Therapeutic Music

Bedside harp photo.bmp

Laurie Riley was a pioneer in therapeutic music as a bedside offering in hospitals and hospices, was the founder of the Clinical Musicians Home Study Course (also known as Harp for Healing, now administered by Mary Stevens – see http://www.harpforhealing.com); she was also a co-founder of the Music for Healing and Transition Program (www.mhtp.org). She was a charter member of the National Standards Board for Therapeutic Music. Her purpose in promoting essential training is to keep the best interests of patients in mind, and to encourage every therapeutically-minded musician to do their work with the utmost integrity.

What Kind of Music is “Therapeutic”?
Music that helps to alleviate physical, emotional, or mental concerns can be considered therapeutic. Music has been used since earliest times, formally and informally, to bring relief and also to change, create or enhance moods.
Therapeutic music takes many forms. Most music is therapeutic to someone in some way. The common usage of the term, however, usually refers to pleasant acoustic music played live in medical settings such as hospices, nursing homes, and hospitals. Therapeutic music has been shown to be beneficial for many kinds of patients, enhancing the healing atmosphere in medical settings.
Those who provide live therapeutic music in medical settings may be:
1. Music Therapists: therapists with a bachelor’s or master’s degree that allows them to use music as a tool in interactive (verbal or physical) therapy. Music Therapists often work with groups doing music activities such as singing along or movement, usually with a goal of socialization or of psychiatric or neurologic enhancement. They may work with mentally disabled, physically handicapped, and dementia patients, among others. The American Music Therapy Association owns the title Music Therapy, so those certified from other organizations must use other titles (see below).
2. Certified therapeutic musicians: musicians with a certification to play music one-on-one in the rooms and at the bedsides of patients in medical settings; no solicitation of verbal or physical interaction is necessary because the music is the therapy. Their work is mostly at the bedsides of patients who are not required (and sometimes not able) to respond physically or verbally. Some of he titles used by certified therapeutic musicians are Certified Music Practitioner, Certified Harp Therapist and Certified Clinical Musician. Those graduating from accredited programs are qualified to play for patients in ICU, CCU, NICU, ER, Post-op, oncology, and general care. This work is not entertainment or performance; the focus is entirely on the patient, who is not required to interact, especially since patients who are very sick, anesthetized, medicated or comatose are usually unable to do so.
3. Volunteers: certified or uncertified. Those who are not certified may play in hallways, waiting rooms and public areas in medical settings, but usually not in patients’ rooms unless they are family. Those who are certified may play according to the qualifications of their certification.
(The above definitions are general; for more detail see the links below.)
There is a great deal of detail for practitioner students to learn about what kind of music is best received by which patients and under what circumstances. Although it may seem obvious that anyone who plays well should be able to play for a patient in a medical setting, there are codes of deportment within medical institutions that are not the same as elsewhere; what is normal, polite deportment in the world outside the medical facility may not be at all appropriate within. To function well in such environments one must also have a working knowledge of corporate compliance. Additionally, anyone working in an official capacity in a medical setting must be familiar with codes and ethics, emergency procedures, monitor reading, and the like. Those, plus understanding how specific kinds of music effect the body and psyche on a scientific level as well as emotionally and psychologically, is why training programs exist, which ensure that you will be knowledgeable and confident as you do your therapeutic musical work.

Why is Certification Necessary?
A common question is, “Why do I need to be trained just to play music as a heartfelt service for a sick person?” This deserves a thoughtful answer. First, anyone may play music for a sick friend or family member at home, or with permission for a sick friend you are visiting in a medical institution. But within a medical setting, playing in an official capacity puts you in a different position. Although it may seem that anyone who plays well should be able to play for a patient in a medical setting, there are codes of deportment within medical institutions that are not the same as elsewhere; what is normal, polite deportment in the world outside the medical facility may not be at all appropriate within. To function well in such environments one must also have a working knowledge of corporate compliance. Additionally, anyone working in an official capacity in a medical setting must be familiar with codes and ethics, emergency procedure, and the like. That, plus understanding how specific kinds of music effect the body and psyche on a scientific level as well as emotionally and psychologically, is why training programs exist, which ensure that you will be knowledgeable and confident as you do your therapeutic musical work.
For Music Therapists, a degree in the psychological effects of therapy and how to proceed with prescriptive, interactive therapies for neurological or physical rehabilitation is mandatory.

For training and certification to play therapeutic music one-on-one with patients in medical settings, please go to http://therapeuticmusician.com which is the website of the National Standards Board for Therapeutic Music.

Why Harps?

Although there are many instruments that can be used therapeutically, the vast majority of therapeutic musicians are harpers and harpists. There are many theories as to why harps are so effective as therapeutic instruments. Some say it is the richness of overtones due to fact that harp is the only stringed instrument that has so many strings going directly into the soundboard at a right angle rather than running parallel to the soundboard, or the fact that so many strings vibrate sympathetically (with each other) at once. Whatever the conjecture, the fact is that harps are by far the preferred instrument for therapeutic musicians. Many harp builders make small harps that are commonly called “therapy harps”. These are easy to carry around in a medical setting without the impression of being imposing. However, all harps are therapeutic when appropriately used. In fact, larger harps are often favored for their soothing deep tones.

Live Music vs. Recorded Music in Therapy
Recordings of restful or meditative music abound these days, and can sometimes be used effectively for therapeutic purposes. However, recordings are engineered with the sound compressed so that a full range of frequency is not present. Since frequency is an important component of the therapeutic effects of music, live music is usually significantly more effective. Appropriate live therapeutic music at the bedside in medical settings differs from recorded music in that:
1. It can be changed according to the patient’s needs and requests
2. It represents a caring human element
3. It is not merely entertainment – it is has proven therapeutic benefits
4. Research has shown it to be effective in specific rather than just general ways

Acoustic vs. Electronic Music n Therapy
Live music played as therapy in medical settings is usually acoustic. Wider, richer frequency ranges are present in acoustic instruments than in electronic ones. Electronic music lacks overtones and undertones that create richness of frequency, and it is therefore not generally as effective as acoustic music, and certainly not as restful, (and is usually not allowed in medical settings except in care homes where there is a high percentage of residents with hearing loss.
Therefore, the most common styles you’ll hear in the genre of “healing music” or “therapeutic music” is restful and quiet. It may or may not have a beat or rhythm, depending on the perceived needs of the patient in the moment. It may or may not be familiar music. Therapeutic music is not New Age music, and the slow, simple music often used in medical settings does not comprise the whole of therapeutic music styles.

Likewise, electronic music lacks overtones and undertones that create richness of frequency, and it is therefore not generally as effective as acoustic music, and certainly not as restful (and is usually not allowed in medical settings). Wider, richer frequency ranges are present in acoustic instruments.
Amplified music is usually also not appropriate except in care homes where there is a high percentage of residents with significant hearing loss.

How Did it All Start?
Music Therapists have been active since the 1940s. Therapeutic musicians’ work, which is a separate field and addresses different needs, started in 1993.
I was asked to co-create a training program for bedside musicians. In addition to teaching solid music skills, we engaged medical personnel to teach clinical deportment, anatomy-physiology, basic pharmacology, patient monitoring, charting, infection control, and so on. We developed a comprehensive curriculum. Thus was born The Music for Healing and Transition Program, which was incorporated as a 501C3 nonprofit in 1993. Soon the program was being offered nationwide. It is said that when an idea’s time has come, it will be manifested in more than one place.
Two other similar training programs emerged around the same time: International Harp Therapy (Christina Tourin) and Chalice of Repose (Therese Schroeder-Sheker), and in the years that followed, several more programs were founded by graduates of the original programs, including Stella Benson’s Therapy Harp Training Program, which closed after her passing in 2014, and Edie Elkan’s Bedside Harp program.. In 2004, the National Standards Board for Therapeutic Music (NSBTM) was formed to develop and maintain standards for therapeutic music training programs and to define courses of study, scope of practice, a code of ethics, and other rules of conduct for the certified therapeutic musician. There are currently four accredited programs. Accreditation means these four programs meet the basic and essential standards of training.
An important task was discussion between the NSBTM and the American Music Therapy Association (AMTA) to ensure clarity on the scopes of practice between the fields of Music Therapy and therapeutic music. (The former is a title owned by the American Music Therapy Association, and the latter includes the work of Certified Clinical Musicians, Certified Music Practitioners, Certified Harp Therapists, Certified Healing Musicians, and Certified Bedside Harpists.) A precise way to define the difference is this: Music Therapy is the use of music as a tool in interactive therapy, while therapeutic musicians use music as the therapy itself.

Accreditation Standards of the National Standards Board for Therapeutic Music

Standard 1: Approved programs shall include in their curricula certain educational requirements as listed below:
1.1. Screening Process: Approved programs will have an admission screening process, admitting candidates who demonstrate appropriate musical skills, interpersonal skills and suitability. Admission decisions shall be made without discrimination based upon gender, race or religious affiliation.
1.2. Required Reading: Approved programs will require that students submit book reviews of selected books from the Program’s required book list. The program’s required book list will include books which cover a broad range of topics, such as: music, healthcare, integrative medicine and healing, the science of sound, topics on death and dying, self-care, and the art of service.
1.3. Independent Study Internship: Approved programs will require graduating students to complete an Independent Study Internship, fulfilled by completion of a minimum of 45 hours of music provided directly at the bedside at approved facilities. Students will play for a minimum of 100 patient encounters during their internship. The 45 hours of internship are to be specifically 45 hours of playing therapeutic music at the bedside. This does not include other time spent in the facility, conversation with staff, family or the patient, or record keeping. A completed intern log for each patient session along with a site supervisor evaluation form is to be included in completed course work.
1.4. Continuing Education: Approved programs will request that graduates complete ongoing Continuing Education activities as outlined and approved by their certifying program. The approved Continuing Education activities will be the equivalent of 40 hours every four years, and must directly enhance the work of the therapeutic musician.
1.5. Final Music Submission: Approved programs will require a final music submission. Each student is minimally required to present an audio sample demonstrating musical ability and appropriate music, and any other final submissions the approved program deems fit in order to graduate their students.
Standard
2: Approved Programs shall teach the subject of Clinical Protocols. These shall include certain areas of study.
2.1. Assessment techniques and processes: Students will learn to develop their senses and critical thinking skills; how to unobtrusively gather information from the environment, colleagues, and the patient, in order to develop an immediate course of action in providing therapeutic music to the patient.
2.2. Reporting methods/logging and/or charting: Students will learn about the various sources of referrals and intake forms. Students will learn the general reporting/monitoring paper-flow systems in healthcare set forth by JCAHO (Joint Commission on Accreditation of Healthcare Organizations), which includes medical records, patient record keeping, and reporting. Students will learn the proper and critical information required for reporting and logging patient hours.
2.3. Infection control/bio hazards: Students will learn about infection control and Universal Precautions: Students will learn about inoculation requirements for healthcare workers in their respective state/country. Students will learn about biohazards, airborne and tactile microbial and viral infections, how to personally handle such situations, and general healthcare procedures regarding patient contact.
2.4. Case Studies: Students will review case studies concerning clinical situations with non- ambulatory patients. Students will review or participate in case studies where difficult bedside situations require the student to consider possible reactions and outcomes.
2.5. General understanding of monitoring equipment: Students will learn about the various types of devices that monitor patients’ vital signs and will be briefed on standard equipment as an introduction to various diagnostic and life sustaining devices.
Standard 3: Approved Programs will teach healthcare basics, professional behavior and terminology.
3.1. Students will be prepared to provide individualized therapeutic music for patients of many ages and conditions who are receiving healthcare services in institutional settings such as hospitals, clinics, hospices, nursing homes, and out-patient healthcare facilities, as well as those receiving home care as an extension of rehabilitative, hospice and palliative care.
3.2. Students will be oriented to the unique, professional skills required to work in different types of healthcare facilities as part of a healthcare team. They will be taught about accountability and liability issues, policies and procedures, medical and administrative terminology specific to healthcare.
3.3. Students will be introduced to basic human anatomy and physiology.
3.4. Students will be taught the importance of proper dress code, cleanliness and good health. Training will include information about the potential negative effects of body scents and perfumes. Confidentiality laws and related issues, and proper deportment with patients, administrators, other workers and clinicians in the healthcare environment will be addressed.
Standard 4: Approved Programs will emphasize Deepening Perceptual Awareness.
4.1. Students will be taught theoretical models, multi-level processes and/or methods to assess and serve a patient. These models, processes and/or methods, which are based on both scientific and spiritual studies of consciousness, may include, but not be limited to: increasing awareness about self and others through perceptual observation; enhancement of natural sensitivities and empathy; the power of intention; and energetic medicine. Therapeutic Musicians recognize and respect diverse spiritual pathways in their work.
Standard 5: Approved Programs will teach Fundamentals of Music Theory and Music Application.
5.1. Students will be taught the fundamentals of music theory, how to improvise, modulate and play modal music, and about the intrinsic healing value of music. Students will learn to use the elemental qualities of music and healing musicianship in order to best serve the patients.
5.2. For satisfactory program graduation, students will be required to demonstrate an understanding of their principle instrument/voice, and play individualized music at a minimum of intermediate level of proficiency for the patient circumstances. Candidates must play and/or sing in tune, smoothly and without hesitation. They will be required to demonstrate proficiency in improvisation and modulation, and have a repertoire of appropriate duration that meets the needs of many different types of patients.
Standard 6: Approved Programs will include in their curricula the Theory and Holistic Application of the Physics of Sound.
6.1. An understanding of the characteristics and primary elements of sound, specifically how frequency, vibration, and resonance affect the human body, is fundamental to the practice of therapeutic music. Students will learn how these principles can be used through musical elements to facilitate healing. Students learn about the mechanics of sound, relative to various resonant-based methods, and techniques that can address an individual patient’s condition. Students study the physical, emotional, psychological and spiritual effects of therapeutically applied music. Students are introduced to the current research on the effect of music and sound on the mind/body and given resources for further study.
Standard 7: Approved Programs will include a course on Introduction to the Healthcare Business.
7.1. Approved programs will provide students with basic business tools including: writing proposals, invoicing, interview techniques, marketing, networking and employment strategies that are needed to support the successful practice of a therapeutic musician.
Standard 8: Approved Programs will teach Self-Care.
8.1. Students will be taught basic ergonomics and appropriate posture as applied to the use of their musical instruments and/or voice. They will be taught stress reduction techniques and various self-care processes for maintaining optimum physical, mental and emotional health as a therapeutic musician.
Standard 9: Graduate Titles:
9.1. A program accredited by the NSBTM will maintain its unique graduate title.

Just a few of the Research Studies in Therapeutic Music:
• Bailey (Bailey 1983) discovered a significant improvement in mood for the better when playing live music to cancer patients as opposed to playing taped music which she attributes to the human element being involved. Bailey, L. M (1983) The effects of live music versus tape-recorded music on hospitalised cancer patients. Music Therapy 3, 1, 17-28.

• In the Supportive Care Program of the Pain Service to the Neurology Department of Sloan -Kettering Cancer Center, New York, a music therapist is part of that supportive team along with a psychiatrist, nurse-clinician, neuro-oncologist, chaplain and social worker (Bailey 1984; Coyle 1987). Music therapy is used to promote relaxation, to reduce anxiety, to supplement other pain control methods and to enhance communication between patient and family (Bailey 1983; Bailey 1984).

• Bailey, L. M (1984) The use of songs with cancer patients and their families. Music Therapy 4, 1, 5-17. Coyle, N (1987) A model of continuity of care for cancer patients with chronic pain. Medical Clinics of North America 71, 2, 259-70.

• the use of music in the control of chronic cancer pain (although such studies abdicate the human element of live performance in favor of tape recorded interventions): in addition to reducing pain, particularly in pain clinics, music as relaxation and distraction has been tried during chemotherapy to bring overall relief (Kerkvliet 1990), and to reduce nausea and vomiting (Frank 1985). Kerkvliet, G. J (1990) Music therapy may help control cancer pain news. Journal of the National Cancer Institute 82, 5, 350-2. Frank, J. M (1985) The effects of music therapy and guided visual imagery on chemotherapy induced nausea and vomiting. Oncology Nursing Forum 12, 5, 47-52.

• In the Supportive Care Program of the Pain Service to the Neurology Department of Sloan -Kettering Cancer Center, New York, a music therapist is part of that supportive team along with a psychiatrist, nurse-clinician, neuro-oncologist, chaplain and social worker (Bailey 1984; Coyle 1987). Music therapy is used to promote relaxation, to reduce anxiety, to supplement other pain control methods and to enhance communication between patient and family (Bailey 1983; Bailey 1984). As depression is a common feature of the patients dealt within this program, then music therapy is hypothetically an influence on this parameter and in enhancing quality of life. Although quality of life has assumed a position of importance in cancer care in recent years and music therapy, along with other art therapies, is thought to be important, the evidence for this belief is largely anecdotal and unstructured. Bailey (Bailey 1983) discovered a significant improvement in mood for the better when playing live music to cancer patients as opposed to playing taped music which she attributes to the human element being involved. Gudrun Aldridge (Aldridge 1996b), in a single case study, emphasizes the benefits of expression facilitated by playing music for the post-operative care of a woman after mastectomy.

• Bartlett, D., Kaufman, D., & Smeltekop, R. (1993). The effects of music listening and perceived sensory experiences on the immune system. Journal of Music Therapy, 30, 194-209.
• Boldt, S. (1996). The effects of music therapy on motivation, psychological well-being, physical comfort, and exercise endurance of bone marrow transplant patients. Journal of Music Therapy, 33(3), 1996, 164-188.
• Cassidy, J. W., & Standley, J. M. (1995). The effect of music listening on physiological responses of premature infants in the NICU. Journal of Music Therapy, 32(4), 208-227.
• Clair, A. A. (1996). Therapeutic Uses of Music With Older Adults. Baltimore, MD: Health Professions Press.
• Edwards, J. (1998). Music therapy for children with severe burn injury. Music Therapy Perspectives, 16, 21-26.
• Hurt, C. P., Rice, R. R., McIntosh, G., & Thaut, M.H. (1998). Rhythmic auditory stimulation in gait training for patients with traumatic brain injury. Journal of Music Therapy, 35(4), 228-241.
• Lane, D. L. (1991). The effect of a single music therapy session on hospitalized children as measured by salivary Immunoglobulin A., speech pause time, and a patient opinion Lickert scale. Pediatric Research, 29, (4, part 2), 11A.
• Loewy, J. (1997). Music therapy pediatric pain management: Assessing and attending to the sounds of hurt, fear and anxiety. In J. Loewy (Ed.), Music Therapy and Pediatric Pain, (pp. 45-56). Jeffrey Books.
• Lorch, C., Lorch, V., Diefendorf, A., & Earl, P. (1994). Effect of stimulative and sedative music on systolic blood pressure, heart rate, and respiratory rate in premature infants. Journal of Music Therapy 31(2), 105-118.
• MacNay, S. K. (1995). The influence of preferred music on the perceived exertion, mood, and time estimation scores of patients participating in a cardiac rehabilitation exercise program. Music Therapy Perspectives, 13, 91-96.
• Malone, A. B. (1996). The effects of live music on the distress of pediatric patients receiving intravenous starts, venipunctures, injections, and heel sticks. Journal of Music Therapy, 33, 19-33.
• Rider, M., Floyd, J. W., & Kirkpatrick, J. (1985). The effect of music, imagery, and relaxation on adrenal corticosteroids and the re-entrainment of circadian rhythms. Journal of Music Therapy, 22, 46-58.
• Robb, S. L., Nichols, R. J., Rutan, R. L., Bishop, B. L., & Parker, J. C. (1995). The effects of music assisted relaxation on preoperative anxiety. Journal of Music Therapy, 32(1), 2-21.
• Standley, J. (1986). Music research in medical/dental treatment: Meta-analysis and clinical application. Journal of Music Therapy, 23(2), 56-122.
• Standley, J. (1991b). The role of music in pacification/stimulation of premature infants with low birth weights. Music Therapy Perspectives, 9, 19-25.
• Standley, J. (1992a). Clinical applications of music and chemotherapy: The effects on nausea and emesis. Music Therapy Perspectives, 10(1), 27-35.
• Standley, J. M. & C. A. Prickett (Eds.) (1994). Research in music therapy: A tradition of excellence. Silver Spring, MD: National Association for Music Therapy.
• Taylor, D. B. (1997). Biomedical Foundations of Music as Therapy. St. Louis, MO: MMB Music, Inc.
• Thaut, M., Schleiffers, S., & Davis, W. (1991). Analysis of EMG activity in biceps and triceps muscle in an upper extremity gross motor task under the influence of auditory rhythm. Journal of Music Therapy, 28, 64-88.
• Thaut, M.H. (1985). The use of auditory rhythm and rhythmic speech to aid temporal muscular control in children with gross motor dysfunction. Journal of Music Therapy, 22(3), 1-08-128.
• Wheeler, B. (Editor). (1995). Music therapy research: Quantitative and qualitative perspectives. Phoenixville, PA: Barcelona Publishers.

• At UCLA in Los Angeles and Georgia Baptist Medical Center in Atlanta, for example, premature babies at UCLA in Los Angeles and at Georgia Baptist Medical Center in Atlanta gained weight faster and used oxygen more efficiently when music therapy was played for them daily. At Tallahassee Memorial Regional Medical Center, premature babies had shorter stays in the Intensive Care Nursery after daily music therapy. – Deoria Lane, MT – Music as Medicine

• The November/December 2002 Clinical Journal of Oncology Nursing “Restoring the Spirit at the End of Life: Music as an Intervention for Oncology Nurses”. Article summary: “Music is a useful therapeutic intervention that con improve quality of life for dying patients. Physiologic mechanisms in response to carefully chosen musical selections help to alleviate pain, anxiety, and nausea and induce sleep. Expression of feelings enhances mood. Palliative care nurses increase the effectiveness of this intervention through careful assessment of patient needs, preferences, goals of intervention, and available resources. Music, a universal language, is an important clinical adjunct that addresses individual and family needs, thereby assisting patients to achieve a peaceful death. This article explores musical categories of preferences to assist nurses, patients, and families in choosing music that meets specific therapeutic objectives.” In the harp category for relaxation the audio examples are:

• Butler, M (1995) The Magic of the Celtic harp (Golden Bough Music) ; Various artists (1990) The harmonious harp (Hamburg, Germany: Deutsche Grammophon). Article categorizes classification of sounds/instruments, therapeutic goals, audio examples for relaxation, life review and reminiscence, matching isoprinciple and lyrical analysis, and spirituality/connecting.

• Research Report: “Harp Music May Lower Stress Levels In Infants” From The Daily Briefing, Health Care Advisory Board website 7/29/02
Everyone knows that music can be soothing, but researchers at Wake Forest
University Medical Center say the effects of gentle melodies may be chemical
as well as psychological. In one of the first studies of its kind, babies in
the intermediate care unit of the hospital were played live harp music for 45
minutes three times a week during their stay. Physicians found that after
listening to the gentle, soothing sounds, the babies had lower levels of
cortisol, a stress-induced hormone, compared with babies who did not listen
to the music. Researchers comment that the differences were, “Enough to be
clinically significant.” Physicians and nurses in the unit also experienced
reduced levels of stress while listening to the harp, and the study’s lead
researcher says he would like to find out if the music’s positive effects on
the staff affected the cortical levels of the infants. Researchers say the
harp, with its deep bass notes and heavy vibrations may have special
qualities particularly well suited to hospital work. They hope to publish the
study in a medical journal (Deaver, Winston-Salem Journal, 7/21).

• A large number of studies are cited in the book Musical Massage Sound Therapy by Dorothy Gundling, PhD, Morris Publishing, PO Box 2110, Kearney, NB 68848, USA.

• Music Therapy in Childbirth and Neonatal Care is a study available online at http://www.mtbac.com/childbirth.html . The same site has a list of other studies.

• The Center for Prenatal Music has a bibliography at http://www.prenatalmusic.com/bibliography.htm

• Micro Music Laboratories has a site with studies at http://www.micromusiclaboratories.com/15%InternExperts/1132%20D%20Griebner.htm

• Another excellent website is http://www.musichaspower.org , whose chief advisor is Dr. Oliver Sacks.

http://www.nursing.uiowa.edu/sites/PedsPain/Benini/Music_Hospita.htm has info on studies of pediatric pain management through music.

• A reprint of an excellent study called The Effects of harp Music in Vascular and Thoracic Surgical Patients can be ordered from InnoVision Communications at alternativetherapies@innerdorrway.com

• The Harp Therapy Journal often prints accounts of recent research. You can subscribe at 9 E. 3rrd St., Bethlehem, PA 18015 USA

http://science.nasa.gov.headlines.y2001/ast02nov_1.htm?friend had an article on vibrational therapy for astronauts for prevention of bone loss.

• Mechanisms by which Music Therapy Operates can be found at http://www.macalester.edu/~psych/whathap/UBNRP/Audition/site/how%20music%20thera

• Palliative care studies with music can be found at http://www.mtabe.com/palliative.html

Relevant Subscription Publications:

Harp Therapy Journal, 9 E. 3rd St., Bethlehem PA 18015. http://www.harptherapy.com/
The Harp Therapy Journal, published quarterly by Silva Vocat Music, is dedicated to furthering education, research, communication and awareness in the emerging field of harp therapy.

International Journal of Arts Medicine is a publication of The International Arts-Medicine Association E-mail: IAMAorg@aol.com . US mail address: IAMA, 714 Old Lancaster Road, Bryn Mawr, PA 19010.

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