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Therapy in Music for Handicapped Children

br2005_046Nordoff, Paul & Robbins, Clive (2004). Therapy in Music for Handicapped Children (re-issue). Gilsum, NH: Barcelona Publishers. I99 pages. ISBN 1-891278-19-3.

Introduction

With the re-issue of Therapy in Music for Handicapped Children by Paul Nordoff and Clive Robbins, we can rest assured that this groundbreaking work will remain in the contemporary sphere of influence appropriate to its timeless message which is, as Clive Robbins informs us in his acknowledgments for this new edition: “the health and healing latent in the livingness of creative musicing” (p.12). If the poetic sweep of such a statement is considerable, it is justified by the depth of Nordoff-Robbins’ supporting theoretical constructs. It is this integration of searching philosophy, reverence for music, and painstakingly conscientious clinical methodology that has attracted a multitude of astute clinicians, inspired countless students and made the Nordoff-Robbins approach an indispensable contribution to the field of music therapy. Therapy in Music for Handicapped Children, the first of the major publications by Nordoff and Robbins (although adapted from an earlier, more limited edition) continues to be as visionary today as it was when it was first issued in 1971. Barbara Hesser, director of the music therapy degree programs at New York University, noted in her introductory section:

At that time I did not find the music therapy clinical work that I saw or read
about to be what I envisioned possible, and I was at a crossroads in my
decision whether to continue in my pursuit of music therapy as a career. It
was reading this book that confirmed my belief that the artistic and creative
use of music was indeed a powerful tool for work with the mental physical
and emotional problems of children (p.7).

Encounters with Nordoff-Robbins Music Therapy

When I was first introduced to the book in the early 90’s as a music therapy student at New York University, I also deeply resonated with its ideas. But I was a guitarist/singer with stylistic roots primarily in rock, folk and blues and, to me, Nordoff-Robbins was a pianist’s world. The extraordinary command, (both technically and clinically), in Paul Nordoff’s classically influenced piano approach seemed to have established a legacy so formidable as to appear practically impossible for a primary therapist to play another instrument and still call it Nordoff-Robbins music therapy. Although I read a considerable amount of Nordoff-Robbins literature and adopted many of the concepts as my own, I couldn’t foresee any further in-depth study of the approach beyond my New York University master’s degree.

That all changed in 2000 when, through a series of events that seemed somehow miraculous to me, I became the third person to focus exclusively on guitar as a primary instrument during my certification training as a Nordoff-Robbins Music Therapist. To his credit as a progressive thinker, Clive seemed only enthusiastic about my involvement as a guitarist, illustrating another shining feature as Hesser describes: “One of the wonderful aspects of Nordoff-Robbins work is that it is dynamic and does not stay static. It is always evolving as each new generation of therapists add their unique experience, understanding and talent” (p.7). It was truly a life and mind-expanding experience to study with Clive and the staff at the New York Center. The reader of this review is forewarned that he or she will be obliged to forgive my bias. In my opinion, the approach stands at the forefront of the field in the profundity of its musical and theoretical foundations.

Therapy in Music

The wording of the book’s title immediately establishes the Nordoff- Robbins position. It is therapy in music; therapy contained within, or intrinsic to musical engagement. In other words, when a client is actively involved in music, therapy is occurring. Music therapy, in this sense, functions as does all artistic creation; through a process of discovery, often unpremeditated and unforeseeable; taking shape and unfolding moment-by-moment. We can have goals or certain preconceptions in mind, but if we are to stay true to the artistic process, we must be receptive to the manifestation turning out differently from that which we originally imagined. This view is sharply differentiated from that which would be implied by the reverse wording: music in therapy; or, applying music as a device toward the purposes of some disparate clinical conception which may be partly or largely non-musical. This precedent for all that was to become identified as the Nordoff-Robbins approach is lucidly defined on the second page of the authors’ introduction:

Music therefore becomes a sphere of experience, a means of intercommunication
and a basis for activity in which handicapped children can find freedom,
in varying degrees, from the malfunctions that restrict their lives. As such,
music possesses inherent capacities for effecting a uniquely significant
contact with handicapped children and for providing an experiential ground
for their engagement, their personality development, their integration – both
individually and socially. To the extent to which music achieves this it
becomes music therapy; in practice, the range of expression of music as an
art, and the structural constitution of music as an artistic discipline, are
directly involved (p.16).

The full significance of this revolutionary declaration has yet to be fully recognized. To begin with, we must consider the social context of the early 60’s when Nordoff and Robbins began developing their initial ideas. Nordoff and Robbins embarked on their collaborative journey at the Sunfield Children’s Homes for severely disabled children in England. The anthroposophical philosophy of Sunfield, informed by the ideas of Rudolf Steiner, seemed to be extremely progressive for its time. A wide range of painting, music, movement, drama and craft activities were consistently employed. Still, in subsequent writings, Clive Robbins described his extreme frustration at the seeming impossibility of penetrating the communication barriers of profound developmental disability and autism in children during his initial position there as a special education teacher. Sunfield Homes notwithstanding, I would venture that expectations for severely disabled children in those days were rather limited and that in most institutional settings, creative endeavors, if any, were of the bead-stringing variety. Most music therapy models at the time were predisposed to behavioral and/or activity-oriented interventions and remain so in many contemporary schools of thought. The controversy over the degree to which music therapy functions predominantly according to the nature of art and music, as opposed to music taking a somewhat subordinate position to psychoanalytic, behavioral, medical or recreational principles, is as relevant today as it was in the 50’s and 60’s when the field first began to establish itself as a professional discipline.

The title of chapter III, “Outline of a New Music Therapy,” seems to indicate that Nordoff and Robbins were well aware of their essential voices as pioneers and leaders in the relatively nascent field. That music is a universal language is virtually a platitude, and an empty one at that, if music therapists favor other “clinical strategies,” and utilize music in a relatively superficial manner. As Nordoff and Robbins pointed out, “What has yet to be more clearly recognized is the range of expression that is possible in this ‘language.’ The variety of human expression that can be communicated through music is highly diversified and virtually unlimited. Because of this, music becomes vitally important as therapy for exceptional [handicapped] children” (p.49).

The Prototypical Nordoff-Robbins Methods

As the book’s title also indicates, the focus during this early Nordoff-Robbins work consisted exclusively of work with handicapped children. The period of time covered, late 1959 through mid-1967, follows the inception of the work at Sunfield, a European tour of Steiner Homes to widen the scope and first forays into the United States. Structurally, the book takes something of a textbook approach with chapter titles such as “Individual Music Therapy – Categories of Response,” “Experimental Group Activity – Working Report,” “Music Therapy and Personality Change in Autistic Children.” Each chapter contains numerous sub-headings indicating the dominant themes in each section such as: The effect of dissonant harmonies upon children’s attention, actions and singing and, The development of songs to increase awareness and social interaction. Integrated into each section is case material and the applicability of accompanying theory.

The book portrays the evolution and rationale for the prototypical Nordoff-Robbins methods for bringing handicapped children into the experience of creative music, many of which have endured to the present day. The origins of the “one-string” violin and cello and work with drum-beating are examined. The derivations of numerous “children’s play-songs,” are depicted including as the haunting, “Something is Going to Happen” and countless others, often improvised directly out of the needs of the moment with titles like the “Laughing Bird” song and “Faith’s Hair is Growing Longer Every Day.” Descriptions of the musical games and stories that Nordoff and Robbins developed such as “Pif-Paf-Poltrie,” “The Three Bears,” and “The Children’s Christmas Play” are also provided. Although these pieces addressed issues inherently meaningful to the children, none of them are, in any way, condescending, either musically or thematically. They invoke a high degree of alertness, challenge and involvement. I know, because I participated in many of them as a student. In particular, the exquisitely intricate “hist-whist,” stands out in my mind. This full-length composition, based on an e.e. cummings poem, encompasses specific orchestrations for a group of children. I worked on it with my fellow students for the whole of a two-hour class and, personally, never achieved anything one could honestly describe as mastery (although to be fair to myself, I seem to remember trying to cover two parts). Nevertheless, if this was music for handicapped children, the clients must have intuitively realized that, for once, someone (or ‘something’ inherent in music) was taking them seriously, offering them an opportunity to rise to the occasion. Regarding this, it is noted:

The piece took three-and-a-half minutes to perform, but eight sessions, each
an hour and fifteen minutes in length, were required to perfect it. This is
where the therapy lay. Once weekly the ‘sextet’ met and worked hard
without pause, learning and practicing the piece, section by section.
The children accepted the therapists’ single-minded purposefulness
in the same spirit; they shared their enthusiasm and gave themselves
completely to the hard musical work the piece demanded. Observers
of the sessions, who knew the children, were incredulous over their
capacity to sustain this kind of complete concentration for over an
hour (Appendix II).

Assessment

Therapy in Music for Handicapped Children also introduces the first of the Nordoff-Robbins assessment scales: “Categories of Response,” which outlines thirteen categories (with various sub-categories) for evaluating a child’s manner of participating in music (i.e., – Complete Rhythmic Freedom, Compulsive Beating, Evasive Beating, Responses by Singing, Responses to Specific Musical Idioms). Further rating scales were to come in subsequent publications. Although a review of contemporary music therapy literature reflects a diversity of assessment scales designed for work with children, most of them evaluate behavioral tasks that are seemingly unrelated to the dynamic musical relationship that naturally occurs between client and therapist. To this day, the Nordoff-Robbins Scales remain in the minority of music-centered assessment instruments utilized in the field.

Nordoff, the Composer

In understanding the origins of such a profound focus on music, we cannot underestimate the significance of Nordoff’s background as a serious composer, university professor and virtuoso pianist. This was not a man to play some insipid version of a children’s song and leave it at that. In the depth of Nordoff’s commitment to put his former career aside to investigate the possibilities of music therapy coupled with Robbins’ emancipation from the limitations of special education, the sense of possibility and rejuvenation they feel is palpable on every page, as illustrated by passages such as this one:

The therapist feels reborn in his new musical-therapeutic experiences
and realizes the art of music as therapy will never cease to challenge him,
never cease to require all his musical resources. As mediator of therapeutic
music he assumes new, uplifting responsibilities. Out of his love for music
he approaches handicapped children musically, feels them musically.
Through his practical ability as a musician he works with them clinically.
With his musical perceptiveness and musical intelligence he understands
their responses artistically and humanly recognizes what they express (p.142).

From the very first project, at Herbert Geuter’s (Sunfield’s treatment team director) suggestion, Nordoff and Robbins plunged in with a sense of passion and discovery. In collaborating on developing a musical game for children based on the Grimm’s Fairy Tale, “Pif-Paf-Poltrie,” they noted: “The deliberate, judicious use of dissonance had a liberating effect on the children” (p.22). A bit further on in the book, this finding is stated even more definitively:

One fact, however, emerged: dynamic, dissonant music does not necessarily
excite or disturb psychotic children…As I aimed to express the turbulence of
their emotional lives in the music I improvised, it was often wild and dissonant.
This experience appeared to be more significant than quiet, soothing music
which might have been considered more suitable (p.41).

The courage involved in resisting the dominant sentiment of the time cannot be overstated and is no less germane an issue today. However, at least when contemporary music therapists engage in methodological debates with other professionals or administrators, they have Nordoff-Robbins and those who followed in their path to substantiate the work. Nordoff and Robbins had only their own convictions, as they recounted:

The visits to Sonnenhof, Switzerland and Bingenheim, Germany were important because of the clarification of concepts our experiences there
demanded. Both institutions placed great value on music in the lives of
their children and in the discussions that took place we were seriously
challenged to justify our use of music. Many workers found much of it
too loud, too dissonant and too rhythmic. They were of the opinion that
music for handicapped children should be soothing, rather soft,
conventionally harmonious, and, if active, not stimulating (p.44).

They go on to characterize such soporific musical participation to be “…more a mild form of entertainment than a music therapy, and could be a subduing, conditioning factor in a child’s life. Music, we fervently believe, could be more than this” (p.45) [bold italics mine].

In another early example, work with a hypertonic, epileptic boy at Sunfield is discussed. This boy could only take small, awkward steps and was unable to raise his arms above his shoulders. Dr. Geuter prescribed a specific movement – to take a big stride and at the same time thrust his arms outwards, spreading them above his head:

He was to attempt to make this large free movement by his own efforts to a
rhythm, one often found in Spanish music…After seven months, having
worked thrice weekly, he was able to perform it successfully. As a result
all his movements became freer and the tensions that had hindered his
mixing with others began to ease. His speech became less strained and
gained in fluency. The strongly accented accompaniment in the Spanish
idiom I used was an essential part of the treatment (p.27).

These examples trace the roots of Nordoff-Robbins’ music-centered convictions, wherein a specific idiom, harmony or any other musical form is, in and of itself, an intervention. This requires a substantial musician. Right from the start, Nordoff and Robbins held us all up to the highest standard of clinical music and I think many music therapists might be intimidated, justifiably so. As a guitarist beginning my training, I was certainly unnerved. It simply would not be an option for my musical resources to be confined to the rhythmic strumming with full, consonant chords and predictable tonal resolution to which many guitarists are habituated. I needed to cultivate a more highly developed sense of clinical presence and musical dexterity as I experimented with techniques that generated the tensions, dissonances, modal influences, use of intervals, diverse harmonies, idioms and flexible rhythms that seemed true to the criterion set by Nordoff and Robbins, as in this description:

All the compositional styles of the last seven centuries, all the folk music, the
idioms, the elements of music, the very notes themselves – even the smallest
expressive and structural components – become significant in countless,
undreamed-of ways. The world of music opens anew, now disclosing an
inner musical life of therapeutic potential (p.142).

The Music

Music in modern times has, to a great extent, been trivialized, marginalized and characterized primarily as entertainment or background. Pop music is a billion-dollar industry, classical concerts fill halls, jazz aficionados gather in dark clubs, folkies travel to festivals, wedding bands play endless parties. Music is used to create a desired atmosphere in films, television commercials, and shopping malls. Entire careers are devoted to criticizing it, analyzing it and merchandizing it. Our lives are saturated with music yet somehow it all seems so frivolous. Legions of musicians continue to nurture the dream of becoming rich and famous. Nordoff, himself, was on sabbatical from his university to further his composing career in Europe when he was first introduced to the idea of music as therapy. Had his original intent worked out more to his satisfaction, perhaps the Nordoff-Robbins partnership would never have happened. It was frustration – Nordoff’s with the music profession and Robbins’ with the special education system that led to the need to look beyond the way things were and create something different.

Perhaps it is a cliche or a generalization to say that the most potent music arises out of a mood of social or personal oppression, but I still think it is basically true. Music may be promoted as an entertainment and star-making business to serve the purposes of a capitalist culture but this is not its reality. In music, we are able to transcend the loneliness, fear and constraint inherent in the experience of being human. As Nordoff and Robbins noted, within handicapped children live some of the deepest needs of humanity and this is why music can become so important in their lives. But as music therapists, we are not simply providers. In participating in music that has been restored to a context more worthy of its essence, we are all renewed. This intensely humanistic, even spiritual perspective lives at the heart of the Nordoff-Robbins approach:

As [the therapist] leads and follows the child into new regions of
self-expression, into new discoveries of freedom, his joy is the child’s
joy, his fulfilment is the child’s fulfilment. The relationship he has to
the child’s self-creating self through the creative effort of his music-making,
gives his own musical nature – and with it the art of music – a new moral
reality in the world (p.144).

The Therapist

We have a profound responsibility toward clinical and professional standards if we are to refer to ourselves as therapists. Our encounters with our clients may affect us in untold ways but this is not our focus. We enter a session in service to our clients. At the same time, in music we are united. Two or more people playing together generate one sound; one creation. The purpose of music therapy is to offer an opportunity to step outside of the restrictive boundaries imposed by society, pathology and ego-isolation. As therapists, we cannot stand back dispassionately and apply music like some sort of quasi-medical treatment and expect to facilitate a creative environment that has any heart. Our objective is to visit the world of music with our clients and help them to return with something new; maybe something they can use.

Conclusion

I have come to this view of music therapy and feel empowered to write like this largely through the example of Nordoff and Robbins. This is certainly not to suggest that my opinions represent a consensus among Nordoff-Robbins therapists, or that there even is one. It is, in fact, its diversity, encouraging dialogue and debate that makes the Nordoff-Robbins approach so vital 35 years after the initial publication of Therapy in Music for Handicapped Children. Since then, many additional brilliant insights, elucidations, and interpretations have been set to paper by Nordoff and Robbins, Clive and Carol Robbins, Clive by himself, the many notable Nordoff-Robbins trained clinicians, and other kindred spirits. But with this book, Nordoff and Robbins created the paradigm that, like any great work of art, responded to the needs of its time as much as it illuminated the future.

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