1. Zanders, Michael L.

Article Content

Throughout history, written or verbal, humankind has had a fascination with music and health. The ancient Greeks, most notably Aristotle and Plato, wrote about the healing effects of music. Although it may have earlier origins in ancient Egypt, Hipprocates, the father of modern medicine, theorized that music balanced the 4 humors of the body and related this to temperaments or moods, emotions, and behaviors.1 Not until the 18th century would any writing relate specifically to a field of music therapy. The first music therapy intervention was recorded in the early 19th century, which then gained further interest in organizing music interventions, particularly medical, into a field. It was not until the 1940s that music therapy became organized as a clinical profession,2 including educational and clinical training.


E. Thayer Gaston3 was instrumental in starting the first music therapy training program and also in providing foundational thought in his seminal book entitled Music in Therapy. In Gaston's3 book, he noted 3 principles of music therapy: "(1) the establishment or re-establishment of interpersonal relationships, (2) the bringing about of self-esteem through self-actualization, and (3) the utilization of the unique potential of rhythm to energize and bring order." This book then promoted further thought on theory, practice, and research in music therapy. It was not until 1987 that Bruscia4 posits the initial discussion of music as therapy versus music in therapy. Then in 1989, Bruscia5 further defined the difference between "as" and "in." In music as therapy, the "music has a direct influence on the client and serves as the primary agent of therapeutic change."5 In this way, music has a direct influence, and the therapist is a "facilitator" and has the expertise to provide the appropriate musical experience.


With music in therapy, "music is used not only for its own healing properties but also to enhance the effects of the therapist-client relationship or other treatment modalities."5 In this approach, music is not primary, and music experiences used depend on the music therapist. By definition, therapy is treatment to help a person get better6 but also includes a process of understanding the inherent dynamics related to health. Thus, both music as and music in therapy are both readily used by music therapists. As a continuum, then it could be seen within a session as how primary is the music experience or how primary is the music therapist. Zanders7 further described music therapy, which will hopefully be informative in further defining music as versus music in.


Further Defining

Zanders7 wrote that "Kenneth E. Bruscia's theory Defining Music Therapy theorizes the foundational and fundamental characteristics of the roles of the therapist, the client, and the music within music therapy."8 In Bruscia's8 definition, "music therapy is a reflexive process wherein the therapist helps the client to optimize the client's health, using various facets of music experience and the relationships formed through them as the impetus for change[horizontal ellipsis]. music therapy is the professional practice component of the discipline, which is informed by theory and research." The key components to this definition are reflexive process, music experiences, relationships formed, and a professional practice.


In being reflexive, the music therapist is aware of the dynamics of change as well as how the fundamental elements of music, namely, rhythm, harmony, melody, and so forth, relate to the patient's health. As this is a process, the product of health or "illness" is manifested through the patient's development. For example, a holistic approach to music therapy would see that reducing anxiety and stress in patients has a physical effect on the body and the health condition. Metaphorically, or perhaps literally, the elements of music are the elements of life. We are compositions or pieces of music, and when we create our "compositions," we create our health.9


Music therapy is experience oriented in that sessions may be strictly musical or include verbal components. This goes back to the discussion of "as" and "in"; for example, what is the primary agent of change, the music experience or the therapist? There are 4 main methods or music experiences used in music therapy: receptive, recreative, composition, and improvisation.8 Receptive experiences include both listening and responding to music whether physically, emotionally, or verbally. Recreative experiences involved the patient engaging in and learning music or playing. Zanders7 further remarked, "In this method, musical development does not mean that the client becomes 'good' at making music but that growth, change, or meaning is found in the act of making music." Composition, or more commonly song writing, is as the name implies-writing music as part of a health outcome. Improvisation is spontaneous music making with various musical instruments, both traditional and not, including vocal improvisations.


Music therapy is then a creative form of therapy. "Music therapists presume that musical products employed within various music experiences are creative experiences and are valued as part of the process. Creativity in the music allows for the client to imagine, think, or experience new ways of being."7 In this creativity, relationships are then formed. Thus, music therapy is relationship and method based and not prescriptive. Whereas traditional forms of therapy focus on patient-therapist, music therapy focuses on the therapist, patient, and music. In music therapy, "these relationships can be manifested and experienced physically, musically, mentally, behaviorally, socially, or spiritually."8


Music therapy is a professional practice and discipline and, like all health professions, requires rigorous training and education. In music therapy, competency is taught within 3 main areas: music foundations (thorough formal music education), clinical foundations (therapeutic relationship), and music therapy foundations (principles of music and health). Anyone can use music and have it be therapeutic. We all use music as a psychological resource, whether it is for relaxing, exercising, or even sleeping. Hence, neuroscience nurses and other healthcare professionals can use music as part of their practice. However, it is not music therapy, and for the purpose of the discussion, neither music "as" or "in." Music therapists do not own the health benefits of using music. However, by definition, music therapy is a process and does not only use music as a product. A significant difference is that music therapists are educated and trained to assess, treat, and evaluate how the elements of music influence and effect health goals. Without this fundamental music understanding, the therapeutic benefits are limited to a self-help anecdote or simply using music as a by-product to other health service outcomes. For example, I am no more a nurse because I can take someone's blood pressure. In addition, just because going to a music concert may be therapeutic, it does not make it therapy.


Essentially, music "as" or "in" is a philosophical discussion. Music therapists, as part of professional practice, use both interchangeably. At times, the music is used as the curative change. In this way, melody, harmony, rhythm, texture, tonality, and so forth are all part of who the patient is. To then understand the health need of the patient or client, you need to have a comprehensive training in the musical health need. At times, the therapist is the primary agent for the curative change and uses music within that process. For example, in the medical field, a professional can use music to help a patient relax, reduce physiological or physical symptoms, increase endorphin levels for pain, and so forth. This would be using music "in." Although beneficial and effective, it is still not music therapy because the relationship is still only between the medical professional and the patient. For the music therapist, the relationship would be between the therapist, the patient, and the patient's music. This relationship is not "social or entertainment based, but one based on the inherent meaning found through and with the music and the patient."7 Recently, Mortimer and Berg10 noted that integrative therapies such as music are useful for patients recovering from traumatic brain injury. However, the article does not fully present the fundamental understanding of the physical, psycho-physiological, neurological, emotional, and even spiritual dynamics of music.


Music therapy, and more specifically the discussion of music as versus music in, may be viewed as a movement between science, art, and humanity. "As a science, music therapy has predictable and observable changes. As an art, the engagement in the music experience provides meaning in and of itself. As a humanity, music therapy situates the patient, the therapist, and the music experiences in the larger health context of the client's ecology."7 In this way, the patient's "health" is related to the patient's ecological "health."




1. Kagan J. Galen's Prophecy: Temperament in Human Nature. New York, NY: Basic Books; 1998. [Context Link]


2. American Music Therapy Association. History of music therapy. Available at Accessed January 29, 2018. [Context Link]


3. Gaston ET. Music in Therapy. New York, NY: The Macmillan Company; 1968. [Context Link]


4. Bruscia KE. Improvisational Models of Music Therapy. Springfield, IL: Charles C. Thomas Publishers; 1987. [Context Link]


5. Bruscia KE. Defining Music Therapy. Spring City, PA: Spring House Books; 1989. [Context Link]


6. Cambridge Dictionary. Therapy. Available at Accessed January 29, 2018. [Context Link]


7. Zanders ML. Music Therapy. In: Neukrug E, ed., The SAGE Encyclopedia of Theory in Counseling and Psychotherapy. Thousand Oaks, CA: SAGE Publications; 2015:687-690. [Context Link]


8. Bruscia KE. Defining Music Therapy. 3rd ed. University Park, IL: Barcelona Publishers; 2014. [Context Link]


9. Lee CA. The Architecture of Aesthetic Music Therapy. Gilsum, NH: Barcelona Publishers; 2003. [Context Link]


10. Mortimer DS, Berg W. Agitation in patients recovering from traumatic brain injury: nursing management. J Neurosci Nurs. 2017;49(1):25-30. [Context Link]