Music Therapy and Music-based Interventions for Older Adults
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Music is an effective tool to bring forth strong emotions from the past. Sometimes clients cannot find the words to express what they feel in a counseling session but can choose, sing, or play a song. This makes music therapy and music-based interventions ideal for older clients, who have difficulty communicating their thoughts and feelings.
Counselors utilize music in various settings, including outpatient clinics, senior centers, assisted living, and hospital programs. Music-based interventions and techniques are inclusive, meaning older adults from various backgrounds and cultures can participate.
The Voice of the Older Adult
Some older adults are no longer appreciated for their wisdom, thoughts, and feelings. Societal ageism can cause older adults to repress or hold back their vocal expression. Music can give a voice to older adults who feel invalidated or ignored.
Physical changes in aging can affect the voice as well. Music can help this population heal or perhaps find their voice for the first time. Linstrom et al., 2022 writes:
The voice is important for older adults, and an insufficient voice can affect communication and social participation. Information about aging voice and voice exercises, for example from speech-language pathologists, could be of interest among older adults.
Music Creates a Sense of Safety
Music has a beginning, middle, and end. The song creates a holding space for intense feelings and thoughts. A client may experience grief or trauma, as an endless experience. Music can hold a piece of conscious or subconscious emotional pain to process and integrate it. For this reason, music works well with any client who experiences overwhelm due to grief or trauma.
Clients who select their own music demonstrate a sense of self-command over the therapeutic session and share an expression of themselves in this moment and time. A sense of control and self-mastery is important in raising self-esteem and empowering clients. The song selection can be useful for assessing the clients’ current mood and cognitions.
What is Music Therapy? How to Incorporate Music into Counseling Sessions
Music-based interventions and therapy can be practiced in an individual counseling session or a group setting. The counselor can play a piece of music for the client, have a variety of music available for the client to choose, ask the client to bring in a song, hand out written song lyrics for the client to sing, or bring in some instruments for the client to play.
Music can be interactive or receptive, depending on the technique used. In addition to performing, listening, or choosing a song, therapy can include discussing what the song or lyrics mean to the client. This form of expressive art can be combined with other types of art, such as dancing or drawing, and other psychotherapy approaches.
Singing or playing music can be a tool for clients to reminisce about the past, change a client’s mood, reduce stress, and practice mindfulness. Group singing or playing of instruments can increase client socialization, which may reduce loneliness, depression, and anxiety.
Music can be combined with movement therapy or dance which can be useful in group counseling sessions. Many mental health improvements were found with a BMC Geriatrics research study in 2023, involving music, movement, and 49 older adults (aged 65+ years) from ten care homes. The researchers stated:
Residents reported improved mood, physical health, job satisfaction, and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress, and sleep satisfaction.
How Do Music Therapy or Music Interventions Work?
Clients may not understand how music affects the brain, but they often report a lighter mood, feel more connected to others, with less stress and more relaxation. According to the National Center for Complementary and Integrative Health (NCCIH),
Performing or listening to music activates a variety of structures in the brain that are involved in thinking, sensation, movement, and emotion. These brain effects may have physical and psychological benefits. For example, music causes the release of brain chemicals (neurotransmitters and hormones) that can evoke emotional reactions, memories, and feelings and promote social bonds.
Physically, music activates many different brain areas and structures. Music is ideal for patients and clients who suffer from various brain disorders, such as strokes, dementia, brain injuries, and many mental health issues. Zoppi 2020 writes in Medical News Today:
The way that music affects the brain is very complex. All aspects of music—including pitch, tempo, and melody—are processed by different areas of the brain. For instance, the cerebellum processes rhythm, the frontal lobes decode the emotional signals created by the music, and a small portion of the right temporal lobe helps understand pitch. The reward center of the brain, called the nucleus accumbens, can even produce strong physical signs of pleasure, such as goosebumps, when it hears powerful music. Music therapy can use these deep physical reactions the body has to music to help people with mental health conditions.
Reminisce Therapy
Reminisce therapy helps older clients connect with memories, thoughts, and feelings from the past. Clients report improved mood and become mentally stimulated, by using music as a prop, to connect with a positive memory. These memories can be utilized to create life stories.
Wood et al., 2018 writes:
Reminisce therapy involves discussing events and experiences from the past. It aims to evoke memories, stimulate mental activity, and improve well‐being. Reminiscence is often assisted by props such as videos, pictures, and objects. It can take place in a group or be done with a person on their own, when it often results in some form of life‐story book being created. Reminisce therapy helps older people with depression. It may be suitable for people with dementia both because depression is common in dementia and because people with dementia typically have a better memory for the distant past than for recent events.
How Music Helps Older Adult Clients
Improves Cognitive Functioning: All older adults can benefit from music cognitively. The American Psychological Association defines cognition as, “all forms of knowing and awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem-solving. Along with affect and conation, it is one of the three traditionally identified components of mind.”
Older clients with dementia have demonstrated positive cognitive effects using music techniques. Often clients who have a dementia diagnosis lose their short-term memory but can access their long-term memories. Music can be a vehicle to access past memories and connect them to their loved ones in the present moment.
It is important to keep a few guidelines in mind with this population. Ensure to use the music the client chooses and pay special attention that the music is not connected to a past trauma. Not only can music be helpful to enhance cognitive functioning, but also can help reduce anxiety.
Reduces Anxiety: Music can distract from anxious feelings or help the client connect with calming or positive feelings, such as joy or peace. Meditation music can cause a sensation of relaxation through mindfulness practice.
Reduces Stress: Life change, loss, and the aging process can create stress for older adults. Music can be one treatment to help ease these transitions. Research in the Health Psychology Review found,
The current meta-analytic review provides evidence that music therapy can be effective in reducing stress and provides justifications for the increasing use of music therapy carried out by a qualified music therapist in both mental health care practice and medical settings.
Reduces Depression: Older adults may experience depression from life changes, losses, and the aging process. Music can bring the client back to a time of positive feelings, thoughts, and memories. The Cochrane Database of Systematic Reviews in 2017 cites,
Findings indicate that music therapy provides short‐term beneficial effects for people with depression. Music therapy added to treatment as usual seems to improve depressive symptoms compared with treatment as usual alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.
Increases Socialization: Music when sung in a group, can connect members to one another and elicit positive feelings. In a 2020 study in The Journals of Gerontology, it was found:
Singing in a choir can reduce feelings of loneliness and increase interest in life among diverse older adults. Community choirs are typically affordable, sustainable, and accessible, and can be culturally tailored, making them relevant and useful for helping to reduce health disparities among diverse older adults who are more likely to experience financial hardship and live in low-resourced communities compared with white older adults.
Music Therapy Certifications
Anyone who has a master’s degree in counseling can use music-based interventions in their work. A person with this level of experience can say they utilize music techniques. It is unethical to claim you are a “music therapist” without the proper education, training and certifications. If you are interested in learning more about music art therapy, inquire with your state about what qualifications are necessary to become a music therapist.
According to the American Music Therapy Association, candidates must have at least a bachelor’s- or equivalency-level approved training in music therapy (including an internship). They can then take a national exam offered by the Certification Board for Music Therapists, and qualify for the credential Music Therapist, Board Certified (MT-BC).
Lisa Hutchison, LMHC
Writer & Contributing ExpertLisa Hutchison, LMHC, is a licensed mental health counselor for the Commonwealth of Massachusetts. She works for professionals who want to treat and prevent compassion fatigue. With over 20 years of psychotherapy experience, she helps her clients assert themselves, set boundaries, and increase their coping skills. Her specialty is decreasing stress, anxiety, and depression while increasing realistic methods of self-care for those who help others. Ms. Hutchison’s psychological advice has been featured in Reader’s Digest and the Huffington Post. Her articles have been published in numerous magazines, including Grief Digest and Today’s Caregiver.
Lisa is the bestselling author of I Fill My Cup: A Journal for Compassionate Helpers and a faculty member writer for NetCE. Her latest continuing education unit publication is “Setting Ethical Limits for Caring and Competent Professionals.” She has taught creative writing in colleges and presented on boundaries for the compassionate helper; the use of expressive art to heal grief, anxiety, and depression; inspirational and motivational topics; and creative writing techniques.