Veiws on Music Therapy, Bottom Up and Many Populations

In every scenario of music therapy, music therapists are working towards bettering our clients. Music therapy services a wide range of population including mental health, hospice, individuals with autism, trauma issues, traumatic brain injury, and individuals with intellectual and developmental disabilities. In many cases, we (as a profession) are working from a bottom-up approach meaning we are assessing the client’s capabilities and formulating goals and interventions based on the client’s basic brain development, and then building upwards from there.

The bottom-up approach uses the intrinsic “iso-principle;” the “iso-principle” technique matches a client’s disposition and gradually adjusts it using musical ideas and stimuli which can be achieved by increasing or decreasing the music’s tempo and volume, and changing the accompaniment pattern on a chosen instrument. Because the bottom-up approach works with the basics of a client’s brain development, there is no-where but for the client to grow as the music therapist works to help the client achieve appropriate goals. The bottom-up approach can be modified and used with virtually any population. Here are a few examples of how the bottom-up approach works:

  • Barbara was a 93-year-old hospice patient with a terminal diagnosis of Alzheimer’s disease. She was sitting in the common area of her nursing home when the music therapy intern, Caroline, arrived for their weekly session. Barbara had her eyes closed, mouth open, and was making snoring-like vocalizations. Caroline softly invited Barbara into the session and wheeled Barbara to her room. Caroline began slowly to rouse the patient, and encourage Barbara to engage, at her most comfortable level. Providing soft, slow, fingerpicking on a guitar, Caroline musically facilitated matching the client’s deep breathing and fatigued presentation. It was important for this end of life client, to be able to feel relaxed and unlabored.As Caroline began to gradually increase the volume and tempo of Barbara’s preferred music (gospel songs), she helped Barbara to gain awareness of the musical support and connectedness, at a comfortable level. Barbara began to rouse and open her eyes wider over the course of the session. Barbara slowly began to engage by singing short, familiar phrases of her favorite gospel songs with Caroline. As Caroline increased the tempo, the lively strumming of Caroline’s guitar ignited Barbara’s singing with Barbara ultimately singing a fast gospel song, “Swing Low, Sweet Chariot.”Barbara actively participated for 8 minutes of continuous, conscious singing. Barbara was comfortably alert and engaged in the music therapy session. Her eyes smiled with Caroline’s, throughout. Caroline’s ability to match the client’s emotional and musical awareness level motivated the client to help her socially engage in the music therapy session.
  • Neil is a 5-year-old boy with autism. When Neil arrives for his music therapy visit, the music therapist (MT) notices that Neil is covering his ears with his hands and breathing rapidly. He is vocalizing by moaning and is scrunching his face and furrowing his brow, revealing that Neil is easily over-stimulated by loud noises. When asking Neil’s mother about his presentation, Neil’s mother tells the music therapist that there was loud construction on the way to the session and had been showing signs of distress on the way over (i.e. crying, covering ears, having moaning-like vocalizations).The MT invites Neil into the session room and beings by playing at a moderate volume on the piano and at a steady tempo to match Neil’s behavior and mood. Neil shuffles around the room at a relatively fast pace and continues to moan. The MT watches Neil and adds his moaning into the music by mirroring it on the piano or mirroring it using her voice. The MT begins to gradually decrease the music’s tempo and volume on the piano. Neil begins to slowly walk around the room and begins to remove his hands from over his ears. Neil’s breathing has slowed down and he slowly opens his eyes. By matching Neil’s presentation and decreasing the musical stimuli to a tolerable level for the client, the MT has effectively demonstrated the bottom-up approach in matching the client’s vocalizations and recognizing the client’s developmental needs.

The bottom-up approach allows the therapist to recognize the client’s physical and emotional responses and use music to facilitate a worthwhile musical experience where children can feel comfortable and safe enough to interact with the therapist. The bottom- approach can be used with many different populations, but it may look different, as described above. It is important to know that although each population is unique in their needs, approaches like bottom-up approach can be virtually universal to music therapists in helping their clients reach their goals.

Carly Flohs

Music Therapy Intern


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