World Music Therapy Week: Liz Nolan on the healing power of music

"Sad songs say so much…" there's no denying the wisdom of Sir Elton. He’s far from the first to salute the powerful effects of music on our lives.

It’s Schubert’s holde Kunst or 'beloved art’, a ‘moral law’ in Plato’s imagining: while for Shakespeare, "The man that hath no music in himself, Nor is not moved with concord of sweet sounds, Is fit for treasons, stratagems, and spoils".

Testimonials aside, the healing potential of music has been harnessed in the evidence-based approach of music therapy. A clinically recognised profession, music therapy addresses a broad range of psychological, physical, behavioural and social challenges.

Practitioners generally work in conjunction with medical doctors and other clinicians to further an integrated recovery, or well-being, among patients. It’s an exciting dynamic; trials of music therapy practice have shown powerful improvement in patients’ physical and emotional well-being, in a holistic delivery that conventional medicine can’t replicate.

Hilary Moss is Associate Professor in Music Therapy at the Irish World Academy of Music and Dance, and chair of the Arts and Health Research Network at University of Limerick. An eloquent and hugely engaging advocate for her profession, Hilary is a frequent guest contributor on RTÉ lyric fm programmes, where she translates music therapy principles into everyday terms - check out the Music and the Mind series with the RTÉ Concert Orchestra, or a forthcoming lyric podcast on the Music Leaving Certificate.

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"It can’t be measured in the same way as, say, lab tests of a pill or vaccine, Hilary explains. "Music therapy can often help in the grey areas of health care." She continues "It’s all about the quality of life - it’s about other things being equally important as the fix. So, I think music therapy fits in to that area of medicine."

She relates a story of working with a group of stroke patients over six months, to research the effect of music therapy on their care. "I went round to all the members of the team; and they all said, ‘Well, I work very much on this aspect of stroke rehabilitation; the occupational therapist works on helping a person to be able to complete their activities in daily life such as using the toilet, dressing and attending leisure activities’, and the doctors are working with the symptoms of stroke and medication and other things.

"And they all said to me ‘There’s no one who talks to them about how they feel about this - how they’re processing this really traumatic event that’s happened to them. How are they expressing that emotion? And if you can’t talk, how are you expressing yourself? So, I think that’s where music therapy plays a role.

"I suppose it’s complementary to psychology as well, in that it’s a psychological therapy. It’s about giving people a vehicle to express themselves, whether that’s through playing an instrument, or singing, and helping people to adapt and cope. And often, finding something really positive in their lives.

"It’s a resource, isn’t it, music? Something people love to do, so they can continue that activity or that pleasure when they can’t do other things."

Hilary Moss began her career with a degree in classical music, and a vocation towards volunteering and social activism. "I realised that music therapy combined my talents, so I got involved, did some voluntary work, and became a music therapist" she says.

As a healthcare profession, music therapy grew out of the aftermath of the two World Wars; musicians would perform in hospitals for injured and traumatised soldiers. Between the 1950s and ‘70s, accredited associations for music therapy were established in the United States and the UK among others, and its practise spread worldwide. "At that time, there was a move away from the Freudian psychoanalysis to more humanistic therapy methods", Moss explains. Therapists are trained in a wide range of intervention techniques, which include improvisation, singing and playing instruments, song writing, and music relaxation.

Hilary Moss brings the theory to life, as she describes one technique called Matching and Mirroring: "So, if a client starts banging a drum - maybe they’ve only got one hand, and they’re making a sound. You match the sound with what you do, musically, as in, you’re thinking, what’s the volume? What’s the dynamic? Let’s suppose they’re not playing a drum, they’re playing keys on the piano randomly - what’s the tonality? what key could you play in, that would make them feel that you’re hearing them and matching them? It’s really that flexibility as a musician that makes [the therapist] able to adapt, and at a moment’s notice change a song from the key of D to F, because the person starts singing, and you want to match them - you want to say, I’m listening to you and I’m responding to you as you are."

Such skills in improvisation and agility require a high degree of musicianship. What kind of qualifications do you need to enter a Music Therapy degree? It’s quite a broad church, Moss explains. As well as music degree graduates, her MA course includes singer-songwriters and performers who haven’t come up through a formal music education. "I had a student recently who had worked in construction all his life, he was a builder, but was an amazing singer-songwriter and a guitar player," she says. "He came on the course, and he was terrified academically, but there is a route you can take, if you don’t have the academic qualifications - and he came out with a first, and he’s a fabulous music therapist now. So, we’re very open to different kinds of approaches".

But, she adds firmly, you have to be a good musician, one with the ability to communicate musically, and to be adaptable, in order to make a link with a person through music.

Music therapy takes in a flexible array of scenarios, geared towards a range of outcomes: Hilary Moss describes community music therapy ventures, where clients are supported through engaging with music, and building ties with others; "or it might be individual music therapy, helping the person to speak, because their verbal language is lost, but they can sing."

"When you have dementia, the ability to respond to music remains intact right to the end," she says.

Later on, she returns to the topic of neuroscience, and the startling potential of music therapy in this area: "Particularly among people with acquired brain injury and late stage dementia, for example; basically, music lights up many parts of our brain, when we interact with music or listen to music, or sing, or whatever. Whereas with speech, there are less parts of the brain activated in order to help you speak.

"One music therapist described it like this; if you’re trying to help someone to speak after brain injury, it’s like, there’s a straight road there. But with this injury, you have to take a detour through different parts of the brain. So your brain can adapt, and use different parts of the brain to get there. That’s why we use singing a lot, and speech therapists, who we work with, they would use music a lot, to sing words and then to move to speaking them. It’s using different parts of the brain that can help you do that."

In her own research and practise, Hilary focuses on singing and choral sessions as a therapeutic tool, and also as a means of overcoming social stigma: "Sometimes, if you say ‘Do you want to come and do music therapy?’ a young child or an adolescent might say ‘I’m not going to come to therapy, I don’t get it’. But if you say, Come and sing! It’s something a bit more accessible".

She goes on to mention a weekly choir session for dementia clients, and also her work in a mental health ward. "I’d had one music therapy group for years, but on a Monday morning, I just decided to start a singing group," she says. "So that anyone who’d just come in over the weekend, maybe suicidal or in crisis, or really at risk, they were just in the door, and it’s a bleak place to be. If you end up in a psychiatric ward on a Monday morning, you know, it’s tough," she states bluntly. "And I said, ‘There’s a singing group. And people could come along and listen to me sing, or sing a favourite song, or request a song. It allowed people very gently to engage with others as much as they felt comfortable and to participate in a therapeutic group, without the intimidation of walking into ‘group therapy’ and being expected to stay and participate verbally".

In her work with the Irish World Academy of Music and Dance, Moss has set up a research team looking into singing and social inclusion, and with one of her research students, an interactive web map which documents all Singing for Health and Well Being groups in the Republic of Ireland, an initiative run in conjunction with Sing Ireland.

Then there’s her work in her other speciality: chronic illness and pain, and how music therapy can support those who suffer from this. "There’s the whole area of coping with pain, and accepting that you have to live with something, whether it’s arthritis, or MS, or anything that can’t be cured," she says. "You have to live with it: at some level you have to accept and cope with it, and find ways to adapt."

With the organisation Chronic Pain Ireland, Moss and her colleagues offer online therapy to individual clients, and she also works with consultant anaesthetist Prof. Dominic Harmon of UHL. "[Prof. Harmon] talks about things like hope and optimism- which are so important, and he rates music therapy highly. Because it’s a way of connecting with something which you can control, that you enjoy, that you can express yourself and be individual. You can use music in your life to get you through".

How about a little music therapy in our everyday lives? Hilary Moss nods and grins. Mindfulness and music are a great resource, she remarks, as are curated playlists: to relax, to stimulate us in the gym... "And lifting the mood in the kitchen! I often say this one, that when you've got grumpy family members, kids, you know! Put on a bit of music and change that atmosphere. It really can just lift things a bit and change the mood of the place".

Regarding music choices: is there a prescribed repertoire of music for relaxing, for energy, and all the rest? I add my own tuppence-worth - of how this blanket definition of classical music as "relaxing" takes me from zen-to-homicide in seconds. Hilary laughs. "All the research that’s done to date would say that your preferred music is what we should work with," she says. "Whatever you find relaxing or you find stimulating is what we should be using. But then, there’s also a school of thought that you need to curate that, and that’s where a music therapist could help". She explains that a certain song, or piece of music, might carry too much emotional baggage to enable that individual to relax; she also recommends music without words when going to sleep, to calm the analytical brain.

Given the range of proven benefits offered by music therapy, it’s almost perverse of me to throw Gwyneth Paltrow in the mix... but here we go. With the prevalence of the wellness industry in today’s society, its plethora of alternative cures and therapies, sometimes of dubious effect, is there a risk that music therapy could be regarded as belonging to the ‘Goop’ phenomenon? "It’s one of the common myths, like ‘Is it a hippie thing?’" responds Moss, entirely unfazed. "Often in a healthcare situation it’s seen as the icing on the cake, like the pictures on the wall, or having an artist come and do some work. It’s not seen as integral to someone’s wellbeing". She warms up to the subject: "There are some psychological frameworks that show that your creative needs are real psychological needs. So, "if you’re in an institution, one of the things about institutionalisation is that you lose your leisure interests, and your family connections, and you become part of the system - like nursing home care, if you’re not careful you become that." She nods, "That thing, where you have your meal at the same time every day, and you have the same cup for your coffee, not the kind of coffee cup that you choose, that you find aesthetically pleasing".

"So, in the same way, we actually have a need for music and the arts", Moss says. "There are frameworks that say that it’s a psychological need that we have, that it should be met. It shouldn’t be ignored. It often gets left off the list, as it’s higher up the chain, it’s not the basic things - pain and safety - that have to be attended to first. Sometimes, health care managers forget that the other things are important to people".

As our meeting time draws to a close, there’s still so much to discuss, such as the benefits of music therapy for young people. "In relation to adolescents and mental health, it’s a no-brainer to me, that music should be the first psychological input," she says. "Because my own adolescent children, with them the way to get through is to ask them ‘What music are you listening to?’ There’s rarely music therapy in adolescent mental health units, I think there’s only two in the country where music therapy is part of the team".

'You are my sunshine' World Music Therapy Week celebrated by some of our music therapy team in ⁦@CHI_Ireland⁩ in our hospital at Crumlin - key part of care for children with fabulous facilities planned in our new hospital ⁦@nch_info⁩ pic.twitter.com/JHxu1sv7K1
— Eilish Hardiman (@CeoHardiman) April 11, 2023

We also touch upon the benefits of music therapy in tackling the effects of long Covid, in particular with regard to breathing issues. "It’s very interesting; I’ve a physiotherapy colleague at UL, Dr Roisin Cahalan, who’s working on this. She says the muscles you’d use for singing are the same muscles a physiotherapist would be advising someone with respiratory issues to use. So, they’ve developed a singing group called Sing Strong! rather than a physiotherapy session. They’re learning the same muscle skills from their diaphragm in the breathing".

For a final question, I ask Hilary Moss about her own plans and hopes for music therapy in Ireland. "The big thing for us as therapists is to be state registered as a profession alongside physiotherapy, speech therapy and the rest," she replies without hesitation. "We’re not officially recognised by the state, which means that anyone could call themselves a music therapist - which isn’t safe for the client. And then it would also mean that maybe more health services would recognise music therapy as a worthwhile service".

And then there’s her own continuing work as a therapist, to balance her research "so it’s not an ivory tower activity!" she laughs. "You know, we get very stuck in our professional identities, music therapy is one thing, music education is another, community music is another. Singing kind of goes across everybody… It’s just amazing.

"Sometimes, just the singing itself can produce such good feelings. It can lift your mood, it can break down social barriers and you can end up talking to someone you didn’t expect to talk to - it can do all of that without any education or therapy".

Thro' all the tumult and the strife

I hear the music ringing;

It finds an echo in my soul—

How can I keep from singing?

World Music Therapy Week runs from April 10th - 15th - find out more here, and find out more about the MA in Music Therapy at University Of Limerick here.

World Music Therapy Week: Liz Nolan on the healing power of music

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