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A Behavioral Approach to Music Therapy

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A behavioral approach to music
therapy
Clifford K. Madsen
Center for Music Research
School of Music, The Florida State University
While I have been asked to address this group as providing a
“founding model” of one of the Five International Models of Music
Therapy, I take no personal credit for founding this approach,
other than my own research and the research that I have completed
with my associates.
I first spoke of using a behavioral approach to music therapy
during the National Association for Music Therapy Conference
in Cleveland, Ohio, in 1966, in an address to the general assembly
titled “Music in Behavior Modification” (1996). Subsequently,
an article titled “A Behavioral Approach to Music Therapy” was
published in the Journal of Music Therapy in 1968 co-authored
with the late Vance Cotter who was instrumental in developing
this approach at the Parsons State Hospital, Topeka KS, during
his association with the University of Kansas and my brother
Charles who is a behavioral psychologist. During those times the
behavioral approach was just beginning to be recognized; today
many music therapists are committed to this orientation.
The behavioral approach to music therapy rests on the
defining characteristic of music therapy as the scientific application
of music to accomplish therapeutic aims whether they are
behavioral, developmental and/or medical. It is the use of music
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and the therapist’s self to influence changes in behavior. The
behavioral approach to music therapy relies upon learning
principles and concentrates on assessment and remedial programs
based upon the environmental control of behavior. Behavior is
modified by explicitly arranging the consequences of responses
based upon reinforcement principles.
Music therapy as a method of behavioral manipulation is
automatically considered as falling under the purview of the
applied sciences and the effects of music interventions in applied
medical research. Sometimes this approach is called “applied behavior
analysis” and often it is referred to as music cognitive/behavior
modification. Regardless, it is the nature of the research concerning
this approach that serves as its distinguishing feature. While the
term “research” is often associated with many approaches, the term
is used in the behavioral context to indicate those empirical
findings that are publicly verifiable and replicable.
The theoretical underpinnings of this approach are consistent
with other scientific approaches and are intentionally parsimonious,
yet very far reaching. Music can be used (1) as a cue, (2) as a time and
body movement structure, (3) as a focus of attention and (4) as a
reward. While principles are few, effective application of the
behavioral model is extremely complex and requires extensive
training for effect intervention. Behavioral music therapy requires
a solid understanding of the principles of behavior, a refined ability
to analyze, criticize and choose alternatives, necessitating extensive
creativity in designing procedures. This approach involves the
creation, selection, and improvisation of music idiosyncratic to
the specific necessities of dealing with shaping the behavior of
each individual patient or client.
Behavioral therapists condition, counter-condition,
extinguish, desensitize, role-play, and train or retrain their clients,
patients, or subjects as well use relaxation, conditioned avoidance
responses, self-disclosure, emotive imagery, modeling, negative
practice, expressive-rational approaches, and stimulus deprivation.
All use music toward the end of producing empirical changes in
behavior. This approach advocates the use of strict experimental
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procedures to study observable behavioral responses in relation to
environmental stimuli.
The history of the behavior modification movement includes
several eminent scientists and has corollary within the philosophical
community. The American psychologist John B. Watson was a
founding pioneer in the early 20th century. At that time, psychology
was viewed predominantly as the study of inner experiences or
feelings by subjective, introspective methods. Watson did not deny
the existence of inner experiences, but insisted that these
experiences could not be studied because they were not observa-
ble. Watson proposed to make the study of psychology more
objective by using procedures, such as laboratory experiments
designed to establish statistically significant results. This
behavioristic view led him to formulate a stimulus-response theory
of psychology. The philosophical corollary to behaviorism was
logical positivism as advocated by Rudolf Carnap and Ludwig
Wittgenstein.
In the mid-20th century, American psychologist B. F. Skinner
developed a position that he later referred to as radical behaviorism.
He agreed with Watson’s view that psychology ought to be centered
on the study of the observable behavior of individuals interacting
with their environment. However, he maintained that inner
processes, such as feelings, should also be studied using scientific
methods, with particular emphasis on controlled experiments.
Since 1950, behavioral psychologists have produced a vast
amount of research mostly dealing with basic research directed at
understanding how behavior is developed and maintained.
Behavioral music therapists generally use applied research designs
(both experimental and single subject) to document changes in
behavior attributable to specific music therapy interventions. This
research was intended to separate the effects of music therapy from
other variables such as regular therapy, drugs, institutional regime,
placebo effects, Hawthorne effects, and so on. Experiments were
conducted concerning all aspects of music therapy in general and
music in modifying specific behaviors in particular. This line of
research continues and most of the ongoing practices of music
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therapists in the United States rest on solid demonstrable evidence
concerning music therapy’s documented efficacy.
Over the years, music therapists have done prodigious works
in documenting behavioral, developmental and medical procedures
with the kind of data acceptable to the greater scientific and
medical communities. As early as 1955, Jeffrey reported in the
journal Science the effective use of music as a reinforcer (Jeffrey,
1955). Another classic study used the contingent interruption of
music to reduce multiple tics (Barrett, 1962). Experimentation
in the area of music therapy began to burgeon in the mid-1960s
at several centers of development most notably Parsons State
Hospital in Topeka Kansas and The Florida State University,
Tallahassee, Florida. I combined some of this early research with
the help of Doug Greer and my brother into a book published in
1975 (Madsen, Madsen, & Greer, 1975). Experimentation
continues to this day and includes a vast database, much of it
chronicled in the Journal of Music Therapy, emphasizing the
empirical basis of this methodology. Indeed, this foundation of
research is expected as the sine qua non of being able to practice
within many institutions and agencies in the United States. This
is because of the growing emphasis on measurable outcomes
demanded for any therapeutic procedure. Some of the best
examples of this approach can be found in a recent publication:
Outstanding Reprints from the Journal of Music Therapy, (Edited
by Jayne M. Standley and Carol A. Prickett), Silver Spring, MD:
National Association for Music Therapy, Inc., 1994.
Now, I would like to discuss an early study of mine “Music as a
Behavior Modification Techniques with a Juvenile Delinquent.” in
some detail in order to illustrate the music therapy techniques used:
The client was a 15 year-old boy (Fred) who was apprehended
by the police for physically abusing his mother, throwing her out
of the house, locking himself in his house and threatening others
with a gun. He was taken to the Juvenile Detention Center where
he was place under my supervision. To the question “What seems
to be the problem? He emphasized his “mother’s past
institutionalization as a mental patient” and de-emphasized per-
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sonal responsibility for his recent brutal attack (which started over
which TV program to watch). During this first 10-15 minute
monologue, Fred stated he loved music, played his guitar two-
three hours daily, and wanted to be left entirely alone.
Freds mother appeared severally bruised and obviously upset,
but wanted Fred home as soon as possible because in her words “I
so want him to love me.” She was assured that Fred would return
and that his behavior would improve if explicit directions were
followed. She was told that (1) Fred would, in her presence, receive
explicit written instructions to complete graduated work tasks
around the house under her supervision; (2) that she should
immediately report any deviations; (3) that shortly after the
counselor left Fred would disregard all instructions and threaten
her physical well being if she reported deviations to the counselor
(continuing experimentation in behavior modification make
predictions such as this possible); (4) that she should remain within
view at a window and the counselor would wait across the street
to return upon her signal.
Later that evening, in the presence of his mother, Fred was
assigned some simple work tasks and told that he could play his
electric guitar if he completed those tasks but that the guitar would
be taken away for a day if he did not perform to the satisfaction
of his mother. He was told that his mother would immediately
contact the counselor upon his refusal to comply. The counselor
left the house and waited across the street. In 25 minutes the
mother signaled. She reported that Fred had thrown a chair down
the stairs and threatened to “beat her up” if it was reported. The
counselor immediately confronted Fred, told him to begin making
a wooden paddle with the broken chair, and removed his prized
guitar. The counselor stated that he would return the next evening.
The mother was told that if Fred were left alone his behavior would
be relatively tranquil during the next 24 hours. It was.
The next evening the counselor returned, checked off the
assigned work tasks, inspected progress on the construction of
the paddle, and then gave Fred a lesson on his guitar. Fred was
praised for his work performance and assigned greater responsibilities.
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Thereafter guitar lessons, including improvisation, were made
contingent upon the completion of the assigned tasks. Work tasks
became more involved and took longer to perform each day.
Fred responded well until the fourth day. An argument
occurred with his mother “Because shes always trying to talk to
me and wont leave me alone.” The mother reported that she was
very happy that Fred neither physically abused nor called her
names, but she did express some doubts saying “I just dont think
this different approach will work with Fred because every time I
try to talk with him and explain how I feel, he somehow turns my
words against me and then goes into his room to listen to music.
I am deeply concerned that Fred just doesn’t understand me.”
Additional procedures were introduced at this point. The object
was to develop communication skills of a pro-social nature between
Fred and his mother while decreasing the emotional responses of
anxiety and anger. Temporally graduated sessions were applied. The
object was to increase the low frequency behavior of talking together
while relaxed, by pairing with a high frequency behavior of listening
to music incompatible with intense emotional reactions. Fred selected
several of his favorite recordings. Fred and his mother, with the
counselor present, listened to one entire recording 30 minutes. The
counselor then directed several questions concerning the music to
Fred and his mother lasting 3 minutes. The second listening session
was decreased to 20 minutes with attendant increase in questioning
of 8 minutes. Following the third session consisting of 9 minutes of
rock ‘n’ roll tunes, the counselor asked the mother to respond to one
of Freds views concerning the quality of the music. This began their
first verbal interchange lasting 10 minutes. Later that same evening
after Fred retired, the mother was instructed in methods of verbal
reinforcement of attention and praise contingent on appropriate ver-
bal behavior. She was given three 10-minute practice sessions in role-
playing with the counselor acting the part of Fred. Subsequent
communication sessions between Fred and his mother were gradually
increased by 30 minutes and were always followed by guitar lessons.
During the “communication sessions” recorded music was played in
the background.
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After four weeks the case was officially terminated. However,
the total time investment of the counselor totaled 48 hours. For-
mal guitar lessons were arranged through a local teacher and Fred
was helped to secure a part-time job at a music store.
This case demonstrates several procedures common among
behaviorally orientated therapists: (1) The treatment took place
in the home where the problem occurred. There is no reason to
expect behavior to transfer to extra-therapy situations unless
stimulus generalization is assured; (2) behavioral shaping by
successive approximations to the desired terminal goals to teach
Fred to perform social work tasks of ever increasing duration and
complexity as well to teach communication skills; (3) the therapist
takes the responsibility for defining explicit, measurable, socially
appropriate goals of treatment; (4) Fred’s mother was taught through
role-playing how to deliver appropriate verbal reinforcers; (5) the
therapy used effective and socially appropriate reinforcers,
including guitar lessons was provided as well as removal of the
guitar; (6) the contingent delivery of guitar lessons for completed
work tasks; (7) elements characteristic of “desensitization” also
occurred when Fred and his mother were taught to interact without
the high level emotional responses of anger. And, lastly (8) a large
investment of time in initial stages of therapy with a lesser time
investment as pro social behavior increases.
Intermittent short-term follow-up indicated that both Fred
and his mother continued appropriate behavior without any other
arrests, beatings, or verbal abuses. Fred purchased a large guitar
amplifier with his own money and gave money and, (on
appropriate occasions) presents to his mother. In referring to his
past behavior Fred stated that he was “immature” (Madsen &
Madsen, 1968). Long-term follow-up across many years indicates
that Fred continues to do well.
There has been some resistance from certain psycho-dynamically-
oriented clinicians to place music therapy within the realms of the
behavioral movement and reasons some therapists may reject this
proposal should be analyzed. There has been in the past a great
resistance to some of the language and terms used by the therapist of
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the behavioral school to describe what it is that the therapist does.
One often hears that the behaviorist attempts to negate the
complexities of human behavior; or that they deal only with the
minutiae of minor motoric behavior; that the behaviorist’s clients
will become mechanized or in some unknown way dehumanized.
These misunderstandings can quickly be answered if one goes
to the writings of the many well-known music therapists who call
themselves behavioral clinicians. In the literature the word
“behavior” includes motor behavior, but it is also used to denote
emotional responses, as well as cognitive and ideational behavior.
The term “conditioning” is a descriptive general term and refers
not only to classical and instrumental procedures; it also includes
learning by association of a central nature as well as the methods
by which this learning is completed.
Even though the term “behavior” does include a more complex
set of operations, the crucial question is not whether the term may be
stretched to encompass most clinical behavior, but whether the
manipulations involved have been subjected to scientific scrutiny.
Our basic concern should be for experimentation based upon con-
trol and manipulation of the behaviors and instruments involved. In
this manner the field can continue to build research documented
procedures across the full gamut of problems for which clients seek
relief.
RR
RR
Referefer
eferefer
eferencesences
encesences
ences
Barrett, B.H. (1962). “Reduction in rate of multiple tics by free
operant conditioning”, in Journal of Nervous and Mental Disease,
135, 187-195.
Jeffrey, W.E. (1955). “New technique for motivating and
reinforcing children”, in Science, 21, 371.
Madsen, C.K., Cotter, V.A. & Madsen, C.H. Jr. (1968). “A behavioral
approach to music therapy”, Journal of Music Therapy, 5, 69-71.
23
Madsen, C.K. & Madsen, C.H. Jr., (1968). “Music as a behavior
modification technique with a juvenile delinquent”, Journal of
Music Therapy, 21, 72-76:
Reprinted in Standley, J. M. & Prickett, C. A. (Eds.). Research
in Music Therapy: A Tradition of Excellence. Outstanding Reprints
from the Journal of Music Therapy (pp. 585-590). Silver Spring,
MD: National Association for Music Therapy, Inc., 1994.
Madsen, C.K., Madsen, C.H. Jr., & Greer, R.D. Research in
Music Behavior. New York: Teachers College Press, 1975.
Address before the general assembly of the 9th World Congress
of Music Therapy, Washington, D. C. November 1999.
... Específicamente, el ritmo, elemento esencial de la música, y su aplicación con fines terapéuticos han sido ampliamente estudiados (Arango y Recuero, 2010;Bronson, Vaudreeuil y Bradt, 2018;Madsen, 2014, Poch, 2001Vannay, 2014, Vescelius, 1918. ...
... Específicamente, este recurso musical ha sido empleado con pacientes diagnosticados con depresión, en quienes se produjeron mejoras tanto en niveles de depresión y de ansiedad (Romero-Naranjo y Romero-Naranjo, 2013), incremento y calidad de la comunicación y del lenguaje corporal, búsqueda frecuente de relaciones sociales, aumento del estado de ánimo, disminución de la anhedonia y disminución en la frecuencia de ideación suicida (Crespo-Colomino y Romero-Naranjo, 2014; Salerno et al., 2016). De igual modo, han sido estudiados factores neurológicos implicados en la rítmica de lo auto percutido, mostrando efectos positivos tanto en las capacidades psicológicas y sociales como en el nivel de activación conductual (Romero-Naranjo, 2013) enfatizando en el efecto protector que estas capacidades ejercen sobre la ansiedad o la depresión (Ahokas, 2015, Madsen, 2014, Romero-Naranjo, 2013, considerando este recurso como una herramienta muy eficaz (Serna-Domínguez et al., 2019). A partir de estas premisas y aunque se ha acrecentado significativamente el interés por conocer los efectos que la música genera en el ser humano, el estudio de la relación música y salud mental ha recibido una atención más limitada. ...
... Al decidir incluir un módulo de percusión-corporal en el tratamiento de este paciente, encontramos múltiples ejemplos de cómo el uso terapéutico del ritmo influye en la mejoría de diversas afecciones en el ámbito clínico (Vescelius, 1918;Bronson et al., 2018). Asimismo, se subraya cómo el aumento de la actividad conductual en nuestro sujeto de estudio muestra la perspectiva de la modificación de conducta ya hecha explícita en intervenciones similares en el pasado (Madsen, 2014). Por otro lado, el uso del ritmo como metodología compleja es expresada por autores tan relevantes como Nordoff y Robbins o Mary Priestley (Arango y Recuero, 2010;Vannay, 2014). ...
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... Aesthetic criteria are irrelevant. General principles are explained by cognitive-behavioural psychology and inform basic functions of behavioural music therapy Madsen, Cotter & Madsen, 1968;Madsen, 1971). ...
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Aesthetic perspectives play a crucial role in music therapy. By contrast, issues of sound quality are only relatively rarely studied. Cases of clinical and educational music therapy with instruments of inferior quality raise questions about appropriate tools and criteria for sound quality. In view of the patients' nuanced forms of sensory experience and responsiveness to sounds, we suggest we approach sound quality from artistic, patient-centred, and scienti c perspectives that involve physical, neuroscienti c, psychological, aesthetic, and metaphysical facets. These re ections result in a theoretical framework for the discussion of sound quality in clinical music therapy. This concept is based on eight crucial perspectives: aesthetic beauty; symbolic signi cance; identity and 'sound-selves'; ontological and cosmic characteristics; functional healing mechanisms; creative inspiration and sound-triggered epiphany; self-healing potential and new self-images; sounds that reconnect 'denatured' individuals and their human nature. Sound quality comprises to both aesthetic criteria (the 'good' sound) and the multifaceted, therapeutically relevant natures of sound. Zusammenfassung Während ästhetische Aspekte in der Musiktherapie eine bedeutende Rolle spielen, scheint die Frage nach der Qualität von Klang einen Nebenschauplatz darzustellen. Der musiktherapeutische Einsatz "schlechter" Instrumente im klinischen und pädagogischen Bereich ruft allerdings die Frage nach adäquaten Kriterien für die Qualität von Klang in der Musiktherapie aufs Tapet. Auf-grund der patientenseitig unterschiedlichen und oftmals höchst nuancierten Klangerfahrungen und Reaktionen auf auditive Stimuli werden künstlerische, patientenzentrierte und interdiszi-plinär forschungsbasierte Zugänge, die physikalische, neurowissenschaftliche, psychologische, ästhetische und metaphysische Perspektiven berücksichtigen, vorgeschlagen. Diese Überlegun-gen führen zu einem theoretischen Modell zur Diskussion von Klangqualität in der klinischen Musiktherapie. Dieses beruht auf acht Dimensionen: (i) ästhetische Schönheit, (ii) symbolische Bedeutung, (iii) Identität und "Klang-Ich", (iv) ontologische und kosmologische Charakteristika, (v) funktional-kurative Mechanismen, (vi) kreative Inspiration und durch Klang hervorgerufe-ne Spontanerkenntnis, (vii) Selbstheilungspotenzial und neue Selbstbilder und (viii) Klänge, die ein verlorenes Ich wieder zurückbringen können. Qualität von Klang berücksichtigt dabei so-wohl ästhetische Kriterien (der "gute" Klang) als auch seine facettenreichen, therapierelevanten Wesenszüge.
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PARTICIPANT music activities have been p. used as adjunctive therapy in many diverse institutional settings.1,2,3 However, there appear to have been few applications of music in the environmental control of deviant behavior.4 The behavioral modification approach relies upon learning principles and concentrates on assessment and remedial programs based upon environmental control. Behavior is modified by explicitly arranging the consequences of responses based upon reinforcement principles. Modem day behavioral therapists use treatment systems based upon extensions of experimental evidence. Behavioral therapists condition, counter-condition, extinguish, desensitize, role-play, and train or retrain their clients, patients, or subjects as well as use relaxation, conditioned avoidance responses, self-disclosure, emotive imagery, modeling, negative practice, expressive rational approaches, stimulus deprivation and satiation as well as in situ presentations.5,6 The case study presented here illustrates the contingent use of music and music participant activities in the treatment of a severely disturbed youngster while on court probation.