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Nordoff- Robbins

 * Further Information: Nordoff-Robbins

Paul Nordoff, a Julliard graduate and Professor of Music, was a gifted pianist and composer that upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. Dr. Clive Robbins, a special educator, partnered with Nordoff for over 17 years in the exploration and research of music’s affects on disabled children- first in the United Kingdom, and then America in the 1950’s and 60’s. Their pilot projects included placements at care units for autistic children and child psychiatry deparments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and handicaps. Their success at establishing a means of communication and relationship with autistic children at the University of Pennsylvania gave rise to the National Institutes of Health’s first grant given of this nature, and the 5-year study “Music Therapy Project for Psychotic Children Under Seven at the Day Care Unit” involved research, publication, training and treatment. Several publications including Music Therapy for Handicapped Children, Creative Music Therapy, Music Therapy in Special Education, as well as instrumental and song books for children were released during this time. Nordoff and Robbins’ success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. Funds were granted to support the founding of the Nordoff-Robbins Music Therapy Center in Great Britain in 1974, where a one-year Graduate program for students was implemented. In the early eighties, a center was opened in Australia, and various programs and institutes for Music Therapy were founded in Germany and the United States.

The Nordoff-Robbins approach is now practiced by hundreds of therapists internationally, which is based on the belief that anyone is capable of benefitting in personal growth through music. It focuses on treatment through the creation of music by both therapist and client together. Various techniques are used to accommodate all capabilities so that even the most low functioning individuals are able to participate actively.

Orff Music Therapy

 * Further Information: Orff-Schulwerk

Developed by Gertrude Orff at the Kindezentrum München, is another approach known as Orff Music Therapy. Both the clinical setting of social pediatrics as well as the Orff-Sculwerk (Schoolwork) approach in music education (developed by German composer Carl Orff) influence this method, which is used with children with developmental problems, delays and disabilities. The area of social pediatrics was developed after the Second World War in Germany by Theodor Hellbrügge, who understood that medicine alone could not meet the complex needs of developmentally disabled children. He consulted psychologists, occupational therapists and other mental healthcare professionals whose knowledge and skills could aid in the diagnostics and treatment of children. Gertrude Orff was asked to develop a form of therapy based on the Orff-Sculwerk approach to support the emotional development of patients. Elements found in both the music therapy and education approaches include the understanding of holistic music presentation as involving word, sound and movement; the use of both music and play improvisation as providing a creative stimulus for the child to investigate and explore; Orff instrumentation, including keyboard instruments and percussion instruments as a means of participation and interaction in a therapeutic setting; and lastly, the multisensory aspects of music used by the therapist to meet the particular needs of the child, such as both feeling and hearing sound.

Corresponding with the attitudes of Humanistic psychology, the developmental potential of the child- as in the acknowledgement of their strengths as well as their handicaps, and the importance of the therapist- child relationship are central factors in Orff Music Therapy. Theoretical foundations are also influenced by the strong emphasis on social integration and the involvement of parents in the therapeutic process found in social paediatrics. Knowledge of developmental psychology puts into perspective how developmental disibilities influence the child, as do their social and familial environments. The basis for interaction in this method is known as responsive interaction, in which the therapist meets the child at their level and responds according to their initiatives, combining both humanistic and developmental psychology philosophies. Involving the parents in this type of interaction, by having them participate directly or observe the therapist's techniques, equips the parents with ideas of how to interact appropriately with their child, thus fostering a positive parent-child relationship.

Bonny Method of Guided Imagery in Music (GIM)

 * Further Information: Guided imagery

Music educator and therapist Helen Lindquist Bonny (1921- May 25,2010) developed an approach influenced by humanistic and transpersonal psychological views, known as the Bonny Method of Guided Imagery in Music, or GIM. Guided imagery refers to a technique used in natural and alternative medicine that involves using mental imagery to help with the physiological and psychological ailments of patients. . The practitioner often suggests a relaxing and focusing image and through the use of imagination and discussion, aims to find constructive solutions to manage their problems. Bonny applied this psychotherapeutic method to the field of music therapy by using music as the means of guiding the patient to a higher state of consciousness where healing and constructive self- awareness can take place. Music is considered a "co-therapist" because of its importance. GIM with children can be used in one-on-one or group settings, and involves relaxation techniques, identification and sharing of personal feeling states, and improvisation to discover the self, and foster growth. The choice of music is carefully selected for the client based on their musical preferences and the goals of the session. Usually a classical piece, it must reflect the age and attentional abilities of the child in length and genre, and a full explanation of the exercises must be offered at their level of understanding. .

The use of guided imagery with autistic children has been found to decrease stereotypical behaviours and hyperactivity, increase attention and the ability to follow instructions, as well as increase self-initiated communication, both verbal and non-verbal.

Assessment and Interventions
As with any type of therapy, the practice of Music Therapy with children must uphold standards of conduct and ethics, agreed upon by national and provincial associations such as the Canadian Association for Music Therapy. In part with this, formal assessment is crucial for understanding the child – their background, limitations and needs, as well as to create appropriate goals for the process and select the means of achieving them. This serves as the starting point from which to measure the client’s progression throughout the therapeutic process and to make adjustments later, if necessary. Similarly to how assessments are conducted with adults, the music therapist obtains extensive data on the client including their full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and nonmusical functioning (social, physical/motor, emotional, etc). The assessment process is then carried out in formal, informal, and standardized ways.

The following are the most common methods of assessment:
 * Interviews with Clients and/or Family Members
 * Structured or Unstructured Observation
 * Reviewing of Client Records
 * Standardized Assessment Tests

Information gathered at the music therapy assessment is then used to determine if music therapy is indicated for the child. The therapist then formulates a music therapy treatment plan, which includes specific short term objectives, long term goals, and an expected timeline for therapy.

Music therapy interventions used with children can fall into two categories. The first, Supportive active therapy, is product- oriented and can included rhythm activities such as body percussion (stomping feet, clapping hands, etc.), singing songs which re-inforce nonmusical skills, awareness and expression, or movement to music (as simple as marching to the beat, as complex as structured dances). The second area is called Insight music therapy which is process-oriented. Activities could include song-writing, active listening and reacting, or auditory discrimination activities for sensory skill development.