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What is music therapy?
We all have experiences of being engaged in music – even if it is only by tapping our foot to a song on the radio, or singing in the shower. Most of us don’t need any help to access the opportunities music offers for socialising, communication, expression or just plain joy. But people who have the most need for these experiences often need skilled help in accessing musical opportunities moment-by-moment and in being able to make use of them. That’s what Nordoff Robbins music therapists are there to do: they are skilled musicians who have a thorough understanding of the challenges faced by the people they work with and work hard to make music's opportunities available in ways which are accessible but also impact on people's lives more generally. This happens via engagement in shared music making, whether this is done improvisationally, making use of music people already know, creating new music together, or working towards some kind of performance.
Who are Nordoff Robbins music therapists?
We train our own therapists via our two-year Masters programme (validated by Goldsmiths, University of London and approved by the Health and Care Professions Council): we select passionate, capable, flexible musicians and equip them with the knowledge and skills they need to be as useful as possible in real-life situations.
As well as delivering music therapy on our own premises, our therapists work with a wide range of partner organisations to deliver music therapy in schools, hospitals, care homes and other community settings. Sessions happen with individuals and groups in these places, but our music therapists are also committed to bringing the benefits of music making to the communities as a whole, something our partners tell us they value highly.
A little bit of history – the growth of the approach
Paul Nordoff (an American composer and pianist) and Clive Robbins (a British teacher of children with special needs) worked together in the 1950s, 1960s and 1970s, developing their approach to music therapy. They found that opportunities for engagement in active music-making, when skilfully offered, guided and supported, enabled the children they worked with to go beyond what people assumed they could do, both demonstrating and experiencing their capacities for expression and interaction. This isn't a method – rather it is about the cultivating of a musical attitude which recognises both the potential in everyone (regardless of pathology, illness, disability, trauma or social isolation) for engagement in active, communicative, expressive music-making and the importance of this in developing skills, a sense of self, and a capacity for satisfying social interaction. In those early days, Nordoff and Robbins worked mostly in schools and entirely with children – autistic children and children with developmental delay. You can see historical examples of Nordoff and Robbins working together in the videos below.
Nordoff and Robbins trained other musicians in their ways of working and many of these therapists took the work in new directions – working with diverse populations and in a wider range of settings. Nowadays our therapists work in a vast array of places with people of all ages who are facing challenges resulting from a wide variety of life situations. What they all have in common is their readiness and ability to use their musical skills in ways which are specific to each person, each group, or each community. Thus no two sessions are the same, but the therapist will always be thinking strategically, tailoring the musical work in ways which are pertinent to each person's situation, strengths and needs. Much of the music is improvised and thus focused moment-by-moment on the client and their involvement, but our therapists will also make use of existing music or compose music with clients. In some situations it is useful to work towards performance of some kind.
Lots of people say, “I’m not musical” – but we know that this isn’t true! Our first experiences of building a relationship, of feeling safe, of shared joy, of finding out who we are and what we can do come in our earliest interactions with our caregivers – and these interactions are all musical. In this sense we are all “hard-wired” for creative musical interaction. Whilst disability, illness, trauma or social exclusion may obstruct our capacity for engagement in music with others, it never removes it entirely and it is the job of a Nordoff Robbins music therapist to help each person they work with to find their own routes to living life to the full and contributing actively to society via meaningful engagement in music-making.
Not just with individuals, not just with groups – growing the connections between people
Many people can attest to the social power of music. There is something about singing in a choir or playing in a band that people find thrilling and strengthens the sense of connection between people. Whilst this is simply enjoyable for most of us, for some people it is a very important means of combatting social isolation or of overcoming limitations associated with illness, disability or trauma. That’s why our therapists work with people individually when privacy and individual attention is important, but also in groups and sometimes in large public spaces, where the emphasis might be more on growing a sense of community and collaboration rather than on pathology as such. So, for example, our therapists might run a community choir, or help to get a band going as part of their work.
What about “conditions”?
Nordoff Robbins music therapy works with the particular person, or group of people or community involved, not primarily with the labels of pathology. Nevertheless, we know that certain aspects of the work we do can be of particular relevance to people living with particular conditions. Here we provide some examples of how music therapy works in relation to particular life situations:
We work with people of all ages, but when working with young children we recognise the crucial importance of the child’s parents or primary carers. For this reason we often work with children and their parents together.
Music making is part and parcel of the way that all children learn about the world around them and develop new skills. It is a safe way of taking risks and developing independence. It is playful and intrinsically interactive. It is motivating and encourages children and their parents to keep trying things. Above all it enables parents and carers to see the possibilities for their child's development at a time when they can otherwise be overwhelmed by the challenges ahead.
Nordoff Robbins is well known for its work with children and adults with learning difficulties. One reason for this is the non-verbal basis of the work we do: it’s not just that words aren't needed; it is that music allows expression and interaction which may simply not be possible in words. People with learning difficulties benefit as much as anyone else from opportunities for self-expression and meaningful collaboration with others but need opportunities tailored especially for them, and the need for this does not diminish as people get older – that's why we are committed to working with people with learning difficulties across the age range.
Autism impacts differently on each person’s life. It is often defined in terms of a “triad of impairments” affecting social communication, social interaction and social imagination. Music is uniquely placed to help with these impairments, because it is so fundamentally social without the need for words or the exchange of specific information. There is a musical dimension to all of these: we learn to do them musically first (with our parents, before we can speak, and even before we know who we are) and music also offers lots of “ways in” to experience of these. Therefore if music therapy is to be useful for people with autism, it must work hard to engage people in active musical interaction. Improvised music makes interaction inviting to people on their own terms, since the music therapist will be working hard to tailor their offerings to whatever the client is already doing – including movements, vocalisations and even eye movements. As clients respond to these offerings, the therapist will work to extend the responses and increase awareness of them.
Autism is usually diagnosed when a child is still quite young: having an autistic child can be extremely demanding for parents, but parents are also uniquely positioned to help their children in terms of offering opportunities for social communication, interaction and imagination. Nordoff Robbins music therapists will therefore sometimes work with parents and children together, partly to model this for parents but also so that parents get to see their children’s potential for communication and interaction that music therapy can make evident.
Nordoff Robbins music therapists also work with children diagnosed with learning difficulties and / or autism in schools, with teenagers in colleges, and with adults in day centres and resource centres. Leaning difficulties and autism affect people throughout their lives, and can seriously restrict people’s ability to engage with the world around them, so it is really important that we provide services which continue to provide opportunities for meaningful and motivating social communication, interaction and imagination across the lifespan. You can see an example of our work with an autistic boy in a school environment here: you will see how the therapist is tailoring the music to everything Jack does, thus drawing him into a level of shared, meaningful and sustained interaction which would simply not be possible outside of music.
People experiencing mental health problems may find that their lives are chaotic or rigid, or that they find it difficult to be expressive. Because of this, it is often difficult to have creative, satisfying experiences of interaction with other people. Nordoff Robbins music therapists seek to use the opportunities music offers for structure, expression and shape to offer these experiences to a wide range of people. Some of our therapists work in psychiatric hospitals, where the approach is particularly well suited to patients in acute situations because it doesn't rely on verbal interaction. Others work in forensic or community settings.
Many people who identify themselves as living with ongoing mental health challenges also refer themselves to our direct referral services. They tell us that this is an important source of social support for them as well as a way of experiencing successful, creative relationships with other people.
Many people find that mental health problems disrupt their existing relationship with music as a source of wellbeing: therefore linking people up to musical pathways which help them to keep well (and avoid being re-admitted to hospital) is something that we can help with too.
As people we need to make order out of chaos. And music’s one way of doing that—it’s the way that works for me. Everything was chaotic for me, and music helped me to order things. Even the music I was doing back then was chaotic, and music therapy helped me get it back into order. And that way my life has order too. I’ve got some control back and the life I’m living now thanks to that—well, it’s full of music and it’s amazing. I feel lucky.
Steve, who took part in music therapy in a community mental health centre
Many of our clients tell us that music therapy brings them a highly valued sense of hope. In particular, music’s ability not only to help people to do something meaningful together but to do this in real time and to go forwards in time creatively can be uniquely important for people who may otherwise struggle to find such experiences of meaning, relating and creating.
Neurological injury – or brain damage – can happen to anyone at any time and usually occurs out of the blue, most often as the result of a road traffic accident or a stroke. The results can be devastating, with a person’s life and future prospects transformed in moments. People may lose some or all speech and understanding of speech, some or all cognitive functioning, as well as some or all ability to move. Once a person in this situation has been medically stabilised, they will usually enter a lengthy process of neurological rehabilitation where the emphasis is on helping them to regain as much capacity as possible, and to relearn skills where possible. Nordoff Robbins music therapy can contribute significantly to this, both in its own right and in collaboration with other professionals. The repetitive nature of the exercises required for effective speech and language therapy or occupational therapy interventions can be eased by the skilled use of music, not just as a recorded background but as an interactive part of the process. For people who have lost speech, music therapy is a place to use their voice, with or without words, to be expressive and this can help in the regaining of speech too. And many people who find themselves in this situation are simply overwhelmed by the devastation that has happened to their lives: engagement in Nordoff Robbins music therapy can help people to stay motivated, to feel emotionally supported and to show others the creativity of which they are still capable.
As the population ages, more and more people are living with dementia. Whilst dementia can't be cured, we can help people to live as well as possible with dementia. A diagnosis of dementia can be frightening and as the condition progresses, sustained interaction with family and friends becomes more and more difficult. Dementia doesn't just affect people's memory – it affects their sense of who they are and, coupled with the disorientation that comes from being in a care home, for example, this can lead to isolation, fear and confusion. It also impacts directly on the lives of family and friends.
Our music therapists work with people with dementia in care homes, in day centres and on our own premises. Group work is ideal for people whose needs include social interaction or experiencing moments of joy in shared music-making. You can see an example of group work, and its benefits for family members as well as the person directly affected by dementia in Betty's story.
Individual work may be more appropriate for people who find social interaction difficult or overwhelming, or for whom life has become frightening. The music-centred nature of the Nordoff Robbins approach is particularly good for working with people who have lost language and whose very identity is withering. Music which is sensitively tailored to the person’s movements, breathing and vocal sounds can create a profound and unique sense of connectedness – something extraordinarily valuable to someone in this situation. You can see an example of this work here.
Death is the one certainty for everyone in life regardless of their circumstance, and whilst we would all like to think that we will die peacefully, surrounded by our family, this isn’t the case for everyone. For some people it is a terrifying prospect, and for others there is suddenly a need to express things that have never been expressed before.
Nordoff Robbins music therapy can be part of hospice provision, offering people opportunities for creativity and expression at a time when these can otherwise be difficult to achieve, and helping people to live life to the full right to the end. It can also be an important means for people to experience solidarity and expression.
For someone in the final approach to death without friends or family to accompany them, a music therapist providing skilled musical companionship by sitting with them and singing with their breathing, or playing gently to them, can be a great comfort. Working with someone as they approach the end of their life is a great privilege but also a great responsibility, requiring both skill and understanding. This is another reason why we train our own therapists and assure the quality of all of our work.
Read more about Nordoff Robbins music therapy in palliative care.
Is there any evidence that music therapy works?
As well as training music therapists and providing music therapy services, Nordoff Robbins has an innovative and vibrant research team. They explore questions such as what happens in music therapy and why? How is it viewed by the people who engage with it in different ways? What are the effects of music therapy seen to be? Their work is made available as widely as possible. For more information, please see the Research pages.
You can explore the Nordoff Robbins Research & References Listings, which includes links to the various Cochrane Reviews of music therapy in various areas.
What is the impact of Nordoff Robbins? And what do the users of Nordoff Robbins services say?
For the past 40 years Nordoff Robbins have been developing their music therapy services. Last year we delivered over 19,000 music therapy sessions, through our own centres and by working in partnership with 92 organisations including schools, care homes and hospitals.
Over 4,500 people accessed our services - many of them for long-term support. And through our funding of Nordoff Robbins Scotland we provided more than 1,000 hours of music therapy.
- 89% said that music therapy had provided a positive or creative experience
- 87% said that music therapy had enhanced their quality of life
- 86% said that music therapy had enabled them to develop social skills and interaction
Families and carers
- 78% said that music therapy had improved their relationship with their relative or child
Staff and partner organisation
- 73% said that music therapy had enhanced staff skills and understanding
- 88% said that music therapy had changed positively the atmosphere of the organisation
Take a look at our recent publications to find out more.
Nordoff Robbins – growing access to high quality music therapy
As an organisation, we train our own therapists and provide them with regular supervision in order to assure the quality of the services we deliver. We are working to make the best quality music therapy available to as many people as possible in as many places as possible.
We invite you to join with us in this exciting work, whether as a partner organisation, as a supporter, or as a potential Nordoff Robbins music therapist.
It is the finest work that music can do.