The development of music therapy in mainland china

The development of music therapy in mainland china Abstract The application of music therapy in mainland China has unique features, with its own cultural and historical characteristics. From the ancient usage of music to cure diseases to the modern standardized practices of music therapy, the history of exploring the therapeutic use of music in China goes back thousands of years. The purpose of this article is twofold: to review the development of music therapy in mainland China from a historical perspective, and to introduce recent accomplishments and future developmental trends. Evidence of the therapeutic use of music in China dating back to the earliest music theory book and a traditional Chinese medicine book indicates the relationship of music and medicine in the roots of Chinese culture. The invention of music electrotherapy, the collaboration between doctors and musicians, as well as experimental music therapy projects are just a few examples of early exploration of music therapy in China. Tian Gao is considered the pioneer in this field of study, with contributions in education, advocacy, and the application of music therapy in modern mainland China. Today, music therapy in mainland China is facing both challenges and opportunities. International conferences and trainings as well as exchange programs and opportunities to study abroad are opening doors of communication and collaboration. The political and financial support of the government as well as the introduction and popularization of different music therapy approaches will propel the music therapy profession in mainland China into a new developmental era. history, culture, music therapy, philosophy, music Music therapy in mainland China has come a long way from the ancient therapeutic use of music to modern standardized practices, and yet still maintains its own cultural and historical characteristics. As a country that has over 5,000 years of history, China started to use music to cure diseases, to enforce social norms, and to execute the administration of government as early as 500 BCE, as recorded (Lin, 2006, p. 164). The ancient philosophy and theory of therapeutic uses of music built a profound foundation for today’s music therapy practices, and this legacy has been cherished and continuously adapted to the contemporary application of music therapy in mainland China. In the 1980s, music therapy as a profession began to take hold in mainland China (Chinese Music Therapy Association, 2013). A growing number of people had access to music therapy services, and the Chinese government supported the field both politically and financially. The purpose of this article is to review the development of music therapy in mainland China from a historical perspective and to introduce recent accomplishments and future developmental trends. Ancient Philosophy and Theory Since ancient times, the Chinese words for “music” (樂) and “medicine” (藥) have been very similar. In ancient China, “music” (樂) and “medicine” (藥) have the same origin in oracle bone script and Jin script (formed between 1600 BC and 1000 BC) (Wang, 1987, p. 467). Many people believed that their ancestors used music as medicine to improve their physical, emotional, and spiritual well-being in ancient times (Lai, 2000, p. 119). Two ancient books written between 476 BCE and 221 BCE discussed the therapeutic use of music. Yue Ji, translated as Record of Music, is the earliest fully developed treatise on music to survive in China (“Record of music,” 2011). This document systematically discussed ancient Chinese music theory and music philosophy, including “the origin, substance, and characteristics of music and its relationship to government and society” (Cook, 1995, p. 11). The book recognized that music is an indispensable part of people’s lives and emphasized the social-cultural function of music; the use of music should cooperate with other areas, including governance, social norms, ethics, and education (“Yue Ji,” 2016). The book is “thought to be the single most influential work on music in the Chinese tradition, inasmuch as the thought exemplified in this work has continued to exert a great and inescapable formative influence on much of subsequent Chinese musical thought” (Cook, 1995, p. 11). According to Yue Ji, music is a reflection of social life and also a method of expressing emotion (“Yue Ji”). On the other hand, music can affect one’s emotions, will, characteristics, and behaviors (ibid.). Different types of music have different effects: rapid and loud music typically makes people fretful and impatient; harmonious and soft music usually has calming and satisfaction-inducing effects (“Record of music”). Yue Ji indicates that music education includes not only teaching knowledge of music and arts, but also cultivating moral virtue and emotional health (ibid.). Because music is sequential and structured, social rules and norms were often taught through songs and dances; because music is expressive and inspirational, it was also used to develop value traits such as honesty, love, kindness, and integrity (ibid.). Based on this philosophy, music was used as a political and educational tool in the administration of society to promote social stability, to educate social morals and norms, as well as to develop good personal characters and enhance self-cultivation (“Yue Ji”). Some controversy exists regarding the authorship and publication of Yue Ji. Guo Moruo (1892–1978), a Chinese historian, archaeologist, and writer, asserted that the book was written by Gongsun Ni Zi (birth and death unknown), who was Confucius’s second-generation disciple and lived during the early Warring States period (476–221 BCE) (Guo, 1945, p. 161). In contrast, Cai Zhongde (1947–2004), a Chinese musical historian and philosopher, indicated that Yue Ji was written by Liu De (?–130 BCE), the second son of Emperor Jing of Han and a bibliophile in the Western Han Dynasty (206 BCE–8 AD) (Cai, 1997, p. 72). Besides being used by governors as a political and educational tool, music was also used by average people to enhance their health. As written down in the literature of traditional Chinese medicine, music is the link to mood and behavior and helps promote harmony and balance between body, soul, and spirit (Alter, 2005, p. 7). Huangdi Nei Jing, also translated as Yellow Emperor’s Inner Canon, is the earliest traditional Chinese medicine theory book and is “treated as the fundamental doctrinal source for Chinese medicine for more than two millennia” (“Huangdi Neijing,” Wikipedia, 2014). The book collected 162 traditional Chinese medical articles and was most likely written during the Warring States period (475221 BCE) (“Huangdi Neijing,” Medical Encyclopedia). According to Huangdi Nei Jing, different types of music have different effects on the human body (Li, 2007). Traditional Chinese music is based on pentatonic scales. The five basic modes are Gong (C-D-E-G-A), Shang (D-E-G-A-C), Jue (E-G-A-C-D), Zhi (G-A-C-D-E), and Yu (A-C-D-E-G). Huangdi Nei Jing discussed the relationship between these five modes and five human organs, the liver, heart, spleen, lung, and kidney (Mu, Xuan, & Li, 2000, p. 92), as well as how to use this relationship to improve overall health in human beings (Zhang, 2000, pp. 138–139). These two ancient books showed the rich tradition of the therapeutic use and philosophy of music in Chinese history; this became part of the culture and influenced the subsequent development in Chinese music therapy. In Horden’s book Music as Medicine—The History of Music Therapy since Antiquity, he said that “the whole of Chinese culture, including music, is therapeutic” (2005, p. 47). Early Exploration After the establishment of the People’s Republic of China in 1949, music therapy attracted the interest of many musicians, researchers, and clinicians. Music electrotherapy became an early, exploratory tool for Chinese medical practice and music therapy. Research suggested the effectiveness of music electrotherapy on a variety of populations. Many clinical and educational institutes started to develop their own music therapy programs. In the 1980s, music electrotherapy was introduced at international conferences and China started to be active in music therapy affairs worldwide. In the 1970s, hospitals began to apply music electrotherapy in rehabilitation and disease prevention (Zhang & Huang, 2010). Music electrotherapy is the use of music incorporated with electro-acupuncture. Electro-acupuncture attaches needles to electrodes, which “send electrical currents or pulses into the body” (Hsu, 2013). One shortcoming of electro-acupuncture is that the electrodes keep the same frequency. This increases the likelihood that patients will get used to the repetitive electrode signals; the outcome is therefore not as effective (Wang, Xu, Dong, & Dong, 2014, p. 1247). The principle of music electrotherapy is to transfer a music signal into low-to-middle electrode frequency (20–20000 Hz) and apply this signal to patients’ meridian system (the meridian system is “a concept in traditional Chinese medicine about a path through which the life-energy known as ‘qi’ flows”; Novella, 2012) while patients are listening to the music. Since music is melodic, rhythmic, and has changes in volume, the random pulse waveform stimulates the meridian system with varied electrode frequency that enhances the effect of the treatment (Wang, Xu, Dong, & Dong, 2014, p. 1247). In addition, soft music with a flowing melody can calm patients and bring enjoyment to them during treatment. The benefit of music electrotherapy is “improving the person’s psychological and physiological conditions through music and music signals that act on the auditory system and other systems in the human body to achieve health, disease prevention, and rehabilitation purposes” (Zhang & Huang, 2010). Music electrotherapy was widely used for various psychiatric and neurologic conditions such as depression, muscle injury, facial paralysis, neurasthenia, neurosis, dementia, and stroke (Wang, Xu, Dong, & Dong, 2014, p. 1247). Music electrotherapy was utilized in stroke rehabilitation by applying electric current on the impaired limb and causing muscle contraction (Liu, 1987, p. 111). The muscle contraction and expansion caused by electric pulses can enhance muscle strength and muscle tension, and thus promote functional recovery of the impaired limb (ibid., p. 113). The blood vessels also contract and expand under the stimulation of electric current. Research has shown that this “blood vessel massage” can promote vasodilation and increase blood flow, and therefore improve the cerebral ischemia and hypoxia status (ibid., p. 112). In a study conducted by Shuyun Chen (1991, p. 106), she compared the effects of music electrotherapy and regular electrotherapy on athletes’ muscle soreness recovery. The results suggested that music electrotherapy was more effective than regular electrotherapy and that music also helped reduce central nervous system fatigue (ibid., p. 107). The Qingdao Air Force nursing home tested the long-term effectiveness of music electrotherapy on 168 patients who had neurosis with symptoms such as headache, insomnia, fatigue, and anxiety (Dong & Sun, 1996, p. 54). The researchers followed the 168 patients after their treatment for 2–5 years. Results showed that 52.38% of the patients did not relapse over two years and also avoided the side effects of traditional medication therapy (ibid., p. 55). According to Jihong Liu et al. (2013, p. 101), music electrotherapy can also assist in keeping up the morale of navy officers and soldiers. The “Healthy Music Electrotherapy Machine” used in this study combined electrotherapy, heat therapy, music, and pictures, resulting in two national utility patents in China (ibid., p. 104). During the 1990s, music electrotherapy was used with psychotherapy in treating anxiety neurosis in order to enhance the treatment effect (Hu, Liu, & Li, 1994, p. 160). Music electrotherapy was first introduced internationally to music therapy professionals at the International Music Therapy Leadership Conference beginning April 16 through 20, 1987, in Provo, Utah (Miu, 1987, p. 155). Hongshi Miu gave a presentation on music electrotherapy that attracted great attention. Dr. Peter Jampel, the president of the American Association for Music Therapy at the time, commented that this approach “opened another door and developed a new approach for music therapy” (ibid., p. 156). In 1993, the First International Symposium on Oriental Medicine was held in New York. Delin Li, representing the Chinese Music Therapy Association, gave a speech, “Current Development and Future Trends of Music Electrotherapy in China,” that received positive feedback (Zhao & Li, 1996). In 1980, Bangrui Liu’s introduction of music therapy to mainland China greatly expanded people’s knowledge of music therapy and spearheaded the recent exploration of this field. Bangrui Liu, a Chinese American who was an Arizona State University Associate Professor of School of Liberal Arts, was invited to the Central Conservatory of Music in China in 1980 and first introduced music therapy to China (Liu, 1980, p. 58). During her stay at the Central Conservatory of Music in China (March 14–June 27), Liu presented five lectures under the title of “Several Topics of Western Musicology Study” and held eight seminars with students in the Asian-African-Latin music group in the musicology department (ibid.). The last of the five lectures, “The Topic of Music Therapy,” was given on June 27, 1980 (ibid.). In this lecture, Liu talked about the origin and development, research trends and theories such as ISO principle, and application of music therapy in the U.S., as well as her own experience working as a music therapist (ibid., pp. 58–63). Thereafter, many agencies and individuals started to explore music therapy in mainland China. In 1984, Hunan Mawangdui Nursing Home founded the first music psycho-therapy center in mainland China, and used the “YZJ series microcomputer-controlled music psycho-therapy machine” to address physical and psychological disorders such as neurosis, hypertension, coronary heart disease, and so on (Chinese Music Therapy Association). In the 1980s, Beijing Huilongguan Hospital and Shanghai Mental Health Center explored the application of music intervention with psychiatric patients (Peng, 2009, p. 22). From 1986 to 1988, the China Conservatory of Music and Beijing Huilongguan Hospital developed a partnership on studying “Music Therapy and Chronic Schizophrenia”; this study was awarded the third-place Beijing Science and Technology Progress Award (Zhang, 2004, p. 106). Beijing Huilongguan Hospital built the first music therapy room among all the psychiatric hospitals in the nation in 1991, becoming a new method in psychiatric rehabilitation in China (Chinese Music Therapy Association). Thereafter, many psychiatric hospitals, nursing homes, and rehabilitation centers launched music therapy programs (Zhang, 2004, p. 106). In 1994, the psychological counseling department at Beijing Tongren Hospital launched a program to facilitate the treatment of elderly cardiovascular disease and sleep disorders by using music (ibid.). The program was well received and was called “enjoyable treatment” by the public (ibid.). Soon after, music therapy was not only practiced in specialized medical facilities, but was also integrated into various departments in general hospitals (ibid.). In 1988, the China Conservatory of Music established the first music therapy program in mainland China beginning in 1989 (Chinese Music Therapy Association).The music therapy program included both undergraduate- and graduate-level studies with Hongyi Zhang as the only instructor (Hongyi Zhang, e-mail message to author, April 13, 2014). The first music therapy organization in mainland China, the Chinese Music Therapy Association (CMTA) was founded by a group of musicians, psychologists, and medical professionals in October 1989 (Chinese Music Therapy Association). The mission of CMTA is: “Discussing, studying and advocating music therapy, as well as creating and developing music therapy with Chinese characteristics by cooperating closely with professionals from the disciplines of music, medicine, psychology, science and medical equipment making” (Zhang, Gao, & Liu, 2016, p. 67). The association became the bridge to connect music therapy researchers and clinicians that spurred the development of music therapy in mainland China (Zheng & Chen, 2004, p. 92). In 1993, China was invited to join the World Federation of Music Therapy (WFMT) and Hongyi Zhang became one of the council members (Zhang, 2004, p. 106). Since then, China has participated in music therapy affairs worldwide. Development over the Past 20 Years The modern practice of music therapy in mainland China began with the contribution of Tian Gao. Gao came to the U.S. and studied music therapy at Temple University in 1986. At the end of 1996, he moved back to Beijing, China, becoming the first and only person to return after studying music therapy systematically overseas during the next 15 years (Gao, e-mail message to author, January 29, 2014). He then implemented in China those theories and techniques he learned during his studies (Gao’s Music Therapy Center, “Therapist Tian Gao,” 2014). After returning to China, Gao attended many trainings related to psycho-social therapy, such as hypnotherapy, family therapy, psychodynamic psychotherapy, and Eye Movement Desensitization and Reprocessing (EMDR), all of which were presented by international well-known professionals (Gao, e-mail message to author, December 1, 2015). As a certificated EMDR therapist, Gao combined the idea of music entrainment and music imagery with EMDR, then developed one kind of treatment for Post-Traumatic Stress Disorder (PTSD) called Music Entrainment and Reprocessing (MER) (Gao, 2013A, p. 99). “MER is aimed at changing clients’ state of pain and anxiety toward more positive states as the therapist guides the client through various relaxation, imagery, and cognitive-based techniques that are supported with therapist-selected music” (ibid.). This technique has been suggested to be an effective method “in eliminating the influences of traumatic events on many clients” (Gao, 2013B, p. 108). In his 25 years of clinical practice in both Western and Eastern cultural conditions, Gao gradually developed his culturally based approach to facilitate the situations and meet the needs of Chinese clients. According to Gao, many Western psychology theories and cultural norms are in conflict with traditional Chinese culture and values (Gao, e-mail message to author, February 6, 2014). For example, in Chinese culture, children obey their parents when they are young. As they grow up, they become responsible for their elders. At the beginning of his practice, Gao employed the Western style of psychotherapy techniques to guide clients, but it turned out that the tension between clients and their family members increased (ibid.). In order to meet the needs of Chinese clients, blending the Western and Eastern philosophies and adapting music therapy theories and techniques has been necessary. Gao started to involve traditional Chinese cultural context and social norms to treat clients; by using this cultural structured application, the clients’ conditions improved (Gao, e-mail message to author, December 1, 2015). In 1996, Gao established the Music Therapy Research Center of the Central Conservatory of Music in Beijing, China. This institution was the first specialized music therapy research institution that combined teaching, research, and clinical services together. In order to establish a standard, high-quality, internationally acceptable program, the Music Therapy Research Center referred to American curricula to develop courses; English materials were also used to teach. Many researchers and music therapists from all over the world were invited to give guest lectures or trainings in the Central Conservatory of Music in China. The master’s program in music therapy at the Central Conservatory of Music was established in 1999, and a bachelor’s program followed in 2003 (Central Conservatory of Music, 2014). In 1999, Gao opened the first specialized music psychotherapy agency in China, called Gao’s Music Therapy Center (Gao’s Music Therapy Center, “Therapist Tian Gao”). In the same year, he started a radio program named “Music Therapy in Beijing People’s Broadcasting Station” that provided services for people suffering from sleep disorders and neurasthenia (ibid.). Chinese society was quite open to accepting music therapy, with many newspapers and TV stations producing reports about music therapy (Gao, e-mail message to author, January 29, 2014). Consequently, through extensive media coverage, music therapy gained more recognition by the public. In addition to an increased number of students enrolling in music therapy programs, there has also been an increased interest by many music teachers, students, doctors, nurses, and counselors who were hoping to have more opportunities to learn music therapy theories and techniques (ibid.). Since 2004, Gao’s Music Therapy Center has offered music therapy training programs to the public. The center developed a systematic training model that included both online and on-campus courses at novice, intermediate, and advanced levels. Each level has 5–7 courses that are available throughout the year. However, since these courses are being offered to working professionals, most classes are held during summer, winter, and holiday breaks (Gao, e-mail message to author, December 1, 2015). In the past 10 years, over 50 trainings have been held; students and professionals from all over the country have completed the training and received certificates (Gao, e-mail message to author, January 29, 2014). The number of attendees has steadily increased by 600 people every year (Gao, e-mail message to author, December 1, 2015). Some of the trainees were from medical institutions, such as hospitals and clinics, and then incorporated music therapy into their own practices (Gao, e-mail message to author, January 29, 2014). In 2007, Gao established the Chinese Professional Music Therapy Association (CPMTA) in Beijing that provides distance education, professional training, updated music therapy information, and certified examinations in China (Chinese Professional Music Therapy Association, 2007). CPMTA is the organization that identifies Chinese music therapists who have advanced knowledge and skills for music therapy practice (Bing Li, in discussion with the author, March 2016). The mission of CPMTA is “promoting the education and training of music therapists in China, establishing a team of Chinese music therapists that meets the international professional standard and driving the profession to develop in a fast and healthy way” (Zhang, Gao, & Liu, 2016, p. 68). The Music Therapy Certified Training Institution provides a comprehensive curriculum including courses such as Music Therapy, Music Theory, Musical Skills, Psychology, Physiology, and Counseling, among others (Gao, e-mail message to author, January 29, 2014). Certification includes three levels (novice, intermediate, and advanced), with each level having specific requirements (Chinese Professional Music Therapy Association). After completing coursework, students must complete a 720-hour supervised internship before becoming certified. By 2015, about 2,000 people had participated in the training, with over 200 people receiving certification (Gao, e-mail message to author, December 1, 2015). In 2008, the devastating Sichuan earthquake occurred in Wenchuan, Sichuan Province, China. This earthquake measured 8.0 on the Richter scale, causing the deaths of 69,712 people with 17,921 people missing (“The number of dead and missing students in Wenchuan earthquake reached 5,300,” 2009). In response to this tragedy, Gao organized three groups of music therapy undergraduate and graduate students who traveled to Wenchuan. Each group spent one month in the earthquake-hit area and applied music therapy to relieve the pain of people who suffered the loss of family and loved ones (Wang, Zhang, & Song, 2013). They set up a series of music therapy experiences and interventions, such as “music performances, music games, sing-alongs, and music with dance or movement activities” to help the victims vent their agony, relieve suffering, and rebuild their hope for life (ibid.). As an observer, a TV reporter stated that, due to music interventions, “it was the first time he had seen people happy since the earthquake” (Gao et al., 2012). Besides Gao and his team, the Guangdong Provincial Association of Chinese Medicine launched the “Music Love Home” post-earthquake music therapy rehabilitation assistance project, which involved the Guangzhou University of Chinese Medicine, Xinghai Conservatory of Music, and China Conservatory of Music participating (Huo, 2010, p. 685). Gao became a founding member of the International Association for Music and Medicine (IAMM) in 2009, where “He has played a critical role in the international efforts in growing and integrating music and medicine across the globe” (Zhang, Gao, & Liu, 2016, p. 69). After 2012, many Chinese music therapists decided to return to China after studying overseas (Gao, e-mail message to author, January 29, 2014). Currently, there are 13 universities/colleges that have a music therapy major in mainland China (see Figure 1). Current programs include the Central Conservatory of Music, China Conservatory of Music, Shanghai Conservatory of Music, Sichuan Conservatory of Music, Wuhan Conservatory of Music, Shenyang Conservatory of Music, Minzu University of China, Yunnan Arts University, the Third Military Medical University, Jiangxi University of Traditional Chinese Medicine, Shandong University of Arts, Nanjing Technical College of Special Education, and Shanxi Changzhi Medical College (Gao, e-mail message to author, January 29, 2014). In addition, there are other schools preparing to offer music therapy courses (Gao, e-mail message to author, December 1, 2015). Figure 1. View largeDownload slide Schools that offer music therapy degrees in mainland China. Figure 1. View largeDownload slide Schools that offer music therapy degrees in mainland China. One of the weaknesses of Chinese music therapy education has been the lack of supervision by qualified music therapists in students’ practica and internships (Gao, e-mail message to author, January 29, 2014). Therefore, the students’ clinical experience may have been substandard, hindering their ability to achieve a high standard of practice. This lack of supervision began to change in 2013. First, more music therapy major students were encouraged to work in hospitals after graduating, in order to gain clinical experience. Moreover, a group of students who had studied abroad and were systematically trained joined the field of music therapy in mainland China and brought the standards of Western clinical practice into Chinese music therapy practices (Gao, e-mail message to author, December 1, 2015). In 2015, Gao’s Music Therapy Center in Beijing started to accept music therapy interns. At the same time, a number of music therapists returned to China after finishing their course of study and clinical training, working as both clinicians and supervisors at the center. The growing needs of music therapy and growing number of music therapy supervisors enabled the center to have more interns. According to Gao, there are many more students who will finish their studies in the U.S. and plan to go back to China (ibid.). The center plans to expand their services and aims to have the largest capacity possible to accept music therapy interns in mainland China (ibid.). In addition, many cities, such as Beijing, Guangdong, Zhengzhou, Chengdu, in mainland China have started to hire music therapists on staff in their public or community health care systems. Some of the hospitals include Peking University Cancer Hospital, Fengtai Maternal & Child Health Hospital, and Jiangmen Maternity and Child Health Care Hospital, among many more (Li, in discussion with the author, March 2016). As an authority in Chinese music therapy, Gao recommended two students who studied abroad to work in Wuxi Tongren International Rehabilitation Hospital, in Jiangsu Province (Gao, e-mail message to author, January 29, 2014). Wuxi Tongren International Rehabilitation Hospital is an upper first-class hospital (the highest level of hospital in mainland China) and has various departments, including neurological rehabilitation, psychiatric, cardiovascular, otolaryngology, and geriatric wards, among other medical services (Wuxi Mental Health Center, “About the hospital,” 2013). Gao had an agreement with the hospital director to establish the hospital as a designated internship setting for music therapy major students; the hospital director indicated that all the departments of the hospital would be open to the practice of music therapy students (Gao, e-mail message to author, January 29, 2014). The hospital became a university-affiliated internship site for Chinese students who study at the University of Melbourne in Australia, Chonbuk National University in South Korea, the Central Conservatory of Music, Jiangxi University of Traditional Chinese Medicine, Xiamen University, Changzhi Medical College, and others in mainland China (Wuxi Mental Health Center, “The first international neurologic music therapy training program in China was held in Wuxi,” 2016). The full-time music therapists working in this hospital also serve as supervisors for the music therapy internship programs, providing students more opportunities to practice and gain clinical experiences (Gao’s Music Therapy Center, “A notification of music therapy internship”). In addition to Wuxi Tongren International Rehabilitation Hospital, other music therapy internship sites that employ full-time music therapists are Beijing Anding Hospital, Beijing Boai Hospital, Xuanwu Hospital, Beijing Children’s Hospital, Beijing Xicheng Pingan Hospital, China Rehabilitation Research Center, and the Young Activities Center of China Disabled Persons Federation (CDPF) (Zhang, Gao, & Liu, 2016, p. 68). In 2014, Beijing Yinling Nursing Home and the Second Hospital of Beijing were added as designated internship settings for music therapy major students; these facilities also have full-time music therapists to supervise students’ practice (Gao, e-mail message to author, March 23, 2014). In addition to teaching and conducting music therapy and research, Gao has written, translated, and edited several books that are quite influential in mainland China (see appendix): Basic Theory of Music Therapy; An Introduction to Music Therapy; Clinical Training Guide for the Student Music Therapist; Receptive Music Therapy; Improvisation: Methods and Techniques for Music Therapy Clinicians, Educators, and Students; Music Therapy Clinical Application; and Music Therapy in Dementia Care (Tian Gao’s Music Therapy Center, 2015). In recent years, with the development of music therapy in mainland China, many music therapists who once studied under Gao have carried out their own music therapy programs around the country. Chunmiao Burn Camp in Chongqing has been providing free services every year since 2011 for children ages 6–18 who have experienced burn trauma but do not have access to outpatient treatment. Music therapy is part of this interdisciplinary team that includes doctors, psychotherapists, physical therapists, and occupational therapists. Starting in 2015, the camp began to recruit music therapy student volunteers nationwide and music therapy professional volunteers worldwide. Music therapists, music therapy students, and musicians from America, Canada, Taiwan, and mainland China have participated in this program. Charities and companies donate to cover fees and living expenses for the clients and volunteers (Li, e-mail message to author, January 25, 2017). Dr. Annie Heiderscheit from Augsburg College was invited to visit the camp in 2015, developing a program called “Music Therapy in China: Chongqing Burn Camp,” which was designed to enrich students’ global education experience by visiting music therapy clinics and communicating with Chinese music therapists. Augsburg College now offers music therapy undergraduate and graduate students the following courses: Music Therapy Practicum (MUS 374) and Transcultural Music Therapy II (MUS 582) (Center for Global Education and Experience, 2017). Yueling Music Therapy Service Center, founded in 2014 in Chengdu, Sichuan Province, is the first and only music therapy public welfare service organization in mainland China (Yueling Music Therapy Service Center, 2017). The organization provides music therapy services to children with developmental disabilities, homeless adolescents, older adults, and the general public (ibid.). In August 2014, the Yueling Music Therapy Service Center (in cooperation with the Chengdu Charity General Association) launched the “Sunshine Charity Music Therapy Project.” This project provides free music therapy intervention to homeless children and orphans, as well as to children with developmental delays such as autism spectrum disorder, Down syndrome, and cerebral palsy. The families of these children often cannot afford the expenses of therapies (Wang, in discussion with the author, February 2017). After three years of therapy, the clients’ communication skills, social adaptability, along with speech and language abilities, improved greatly (Yueling Music Therapy Service Center). Up to now, the center has worked with more than 3,000 homeless children, with the support of government funds (Zhang, Gao, & Liu, 2016, pp. 69–70). Future Prospects Government’s Involvement The Chinese government has also played an important role in supporting the growth of music therapy in mainland China. China has an increasingly aging population, which presents challenges for Chinese society. The Ministry of Civil Affairs of the People’s Republic of China predicted that in 2050, China will have about 400 million people above 60 years old, which is about 30% of the total population (“A forecast report on the development trend of population aging in China,” 2006). The China Central Television (CCTV), the official media in China, presented a one-week special report about dementia and Alzheimer’s disease in 2013. The government emphasized the aim to “establish a fairer and more sustainable social welfare system” and “further develop the elderly services industry” (“The decision on major issues concerning comprehensively deepening reforms,” 2013). These facts support the argument that Chinese society needs music therapy services, which in turn promotes further development of music therapy in mainland China. The social challenge of a growing elderly population became a catalytic factor for China’s New Government Funded Public Service Model. “A Government’s Purchase Public Service (GPPS) model is defined as government transferring part of public service to social organizations, in order to enhance the quality of public service and efficient use of funding, to improve the social governance framework, and to fulfill the more diverse and individualized needs of the public” (Yueling Music Therapy Service Center). The national conditions and government’s support provide more job opportunities for music therapists and new graduates. Gao’s Music Therapy Center contracted with the Beijing Disabled Person’s Federation to serve approximately 500 people who have developmental disabilities (ibid.). By the end of 2016, thirty-seven community music therapy service programs were currently thriving (Li, in discussion with the author, November 2016). The music therapy team at Gao’s Music Therapy Center have been striving to expand the areas of music therapy services and advocate for the music therapy profession. From 2015 to 2016, the amount of government funding increased from $101,890 to $159,480; the number of employed music therapists increased from three full-time and two part-time music therapists to six full-time and one part-time music therapist; and the number of music therapy interns increased from five to eighteen (Li, 2016). Besides government grants, other sources of income in the field of music therapy in mainland China are insurance reimbursement and personal pay (Li, in discussion with the author, March 2016). In 2014, Gao and his team started to popularize music therapy interventions for Alzheimer’s disease and patients with post-stroke symptoms on a large scale (Gao, e-mail message to author, March 23, 2014). This important historic opportunity to promote music therapy development in China is closely related to international professional development and academic communication. International Conferences and Trainings China has hosted several international conferences and invited well-known music therapists and researchers as keynote speakers and workshop trainers. Many internationally renowned music therapists, including Drs. Cheryl Dileo, Clive Robbins, Barbara Wheeler, Roberta Kagin, Suzanne Hanser, Michael Rohrbacher, Rob Amchin, Maria Montserrat Gimeno, Blythe LaGasse, and Annie Heiderscheit, have come to mainland China to share their knowledge and skills with Chinese music therapists (Zhang, Gao, & Liu, 2016, pp. 68–69). The conferences and trainings have provided important opportunities to build international connections. Since 2009, Dr. Lisa Summer, the Director of Music Therapy at Anna Maria College, has led the Guided Imagery and Music (GIM) training institute in Beijing, and she has been invited to present in multiple universities and colleges across mainland China (ibid., p. 69). Throughout the years, Summer witnessed the quick growth of music therapy in China and found “the spirit of the Chinese music therapists to be so kind, giving, and dedicated to their work” (Summer, e-mail message to author, April 15, 2017). Today, Chinese music is widely used with most methods in the Continuum Model of GIM that developed in the 1980s (except for the Bonny Method, which only uses Western classical music). This allows Chinese music therapists to provide a client-centered, supportive environment for Chinese clients (ibid.). Dr. Michael Thaut, the director of the Robert F. Unkefer Academy for Neurologic Music Therapy and the founder of Neurologic Music Therapy (NMT), attended the Twelfth Chinese Music Therapy Association conference as a keynote speaker in April 2015 (Gao, e-mail message to author, January 29, 2014). The first International Neurologic Music Therapy Training in China was held in Wuxi on June 18–21, 2016 (Wuxi Mental Health Center, “The first international neurologic music therapy training program in China was held in Wuxi”). Over 150 music therapists attended the training, and it was estimated that one-third of the attendants are from countries outside mainland China, such as America, France, Singapore, Malaysia, Korea, Hong Kong, Macao, and Taiwan (ibid.). The training program “provides therapists with advanced clinical training and scientific knowledge in the field of NMT” (Center for Biomedical Research in Music, 2014). Dr. Thaut expects the introduction of NMT to supply this developing profession in China with a scientific foundation (Thaut, e-mail message to author, May 1, 2014). In October 2016, the first Nordoff-Robbins Music Therapy training in mainland China was held in Beijing. Jacqueline Birnbaum and Jenny Fu from the Nordoff-Robbins Center for Music Therapy introduced this approach to Chinese music therapists, behavior therapists, social workers, special education teachers, and so on (Wucailu Autism Spectrum Disorder Research Center, “The first Nordoff-Robbins music therapy training held in Beijing,” 2016). Due to the great feedback received from the first training, Dr. Alan Turry, the managing director of Nordoff-Robbins Center for Music Therapy, and Dr. Dong Min Kim, the president of the Korean Nordoff-Robbins Music Therapy Association, were invited to Beijing to provide the second training in March 2017 (Wucailu Autism Spectrum Disorder Research Center, “Nordoff-Robbins music therapy training,” 2017). This event has also received support from the China Disabled Persons’ Federation (ibid.). Dawn Miller, the music therapy internship director at Park Nicollet Health Services, was invited to present at two conferences in different parts of China. At the Fourth International Conference of the International Association for Music and Medicine (IAMM) (June 11–13, 2016), which was hosted by the Chinese Society of Music Therapy and the Chinese Professional Music Therapists Association, Miller gave a presentation entitled “Healing from the Core: Music and Imagery in the Cancer Journey.” At the CPOS Academic Annual Conference and Eighth Psycho-Oncology and Palliative Care Training Meeting (June 17–19, 2016) hosted by the Hunan Cancer Hospital and Chinese Psycho-Oncology Society, Miller presented on the topic of “Music Therapy in Oncology.” After interacting with Chinese music therapists and learning about music therapy in China, Miller stated her impression of Chinese music therapy: “It is a very exciting time right now for music therapy in China. I met some music therapy professionals and a lot of students, who are intelligent, competent, motivated, and excited about music therapy. I am very impressed about the students from the Central Conservatory of Music and the leadership from Tian Gao.” Miller also learned that many music therapists who studied in America or Europe had come back to China to develop this field. According to Miller’s observation, these professionals worked well with each other, and “Music therapy will grow in China, and people will need music therapy” (Miller, in discussion with the author, July 2016). Exchange Programs The undergraduate exchange program between the Central Conservatory of Music (CCM) and the State University of New York (SUNY) at New Paltz, New York, was established in 2005. The exchange program provides the music therapy undergraduate students at CCM the opportunity to spend their senior year in the U.S. and study at SUNY, New Paltz (Liu, in discussion with the author, October 2016). Exchange programs with Colorado State University and Augsburg College in Minnesota are in process, and this exchange may provide opportunities for students from both countries to learn from each other (ibid.). Summary From the ancient usage of music by governors to today’s application of Western music therapy techniques blended with Chinese cultural traditions, the history of exploring the therapeutic use of music in China goes back thousands of years. Since early exploration of this subject included cultural traditions, the practical application of music therapy in mainland China has very unique features. The increasingly aging population in China’s society provides an opportunity for the further development of this profession. The support of government and the introduction and popularization of different music therapy approaches will propel the music therapy profession in mainland China into a new developmental era. As a timely topic of intercultural experience and diversity in music therapy, this article may provide Western clinicians with an insight into traditional Chinese music philosophy and its impact on today’s practice. The author hopes that the cultural differences discussed in this article will provide implications for clinicians who may be working with people of Chinese descent. Music therapy in mainland China is growing rapidly, and there is an air of expectancy for future international collaborations. Yue Wu is a native of China, who completed her graduate music therapy study at Colorado State University and now is working as a full-time music therapist at the MacPhail Center for Music in the Twin Cities area. The author wishes to thank Tian Gao, Hongyi Zhang, Mingming Liu, Bing Li, Jinyi Li, and Lujie Wang for generously providing information about the development of music therapy in mainland China, as well as Drs. Michael Thaut, Lisa Summer, and Dawn Miller for graciously sharing their experiences and perspectives on music therapy in China. The author is immensely grateful to Drs. William Davis, Roberta Kagin, Blythe LaGasse, and Andrew Knight for their guidance and support during the process of writing this article. References Alter , J. S . ( 2005 ). Asian medicine and globalization . Philadelphia : University of Pennsylvania Press . Google Scholar CrossRef Search ADS Cai , Z . ( 1997 ). Notation and study of “Yue Ji” and “Sheng Wu Ai Le Lun.” Zhejiang : China Academy of Art Press . Center for Biomedical Research in Music . “NMT Training Institute.” Retrieved from http://cbrm.colostate.edu/?page_id=36 Center for Global Education and Experience . “Programs: Brochure . Retrieved from http://studyabroad.augsburg.edu/index.cfm?FuseAction=Programs.ViewProgram&Program_ID=55383#DATES Central Conservatory of Music . 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Wucailu Autism Spectrum Disorder Research Center . “The first Nordoff-Robbins music therapy training held in Beijing.” Retrieved from https://freewechat.com/a/MzAwNDQxMjQyNw==/2651960003/1 Wucailu Autism Spectrum Disorder Research Center . “Nordoff-Robbins music therapy training.” Retrieved from https://mp.weixin.qq.com/s/T-g9Rc9bn2mdS8Cw_TMuyg Wuxi Mental Health Center . “About the hospital.” Retrieved from http://www.wuximhc.com/text.asp?fid=11 Wuxi Mental Health Center . “The first international neurologic music therapy training program in China was held in Wuxi.” Retrieved from http://www.wuximhc.com/news.asp?act=show&fid=2&cid=2&tid=1698 Yue Ji . ( 1958 ). Translated by J. Liankang . Beijing : Music Publishing House . “ Yue Ji .” Baidu Encyclopedia. Retrieved from http://baike.baidu.com/view/25026.htm Yueling Music Therapy Service Center . “Yueling music therapy.” Retrieved from http://mp.weixin.qq.com/s/vWbq7c1fGLToJd7LYhGxQA Zhang , H. , & Huang , H . ( 2010 ). 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The development of music therapy in mainland china

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Abstract

Abstract The application of music therapy in mainland China has unique features, with its own cultural and historical characteristics. From the ancient usage of music to cure diseases to the modern standardized practices of music therapy, the history of exploring the therapeutic use of music in China goes back thousands of years. The purpose of this article is twofold: to review the development of music therapy in mainland China from a historical perspective, and to introduce recent accomplishments and future developmental trends. Evidence of the therapeutic use of music in China dating back to the earliest music theory book and a traditional Chinese medicine book indicates the relationship of music and medicine in the roots of Chinese culture. The invention of music electrotherapy, the collaboration between doctors and musicians, as well as experimental music therapy projects are just a few examples of early exploration of music therapy in China. Tian Gao is considered the pioneer in this field of study, with contributions in education, advocacy, and the application of music therapy in modern mainland China. Today, music therapy in mainland China is facing both challenges and opportunities. International conferences and trainings as well as exchange programs and opportunities to study abroad are opening doors of communication and collaboration. The political and financial support of the government as well as the introduction and popularization of different music therapy approaches will propel the music therapy profession in mainland China into a new developmental era. history, culture, music therapy, philosophy, music Music therapy in mainland China has come a long way from the ancient therapeutic use of music to modern standardized practices, and yet still maintains its own cultural and historical characteristics. As a country that has over 5,000 years of history, China started to use music to cure diseases, to enforce social norms, and to execute the administration of government as early as 500 BCE, as recorded (Lin, 2006, p. 164). The ancient philosophy and theory of therapeutic uses of music built a profound foundation for today’s music therapy practices, and this legacy has been cherished and continuously adapted to the contemporary application of music therapy in mainland China. In the 1980s, music therapy as a profession began to take hold in mainland China (Chinese Music Therapy Association, 2013). A growing number of people had access to music therapy services, and the Chinese government supported the field both politically and financially. The purpose of this article is to review the development of music therapy in mainland China from a historical perspective and to introduce recent accomplishments and future developmental trends. Ancient Philosophy and Theory Since ancient times, the Chinese words for “music” (樂) and “medicine” (藥) have been very similar. In ancient China, “music” (樂) and “medicine” (藥) have the same origin in oracle bone script and Jin script (formed between 1600 BC and 1000 BC) (Wang, 1987, p. 467). Many people believed that their ancestors used music as medicine to improve their physical, emotional, and spiritual well-being in ancient times (Lai, 2000, p. 119). Two ancient books written between 476 BCE and 221 BCE discussed the therapeutic use of music. Yue Ji, translated as Record of Music, is the earliest fully developed treatise on music to survive in China (“Record of music,” 2011). This document systematically discussed ancient Chinese music theory and music philosophy, including “the origin, substance, and characteristics of music and its relationship to government and society” (Cook, 1995, p. 11). The book recognized that music is an indispensable part of people’s lives and emphasized the social-cultural function of music; the use of music should cooperate with other areas, including governance, social norms, ethics, and education (“Yue Ji,” 2016). The book is “thought to be the single most influential work on music in the Chinese tradition, inasmuch as the thought exemplified in this work has continued to exert a great and inescapable formative influence on much of subsequent Chinese musical thought” (Cook, 1995, p. 11). According to Yue Ji, music is a reflection of social life and also a method of expressing emotion (“Yue Ji”). On the other hand, music can affect one’s emotions, will, characteristics, and behaviors (ibid.). Different types of music have different effects: rapid and loud music typically makes people fretful and impatient; harmonious and soft music usually has calming and satisfaction-inducing effects (“Record of music”). Yue Ji indicates that music education includes not only teaching knowledge of music and arts, but also cultivating moral virtue and emotional health (ibid.). Because music is sequential and structured, social rules and norms were often taught through songs and dances; because music is expressive and inspirational, it was also used to develop value traits such as honesty, love, kindness, and integrity (ibid.). Based on this philosophy, music was used as a political and educational tool in the administration of society to promote social stability, to educate social morals and norms, as well as to develop good personal characters and enhance self-cultivation (“Yue Ji”). Some controversy exists regarding the authorship and publication of Yue Ji. Guo Moruo (1892–1978), a Chinese historian, archaeologist, and writer, asserted that the book was written by Gongsun Ni Zi (birth and death unknown), who was Confucius’s second-generation disciple and lived during the early Warring States period (476–221 BCE) (Guo, 1945, p. 161). In contrast, Cai Zhongde (1947–2004), a Chinese musical historian and philosopher, indicated that Yue Ji was written by Liu De (?–130 BCE), the second son of Emperor Jing of Han and a bibliophile in the Western Han Dynasty (206 BCE–8 AD) (Cai, 1997, p. 72). Besides being used by governors as a political and educational tool, music was also used by average people to enhance their health. As written down in the literature of traditional Chinese medicine, music is the link to mood and behavior and helps promote harmony and balance between body, soul, and spirit (Alter, 2005, p. 7). Huangdi Nei Jing, also translated as Yellow Emperor’s Inner Canon, is the earliest traditional Chinese medicine theory book and is “treated as the fundamental doctrinal source for Chinese medicine for more than two millennia” (“Huangdi Neijing,” Wikipedia, 2014). The book collected 162 traditional Chinese medical articles and was most likely written during the Warring States period (475221 BCE) (“Huangdi Neijing,” Medical Encyclopedia). According to Huangdi Nei Jing, different types of music have different effects on the human body (Li, 2007). Traditional Chinese music is based on pentatonic scales. The five basic modes are Gong (C-D-E-G-A), Shang (D-E-G-A-C), Jue (E-G-A-C-D), Zhi (G-A-C-D-E), and Yu (A-C-D-E-G). Huangdi Nei Jing discussed the relationship between these five modes and five human organs, the liver, heart, spleen, lung, and kidney (Mu, Xuan, & Li, 2000, p. 92), as well as how to use this relationship to improve overall health in human beings (Zhang, 2000, pp. 138–139). These two ancient books showed the rich tradition of the therapeutic use and philosophy of music in Chinese history; this became part of the culture and influenced the subsequent development in Chinese music therapy. In Horden’s book Music as Medicine—The History of Music Therapy since Antiquity, he said that “the whole of Chinese culture, including music, is therapeutic” (2005, p. 47). Early Exploration After the establishment of the People’s Republic of China in 1949, music therapy attracted the interest of many musicians, researchers, and clinicians. Music electrotherapy became an early, exploratory tool for Chinese medical practice and music therapy. Research suggested the effectiveness of music electrotherapy on a variety of populations. Many clinical and educational institutes started to develop their own music therapy programs. In the 1980s, music electrotherapy was introduced at international conferences and China started to be active in music therapy affairs worldwide. In the 1970s, hospitals began to apply music electrotherapy in rehabilitation and disease prevention (Zhang & Huang, 2010). Music electrotherapy is the use of music incorporated with electro-acupuncture. Electro-acupuncture attaches needles to electrodes, which “send electrical currents or pulses into the body” (Hsu, 2013). One shortcoming of electro-acupuncture is that the electrodes keep the same frequency. This increases the likelihood that patients will get used to the repetitive electrode signals; the outcome is therefore not as effective (Wang, Xu, Dong, & Dong, 2014, p. 1247). The principle of music electrotherapy is to transfer a music signal into low-to-middle electrode frequency (20–20000 Hz) and apply this signal to patients’ meridian system (the meridian system is “a concept in traditional Chinese medicine about a path through which the life-energy known as ‘qi’ flows”; Novella, 2012) while patients are listening to the music. Since music is melodic, rhythmic, and has changes in volume, the random pulse waveform stimulates the meridian system with varied electrode frequency that enhances the effect of the treatment (Wang, Xu, Dong, & Dong, 2014, p. 1247). In addition, soft music with a flowing melody can calm patients and bring enjoyment to them during treatment. The benefit of music electrotherapy is “improving the person’s psychological and physiological conditions through music and music signals that act on the auditory system and other systems in the human body to achieve health, disease prevention, and rehabilitation purposes” (Zhang & Huang, 2010). Music electrotherapy was widely used for various psychiatric and neurologic conditions such as depression, muscle injury, facial paralysis, neurasthenia, neurosis, dementia, and stroke (Wang, Xu, Dong, & Dong, 2014, p. 1247). Music electrotherapy was utilized in stroke rehabilitation by applying electric current on the impaired limb and causing muscle contraction (Liu, 1987, p. 111). The muscle contraction and expansion caused by electric pulses can enhance muscle strength and muscle tension, and thus promote functional recovery of the impaired limb (ibid., p. 113). The blood vessels also contract and expand under the stimulation of electric current. Research has shown that this “blood vessel massage” can promote vasodilation and increase blood flow, and therefore improve the cerebral ischemia and hypoxia status (ibid., p. 112). In a study conducted by Shuyun Chen (1991, p. 106), she compared the effects of music electrotherapy and regular electrotherapy on athletes’ muscle soreness recovery. The results suggested that music electrotherapy was more effective than regular electrotherapy and that music also helped reduce central nervous system fatigue (ibid., p. 107). The Qingdao Air Force nursing home tested the long-term effectiveness of music electrotherapy on 168 patients who had neurosis with symptoms such as headache, insomnia, fatigue, and anxiety (Dong & Sun, 1996, p. 54). The researchers followed the 168 patients after their treatment for 2–5 years. Results showed that 52.38% of the patients did not relapse over two years and also avoided the side effects of traditional medication therapy (ibid., p. 55). According to Jihong Liu et al. (2013, p. 101), music electrotherapy can also assist in keeping up the morale of navy officers and soldiers. The “Healthy Music Electrotherapy Machine” used in this study combined electrotherapy, heat therapy, music, and pictures, resulting in two national utility patents in China (ibid., p. 104). During the 1990s, music electrotherapy was used with psychotherapy in treating anxiety neurosis in order to enhance the treatment effect (Hu, Liu, & Li, 1994, p. 160). Music electrotherapy was first introduced internationally to music therapy professionals at the International Music Therapy Leadership Conference beginning April 16 through 20, 1987, in Provo, Utah (Miu, 1987, p. 155). Hongshi Miu gave a presentation on music electrotherapy that attracted great attention. Dr. Peter Jampel, the president of the American Association for Music Therapy at the time, commented that this approach “opened another door and developed a new approach for music therapy” (ibid., p. 156). In 1993, the First International Symposium on Oriental Medicine was held in New York. Delin Li, representing the Chinese Music Therapy Association, gave a speech, “Current Development and Future Trends of Music Electrotherapy in China,” that received positive feedback (Zhao & Li, 1996). In 1980, Bangrui Liu’s introduction of music therapy to mainland China greatly expanded people’s knowledge of music therapy and spearheaded the recent exploration of this field. Bangrui Liu, a Chinese American who was an Arizona State University Associate Professor of School of Liberal Arts, was invited to the Central Conservatory of Music in China in 1980 and first introduced music therapy to China (Liu, 1980, p. 58). During her stay at the Central Conservatory of Music in China (March 14–June 27), Liu presented five lectures under the title of “Several Topics of Western Musicology Study” and held eight seminars with students in the Asian-African-Latin music group in the musicology department (ibid.). The last of the five lectures, “The Topic of Music Therapy,” was given on June 27, 1980 (ibid.). In this lecture, Liu talked about the origin and development, research trends and theories such as ISO principle, and application of music therapy in the U.S., as well as her own experience working as a music therapist (ibid., pp. 58–63). Thereafter, many agencies and individuals started to explore music therapy in mainland China. In 1984, Hunan Mawangdui Nursing Home founded the first music psycho-therapy center in mainland China, and used the “YZJ series microcomputer-controlled music psycho-therapy machine” to address physical and psychological disorders such as neurosis, hypertension, coronary heart disease, and so on (Chinese Music Therapy Association). In the 1980s, Beijing Huilongguan Hospital and Shanghai Mental Health Center explored the application of music intervention with psychiatric patients (Peng, 2009, p. 22). From 1986 to 1988, the China Conservatory of Music and Beijing Huilongguan Hospital developed a partnership on studying “Music Therapy and Chronic Schizophrenia”; this study was awarded the third-place Beijing Science and Technology Progress Award (Zhang, 2004, p. 106). Beijing Huilongguan Hospital built the first music therapy room among all the psychiatric hospitals in the nation in 1991, becoming a new method in psychiatric rehabilitation in China (Chinese Music Therapy Association). Thereafter, many psychiatric hospitals, nursing homes, and rehabilitation centers launched music therapy programs (Zhang, 2004, p. 106). In 1994, the psychological counseling department at Beijing Tongren Hospital launched a program to facilitate the treatment of elderly cardiovascular disease and sleep disorders by using music (ibid.). The program was well received and was called “enjoyable treatment” by the public (ibid.). Soon after, music therapy was not only practiced in specialized medical facilities, but was also integrated into various departments in general hospitals (ibid.). In 1988, the China Conservatory of Music established the first music therapy program in mainland China beginning in 1989 (Chinese Music Therapy Association).The music therapy program included both undergraduate- and graduate-level studies with Hongyi Zhang as the only instructor (Hongyi Zhang, e-mail message to author, April 13, 2014). The first music therapy organization in mainland China, the Chinese Music Therapy Association (CMTA) was founded by a group of musicians, psychologists, and medical professionals in October 1989 (Chinese Music Therapy Association). The mission of CMTA is: “Discussing, studying and advocating music therapy, as well as creating and developing music therapy with Chinese characteristics by cooperating closely with professionals from the disciplines of music, medicine, psychology, science and medical equipment making” (Zhang, Gao, & Liu, 2016, p. 67). The association became the bridge to connect music therapy researchers and clinicians that spurred the development of music therapy in mainland China (Zheng & Chen, 2004, p. 92). In 1993, China was invited to join the World Federation of Music Therapy (WFMT) and Hongyi Zhang became one of the council members (Zhang, 2004, p. 106). Since then, China has participated in music therapy affairs worldwide. Development over the Past 20 Years The modern practice of music therapy in mainland China began with the contribution of Tian Gao. Gao came to the U.S. and studied music therapy at Temple University in 1986. At the end of 1996, he moved back to Beijing, China, becoming the first and only person to return after studying music therapy systematically overseas during the next 15 years (Gao, e-mail message to author, January 29, 2014). He then implemented in China those theories and techniques he learned during his studies (Gao’s Music Therapy Center, “Therapist Tian Gao,” 2014). After returning to China, Gao attended many trainings related to psycho-social therapy, such as hypnotherapy, family therapy, psychodynamic psychotherapy, and Eye Movement Desensitization and Reprocessing (EMDR), all of which were presented by international well-known professionals (Gao, e-mail message to author, December 1, 2015). As a certificated EMDR therapist, Gao combined the idea of music entrainment and music imagery with EMDR, then developed one kind of treatment for Post-Traumatic Stress Disorder (PTSD) called Music Entrainment and Reprocessing (MER) (Gao, 2013A, p. 99). “MER is aimed at changing clients’ state of pain and anxiety toward more positive states as the therapist guides the client through various relaxation, imagery, and cognitive-based techniques that are supported with therapist-selected music” (ibid.). This technique has been suggested to be an effective method “in eliminating the influences of traumatic events on many clients” (Gao, 2013B, p. 108). In his 25 years of clinical practice in both Western and Eastern cultural conditions, Gao gradually developed his culturally based approach to facilitate the situations and meet the needs of Chinese clients. According to Gao, many Western psychology theories and cultural norms are in conflict with traditional Chinese culture and values (Gao, e-mail message to author, February 6, 2014). For example, in Chinese culture, children obey their parents when they are young. As they grow up, they become responsible for their elders. At the beginning of his practice, Gao employed the Western style of psychotherapy techniques to guide clients, but it turned out that the tension between clients and their family members increased (ibid.). In order to meet the needs of Chinese clients, blending the Western and Eastern philosophies and adapting music therapy theories and techniques has been necessary. Gao started to involve traditional Chinese cultural context and social norms to treat clients; by using this cultural structured application, the clients’ conditions improved (Gao, e-mail message to author, December 1, 2015). In 1996, Gao established the Music Therapy Research Center of the Central Conservatory of Music in Beijing, China. This institution was the first specialized music therapy research institution that combined teaching, research, and clinical services together. In order to establish a standard, high-quality, internationally acceptable program, the Music Therapy Research Center referred to American curricula to develop courses; English materials were also used to teach. Many researchers and music therapists from all over the world were invited to give guest lectures or trainings in the Central Conservatory of Music in China. The master’s program in music therapy at the Central Conservatory of Music was established in 1999, and a bachelor’s program followed in 2003 (Central Conservatory of Music, 2014). In 1999, Gao opened the first specialized music psychotherapy agency in China, called Gao’s Music Therapy Center (Gao’s Music Therapy Center, “Therapist Tian Gao”). In the same year, he started a radio program named “Music Therapy in Beijing People’s Broadcasting Station” that provided services for people suffering from sleep disorders and neurasthenia (ibid.). Chinese society was quite open to accepting music therapy, with many newspapers and TV stations producing reports about music therapy (Gao, e-mail message to author, January 29, 2014). Consequently, through extensive media coverage, music therapy gained more recognition by the public. In addition to an increased number of students enrolling in music therapy programs, there has also been an increased interest by many music teachers, students, doctors, nurses, and counselors who were hoping to have more opportunities to learn music therapy theories and techniques (ibid.). Since 2004, Gao’s Music Therapy Center has offered music therapy training programs to the public. The center developed a systematic training model that included both online and on-campus courses at novice, intermediate, and advanced levels. Each level has 5–7 courses that are available throughout the year. However, since these courses are being offered to working professionals, most classes are held during summer, winter, and holiday breaks (Gao, e-mail message to author, December 1, 2015). In the past 10 years, over 50 trainings have been held; students and professionals from all over the country have completed the training and received certificates (Gao, e-mail message to author, January 29, 2014). The number of attendees has steadily increased by 600 people every year (Gao, e-mail message to author, December 1, 2015). Some of the trainees were from medical institutions, such as hospitals and clinics, and then incorporated music therapy into their own practices (Gao, e-mail message to author, January 29, 2014). In 2007, Gao established the Chinese Professional Music Therapy Association (CPMTA) in Beijing that provides distance education, professional training, updated music therapy information, and certified examinations in China (Chinese Professional Music Therapy Association, 2007). CPMTA is the organization that identifies Chinese music therapists who have advanced knowledge and skills for music therapy practice (Bing Li, in discussion with the author, March 2016). The mission of CPMTA is “promoting the education and training of music therapists in China, establishing a team of Chinese music therapists that meets the international professional standard and driving the profession to develop in a fast and healthy way” (Zhang, Gao, & Liu, 2016, p. 68). The Music Therapy Certified Training Institution provides a comprehensive curriculum including courses such as Music Therapy, Music Theory, Musical Skills, Psychology, Physiology, and Counseling, among others (Gao, e-mail message to author, January 29, 2014). Certification includes three levels (novice, intermediate, and advanced), with each level having specific requirements (Chinese Professional Music Therapy Association). After completing coursework, students must complete a 720-hour supervised internship before becoming certified. By 2015, about 2,000 people had participated in the training, with over 200 people receiving certification (Gao, e-mail message to author, December 1, 2015). In 2008, the devastating Sichuan earthquake occurred in Wenchuan, Sichuan Province, China. This earthquake measured 8.0 on the Richter scale, causing the deaths of 69,712 people with 17,921 people missing (“The number of dead and missing students in Wenchuan earthquake reached 5,300,” 2009). In response to this tragedy, Gao organized three groups of music therapy undergraduate and graduate students who traveled to Wenchuan. Each group spent one month in the earthquake-hit area and applied music therapy to relieve the pain of people who suffered the loss of family and loved ones (Wang, Zhang, & Song, 2013). They set up a series of music therapy experiences and interventions, such as “music performances, music games, sing-alongs, and music with dance or movement activities” to help the victims vent their agony, relieve suffering, and rebuild their hope for life (ibid.). As an observer, a TV reporter stated that, due to music interventions, “it was the first time he had seen people happy since the earthquake” (Gao et al., 2012). Besides Gao and his team, the Guangdong Provincial Association of Chinese Medicine launched the “Music Love Home” post-earthquake music therapy rehabilitation assistance project, which involved the Guangzhou University of Chinese Medicine, Xinghai Conservatory of Music, and China Conservatory of Music participating (Huo, 2010, p. 685). Gao became a founding member of the International Association for Music and Medicine (IAMM) in 2009, where “He has played a critical role in the international efforts in growing and integrating music and medicine across the globe” (Zhang, Gao, & Liu, 2016, p. 69). After 2012, many Chinese music therapists decided to return to China after studying overseas (Gao, e-mail message to author, January 29, 2014). Currently, there are 13 universities/colleges that have a music therapy major in mainland China (see Figure 1). Current programs include the Central Conservatory of Music, China Conservatory of Music, Shanghai Conservatory of Music, Sichuan Conservatory of Music, Wuhan Conservatory of Music, Shenyang Conservatory of Music, Minzu University of China, Yunnan Arts University, the Third Military Medical University, Jiangxi University of Traditional Chinese Medicine, Shandong University of Arts, Nanjing Technical College of Special Education, and Shanxi Changzhi Medical College (Gao, e-mail message to author, January 29, 2014). In addition, there are other schools preparing to offer music therapy courses (Gao, e-mail message to author, December 1, 2015). Figure 1. View largeDownload slide Schools that offer music therapy degrees in mainland China. Figure 1. View largeDownload slide Schools that offer music therapy degrees in mainland China. One of the weaknesses of Chinese music therapy education has been the lack of supervision by qualified music therapists in students’ practica and internships (Gao, e-mail message to author, January 29, 2014). Therefore, the students’ clinical experience may have been substandard, hindering their ability to achieve a high standard of practice. This lack of supervision began to change in 2013. First, more music therapy major students were encouraged to work in hospitals after graduating, in order to gain clinical experience. Moreover, a group of students who had studied abroad and were systematically trained joined the field of music therapy in mainland China and brought the standards of Western clinical practice into Chinese music therapy practices (Gao, e-mail message to author, December 1, 2015). In 2015, Gao’s Music Therapy Center in Beijing started to accept music therapy interns. At the same time, a number of music therapists returned to China after finishing their course of study and clinical training, working as both clinicians and supervisors at the center. The growing needs of music therapy and growing number of music therapy supervisors enabled the center to have more interns. According to Gao, there are many more students who will finish their studies in the U.S. and plan to go back to China (ibid.). The center plans to expand their services and aims to have the largest capacity possible to accept music therapy interns in mainland China (ibid.). In addition, many cities, such as Beijing, Guangdong, Zhengzhou, Chengdu, in mainland China have started to hire music therapists on staff in their public or community health care systems. Some of the hospitals include Peking University Cancer Hospital, Fengtai Maternal & Child Health Hospital, and Jiangmen Maternity and Child Health Care Hospital, among many more (Li, in discussion with the author, March 2016). As an authority in Chinese music therapy, Gao recommended two students who studied abroad to work in Wuxi Tongren International Rehabilitation Hospital, in Jiangsu Province (Gao, e-mail message to author, January 29, 2014). Wuxi Tongren International Rehabilitation Hospital is an upper first-class hospital (the highest level of hospital in mainland China) and has various departments, including neurological rehabilitation, psychiatric, cardiovascular, otolaryngology, and geriatric wards, among other medical services (Wuxi Mental Health Center, “About the hospital,” 2013). Gao had an agreement with the hospital director to establish the hospital as a designated internship setting for music therapy major students; the hospital director indicated that all the departments of the hospital would be open to the practice of music therapy students (Gao, e-mail message to author, January 29, 2014). The hospital became a university-affiliated internship site for Chinese students who study at the University of Melbourne in Australia, Chonbuk National University in South Korea, the Central Conservatory of Music, Jiangxi University of Traditional Chinese Medicine, Xiamen University, Changzhi Medical College, and others in mainland China (Wuxi Mental Health Center, “The first international neurologic music therapy training program in China was held in Wuxi,” 2016). The full-time music therapists working in this hospital also serve as supervisors for the music therapy internship programs, providing students more opportunities to practice and gain clinical experiences (Gao’s Music Therapy Center, “A notification of music therapy internship”). In addition to Wuxi Tongren International Rehabilitation Hospital, other music therapy internship sites that employ full-time music therapists are Beijing Anding Hospital, Beijing Boai Hospital, Xuanwu Hospital, Beijing Children’s Hospital, Beijing Xicheng Pingan Hospital, China Rehabilitation Research Center, and the Young Activities Center of China Disabled Persons Federation (CDPF) (Zhang, Gao, & Liu, 2016, p. 68). In 2014, Beijing Yinling Nursing Home and the Second Hospital of Beijing were added as designated internship settings for music therapy major students; these facilities also have full-time music therapists to supervise students’ practice (Gao, e-mail message to author, March 23, 2014). In addition to teaching and conducting music therapy and research, Gao has written, translated, and edited several books that are quite influential in mainland China (see appendix): Basic Theory of Music Therapy; An Introduction to Music Therapy; Clinical Training Guide for the Student Music Therapist; Receptive Music Therapy; Improvisation: Methods and Techniques for Music Therapy Clinicians, Educators, and Students; Music Therapy Clinical Application; and Music Therapy in Dementia Care (Tian Gao’s Music Therapy Center, 2015). In recent years, with the development of music therapy in mainland China, many music therapists who once studied under Gao have carried out their own music therapy programs around the country. Chunmiao Burn Camp in Chongqing has been providing free services every year since 2011 for children ages 6–18 who have experienced burn trauma but do not have access to outpatient treatment. Music therapy is part of this interdisciplinary team that includes doctors, psychotherapists, physical therapists, and occupational therapists. Starting in 2015, the camp began to recruit music therapy student volunteers nationwide and music therapy professional volunteers worldwide. Music therapists, music therapy students, and musicians from America, Canada, Taiwan, and mainland China have participated in this program. Charities and companies donate to cover fees and living expenses for the clients and volunteers (Li, e-mail message to author, January 25, 2017). Dr. Annie Heiderscheit from Augsburg College was invited to visit the camp in 2015, developing a program called “Music Therapy in China: Chongqing Burn Camp,” which was designed to enrich students’ global education experience by visiting music therapy clinics and communicating with Chinese music therapists. Augsburg College now offers music therapy undergraduate and graduate students the following courses: Music Therapy Practicum (MUS 374) and Transcultural Music Therapy II (MUS 582) (Center for Global Education and Experience, 2017). Yueling Music Therapy Service Center, founded in 2014 in Chengdu, Sichuan Province, is the first and only music therapy public welfare service organization in mainland China (Yueling Music Therapy Service Center, 2017). The organization provides music therapy services to children with developmental disabilities, homeless adolescents, older adults, and the general public (ibid.). In August 2014, the Yueling Music Therapy Service Center (in cooperation with the Chengdu Charity General Association) launched the “Sunshine Charity Music Therapy Project.” This project provides free music therapy intervention to homeless children and orphans, as well as to children with developmental delays such as autism spectrum disorder, Down syndrome, and cerebral palsy. The families of these children often cannot afford the expenses of therapies (Wang, in discussion with the author, February 2017). After three years of therapy, the clients’ communication skills, social adaptability, along with speech and language abilities, improved greatly (Yueling Music Therapy Service Center). Up to now, the center has worked with more than 3,000 homeless children, with the support of government funds (Zhang, Gao, & Liu, 2016, pp. 69–70). Future Prospects Government’s Involvement The Chinese government has also played an important role in supporting the growth of music therapy in mainland China. China has an increasingly aging population, which presents challenges for Chinese society. The Ministry of Civil Affairs of the People’s Republic of China predicted that in 2050, China will have about 400 million people above 60 years old, which is about 30% of the total population (“A forecast report on the development trend of population aging in China,” 2006). The China Central Television (CCTV), the official media in China, presented a one-week special report about dementia and Alzheimer’s disease in 2013. The government emphasized the aim to “establish a fairer and more sustainable social welfare system” and “further develop the elderly services industry” (“The decision on major issues concerning comprehensively deepening reforms,” 2013). These facts support the argument that Chinese society needs music therapy services, which in turn promotes further development of music therapy in mainland China. The social challenge of a growing elderly population became a catalytic factor for China’s New Government Funded Public Service Model. “A Government’s Purchase Public Service (GPPS) model is defined as government transferring part of public service to social organizations, in order to enhance the quality of public service and efficient use of funding, to improve the social governance framework, and to fulfill the more diverse and individualized needs of the public” (Yueling Music Therapy Service Center). The national conditions and government’s support provide more job opportunities for music therapists and new graduates. Gao’s Music Therapy Center contracted with the Beijing Disabled Person’s Federation to serve approximately 500 people who have developmental disabilities (ibid.). By the end of 2016, thirty-seven community music therapy service programs were currently thriving (Li, in discussion with the author, November 2016). The music therapy team at Gao’s Music Therapy Center have been striving to expand the areas of music therapy services and advocate for the music therapy profession. From 2015 to 2016, the amount of government funding increased from $101,890 to $159,480; the number of employed music therapists increased from three full-time and two part-time music therapists to six full-time and one part-time music therapist; and the number of music therapy interns increased from five to eighteen (Li, 2016). Besides government grants, other sources of income in the field of music therapy in mainland China are insurance reimbursement and personal pay (Li, in discussion with the author, March 2016). In 2014, Gao and his team started to popularize music therapy interventions for Alzheimer’s disease and patients with post-stroke symptoms on a large scale (Gao, e-mail message to author, March 23, 2014). This important historic opportunity to promote music therapy development in China is closely related to international professional development and academic communication. International Conferences and Trainings China has hosted several international conferences and invited well-known music therapists and researchers as keynote speakers and workshop trainers. Many internationally renowned music therapists, including Drs. Cheryl Dileo, Clive Robbins, Barbara Wheeler, Roberta Kagin, Suzanne Hanser, Michael Rohrbacher, Rob Amchin, Maria Montserrat Gimeno, Blythe LaGasse, and Annie Heiderscheit, have come to mainland China to share their knowledge and skills with Chinese music therapists (Zhang, Gao, & Liu, 2016, pp. 68–69). The conferences and trainings have provided important opportunities to build international connections. Since 2009, Dr. Lisa Summer, the Director of Music Therapy at Anna Maria College, has led the Guided Imagery and Music (GIM) training institute in Beijing, and she has been invited to present in multiple universities and colleges across mainland China (ibid., p. 69). Throughout the years, Summer witnessed the quick growth of music therapy in China and found “the spirit of the Chinese music therapists to be so kind, giving, and dedicated to their work” (Summer, e-mail message to author, April 15, 2017). Today, Chinese music is widely used with most methods in the Continuum Model of GIM that developed in the 1980s (except for the Bonny Method, which only uses Western classical music). This allows Chinese music therapists to provide a client-centered, supportive environment for Chinese clients (ibid.). Dr. Michael Thaut, the director of the Robert F. Unkefer Academy for Neurologic Music Therapy and the founder of Neurologic Music Therapy (NMT), attended the Twelfth Chinese Music Therapy Association conference as a keynote speaker in April 2015 (Gao, e-mail message to author, January 29, 2014). The first International Neurologic Music Therapy Training in China was held in Wuxi on June 18–21, 2016 (Wuxi Mental Health Center, “The first international neurologic music therapy training program in China was held in Wuxi”). Over 150 music therapists attended the training, and it was estimated that one-third of the attendants are from countries outside mainland China, such as America, France, Singapore, Malaysia, Korea, Hong Kong, Macao, and Taiwan (ibid.). The training program “provides therapists with advanced clinical training and scientific knowledge in the field of NMT” (Center for Biomedical Research in Music, 2014). Dr. Thaut expects the introduction of NMT to supply this developing profession in China with a scientific foundation (Thaut, e-mail message to author, May 1, 2014). In October 2016, the first Nordoff-Robbins Music Therapy training in mainland China was held in Beijing. Jacqueline Birnbaum and Jenny Fu from the Nordoff-Robbins Center for Music Therapy introduced this approach to Chinese music therapists, behavior therapists, social workers, special education teachers, and so on (Wucailu Autism Spectrum Disorder Research Center, “The first Nordoff-Robbins music therapy training held in Beijing,” 2016). Due to the great feedback received from the first training, Dr. Alan Turry, the managing director of Nordoff-Robbins Center for Music Therapy, and Dr. Dong Min Kim, the president of the Korean Nordoff-Robbins Music Therapy Association, were invited to Beijing to provide the second training in March 2017 (Wucailu Autism Spectrum Disorder Research Center, “Nordoff-Robbins music therapy training,” 2017). This event has also received support from the China Disabled Persons’ Federation (ibid.). Dawn Miller, the music therapy internship director at Park Nicollet Health Services, was invited to present at two conferences in different parts of China. At the Fourth International Conference of the International Association for Music and Medicine (IAMM) (June 11–13, 2016), which was hosted by the Chinese Society of Music Therapy and the Chinese Professional Music Therapists Association, Miller gave a presentation entitled “Healing from the Core: Music and Imagery in the Cancer Journey.” At the CPOS Academic Annual Conference and Eighth Psycho-Oncology and Palliative Care Training Meeting (June 17–19, 2016) hosted by the Hunan Cancer Hospital and Chinese Psycho-Oncology Society, Miller presented on the topic of “Music Therapy in Oncology.” After interacting with Chinese music therapists and learning about music therapy in China, Miller stated her impression of Chinese music therapy: “It is a very exciting time right now for music therapy in China. I met some music therapy professionals and a lot of students, who are intelligent, competent, motivated, and excited about music therapy. I am very impressed about the students from the Central Conservatory of Music and the leadership from Tian Gao.” Miller also learned that many music therapists who studied in America or Europe had come back to China to develop this field. According to Miller’s observation, these professionals worked well with each other, and “Music therapy will grow in China, and people will need music therapy” (Miller, in discussion with the author, July 2016). Exchange Programs The undergraduate exchange program between the Central Conservatory of Music (CCM) and the State University of New York (SUNY) at New Paltz, New York, was established in 2005. The exchange program provides the music therapy undergraduate students at CCM the opportunity to spend their senior year in the U.S. and study at SUNY, New Paltz (Liu, in discussion with the author, October 2016). Exchange programs with Colorado State University and Augsburg College in Minnesota are in process, and this exchange may provide opportunities for students from both countries to learn from each other (ibid.). Summary From the ancient usage of music by governors to today’s application of Western music therapy techniques blended with Chinese cultural traditions, the history of exploring the therapeutic use of music in China goes back thousands of years. Since early exploration of this subject included cultural traditions, the practical application of music therapy in mainland China has very unique features. The increasingly aging population in China’s society provides an opportunity for the further development of this profession. The support of government and the introduction and popularization of different music therapy approaches will propel the music therapy profession in mainland China into a new developmental era. As a timely topic of intercultural experience and diversity in music therapy, this article may provide Western clinicians with an insight into traditional Chinese music philosophy and its impact on today’s practice. The author hopes that the cultural differences discussed in this article will provide implications for clinicians who may be working with people of Chinese descent. Music therapy in mainland China is growing rapidly, and there is an air of expectancy for future international collaborations. Yue Wu is a native of China, who completed her graduate music therapy study at Colorado State University and now is working as a full-time music therapist at the MacPhail Center for Music in the Twin Cities area. The author wishes to thank Tian Gao, Hongyi Zhang, Mingming Liu, Bing Li, Jinyi Li, and Lujie Wang for generously providing information about the development of music therapy in mainland China, as well as Drs. 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Journal

Music Therapy PerspectivesOxford University Press

Published: Feb 15, 2018

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