Music Therapy for Processing Emotion in Clients with Intellectual and Developmental Disabilities

Steve Martin once said, “Talking about music is like dancing about architecture.” This is especially true when talking about the emotional qualities of music- musicologists, philosophers, and theorists have argued about where the emotion comes from for years- is it in the music? Is it in the listener? Is it in the quarks that lie between? For the sake of ‘getting to the point’, we’re going to skip this discussion and just agree that music and emotion are closely connected. The second discussion that should be touched upon is whether emotion, an instinctive state of mind, is hard-wired or socially constructed. Turner (2005) argues that many emotions are hardwired and some emotions are developed in order to form social bonds. When working with children or adults with intellectual and developmental disabilities (ID/DD), emotional regulation may be underdeveloped and it is therefore difficult for social relationships to develop appropriately.

Often, the staff at day programs for adults with ID/DD will redirect negative emotions without addressing them. “Be positive!”, which is a well-intentioned phrase meant to keep everyone happy, can sometimes have the opposite effect and leave clients feeling unheard and staff wondering what went wrong. ‘Negative’ emotions, like sadness, loneliness, and anger; are sometimes coming from a desire to get attention but should nevertheless be addressed and not ignored or discouraged. When the automatic reaction is to ignore or change these feelings, it can come across as a poor assumption about the capacity of clients with ID/DD to express, discuss, and process how they feel. Ignoring feelings entirely, instead of exploring where they might be coming from, is a disservice to the person who owns those feelings.

Adults with disabilities like Down syndrome can have irregularities in areas of reasoning, judgment, and impulse control. This means that they sometimes have strong emotional reactions to new circumstances. But if emotional control is related to the disability, it should be included in assessment and turned in to a goal of expanding emotional potential and learning to appropriately express emotion, rather than deterring behaviors related to the emotion. We want to prepare clients for challenging emotions, so that when unexpected things happen they’ll be able to navigate changes appropriately.

Music therapy is useful in addressing emotions in a number of ways. Music induces emotional states by initiating changes in the distribution of neurochemicals that can induce positive moods and heightened arousal, which may in turn increase the rate of change in the brain, speeding rehabilitation. These emotional states can be experienced and moved through even with nonverbal clients- if you’ve ever sat through a drum circle experience, there is an arc to the drumming that moves through a number of emotional states.

Alexithymia is the inability to describe emotion to others. Many clients with autism have this condition, and it is therefore difficult for them to express their own emotions and/or recognize and name others’ emotions.  A 2008 study by Heaton-Pring showed that individuals with autism spectrum disorder could appropriately understand and name both simple and complex emotions within music. This is true in other populations, as well- a 2009 study by Gagnon (University of Sherbrooke, Quebec) showed that patients with Alzheimers could correctly judge emotional connotations of various musics despite their significant cognitive decline.  Children with autism can listen to music and get an idea of the composers’ emotional state. Therapists can in turn help them learn to think about what other people may be feeling, developing empathy.

Music and imagery can be used to explore feelings by actively listening to instrumental music and being mindful (by drawing or describing) the images that are evoked by the music. These images may even be unconscious, and can lead to changes in affect. The response to different kinds of music is not universal; the conscious images can sometimes be cultural- products of learning and experience. For instance, the overture to Offenbach’s “Orpheus” may evoke images of women dancing with legs kicking high, and this collective image doesn’t necessarily give a peek into the listener’s psyche. This kind of imagery can lead to extramusical diversion; therefore it’s important to choose pieces of music that may be unfamiliar to the listeners so that their responses will be personal and non-referential.

Group singing and/or improvisation can improve group dynamics by helping clients learn to listen to each other and self-regulate so as to be a part of the music group, sharing in the experience of creating. Communication of emotions is improved as group members get a chance to share how they feel about the music process, both musically and verbally. If one group member hits a drum much harder than the rest of the group, the group has to stop and address this, possibly realizing that that individual was upset. They can then find a way to work together to help the individual feel better, and other group members may share in his feelings.

Listening and lyric discussion is another helpful way for clients to discover and process emotions. Often, when a song is suggested by a client, I’ll print out lyrics and we’ll discuss the meaning of the words and how these words relate to the client’s current state. Sometimes the words are literal and referential; sometimes they have to be more deeply explored.

And will a music therapist come in, stir up emotions of clients, and then leave them to wallow in sadness? NO, of course not! One of the beautiful things about music, and particularly songs, is that they have a beginning, a middle, and an end. Listeners can join the song on its journey and then go on with their day. Have you ever been driving and a song comes on the radio that just brings you to a whole other world? (hopefully, not off the road…) But then the song is over, and you’re back!

In Western music we expect a resolution to the tonic (the I chord). One of the pieces of music that provides a gut emotional response is the idea of tension (“going somewhere”) and resolution (“getting there”). Music activates tension, and inhibits it, and resolves it. Branca’s Symphony No. 3, 3rd movement, “Gloria” is a good example of this- he modified harpsichords in order to use smaller intervals, creating tension that continuously resolves into a M7 chord.

Tonal organization rearranges melodies into scales, which musicologists often do; we can assign feelings to different musical modes. Often, minor keys remind us of sadness, while major diatonic scales remind us of contentment. If a modal norm has been established in a work, reversing it can have a powerful effect. The first movement of Schubert’s String Quartet in A Minor is a good example of this, when the theme is repeated in Major there is a sense of peace and spirituality.

It isn’t just chord progressions that create tension and release- tension can be built through other musical elements, like moving melodic lines, rhythmic structure, tempo changes, and beat structures.

This tension is representative of the aforementioned difficult emotions- suspense, uncertainty, sadness- and the resolution can help listeners move through these issues to a resolution of positivity. Unresolved tensions in music, as well as key changes or rhythmic surprises, can help listeners learn to deal with unexpected changes and accept them.

In short, if your clients are dealing with difficult emotions, address them with music!


Kate Beever

About Kate Beever

I am a board-certified neurologic music therapist and owner of Maine Music & Health, which provides services and consulting to healthcare and arts agencies throughout the state.