection, especially with regard to setting, needs and the demographics of the particular audience. One that is a constant, however, is the result of music on those who play and listen. “When people sing together in a room, your brain releases oxytocin,” he says, “which is the same chemical released during other archetypal positive experiences.”
One can see these benefits in a patient, like David, who demonstrates during his sessions an expressiveness and humanity that mirrors the catharsis Aristotle connected with drama and the arts, which can be seen in the rapt faces of many of us when we attend big concerts, engage a talented band in a local club, or even when we experience a lullaby or a simple tune with someone we love.