Music Therapy With Emotionally Disturbed Children

Music therapy is defined as "the prescribed use of music by a qualified person to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems" (American Music Therapy Association, 2003). While music therapy is closely aligned with the behavioral sciences, it is distinct in that it bridges art with science. Two publications by Elio Frattaroli, M.D., (2002, 2001) illustrate the dilemma faced by modern psychiatry in trying to understand mental illness, not only in the science of neurological processes but also in the art of skillful healing relationships. Music therapists are skillful practitioners who orchestrate their talents to help soothe a wide variety of painful human conditions. While many psychiatrists are aware of the uses of music therapy for the treatment of autism, substance abuse, Alzheimer's disease and pain, far fewer are aware of the exciting work that's being done with children who have serious emotional disturbances. Children with such disturbances have diagnosable mental health disorders and extreme functional impairment that limit or interfere with the ability to function in the family, school and/or community (Stroul and Friedman, 1994). Conservative estimates from epidemiological studies suggest that 8% to 12% of students ages 6 to 21 suffer from a significant disability, and approximately 8%, roughly 470,000 of this population, are identified through their schools as being emotionally disturbed (U.S. Department of Education, 2001). A review of the music therapy literature delineates at least three broad domains of functioning where music therapy has been successfully utilized in the treatment of emotionally disturbed children: affect regulation, communication and social/behavioral dysfunction. Assessment and intervention in each of these domains requires strong grounding in developmental theory, a key component in the training of music therapists. Early on, music therapy was identified as an intervention to treat impairments in affective functioning, including reducing levels of anxiety (Cooke, 1969), and as a tool to improve emotional responsiveness (Wasserman, 1972). Music therapy has been well-suited to help improve communication deficits and stimulate nonverbal communication. Numerous positive outcomes in improving social functioning, social awareness and cooperation (Werbner, 1966), and decreasing disruptive behaviors (Hong et al., 1998) have been reported. One of the major contemporary applications for music therapy is working with children who have serious emotional disturbances and high degrees of impulsivity and limited ability to self-regulate (Layman et al., 2002). Some of the modalities and techniques used in the treatment of emotionally disturbed children include live music production (e.g., playing instruments and/or singing), improvisation, guided imagery (e.g., pairing of visualization with music), creative songwriting and lyric analysis. After a careful assessment of the child's needs and capabilities, music therapists formulate individualized treatment plans that include goals and measurable objectives. Music therapists reinforce and shape targeted behaviors, while dynamically exploring underlying feelings and issues. Music therapists who work on multidisciplinary treatment teams often concentrate on a specific subset of treatment goals or objectives most appropriate for music therapy intervention. These techniques are applied in a variety of community treatment settings, as well as in hospitals, residential treatment centers and partial hospitalization programs. Therapy sessions with children typically last from 30 to 60 minutes and may be structured to include individual, family and group formats. Rationale for Music Therapy An advantage of music therapy is that it is an inherently nonthreatening and inviting medium. It offers a child a safe haven from which to explore feelings, behaviors and issues ranging from self-esteem to severe emotional dysregulation. Music therapy techniques can be designed to