5.

4 Nordoff-Robbins Music Therapy

J98), AOM
::1 it has re- Lars Ole Bonde and Gro Trondalen
-rn), and at
- the client's

A historical outline and definitions

TheNordoff-Robbins(N-R)approachisoneofthemostfamousimprovisational
models of music therapy a"uttãptd since
the 1950s'Paul Nordoff' an American
composerandpianlst,andCiiveRobbins,aBritish-trainedspecialeducator,
collaboratedtopioneerthemodel,whichisknownworidwideandhasbeentaught
inavarietyofcountriesacrosstheworld.Nowadays,themodeliscalledNordoff-
Robbins,butisalsoknowninsomecountriesandinsomeoftheliteratureas
aimed
.creative Music Therapy' (Nordoffand Robbins 2oo7).In the beginning' it was

at children with learning disabilities,

from the mild end of the spectrum to the Severe
(Aigent998).PaulNordoffdiedin1977,and'CliveRobbinsfurtherexpandedthe
and other colleagues, including a
work together with his second wife, Carol Robbins,
newfocusonchildrenwithhearingimpairment(RobbinsandRobbinsiggB).Music
therapiststrainedintheN-RmodelintheUS,intheUKandinGermanyhave
."purrd.dtheclinicalspectrumtoencompassadultclientsinareassuchasneuro-
palliative care'
rehabilitation, psychiatry and somatic and
In the early years of ieveloping their mode1,
Nordoffand Robbins were influenced
bytheideasofRudolfsteinerandtheanthroposophicmovementinhumanistic
drums
2005)' However' their r'rse of
psychology (Lee and Houde 2otr,p'46f'\Robbins
such a framework. They d.el,eloped the idea
and percussion was controversial within
thatwithineveryhumanbeingthereisaninnateresponsivenesstomusic,andwithin
everypersonalityonecanreacha'musicchild'ora'musicperson''Theideawas
as they believed in the potentially
vital in their approach to the disabled population,
of music to enable self-expression
natural responsiveness to music and the power
of learning and physical disabilities'
and communication, in spite of severe degrees
core of the model:
Robbins (2007)writes about the music-centred
fundamentally musical' The work came
The motivation that generated this work was
aboutfromaloveofmusicalcreatlon,musicalexpression,andmusicalexperience.It
arose from Nordoff,s natural enthusiasm
for music making, from his intLlitive feeling

forthePoweÍsofspontaneouscommunicationinmusicalparticipation,anclfrom
ski11 and experience' Robbins,s
the consiclerable extent of his musical knor,t,ledge,
empatheticrecognitionofthehealingimmediacyofNordoff,sclinicailnnovations
supportedtheuirthofthetherapyandadaptivelynurtureditsdevelopmentinallthe
directions it took. The work did not originate
in steiner's teaching' (p'65)
176 A COÀIPREHENSIVL GtllDE lO tvltistC TI]ERApy

Later Nordoffand Robbins related their therapeutic goals to the humanistic concepts
of Abraham Maslow, including in their framework the aspiration towards self-
actualisation, peak experiences (Maslow 1.962) and developing special creative talents.
The relationship with the ciient is built on a warm, friendly approach (accepting
the
child as they are, recognising, reflecting and respecting the child's feelings, allowing
the child to make choices), and a non-directive approach to give the child autonomy,
and the therapist the role of following and faciiitating. At the same time, the child's
(sometimes rigid) patterns of behaviour and attachment can be confronted
and
challenged within the musical relationship. This is a dominating feature in early
documented examples of N-R therapy (Aigen 199g). Based on a non_directive
attitude, the child's development is stimulated towards autonomy, ancl the primary
role of the therapist is to follow, support and stimuiate the child in developing new
patterns - unless there is a situated need for a more challenging approach and thus
also a more directive therapist role. In all situations, the core of the N-R model is the
belief in music itself as a medium of growth and clevelopment together with the
-
axiom that every human being, no matter what disability, illness, trauma or mental
health problem is at hand, has an ability to respond to music and thus the access to
enhancing quality of life and promoting healing in their life (Etkin t99g).

The session: procedure and techniques

The Nordoff-Robbins working style is unique and often easily recognisable. From the
very beginning, the music is placed at the centre of the experience, and the client's
musical reponse is the primarymaterial for the therapists'work in the session and later
in the analysis and interpretation of the video recording. The therapists are usually
highly skilled musicians because the rich flexibility and variability of a harmony
instrument are central to their working style. During training, the music therapists
develop a sophisticated use of piano and/or guitar in improvised music-making.
in individual therapy, clients were traditionally offered a limited channel for their
musical material, mainly the cymbal and drum, together with strong encouragement
to use their voice. Today, and especially in group work, other instruments are
involved - pitched instruments, reed horns, wind instruments and various string
instruments - because they are fairly easy to play and produce great sound.
In much of the individual work, Nordoff-Robbins therapists (where possible)
traditionally worked in a pair. One person established a musical relationship from the
piano, while the other therapist facilitated the child's responses and engagement.
This
working model originated in the early years oí the Nordoff-Robbins coliaboration
where Paul Nordoff was the pianist-therapist and clive Robbins the supporting
therapist. Today, most N-R music therapists work individually (Tsiris, personal
communication 2018). Another pillar in the rnusical style of this model is paul
Nordoff's own tonally founded compositions. Nordoff developed a unique style of
improvisation that was transformed into two volumes of Playsongs
for Children (now
 SEI-I]C] ED MUSIC TT]ERAPY MODELS AND INTERVENTIONS 771

available in several languages). Contemporary N-R therapists improvise creatively

in this style and create a living musical atmosphere in the therapy room, from
the moment the client enters until they leave. Examples can be heard on the CD
accompanying Gary Ansdell's Music for Life (Ansdelt rSSS).
in N-R music therapy, the approach comes within the conceptual framework
of music as therapy, where the music provides the therapeutic catalyst through
which change will take place. The relationship itself is formed in the music.
The therapists work through different phases in their therapy: 'Meet the child
musica1ly... Evoke musical response...develop musical skiils, expressive freedom,
and interresponsiveness' (Bruscia t987, p.45).
Within this mode1, a model of analysis has been developed to facilitate description
and characterisation of what goes on in therapy, and to enable assessment of eventual
progress. The model includes a number of rating scales:

. 13 response categories

. the client/therapist relationship

o musicalcommunication

. musical response scales: instrumental/rhl,thmical and vocal response.

:r the Clinical application

. : ent's Nordoff and Robbins offered a significant perspective on how music can be used
- -ater in music therapy, from the use of musical play songs (e.g. NordoÍl and Robbins
, ra1ly ).966, 1969 - with texts translated to many languages) to pure improvisation.
:10ny Examples include: the improvisational style of music must be free from musical
, .Pists conventions, and flexible; intervals are considered important and represent different
.<ing. feelings, when used in melody; triads and chords can be used in special ways; and
rheir improvised music should also include 'musical archetlpesl such as organum, exotic
-:illeflt scales (fapanese, Middle Eastern), spanish idioms and modal frameworks (Robbins
:s are and Robbins 1998).
.rring The therapist often provides a musical frame, frequently establishing clear
rhythm and pu1se, and particularly, singing about what the client is doing while
, sible) it is happening, in order to bring into focus the experience that is occurring. Any
n the musical expression produced by the client, vocal or instrumental, is incorporated
,. This into a frame, and encouraged.
:ation The clinical application of creative Music Therapy has been introduced in
,rting wide-ranging and in diverse ways. The graduates of the courses in the Nordoff-
:l'SOnâ1 Robbins model, particularly in New York, London, sydney and witten/Herdecke
. Paul in Germany, have diversified the approach to work with adult patients in the areas
,r-le of of neuro-rehabilitation, psychiatry and terminal illness. The model has been greatly
. (now developed through research and extension ofapplication (Aigen 1g9t,1996, t9g},
I7B A COMPREHENSIVE GUIDE TO MUSIC THERAPY

2oo5,2ol4; Ansdell 1gg5,1996, 1997,201.4; Brown 1999; Guerrero et ql. 2ol4;Lee One i
tg96,2OOO; Neugebauer and Aldridge 1998; Ness and Ruud zOOB; Pavlicevic t995, illustratio
7997;Pavlicevic and Trevarthen 1994; Schmid 2005; Spiro, Tsiris and Pavlicevic and the t'
2014; Tsiris 2013; Tsiris, Spiro and Pavlicevic 2OI7). A special issue of Mzsic Therapy in the lío
Perspectives (2014, r) was devoted to lecent developments in N-R therapy' Streeter with diffe
(rSSSb) offers a critique of the model. and explc
Nord
both cour
Documentation at a more

This model of music therapy has also developed methods of analysing what is music thr
going on and how therapy is progressing. As mentioned above, a number of rating Norwegir
scales have been generated, including: 13 categories of response, child-therapist developn
relationship, musical communicativeness, musical response scales (instrumental Nord
rhlthmic responses, singing responses). the incre
So far, case studies are the most typical way in which therapists working in publicati
the Nordoff-Robbins tradition document their work (e.g. Aigen 2OO2,2OO5;Etkín writings
1999; Howat 1995).4 number of earlyN,R cases are documented and discussed Robbins
by Aigen (rgSA). The material is often presented as a 'story', a narrative description extensive

ofthe process and progress oftherapy. Howat IrOOS) presented a lengthy and 1995; Brt

detailed account of individual work with a young 10-year-old girl with autism called
Elizabeth, documenting more than roo sessions over a five-year period. The narrative
descriptions, sometimes brief and sometimes more detailed, mainly focused on her Categc
musical behaviour in the sessions, explaining how she played with many examples In Brusc
and interpretations of the emotional expression present in her playing. Life events Robbins
were also included in order to provide a context for the musical process in the therapy. Therapy
Etkin (1999) described a period of therapy with an emotionally, physically and 1pp. r 89,

socially abused and deprived child called Danu. She described the way that Danu through
played during the initial assessment session, and then set out the case study in the
earlywork - emergence of songs and stories - disclosure - endings.
stages of therapy:
A method of improvisation called 'singspiel' or 'sprechgesang' featured strongly in
the therapy sessions, and there was signiflcantiy more verbal material than is tlpical
in other case studies from this tradition. From this example, it is clear that while
ihe original conceptual model of Nordoff-Robbins provides the basis for a strong
al; srounded training, individual therapists develop methods and techniques out
:- :::r:r lrirnarv approach. Piano-based improvisation stil1 forms the foundation,
r.:- i;,:::-rased improvisation developed by Dan Gormley in the US, jazz and
:--:s -::--::--.--saiion st],ies more culturally effective with some populations in New
\c:.. :.-,.-::=; :r ,1ian Turr,r., and Aesthetic Music Therapy defined by Colin Lee
il C.:-. t. - :. I - i- -r'. among others, have emerged from the initial foundations of
1\-^ t---:_, -_ : :- ,
 SELECTEI) N"{USIC THER APY \4ODELS i\ ND I N'lllR\''ENTION S r79

One of the most famous early cases in the N-R tradition is that of 'Edwardl a fine
illustration of the dynamic span of the model. The dramatic meeting between Edward
and the two therapists in the very fi.rst session was the topic of a series of analyses
in the .Atordi c lournal of Music Therapy ( 199S-99). Music therapists and researchers
with different backgrounds discussed how this fascinating case could be understood
and explored from many perspectives.
Nordoff and Robbins also taught in Denmark and in Norway, and therapists in
both countries followed their style of work while others incorporated their concepts
at a more general level with certain clinical populations. Among them are the Danish
music therapist Claus Bang,3 who worked with hearing-impaired children, and the
Norwegian music therapist Tom Ness, who used to work mainly with people with
developmental disabilities (Nass 1989; Stensaeth and Ness 2013).
Nordoff-Robbins music therapy has stood the test of time. This is visible in
the increasing number of music therapists using this approach and the extensive
publications of case studies based on N-R music therapy. Some very important
writings are published by Paul Nordoff and Clive and Carol Robbins (Nordoff and
Robbins t977, r971183, rg77; Robbins and Robbins 1980, 1998). There is also an
extensive literature on case studies in books (see, for example, Aigen 1996; Ansdell
r995; Bruscia l99t Paviicevic i997; Wigram and De Backer 1999a).

Categorisation
In Bruscias systematic account of music therapy models (Bruscia 1998), Nordoff-
Robbins music therapy is placed as either'Developmental Music Therapy' or'Music
Therapy in Healing' or 'Transformative Music Psychotherapy' at the intensive level
(pp.r89, 2to,2rg), because the therapeutic goal is transformation of personality
through the musical process itself.

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