MELOTERAPY

From DIMA

Author : Nelida Nedelcut

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Contents 1 Music Therapy in Fighting Certain Behaviour Disorders 2 Introduction 3 Methods of music therapy 4 Experiments coordinated by musicians 5 The repertoire and the instruments used in the music therapy sessions 6 Conclusions

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Music Therapy in Fighting Certain Behaviour Disorders

Introduction

The therapeutic value of music has been documented for centuries; the medical (ambient, receptive and active) applications of music generate a wide range of therapeutic changes: physiological, psycho-physiological, sensory motor, perceptive, cognitive, behavioural, communicative and creative. The connexion between music and medicine originates in the antiquity, when people used to treat certain afflictions or physical disorders by rituals of white magic accompanied by music. Likewise, music therapy was used in order to comfort the depressed and to encourage soldiers about to set forth to battle. Pythagoras’ disciples were said to treat epilepsy and fever with the help of music, as they considered disease to be the direct consequence of an imbalance between cosmic harmony and the human being.[8].

Music therapy was introduced and promoted by Plato, who used it in order to restore the health of his fellow men but until the 19th century it was viewed as an empirical method of treatment and therefore doctors did not study the curative effect of some melodies’ sounds, harmony and rhythm for the treatment of physical and, more importantly, of psychic disorders. Modern psychiatry has produced the most significant results in music therapy, as the beneficial action of music ameliorates nervous seizures and, quite often, subjects suffering from behaviour disorders are recovered. It has been proved that music influences the psychic by inducing a state of profound relaxation and thus indirectly stimulating the optimal functioning of the human body. Having in view the fact that daily existence is characterized by permanent tensions and outer pressure, music therapy stimulates the preservation of health in general and of psychic health in particular.

This type of therapy can treat hidden aggressiveness, affective and behaviour disorders, certain obstructions, as well as a number of psychosomatic diseases (such as asthma and feeding disorders).

Nowadays, there are many research institutes and sanatoriums where melotherapy is being successfully used as a therapeutic method (e.g. Perceval St. Prex Vaud Institution- Switzerland, Cross - France, Deutsche Akademie für Wissenschaftliche Musiktherapie, Medizinische Resonanz Therapie Musik , Center for the Study of Violence - Iowa State University, USA). They improve and note healings in affections like: stress, nervousness, anxiety, physical and psychological asthenia, headaches, migraines, insomnia, depression, high blood pressure, palpitations, arrhythmia, dyslexia, Parkinson disease, Alzheimer’s disease, cardiac insufficiency etc.[8]. By resorting to music one obtains tranquillity and interior harmony. Scientific research has confirmed that the pulse becomes normal and the heart relaxes, producing a state of inner calmness.

Methods of music therapy

Music therapy is a science which studies the complex sound – the human being, which uses movement, sound and music in order to open channels of communication for the human being and thus to obtain therapeutic and psycho-prophylactic effects. Music therapy resorts to verbal and non-verbal closeness techniques, by associating sound, the body and graphism, by implementing instrumental devices as well as expressions of the body and the voice. These techniques aim to create an emotional balance with obvious consequences on relational behaviour.

Therapists use various types of interventions, relying on psychological and social factors, according to the subjects’ anamnesis.

The receptive method aims to obtain a psycho-musical depressurization, stimulates relaxation and the opening of communication channels between the patient and the therapist. It consists in organizing sessions of associated opera presentations, the purpose of which is to overcome lack of communication, to ascertain traumatizing affective disorders, and then to pursue their evolution. The advantage of this method is that the patient’s verbal expression can be facilitated from the very beginning, therefore the method is successfully applied in the case of children and teenagers with aggressive behaviour and of adults with depressive disorders [3].

The sessions can be held either individually or in groups; a cycle of receptive music therapy consists of: the initial meeting and discussion of the therapist and the subjects, the participation in the sessions, a new individual meeting of the subjects and the therapist, a new series of sessions and, at the end of the cycle, another individual meeting of the subjects and the therapist. In this final meeting the melotherapist decides whether a new cycle is needed.

Active music therapy follows the same pattern as receptive music therapy, but the ways of communication between the therapist and the patient are intermediated by concrete musical actions.

As regards group sessions of active melotherapy, the subjects gather out of the desire to sing and to exchange ideas, which turns this method into a privileged means of communication and expression. In this therapeutic execution, the patients go through all group-specific forms: leader, co-leader, who can speak or sing, expression monopoly, inhibition etc.

Musical self-expression allows the subjects to exteriorize their human feelings in a non-verbal language of interaction and communication by means of various techniques usually implemented by therapists with musical education.

The improvisatory method relies on a musical algorithm offered by the therapist, according to which the patient will spontaneously create a sonorous production, which can be a rhythm, a melody or a song. The starting point is made accessible to the subject based on his or her level of musical education; the suggested improvisation can resort to extra-musical elements of visual, graphical or semantic type (composition, photo-composition, musical graphism), such as can be found in the musical works of the 20th century modernism.

The recreative method consists in reproducing a musical form by means of easy to handle instruments, pseudoinstruments or primary sound sources (Orff instruments).

By means of the compositional method one can initiate either the creation of musical products (collages, cassettes, compact discs, videotapes) or the composition of songs or instrumental pieces.

Music is the environment which favours the empathy [3] between the subject and the psychotherapists. When people sing the same song together, they share the same sound experience, articulate the same words, follow the same rhythm, resonate with the same vibrations; the attention is focused on the same purpose, the stimulation of emotions is facilitated, the level of communication within the group and with the therapists is optimal. Music is such an empathic environment not only because it unites the participants who produce it in the same sensory-motor activity, but also because it keeps them and their listeners within the same sonorous space and time.

Empathic techniques can be found both in the active forms of the music therapy and in the receptive music therapy. In the active music therapy for instance, the therapist may use such techniques as: imitation (the echo of a melody or of a rhythmical structure presented by the subjects); synchronisation (the same melody or rhythm at the same time as the subject); reflection (the musical description of the subject’s state, attitudes or feelings); incorporation (the use of a musical motive of the subject as part of the music). In the case of receptive music therapy the therapist uses empathy in choosing the pieces that are to be listened to according to the iso principle, that is, by matching the music to the physical, emotional or mental states that the subject is experiencing. The music therapist can choose music which trains (matches autonomous responses, such as the pulse) or resonates with the subject (vibrates at the same frequency), which reflects the subject’s feelings, states or attitudes, or music which expresses what the patient expresses on a conscious or unconscious level. Empathy is essential in the therapist-subject relationship; it offers the basis for all the therapist’s interventions, helps build the relationship, to gain trust and to prepare the subject for other types of assistance that the therapist is able to offer.

Experiments coordinated by musicians

In fighting behaviour disorders, music therapy can produce positive effects by releasing pressure, reducing anxiety, exteriorizing emotions, facilitating the relationship with the environment. That is why educational institutions initiate numerous experiments in music therapy, and the analysis of two such examples is the object of the present paper.

In the first case, the children of a special class from Nazareth-Israel (the Tour Daburya School) assisted by a Romanian musician (a student of the “Gheorghe Dima” Music Academy in Cluj Napoca) were submitted to the above mentioned methods of music therapy, in order to overcome the stress caused by disabilities such as: dental braces, overweight, speech impediments, motor difficulties, the ADSH syndrome – characterized by a lack of adaptability, attention and concentration with or without hyperactivity; the children were suffering from stress-related behaviour disorders.

The group (15 teenagers between 10 and 17 years of age) were instructed by an interdisciplinary team (a psychologist, a general practitioner and a musician) and were taught how to express themselves through various musical activities (performance, improvisation and composition). The therapy lasted between three months and a year and the subjects underwent a surprising evolution, which was quantified by the therapists according to the therapy type (individual or in group), to the type of the contact to the music, to the sound parameters involved and to the communication factors.

The partial results of the experiment highlighted, besides the behavioural improvement, the progress of several psycho-relational parameters:

• The development of dexterity and even of motor abilities (through musical games)
• Stimulation of attention and concentration (through rhythmic exercises which used clapping, stamping and finger snapping)
• Establishing discipline and optimizing the collaboration among the children (through collective musical performances)
• Willing participation in the proposed activities (because the children were eager to use the instruments)
• Opening channels of communication through non-verbal languages (respecting the rules of musical construction and handling the instruments)
• Overcoming timidity and even fear (through self expression within musical productions or solos within the group).

As a final result, 12 children in the group improved their behaviour and were able to return to the group they had been originally selected from.

Another experiment was organized in a special school in Alba Iulia. The students who became the subjects of the research were particularly dangerous due to aggressive behaviours resulting from a repulsion directed against everything that can be called moral or social norms. The students of the Special School in Alba Iulia benefit from a number of activities aiming at psycho-pedagogical recovery (speech therapy, psychotherapy, physical culture) which take place in specialized spaces. The corrective-recuperative activities are conducted within 111 hours/week, out of which 90 hours for the therapy of speech disorders and 21 for psychotherapy.

Out of the 80 students (100%) taken into consideration, 50% have a heretic behaviour – verbal and behavioural hyper-aggressiveness, 40% have a slight mental retardation with moderate verbal and behavioural aggressiveness, 7% are diagnosed with moderate mental retardation with restlessness and 3% have Down Syndrome or Little Syndrome (convulsive syndrome).

Graphic 1. Students’ pathology

The most frequent diagnoses for the students of the studied group are presented in fig. 1.

Fig. 1. Types of pathologies present in the students of the studied group

To a great extent, both active and passive music therapy were applied individually due to the high aggressiveness of the group. The recuperation of the children with educational necessities relied on three basic principles:

1. the need to know the subject in detail

2. the need to personalize the therapeutic methods

3. the need for teamwork (from musical, psychological and medical points of view)

The sessions of collective music therapy also played a very important role, since the subjects became thus familiar with different sound patterns, which some of them had never heard before. Although the time awarded for this research was extremely short compared to the huge problems of the children in this school (aged between 10 and 13), many of them reacted positively during the sessions of music therapy and subsequently. A certain change of behaviour and a higher class attendance were to be noticed.

The partial results revealed:

• induction of a state of relaxation, goodwill stimulation;
• improvement of emotional relations;
• stimulation of the individual’s positive features, imagination, creativity;
• an increased ability to express verbally in physically healthy, but emotionally illiterate individuals;
• an anti-stress prophylaxis with positive consequences on aggressive behaviour.

The psychological coefficients of the children involved in the experiment improved as follows:

Graphic 2. Students’ psychological coefficients

The repertoire and the instruments used in the music therapy sessions

All forms of music therapy, be they educational, medical or psychotherapeutic, aim at helping the patient to build connections [2] of all kinds, to put everything together in a harmonious whole. The connections can be made between the different parts of the self (body, mind and spirit), between different parts of the body (hands and eyes or ears), between different parts of the psychic (the conscious and the unconscious; thoughts, feelings, images, memories, attitudes, beliefs) or between oneself and the others (people, objects, the universe etc.). Music is particularly helpful for the creation of these types of connections, as it involves them all; when we sing or play an instrument, we must connect the ears and the mind, the eyes and the hands, the thoughts and the feelings, the unconscious fantasies and the conscious intentions, the beliefs and the actions, the inner and the outer worlds, the self and the others. Similarly, when we listen to music we feel the vibrations in different parts of the body, we hear the ideas and the feelings match, we link the past and the present, we hear how the world is connected.

The direct contact to the world of music, as well as knowing the personality of each particular subject allows us to create an appropriate setting for an optimal progression of music therapy sessions [9]. The selection of the music, of the repertoire, for these sessions is essential. The subject of the therapy and his or her anamnesis must be taken into consideration, since music as a whole is perceived differently by different people and especially by people with accentuated communication deficits. The therapist should therefore possess vast musical knowledge and know effective methods of actively involving the listener in the listening process or in the production of the sound phenomena. We believe that, during musical activities, the spirit, the soul, is incited by the sonorous event, and at least for the moment, the subject’s attention and concentration are attracted by the musical act. In this way, the psychic receives a beneficial influence and, for a shorter or a longer while, the patient gives up the world that he or she perceives as traumatizing [1]. In time, these escapes stimulated by music therapy, along with other forms of expressive psychotherapy, may cause progress in the development of people with behaviour disorders [10]. The therapist must know not only the score, but also the other layers of the opus and, using the subject’s anamnesis, must propose the appropriate form of emotional stimulation through music.

Prior experiences show that the musical works are very often recommended at random. There exists also a preference for programmatic music, respectively for the situations when the composer’s musical idea is explained in words, usually presented in the title of the musical work, for example, Antonio Vivaldi’s The Seasons. The work’s impact is different and unique for every individual subject; the verbal explanation itself can differ greatly from one person to another. We must mention that, by association, such works translate the musical content in order to make it intelligible, to the detriment of the affective-emotional experience.

Music therapy must involve a responsible musician who selects the repertoire according to psycho-physiological criteria. The first step in implementing this therapy is the evaluation of the patient from intellectual, psychological and musical viewpoints, and the second step – the special care for the education and the formation of musical skills that will facilitate the understanding of the musical work. Conversation is therefore very useful in melotherapy. Its purpose is to help the therapist become aware of the patient’s musical tastes and whether he or she is able to receive music as a means of therapy. When verbal communication is difficult, listening to music during the conversation may establish a contact.

The selection of an adequate repertoire is a necessity that many therapists disregard, therefore the involvement of a specialist becomes mandatory. The music must be presented like an expression, a kind of language, a message, so that the emotional receptivity is efficient. The repertoire is the fundamental element in music therapy sessions – the selection, the allocation and the succession of which are essential for the therapeutic results. The repertoire will be arranged according to various levels of auditory accessibility and emotional receptivity; it must correspond to each patient’s development of musical skills, intellectual and artistic capacity.

In the case of active methods, the purpose of the activities is to involve the patient behaviourally, depending on discovering the favourite instrument, in musical actions organized within the therapy sessions. The musical instrument in music therapy is therefore the central piece, which polarizes all the other activities. It is the means which permits the release of elementary rhythmic and melodic forces, by means of individual and collective singing and improvisation. The increased attention paid to the instrument and its introduction from the very first organized contact of the subject to the music particularizes the psychological or the medical attempt.

In order to attain this purpose, one can adapt or create special instruments which can insure the efficiency of the therapeutic act. To this category belong the pseudoinstruments as well as the Orff instruments, where most instruments belong to percussion, along with the straight flute and certain string instruments (viola da gamba, cello, contrabass, lute, guitar). Beside manmade instruments, therapy uses the so-called “natural instruments”. The latter ones do not benefit from special lessons for the formation of technical skills, as this is not a purpose in itself. The instrument’s presence excludes the traditional “training”; the instrument is gradually integrated into the musical education activities, starting with sonorous gestures, by means of which one trains the skills necessary for learning the rhythmical instruments of small percussion and then the melodic ones with plates (fig. 2).

Fig.2. Types of pseudoinstruments

In an order that pays attention to the development of technical possibilities, the proposed activities involving musical instruments can include: sonority games, incipient accompaniments, improvisation of instrumental pieces, creating a musical background for readings and dramatizations, performance of melodies and songs, accompaniments and more complex instrumental pieces. Contemporary pedagogy is feverishly working towards involving computer assisted technologies in musical activities in order to learn how to use computer programs and how to apply this knowledge creatively in music teaching in schools, as well as to understand the relationship of music to other fields. The use of technology in music teaching and learning has been a field of research for many years and the highly interdisciplinary nature of the field is reflected in the diversity of approaches given to the applications of ICT in music as melotherapy. Technology creates possibilities for performance that otherwise may not have existed. In a sense, a computer can become a musical instrument that pupils may use for creating or performing music [6]. By means of electronic instruments we can create controllers and interfaces to catch performance gestures and sound modules to produce sounds. In music therapy, the music technology is targeted on well-defined directions related to teaching activities that can be expressed by the existing music software, as well. Among the issues involved in this process we can consider the following cognition matters: auditory perception, low-high grouping mechanisms, timbre, pitch and time and rhythm perception. However, there are many open research topics related to disciplines such as psychoacoustics, psychology, perception and cognition [7]. As a music therapy behaviour, the professionals participating in this therapy must organize a psycho-musical (active) analysis, consisting in:

1)Having, as a background, instruments which are easy to use (including the computer), the patient is invited to do whatever he/she wants; 2) Operating these sources has to be done under the influence of different pretreated fragments, individualized by rhythm, harmony and electro acoustics within a melody. The main objective is to observe the patient’s behaviour when faced with a musical instrument, to determine the limits and the ability to interact with an instrument and to intuit the emotional and the musical perception affinities, before actually beginning a melotherapy session.

Placing the tools of technology into pupils’ hands can guide them to active music making and can offer alternative ways of learning to those children who may experience difficulty with more conventional approaches [5].

There are many types of both instructive and attractive composition-related activities students can perform with the help of ICT [4], such as:

Conclusions

Melotherapy is an alternative psycho-preventive therapy which involves the subjects, using movement, sound and music, in order to open new channels of communication for people. In modern psychiatrics, the use of melotherapy has brought benefic results through the improvement of nervous disorders, noting every so often the patient’s recovery.

The numerous forms of therapy are claiming an ever more important role in contemporary society. Music occupies an extremely important position among these therapies, as it establishes non-verbal channels of communication for those who suffer from communication disorders.

By means of melotherapy we can resort to verbal and non verbal techniques of closeness by associating sound, movement and graphics, using instrumental support and expressions of the body and of the voice, in order to reach a psychic relaxation induced through music. The purpose of these techniques is to act on various personality disorders in order to adjust the behaviour of the subjects emotionally, as well as relationally. The group sessions bring tranquility and inner harmony. The nervous tensions are disintegrated in a blink. Medical assistance has confirmed exceptional results: the pulse becomes normal, the heart relaxes, the thoughts and mental restlessness melt in the harmony of music.

Music therapy is a process, because it takes place in time. For the patient, this time involves a process of transformation; for the therapist, it means a temporally ordered sequence of interventions and experiences which lead to a desired state, rather than a singular event that produces a certain effect. It is not merely a singular interpersonal encounter or an isolated musical experience, nor an isolated therapeutic act; it is a series of interactions which lead to a therapist-patient relationship and, at the same time, a stratified progression of musical encounters, a gradual process of transformation for the patient.

In the prevention and in fighting against difficulties of communication in the case of people with behaviour deficiencies, music therapy is an alternative with obvious chances of success, the involvement of interdisciplinary teams and the complex computerized infrastructure being overwhelmingly decisive for the therapeutic results.

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