From splints to spirometry lung function tests, your patients are quite familiar with the instruments used in their therapy sessions. But using an instrument, possibly from the woodwind or percussion family, might serve as a pleasant surprise.

Many emergent therapeutic practices are examining the connections among the sensory realm of the mind and its effects on the physical body. Chief among these are the studies of sound and music therapy, as these fields are now closely codified as disciplines that can yield demonstrable outcomes, even if the processes behind them are not yet entirely understood.

According to the American Music Therapy Association (AMTA), music’s healing influence has been on record since ancient times. As a discipline, music therapy emerged in the wake of World Wars I and II, when musicians began to realize the value of visiting hospitalized veterans recovering from physical and emotional trauma.

More recently, Liora Laufer, an Israel-based graphologist, discovered the influence of music on scholastic disciplines 15 years ago by setting handwriting exercises to a soundtrack. Her observations resulted in her Charlottesville, Va.-based business that creates handwriting lessons for people slow to master written skills, and her signature Callirobics program, which blends elements of calligraphy and aerobics.

Laufer observed that children who have trouble writing the letters of the alphabet do not often demonstrate the same difficulty when drawing shapes. Similarly, research uncovered instances of children with learning disabilities performing better with auditory rather than visual disciplines. When music was added to the handwriting exercises, the structure and meter of the melody lent a rhythm to the writing motion, and so the auditory component became essential to the exercises.

“The music is indispensable,” says Laufer. “Think of doodling when you talk on the phone. Sometimes when you listen, even in a lecture, you doodle. The repetition of movement to music is very relaxing.”

The Callirobics program is based on the premise that certain musical styles, rhythms and melodies can be correlated with certain patterns and shapes. For instance, when students are being coached to make a straight line, the music is upbeat; by contrast, the music to which lessons involving curved lines are set is slow and quiet. Between the two extremes, participants can develop a balanced handwriting style that has some grounding in sensory experiences from their everyday lives, Laufer says.

“Music is a powerful tool,” she says. “Students are calmer and more relaxed, they can concentrate better, and their memory is better. We have seen that autistic children or those with attention-deficit disorder have extended their sitting times when working with Callirobics.”

The Callirobics programs are divided among sets of age-appropriate lessons, each of which is set to different music. Laufer discovered that older adults who have suffered from strokes or Parkinson’s or Alzheimer’s diseases are often comforted by the familiarity of music from the 1920s, ’30s and ’40s. Children, ages 4 to 7, respond to instrumental versions of familiar songs like “Row, Row, Row Your Boat.” Another advanced program for children who have developed some mastery of their alphabet allows them to practice writing and drawing in an open-ended setting.

“They have an opportunity to come up with their own shapes and lesson titles, their own positive directions,” says Laufer. “It’s much more creative and advanced, so the music in the program is drawn from the styles of 11 countries, each of which is a source of different music.”

For participants in the program who have developmental disabilities, or who cannot make patterns or shapes, a basic movement exercise trains them in manipulating their pen to simple directions: down, up, across and in circles.

“We have a singer who will sing a direction to improve gross movement,” says Laufer, “something like, ‘down, down, down.’ When they get instructions to the music, many times they hear what they are doing [and are better able to reproduce the effect],” she says.

“Teachers expect kids to just jump into letters, which is very difficult for someone who [has a problem] with hand-eye coordination or fine motor skills,” says Laufer. “When a kid can finally come to something stress-free, and just draw shapes to music, this is amazing to them.”

Furthermore, music therapy is slowly making inroads across the country as more insurers recognize its benefits. About 20 percent of music therapists report being reimbursed by a third-party payer for their services, according to AMTA, and new jobs are consistently being created.

Today, the AMTA’s nearly 5,000 music therapists work in a multitude of patient-care settings, including hospitals, nursing homes, mental-health facilities, assisted-living facilities and hospices.

As a therapeutic tool, music has been shown to impart numerous emotional and physical benefits. Treatments can be designed to relieve stress, reduce pain, ease depression, alleviate nausea and improve sleep, for example.

Similar to the practice of using music to correct and fine-tune motor skills, sound therapists like Amrita Cottrell of the Healing Music Organization in Santa Cruz, Calif. use natural and familiar physical sounds and breathing techniques to curb pain, stress and produce a physical outlet for emotional disorder.

“The main difference between music therapy and sound healing is that music therapy requires a licensure,” says Cottrell. “There is none available for sound healing, although several schools are beginning programs, like the California Institute of Psychoacoustics [the study of how sound affects the body and emotions].”

According to Cottrell, the study of sound healing is as ancient as recorded history. In many indigenous cultures, she says, a shaman or healer employed sound as a means of taking his patients into altered states to heal them. To this end, the healer would sing, chant and use aboriginal instruments – such as drums, the didgeridoo or a bullroarer – based on the original musical scale.

“The original scale is a more natural scale based on Pythagorean mathematics and natural harmonics,” says Cottrell. “For example, the harmonic overtones that you naturally hear in chants done by Buddhist monks that seem to vibrate and tremble are based on the natural scale.”

However, it is important to note that the natural scale is not the Pythagorean scale, says Gordon Dalgarno, BSc, MIOA. "In fact the Pythagorean scale is built entirely on ratios of 2 and 3," he explains. "The very important interval of major third in the natural scale has a frequency ratio of 5/4 to the tonic."

The musical instruments with which most people are more familiar are based on a tempered scale in which notes are designed to overlap more neatly with one another, says Cottrell. This distinction is a difficult one for untrained ears to make, she says, but after the ear has been taught to listen for them, harmonics are omnipresent in the world.

“I can be in my little cabin with the door and the windows shut and hear a beautiful song,” Cottrell says, “and when I open the door, I might hear a leaf blower. Close the door, I hear a song; open the door, I hear a leaf blower. My ear is trained to hear the harmonics floating above the sound of that machine. A lot of times you can’t hear them from the fundamental sound, but when the door is shut and I don’t hear the fundamental sound of the leaf blower, I can still hear its harmonics.”

The chief distinction between music therapy and sound therapy, according to Cottrell, is that the study of music therapy is far more organized, regulated and scientific in its approach. The impetus for sound therapy draws practitioners whom she says are more naturally inclined to work in a somewhat extra-sensory realm.

“Music is a very fine therapy and does wonderful things for a lot of conditions using prescriptive music for certain conditions,” says Cottrell. “Music therapists set up treatment plans and they have to keep notes. Sound healing is more intuitive. People who are very sensitive and can sense energy changes, feel movement and blockages and see auras are very drawn to this type of work. It’s a way they can use these gifts they have to help people.”

The majority of sound healing, says Cottrell, involves training patients in proper breathing techniques and proper use of their voices. Certain other techniques, like chanting and toning, can provide additional therapeutic benefits. Chanting involves the recitation of sacred syllables in a certain order, such as is done by monks. The practice of toning involves using the voice to sustain vowel sounds on various notes when producing natural sounds like yawning, sighing or humming. Natural, commonplace sounds like these, Cottrell says, are fundamental elements of sound healing, and express physical symptoms or emotional expressions.

“When you stub your toe and go ‘Ow!’ that’s a form of sound healing,” she says. “That noise releases that pain and gives that pain a voice. A good, long, deep sigh is something that we teach people to do. Humming is a great way to calm down and release energy. It is probably one of the most socially acceptable sounds. It doesn’t even have to be a melody. We can give voice to these things that need to be released from the body; the tension, the pain. These can all be given sounds.”

“In our culture,” says Cottrell, “we’ve been taught that certain sounds are unacceptable. If you did a lot of toning or sighing in public, you would get looked at sideways; but sound effects are great. Kids make them all the time. As we have gotten older, our teachers have told us that this is inappropriate. We try to awaken that impulse again in people.”

Foremost among those conditions aided by sound healing is stress and all the effects of stress, says Cottrell, including tension, anxiety, depression, lack of motivation and muscle pain. She claims that high blood pressure and asthma can all be assisted by sound work, and often in the course of basic workday routines.

“One of the simplest things to do is to utilize ‘you time’ in the car. You can release that energy on the ride home, and by the time you get home, you can feel better enough to not burden your family with your stress.”

Even body noises like cracking your knuckles and joints can become forms of sound therapy, says Cottrell. More importantly, silence can also be a form of sound therapy.

“I work with people not only on making sounds but on being still and listening to their bodies,” she says. “Our body knows exactly what it needs to stay healthy, but we are in such a distracted society that we hardly have a moment of peace. People seldom sit and listen to what their bodies are telling them. The body itself is always trying to self-correct. The body always knows, and if we ask, the body will tell us.”


Matt Skoufalos is a New Jersey-based freelancer. Questions or comments can be directed to editorial@TherapyTimes.com.