This six-year-old has autism. Jeslie Tew can’t sit for long enough to finish colouring a picture or write a story. She is hyperactive, constantly on the move and easily frightened by sounds, thanks to a sensory hearing impairment. All it takes to startle her is a commercial coming on the television or someone switching on the radio.
Then along came music therapy.
“I was initially sceptical about how effective it would be. We have sent our daughter for several kinds of therapy, each addressing a specific area, ranging from speech skills to behavioural issues – and progress is slow,” says mother Elaine Lim.
So it came as a pleasant surprise that Jeslie was particularly receptive to music therapy. Lim, 31, says it took about six one-hour sessions, held over six weeks, before they saw results.
“Since she started with music therapy (last September), she has calmed down and is more willing to listen to instructions. She is able to sit still for a longer period to concentrate on completing a task, like colouring or writing, when before she couldn’t. She is also not as scared of sounds from the television or radio now,” Lim says.
Music therapy is an allied health profession where music is used to improve or maintain one’s health and general well-being. It is the planned use of music to achieve non-musical skills that are transferable to other aspects of life. It is often used to address specific needs of an individual, be it his physical, emotional, psychological, cognitive or social needs.
In Jeslie’s case, registered music therapist Cheryl Mow says they are working on improving her fine and gross motor skills, communication and behavioural skills such as turn-taking, imitation and learning to follow instructions.
“Jeslie has a very good memory and good observational skills. She is able to play songs on the xylophone and keyboard by ear or by observation. We have made progress with movement and co-ordination and she has been increasing her musical repertoire which helps her cognitive skills,” she says.
Playing blind
Sing along with the guitar and learn how to interact with others? Move to music as part of stroke rehabilitation? Play the xylophone and emerge with life skills?
The concept seems somewhat abstract, to put it mildly, particularly to someone who is unaware of the finer details of music therapy. But Mow, 29, explains that in reality, it is very much more grounded than it might sound for the uninitiated.
Music is an intrinsic part of life – breathing, heart rate and movement have rhythms; speech, laughter and crying have melodies.
It has been demonstrated to have an effect on physiological responses (such as heart rate and breathing), which in turn can affect mood, movement, pain perception, and communication, among other things. Research suggests that when music therapy is used in conjunction with traditional therapy, success rates are improved. And contrary to popular belief, one does not need a background in music or to be able to play an instrument to go for music t herapy. Its sessions are designed to take advantage of our innate ability to appreciate music.
“People sometimes confuse music therapy with music education. They think that going for music therapy means learning how to play an instrument. But that’s music education – where you hone your musical skills and improve your musical knowledge. In music therapy, we are simply using music as a tool to help people achieve something non-musical, whether it is so they can move better, speak better or function better in their daily lives,” explains Mow, who runs classes at
Anne Muzikschule Performing Arts Centre in Ara Damansara in Petaling Jaya, Selangor, and Kid’s E World at The Gardens Mall, Mid Valley City, Kuala Lumpur.
She estimates that there are fewer than 10 registered music therapists working in Malaysia. In neighbouring Singapore and Hong Kong, music therapists are employed in hospitals. Malaysia, she comments, is a long way – maybe two or three decades – from being on a par with countries that recognise music therapy as an aspect of healthcare.
“Singapore has its own music therapy board; in Malaysia we don’t. The future for music therapy looks quite bright but the pace is slow. There are people who are open to it, but then there are many others who think that it is not yet the time for this. But compared to five years ago, before I left to pursue my Master’s, there is definitely more awareness now,” notes Mow.
Trust issues
When a child comes in for therapy, the first thing Mow does is an assessment to gauge his (or her) communication, cognitive, social, and motor skills. Does he have any music background? How receptive does he seem to music? Is he sensitive to certain sounds? What does he want to get out of therapy? Each programme is tailored to the individual’s needs, and as such, there is no “typical music therapy” session.
“The programme plan and goals are pretty specific. If a child is working on improving motor skills, one of the objectives might be that he will be able to better co-ordinate his left hand movements by the end of 10 sessions,” she says.
Mow finds it ideal working in 10-session blocks and says you probably won’t get accurate results if you stop too early into the therapy for an evaluation.
“The child often needs a few sessions just to warm up to you. It’s about building up trust – that he trusts you, doesn’t feel threatened and knows that you are not going to force him to do certain things. We have to give them the time and space they need to respond,” she says.
Whatever is learned within a music therapy setting is ultimately applicable to everyday life. Let’s take the case of the child who is working on his motor skills, say, to be able to grasp objects.
“We work with instruments that he can hold in his hands, like shakers or drum sticks. He will first be prompted to pick up these instruments and use them within a music therapy setting, but eventually we want him to do it independently of cues. The same skill can be transferred to other things, like picking up a toothbrush. The instruments merely serve as a motivation to learn the movement skill,” Mow explains.
Music therapy can also assist in addressing short attention span issues. For example, the child will be taught to identify and anticipate his cue, and wait his turn, to join in with his part in a song.
Mow uses a range of instruments and toys like finger puppets to help the kids connect better with the music.
“There’s the keyboard, xylophone, guitar, drums, maracas, tambourine ... I basically use anything that makes sounds!” she says, laughing.
Music can also be used to assist with communication skills. With individuals that are non-verbal, a music therapist will encourage them to sing and do breat hing exercises to help them project their voice.
“Over time, you might notice that they are able to say certain words clearer in a song than in normal speech because singing motivates them to stretch certain syllables in the song. If they are able to sing certain words, they will also be eventually able to say them. Hopefully, they will then go on to apply this in normal speech,” she says.
The Ipoh-born Mow, who holds a bachelor degree in music arranging from Britain’s University of Westminster, and a master of music therapy from the University of Queensland, Australia, is registered as a music therapist with the Australian Music Therapy Association.
The older of two children who grew up in Petaling Jaya, Mow plays the piano, guitar and flute and was previously attached to a disability centre as a music therapist and an aged care facility as a diversional therapist in Australia. There, she also worked closely with children in the oncology section in hospitals and special schools.
After trying her hand at working with people from all age groups, she returned to Malaysia in April last year.
“Although most research done in music therapy is for adults in aged care, I’ve decided to now focus on working with children and young adults. They are the population I best enjoy working with. So far I’ve worked with a range of special needs kids, from those with autism, cerebral palsy and Down Syndrome to global developmental delay,” she says.
Lifelong journey
The healing properties of music were known even in ancient times. The Greek father of medicine Hippocrates was said to play music for his mental patients. The Native Americans used chants to heal the sick. Among the earliest references to music therapy appeared in an article in Columbian Magazine in 1789. By the 19th century, the therapeutic value of music had been mentioned in medical literature and the first recorded systematic experiment in music therapy was carried out.
The aftermath of the world wars provided a space for music therapy to be explored. Music was used as a morale-booster and an all-round complement to traditional therapies, whether occupational or psychiatric in nature. Musicians made their rounds to military hospitals after the world wars to play for soldiers suffering from physical and emotional trauma.
Over the decades, music therapy has offered solace and assistance to millions of people around the world. Early last year, US congresswoman Gabrielle Giffords was shot in the head by a 22-year -old during a public meeting with constituents in Tucson, Arizona, in an assassination bid. (Six people were killed and 13 others, including Giffords, were injured in this mass shooting.) The bullet entered over her left eye and punctured through the left hemisphere of her brain. She survived, but was unable to speak and walk. A month after the incident, Giffords started on music therapy and made surprising progress with regaining her faculties.
On Jan 8, exactly one year after that fateful day, the Democratic lawmaker slowly walked unaided to the centre of an outdoor stage in Tucson and led hundreds of people in the Pledge of Allegiance with her head held high during the commemoration of the one-year anniversary of the shooting. (On Jan 25, Giffords, 41, resigned from the US Congress to concentrate on furthering her recovery.)
These are inspiring stories, but it is also testament to the fact that the journey to recovery is a long one fraught with challenges and involves a whole lot of hard work and perseverance ... and then some more.
And Mow adds, pragmatically, that it doesn’t mean that everyone will necessarily benefit from music therapy at any given time in his life. Sometimes the reason could be as simple as there being too many distractions in the room, or the individual not being in the mood. Other times, it’s perhaps just not the ideal time in the development stage to introduce music therapy.
“For instance, I once met a child who was very sensitive to noise and would physically shut his ears and refuse to touch any instruments. But he was in terested in drawing, so I thought at that stage, it would be best to build on this interest instead of forcing him to do something he didn’t want to,” she says.
But what if the case is not as clear-cut?
Out of the blue
Liang Yihui, 22, is autistic and is no stranger to music therapy, having gone for it occasionally in his childhood, up to when he was 10 years old, in Britain.
His mother, who wants to be known only as Mrs Liang, says: “In England, music therapy is conducted daily in schools. We believe that music therapy did help with his hyperactivity. But the school had many outdoor activities, massages, pilates and so on, so we do not know whether it is the music therapy or combination of all these activities that resulted in his behavioural improvement.”
When the family moved back to Malaysia, he took a break from therapy as his parents “couldn’t find any suitable places offering music therapy” for him.
But when Liang, 44, heard about Mow and the work she does, she decided to start Yihui on therapy again. He has been attending music therapy sessions with Mow for around six months to address social skills, and build confidence and self-esteem when interacting with others. The therapy is geared towards encouraging verbal communication and age-appropriate interaction.
Liang says Yihui seems to be indifferent to the whole thing. “He doesn’t resist it, but he also hasn’t openly expressed his interest so far. I have not seen much improvement since he started on music therapy here, but we think we need to give it more time before we expect results.”
But she adds: “I do believe that music therapy is beneficial to persons with learning disabilities. Music therapy is not common in Malaysia but, to me, it is worthwhile to be given a try, no matter how small the benefit to the child might be.”
Mow says that you will never know when someone might respond out of the blue.
“It’s quite a high point when it does happen. You think it’s not working for them but then suddenly, one day, they respond. And then you realise that they do, in their own way, and in their own time of course, take in things around them.”
She shares the story of a boy who seems to remain in his own world when he comes for therapy. He plays with instruments but doesn’t do much of anything else.
“He doesn’t sing, he doesn’t talk, he doesn’t communicate. Then one day, his mum told me, ‘My son was singing that song you usually sing to him. He was humming it in the car!’ So that just goes to show that he knew he was on his way here, and that sometimes you think they don’t understand but, in their own way, they do.”
The most rewarding aspect of her job, Mow says, is when she hears about what the kids are doing outside the classroom with what she has taught them.
“That’s my motivation right there, when I hear about such things,” she says with a smile.
Mow seems to have dedicated herself to this cause, though it is not always an easy road to walk. She recalls one of her lecturers saying that you have to make sure it is a calling before you go into music therapy. And she believes that it is indeed what she is meant to do.
“One thing I’ve learned along the way is that just because society thinks of them differently, it doesn’t mean they can’t do certain things. There are so many areas they can explore, it’s really all about finding the right connection and letting them grow. Dealing with difficult people all the time is not generally most people’s cup of tea. You have to be really patient, you need to love and care for others, and not judge them,” she says.
Many people who sign their kids (or themselves) up for music therapy do so with a specific goal in mind. But often, much like watching their children grow up, it ends up being not only about the goal, but also about the journey.
In a world where words are often absent or inadequate, sometimes music is as good a language as any other.
For more information, go to musictherapymalaysia.com.
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