In my last post, I discussed questions I received from high school students during a Q&A. One question that stood out to me was: You said in your TED talk that music can be harmful. How is music harmful and why?
This question caught my attention because it addresses a big misconception about music therapy – that it’s simply entertainment or that anyone can do it. We all can agree that music is helpful, but not everyone is qualified to use music as a therapeutic tool. Music therapists become protective about how music is used in healthcare and educational settings because we want to protect our clientele from further damage. In many situations, music can be unhelpful and potentially harmful if you do not have the understanding of a person’s emotional, physical, physiological, mental, and spiritual responses to music.
There are many elements to music, and each element needs to be heavily considered within the context of therapy. Here are a few key elements I wanted to highlight to better your understanding of the depth of the music within music therapy, but know that it won’t cover the extent of this issue. This is something that music therapists dedicate their education to, and frankly, requires a lot of study and training.
Elements of Music That Could Lead to Physical, Emotional, Mental, Spiritual, or Physiological Harm:
1. The Lyrics: One of the more obvious ways music could be harmful is within the lyrics. This harm is not necessarily in terms of “negative vs. positive” lyrics, but more in the sense of how the lyrics make you feel. Lyrics in music therapy are first meant to validate and affirm your own feelings and build rapport. Then, the music therapist may use lyrics to create conversation, challenge your thinking, address an issue, problem-solve a situation, or form a direction for your therapeutic goals. The music therapist is very mindful of what the lyrics may be conveying and how they affect the patient.
For example: What if a you were a homeless patient and are unable to pay for medications. How would you feel if someone played the song, “Don’t Worry, Be Happy” by Bobby McFerrin? Is it possible that song could make you feel isolated, guilty, and/or frustrated? That song might convey to the patient that you don’t understand them or their situation. Or, what if you were recently diagnosed with cancer, have no family support, and someone plays the song, “I’m Gonna Love You Through It” by Martina McBride? Is it possible that song would increase your sadness over being alone during this difficult time, or more importantly, push you towards feelings you are not comfortable addressing yet?
Words can be harmful, which means lyrics can be harmful. Music also lends to vulnerability, which increases your chances of experiencing harm. It’s the music therapist’s job to know what to say and how to say it within the music at the appropriate time.
2. The Sound: There are many factors regarding the sound of music, including the volume, timbre, acoustics, and the types of instruments used. Sound connects deeply with stimulation, which generally refers to a person’s physiological state (heartbeat, respiratory rate, movement, etc.). When someone experiences overstimulation, it can be unproductive towards therapeutic goals and can sometimes be harmful to the patient depending on their condition.
When a typical adult is overstimulated, they might feel discomfort, agitation, anxiety, or physical distress. Often, if an adult is overstimulated while experiencing music, they might simply ask you to stop or they will leave. Think about this in terms of attending a concert that you consider is too much. You might feel that the volume is too loud, the bass thumps too strongly in your chest, and the patrons are too crowding over your personal space. What does this all of this feel like? Overstimulation. Most adults are equipped to deal with this overstimulation, but it becomes an issue when experienced by those who cannot advocate for their needs. Two examples of this are those who have developmental disabilities or babies in the NICU. For these patients, they are often unable to express their overstimulation in a way that is typical, so it is up to the therapist to assess their responses to the music to prevent feelings of discomfort, neurological distress, or increased agitation. The therapist makes decisions about their responses and adjusts as necessary, such as decreasing the volume, changing their instrument or the quality of their singing voice, or closing a door. When overstimulation occurs with those who are fragile, the outcome could be more damaging than helpful.
3. The Implementation: I’ve written about a music therapy concept called iso-principle in the past, and it remains a difficult concept to describe briefly.Similarly to sound, iso-principle is a phenomenon that requires constant awareness and assessment of responses. In simplest terms, I think of iso-principle as being a technique that allows the therapist to meet the patient where they are at and move them towards their goal, all within the music. This technique is important to develop because it prevents harm of a patient. For example, if you do not meet a client where they are at within the sound quality, tempo, lyrics, and overall manner of which you enter a room, a patient is first, likely to be turned off towards music therapy and second, possibly at risk for harm.
Picture this: A musician enters the hospital room of a pediatric patient recently diagnosed with cancer. The family is present, they have no experience with this type of cancer, and they only learned of this diagnosis a few hours ago after a terrifying experience of their child becoming very sick. They have been feeling shock, fear, and worry about the future of their child, while their child currently remains feeling sick and scared. The musician loudly announces her arrival, exclaiming she’s there to play music for the child and family in order to lift their spirits. The musician stands tall over the child lying in bed, presents an animated smile on her face and begins to play an upbeat, loud version of the song, “Happy” by Pharrell.
How does this scenario meet the family and child where they are at? Everyone has good intentions and music often helps people feel better. But in this scenario, the musician put her own needs first (to get a job done) and was unaware of the needs of the pediatric patient and family. This is evident from the way she entered the room, the song she chose, the way in which she played the song, and the lack of understanding of the situation at hand.
The harm was not in the music itself, but in how it was implemented.
This question of how music can be harmful is especially pertinent today, during #FloridaMusicTherapy week. Currently, music therapists in Florida are working to pass a legislative bill to create a registry of music therapists that would protect the consumer by ensuring that only board-certified music therapists offer music therapy in the state of Florida. Music therapists are the first to agree that we do not hold a monopoly on music – that is someone everyone is allowed to enjoy and experience. But it is our responsibility to advocate for the safe and proper use of music as a therapeutic tool.