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Music Therapy, Sensory Integration and the Autistic Child
First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.
- GenresMusic
256 pages, Paperback
First published January 1, 2002
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Displaying 1 - 3 of 3 reviews
December 4, 2022
Note: I use a lot of quotes in this review in order to document the types of language used in this book and the way of talking about autistic people. Quite a lot of subtle information is communicated through word choice and that fact is particularly apparent in this book.
______
I'm always nervous to read music therapists writing about autism, especially books written by music therapists that use phrases like "special needs person" (p. 14) or describe autism as "a spectrum of deficient function" (p. 171).
The author describes this book as presented from a "multidimensional physiologic perspective" (p. 173). The term is not defined or elaborated upon. This is the type of book that describes Western neuronormativity through the inexplicable statement: "Mom, Dad and teacher are happy, as are neighbors, extended family members and God." God is happy? What??!? I honestly have no idea what this is supposed to mean (and the author moves on immediately with no explanation).
Berger is not autistic, and she is explicit in her assumption that the reader is also not autistic, as shown in asides such as: "Typical populations (we, the undiagnosed) take..." (p. 158). The implication here is not only that the reader is not autistic but that they are free of any diagnoses indicating atypicality, ...the reader, included in the 'royal we,' invited automatically into the blank slate of typicality by virtue of the ability to read this book. The author's unacknowledged underlying belief begins to stand out as a belief that autistic people do not read books about autism.
Berger defines music therapy as "an approach to solving a physiologic or psychologic problem through understanding possible causes creating the problem and considering how music, through its elements, can be applied as a targeted intervention to alter the issue" (p. 15). "The manner of intervention depends on the therapist’s ability to recognize and evaluate the deficit" (p. 100) and it is an "ominous responsibility" for the music therapist to apply their "comprehensive knowledge" into the development of goals and treatment (p. 170). Music is considered a "natural sedative" (p. 54) used to "condition," "contain," "permanently alter," or "reprogram" the autistic nervous system out of atypical sensory processing patterns and to "shape and redirect" "preferences and mood" in order "to become more suitable" (p. 138, 153). She claims that music works by "fooling" the brain into learning an adaptive behavior (p. 75), and that as a result, music can make autistic people "forget" their tactile sensitivity (false) (p. 71).
The author stresses that music therapy is not a cure for autism but she does write that "it would be an ideal world if 'adaptation' and 'cure' were synonymous, but this is not the case" (p. 152), and then she compares autism to diabetes. She does claim, only 10 pages later, that music therapy might permanently displace sensory issues (p. 162).
At one point, Berger describes her clinical music as "native flute music" (native to where? Berger does not elaborate, as if all Indigenous people are known to share the same musical culture) (p. 56). Later, she refers to playing "pure American Indian flute music in the background" (p. 167). I assume that by 'pure' she means that it is a flute solo with no other instruments, rather than some of the other ways that the word 'pure' can be understood.
Likewise, she indicates the use of "African instruments" and "primitive noise-makers" (p. 145) - does she mean a bondjo? vuvuzela? kora? Is she referring to African drums? All the reader is left with is the name of the continent the instruments originated in.
This text implicates a medicalized behavioral outlook early on, not only through describing music's ability to "condition" autistic people into normalized responses but through moments like asking in the first paragraph of the preface if the traditional music therapy goals "for the autistic population" are "enough to instigate permanent changes in behavior that can be generalized into other situations" (p. 12). It takes a deficit-centered perspective, describing "major [complaints] with autism" like the "inability of the autistic brain" to "properly" process sensory information (pp. 16, 85) leading to seeming "lacking" in "the elements of curiosity and creative play" (p. 162). Therapists, on the other hand, are consistently granted the presumption of competence (p. 16).
The medical model is deeply pervasive. Berger uses functioning language, leans heavily on biocertification-referring often to "diagnosed individuals" (p. 14, 16, 50) as a way to avoid saying 'autistic people')-and relying heavily on euphemisms like "children/persons within the autistic spectrum" (p. 19, 69). Non-autistic people are "typical" (p. 158). Note: Defining autistic people as "diagnostic individuals" neglects the reality that autistic people are autistic whether they are diagnosed are not, and many autistic people who appear in therapy are not diagnosed or may not disclose their diagnoses to a music therapist.
Berger very often refers to Autistic people as "systems" rather than people - as if autistic people are collections of biological units rather than people. For example, she writes, "teaching a system to adapt (or readapt) in a more expeditious (functional) manner is of immediate concern to a clinician" (p. 50).
Berger definitely seems to think of herself as somehow different from the deficit-focused, medicalized and behavioral views of autism but she consistently describes autistic traits as medical deficits with medical explanations that require intervention to the degree where her described interventions display the absolute absurdity of neurotypicality. Behavioral goals are set aside temporarily - sensory regulation is seen as a prerequisite to working towards behavioral goals.
The author considers autistic behaviors not to be the problem, but rather symptoms of the underlying problem (p. 23). She even criticizes behavioral programs that coerce typical behavior through the reward of cookies but fails to see how she truly recreates behavioral perspectives. Berger even goes into detail about how she believes music therapy can't be like standard behavioral modification therapies because in music therapy "music itself is the modifier .... and the reward." She states that music therapy "redirects" behavior rather than "modifying" it and develops "compliance intelligence" (pp. 160-161) - an entirely semantic claim. Within one sentence she claims not to see these "redirected" behaviors as wrongdoing but then immediately frames it as a matter of turning something negative into a positive (p. 161). It is a stunning example of changing the vocabulary and terminology without changing the underlying belief or perspective.
Berger describes a student with Fragile-X Syndrome who hums when he walks down long hallways. She first suggests a relationship between the pitch being hummed and "muscular frequencies" - a concept she makes no attempt to describe or explain, and makes no pretenses at describing how humming interacts with "muscular frequencies" (p. 20). I suppose it's good enough to sound sciencey.
Although Berger attempts to portray the idea that unlike the rest of the special education team, that she respects autistic sensory differences and challenges the assumptions of social norms, she nonetheless proceeds to describe how she required the child to use a recorder or kazoo while navigating the hallway (p. 21). Berger claims that playing kazoos and recorders while walking down the hall at school is more "socially acceptable" and I can't help but wonder what planet she inhabits in which playing a kazoo is more socially acceptable than humming. Neurotypical therapists truly make up what they consider socially acceptable as they go, and whatever is socially acceptable is always whatever the therapist tells you to do. I feel quite confident that if someone was using a recorder or kazoo while walking down the hall at school, the therapist would then say this is socially unacceptable and would work to modify it into humming. Ultimately, "extinguishing" the behavior is still the ultimate goal so we are working with behaviorist goals even if the approach is not strict ABA. Oddly enough, she also later claims that playing the kazoo is musical, whereas humming is not (p. 47). I find this claim to be entirely baffling and self-serving as humming is simply singing with the lips closed. She spends no time defending or elaborating upon why humming is non-musical and socially acceptable but playing kazoo is socially acceptable and musical - we are simply meant to accept her authoritative declarations of fact. This is one of the main clinical snapshots of her work featured in the book, and she comes back to it many times, referring to the students as "our little humming friend" and eventually admitting that it took 3 hours a week for 18 months to extinguish the student's humming behavior (p. 56).
Berger follows up with these statements by writing, "in some cases, it could take a lifetime before system changes are permanent. .... There is no such a thing as too much music intervention," illustrating her deep commitment to normalizing autistic people (p. 57). And what does that mean, to claim that it takes a lifetime to make changes permanent - after a lifetime, presumably one is dead - is she normalizing ghosts? There is no explanation or elaboration on what it means for the idea that it may take a lifetime of music therapy in order to permanently change autistic people.
Berger very much writes as if she feels she represents a very progressive stance but she very much is rooted in a medicalized and behavioral pathology model, refers to autism as a disorder, and promotes behavioral intervention. It's like an early 2000s example of "neurodiversity-lite." Her description of autism begins with the "inability" to form "normal" relationships and travels through to "disturbed or inappropriate affect," "deficits" and areas that are lacking, defiance, and "inability to unwillingness" to be compliant. She will offer three paragraphs of helpful commentary reminding the MT that the client might hear things very differently than the therapist, but then couch it in dozens upon dozens of pages of an intro to the psychology of music and neuroanatomy and deeply biomedical, deficit-focused views of autistic experience. And then she will randomly drop in a tidbit about responding to an autistic child who is agitated and screaming by engaging in a screaming contest with the child, or operatic singing (p. 161), or she writes with an explicitly behavioral framing, suggesting "the more the treatment (training) reinforces the newly learned behaviors, the more the long-term adaptation is assured" (p. 165).
Berger begins in the right direction, asserting that autistic people cannot simply will away sensory distress, but still commits firmly to a curative or corrective response to a medical deficit. "These behaviors cannot be willed away," she writes, referring to behaviors associated with sensory distress. "They must systemically, and systematically, be altered. This is where the work of music, and music therapy begins" she proclaims (p. 169).
Throughout the book, the author uses terms like "poor" skills, "difficulty," "retardation," "dysfunction," "disorganization," "impairment," "inability," "shortcomings," "deficits," "inabilities," "insecurities," "defensiveness," "problems," "issues," "misinterpretations," and "inaccuracies" - often repeatedly. Music therapy is praised for its ability to be a "continuous disturbance" that "[corrects]" the "demanding," "evasive," "inefficient," "erratic," "inconsistent," "too slow" autistic "system" which is "unable" or "devoid of" skills (pp. 60, 75-76, 122, 125-126, 166-167, et al.). Meanwhile, non-autistic people are described as "normal" (p. 28). The book is jarring because she spends a page claiming to question these things and then immediately jumps into presenting these concepts uncritically and without apparent insight into the contradiction (pp. 27-28).
Splinter skills are not seen as strengths and in fact she dismisses them by saying "whatever that means" and "all skills are splinter skills" (p. 148). Berger has clearly failed to understand this common reality of autistic experience and in her ignorance has rushed to invalidate it through logic that called to mind the foolishness of saying "we are all a little autistic."
Berger makes some broad claims that I would not agree reflect reality - for example, she writes, "the world-at-large is often unwilling to accept data that is not scientifically proven" - I see no evidence that this is true and in fact, the world at large largely operates in defiance of that which has been 'scientifically proven' (p. 19).
Parts of this book are very odd, such as when she explains autistic sensory differences by pointing out that the autistic brain might "not be able to redirect nervous energy away from hand flapping" toward cigarette smoking (p. 24).
She makes weird claims like the brain only "seeks only what it needs for survival" (p. 30). This is quite a big claim and she doesn't actually establish that it is true, considering how often people regardless of neurotype seek things beyond what is needed for survival. She does this in order to explain autistic 'aloneness' but honestly, I think that non-autistic people have no business trying to explain 'autistic aloneness' because it will never be anything beyond mere speculation.
Another weird and unelaborated claim is that people hold glasses (cups) differently according to whether they are empty or full (p. 67).
Several times in the text she addresses the question of the frequency of music therapy sessions. Strangely, during these portions of the text, she takes a hard right turn toward discussing research about how long it takes someone's body to adjust after relocating their home from sea level to a high altitude location. She says, a child doesn't only go to school a few hours a week, and a professional tennis player or ice skater doesn't win championships with fancy skills by only practicing their sports for an hour or two a week, and as a result, suggests a minimum of 2-2.5 hours per week "throughout a child's formative years" delivered through short, frequent sessions (p. 164-165).
Berger writes, "There is therefore no such thing as 'too much' exposure. There can be, as we saw, 'not enough'. In assessing and planning recommendations for treatment with music therapy, the therapist needs to consider what minimum input will adequately begin the re-education process. The maximum is unlimited" (p. 164). Note that therapy is described here as "re-education."
Another weird claim is when she speculates that autistic people might see in the manner of flies - yes, flies as in insects (p. 73). If I ever meet her at a music therapy conference I will have to reassure her that no, autistic visual processing is not in fact like that of insects - and especially not like insects which are widely perceived as vermin.
A lot of this book is about neither music therapy nor autism but about the therapist explaining an early 2000s view of neuroanatomy and sensory processing. Approaches and activities used in music therapy are barely even approached tangentially, through quickly cast suggestions such as that the therapist can use music education techniques like Dalcroze, Kodaly, and Orff or unspecified "adaptations in ear training and movements tasks used in the education of musicians" (p. 101). I don't think this book is written for an audience of music therapists - for example, it takes time to explain music fundamentals, like the difference between a rhythmic pulse, rhythmic pattern, and tempo. The author takes time to explain the rationale for very basic uses of different instruments in music therapy and the practice of adaptive lessons. Perhaps this book is meant for an introduction to music therapy course.
Chapter 7 introduces a case study. Four-year-old Jason, repeatedly referred to as "our gong-child," (p. 109, 124) screamed and cried while the music therapist played piano and sang. The author describes how imitating him and describing him in song only increased his distress, how he would not come near her. He was subjected to this for six weeks. This torment is followed by a genuinely insightful list of erroneous assumptions often made by music therapists such as the idea that music is always fun or that hearing the therapist sing is pleasant, but then again the pages that follow seem to greatly contradict the assumptions (pp. 93-94). She again directly contradicts her own advice when claiming that "music is 'joyful' and eases stress" (p. 163) and "everyone enjoys music" (p. 164).
Berger describes her work, writing:
"Although I basically subscribe to child-centered approaches, I also believe that a child, or system, may not always recognize 'functionally adaptive’ choices that will teach the brain new things it desperately needs in order to encourage changes. What’s more, I, the therapist, also have needs and choices that others must consider. This, too, is a learning process. And with David, my system needed quieting as much as his. My response to David’s queries was non-verbal. I simply continued to play. He eventually became quiet and, although he did not blow into the recorder, he did become less restless. ..." (p. 168)
Frankly: reading this makes me wish I wasn't a music therapist - or any kind of therapist. I cannot in any good conscience recommend this book.
This review is also posted free for patreons at: https://www.patreon.com/posts/no-we-d...
______
I'm always nervous to read music therapists writing about autism, especially books written by music therapists that use phrases like "special needs person" (p. 14) or describe autism as "a spectrum of deficient function" (p. 171).
The author describes this book as presented from a "multidimensional physiologic perspective" (p. 173). The term is not defined or elaborated upon. This is the type of book that describes Western neuronormativity through the inexplicable statement: "Mom, Dad and teacher are happy, as are neighbors, extended family members and God." God is happy? What??!? I honestly have no idea what this is supposed to mean (and the author moves on immediately with no explanation).
Berger is not autistic, and she is explicit in her assumption that the reader is also not autistic, as shown in asides such as: "Typical populations (we, the undiagnosed) take..." (p. 158). The implication here is not only that the reader is not autistic but that they are free of any diagnoses indicating atypicality, ...the reader, included in the 'royal we,' invited automatically into the blank slate of typicality by virtue of the ability to read this book. The author's unacknowledged underlying belief begins to stand out as a belief that autistic people do not read books about autism.
Berger defines music therapy as "an approach to solving a physiologic or psychologic problem through understanding possible causes creating the problem and considering how music, through its elements, can be applied as a targeted intervention to alter the issue" (p. 15). "The manner of intervention depends on the therapist’s ability to recognize and evaluate the deficit" (p. 100) and it is an "ominous responsibility" for the music therapist to apply their "comprehensive knowledge" into the development of goals and treatment (p. 170). Music is considered a "natural sedative" (p. 54) used to "condition," "contain," "permanently alter," or "reprogram" the autistic nervous system out of atypical sensory processing patterns and to "shape and redirect" "preferences and mood" in order "to become more suitable" (p. 138, 153). She claims that music works by "fooling" the brain into learning an adaptive behavior (p. 75), and that as a result, music can make autistic people "forget" their tactile sensitivity (false) (p. 71).
The author stresses that music therapy is not a cure for autism but she does write that "it would be an ideal world if 'adaptation' and 'cure' were synonymous, but this is not the case" (p. 152), and then she compares autism to diabetes. She does claim, only 10 pages later, that music therapy might permanently displace sensory issues (p. 162).
At one point, Berger describes her clinical music as "native flute music" (native to where? Berger does not elaborate, as if all Indigenous people are known to share the same musical culture) (p. 56). Later, she refers to playing "pure American Indian flute music in the background" (p. 167). I assume that by 'pure' she means that it is a flute solo with no other instruments, rather than some of the other ways that the word 'pure' can be understood.
Likewise, she indicates the use of "African instruments" and "primitive noise-makers" (p. 145) - does she mean a bondjo? vuvuzela? kora? Is she referring to African drums? All the reader is left with is the name of the continent the instruments originated in.
This text implicates a medicalized behavioral outlook early on, not only through describing music's ability to "condition" autistic people into normalized responses but through moments like asking in the first paragraph of the preface if the traditional music therapy goals "for the autistic population" are "enough to instigate permanent changes in behavior that can be generalized into other situations" (p. 12). It takes a deficit-centered perspective, describing "major [complaints] with autism" like the "inability of the autistic brain" to "properly" process sensory information (pp. 16, 85) leading to seeming "lacking" in "the elements of curiosity and creative play" (p. 162). Therapists, on the other hand, are consistently granted the presumption of competence (p. 16).
The medical model is deeply pervasive. Berger uses functioning language, leans heavily on biocertification-referring often to "diagnosed individuals" (p. 14, 16, 50) as a way to avoid saying 'autistic people')-and relying heavily on euphemisms like "children/persons within the autistic spectrum" (p. 19, 69). Non-autistic people are "typical" (p. 158). Note: Defining autistic people as "diagnostic individuals" neglects the reality that autistic people are autistic whether they are diagnosed are not, and many autistic people who appear in therapy are not diagnosed or may not disclose their diagnoses to a music therapist.
Berger very often refers to Autistic people as "systems" rather than people - as if autistic people are collections of biological units rather than people. For example, she writes, "teaching a system to adapt (or readapt) in a more expeditious (functional) manner is of immediate concern to a clinician" (p. 50).
Berger definitely seems to think of herself as somehow different from the deficit-focused, medicalized and behavioral views of autism but she consistently describes autistic traits as medical deficits with medical explanations that require intervention to the degree where her described interventions display the absolute absurdity of neurotypicality. Behavioral goals are set aside temporarily - sensory regulation is seen as a prerequisite to working towards behavioral goals.
The author considers autistic behaviors not to be the problem, but rather symptoms of the underlying problem (p. 23). She even criticizes behavioral programs that coerce typical behavior through the reward of cookies but fails to see how she truly recreates behavioral perspectives. Berger even goes into detail about how she believes music therapy can't be like standard behavioral modification therapies because in music therapy "music itself is the modifier .... and the reward." She states that music therapy "redirects" behavior rather than "modifying" it and develops "compliance intelligence" (pp. 160-161) - an entirely semantic claim. Within one sentence she claims not to see these "redirected" behaviors as wrongdoing but then immediately frames it as a matter of turning something negative into a positive (p. 161). It is a stunning example of changing the vocabulary and terminology without changing the underlying belief or perspective.
Berger describes a student with Fragile-X Syndrome who hums when he walks down long hallways. She first suggests a relationship between the pitch being hummed and "muscular frequencies" - a concept she makes no attempt to describe or explain, and makes no pretenses at describing how humming interacts with "muscular frequencies" (p. 20). I suppose it's good enough to sound sciencey.
Although Berger attempts to portray the idea that unlike the rest of the special education team, that she respects autistic sensory differences and challenges the assumptions of social norms, she nonetheless proceeds to describe how she required the child to use a recorder or kazoo while navigating the hallway (p. 21). Berger claims that playing kazoos and recorders while walking down the hall at school is more "socially acceptable" and I can't help but wonder what planet she inhabits in which playing a kazoo is more socially acceptable than humming. Neurotypical therapists truly make up what they consider socially acceptable as they go, and whatever is socially acceptable is always whatever the therapist tells you to do. I feel quite confident that if someone was using a recorder or kazoo while walking down the hall at school, the therapist would then say this is socially unacceptable and would work to modify it into humming. Ultimately, "extinguishing" the behavior is still the ultimate goal so we are working with behaviorist goals even if the approach is not strict ABA. Oddly enough, she also later claims that playing the kazoo is musical, whereas humming is not (p. 47). I find this claim to be entirely baffling and self-serving as humming is simply singing with the lips closed. She spends no time defending or elaborating upon why humming is non-musical and socially acceptable but playing kazoo is socially acceptable and musical - we are simply meant to accept her authoritative declarations of fact. This is one of the main clinical snapshots of her work featured in the book, and she comes back to it many times, referring to the students as "our little humming friend" and eventually admitting that it took 3 hours a week for 18 months to extinguish the student's humming behavior (p. 56).
Berger follows up with these statements by writing, "in some cases, it could take a lifetime before system changes are permanent. .... There is no such a thing as too much music intervention," illustrating her deep commitment to normalizing autistic people (p. 57). And what does that mean, to claim that it takes a lifetime to make changes permanent - after a lifetime, presumably one is dead - is she normalizing ghosts? There is no explanation or elaboration on what it means for the idea that it may take a lifetime of music therapy in order to permanently change autistic people.
Berger very much writes as if she feels she represents a very progressive stance but she very much is rooted in a medicalized and behavioral pathology model, refers to autism as a disorder, and promotes behavioral intervention. It's like an early 2000s example of "neurodiversity-lite." Her description of autism begins with the "inability" to form "normal" relationships and travels through to "disturbed or inappropriate affect," "deficits" and areas that are lacking, defiance, and "inability to unwillingness" to be compliant. She will offer three paragraphs of helpful commentary reminding the MT that the client might hear things very differently than the therapist, but then couch it in dozens upon dozens of pages of an intro to the psychology of music and neuroanatomy and deeply biomedical, deficit-focused views of autistic experience. And then she will randomly drop in a tidbit about responding to an autistic child who is agitated and screaming by engaging in a screaming contest with the child, or operatic singing (p. 161), or she writes with an explicitly behavioral framing, suggesting "the more the treatment (training) reinforces the newly learned behaviors, the more the long-term adaptation is assured" (p. 165).
Berger begins in the right direction, asserting that autistic people cannot simply will away sensory distress, but still commits firmly to a curative or corrective response to a medical deficit. "These behaviors cannot be willed away," she writes, referring to behaviors associated with sensory distress. "They must systemically, and systematically, be altered. This is where the work of music, and music therapy begins" she proclaims (p. 169).
Throughout the book, the author uses terms like "poor" skills, "difficulty," "retardation," "dysfunction," "disorganization," "impairment," "inability," "shortcomings," "deficits," "inabilities," "insecurities," "defensiveness," "problems," "issues," "misinterpretations," and "inaccuracies" - often repeatedly. Music therapy is praised for its ability to be a "continuous disturbance" that "[corrects]" the "demanding," "evasive," "inefficient," "erratic," "inconsistent," "too slow" autistic "system" which is "unable" or "devoid of" skills (pp. 60, 75-76, 122, 125-126, 166-167, et al.). Meanwhile, non-autistic people are described as "normal" (p. 28). The book is jarring because she spends a page claiming to question these things and then immediately jumps into presenting these concepts uncritically and without apparent insight into the contradiction (pp. 27-28).
Splinter skills are not seen as strengths and in fact she dismisses them by saying "whatever that means" and "all skills are splinter skills" (p. 148). Berger has clearly failed to understand this common reality of autistic experience and in her ignorance has rushed to invalidate it through logic that called to mind the foolishness of saying "we are all a little autistic."
Berger makes some broad claims that I would not agree reflect reality - for example, she writes, "the world-at-large is often unwilling to accept data that is not scientifically proven" - I see no evidence that this is true and in fact, the world at large largely operates in defiance of that which has been 'scientifically proven' (p. 19).
Parts of this book are very odd, such as when she explains autistic sensory differences by pointing out that the autistic brain might "not be able to redirect nervous energy away from hand flapping" toward cigarette smoking (p. 24).
She makes weird claims like the brain only "seeks only what it needs for survival" (p. 30). This is quite a big claim and she doesn't actually establish that it is true, considering how often people regardless of neurotype seek things beyond what is needed for survival. She does this in order to explain autistic 'aloneness' but honestly, I think that non-autistic people have no business trying to explain 'autistic aloneness' because it will never be anything beyond mere speculation.
Another weird and unelaborated claim is that people hold glasses (cups) differently according to whether they are empty or full (p. 67).
Several times in the text she addresses the question of the frequency of music therapy sessions. Strangely, during these portions of the text, she takes a hard right turn toward discussing research about how long it takes someone's body to adjust after relocating their home from sea level to a high altitude location. She says, a child doesn't only go to school a few hours a week, and a professional tennis player or ice skater doesn't win championships with fancy skills by only practicing their sports for an hour or two a week, and as a result, suggests a minimum of 2-2.5 hours per week "throughout a child's formative years" delivered through short, frequent sessions (p. 164-165).
Berger writes, "There is therefore no such thing as 'too much' exposure. There can be, as we saw, 'not enough'. In assessing and planning recommendations for treatment with music therapy, the therapist needs to consider what minimum input will adequately begin the re-education process. The maximum is unlimited" (p. 164). Note that therapy is described here as "re-education."
Another weird claim is when she speculates that autistic people might see in the manner of flies - yes, flies as in insects (p. 73). If I ever meet her at a music therapy conference I will have to reassure her that no, autistic visual processing is not in fact like that of insects - and especially not like insects which are widely perceived as vermin.
A lot of this book is about neither music therapy nor autism but about the therapist explaining an early 2000s view of neuroanatomy and sensory processing. Approaches and activities used in music therapy are barely even approached tangentially, through quickly cast suggestions such as that the therapist can use music education techniques like Dalcroze, Kodaly, and Orff or unspecified "adaptations in ear training and movements tasks used in the education of musicians" (p. 101). I don't think this book is written for an audience of music therapists - for example, it takes time to explain music fundamentals, like the difference between a rhythmic pulse, rhythmic pattern, and tempo. The author takes time to explain the rationale for very basic uses of different instruments in music therapy and the practice of adaptive lessons. Perhaps this book is meant for an introduction to music therapy course.
Chapter 7 introduces a case study. Four-year-old Jason, repeatedly referred to as "our gong-child," (p. 109, 124) screamed and cried while the music therapist played piano and sang. The author describes how imitating him and describing him in song only increased his distress, how he would not come near her. He was subjected to this for six weeks. This torment is followed by a genuinely insightful list of erroneous assumptions often made by music therapists such as the idea that music is always fun or that hearing the therapist sing is pleasant, but then again the pages that follow seem to greatly contradict the assumptions (pp. 93-94). She again directly contradicts her own advice when claiming that "music is 'joyful' and eases stress" (p. 163) and "everyone enjoys music" (p. 164).
Berger describes her work, writing:
"Although I basically subscribe to child-centered approaches, I also believe that a child, or system, may not always recognize 'functionally adaptive’ choices that will teach the brain new things it desperately needs in order to encourage changes. What’s more, I, the therapist, also have needs and choices that others must consider. This, too, is a learning process. And with David, my system needed quieting as much as his. My response to David’s queries was non-verbal. I simply continued to play. He eventually became quiet and, although he did not blow into the recorder, he did become less restless. ..." (p. 168)
Frankly: reading this makes me wish I wasn't a music therapist - or any kind of therapist. I cannot in any good conscience recommend this book.
This review is also posted free for patreons at: https://www.patreon.com/posts/no-we-d...
January 15, 2026
would have loved more references to research on the subject, but considering the circumstances, it was a well rounded approach informed by a clear wealth of evidence based practice. especially loved the inclusion of assessment and documentation at the end — great clinical examples to compare to.
November 9, 2011
This was VERY helpful to me when I was doing my Extended Essay for school. I've learnt a lot from it.
Displaying 1 - 3 of 3 reviews