Dori, would you tell us about music therapy in general? What is it?

Music Therapy can be better described by saying music-based treatment, because it is a treatment in which various elements of music are applied to address human health issues. Music, as many know, contains six elements, including rhythm, tonality (melody), timbre, harmony, dynamics, and form, and variations thereof.

Any one or more of these can be directed toward treatment interventions to address a variety of health needs. Music-based treatments are applied to a variety of diagnoses, including ASD, Sensorimotor issues, Parkinson’s, ADHD, Alzheimer’s and various dementias, PTSD, Strokes, COMA and other conditions involving consciousness, pain management, cardiac problems, and so much more.

Many people confuse music therapy with “just listening to music”. Would you tell us about the difference and the overlaps?

Music-based treatment, aka music therapy, is a clinical intervention provided by a specially trained and credentialed (Board Certified, Licensed, etc.) clinician. There is a difference between music as “therapeutic”, and music therapy.

So, how would you describe “just listening to music”?

Music can be “therapeutic” when listened to recreationally. Listening to music may induce mood changes, memories, relaxation, release stress, help concentration and task attention, and more. But that is not “treatment” – it is like a self-medicated treatment, and yes, it’s good, but it is “in the moment.”

Then, how would you describe Music-based treatment?

Music-based treatment has goals and objectives for changes and functional adaptations related to an individual’s current situation to enhance better coping and responses to problems.

How does Music-based treatment work, then?

If you’re an anxious person, you want a music-based clinician who can administer the kind of music intervention that will ultimately strive to more permanently release anxiety. Another way to look at this, is that you want a therapist who can utilize music to alter the function of the brain’s amygdala (moving the individual’s nervous and physiological system from high arousal to calmer). A music-based clinician can help you mediate fight/flight with music. Anxious people, and people with misophonia, both tend to have higher arousal systems, involving fight/flight. When a person is in fight/flight the HPA Axis (Hypothalamic-Pituitary-Adrenal) shoots catecholamine in the blood stream (cortisone, adrenalin, etc.), and other hormonal and physiological processes occur. It is generally unhealthy for the body to be frequently and excessively activated like this.

Oh, so you are saying that music-based treatment can affect changes in the neurological/physiological system?

Yes. Sensorimotor and Neurologic Music Therapy treats all sorts of issues in persons of all ages. In essence, ‘just listening’ does not require a music-based clinician, but music-based treatment does, because it is interactive, and active interaction with music is a whole-brain activity that can address areas of function that ‘just listening’ omits (e.g., motor function, visual, tactile, etc.). I approach from a physiologic perspective, with the belief that even “psychology” is physiology.

I am so glad to hear you say that! Dori, one of the ideas I have always had, which we have discussed on and off for almost a decade, is that of using music as a “tool” for down-regulating the nervous system specifically for people who are auditory over-responsive. However, for people with misophonia, this might be counter-intuitive because certain noises are so bothersome. In other words for people with misophonia music itself can be a double-edged sword.

I think there are several ways music-based treatment can approach interventions for people with misophonia. As we’ve talked about, we can work on utilizing music as a means of down-regulating or “calming the system”.

I’m remembering an article from years ago…it was an academic article entitled “What Gives You Chills” or something like that. The main point was that while there are some universal elements that apply to what make music calming and/or up-regulating, personal choice is really where one needs to begin. For example, I know you find classical music to be relaxing, whereas for me (a person with misophonia) most classical music is highly aversive to me. In fact, what I find calming is kind of random, and certainly not genre specific. I’m guessing it is probably the same with most people with misophonia.

Of course, remember that listening to music and Music-based treatment are different. However, you are right (and this is particularly pertinent to misophonia). Finding the right music for the therapist to work with is going to be challenging. This is uncharted territory and we need to be careful.

I would think the best place to start is to ask the individual.

Absolutely. And once, we begin working with music a person likes, we can deconstruct the elements of that music that he or she likes. Remember before I was talking about the different elements of music; rhythm, tonality (melody), timbre, harmony, dynamics, and form…

Yes

Also, we can work with frequencies. If a person is discomforted by high frequencies, for example, you can add just a tiny bit of high frequency into music so that the brain can adapt.

That’s interesting.

Well, this is why I pointed out that Music based treatment is a lot more than just listening and that it involves use of the whole body. Expressing music, making music is not the same as listening and that can be a big part of music therapy treatment as well.

Of course, and you have done so much work in this regard for people with SPD, and Autistic Spectrum Disorder etc. who of course are often auditory over-responsive (which is similar to or may be a variant of misophonia). While we are on the subject, would you describe from your experience the difference of these disorders?

The main difference that I have found between ASD and SPD is the ability to modulate behavior, and control responses more functionally by persons with SPD vs. persons with ASD. In ASD, socialization difficulties are usually very evident, whereas in SPD they are not. In ASD, cognitive delays, language delay or difficulty with the social elements of language (which includes variations in pitch, or prosody, knowing when the timing is right to interject in a conversation, etc.) and slower information processing are most always present. However, in SPD these elements are not necessarily present. In other words, individuals with SPD and ASD share the sensory issues but those with SPD do not have the significant cognitive/social/language impairment. In terms of behavior, then SPD and ASD look very different, and I, for one, never confuse the two. It’s almost like asking what’s the difference between a man with black hair, and a woman with black hair. Characteristics of each are entirely different, although they both have black hair.

Well-stated Dori! I would add that people with Misophonia have extreme reactivity to certain noises and have great difficult modulating behavior because of the underlying fight/flight response that is triggered by this stimuli. I don’t think Misophonia is defined by any cognitive or language delays. However, there is no official definition yet. Speaking of which, many people with misophonia are also bothered by the visual perception of movement (often specifically of other people’s movement). Do you think music therapy might help with this?

I know music therapy can address this issue, with movement activities. And a mirror. In other words, what if “the other person” was in the mirror? I have many ideas for helping with visual interruptions of perception. I have a friend with ASD (“Asperger’s) who has a terrible, terrible stutter. He told me that when he speaks in person to someone, the visual movements he sees of the other person causes him to stutter very badly. However, when he speaks on the phone to the person, he’s better with language flow! So I suggested that he practice talking to his image in his mirror, and this changed the visual distraction. In music-based treatment, I would have us play fun instruments in front of a mirror, sing in front of the mirror, move our bodies, while singing before a mirror, and more.

That is really interesting Dori and this is really something that should be researched further! I have a question about art therapy. How is it different from music therapy? Do music and art therapists have different training?

I am not really qualified to talk about training of art therapists, except to note that art therapy is more a psychologically-based treatment – express your feelings through color, design, etc. Music expression does that also, but with the clinician who also participates with the client in music-making! Or – within a group. Art is individual, like the “just listening to music” vs. making music with another. The art therapist doesn’t make art with the client – the client is left to be inside his/her own head, without other external influences, while making music is collaborative with the clinician – we both make music with each other, and I will guide toward reaching an objective of self-expression, reduction of anxiety, and recognition of self. So yes, art therapists have different training as far as the treatment goals, objectives, and approaches. Art therapy’s main objectives are psychological (mind), while music therapy’s goals and objectives are mind-body – the whole persons, including muscles, joints, movements, etc. We don’t just sit in a chair and draw, paint, sculpt for a final result. We (music therapists) move, play, sing, share, interact, in a temporal manner – in the here and now and gone manner. (Unless we notate the music for future rendition – which does happen at times). Please understand, though, that I’m not comparing as to whether one or another is better – I have worked with art therapists and music, which was an ideal great advantage! It’s fun and a no-lose intervention for all.

I know that you also research in the field and write books. Would you tell us about that?

My books and research involve behavior characteristics of particular neurologic and sensorimotor difficulties. I have four published books, my first being on the subject of Performance Anxiety in musicians, but the following three books involve music and how physiology plays a role in treatment of various diagnoses through music interventions. My books can be found at Amazon, under my name Dorita Berger, and some of my writings are posted on Academia.edu, including my research paper. My books have descriptions of case studies. And…. I am now in the process of writing my 5th book, a kind of ‘non-academic’ book for parents, titled “Kids ‘n’ Music: Thinking Beyond The Spectrum”. It’s not an “academic” book, but a quick read with advice. Titles of my other books: Eurhythmics For Autism and Other Neurophysiologic Diagnoses: A Sensorimotor Music-Based Treatment Approach (JKP, 2015); The Music Effect: Music Physiology And Clinical Applications (JKP 2006, with Daniel J. Schneck); Music Therapy, Sensory Integration and The Autistic Child (2002, JKP); and Toward The Zen Of Performance: Music Improvisation Therapy For Developing Self-Confidence In The Performer.

That’s amazing Dori. I don’t know how you find the time to write all of these books! As my final question, would you please tell us a little more about yourself? How did you get started as a music therapist?

I started music when I was 5 years old, after being taken to the movies to see “A Song To Remember”, which is the life of Chopin – well, as Hollywood saw it. But the music (played by Arthur Rubinstein, by the way) was so gorgeous; all I wanted to do was to play the Piano!

Imagine, even at the age of 5, a child can already sense emotions in music! I began piano lessons then, in my native Argentine, and continued studying once we relocated from Argentina to New York City. And that was my life. I attended the High School of Music & Art in NYC, then went on to graduate in Piano Performance from Carnegie Mellon Univ. (I wanted to go out of town of course), returning to NY to attend graduate studies at Juilliard. Performed here and there, mostly chamber music, married, had kids, travelled, moved to different locations as a result of my husband’s profession, so performing became limited.

Then when one of our two daughters became a serious and excellent student on the violin, I helped her attend Juilliard, Aspen, and all the spots for upcoming performers, in addition to concertizing with her at many locations. And one day, I read an article about a Music Therapy clinic working with Autistic children, and what they described I thought to myself, “I’ve already done that…. Maybe I should get the degree”. I had worked with children, taught them, did improvisation, movement, etc. So I thought why not?

My intention was actually to work with psychiatric adults. So I attended NYU’s music therapy program, and two years later, Master’s Degree and Board Certification in hand, I was on my way to working at a special school for Neurodevelopmentally Delayed children – as in, Autism. When I started to work, I realized that I was incorporating my Dalcroze Eurhythmics training as interventions for sensorimotor deficits! And that ultimately led me to author several book dealing with music, physiology, sensorimotor systems, Autism, and more.

Thank you very much Dori. Please feel free to add any comments you would like.

Thank you for your interest in my work, my background, and me.

I am very supportive of your magazine, and the work you are doing to bring about awareness of misophonia. It similar to my discussions to people of Scotopic syndrome in which there is such visual processing issues due to light glaring on a piece of paper that then distorts and convolutes the image on the page – especially the writing on the page. Teachers expect special needs and sensory sensitive students to read the book that is lying flat on the desk, without ever considering that perhaps life refraction is disturbing the image and the student simply can’t make out what, precisely, is on the page!! So much is taken for granted, for lack of awareness, so I thank you for the work you are doing to bring about awareness of misophonia, which I think everyone experiences, at one time or another!

Dorita Berger, PhD, MT-BC, LCAT, has more than 20 years of experience as a Sensorimotor Music Therapist specializing in treating auditory and allied sensory factors in Autism Spectrum and related neurophysiologic diagnoses in all age groups. Dr. Berger has several published books lauded internationally, and peer- reviewed Journal articles and research on the role of music in human adaptation.

Dr. Berger received a Fulbright Visiting Professorship to teach Music Therapy in the Ukraine, a Global Education Grant to teach and lecture in Argentina (where she was born), and in Italy, and is sought nationally and internationally to lecture and teach about the role of music-based treatment in sensory processing and behavioral disorders.

Dr. Berger’s authored books include “The Music Effect: Music Physiology and Clinical Applications” (2006) co-authored with Virginia Tech’s Professor Emeritus, Dr. Daniel J. Schneck; “Music Therapy, Sensory Integration and The Autistic Child”, (2002), which has also been issued in the Korean Language (2012), and has been designated as one of the year’s best academic books by the National Academy of Sciences in Korea (2013); and “Toward The Zen Of Performance: Music Improvisation Therapy For Developing Self-Confidence In The Performer”: (1999).

Dr. Berger’s 4th book, Eurhythmics for Autism and Other Neurophysiologic Diagnoses: A Sensorimotor Music-Based Treatment Approach was released in 2015. In addition to teaching and lecturing, Dr. Berger, formerly from Norwalk, CT, is Clinical Director at Rhythm and Rehab Music Therapy Clinical Services in Durham, North Carolina.