In addition to voice, music therapists are trained to use guitar, piano, and percussion instruments in clinical settings. These instruments are described as “functional” instruments by the American Music Therapy Association (AMTA) Professional Competencies. However, many other instruments outside of these categories - like string instruments or woodwinds - are often viewed as additional, non-clinical instruments. This can cause confusion or uncertainty for music therapists who want to learn how to clinically use their primary instrument and yet do not receive formalized training for how to do so.
As a classically trained cellist, I wanted to learn how to use my primary instrument in clinical settings, and have experienced difficulty navigating this dilemma throughout my education and professional practice. Thanks to guidance from supervision and personal experience, I discovered that utilizing a string instrument (i.e. cello, violin, viola, harp, upright bass, etc.) as a live music alternative can have numerous benefits with almost any client population.
Here are SIX ways to utilize YOUR primary string instrument in clinical settings:
1. Introduction to New Stimuli
A primary benefit of using a string instrument in sessions is to use it as a new visual, auditory, and tactile stimulus. Clients might have never heard nor seen your primary instrument and would enjoy being exposed to the new sounds, visuals, textures, and vibrations. Additionally, bringing in your string instrument can be a novelty to many clients - especially children! Expect a lot of, “Woah”s and “Ooooh”s!
Because this might be a new stimulus, it is important to slowly introduce your string instrument to ensure as little overstimulation as possible. Start by simply displaying the instrument and the different mechanisms to provide exposure to the new stimulus. Begin to add in softer sounds, and gradually increase the volume to assess the appropriate amount of auditory stimulus for your client. If you feel comfortable, have clients gently place their hands on your instrument while you play to add in a new tactile stimulus. If a client shows any signs of distress during the instrument demonstration, remove the stimulus and focus on re-introducing, if and when appropriate.
2. Name That Tune
'Name That Tune' requires the music therapist to play melodies to familiar or client-preferred music on their instrument while providing clients the opportunity to guess the name of the song. This intervention can be adapted to use with many age demographics. You can support older adults with memory recall of familiar songs and melodies. You can also utilize this intervention to promote rapport building and social engagement with children, adolescents, and adults.
Steps for this intervention include:
a. Obtain client-preferred music before this intervention.
b. Play melody of a song on your instrument.
c. Allow clients to guess/call out song title or artist.
d. For more of a structured intervention, you can adapt to a jeopardy-style.
3. Improvisation
Using your instrument may provide both expressive and receptive communication opportunities for your clients. A structured improvisation requires clients to actively listen to the music therapist’s directions through musical cues. Utilizing different elements of music (i.e. timbre, plucking styles, percussive elements, bow speed, volume, etc.) can direct your clients to play in certain ways. For example, playing louder on your instrument would indicate that the group plays louder; or, playing faster on your instrument would indicate that the group plays faster.
Additionally, adding in different techniques could identify prompting only specific instruments to play. For example, knocking on the instrument could be a signal for only those with drums to play; or, pizzicato could be a signal for those with shakers to play. This is completely up to you as a music therapist to decide what signal to match with each sound.
4. Conducting
Similar to the improvisation intervention, this intervention focuses on giving and following directions. However, instead of the music therapist giving directions to the clients, the clients give directions to the music therapist! Goals that may be associated with this intervention can include autonomy, expressive communication, and speech and language development. Clients communicate how they want the music therapist to play their string instrument, and the music therapist follows the directions to the best of their ability. This intervention can include visuals for clients to use if they do not use verbal communication. However, if you are specifically working on speech goals, you can adapt the instructions accordingly. For example, if a client wants you to play faster, they can show visual cue to depict 'faster' or can verbally say, “faster”.
Steps for this intervention include:
a. Ask clients which pieces/song they would like to hear.
b. Present clients with the conducting visuals and explain what each means.
c. Ask the clients how they would like to hear the song.
d. Play the song, as directed.
5. Music and Art
Music and art is a widely used intervention with clients when focusing on emotional expression and orientation to place and self. As a classically trained musician, I have found numerous pieces that can evoke different emotional reactions in myself while playing them. The emotions that may come from the pieces can be placed in a theme (i.e. happy, sad, excitement, anger, etc.). When using this intervention, focus on a theme that you would want to perform through your chosen pieces. Ask clients to draw what they hear in the music and identify emotions that may arise. Discuss emotions or thoughts with your clients that may have occurred during the piece, and explore how the process affected the members of the group. Depending on the age and abilities of your client, you might ask your clients if they experienced visceral responses (i.e. heart rate increase/decrease, restlessness, relaxation, etc.). If they found the activity helpful, encourage the clients to use this technique as a potential coping tool. *Important Note: This is not the Bonny Method for Guided Imagery in Music*
Steps for this intervention include:
a. Direct clients to draw what the music sounds like and identify the corresponding emotions.
b. Play a few songs that focus on a specific theme.
c. Discuss and process emotions felt, art created, and/or visceral responses with the group.
d. Discuss how music may be used as a coping skill.
6. Accompaniments
Like I have stated before, music therapists are primarily taught to utilize guitar, percussion and piano as their accompaniment instruments. Those who have a primary string instrument have a special advantage to use their primary instrument as an additional accompaniment instrument. Basic accompaniments may include strummed chords, pizzicato arpeggios, and double stops. This technique can be facilitated as an introduction to new stimuli and/or a method of relaxation. This can also provide an unfamiliar sound, which might evoke different emotions and conversations with your clients.
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