Music Therapy Helps Facilitate the Field's First Licensure Law

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University of North Dakota


In just over a decade, the University of North Dakota’s Music Therapy Program grew from zero students to 38 majors and has established itself as a go-to program in the region. The program also worked with the North Dakota Legislature this year to facilitate the passage of the country’s first music therapy licensure law.

“It’s a phenomenal accomplishment,” said Andrew Knight, assistant professor of music therapy in the UND Department of Music. “We’ve now got about as many students majoring in music therapy as we have graduated since the program was launched in 2000.”

The program was the brainchild of former Music Dept. chairperson James Fry. The program was actually launched subsequently under chair Gary Towne.

“That was a very entrepreneurial thing James and Gary did to get the program started,” said Therese Costes, who retired this year. Costes was brought aboard by Fry to write the music therapy curriculum and direct the program. She got the program going from scratch with just a couple of students in the second semester of the 2000-2001 academic year. Today, the program has 38 majors and continues to grow.

North Dakota first with music therapy licensing program

“When I moved here in 2008, we already had a music therapy task force comprising Therese Costes, Emily Wangen and Natasha Thomas (both grads of the UND Music Therapy Program, and both practitioners around Grand Forks),” Knight said. “They were talking with three people from our certification board and the national association. So six people doing conference calls saying ‘as an association, we want a 50-state plan for official recognition of the music therapy certification.”

The key impetus behind the push for certification legislation was protection.

“Once you are recognized, licensed, and certified as a service, then you’re protected and your clients are protected, so that everyone knows that you’re getting a legitimate service, like other health practitioners,” Knight explained. “The music therapy task force is about educating people.”

Knight called area legislators shortly after he joined the UND Music Therapy faculty to press forward with the call for state music therapy licensing.

“North Dakota Rep. Lois Delmore, Dist. 43, an English teacher at Red River High School, told me how bills were introduced, so we hustled for a week in late January to get information to the Legislative Council to draft a bill in early February,” Knight said. The upshot is that North Dakota this year passed the nation’s first--and at the time only--music therapy licensing law under the State Board of Integrative Health Care. Since that time, Nevada passed a similar bill and other states are taking a cue from North Dakota in writing new legislation.

The UND Music Therapy Program is planning an event later this year to celebrate the passing of this vital licensure legislation and Rep. Delmore’s help in getting it passed.

Getting into Music Therapy

Knight, an energetic ambassador for the program, got interested in music therapy as a career while he was on a summer break from school.

“I was at a backyard BBQ at a relative’s house near Milwaukee, Wisc., where I grew up,” said Knight. “A family friend had majored in music therapy. I’d never heard of it. All it took was summer’s worth of hearing about this in my junior year in college … I went to graduate school at the University of Minnesota. I thought, ‘this is it!’”

“I went to Minnesota because a leading researcher in the field of music therapy was there,” said Knight, who trained as a percussionist. When he came to UND to teach, he also brushed up with voice lessons from UND Music faculty member Royce Blackburn to expand his musical skills, a requirement for competence in music therapy.

“All music therapists must be proficient in voice, piano, guitar, and percussion,” Knight said.

“You need to be able to play ‘coffee shop’ piano, to play an hour-long set of anything from Bob Dylan to a couple of Beatles songs to songs that you have written to kids songs, and be able to switch in the middle of the set, with the chords in your memory, and play them on the guitar,” Knight said.

“That’s how well you have to know these musical skills,” Knight said. “So you’re not staring at sheet music, instead you’re looking at your clients. The music becomes secondary. It’s really a challenge, esp. for 18, 19-year-olds who’re starting in this field.”

In music therapy, the music is the tool.

“Think of any profession where you have a basic tool,” Knight explained. “If you’re welder and you’ve got a bad torch, it’s no good. For a music therapist, the tool is a thorough knowledge of how to create good, live music experiences and have a good knowledge of a lot of different genres and different periods of music.”

“A music therapist is trained to be doing this in real time,” Knight said. “The research has shown, even as far back as World War I when the military started using music therapy, it was the live music that worked with patients.”

Improvisation is huge in music therapy

“In fact I just taught the improvisation course this past spring,” Knight said. “It’s a demanding profession in terms of skill sets and knowledge base. I’m working on how to explain that to prospective students without scaring them.”

Even students who come to the major with a genuine passion for music and people have to grasp the breadth and intensity of commitment to become a competent music therapy professional.

“What they’ll say is, ‘I love music, I’ve been doing music all my life, and I want to help people,’” Knight said. “That’s great! That’s the first thing that we have to hear from a prospective major. The second thing is ‘I’m so motivated to do that, I’m willing to learn whatever I have to learn and put all the practice hours in.’”

It’s really about making a visceral connection with the person or people you’re working with.

“In a therapeutic relationship, the music is making it happen, and I’m not staring at my fingers trying to remember chords,” said Knight, who is also completing a PhD here at UND.

“When I’m working with a child with autism, I can’t be worrying about my pitch on the ‘Hello’ song because therapy is what’s happening,” Knight said. “You can’t do the therapy if you’re worrying about the music. You have to completely command the music--that’s built into every course across the curriculum.”

Like Costes, Knight sees incredible growth in music therapy in the last five years and strong future expansion.

“We’re also seeing that other health care professions are reaching out to music therapy,” he said. “Physicians, nurses, neuroscientists, they’re all looking at music, especially with the advent of some amazing neural imaging technologies. Now we can see what music does to the brain. We don’t have to hypothesize as much, and we want to know more about this incredibly unique stimulus.”

“We can help people with aphasia or gait training--helping people learn to walk again after a stroke or other injury--all the way to kids who have autism,” Knight said.

Ultimately, there’s a reason why the word discipline--a common term in academia--applies especially in music therapy.

“A music therapist must be a disciplined person,” Knight said. “If you don’t have discipline, therapy sessions break down quickly. You can tell that clients aren’t getting the benefit that they should be.”

Technically defined, music therapy is the use of music to address the physical, emotional, cognitive, and social needs of an individual or a group, according to the American Music Therapy Association (AMTA). It uses activities such as listening to melodies, playing an instrument, drumming, writing songs, and guided imagery. Music therapy can work for people of all ages, whether they are virtuosos or tone deaf, struggling with illnesses or totally healthy.

Music therapy touches all aspects of the mind, body, brain and behavior. Music can provide a distraction for the mind, it can slow the rhythms of the body, and it can alter our mood, which in turn can influence behavior.

Trained and certified music therapists work in a variety of healthcare and educational settings. They often work with people suffering from emotional health issues such as grief, anxiety, and depression. They also help people address rehabilitative needs after a stroke, a traumatic brain injury, or with chronic conditions like Parkinson’s or Alzheimer’s disease.

Music therapy sessions are designed with a number of factors in mind, including the clients’ physical health, communication abilities, cognitive skills, emotional well-being, and interests. After weighing these factors along with the treatment goals, the therapist decides to employ either the creative or receptive process, according to the AMTA.

In the creative process, the music therapist works with the client to actively create or produce the music. This may include composing a song, engaging in music or song improvisation, or drumming. In the receptive process, the therapist offers music listening experiences, such as using music to facilitate a client or group’s relaxation. Clients or groups may then discuss thoughts, feelings, or ideas elicited by that music.

“Sometimes, it’s not what I see as a music therapist, but what everybody else sees, the health care professional and the staff, that’s the neatest thing for us,” Knight said.

“For us, it might just look like a bunch of people having a lot of fun with the music,” Knight said. “Maybe the other 23 hours of the day, the cliet could be pretty agitated or confused, but maybe for the 45 min. music therapy session, we’re just two people who are doing what they did back in, say, the 1940s, doing music. And with that we’re giving them a bit of reality orientation, we’re increasing their quality of life.”

Music therapy can include support for caregivers for people with dementia, too.

“Caregivers love that they’re in the music therapy session and our client recognized their spouse,” Knight said. “The caregiver says ‘I could tell she recognized me.’ Those are powerful stories when you’re first getting into the music therapy profession. It sounds like the movies, it’s so magical.”

In fact Hollywood has recognized the powerful stories related to music therapy.

“They’re making movies about this stuff now,” Knight said. “There’s one out now, as a matter of fact, called the ‘Music Never Stopped’ based on a book by famed neuroscientist Oliver Sacks (who also wrote the book that became the Robert de Niro movie ‘Awakenings’). The main character is a music therapist.”