BY PAM MCGRATH

MINA CHAREPOO, MD, PSYCHIATRIST, AND CHUCK EVANS, MT-BC, MUSIC THERAPIST.

Photography by Gregg Goldman

“Music is a moral law. It gives a soul to the Universe, wings to the mind, flight to the imagination, a charm to sadness, gaiety and life to everything. It is the essence of order, and leads to all that is good and just and beautiful. — Plato

Melody, harmony, rhythm, tempo, beat, dynamics, structure, timbre, texture, pitch—these are the elements that define music. Their countless combinations create moments in time that can sooth, excite, uplift, unsettle, amuse and bring joy to those listening.

Belief in the connection between music and the body and mind’s well-being dates back millennia, but the genesis of modern music therapy occurred after World War II, when physicians and nurses witnessed the positive emotional and physical response recovering veterans had to music. Since those anecdotal observations were made in the late 1940s, music therapy has developed into an accredited, allied health profession that uses evidence-based (scientifically and clinically proven) music interventions to address the physical, emotional, cognitive and social needs of groups or individuals.

Within Barnes-Jewish Hospital’s psychiatric unit, music therapy is an important—and popular—means of communicating with and understanding adult patients of different ages and varying mental-health needs.

Recently, I spoke with Washington University psychiatrist Mina Charepoo, MD, the unit’s medical director, and with Charles “Chuck” Evans, MT-BC, activity therapy supervisor and one of three music therapists working with patients in the hospital’s psychiatry unit. We talked about how music therapy benefits people receiving psychiatric care.

How do you define music therapy?

Evans: According to the American Music Therapy Association, music therapy is “the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”

In my experience, music therapy takes a different approach to the same questions asked in a traditional therapy session. And it’s used as a diagnostic tool. For example: Physicians and nurses use a stethoscope and blood pressure monitor to check patients’ vital signs. For music therapists, music is the instrument we use to measure what patients are thinking and how they are communicating.

THERE ARE A VARIETY OF INTERVENTIONS WE CAN USE TO HELP PATIENTS COPE WITH THEIR EMOTIONS—OR SIMPLY FEEL BETTER WHEN THEY LEAVE THE SESSION THAN THEY DID WHEN WE STARTED.

Photography by Gregg Goldman

How does music therapy benefit patients?

Charepoo: Music therapy in its many different forms—recorded, performed in person, created by patients writing songs or playing instruments—has a therapeutic effect because it invites people to express themselves in a meaningful way.

What kind of education and training is needed to become a music therapist?

Evans: A music therapist first earns a bachelor’s degree or above in music therapy from a college or university approved by the American Music Therapy Association. The degree curriculum includes 1,200 hours of clinical training. In addition, a music therapist must hold an MT-BC credential issued by the Certification Board for Music Therapists. We are recertified every five years.

Do all patients in the hospital’s psychiatry unit receive music therapy?

Evans: Participation is voluntary, but we encourage patients to attend our group sessions. When they participate, they receive benefit—and they are giving us the opportunity to better understand other ways we can help them recover. For instance, participation in a drumming intervention can help people communicate emotion and can help lower anxiety while also giving me insights into their well-being. We usually lead three one-hour group sessions a day, which provide multiple opportunities for patients to participate.

Individual sessions are available if the care team determines they would be beneficial. We might use individualized music therapy for someone who isn’t comfortable in a group setting or who wants to address a particular issue. For example, we might use individual sessions to work on verbal processing or on coping skills. These sessions typically range in length from 30 minutes to an hour, depending on the patient’s needs.

Why did you want to become a music therapist?

Evans: I’ve always loved music. I began performing at an early age, singing when I was a child and taking up the violin when I was 10. Ultimately, I played violin and other instruments as a professional—and still do—but over time I found I wanted to move beyond performing. I wanted to find a way to use music to help people. Music therapy allows me to do that, in a variety of settings. I like to learn, and I’m continuously challenged working in a field that looks for ways to help people connect psychologically and emotionally to music.

What value do music therapists bring to patient care?

Charepoo: They provide therapeutic interventions that support patients until they are discharged and begin one-to-one therapy outside the hospital setting.

They also bring value by being members of our treatment team. I can tell them my concerns and insights about certain individuals and ask them to look for behaviors or issues that may signal a problem. In addition, because they are trained as keen observers and have a different relationship with patients than I do, they sometimes come to me to report concerning behaviors they’ve identified that I’ve not observed myself.

Our music therapists are professional, caring and skilled at what they do—and their music is an important part of the unit’s environment.

How do you approach your group therapy sessions? Describe some of the interventions you use.

Evans: I practice a person-centered approach that aligns with a humanistic perspective. That means, I meet our patients in the moment, then use music and music interventions to help bring them to a better outcome.

I pre-plan sessions based on patient assessments and a medical-records review, and by talking with the unit’s staff. Once the session begins, however, my planned approach may change depending on what I perceive as the group’s needs at the time. Another factor influencing how the session unfolds is the fluidity of any given group’s makeup. Some patients stay a day on the unit, others a week or sometimes a month. The dynamics of the group change frequently; I adjust my music therapy to accommodate that fluidity.

During a typical session, I may start out playing a song on my guitar—“Here Comes the Sun,” for example—as a way to welcome people to the session and to warm up the environment. If I sense anxiety in the group, I may play calming chords and encourage listeners to use provided colors to fill in mandala designs. Other times I may ask people to suggest a song; after they listen, we talk as a group about what the lyrics mean personally and what feelings the song evokes. Sometimes I’ll hand out instruments, and we’ll play together as a band. Or we may write a song together. There are a variety of interventions we can use to help patients cope with their emotions—or simply feel better when they leave the session than they did when we started.