Susan C. Gardstrom, James Hiller, Annie Heiderscheit. Contributing Author: Nancy Jackson (2025). Re-Creative Methods of Music Therapy. Barcelona Publishers, 2025. 201 pages, e-book publication.
As is well-known, there are four main methods or musical approaches in music therapy: Re-creative and performance-based activities, Improvisation, Creative activity, in addition to Receptive music therapy. Members of this author team have already published books on improvisation and creative methods in music therapy with Barcelona Publishers. Now, the re-creative working forms are the focus in this newly published book.
The term "method" here refers to working forms or musical approaches. The term is used generally and does not imply a theoretical foundation. However, as we will see, the authors are careful to specify procedures when the methods are implemented. At the same time, they allow the user to frame the activities according to their theoretical foundation.
Definition
Re-creative methods refer to musical approaches where the client reproduces music in some form – a short musical pattern, such as a rhythmic figure, a part of or an entire music piece, whether a song or an instrumental piece. This may involve imitating music, learning, and performing music. Re-creation occurs either individually (solo) or in a group. The client is always actively engaged, as opposed to a situation where the therapist plays and the client only listens, as in receptive music therapy. The performance-based aspect is not discussed in this definition.
Implementation and Procedures
The book is written for music therapy students and is pedagogically adapted. The authors have extensive experience as clinicians and educators, and we are presented with detailed instructions on how to implement the method, what procedures to follow. The text includes imagined case descriptions that illustrate how to proceed and what to take into consideration.
Implementation procedures focus on which method variant to choose, for example, working in a group, using singing, or playing instruments. The activity is chosen based on what it offers (affordance) in relation to the set goals for the work. The procedure also involves assessing the participants' prerequisites, planning which activities to select, identifying the opportunities and challenges in each activity, and how to engage the users.
Special techniques, such as lead techniques, are introduced and can be followed up with accompaniment from the therapist on their instrument. Observation of the process is part of the procedure. Additionally, one must assess contraindications and whether the user can play the instrument or if adjustments are needed. It may also be required that the therapist intervene to assist the user.
Risk and possible adjustments must be evaluated along with the challenges that arise in the process. The process must be summarized and assessed in relation to the user's development before concluding the session, possibly with a discussion with the participants and plans for continuation. All of these points function as a template for the upcoming chapters and are repeated and specified through illustrative case scenarios.
Result-Oriented or Experience-Oriented?
In music therapy, the work can either be oriented toward achieving a clearly defined goal or open to experiences that provide further direction for the work. In many cases, music therapy can address the user's needs as identified in an assessment process. This may involve stimulating or rewarding a desired response, encouraging the use of specific skills, and supporting a treatment protocol with clearly defined and measurable goals. Music here becomes a means to realize non-musical goals. This working form fits within an evidence-based practice and is required in cases where music therapy must relate to, for example, insurance arrangements, as is often the case in the privately funded healthcare system in the United States. This working form often implies a medical diagnosis or understanding model.
The experience-oriented approach belongs in cases where health-related goals are unknown or unclear for various reasons. Here, therapy is aimed at a general concern that led the user to therapy, and the treatment process develops through the user's engagement with the music. There is no cause-and-effect relationship here, as in the result-oriented approach. In the experience-oriented working form, music functions as a medium for experiences where clinical goals can be identified and clarified, and where one can explore the user's resources and possibilities. This working form aligns more with a contextual model in mental health care, where the client's values and understanding of their illness take precedence, such as in personal recovery.
Theories Behind Clinical Decisions
Chapter 2 is dedicated to the most common theories that therapists rely on when selecting working forms and determining goals. Here, we get a good illustration of how different theories frame and guide the work. For example, a behavioral analytical approach would be appropriate when working with concrete goals, such as the result-oriented working form. An example here is when you want to train a user to improve articulation. Cognitive behavioral theories may be used when the client shows signs of performance anxiety and will need help to reframe the anxiety into more self-affirming statements.
Within a humanistic-existential practice, emphasis is placed on the user's experience of making music and how the therapeutic relationship can promote the user's growth and self-realization, in addition to giving the user a sense of self-awareness, agency with choices, and responsibility. In the analytical approach, music is seen as a representation of and symbolic expression of the user's inner life and personality, something that can be read through the way the user expresses themselves musically.
The music-centered perspective is that musical engagement in itself is therapeutic. Through musicking, the client will use and demonstrate intelligence, sociability, agency, and other aspects of possessing health. When the therapist adopts a resource-oriented view, it refers to the importance of nurturing the user's strengths (musical) resources and focusing on cooperation with the therapist. Within a community music therapy model, much importance is placed on establishing cooperation with the local community so that the user finds a sense of belonging and community through music in the local music scene.
This chapter also contains sections on intersectionality, cultural humility, dangers of cultural appropriation, and a longer section on trauma-informed work.
Group Work
Chapter 5 is dedicated to group work. Here, we are introduced to a model from group psychology that can be applied to music therapy groups. Things happen in groups, and it can be helpful to have some tools to understand the processes that may arise. The theory called "forming, storming, norming, performing, and mourning" is reviewed and illustrated with a hypothetical music therapy process. In general, it concerns processes that illustrate what happens when a group is formed, when resistance arises, when norms are agreed upon, during performance processes, and what is experienced when groups dissolve.
Vocal Re-creation
James Hiller (Chapter 6) has successfully taken on the task of providing an overview of the use of voice, breath, and other intentional ways to produce sound through the vocal apparatus. We must not limit the understanding of vocalization to just singing but must also understand re-creative sound production to include humming, grunting, sighing, whispering, breathing sounds, and whistling. What is called "oral-motor" sounds includes tongue clicking, lip sounds, and hissing.
In addition to singing, working forms also include "chanting" (rhythmically repeating words or phrases), rap, beatboxing, imitation of sounds from the environment, or reading a text to musical accompaniment.
Goals and Affordances
Regarding what re-creative vocal expressions can offer in terms of therapeutic goals, it refers to everything from training articulation and oral motor skills, breathing, speech difficulties, distraction during painful medical procedures, emotional expression, and psychological insight, exploring relationships, learning social skills, and opportunities to participate in community music activities. It also reviews the affordances such activities can have: 1) physical (training muscles related to breath and vocalization, stress reduction), 2) cognitive and communicative (concentration and memory, creativity and problem-solving, access to images, associations, memories, training language and speech skills (e.g., Melodic Intonation Therapy), 3) mental-emotional (increased self-awareness, release of emotional energy, increased personal agency, access to various emotional states, building trust in a therapeutic relationship or with other group members, support for bearing risk), 4) spiritual (e.g., experiencing contact with higher powers and a sense of meaning and purpose in life).
We also get an overview of the prerequisites the user should possess (basic control of breathing, oral-motor abilities to act intentionally, possibly sufficient ability to articulate verbally, as well as necessary memory capacity).
Risks and Contraindications
Risks are also discussed. These refer to vocal use that may harm the vocal cords. Psychological challenges are also mentioned, such as the risk of revealing something about oneself through the quality of the voice or experiencing not meeting norms set in the culture and demonstrated by artists (who often streamline their voices through electronic production).
The contraindication may then include pain during vocalization, hoarseness, unexpected changes in pitch, or reduced voice volume. Psychologically, participation in vocal activities may lead to increased voice shame and reduced self-image. A warning to the music therapist here is never to pressure users into singing if they do not feel ready. There is also the risk of re-traumatization where the lyrics of songs may trigger bad memories of traumatic moments for the client.
Individual and Group
The authors delve more into detail when writing chapters on vocal method variants as used both individually and in groups. They use the same template as in Hiller's overview chapter and adapt it to the format. Thus, there are many repetitions, although important clarifications are made. After each chapter, there are short summaries of journal articles and research. These show how the methods have been applied to various target groups and practice arenas. These summaries are very useful if one wants more detailed information and illustrations of the working forms.
Instruments in Reproductive Work
The next two chapters in the book are dedicated to the use of instruments. Here too, the same approach is followed as we saw in the first chapter but now adapted to instrument use. We learn about product and process orientation, implementation procedures, affordances and goals, individual therapy and group work, risks, and contraindications. Short summaries of research articles where the method has been applied to different user groups are also provided.
Musical Productions
The final chapters are dedicated to an overview of musical productions, such as musical shows, music plays, drama, etc. In Norwegian music therapy tradition, we are familiar with the music plays of Paul Nordoff and Clive Robbins, for example, the song play Pif-Paf-Poltrie. I belong to a generation that experienced the masters themselves leading the music play (with Rita Strand Frisk on piano – and this was no simple piano part). Those of us who participated will never forget how spellbound we were by the charismatic leadership and were sucked into the action, where the roleplay required the autumn leaves to be swept up from the floor with a large broom.
This production form is also embraced by Viggo Krüger in the revue productions of Kom nærmere, and I read that new concert lectures with music therapists and users are currently being planned. The concert productions at the Gjenklangfestivalen and Rockovery must also be part of this method variant.
It is said that such productions involve risks for the performers and require extra care and support from the music therapist. The danger of stigma must be weighed against the positive affirmation that may come with public performance. Even in these chapters, we encounter a familiar structure, with first an overview chapter, then a chapter discussing formats from an individual and group perspective. These chapters are also followed by examples from the literature.
Appendix
There are many pages of organized supplements in the book. We get a list of examples of re-creative method variations, types of songs that can be used, procedures for how to teach a song without relying on sheet music, basic techniques for arrangement, adaptation, and techniques, an overview of equipment for users with developmental and physical challenges, an extended annotated bibliography, as well as a list of musical resources.
Explicit and Systematic Knowledge
Much of the knowledge and experience presented here will surely be familiar to many music therapists. However, there is value in such systematic and explicit presentations of methods. What they encompass, how they can be implemented, what they require, and where they can be applied are knowledge that is part of the professional identity of music therapists. This includes the ability to choose method variations when working with individuals and groups, how to combine them with other working forms, and the necessity of observation, reflection, and evaluation.
Another strength of such method books is that they provide input across theoretical models. There are no specific treatment-theoretical guidelines in these descriptions, but it is left up to the individual music therapist to frame the activity and adapt it to goals and target groups.
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