Rethinking Music Therapy With the Mentally Handicapped

By Ana Sheila Uricoechea

Introduction

The big tendencies of present life do not happen only in the global economy and in the globalization of the information areas, but there is evidence of their influence in education and in the qualification of human resources of the future. The drastic aspects of this new thinking and acting and the technological mutations, as well, will reach the various levels of society; so, to cope with this reality, it is necessary to be prepared in an efficient, creative and dynamic way.

According with Fonseca (1998), we live in a society that is presently defined as "A Cognitive Society", that demands more and more knowledge, creativity, and innovation; cognitive attributes of excellence, and especially excellence that is not obtained through a passive mass perception of information.

To think about new ideas, it is necessary to dismantle our old ideas, mixing the pieces or clichés, if we desire a new text or a new path.

Through our long-term experience in the field of Mental Handicaps, we have always searched for a new orientation to apply to our music therapy practice. We know the importance of music as therapy in the educational field, not only because of our own practices but because we have been studying the work done by authors specializing in this area.

Advancing our research in this direction and, after careful considerations about the issues involved, we have decided to organize this paper with the intention of sharing with other music therapists our ideas, to establish discussion and debate. We sincerely hope to amplify and enrich our ideas.

Nearly a year ago, we came to know the method used by the psychologist Reuven Feuerstein, to deal with the problems of the people with special needs. He uses a modern approach in which Structural Cognitive Modifiability is the main characteristic. His ideas were implemented in more than thirty countries with many positive results.

We also compared these ideas with some music therapy approaches and with some fundamentals of Music Education, trying to gain a better understanding of our own practice in the field of Mental Disability.

A Brief Introduction to the Feuerstein Structural Cognitive Modifiability Theory

Cognitive Educability emerges from the concept of Structural Cognitive Modifiability that was introduced by Reuven Feuerstein (Israeli Psychologist) who, in his synthesis, has proposed that human intelligence, as a dynamic, flexible and modifiable construct, is at the base of species' adaptability in its social-historical nature.

According to Feuerstein, any human being, independently of experience or age, the functioning etiology and cultural context, is open to cognitive modifiability, even having had an unpropitious social and educational background.

Cognitive Modification can be obtained even if expectations are passive or negative and when there is the tendency to raise barriers or make misjudgments about the individual's learning potential.

So far, Cognitive Educability seems to be an alternative and an efficient strategy, a new way of thinking about the many problems and demands that we have to face. This is an optimistic message, but it is also practical and useful in human potential. It represents a belief in potential intellectual capacities that may be amplified or modified according to new thinking about Education (Fonseca, 1998).

According to Feuerstein, the disabled person is a person with rights who exists, feels, thinks, and creates. The person has a corporal or mental, limitation that may affect aspects that give a peculiar, intra-individual profile. Despite the discrepancy in social-bio-psychological development, the individual desires an authentic and true relationship to the world that does not have an irresponsible conformist coexistence.

Despite a century of studies, there is not a global, holistic, and consensual definition of cognition. There is much more for us to apprehend the nature of intelligence. For this reason we find the cognitive perspective of Feuerstein (student under Jean Piaget and an Andre Rey collaborator), practical enough and transcendent to a pure cognitive perspective.

All of his work has been based on a key statement: every human being is modifiable. This is a real belief system.

According to this, every person who desires to become committed to a cultural transmission process (parents, educators, constructors, or mediators) must be sure about this belief.

Feuerstein (1975) and Feuerstein, Rand, and Rynders (1989) advances five basic principles to the mediator:

1. The human being is modifiable;

2. The individual that I am going to educate is modifiable (positive intentionality );

3. I am able to produce modification in the individual (to feel able and active);

4. I must and ought to modify myself (a long term and permanent investment for auto modification);

5. The whole society and all public opinion are modifiable and can be modified (this process is extensive and lasts much longer and demands persistence on its action);

These prerequisites are deeply influenced by Vygotsky (1963), by Piaget and by Bruner. For Feuerstein it is not enough to interact with the environment to achieve the effective learning. It is necessary to have the presence of an affectionate, knowledgeable, and diligent mediator and one who is capable of mediating this interaction. This constitutes an axiom of his theory, which is: The Experience of Mediated Learning (EML) (Fonseca, 1987).

In this conception, the stimuli do not exist by themselves, they are filtered, modulated, mediated, interceded, repeated, reinforced, eliminated, etc. Accordingly, the needs and modifications are introduced and regulated by the mediator.

The mediation is a characteristic of the humankind. It is an interaction that is commonly named "holding" or "vinculum" (Bowlby, 1952), "imprinting social" (Schaffer; Winnicott; Brazelton and others)(in Fonseca, 1998).

It is not enough to be committed with engagements that are rich in stimuli; it is necessary to be a mediator who can act in the cognitive structures and promote their dynamism.

The mentally disabled deserve our attention and our respect. It is necessary to believe that they may be modified even if clients seem extremely limited or marginalized. According to Feuerstein, intelligence is modifiable, not still, and it is necessary to develop critical thinking about the concepts, abilities, strategies, operations and the attitudes that are necessary, for instance, to help the individuals "learn to learn".

After this, let us think about the possibilities of the music therapy in this area, and about the role of the music therapist as mediator in a process for the development, and growth of these people.
 

Music Therapy With the Mentally Disabled: Integrating Feuerstein's Ideas

The music therapy has various definitions. They vary accordingly with Music Therapy Associations of each country and reflect the concepts and practices of their members (Bruscia, 2000). In this work, we will adopt the definition of the Brazilian music therapist Barcellos (1982 p. 2-3):

Music Therapy is the use of the music and|or its integrating elements as an intermediate object in a relationship that allows the development of a therapeutic process, mobilizing social-bio-psychological reactions in the individual, with the intent of minimize his or hers specific problems and facilitating the integration or reintegration in the social, normal environment.

Within a nonverbal context, music therapy is a basic search for relationship. It is the container for the comprehension of and experimentation with the multiple and rich alternatives that the sound universe offers, independently of the pathology. In the individuals with special needs its necessary to change and transform their relations with reality, searching for other experiences, other means of expression.

The strategy of intervention cannot be neutral or non critical, letting the disabled waste their time in inconsequent, repetitive hedonic practices. Will we accept that they just behave as their "inner drive" suggests them to do? Will we conform with the autistic person and follow with their own behaviors? Will we believe that the Down´s Syndrome individuals will never learn?

We agree with Feuerstein when he emphasizes that the individuals with weak cognition are able to enlarge their repertory of adaptability, never doubting or hesitating in this conviction.

We, as music therapists, have in our favor, a variety of actions and interventions through musical language. It is necessary to put more effort into studies and investigations of musical potential as a therapy (a field in which we are specialists), and in which we can make a difference for voice therapists, psychologists, and other professionals in the health area.

At the present moment we are looking into this aspect, searching for fundamentals, in music education (and other applications), that may give us the possibility to give support and effective help for the mentally disabled.

We find some identification, in our work, with the development theory of Bruner (1973) that, according to researchers, has similarities with Piaget´s ideas, that is: learning happens through the experience, research and discovering.

Similar to Bruner, another theoretician, Gardner mentions "perceiving how things are related", that is, the doing, the feeling, and perceiving (artistic process development).

According to Gardner, even 3 or 4 year old children are able to experiment with emotions if they are exposed to symbolic objects. Our objective is the study and research of the limits of the music as a meaningful and valuable element to people with special needs.

Synthesizing the thought of various music therapists and agreeing with them, we shall mention a phrase that seems to reinforce one of the central ideas of this text, that is:

The music is a language (...) that can be stimulating and comforting (.). The right music, used with wisdom, can take the disabled child away from the limits of her or his pathology and placing the child on a level of experience and reaction, where he or she will be free of emotional or intellectual dysfunctions (Nordoff & Robbins 1971, p. 238).

For Bruscia (1999), life is a continuous process of development and growing and this gestation lasts up to after death. It is a universal process, that is, everybody goes through similar stages of social, physical and mental development.

When conceived as a developmental process, music therapy has three main objectives: to facilitate global development and growing, to remedy or compensate for specific disabilities of the development, and to explore a problem recurrent in the development, aiming its solution.

Bruscia points out that modern theoreticians say each stage of development is a challenge or a specific task for the individual. For music therapists, these new theories stimulate other questions, such as:

• what are the tasks that are inherent to each developing stage?

• what happens musically in each one and their disparities, that is, which pathologies appear?

• principally, what are the forms of treatment that are indicated in Music Therapy?

Parallel to this music therapeutic approach, we found accord with instigating ideas within recent Music Education applications, for example, Swanwick's (1982, p. 85) Musical Development Spiral Theory that is similar to Piaget´s game theory. The spiral theory may be considered as the first sequence of fundamental development in the nature of musical experience and allows that the music therapy more and more finds its equilibrium point within the music area. This development will increasingly characterize us as a reliable and singular knowledge in the health area.

It would be impossible to advance more in this work as our objective at this moment, is to revise our thoughts about our practice as music therapists in the field of Mental Handicaps.

We believe that the music therapy "setting" should not be limited to a mere random sounding happening, were empirically everything may be considered valid, but it seems to be relevant to encourage a consistent analysis of the musical happening and its repercussions.

Summary

We summarize by pointing to Feuerstein's ideas, that is, the concept of Structural Cognitive Modifiability that seems to be an alternative and efficient strategy and a new way to think about education, rehabilitation and social reintegration, as it opens positive perspectives from the viewpoint of Special Education, that is INCLUSION.

We intend to go further on this music therapy research direction, to search for new approaches for this work and ways to help mentally disabled people to have more capacity.

We have worked to conjugate dialectically the utopia and the reality, accepting the challenge of the ambiguity, that is, what Basaglia (in Tranchina, 2000) called "to be in contradiction". In practice this means to be with the other and with ourselves, continually working to amplify the power (powerlifiting) of the people that are victims of the social exclusion.

We feel called to mobilize our creative and solutions' generator potential to solve the emerging impasses, breaking the limits and transforming the space, defining a new one. Then we can see the potential of art, of music in particular, and of music therapy more fully.

References

Barcellos,L.R.(1992). Caderno de Musicoterapia, vol.1. Rio de Janeiro: Enelivros.

Barcellos, L. R. (1982). Music as a Therapeutic Element. Paper presented at the First International Symposium on Music and Man. New York University, June 1982. New York City.

Bowlby, J. (1952). Maternal Care and Mental Health. World Health Organization Monograph Series ; 2. Geneva: World Health Organization.

Bruner, J. (1973). On Cognitive Growth - Studies in Cognitive Growth in Children With Learning Problems. In Sapir, S. G. and Nitzburg, A. C. (Ed.) Children with learning problems. New York: Brunner-Mazel Publishers.

Bruscia, K. (2000). Definindo Musicoterapia (Defining Music Therapy). Rio de Janeiro : Enelivros.

Bruscia, K (1999). O desenvolvimento musical como fundamento para a terapia (Musical Origins: Developmental Foundations for Therapy)(L. R. M. Barcellos, Trans.).

Fonseca,V. (1995). Educação Especial --Programa de Estimulação Precoce - Uma introdução às idéias de Feuerstein. Porto Alegre ,Brasil.

Fonseca,V. (1998). Aprendendo a aprender - a Educabilidade Cognitiva. Porto Alegre, Brasil.

Fonseca,V. (1987) Abordagem ativa à problemática da deficiência Mental e das dificuldades de aprendizagem. Revista de Reabilitação Humana , vol. VII , nos. 3 e 4.

Feuerstein , R. (1975). Mediated Learnig Experience - an outline of proximal etiology for differecial development of cognitive functions. ICP, New York.

Feuerstein ,R., Rand,Y. and Rynders,J. (1989). Don't accept me as I am - helping "retarded" people to excel. New York: Plenum Press.

Nordoff, P. and Robbins, C. (1971). Music Therapy in Special Education. New York: The John Day Company.

Ruud, E (1990). Caminhos da Musicoterapia (Music Therapy and its Relationship to Current Treatment Theories). São Paulo: Summus Editorial.

Swanwick, K. (1988). Music, Mind and Education. Routledge, London. (Pg. 85).

Swanwick ,K. (1991). Musica, pensamiento y educación (Music, Mind and Education). Madrid: Ediciones Morata, S.A.

Tranchina, P. (2000). A desinstitucionalização psiquiátrica na Itália :um processo de aquisição de cidadania. In Amarante, Paulo ( Ed.). A loucura da História ,Rio de Janeiro: LAPS/ENSP, Fundação Oswaldo Cruz.

Uricoechea, A.S. (2001). Diversidade e Inclusão : a vivência de um novo paradigma [Unpublished work]. Rio de Janeiro.

Vygotsky, L. S. (1963). Learning and Mental Development at School Age. In Simon, B. and Simon, J. (Ed.). Educational Psychology in the USSR. London: Routledge and Kegan Paul.