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may also be used with older adults to help them achieve better physical functioning. Rhythmic music, for example, acts as a stimulus for helping older patients with gait disorders improve the flow of their walk. In this process, the beat of the music serves as a cue for individuals in anticipating a desired rate of movement. In a brief 8-week study, Segall (2017) found other positive physical results of group singing with a population between 81 and 94 years old. Noting that reduced respiratory function can impact older adults’ nutritional intake, exercise endurance, and social engagement, Segall set up an 8-week group singing intervention. At the end of the intervention, she found that group singing meaningfully contributed to the respiratory health of this sedentary but healthy older adult population. The virtues of group singing as described by Segall are its cost-effectiveness; enjoyability; and value as a method of treating respiratory, voice, and swallowing function issues.

       Families and Couples

      Music by itself may be beneficial to families or couples because of its ability to evoke feelings and promote cooperation. Family-based music therapy is a term used to describe clinical work with children and families (Pasiali, 2013). The primary therapeutic focus is the facilitation of interaction and communication between family members to strengthen relationships. Shared musical experiences during family-based music therapy provide a context that influences a parent-child relationship. Feelings are often ignited or rekindled by playing music (Gladding & Heape, 1987). If a family or couple experienced contentment or positive affect at a previous stage, the music of that time may spark memories that help individuals within these systems to remember specific behaviors that were helpful in achieving harmony. Such memories once triggered can aid the family or couple in getting unstuck from behavioral stalemates and positively reinforcing one another.

A similar method initiated by the counselor may be used in marital counseling. In such a situation, the counselor prescribes a song whose lyrics represent issues brought forth by the couple. For example, Paul Simon’s “Train in the Distance” is a song about yearning to live in a better time. The last verse of the song speaks powerfully to this point:

      “What is the point of this story? What information pertains? The thought that life could be better is woven, indelibly, into our hearts and our brains.” Using that lyric as a cue, the couple is then asked to listen to the song at home, using it as a metaphor from which to initiate discussion of relevant thoughts, feelings, and issues. (V. Perry, personal communication, February 20, 1996)

      Another way of working with couples is to involve spouses in taking turns improvising on percussion instruments to depict musically what they perceive their typical pattern of communication to be. While one spouse improvises, the other writes thoughts that result from what that spouse thinks the other is saying musically. The patterns for different feelings and times of communication are then discussed with the realization that some patterns of communication appear to be automatic and disruptive but that whatever the beat, the pattern can change (Botello & Krout, 2008).

       Groups

      Most people in groups wish to be in concert with themselves and humanity. They are also looking to see where they fit in with others. Music provides an avenue for clients to assess themselves and others. Music can be especially powerful in a group at its beginning or end. Select music can help set an upbeat or a sedate tone when clients first enter the group room. For example, beginning a group by drumming is a “unique way to jump start conversations about group dynamics and each person’s role in them” (Camilleri, 2002, p. 264). In addition, drumming may immediately improve the moods of those who participate in it and thus enhance the beginning of a group (Mungas & Silverman, 2014). Likewise select music or music activities during termination can help instill in clients a sense of closure and can promote integration (Plach, 1996). A number of songbooks, such as Rise Up Singing (Blood & Patterson, 1992), contain a wealth of songs about subjects ranging from faith to friendships; they can be used to introduce music into a group at any stage, especially one that contains people from a wide range of cultural backgrounds.

Hodas (1994) reported using music in a mixed group of White and Black male adolescents to help the group handle anger, learn coping skills, and appreciate universal truths about human nature. In this group, a variety of songs, some of which were even violent, were played. The group members came to realize through the music that when wrongs occur in society more constructive actions than revenge can and should be taken.

      Stephens et al. (1998) used hip-hop music, also known as rap music, in an HIV/AIDS preventive counseling format with Black adolescents and young adults to educate these populations about protective factors for HIV. They contended that the overall implications of using hip-hop music in health promotion with Black youth are limited because this method makes use of culturally relevant materials to address the educational and health needs of the target community and is grounded in an approach that serves to stimulate cooperative learning based on peer-developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. In addition, hip-hop influences men’s willingness to disclose emotion or even to inquire about counseling. Emotional writing, such as in hip-hop, is a form of counseling suggested to be particularly effective with male clients (I. Levy & Keum, 2014).

      Music also has a place in the healing and helping process with survivors of sexual abuse (MacIntosh, 2003). Through the use of music, spontaneity is evoked and participants in the group become involved on a sensory and feeling level with the group or counselor. In the process, group members become fully present in a new way and become more involved in their relationships with others. Specific musical techniques used by MacIntosh (2003) include breathing and tone techniques, song writing in groups, and playing the drums.

       Clients With Illnesses

      Music functions in several therapeutic ways for clients with illnesses (Hanser, 2016). Music can serve to promote closeness within families through group singing, lyric analysis, and reminiscences. This type of bonding enhances the quality of life for family members both inside and outside of the hospital and helps establish better communication patterns and firmer support systems. In the process, anxiety and tension are lessened and intimacy is promoted (Slivka & Magill, 1986). In addition, religious faith may be increased through playing and singing religious music if the family is so oriented.

Rider (1987) stated, “Music has the capacity to touch and bring to the surface emotions that have been repressed for years” (p. 117). Some chronic diseases such as cancer, rheumatoid arthritis, and coronary difficulties correlate with negative feelings such as anxiety, hostility, and depression. Fatigue appears to be an especially prevalent and undertreated symptom in cancer patients and cancer survivors. Select music, in particular violin, flute, and piano, can help clients in these and other tension-filled situations to relax more, especially if it is uniquely and individually selected for each patient (Fredenburg & Silverman, 2014). Therapeutic compositions may also be played universally. Music cited in the literature as instrumental in reducing anxiety include the Largo movement from Dvoák’s New World Symphony and Brahms’s First Symphony (dos Santos et al., 2019).

      Music can also encourage healing by promoting catharsis and refocusing thoughts. For instance, G. Clarkson (1994) recounted the case of a young man with autism who, after several years of music therapy, began to communicate again. Likewise, in clients with trauma-induced dissociative disorders, music may succeed where words sometimes fail because of its ability to reunite and integrate all parts of a client’s total experience (Volkman, 1993). In addition, music therapy seems to be helpful in the recovery of breast cancer patients as they work to find and form new identities (G. Aldridge, 1996). In the process of making music, patients bring feelings into consciousness without any immediate verbal labels being attached to their emotions. This active intervention uses patients’ strength and creativity to cope and maintain coherence in the midst of what might otherwise be chaotic

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