By Richard LeComte
Photos by Samantha Hernandez
Music permeates our lives and gives us great pleasure. But music also can be a tool to help people at their most vulnerable – when they’re suffering from a physical disability, mental illness or dementia.
Even premature infants can benefit from a soothing lullaby with a light guitar accompaniment. Or a well-chosen song can bring a dementia patient to life.
“You pick the right song, and all of the sudden you have this animation and excitement in the client,” says Dr. Carol Prickett, professor of music at The University of Alabama and head of the music therapy program.
“They may smile or start tapping their fingers and toes, and their whole aspect changes from just sitting there with their head down, not paying attention or interacting with anybody when you walk into the room.”
Prickett and Dr. Andrea Cevasco know how to wield music for people with a variety of problems. They use quantitative methods to demonstrate how best to use music therapy in different situations. And, they share their insights with their UA students in a four-and-a-half-year, hands-on program. Music is a tool they use to alleviate antisocial behaviors or suffering.
“If a person is brought into an agency or a care facility, they are not at that agency because they have a music problem,” says Prickett, who founded UA’s music therapy program. “They have a behavior problem or a health problem, a breathing problem, a mobility problem, a cognitive issue or an attention span issue. It’s always a non-music issue. So, what you’re doing is measuring to see if the client improves after music therapy. For example, the number of emotional outbursts or the number of statements like ‘I want to kill myself’ may go down. Those are objective things that can be measured. We use them as outcome measures for our music therapy sessions.”
Prickett, who received the Lifetime Achievement Award from the American Music Therapy Association in 2009, began teaching at UA in 1983, and the music therapy program started in 1985. Cevasco, an assistant professor and chair of the research committee for the Southeastern Region of the American Music Therapy Association, began teaching at UA in 2006.
Both Prickett and Cevasco study by doing. Cevasco, for example, became involved in using music therapy for premature infants in neo-natal intensive care units while she was studying at the University of Georgia. When she came to UA, she started working with preemies at DCH Regional Medical Center. She and other researchers have found that gentle singing with fingerpicking guitar accompaniment, done when the preemie is in the right mood, can improve the infant’s health and actually allow the infant to be released from the hospital two to nine days earlier than infants without music therapy.
“We look at the babies’ oxygen saturation, heart rate and respiration rate for about three to five minutes before we start working with the babies, so we have a baseline of how the baby’s been functioning over the past five minutes,” Cevasco says. “While we’re working with the baby, we’re always recording, looking at the monitor and looking at the baby’s behavior state to see if the baby’s showing signs of distress.”
Obviously, keeping things calm is key – more James Taylor than Eddie Van Halen.
“We use our voice, and we use very slow guitar playing,” Cevasco says. “We typically slow down the music to a slow, simple format so the babies can handle the sensory input. There have been times when the students are learning and think this baby might be able to handle ‘Brahms’ Lullaby’, it’s a little more complex, and they start it, and the baby doesn’t like it. Because the infant’s heart rate increased or body language indicates a stress response, they go back to a slow, simple, steady song, such as ‘Frere Jacques’.”
Cevasco’s experience with preemies highlights one of the prime ideas behind music therapy: that live performance can have a stronger effect than canned music, Prickett says. The field of music therapy is marking 60 years as a formal discipline with university training, clinical training and standards of practice. The idea grew out of volunteers going to veterans hospitals and other institutions and performing music for the patients. Eventually, practitioners found that they got better results if they were trained, if they were more interactive with the patients, and if they used music patients really liked.
“First of all you needed a trained professional,” Prickett says. “We now have a 4 ½-year training programs that leads to a bachelor’s degree with 1,200 clinical hours. Part of that is a six-month full-time internship, plus passing a board certification exam. We used the patients’ preferred music, because it was shown over and over that you needed the genre of music that touches the client. It may be ‘One Day at a Time Sweet Jesus,’ so we may have to be able to give a very good rendition of (it).”
Prickett’s own experiences and research has involved dementia patients. She and her students work at Caring Days, a day clinic for people with memory loss. She has found that singing songs people like can bring them back, for a time, to stronger connections to the world around them.
“We had several students who had worked with this gentleman who was in the early stages of dementia,” Prickett says. “As it progressed, the family said the dad wasn’t talking as much or sharing as many stories, and it got to the point that where the student would go out and work with the gentleman, and the wife would come in during the last 20 minutes of the session because they would sing a song, and he’d say ‘Oh, I used to tap-dance to that,’ and he’d tell stories about these songs. The wife would come in and further prompt him, and she enjoyed that interaction she wasn’t getting any other day of the week. He was so excited when he talked about these songs and his past experiences.”
UA’s music therapy program, the only one in Alabama, is approved by the American Music Therapy Association. The program has between 30 and 35 majors, and Prickett notes that the students have a 100 percent pass rate on the association’s certification exam. Students are supervised in the community in many different clinical settings, including hospice, special-education classrooms and mental institutions. For the music therapy program, students first must be admitted to the School of Music, which requires an extensive preparation in music, and they take music theory and performance classes throughout their major. But music therapists, like one-person bands, have to use their voice and many different instruments, from guitars to a variety of percussion instruments.
“Every semester they’re in school, they have a music therapy class, and that’s where they branch beyond their specialty,” says Prickett, who received the Outstanding Commitment to Students Award from UA’s College of Arts and Sciences. Each student sings and plays the guitar and keyboard, she says. “Every music therapy major has a repertoire beyond what we traditionally teach in a school of music.”
And they have to expand their knowledge of popular music from a variety of periods. Both Prickett and Cevasco have compared what clients, particularly older ones, like to hear from their past with what the music students know. They found a big gap, one that music therapy students fill as their education unfolds. Still, songs Prickett and Cevasco assume everyone knows – “Oh, Susanna,” “This Land is Your Land” or “Frere Jacques” – may not be in their students’ internal MP3 player.
“It was frustrating to deal with college-age students – bright young musicians,” Prickett says. “I said, ‘Teach a round to blind people,’ I thought the challenge was how to bring blind people into the music without visual cues. It turned out that the students’ fear was not how to teach the blind kids; their fear was not being able to teach these songs that I had thought every adult had picked up.”
So Prickett and Cevasco did “Name That Tune” surveys to see what songs students knew and didn’t know. Cevasco took a list of top songs used by music therapists – hymns, show tunes, pop music and the like – and tested a range of music therapist students to see what they knew. Studies show that clients show more positive results when they hear songs they’re familiar with or like, so therapists need to know these songs.
“What we ended up finding out was that the more experience students had working with the older population, the better they would do,” says Cevasco, who sits on the editorial committee of the Journal of Music Therapy, the top journal in the field. “So if you had more clinical experience, you knew more music. We adjusted our curriculum, based on our research findings, to insure our students know the repertoire they need for all their clients.”
Thanks to that experience, music therapists, with techniques honed through research, can bring many different kinds of improvements to people’s lives. Prickett says that at the beginning of her career, she used music therapy to help severely mentally disabled patients in a mental hospital eventually learn simple tasks, like feeding and dressing themselves. For the preemies, it might mean better breathing. Or, for older people, it may mean getting a toehold on life once again.
“With dementia patients, we don’t cure the dementia, but if you want to calm their agitation, extend their participation, increase their respiration, have them improve their posture, sit up, smile, and be able to respond to you – then you sing with them,” Prickett says. “And if they’re past singing, get them to do things that get them tapping. These were the kind of things clinicians were beginning to pick up on, but you need to do research to verify.”