Volume 00 & Number 0 & Month 2018
Music as Therapy Versus Music
in Therapy
Michael L. Zanders
T
hroughout history, written or verbal, humankind
has had a fascination with music and health. The
ancient Greeks, most notably Aristotle and Plato,
wrote about the healing effects of music. Although it
may have earlier origins in ancient Egypt, Hipprocates,
the father of modern medicine, theorized that music bal-
anced the 4 humors of the body and related this to tem-
peraments or moods, emotions, and behaviors.1 Not until
the 18th century would any writing relate specifically to
a field of music therapy. The first music therapy inter-
vention was recorded in the early 19th century, which
then gained further interest in organizing music interven-
tions, particularly medical, into a field. It was not until the
1940s that music therapy became organized as a clinical
profession,2 including educational and clinical training.
E. Thayer Gaston3 was instrumental in starting the
first music therapy training program and also in provid-
ing foundational thought in his seminal book entitled
Music in Therapy. In Gaston’s3 book, he noted 3 prin-
ciples of music therapy: ‘‘(1) the establishment or re-
establishment of interpersonal relationships, (2) the
bringing about of self-esteem through self-actualization,
and (3) the utilization of the unique potential of rhythm
to energize and bring order.’’ This book then promoted
further thought on theory, practice, and research in
music therapy. It was not until 1987 that Bruscia4 posits
the initial discussion of music as therapy versus music
in therapy. Then in 1989, Bruscia5 further defined the
difference between ‘‘as’’ and ‘‘in.’’ In music as therapy,
the ‘‘music has a direct influence on the client and serves
as the primary agent of therapeutic change.’’5 In this
way, music has a direct influence, and the therapist is a
‘‘facilitator’’ and has the expertise to provide the appro-
priate musical experience.
With music in therapy, ‘‘music is used not only for its
own healing properties but also to enhance the effects
of the therapist-client relationship or other treatment
Questions or comments about this article may be directed to
Michael L. Zanders, PhD MT-BC, at mzanders@twu.edu. He is
an Assistant Professor/Coordinator of Music Therapy, Texas
Woman’s University, Denton, TX.
The author declares no conflicts of interest.
Copyright B 2018 American Association of Neuroscience Nurses
DOI: 10.1097/JNN.0000000000000379
Copyright © 2018 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
1
CLINICAL NURSING FOCUS
modalities.’’5 In this approach, music is not primary,
and music experiences used depend on the music thera-
pist. By definition, therapy is treatment to help a person
get better6 but also includes a process of understand-
ing the inherent dynamics related to health. Thus, both
music as and music in therapy are both readily used by
music therapists. As a continuum, then it could be seen
within a session as how primary is the music experience
or how primary is the music therapist. Zanders7 further
described music therapy, which will hopefully be infor-
mative in further defining music as versus music in.
Further Defining
Zanders7 wrote that ‘‘Kenneth E. Bruscia’s theory Defin-
ing Music Therapy theorizes the foundational and funda-
mental characteristics of the roles of the therapist, the
client, and the music within music therapy.’’8 In Bruscia’s8
definition, ‘‘music therapy is a reflexive process wherein
the therapist helps the client to optimize the client’s
health, using various facets of music experience and the
relationships formed through them as the impetus for
changeI. music therapy is the professional practice
component of the discipline, which is informed by theory
and research.’’ The key components to this definition
are reflexive process, music experiences, relationships
formed, and a professional practice.
In being reflexive, the music therapist is aware of the
dynamics of change as well as how the fundamental
elements of music, namely, rhythm, harmony, melody,
and so forth, relate to the patient’s health. As this is a
process, the product of health or ‘‘illness’’ is manifested
through the patient’s development. For example, a ho-
listic approach to music therapy would see that reduc-
ing anxiety and stress in patients has a physical effect on
the body and the health condition. Metaphorically, or
perhaps literally, the elements of music are the elements
of life. We are compositions or pieces of music, and when
we create our ‘‘compositions,’’ we create our health.9
Music therapy is experience oriented in that sessions
may be strictly musical or include verbal components.
This goes back to the discussion of ‘‘as’’ and ‘‘in’’; for
example, what is the primary agent of change, the music
experience or the therapist? There are 4 main methods
or music experiences used in music therapy: receptive,
recreative, composition, and improvisation.8 Receptive
experiences include both listening and responding to
2 Journal of Neuroscience Nursing
CLINICAL NURSING FOCUS music whether physically, emotionally, or verbally. Re-
creative experiences involved the patient engaging in
and learning music or playing. Zanders7 further remarked,
‘‘In this method, musical development does not mean
that the client becomes ‘good’ at making music but that
growth, change, or meaning is found in the act of
making music.’’ Composition, or more commonly song
writing, is as the name impliesVwriting music as part
of a health outcome. Improvisation is spontaneous music
making with various musical instruments, both tradi-
tional and not, including vocal improvisations.
Music therapy is then a creative form of therapy.
‘‘Music therapists presume that musical products em-
ployed within various music experiences are creative
experiences and are valued as part of the process. Crea-
tivity in the music allows for the client to imagine, think,
or experience new ways of being.’’7 In this creativity,
relationships are then formed. Thus, music therapy is
relationship and method based and not prescriptive.
Whereas traditional forms of therapy focus on patient-
therapist, music therapy focuses on the therapist, pa-
tient, and music. In music therapy, ‘‘these relationships
can be manifested and experienced physically, musi-
cally, mentally, behaviorally, socially, or spiritually.’’8
Music therapy is a professional practice and disci-
pline and, like all health professions, requires rigorous
training and education. In music therapy, competency is
taught within 3 main areas: music foundations (thorough
formal music education), clinical foundations (therapeutic
relationship), and music therapy foundations (principles
of music and health). Anyone can use music and have
it be therapeutic. We all use music as a psychological
resource, whether it is for relaxing, exercising, or even
sleeping. Hence, neuroscience nurses and other health-
care professionals can use music as part of their practice.
However, it is not music therapy, and for the purpose of
the discussion, neither music ‘‘as’’ or ‘‘in.’’ Music thera-
pists do not own the health benefits of using music.
However, by definition, music therapy is a process and
does not only use music as a product. A significant dif-
ference is that music therapists are educated and trained
to assess, treat, and evaluate how the elements of music
influence and effect health goals. Without this fundamen-
tal music understanding, the therapeutic benefits are
limited to a self-help anecdote or simply using music as a
by-product to other health service outcomes. For exam-
ple, I am no more a nurse because I can take someone’s
blood pressure. In addition, just because going to a music
concert may be therapeutic, it does not make it therapy.
Essentially, music ‘‘as’’ or ‘‘in’’ is a philosophical
discussion. Music therapists, as part of professional prac-
tice, use both interchangeably. At times, the music is
used as the curative change. In this way, melody, har-
mony, rhythm, texture, tonality, and so forth are all part
of who the patient is. To then understand the health
Copyright © 2018 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
need of the patient or client, you need to have a com-
prehensive training in the musical health need. At times,
the therapist is the primary agent for the curative change
and uses music within that process. For example, in the
medical field, a professional can use music to help a
patient relax, reduce physiological or physical symp-
toms, increase endorphin levels for pain, and so forth.
This would be using music ‘‘in.’’ Although beneficial
and effective, it is still not music therapy because the
relationship is still only between the medical profes-
sional and the patient. For the music therapist, the
relationship would be between the therapist, the patient,
and the patient’s music. This relationship is not ‘‘social
or entertainment based, but one based on the inherent
meaning found through and with the music and the
patient.’’7 Recently, Mortimer and Berg10 noted that
integrative therapies such as music are useful for pa-
tients recovering from traumatic brain injury. However,
the article does not fully present the fundamental un-
derstanding of the physical, psycho-physiological, neuro-
logical, emotional, and even spiritual dynamics of music.
Music therapy, and more specifically the discussion
of music as versus music in, may be viewed as a move-
ment between science, art, and humanity. ‘‘As a science,
music therapy has predictable and observable changes.
As an art, the engagement in the music experience
provides meaning in and of itself. As a humanity, music
therapy situates the patient, the therapist, and the music
experiences in the larger health context of the client’s
ecology.’’7 In this way, the patient’s ‘‘health’’ is related
to the patient’s ecological ‘‘health.’’
References
1. Kagan J. Galen’s Prophecy: Temperament in Human Nature.
New York, NY: Basic Books; 1998.
2. American Music Therapy Association. History of music
therapy. Available at https://www.musictherapy.org/about/
history/. Accessed January 29, 2018.
3. Gaston ET. Music in Therapy. New York, NY: The Macmillan
Company; 1968.
4. Bruscia KE. Improvisational Models of Music Therapy.
Springfield, IL: Charles C. Thomas Publishers; 1987.
5. Bruscia KE. Defining Music Therapy. Spring City, PA:
Spring House Books; 1989.
6. Cambridge Dictionary. Therapy. Available at https://dictionary.
cambridge.org/us/dictionary/english/therapy. Accessed January
29, 2018.
7. Zanders ML. Music Therapy. In: Neukrug E, ed., The SAGE
Encyclopedia of Theory in Counseling and Psychotherapy.
Thousand Oaks, CA: SAGE Publications; 2015:687Y690.
8. Bruscia KE. Defining Music Therapy. 3rd ed. University
Park, IL: Barcelona Publishers; 2014.
9. Lee CA. The Architecture of Aesthetic Music Therapy. Gilsum,
NH: Barcelona Publishers; 2003.
10. Mortimer DS, Berg W. Agitation in patients recovering from
traumatic brain injury: nursing management. J Neurosci
Nurs. 2017;49(1):25Y30.