By Becky Bressan, MusicWorx Intern

When I tell someone that I work in the field of music therapy, one of the most exciting things that can happen to me is that person’s eyes lighting up in recognition. You know, that look that says “Ah yes! Music therapy!” The look that means I don’t have to explain that I’m not a music teacher, I’m not a performer, and yes, it is a profession, and yes, it requires education and clinical training. That simple look of recognition makes my day, because unlike my brother who is a software engineer, the conversation about my profession is rarely short and sweet, and never ends with how nice it is to have Ping-Pong tables in the office space.

Umm…What do you do?

While meeting  a client or patient who knows what music therapy is exciting, it is far from the norm. The first lesson music therapists learn when we enter the field is that very few people know what music therapy is. As students, we start a journey of advocacy by explaining to our friends and family what exactly we are studying. From there, we start our clinical placements and begin learning how to communicate what music therapy is to different types of professionals. This education and advocacy process never really ends. Most of the time, to provide the care we’re trained in, we first need to explain the importance and benefits of music therapy. 

Since completing my music therapy course work and moving toward internship, I have spent a lot of time in hospice and adult hospital settings. Within these settings, a common type of music therapy intervention is “receptive music therapy” or “receptive music therapy techniques.” 

Receptive music therapy is one of the most difficult techniques of music therapy to explain. The casual observer might think the music therapist is simply performing for the patient. The distinction between a music therapist and a performer can be tricky to explain in a medical setting. Those musicians that volunteer and work for hospitals, clinics, and hospice companies are not only needed, but greatly appreciated. Their music does wonders, but it is extremely different from what a music therapist is trained to provide in the form of receptive music. 

Receptive Music vs. Performing

What is receptive music therapy? The book, Receptive Methods in Music Therapy, defines receptive music therapy as an experience “where the client [or patient] listens to music – live or recorded – and responds to the experience silently, verbally, or via another modality…the client’s responses are designed according to the therapeutic purpose of the experience.” In a nutshell, this means that the patient is listening to, or receiving, the music as opposed to creating, recreating, or analyzing the music. However, the key part of this definition is the phrase “therapeutic purpose.” Music therapists work toward a purpose, or a goal that we are trying to reach, and we use music as our tool to reach this goal. We adapt the music to fit the needs of the patient and constantly observe what is required from the music and us – the therapists – to aid the patient. This process of observation and treatment is an assessment cycle. 

• The music therapist assesses the patient’s needs and reactions to the music.
• Then chooses how to use the music clinically (same, louder, softer, slower, different song, etc).
• Then implements, or applies that choice. 
• And then we are back to assessing the patient’s needs and reactions and the cycle continues. 

In contrast, when looking at a performance, the focus of the musician is the music and how it sounds. A performance is a form of entertainment, but also a musical experience, rather than a therapeutic experience. 

Ultimately, the difference between performance and receptive music therapy is what is happening behind the scenes. The difference lies in what thoughts and choices the musician is making and why. As someone that has been on both ends of the scenario I can tell you there is a huge difference. While performing, I try to communicate some form of message to an audience and am focused on how I am communicating that through sound. The focus is internal and musical. My thoughts tend to be along the lines of: 

• “Does this sound correct?”
• “Am I communicating the message through my dynamics?”
• “Can I hit that high note right now?”
• “Am I thinking about the emotion of the song and living it?”

On the other hand, as a music therapist, I am completely focused on the person in front of me and that assessment cycle. For instance, when I am facilitating receptive music techniques, I am constantly observing the patient’s reaction: 

• “Is the patient in pain?”
• “Are they anxious? Sad? Lonely? Confused? Agitated?”
• “What ways can I manipulate music to prompt emotion, relaxation, memory, orientation, and/or happiness?”
• “How can I use the music to alter those states to improve the patient’s quality of life?”
• “How can I alter the tempo and melody of the music to decrease heart rate and agitation?” 

Music therapists and performers are often mislabeled in these medical settings because the musical result of both processes may appear the same – beautiful music in the air. And yet, the therapeutic result is optimized when someone is trained to look for that change and urge it forward. 

My favorite example of this idea came from a former supervisor who asked me to explain to her why I would add a vocal harmony to a song in a session. In a performance, a beautiful harmony is always welcome. Rarely is there a reason to not add another element to the music as it usually enriches the sound and is fun. On the other hand, when using receptive music therapy techniques, the therapist needs to assess if that harmony helps to reach the goals. As a music therapist I have to ask myself: 

• Will it enhance the emotion or will it be too much stimulation? 
• Will it increase relaxation to aid sleep or will it distract the patient and pull them out of sleep? 
• Am I adding it because as the singer I like the sound, or because as the therapist I believe that it is helpful to the patient?

 When a family member, doctor, nurse, etc, sees a music therapist playing a patient’s favorite song, they usually believe the music therapist is performing and that the aim is to entertain patients. This understanding is important because it informs how clinical staff view our services, abilities, and expertise. An entertainer is helpful, but not essential; someone who enriches the environment, but doesn’t necessarily understand a medical team and the goals that team works toward. Furthermore, not all performers know how powerful music can be. Music is not always safe.

• Specific songs or lyrics can be a trigger 
• Dynamics and tempo can dangerously increase or decrease a person’s heart rate, blood pressure, or respiratory rate
• A lack of structure within music can increase confusion and agitation 

Alternatively, a music therapist is someone who has training in psychology, neurology, and the systems of the body. They are trained to monitor positive and negative responses to music, and furthermore, they know how to use music to stabilize someone experiencing physiological or psychological side effects of music. Music therapists work toward the same goals as the rest of the medical team; they are a part of that treatment team. This understanding dictates if other medical professionals call on us to treat patients we know we can help. 

The Internal Battle

The comparison between performer and music therapist can be confusing and seem tedious, not just from the outside, but also as a young music therapist. I have experienced many sessions where I feel like I have not done “enough” for the patient, or that I simply played a few songs and then left. I often have to remind myself that I am not simply a musician entertaining people. I am trained to assess and provide treatment for the patients, to facilitate physical and emotional change using music. And yet…when people constantly compare me to a performer “doing a good deed,” I begin to question if that is all I’m providing. When I feel I am only using one receptive tool instead of all of the other, “cooler” tools, like songwriting or guided relaxation, I think… “maybe I am just a glorified performer, all I did was play preferred music in this session.” The self-doubt is easily confirmed by other people’s observations and it can be hard to believe I am making a difference and acting like a therapist. I have had multiple conversations with my peers about this same feeling; that inner struggle that we feel as if we are selling a lie, that what we are providing is simply a glorified performance. And yet, it is that very thought process of “not providing the right thing” that means we are thinking as therapists, and not performers. Why? Because we are thinking about what the “wrong” thing could be. 

A music therapy education, and eventual certification, teaches us to see music as a tool – a powerful medium that can create many different types of change. The elements of performance become music therapy when that change is not a side effect, but planned with intention.