Music Therapy – Still Experimental?

By Wes Scarborough

Reporting Texas

Rebecca Faulkner holds up an iPad and asks Johnathan to pick a song from the list displayed on the tablet’s screen. He drags his eyes across the room, groans and plants his index finger on the center of the touchscreen.

“I don’t have the voice for that one today,” Faulkner says with a slight chuckle. “What about ‘Ring of Fire’? I somewhat have the voice to be Johnny Cash today.”

Jonathan nods his head while Faulkner grabs her nylon-stringed acoustic guitar and swings into the chorus of the Johnny Cash classic. She sings while cueing Johnathan to sing along in the spaces of the chorus she purposely leaves void.

“Maintaining eye contact is very hard for kids with autism,” Faulkner said. “To keep them engaged for two seconds is huge… Having them sing along builds their confidence. They may not want to speak in complete sentences, but they can sing an entire song.”

Faulkner is a music therapist, a profession that the website for the regional chapter of the American Music Therapy Association says uses clinical and evidence-based musical interventions to accomplish individualized goals within a therapeutic relationship. Music therapy serves clients with various disabilities, illnesses and special needs. Therapists train at both undergraduate and post-graduate programs across the country and are certified nationally by the Certification Board for Music Therapists.

Despite decades of research showing that the therapy helps patients, music therapists struggle to achieve professional status at the state level. Texas is one of 43 states with a task force appointed by the American Music Therapy Association to educate legislators and to spread awareness of the profession’s health benefits. They seek to gain a licensure that would both ensure music therapy is being practiced by qualified professionals as well as help clients secure reimbursement from insurance companies.

Faulkner specializes in special-needs clients, like Johnathan, in the Austin area.

“Some of my students, before working with them, would have almost no verbal language at all,” Faulkner said. “Now they are able to communicate with a picture board to tell me ‘this is what I want.’”

Music therapy was formally introduced shortly after World War I. Community musicians, both amateur and professional, were asked to play at local hospitals around the U.S. to benefit veterans with emotional and physical trauma. The patients’ notable physical and emotional responses to their music led to doctors hiring musicians to be on staff.

Later, advocates for music therapy pushed to have a college curriculum developed. According to the AMTA website, the first academic program was established in 1946 at Michigan State University. Since then, 76 universities have adopted their own music therapy programs. Texas has five different programs at schools such as Sam Houston State and Southern Methodist University.

“We’re a health profession based on the fact that music can be a healthy activity,” said Al Bumanis, director of communications at the music therapy association.

A certified music therapist must have at least a bachelor’s degree and pass the national exam administered by the Certification Board for Music Therapists. Students are musically trained (typically in piano, guitar, and voice) and complete a curriculum that includes clinical coursework and extended internship. There are now about 6,000 practicing music therapists in the nation, with 415 practicing in Texas, according to the southwestern region of the AMTA.

“We’re not just musicians,” said Kate Harrison, a member of the AMTA-appointed Texas task force. “We have significant knowledge in other [fields], such as brain pathology.”

Eddie Konopasek, a music therapist with the Center for Music Therapy of Austin, said it typically focuses on clients with several types of disabilities: cognitive, physical/motor, speech, communication, social, emotional and behavioral.

“It’s not a cookie-cutter treatment,” Konopasek said. “You create an interactive, person-centered experience. Everything is totally customized to that person. We don’t play Black Sabbath for a person who likes Justin Bieber.”

Konopasek offered another analogy.

“When you listen to a CD, it’s cool or whatever,” Konopasek said. “But when you go to a concert or a show, think of the different senses you’re stimulating. Imagine if [the band’s] set list was all of your favorite songs and guided in a way that helps you get better at something.”

A wide variety of studies have been conducted on the effects of music therapy. In 2005, The Journal of Pediatric Nursing published a study that showed music therapy had a 100 percent success rate with pediatric patients for eliminating the need for sedation. Nursing Economics published a study in 2007 showed that using a certified music therapist in a home hospice setting was “a strong point and critical to the program success.”

Since the state of Texas does not license music therapists, those professionals face two big issues: misuse of the term by untrained musicians and difficulties getting insurance coverage.

Untrained performers “don’t have research goals behind their services,” Faulkner said. “I’m glad people provide those services at elderly homes and clinics…But what we’re doing isn’t volunteering. We’re playing music with them, not for them.”

As for insurance coverage, Bumanis, the national spokesman for music therapists, said only 25 percent of clients nationally are reimbursed for music therapy services.

“You look at the other allied health professions,” Bumanis said. “They were going through the same growing pains…but we would like to see more coverage.”

“Some insurance companies say we’re duplicating treatments,” Faulkner said. “As soon as the state of Texas accepts the fact [music therapy] is beneficial the sooner we’ll get our certification.”

Harrison, a Houston area music therapist, said Blue Cross Blue Shield of Texas, for example, still considers music therapy an alternative treatment. Patients can appeal denials of coverage through a doctor’s note or a letter of necessity, she said, but they often fail.

“It’s disappointing they’re not recognizing alternative treatments and that they’re not listening to their members sometimes,” Harrison said. “We will continue to fight for our clients and fight for our field and continue to educate the community and document the benefits of music with the brain.”