January 21, 2004

Reflections on Orff Music Therapy

By Marcia E. Humpal, M.Ed., MT-BC holds duel certification in music education and music therapy. She is a graduate of Baldwin-Wallace College and Cleveland State University where she obtained her masters degree in special education and an early intervention specialist credential. Since 1986 she has been a music therapist for the Cuyahoga County Board of Mental Retardation and Developmental Disabilities in Cleveland, Ohio, USA. Currently she works exclusively in the Early Childhood Division. She is co-chair of the Early Childhood Network of the American Music Therapy Association and is on the editorial board of Music Therapy Perspectives. Contact Address: Marcia E. Humpal, 26798 Mangrove Lane, Olmsted Falls, OH 44138, USA. (Email: mehumpal@ameritech.net):

Abstract

This article is written as a response to and reflections on Orff Music Therapy - An Overview by Melanie Voight, Ph.D. The author will present a short review of early intervention and music therapy service delivery in the United States as well as a brief overview of how music therapy is used with young children in her setting. Comparisons of methodology will be noted.

Introduction

As a music therapist who works with young children in an educational setting, I was very interested in the explanation of Dr. Voight's work that utilizes the technique known as Orff Music Therapy. I am employed by a public agency that provides services for individuals with or at risk for developmental disabilities and mental retardation. In our early childhood division, our staff work with families and children 1) ages birth to age three who have at least one area of risk (programs are developed for each on the Individualized Family Service Plan [IFSP]) and 2) ages three to five who have at least two areas of identified need (programs are developed for each on the Individualized Education Program [IEP]).

In the United States, free and appropriate educational services have been mandated for individuals with mental retardation and/or developmental disabilities since 1975. Public Law 105-17 (known as IDEA-1997) is a reauthorization of the original federal legislation that provides these services.

While music therapy is not specifically listed under the law as a required related service, many children do receive music therapy when assessment has indicated they can benefit from it. The American Music Therapy Association (AMTA) continues to lobby for music therapy to be specifically named in the law.

For detailed descriptions of music therapy in the school setting, legal issues, and proactive support efforts, the reader is referred to the book Models of Music Therapy Interventions in School Settings, edited by Brian Wilson (2002, The American Music Therapy Association, Inc.).

Keeping this background information in mind, I would like to direct attention to how I deliver services to those children who have music therapy listed as part of their IFSP or IEP and how this model compares to the Orff Music Therapy method.

Clinical Setting

In the Early Childhood Division's school settings, children are seen once weekly for one half hour sessions in a group setting. Services are delivered in inclusion (children with and without disabilities in the same class), integrated (one class of typically developing children brought together with one class of children with specific needs just for "specials", i.e. physical education and/or music therapy), reverse mainstream (majority of children with special needs and a few children with no disabilities), or in specialized classes for children with severe or specialized specific needs that follow a pre-determined protocol. Music therapy programs for parents/caregivers and their children also are part of the caseload of the music therapists. A few children receive individual music therapy, but this is a rare exception. Time constraints and large caseloads drastically hinder this type of service delivery.

Goals for children are based on educational needs and all children receive services based on an interdisciplinary team model. The team is comprised of the classroom instructor or early intervention specialist, instructor assistant, music therapist, adapted physical education specialist and the speech/language pathologist, occupational therapist, and/or physical therapist depending on the particular needs of the child. Input from parents/caregivers is always solicited and welcomed.

Music therapists in this setting rarely have goals that are purely music therapy oriented. Rather, they use music to improve or enhance collaborative goals that have been developed by the team and families. Thus, in the group music therapy sessions, musical activities are designed to meet the needs of not only several children, but of several goals of each child. This requires knowledge of each child's goals and needs, general child development, various disabilities and how they present as well as on-going assessment techniques and effective strategies (both musical and educational).

In many ways, our educational setting for young children with disabilities is similar to that of Germany's social pediatrics settings. Our team approach and realization that our children need much more than institutional care and medicine seems to have much in common with the concepts set forth by Theodor Hellbrügge, as explained by Dr. Voigt.

Basic Theoretical Foundations

No discussion about music therapy and early intervention in the United States would be complete without a description of the theoretical foundations upon which many of our service delivery systems are based. Since the late 1980s, the National Association for the Education of Young Children (NAEYC) has been a leader among organizations that follow, research, develop and disseminate information on and for young children. They published Developmentally Appropriate Practice (D.A.P.) in Early Childhood Programs Serving Children From Birth Through Age 8 (Bredekamp, 1987), and have recently updated their policy to include serving children with special needs and added emphasis to the role of the family. These D.A.P. guidelines stress that best practices for working with young children include:

• Providing for all areas of a child's development through an integrated approach
• Basing planning on observations and recordings of each child's special interest and developmental progress
• Planning the environment to facilitate learning through interactive play with adults, peers, and a variety of materials
• Providing for a wide range of interests and abilities.

These developmentally appropriate practices guide the work of the music therapy staff. However, additional philosophical underpinnings also are evident. The importance of play and the classifications regarding developmental stages of play, as set forth by many theorists such as Erikson, Freud, Bruner, Ellis, Piaget, Smilansky and Parten, theorists such as Vygotsky who describe how we can scaffold this development of play, as well as proponents of methods for specialized interventions such as Linder and Greenspan guide our work. Furthermore, general standards for delivering music to young children have been developed by MENC, the national association for music education and these play a part in how we conduct sessions. I am choosing not to review each of these philosophies herein; however, readers who wish to learn more may find interesting reading in the following publications:

Entire edition: Hallquist, M. (Ed.) (2001). Music Therapy in Early Childhood. Early Childhood Connections: Journal of Music- and Movement- Based Learning, Vol. 7, No. 2. [E-mail contact: ecconnect@aol.com]

Entire edition: Hallquist, M. (Ed.) (1997). Children at Play. Early Childhood Connections: Journal of Music- and Movement- Based Learning, Vol. 3, No. 3. [E-mail contact: ecconnect@aol.com]

Humpal, M. (2002). Music Therapy for Learners in an Early Childhood Community Interagency Setting. In B. Wilson (Ed.) Models of Music Therapy Interventions in School Settings. Silver Spring, MD: American Music Therapy Assn.

MENC (1995). Prekindergarten Music Education Standards [brochure]. Reston, VA: MENC.

Musical Background

The Journal of Music Therapy and Music Therapy Perspectives, the two journals of the American Music Therapy Association, as well as Music Therapy, the journal of the former American Association for Music Therapy have published several articles that address using music therapy with young children. The American Music Therapy Association has an Early Childhood Network that meets at each national conference and posts an annual newsletter on the AMTA website (http://www.musictherapy.org). This group generated information that resulted in the publication of the Music Therapy and Young Children Fact Sheet. This fact sheet may be found under "Events and News" on the AMTA website. All of the above publications examine how music is used with young children to address a variety of nonmusical goals (e.g. in communication, academic, motor, emotional, social, sensory and play areas).

The music (and how the therapist uses it) addresses these goals through various aspects of singing (or using the voice), playing (with instruments or props such as scarves or other objects that aid in expression - similar to the Orff Music Therapy instrumentarium), moving and listening. Though he or she often presents the music experiences to a group, the music therapist is guided by the responses of the children.

Spontaneous play and responses are an important part of the session. Children are encouraged to explore and investigate in a type of improvisation. They are presented with a wide variety of ways to play with sound and respond to sound. The abilities of all children are considered and adaptations for instruments, augmentative ways to use the voice, and alternate ways to move are always present so that all children can be successful in experiencing and making music.

In these ways, our approach to music therapy with young children invites comparison to Orff Music Therapy. Our terminology differs, but our overall intent is quite similar. Coming from an educational approach, we meet the child at the level where he or she is functioning and then expand on the responses of children and structure our musical activities to help them respond by using more difficult skills.we "bump them up" to a higher level of play.

In my chapter of the previously mentioned book edited by Wilson, I note that Linder's (1990) Transdisciplinary Play-based Assessment: A functional Approach for Working with Young Children suggests that the following six skills are necessary for facilitating play-based instruction. I added musical examples to demonstrate how these can be accomplished in a music therapy setting:

1. Follow the child's level and the child's choices. (Put out instruments and allow freedom in playing. Imitate the actions of the child.)
2. Parallel play with the child; occasionally comment about the play action. (Play an instrument next to the child then intermittently sing or comment about what is taking place. This demonstrates how to play and gives the child the opportunity to play as (s)he pleases. Indirectly the therapist is helping the child learn to label actions and objects. This is adult facilitated parallel play and far different from peer parallel play.).
3. Encourage any mode of communication the child may have (eye gaze, gestures, words, etc.) by imitating or responding in a turn-taking manner. (Play instruments and imitate both motor and vocal actions, echoing dynamic, pitch and tempo levels. Offer the child a turn and encourage response via various modes.).
4. Let the activity govern the interaction and limit talking. (Hum along with the instrumental play or sing a nonsense syllable to attract attention to the play.).
5. Limit questioning and pause long enough to convey that the child's comments are valued. (Insert a comment or a musical phrase such as "You're playing the blue bells." This is simply an affirmation of the child's play.)
6. Once the child is comfortable interacting and playing, try to "bump up" the level of play. Model and expand upon his/her verbal or creative play ideas. (Whatever music skill the child has been performing, model the next step on the task analysis or show the child another way of doing the skill.).

This "bumping up" step is crucial and is often overlooked by those who do not fully understand the techniques used in D.A.P. If the child's level of play is not showing progress, this is a clue that "bumping up" may be needed.
The results of the interactions and progress in music should correlate to those seen by the interdisciplinary team in other environments. When the music therapy approach is play-based and child-directed in nature, there is a purpose, structure and intent built into the planning and implementation of the session. It is not just play for the sake of play. The children are playing but the music therapist has enabled the play by adhering to the above guidelines and responding to the needs of the child.
(Humpal in Wilson (Ed.), 2002; p. 406)

Thus we employ our version of responsive interaction and provocation.

The above examples lend themselves to delivering music therapy services to individuals or small groups. It is much more difficult to follow these strategies precisely when working with larger groups and/or those made up of children with a wide range of abilities and diverse goals. Such is the reality that faces music therapists who work in many early childhood settings in the United States. Guided large group experiences often are more therapist-directed, focusing on themes, literacy units or activities that directly relate to what is taking place in the children's classroom setting. In fact, many early childhood settings do not have music therapists on staff or may hire a music therapist to act solely as a consultant to classroom staff. Through written literature, seminars, and other public relations vehicles, music therapists in the United States are working to educate the public to the benefits of music therapy in the early intervention setting.

It is always interesting to learn how others are delivering music therapy services. I am struck by how our methodologies have developed in somewhat parallel paths even though we are geographically so very many miles apart.

Thank you for the opportunity to learn about Orff Music Therapy and to reflect upon the similarities of our philosophies.