BHA

Patient-centred healthcare

Transforming lives through music

Health and Homeopathy begins a new series where we take a close look at other complementary therapies and the impact they have on people's lives

When it comes to making a tangible difference to the lives of disadvantaged or vulnerable people, music isn’t usually the first thing that springs to mind. But a growing body of research demonstrates that music therapy, a registered profession in the UK since 1999 (regulated by the Health Professions Council) has a significant impact on people living with a number of challenges.

Nordoff Robbins is the UK’s largest private provider of music therapy. It is a registered charity, founded in 1980 on the pioneering work of the American musician Paul Nordoff and British educationalist Clive Robbins in the 1950s and 60s.

These two men carried out experimental musical work with profoundly disabled children, some of whom bore tragic lives of distress and self-injury. With the help of carefully chosen harmonies, appealing melodies and rhythms, the children were drawn into musical participation and began to develop increased social and self-awareness, as well as discipline and concentration. Placed in front of a snare drum and cymbal, they revealed their sensitivities and their expressive, receptive and relational abilities in their musical responses. It was a profound discovery of how music could be used for human benefit and Paul and Clive documented their observations and techniques in painstaking detail, making and transcribing recordings of their sessions.

Today, music therapists trained in the Nordoff-Robbins approach do not only work with disabled children but with people of all ages who live with difficulties of many different kinds. Their work harnesses the energy and communication which occurs when people make music together, without the need for using words. Music makes sense to people for whom words might be difficult, meaningless or confusing.

What is music therapy?
People can’t help responding to music. It’s everywhere. It changes mood and energy, it gets us moving, affects relationships, makes connections and gives us a sense of belonging and it helps us to communicate.

There are many people who struggle to communicate. Men, women and children of all ages who may have a longterm moderate to severe disability, those with mental health problems or dementia, autism, a brain injury or terminal illness – people with these conditions can and have benefited from music therapy. Another area where Nordoff Robbins has found that music can be hugely effective is in helping people who are isolated. Music has a unique power to transform lives. When music reaches people, it is tremendously powerful.

For some, music therapy has physical benefits; for others emotional or social ones. It helps people feel more motivated, social and self-confident.

People who come to music therapy engage in a way that’s right for them. Sessions can be onetoone, or in small or large groups. Sometimes family members, friends or carers get involved. The work can involve playing different instruments, singing, music that is wellknown, music made up on the spot, movement, writing songs, rehearsing and performing, and creating music-based stories.

The music therapist makes music together with those who have come for music therapy, or facilitates them in discovering the form of music-making that is right for them.

There are many physical benefits of music therapy. Singing, for example, exercises major muscle groups in the upper body and helps breathing – great for people with lung conditions; playing instruments can help those with restricted movement to extend muscles and improve their capabilities; the interactive nature of music therapy is effective in developing many mental and behavioural processes, including cognitive development, language learning, reading ability, creativity and communication skills; and for those with isolating conditions like dementia or mental health problems, making music provides a means of social interaction that alleviates anxiety and depression.

How music therapy is provided
The NHS is the largest provider of music therapy in the UK and this unique form of therapy is usually delivered within hospitals or mental health services. This means that in most cases music therapy is only available to people being treated by a particular specialist unit or service, and unfortunately not accessible to members of the general public. The same is true for music therapy services provided within special needs schools.

Nordoff Robbins delivers over 50,000 music therapy sessions per year in a variety of settings across the UK including schools, hospitals and care homes, as well as its own centres where anybody can be referred for music therapy. The charity’s main centre is based in North West London and it also has a unit at the BRIT School for Performing Arts and Technology in Croydon. Nordoff Robbins works with a number of partners including Great Ormond Street Hospital, Camden Social Services and Barchester Healthcare. All its sessions are delivered by qualified music therapists either in onetoone or group sessions.

Music therapy training
Nordoff and Robbins began training musicians to work as music therapists in 1974, and today this forms an important element of the charity’s work, alongside its music services and research. As a leader in the field, Nordoff Robbins offered the first music therapy Master’s degree in 1995, a twoyear training programme (validated by City University London) and in 2011 launched its new Master of Music Therapy (Nordoff Robbins): Music, Health, Society.

Practising as a music therapist requires a high level of musical skill and wide-ranging psychosocial understanding of how music and music-making impact on a person’s experience of health and wellbeing, individually and communally. Much of the course involves practical, hands-on training in which students learn the best ways to engage people musically, whose life experience, illness or disability or social exclusion make it hard for them to participate in life. They become skilled in using musical-personal skills to engage clients individually and in community contexts, opening up areas of self-experience and of interaction with others. There are modules in psychology, musicology, sociology, culture and health studies, as well as theoretical and research material from the music therapy field. This helps the student music therapist meet wide-ranging needs and learn to explain their work coherently to managers, employers and funders.

Research in music therapy
Pioneering research has been part of the Nordoff Robbins approach from the very beginning. It was established by Paul Nordoff and Clive Robbins over fifty years ago as an integral aspect of their work.

Today the profession needs research activity and evidence in order to:

maintain the high quality of the services provided
provide demonstrable evidence of the benefits of music therapy for individuals, organisations, funders and employers
help train the practitioners of the future
develop disciplinary knowledge and innovative professional practices

Recent research, conducted in Finland, showed how music therapy can help people overcome depression. Adults, who were given music therapy sessions in which they played drums or instruments such as xylophones, showed fewer symptoms of depression or anxiety than those who just had standard counselling.

Professor Christian Gold from the University of Jyväskylä said: “Our trial has shown that music therapy, when added to standard care including medication, psychotherapy and counselling, helps people to improve their levels of depression and anxiety. Music therapy has specific qualities that allow people to express themselves and interact in a nonverbal way – even in situations when they cannot find the words to describe their inner experiences.”

In response to the depression research, Pauline Etkin, CEO of Nordoff Robbins said: “Nordoff Robbins music therapists have been working with people with depression for over 36 years. We regularly see the difference music therapy can make even to people struggling with severe and long-term depression.

“Music therapy offers people with depression an opportunity to express themselves and interact with others without the need for words, thus discovering new ways of relating and being. It has the potential to meet and acknowledge depression while also offering direct experiences of wellbeing, enjoyment and recovery.”

Research continues to be a key part of the work Nordoff Robins does today. Closely interwoven with its music services, research is directed by and fed back into the daily work therapists do, helping them understand the “how” of music therapy.

Case Example 1: Eduardo
Eduardo was 10-years-old when he first came for music therapy at Nordoff Robbins. From an early age he had had difficulties playing and communicating with other children. By the age of 5 he had no friends and was behind at school. After a long period of assessment and tests he was diagnosed with autism.

In music therapy Eduardo initially found it hard to express himself freely. Gradually he began to let go. He began to discover that it was good, safe and exciting to express and share his feelings in music.

His mother said: “Eduardo’s development and progress through music therapy has been astonishing. For him, the world is a frightening, chaotic and confusing place, but he absolutely loves music therapy. Through singing and playing instruments he has found ways to express himself freely and communicate. He has let go of some of his defences and the trusting bond he has developed with his therapist has helped him become much more emotionally stable. His behaviour has improved and he is more able to connect and communicate with others.

“We know that there is no specific cure or medical treatment for autism, but music therapy helped him to develop relationships both inside and outside the family, to give him emotional experiences that he otherwise would not have had. Eduardo has quickly become a more social, happier and confident boy.

“Recently, his school reported significant progress in maths, reading and science – an amazing transformation as a year ago he could barely read at all and struggled with the most basic sums.

“I truly believe music therapy has helped unlock my son’s potential and given him the best chance in life that he could have. I am very thankful for the team of skilled and passionate professionals at Nordoff Robbins.”

Case Example 2: The Chelsea Community Music Therapy Project
This is a Nordoff Robbins project which uses music to help people with mental health difficulties make the transition between life in hospital and their recovery in the community. Sarah Wilson works as a music therapist at South Kensington and Chelsea Mental Health Centre (an NHS psychiatric hospital). With Dr Gary Ansdell she also works in SMART, a community centre for people living with mental health issues. A weekly open group called “SMART Music” is a cross between a music therapy group and an “open mic” session. Two spinoff groups – SMART Singers and SMART Band – have also been formed and supported by Sarah they rehearse weekly and perform in local venues.

One service user who has participated in the project commented: “Music triggered a healing process from within me… I started singing for the joy of singing myself and it helped me carry my recovery beyond the state I was in before I fell ill nine years ago to a level of wellbeing that I haven’t had perhaps for thirty years.”

In 2008, the Chelsea Community Music Therapy Project won the Royal Society for Public Health Arts and Health Award in recognition of the “significant and innovative contribution made to the field of Music and Health practice”. The same year the project was featured by BBC Radio 3 on the Music Matters programme.

Amelia Mustapha is Chief Executive of SMART. She is fully convinced of the profound impact of music therapy at the centre: “SMART Music lights up this organisation and the lives of the people who participate in it. It is one of the most important things we do here.” The project is also currently being tracked in a research project conducted by Nordoff Robbins which follows people from discharge from an acute mental health setting to living resourcefully in the social and cultural community. This research is building a rich theoretical and research perspective on the data through the lenses of cultural sociology and music therapy theory.

For more information about Nordoff Robbins and details about how you can get involved in its life transforming work, visit www.nordoffrobbins.org.uk or call 020 7267 4496.