Unbabbled Episode 11: Music Therapy
More than Mozart: Music Therapy with Karina Hall
When people hear the term “music therapy,” the typical picture that comes to mind is using classical or new age music to reach a state of relaxation. That is just one of the common misconceptions Karina Hall, Board-Certified Music Therapist at The Parish School, addresses. During this episode, Karina explains what music therapy is, who could benefit from it, and ways music therapy can be used to support children in reaching their fine motor, social-emotional and communication goals.
Karina Hall, MM, MT-BC, NMT, earned her BA in Music from the University of St. Thomas and her Master’s of Music from Sam Houston State University. Karina has a rich background of working with various special needs groups and providing therapy through music. Before bringing her talents to The Parish School, she was the music therapy clinic director at Sam Houston State University. Outside of The Parish School, Karina works as a music therapist with Easter Seals of Greater Houston, a non-profit provider of services for individuals with autism, developmental disabilities and other special needs. She also recently presented at the Health Museum of Houston with a lecture entitled, “Do Re Mi, ABC, 123, You and Me: Using Music in the Classroom.”
American Music Therapy Association: www.musictherapy.org
Certification Board for Music Therapists: www.cbmt.org
Blog post discussing using music therapy techniques at home: Rejuvenate Together - Through Music
Stephanie: 00:00 Hello and welcome to Unbabbled, a podcast that navigates the world of special education, communication delays and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel and we're certified speech language pathologist who spend our days at The Parish School in Houston helping children find their voices and connect with the world around them. In this episode we speak with music therapists, Karina Hall. Karina is a board certified music therapist and neurologic music therapist currently working at The Parish School. She has a rich background of working with various, special needs groups and providing therapy through music before bringing her talents to The Parish School, Karina was the music therapy clinic director at Sam Houston State University. During this episode, Karina explains what music therapy is and ways music therapy can be used to support children. She also addresses common misconceptions about music therapy, including the myth that classical music is the only genre used.
Stephanie: 01:04 Welcome today we're talking to Karina Hall. Karina is a music therapist and we're so excited to have you here talking with us today. So welcome. Thank you for having me. So first we'll start off with what is music therapy?
Karina: 01:18 Okay. Well we use the American music therapy association definition, which is music therapy is the clinical and evidence based use of music interventions to accomplish individualized goals within a therapeutic relationship by credential professional who has completed and approved music therapy program. So it covers all the specifics of what you need to identify a professional music therapist. That's an easily understood definition of course. So go ahead and give us your own elevator pitch of what musical therapist is. Music therapy is a health profession like occupational therapy, speech therapy. It just uses music as the tool for non-musical goals. So it can be social communication, physical or social emotional.
Stephanie: 02:12 Interesting. In the more formal definition, they mentioned that musical therapist are certified. What kind of training and background did music therapists have?
Karina: 02:20 Yes, so they have to go through an approved university program, which you can find on the American music therapy association website. I may say AMTA throughout our conversation for short. So you can find those through the AMTA website and the program covers instrument lessons in your primary instrument plus additional lessons in guitar, piano, voice. And so you have to pass those classes. Do classes such as psychology of music. My degree program had had us take anatomy too and development, special education, and then we have to go through an AMTA approved internship. And then after that we're able to sit for the board certification exam. And then that's when we earn our MTBC credentials. Or you may see other credentials like RMT for example.
Stephanie: 03:23 It sounds like through your schooling you go through a variety of different areas of therapeutic intervention. You mentioned psychology and development. Are there any other classes that you take?
Karina: 03:36 Yes. So as I mentioned, the different instrument classes, voice, piano, guitar, basics and percussion. And then again the primary instrument, you take lessons as if you are a music major in that instrument. So you take the same amount as a music major and an addition that there'd be classes which are research classes and how to observe and measure data. So we get a variety of science, psychology, music education. For example, the instrumental skills where we practice playing for a therapy group, which is different than performing. So we learned the different skills of songwriting, improvisation, playing for a group and then how to implement the therapy techniques after that. The counseling techniques, for example, the logistics behind that.
Stephanie: 04:34 So it sounds like the therapeutic programming as the part that sets you apart from say a music teacher.
Karina: 04:41 Yes, it, the degree program is again as if we are doing that, but the other classes in addition.
Stephanie: 04:47 So you have to be a therapist and a skilled musician?
Karina: 04:51 Yes, we do have to be very skilled musicians, especially in our primary instrument. And the lessons in the other instruments is so that we can adapt to our client's preferred instruments and music. For example, the instrumental skills class, again, we are tested on different instruments during different weeks and let's, what if this is thrown at you, here's what you do. So a lot of learning to be flexible and adapting, playing by ear. A lot of those kinds of skills.
Meredith: 05:26 What types of people would benefit from music therapy?
Karina: 05:30 So many from this summer actually worked with age zero for the first time.
Stephanie: 05:37 Oh Wow.
Karina: 05:38 So babies for the first time. So from then to geriatric hospice, any age, it can be someone who has a diagnosis or people who don't have a diagnosis. And most of what we would work on would be relaxation. But anybody can benefit anybody with a high interest in music. Someone who's very motivated by music.
Stephanie: 06:05 So you mentioned that your form of therapy uses musical instruments as your tool to complete the therapy. What does that look like?
Karina: 06:14 It can look like playing around for fun and it's not always instruments either. I've had a lot of clients that prefer the recorded music. Um, and some of my adult groups, the recorded music was preferred because it took them back to when they first heard that song on the radio. And some of my younger clients too that I've had preferred the recorded music. So it could be that, but used in that therapeutic way, which we learn how to do. Also we learned to avoid triggers for trauma, for example. We learn about going with the preferred music of the client. That is always number one and instrument wise we also get a lot of high interest in instruments. It can sometimes look like lessons but they will be adapted lessons and the goal is not teaching the techniques of how to play the instrument. That's not the focus. The focus would be the emotional outcome or whatever goal they're working on. It could be fine motor skills, it could be gross motor skills for example. And they show interest in that area of music making. A client can show interest in listening to music, making music, dancing. So whatever way they show interest in music is what we use to do our work.
Meredith: 07:43 I saw that you had posted something on, I think it was on social media that classical music is not the only type of music that can be used for development or mental health services.
Speaker 3: 07:55 And that you said like metal music, could be really therapeutic. Um, that was, I thought that was really interesting. So it sounds like you can really use any type of music.
Karina: 08:05 Yes. A big misconception is that we use a lot of classical, or I said in that post to Enya for example, the genre would be new age and it's not true. There are some people who really dislike classical and it would make somebody angry. It's not motivating for everybody. I haven't had a client personally who liked metal yet, but, but I have had clients who like hip hop who like oldies music and you get the same result of what you would expect - the typical assumption of the relaxed feeling you would get from classical and new age. You can see it in somebody listening to a whole different genre than that because it's what they like. It's all about their preference and what motivates them. Again, not everybody likes classical, so it might make somebody angry or frustrated if they don't like it. And that is not therapeutic. It's the opposite effect.
Stephanie: 09:14 Right. So you mentioned that you can work with people from a variety of ages focusing in on kids that are in maybe the early childhood and elementary age levels. What things do you typically work with those age groups on?
Karina: 09:30 Typically, Um, I'll use Parish as the example. We do a lot of communication work. I've worked on letter identification with matching, for example, matching notes on my xylophone or my colored bells that have letters on them to a sheet of paper where I've written letters. So we'll do matching letters. We have done singing to help with the fluidity of speech. We have done singing for receiving information. So every week pretty much I do that with the groups with the classes is icing songs related to what they're working on in class because singing is more input for the brain than solely talking. And research has proved that. So it's more for the brain to intake and it's more likely to stay in there.
Stephanie: 10:30 Oh my husband jokes that I can't remember facts, but I know song lyrics to songs that I heard twice 10 years ago. So I think that music can be very motivating and helps children tap into a part of their brain that the language side alone doesn't get into so that they can use that side to start remembering things and making it click and make sense. I mean we all sing abcs to learn them first. And I still remember a song about long division that we did in elementary school.
Karina: 10:59 And what other way would we remember? 26 letters and eight six, seven, five, three. Oh yeah helps a lot with memory and even learning something for the first time. It lights up more areas of the brain than solely speaking. So the brain retains that and pulls that out from those areas.
Meredith: 11:22 And if you have children with language delays, activating different parts of the brain to help them learn. That make sense?
Karina: 11:27 Yes. It's accessing it in different ways. So we do a lot of communication work. I've also done gross motor and fine motor work. So if you think outside the box about holding instruments, for example, there's different grips that you hold the instruments in. So we learn about what the grips are called and which ones we use for what kinds of instruments, so in our degree program you start thinking, they start getting us thinking about this group for this instrument. Do we need a pincer grasp triangle? You hold this thing in a certain way and it's, it's like a fun way to get to work on that. It's physical work for the client, but you get to make music out of it too. So you get that feedback.
Stephanie: 12:19 Yeah, they're developing the hand strength in the range of motion and working on motor planning to move your hands and in a really highly motivating way.
Karina: 12:28 It is a lot of things that we don't initially think about, but once you start then you start thinking about, oh it also works on this. Then with that, I've commonly had my older kids work on socioemotional goals also.
Stephanie: 12:46 coming to mind right now I have young children is all the Daniel Tiger songs that they'll sing and I mean my daughter, even one day saying it to me while I was getting frustrated and she like saying a social emotional song from this story that really resonated with her and stuck with her and helped her work through some of those emotions that she was feeling. Music can be really powerful.
Meredith: 13:07 I hear my son sometimes at at dinner singing try new foods cause it might taste good, which is from Daniel Tiger. So he's using the, the songs that he's heard to try to like work on a goal.
Karina: 13:18 And it could definitely be songs or it could be a lot of what I've done also is improvisation with a client. Thinking about what that takes is flexibility, abstract thinking, working together. There's a lot of things that happen on the spot and you're creating on the spot. It's used a lot for coping skills. Then if something is hard to talk about, then we can try quote unquote talking about it by playing the piano together, improvising on the piano or whatever instrument we're able to do that on. And then we try verbal processing afterwards and sometimes it's easier to get it out on something else first and then put words to it. So it could be instruments, it could be singing.
Stephanie: 14:14 Yeah. Because oftentimes when we're listening to music or even then playing music, how we play the music or what tones and melodies changes with how we're feeling. And I mean everybody's been there that like you can hear different music in the background and you're suddenly taken to a spot with that emotion and it helps you process through that easier than just trying to talk to somebody.
Karina: 14:38 Yes. And the beautiful thing about clinical improvisation, it's called clinical because there is a therapeutic goal attached to it. So the beautiful thing about clinical improvisation is that you will see a progression from one, one emotion to the other or it may stay the same and you get to hear it. And then the client has done this sort of communication without having to put words to it. And they, they also hear the feedback from what they just played. And the therapist's job is to be there with them or accompany them, which we learned to do also in our degree programs. And we set them up for success musically. And it's great to see, especially if they went from one emotion to the other and to hear it also.
Meredith: 15:37 So when you're working on goals, like let's say social emotional goals is the hope that they can also walk away with some techniques to use, um, in these moments when you're not around.
Karina: 15:47 Yes. And that is also a big focus for music therapists is finding what can be transferred outside of the session and sending those recommendations to the team, to the teachers, to the parents, whoever they're working on or in an adult's case, talking about that with them. Can you use this outside of the session? Maybe this is something you could do when you don't feel so good. So that is a big, a big piece for us too is that what we're working on can be transferred and continued.
Stephanie: 16:22 To have specific tangible things that children or adults can use as supportive techniques outside of the group, which is very helpful when it'd be in my questions. It was going to be is how can parents and educators support the carry over into their role?
Karina: 16:38 Yes. Music therapists are recommended to communicate with the team. Like I mentioned earlier, we would let them know what they liked and to stick with the music preference. Again, the misconception of he's listening to this, would this make him more feel more angsty or would this, would this continue the negative emotion? One of the tips would be to stick with the music preference again because that is what's motivating to the client. Uh, another tip is not to get hung up on techniques of instrument playing or what we are used to with music logistics and to think outside the box and we will send examples and recommendations and, and say that there's a lot of things that you can do in unexpected ways, things you can use in unexpected ways and get an amazing result from that. I have another recommendation for making a playlist. If it's someone who loves listening to music is um, against stick with the music preference and to think about where they would be at when they're listening. What is the purpose of this playlist, for example? Are we trying to get the class to calm down? Did they come in revved up and we need them to slow down? Then we'll begin with the more energetic music and then gradually move to slower. And I use the example of if you woke up on the wrong side of the bed one morning and you see somebody who says, well, at least something, something very cheery, it makes you more angry.
Stephanie: 18:31 Oh yes. When I was in college, I was not a morning person. I'm still not, and my roommate was a morning person and it always put me even more in a bad mood when she was like, Hey, good morning, it's time to start our day, rise and shine. I was like, I'm not ready for bright lights in this cheeriness so I could see how music taking it from one extreme to the other would be jarring.
Karina: 18:54 Yes, it will likely have, again, the opposite effect of what we're looking to do. So I use that example for when we're creating a playlist, for example, again, to calm the mood down and also gradual. It's, if it's too big of a jump, it, it won't have that same effect.
Stephanie: 19:14 It's interesting. I really would've never thought of that. I would've thought immediately I need to get them from point a to point B and I'm going to do it this way cause that's gonna [inaudible]
Meredith: 19:23 In fact I've done that. Me Too. So that's really great advice. So for parents out there, I don't know if I'm the only parent, I'm sure I'm not the only parent experiencing this, but between I dunno, five and seven pm my house is can be kind of crazy and we listen to a ton of music in my house. So I maybe have been going too quickly to the slower, more relaxing music or you're telling me I should probably start with more energetic music and then fade out into the more relaxing music?
Karina: 19:56 Yes, we hear, I heard a lot from my professors, meet them where they're at. That was one of the most familiar phrases we had in school and that is what we were taught, meet them where they're at and then gradually move to whichever direction you're trying to go. It could even go on the opposite direction. What if this week is MAP testing and the kids come in burned out.
Meredith: 20:23 And MAP testing is a type of standardized testing we do here on our campus. Yes. So you need them to wake up cause they've been feeling a little lethargic from their testing and sitting around in front of a computer doing the work. Yes?
Karina: 20:35 Yes. Or a bad weather day and recess couldn't happen. So we want them to go the other direction so we start in the opposite way and that's how I plan classes too. And we'll switch in the moment depending on what I see when they are coming in. So I will switch up the order of my plans to keep that in mind. This is in music therapy, what's called ISO principal. So meeting them where they're at and gradually taking them into that other direction.
Stephanie: 21:08 It sounds like the very clinical side of it is always watching and taking notes and then adjusting and it seems like that's another way that really sets music therapy apart from just a music instruction.
Karina: 21:19 Yes. A form of assessment.
Stephanie: 21:20 Interesting. So you've mentioned that pretty much everyone can benefit from some form of music therapy, but if as a parent or as an educator looking and seeing a child struggle or knowing that they're having some difficulties, what would be an indicator that that child might really benefit or be a good candidate for music therapy?
Karina: 21:39 That's a great question. I've gotten some referrals sometimes to where the client does enjoy music, but it's not as big enough of a motivator as something else. And so my guidelines are motivating. It has to motivate them to do the work because our work is fun, but it's work. I've had some that do enjoy music and we did our short term sessions and worked on rapport and attempted to do the work too for those goals that they were working on. But I have also seen them really enjoying art and getting into their art, which we have Chrissy here at The Parish School too, the art therapist. So I will speak to Chrissy, and we'll decide should we refer for art therapy? Maybe that's more motivating. So the motivation to do the work is, one is the defining thing about the candidates for music therapy.
Stephanie: 22:50 So other then having the motivation, is there anything else specific that we can be on the lookout for? Are there things that are easy, more easily addressed during music therapy and are there certain things that are kind of outside the realm of what a musical therapist can address?
Karina: 23:06 There's no need for previous musical skills that is, that's a also another question I get or your statement that, well, I don't know how to play anything. I don't know. I don't know how to play guitar. You don't need to, it's not again about the technique and the product, it's about we're going to use this as our tools to work towards the goals.
Stephanie: 23:31 Interesting. When you're developing the goals, is this something that you work with other professionals or do you have assessments that you go to? Is it parent input? How do you develop your goals?
Karina: 23:43 Actually, Chrissy and I last year a sheet, a referral sheet with checkboxes of typical goals, goal areas that we have and the teacher, the parent, whoever's referring. We've even had some student students refer themselves. We'll go through that and think through is this an area that we could work on? And so we get some input from that, especially because we're working with children, with adults, or sometimes if we have someone nonverbal, or if we don't have the ability to get any previous information from other people, we assess, assess them ourselves. There, there are some formal assessment tools out there for us. It's case by case with the workplace that you are at. And um, a lot of it is we make it, we use what we learned in school about what, how to assess. So, uh, an initial session would usually be addressing and so we'll have an intervention for each one of those things. And then we will see did they struggle a little bit more with this, we can keep working on this and that's our form of assessment. And then we are required to write reports. So we will write an assessment and then we can do in between reports and then a final evaluation to keep up with the data. That way, we're recommended to keep data. Also to see and to be able to show the numbers of they really improved in this or we kind of plateaued and stayed stuck on this. So what our recommendations after that.
Meredith: 25:43 So it sounds like a lot of your goals are developed with client, teacher and parent input generally. That's a big piece of it for you guys.
Karina: 25:51 Yes, and we were able to have that access. So we're really lucky here at Parish and we are able to collaborate with the other therapists too. At Carruth also, which is our onsite clinic. Yes. And then sometimes it won't, it won't be as accessible just depending on what site we're working at. So that's when we do our own, we use our professional judgment in our assessment.
Meredith: 26:19 If a parent is thinking that music therapy might be a nice approach for their child, do you have any recommendations on where they should start to look for a music therapist?
Karina: 26:29 Yes. On our American Music Therapy Association website, musictherapy.org has certified music therapists in your area or CBMT has it also. That's a certification board for music therapists that has where every certified music therapist is in the US and where they're working. So that one we'll show you everybody and AMTA will also show some so you can look there or talk to any music therapists that you might know and we refer to each other. We like to communicate with each other.
Meredith: 27:15 So are there any other misconceptions about music therapy or music in general you want people to know?
Karina: 27:20 There is another one that I see commonly when you Google or Youtube relaxing music or have a relaxing music CD. And I found this out through what I learned in school and even more from my thesis. My study was on how does, what is the music that will best help someone's sleep quality. What I found was lower frequency, slower tempo is much easier for the brain to process. So the brain is able to slow down and relax. So trying to get kids to bed or the kids in your class to relax, slow down a little bit. The way to go would be mid to lower frequency.
Meredith: 28:10 That's so interesting because when my son likes to fall asleep to music. And when you put in Spotify or any of your, um, music apps, a relaxing children's lullabies or music, it's all very high frequency.
Karina: 28:23 It is. And I struggled to find music, a set playlist on Youtube or um, we mentioned Amazon music too, wherever you get your music from that is mid to low frequency. Most of it has some kind of instrument that's high pitched in it and it sounds beautiful but the brain is working hard to process that.
Meredith: 28:47 Yeah. Really commonly we find the high piano, like almost like a toy piano.
Karina: 28:52 Yes. And we were drilled in school do not play that because we also learn how to play live relaxation music. And my professor would say, do not play up there and play here and lower and we would play that in class. And it's again, it's less for the brain to have to work on and you're able to relax if you want to energize, energize who you're working with or who you're spending your time with, then that's when the high frequency comes in.
Meredith: 29:30 Uh, no. When I'm putting my son to sleep, I do not want to energize him. That is great. I'm going to go home and change my bedtime playlist.
Karina: 29:37 Yes. It's a lot of looking through it so it, it takes more time, but it makes a big difference and we have the research, tons and tons of research that and brain scans that show that physical difference when the music has those elements in it.
Stephanie: 29:56 That's interesting. Well thank you very much for sharing so much about the music therapy. I know that I learned a lot. We ask every guest this question at the end of the podcast and it can relate to music therapy. Your answer or at can be just a general life answer, but we ask if you had one piece of advice to give out to our listeners, what piece of advice would you give?
Karina: 30:19 Oh, okay.
Stephanie: 30:21 We're hard hitting on this part, right?
Karina: 30:22 I would say do music in your own way. Uh, and I say that for, do you like to play it then play pick, pick up an instrument, find some music, some sheet music to play along with. If you just like to listen and you don't, learning an instrument seems too stressful. Don't learn the instrument. Just listen and enjoy it. And if you like to dance, find your time to dance. I would say keep enjoying it in your own way.
Stephanie: 31:04 I like that.
Meredith: 31:05 Yeah. Great advice.
Stephanie: 31:05 Well thank you so much. We really appreciate having you on and it was a pleasure to talk to you today.
Karina: 31:10 Thank you.
Meredith: 31:11 Thanks Karina. Thank you for listening to the Unbabbled podcast. For more information on today's episode, including links to resources mentioned, please see our episode description. For more information on The Parish School, visit parishschool.org. If you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice, and if you like what you're hearing, be sure to leave a rating and review a special thank you to Stig Daniels, Amy Tanner and Amanda Arnold for all their hard work behind the scenes. Thanks again for listening.