Music Therapy and the Film, "Alive Inside"

How AMTA and Music Therapy Relate to the Documentary Film "Alive Inside" and the Organization "Music and Memory"

Status Report: September 3, 2014

The intent of this resource is to help music therapists and others understand how the mission of the American Music Therapy Association (AMTA) relates to (1) its position on the documentary film, “Alive Inside;” (2) the programs of the organization known as “Music and Memory;” (3) the use of personalized music delivered via iPod technology; and (4) the coverage that the film has generated from media outlets and public relations firms. This film raises serious concerns and potential misunderstandings related to the provision of clinical music therapy services for those with Alzheimer’s disease and other dementias. AMTA’s concerns arise from our mission, which is to “advance public awareness of the benefits of music therapy and increase access to quality music therapy services in a rapidly changing world.”  Though the concerns are serious and being addressed, the attention garnered by this film and organization offer an exceptional opportunity to educate and advocate for professional music therapy.  The documentary follows Dan Cohen, who discovers that bringing iPods with head phones to elders in skilled nursing facilities and introducing personalized playlists has a profoundly positive emotional effect on the residents; the film captures poignant moments that evidence the powerful effects of music.  The film also deals with the unfortunate and often non-humanistic care provided to residents of nursing homes.

Points of clarification related to personalized music listening and music therapy:

1.  AMTA is unequivocal in stating that what is portrayed in the film is not clinical music therapy. Both Dan Cohen, founder of “Music and Memory.org,” and the filmmaker, Michael Rossatto-Bennett, also have agreed on numerous occasions that they were not attempting to depict music therapy.  However, it is easy for viewers to infer that the film and the organization are portraying “music therapy” because (1) music therapy research is cited; (2) Dr. Oliver Sacks discusses clinical implications that are related to music therapy and he is a public supporter of music therapy; (3) Dr. Peter Davies specifically mentions the power of music therapy for those with Alzheimer’s disease; and (4) Dr. Connie Tomaino, MT-BC, a renowned music therapist, is seen in the film on two occasions.  AMTA officials met with the film’s director and outlined problem areas a year ago.  AMTA edited the script to correct misleading comments, recommending re-filming certain segments as well.  Our attempts to correct misleading and inaccurate information went unheeded, which is why AMTA and AMTA’s Executive Director, Dr. Andrea Farbman did not agree to be partners nor be listed as such.

“Alive Inside” received the audience appreciation award at the 2014 Sundance Film Festival and a scene from the film went viral with over 9 million hits on YouTube. Though this film highlights the power of music listening, it also has resulted in many people confusing music listening and music therapy, thereby leading to an inaccurate and extremely limited impression of what music therapy actually is.  The opportunity exists to educate the public, health administrators, and the media.  See Appendix A for a sample press release that can be customized to clarify this.

2. The use of personalized music programs delivered by iPods with headphones facilitated by nursing home personnel is not clinical music therapy.  The public should be aware that in some cases the iPod can cause more stress and harm to elderly persons, especially those in late stage dementia.  No negative memories of clients, which might have resulted from the music listening, were portrayed in the film.  A music therapist is trained to deal with painful issues that arise when difficult memories return.  Board certified music therapists also have the ability to adjust or adapt the music provided when unpleasant feelings or sensations from the volume, rate of speed, or intensity in the music occurs.  The fact of the matter is that almost anything a board certified music therapist would do using clinical music therapy techniques would potentially have an even more profound effect than passively listening to music.  Techniques used by a board certified music therapist, following an assessment process, such as singing with a client, playing a musical instrument with a client, involving the family in the process, can all have profound and important effects.

3. As for the “Music and Memory ‘Certification’ Program” that has been developed for nursing home personnel to use iPods and develop personalized playlists, we are adamant that this is one more example of misleading the public by implying this is a professional certification program; in reality, it involves 3 webinars, totaling 4.5 hours of training.  We are pleased that nursing home residents will be receiving increased access to the music they love.  However, AMTA is concerned that nursing home administrators will confuse “personalized music” with a clinical music therapy treatment program.  The danger is that administrators may see this as an opportunity to save money by NOT hiring a highly trained board certified music therapist and mistake a “certified” music and memory program for an actual treatment program.  Our recommendation is that consultation and supervision of this program be provided by a board certified music therapist.

4. AMTA is concerned that recent public relations firms’ press releases and media coverage of the film mislead the public about what clinical music therapy is.  AMTA has had numerous communications with the public relations personnel for the film and we continue to emphasize that the film does not portray “music therapy” and that the term “music therapy” should not be used in press materials.  This is a continuous and ongoing challenge as the public relations representatives are not experts on this topic and the press constantly chooses sound bites.  And, paradoxically, because AMTA has generated so much attention for music therapy over the years, press people have heard the term and think they know what it means.  

Furthermore, some news outlets mistakenly label the “Music and Memory” program as music therapy or they interchangeably talk about the program and use clinical music therapy research, which further confuses and misleads the public.  Quoting specific music therapy research and applying it to music enrichment programs is misleading and inaccurate.  The music therapy research highlights evidence-based practice, clinical standards, and planned outcomes; whereas the music enrichment programs like “Music and Memory” can make no such claims.

HISTORY

A YouTube video of an elderly gentleman named “Henry” appears to demonstrate the power of listening to music. http://www.youtube.com/watch?v=5FWn4JB2YLU  However, for a practicing music therapist this is not magical or unusual; rather, it is a typical music therapy outcome.

Dan Cohen, who appears in the video, established what he is calling a “personalized music” program for delivering music to older adults via iPods. Mr. Cohen has a degree in social work and has worked in IT; our understanding is that he is not a licensed social worker.

Mr. Cohen established the MUSIC & MEMORY℠ non-­profit organization that brings personalized music into the lives of the elderly or infirm through digital music technology.  He has collaborated and consulted with several music therapists, including Dr. Connie Tomaino, MT­-BC, and understands the difference between music therapy and his program.

A “Music and Memory Certification Program” has been developed for nursing home personnel to implement the “personalized music” program.  As mentioned before, AMTA is concerned that nursing home administrators will confuse “personalized music” with a clinical music therapy treatment program.

In August 2013, filmmaker Michael Rossato-­Bennett completed a documentary on Mr. Cohen’s work with nursing home residents.  The documentary was an expansion of the YouTube clip that Mr. Rossato-­Bennett originally shot.  AMTA viewed the draft documentary and a four hour meeting resulted in September 2013, between Dr. Andi Farbman, Executive Director of AMTA, Mr. Rossato-­Bennett, and Dr. Tomaino to discuss concerns about the film.  AMTA submitted a number of key edits to the film as requested by Michael and none was used.  Michael re­-filmed Dr. Tomaino with the intention of her differentiating the film’s portrayal of personalized music from that of clinical music therapy.  The additional footage was not used despite requests by AMTA.

The film, “Alive Inside” received the audience appreciation award at the Sundance Film Festival in early 2014. As a result, a company purchased the rights to the film and is distributing the film and publicizing it.  Since that time, AMTA has been in touch with representatives from the film who have requested that AMTA be listed as a “partner in change” in the film.  We were not partners in the development of the film.  We, however, agreed to be listed as a “partner in change,” after the fact in an effort to advocate for more music for nursing home residents and for increasing access to clinical music therapy programs and services and because we believed that the film was going to be widely distributed and we did not want to lose that opportunity to advocate for music therapy.

MOVING FORWARD

When these examples of misrepresentation occur, please contact your regional Professional Advocacy Committee representative to receive assistance in educating and advocating for clarification and improved understanding of music therapy.  Contact information for specific regional representatives can be found on the Professional Advocacy Committee listing on www.musictherapy.org (Member Resources>AMTA Officials, Professional Advocacy Committee link).  When contacting the media outlet or facility, we also ask that you keep your regional representative apprised of developments.

AMTA believes this is an exceptional opportunity to educate and advocate for music therapy and that our work is just beginning.  The Centers for Medicare and Medicaid Services (CMS) have identified music therapy as one of the top non-­pharmacological methods with potential benefit for individuals with symptoms associated with Dementia. (Department of Health and Human Services, 2012).  Our job is to capitalize on this energy about music to explain and demonstrate the capacity of music therapy to facilitate expressive and receptive communication, increase alertness, decrease behavioral and psychological symptoms related to Dementia, increase engagement, increase mobility and physical functioning and validate life experiences.  

REFERENCE

Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2012). Federal Register: Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Changes. Final Rule. 77 FR 22071 (04/12/2012)

APPENDIX A

Setting the Record Straight: 
What Music Therapy Is... and Is Not

The American Music Therapy Association (AMTA) supports music for all and applauds the efforts of individuals who share their music-making and time; we say the more music the better! But clinical music therapy is the only professional, research-based discipline that actively applies supportive science to the creative, emotional, and energizing experiences of music for health treatment and educational goals. Below are a few important facts about music therapy and the credentialed music therapists who practice it:

• Music therapists must have a bachelor’s degree or higher in music therapy from one of AMTA’s 72 approved colleges and universities, including 1200 hours of clinical training.
• Music therapists must hold the MT-BC credential, issued through the Certification Board for Music Therapists, which protects the public by ensuring competent practice and requiring continuing education. Some states also require licensure for board-certified music therapists.
• Music Therapy is an evidence-based health profession with a strong research foundation.
• Music Therapy degrees require knowledge in psychology, medicine, and music.

These examples of therapeutic music are noteworthy, but are not clinical music therapy:

• A person with Alzheimer’s listening to an iPod with headphones of his/her favorite songs
• Groups such as Bedside Musicians, Musicians on Call, Music Practitioners, Sound Healers, and Music Thanatologists
• Celebrities performing at hospitals and/or schools
• A piano player in the lobby of a hospital
• Nurses playing background music for patients
• Artists in residence
• Arts educators
• A high school student playing guitar in a nursing home
• A choir singing on the pediatric floor of a hospital

Finally, here are examples what credentialed music therapists do:

• Work with Congresswoman Giffords to regain her speech after surviving a bullet wound to her brain.
• Work with older adults to lessen the effects of dementia.
• Work with children and adults to reduce asthma episodes.
• Work with hospitalized patients to reduce pain.
• Work with children who have autism to improve communication capabilities.
• Work with premature infants to improve sleep patterns and increase weight gain.
• Work with people who have Parkinson’s disease to improve motor function.

AMTA’s mission is to advance public awareness of the benefits of music therapy and increase access to quality music therapy services in a rapidly changing world. In consideration of the diversity of music used in healthcare, special education, and other settings, AMTA unequivocally recommends the unique knowledge and skill of board certified music therapists.

For more information on this topic please visit the American Music Therapy Association at www.musictherapy.org and go to the Research tab.  To set up interviews with board certified music therapists please contact AMTA at (301) 589-3300.

Background Information

Back