Levels of Music Therapy
Supportive, Activity-Oriented
● Insight as to why behaviors occur is not essential to the therapy
● Typical goals:
○ Increase tolerance of instruction
○ Decrease avoidance behavior in possible failure situations
○ Teach how to achieve success in long-term projects
○ Increase attention span and concentration skills
○ Develop a realistic view of self
○ Increase self-esteem
○ Decrease “irresponsible” behavior in work situations
○ Increase tolerance of authority figures
○ Decrease avoidance behavior in social situations
○ Increase awareness, acceptance, and responsibility to others’ feelings
○ Develop skills in dealing with intense emotions
○ Develop knowledge of ways to avoid seclusive, passive living in the community
● Likely to be appropriate for the most severely ill patients
Re-Educative, Insight and Process-Oriented
● Primary goal of insight into material on a relatively conscious level
● Music is used to elicit emotional and/or cognitive reactions which are essential for
therapy
● Appropriate for clients whose problems do not cause severe personality disorganization
● Ex: listening to or playing music, then discussing the feelings elicited by the music
afterwards
Reconstructive, Analytically and Catharsis-Oriented
● Used when insight into unconscious material is the goal of the music therapy
● Work at this level requires advanced training
,Therapeutic Approaches
Behavioral
● Music can be used to modify behaviors
○ Structure
○ Prompts
○ Redirection
○ Rewards
● Reinforcement: an intervention intended to increase frequency of a behavior
○ Positive: giving reward
○ Negative: taking something away
○ Differentiated: works the slowest; positive reinforcement is used to target one
behavior while another targeted behavior is being reduced or eliminated
● Punishment: an intervention intended to decrease frequency of a behavior
○ Positive: giving something
○ Negative: taking something away
● Extinction: abrupt withdrawal of positive reinforcement that is maintaining an
inappropriate behavior
○ Ignoring, for example, is appropriate for attention-seeking behavior
● Contingencies: parts of the environment that influence the client into modifying their
behavior in a positive direction; rewards
○ Group contingencies: peer pressure leading toward a common target goal
● Token economies: tokens given for on-task behaviors that can be used to cash-in for a
reward
● Operant techniques
○ Task analysis—delineation of a selected activity into sequential parts
○ Prompt—cue that increases probability of a desired response
○ Errorless learning—procedure to establish accurate client response as rapidly as
possible without the appearance of errors
○ Chaining—the process of two or more responses being joined together
systematically, one at a time
■ Reverse chaining: if a child were memorizing a phone number, for
example, omit the last digit to see if they remember, then last two, etc.
■ Successive approximation: behavioral element or subset of a behavior,
each of which more and more closely resembles the specified terminal
behavior
○ Shaping—systematically reinforcing each successive approximation
○ Modeling—demonstrating an action to be taught to the client
● Premack Principle: the use of high-occurrence stimuli to reinforce low-occurrence
behaviors
○ Using a highly desirable activity as a reward; music is a highly desirable and
effective Premack activity
, ● Incompatible responses: teaching a new behavior that is incompatible with the prior,
problematic behavior
● Aversive stimuli: results in pain or discomfort; not recommended or permitted
● Overcorrection: teaches clients correct alternative behaviors in lieu of inappropriate
behaviors
○ Restitutional—requires a client who has disturbed an environment to return the
setting to its improved state
○ Positive practice—client is required to demonstrate appropriate behavior in an
exaggerated manner or overly correct practice; or for an extended period or
number of times
○ Negative practice—requires the client to perform the inappropriate or undesirable
behavior until satiation occurs; fatigue
● Cognitive-Behavioral Techniques:
○ Encompass 3 domains in counselling:
■ Cognitive—cognitive restructuring such as thought stopping or cognitive
reframing, imagery, and use of evidence-based treatment manuals for
consistent intervention
■ Behavioral—exposure, response psychoeducation, modeling,
self-monitoring, role-playing, anger management, and behavioral
activation
■ Physiological—biofeedback and relaxation
○ Progressive relaxation—used in field of medicine; preceded by music listening
and followed by imagery for focus of attention away from the medical procedure
○ Cognitive restructuring—alter the cognitive distortions that caused the client to
perceive themselves negatively
○ Cognitive reframing—more effective; framed with music
○ Assertiveness and anger management—use of improvisational drumming is
effective
Biomedical
● The brain is the basic domain of treatment in all music therapy applications
● Biomedical model's purpose is to provide a biomedical basis for interpreting receptive,
expressive, and physiological behaviors of the human organism during musical
participation
● Sensory integration: the process by which the nervous system receives and organizes
tactile, proprioceptive, vestibular, olfactory, gustatory, visual and auditory sensations
● Basic function of the central nervous system is to receive sensory information, screen
and integrate meaningful stimuli, and respond motorically based on previous experience
● 5 Principles of Biomedical Theory of Music Therapy:
○ Music influences human behavior by affecting the brain and subsequently other
bodily structures in ways that are observable, identifiable, measurable, and
predictable, thereby providing the necessary foundation for its use in treatment
procedures
Supportive, Activity-Oriented
● Insight as to why behaviors occur is not essential to the therapy
● Typical goals:
○ Increase tolerance of instruction
○ Decrease avoidance behavior in possible failure situations
○ Teach how to achieve success in long-term projects
○ Increase attention span and concentration skills
○ Develop a realistic view of self
○ Increase self-esteem
○ Decrease “irresponsible” behavior in work situations
○ Increase tolerance of authority figures
○ Decrease avoidance behavior in social situations
○ Increase awareness, acceptance, and responsibility to others’ feelings
○ Develop skills in dealing with intense emotions
○ Develop knowledge of ways to avoid seclusive, passive living in the community
● Likely to be appropriate for the most severely ill patients
Re-Educative, Insight and Process-Oriented
● Primary goal of insight into material on a relatively conscious level
● Music is used to elicit emotional and/or cognitive reactions which are essential for
therapy
● Appropriate for clients whose problems do not cause severe personality disorganization
● Ex: listening to or playing music, then discussing the feelings elicited by the music
afterwards
Reconstructive, Analytically and Catharsis-Oriented
● Used when insight into unconscious material is the goal of the music therapy
● Work at this level requires advanced training
,Therapeutic Approaches
Behavioral
● Music can be used to modify behaviors
○ Structure
○ Prompts
○ Redirection
○ Rewards
● Reinforcement: an intervention intended to increase frequency of a behavior
○ Positive: giving reward
○ Negative: taking something away
○ Differentiated: works the slowest; positive reinforcement is used to target one
behavior while another targeted behavior is being reduced or eliminated
● Punishment: an intervention intended to decrease frequency of a behavior
○ Positive: giving something
○ Negative: taking something away
● Extinction: abrupt withdrawal of positive reinforcement that is maintaining an
inappropriate behavior
○ Ignoring, for example, is appropriate for attention-seeking behavior
● Contingencies: parts of the environment that influence the client into modifying their
behavior in a positive direction; rewards
○ Group contingencies: peer pressure leading toward a common target goal
● Token economies: tokens given for on-task behaviors that can be used to cash-in for a
reward
● Operant techniques
○ Task analysis—delineation of a selected activity into sequential parts
○ Prompt—cue that increases probability of a desired response
○ Errorless learning—procedure to establish accurate client response as rapidly as
possible without the appearance of errors
○ Chaining—the process of two or more responses being joined together
systematically, one at a time
■ Reverse chaining: if a child were memorizing a phone number, for
example, omit the last digit to see if they remember, then last two, etc.
■ Successive approximation: behavioral element or subset of a behavior,
each of which more and more closely resembles the specified terminal
behavior
○ Shaping—systematically reinforcing each successive approximation
○ Modeling—demonstrating an action to be taught to the client
● Premack Principle: the use of high-occurrence stimuli to reinforce low-occurrence
behaviors
○ Using a highly desirable activity as a reward; music is a highly desirable and
effective Premack activity
, ● Incompatible responses: teaching a new behavior that is incompatible with the prior,
problematic behavior
● Aversive stimuli: results in pain or discomfort; not recommended or permitted
● Overcorrection: teaches clients correct alternative behaviors in lieu of inappropriate
behaviors
○ Restitutional—requires a client who has disturbed an environment to return the
setting to its improved state
○ Positive practice—client is required to demonstrate appropriate behavior in an
exaggerated manner or overly correct practice; or for an extended period or
number of times
○ Negative practice—requires the client to perform the inappropriate or undesirable
behavior until satiation occurs; fatigue
● Cognitive-Behavioral Techniques:
○ Encompass 3 domains in counselling:
■ Cognitive—cognitive restructuring such as thought stopping or cognitive
reframing, imagery, and use of evidence-based treatment manuals for
consistent intervention
■ Behavioral—exposure, response psychoeducation, modeling,
self-monitoring, role-playing, anger management, and behavioral
activation
■ Physiological—biofeedback and relaxation
○ Progressive relaxation—used in field of medicine; preceded by music listening
and followed by imagery for focus of attention away from the medical procedure
○ Cognitive restructuring—alter the cognitive distortions that caused the client to
perceive themselves negatively
○ Cognitive reframing—more effective; framed with music
○ Assertiveness and anger management—use of improvisational drumming is
effective
Biomedical
● The brain is the basic domain of treatment in all music therapy applications
● Biomedical model's purpose is to provide a biomedical basis for interpreting receptive,
expressive, and physiological behaviors of the human organism during musical
participation
● Sensory integration: the process by which the nervous system receives and organizes
tactile, proprioceptive, vestibular, olfactory, gustatory, visual and auditory sensations
● Basic function of the central nervous system is to receive sensory information, screen
and integrate meaningful stimuli, and respond motorically based on previous experience
● 5 Principles of Biomedical Theory of Music Therapy:
○ Music influences human behavior by affecting the brain and subsequently other
bodily structures in ways that are observable, identifiable, measurable, and
predictable, thereby providing the necessary foundation for its use in treatment
procedures
