An Introduction To The Distinct Therapeutic Functions of Music

Foundations for an integrative model for practitioners working with music, altered states of consciousness and psychedelics.

Often I’m asked “what” the therapeutic role of music is in psychedelic therapy.

One morning in 2011, on the fifth floor of a building at Imperial College London, in West London: As usual I sat down at my desk to start my work day. The below, by now well-known picture, appeared on my monitor.

I contemplated music and psychedelic therapy many times before that one morning.

But then, for the first time it struck me that music is not just commonly used in modern clinical research of psychedelic therapy, but how extremely central it actually is to the patient's experiences - in the way psychedelic therapy is currently mostly implemented at least.

Patients are blindfolded, encouraged to focus their attention inwardly, and given headphones to listen to emotionally evocative music for nearly the entire duration of their multi-hour psychedelic trip. On top of that, patients typically receive suggestions alongside to “be carried by” or "surrender to” the unfolding experience .

In other words: During the peak effects of the medicine, music becomes almost the only sensory input and source of direction. And yet… What do we know about the effects of music in this context?

What are the different roles of music in psychedelic therapy? How can we understand the interaction between psychedelics and music? How should practitioners respond to patients disliking or rejecting the selected music? How to know what to play, when and for who? In what ways can music selection be personalised? What are best practices when working with music ? What about familiarity? What about lyrics? Etc.

Focussing in on these and other questions, and studying the therapeutic use of music, increasingly became the central focus of my work.

I decided to publish this article series to introduce the model that has emerged gradually from this research.

It is the framework that I teach in workshops as well as what is implemented within Wavepaths. Its current form is by no means considered fully complete, let alone perfect, but it is intended to be as sufficient, practically useful and evidence-based as possible with the data and knowledge at hand. I will share a few more words about this emphasis on a heuristic approach below.

For Who

One of the intentions behind formulating this approach is for it to be (relatively) agnostic to the practitioner's background. The vocabulary, understandings and considerations that I aim to introduce alongside, are meant to be modular and adaptable: to fit and be useful for a range of styles and approaches.

My hope is to inspire, support and empower practitioners from diverse therapeutic training and orientation.

What all share is simply the curiosity to incorporate music in a therapeutic practice.

Although the model emerged from research into the use of music for psychedelic therapy, it has since been adopted by a growing range of professionals working in other modalities that engage altered states of consciousness (including various forms of breathwork, hypnosis and more), as well as various practices that aim to use music as an adjunct to deepen the experiential dimensions of their work with their clients (IFS, EMDR, Gestalt, psychodynamic therapies, and more).

To this point, over the last years this versatility has been demonstrated increasingly by its adoption by practitioners from a range of diverse background, ranging from psychodynamic, humanistic, transpersonal to behavioural and psychiatric. From psychedelic therapists working with Ketamine in an infusion-based to psychotherapy-assisted frameworks, and from therapists working with MDMA, Psilocybin, to Cannabis, DMT and more.

Content

I will introduce this model in parts. Starting with outlining the foundational concepts and definitions that form key pillars to the approach. Followed by practical suggestions for therapeutic practice, ranging from listening exercises and considerations for music curation, playlist designs and music adaptations.

Importantly, I will provide as many concrete examples of audio, music and use-cases as possible to make this series go beyond words and be an experiential learning experience in itself as much as possible.

In this first part I will introduce the foundational motivations and orientations that determine the way this approach has been defined and presented. I will explain why its primary focus is to provide a framework that is mostly heuristic, integrative, person-centred and experiential (experience-based).

In subsequent parts:

• I will introduce the key concepts that underlie this approach, including viewing music as a non-verbal source of direction and intersubjectivity.

• I will introduce 5 Distinct Therapeutic Functions of Music, detailing how exactly they are distinct, alongside examples, exercises and use-cases.

• I will offer a summary overview of the model and illustrate how this can inform diverse implementations in therapeutic practices. This ranges from the curation, organising, designing to the personalising of music and playlists, in therapeutic work with individuals and groups.

• I will highlight key pitfalls and ambiguities to navigate when working with music, ranging from discussing music’s transpersonal to personal effects, implicit vs explicit processing, introspection vs extrospection, relational vs psychodynamic considerations, and the importance of silence.

Please note that parts of these publications will be behind a paywall for a first time since I started Substack. I will be sharing excerpts of musical examples that are exclusively composed for this work that I prefer not to be too easily and widely available for anyone (for reasons outlined here and here). Also, these publications distill quite some years of my research and work. If you therefore appreciate my outputs, please consider becoming a paid subscriber to my channel.

Key Foundations

A Heuristic Approach

Like I said at the start, I am often asked “what” the therapeutic role of music is in psychedelic therapy. The way in which this question is formulated however, already contains a misleading assumption: that there is one singular role.

What has become increasingly clear is that music doesn’t serve just one function, but multiple. This diversity is critical to recognise from the outset when working with music in therapeutic contexts.

If we were to go about creating a catalogue that lists all the different and diverse subjective effects of music on the physiology and psychology of listeners, including their potential therapeutic relevances - this might seem intellectually satisfying to some, but it would be really useless in practice, and totally missing the point.

To navigate complexity, we absolutely need models — not rigid protocols, but conceptual roadmaps that simplify decision-making.

Much like how Google Maps offers just enough detail to get you from A to B, a therapeutic model of music should ease decision-making by focussing on the primary parameters that inform the most likely outcomes of such decisions.

The rapidly evolving psychedelic therapy field needs such a heuristic approach for music: A model that is less about protocolised decision-trees and fixed objectives, but more about frameworks of understanding that enable choices that are flexible, intuitive and informed by best practices and evidence.

We need a model that maintains a sensitivity to the complexity, dynamism and personal depth of music experienced in the context of psychedelics and altered states of consciousness, while simultaneously functioning to filter out the noise.

An Integrative Approach

As Edward O. Wilson warned in Consilience, the increasing specialization of knowledge can undermine our ability to see the interconnected whole - that all forms of inquiry are ultimately connected by a shared foundation of empirical understanding.

This applies very well to the present topic, which includes music research, psychedelics research and mental health research. Each already offers an immensely rich tapestry of perspectives and disciplines - ranging from molecular to system neuroscience, from developmental psychology and psychiatry to psychodynamic, transpersonal and behavioral theories. It includes cultural studies of ritual and medical use, as well as the constantly expanding frontiers of technology.

Although I do immerse myself in such a range, it is not the goal here to give equal weight to all of them - but to try to formulate a unifying perspective on how to harness music’s therapeutic power.

An Experiential Approach

One immediate example of where this integrative intention is being expressed is in recognising the importance to harmonise our emergent understanding of the mechanisms of psychedelic therapy.

This includes both neuroscience and psychological elements. For example, I could summarise in a high-level manner the therapeutic potential of psychedelics by explaining that via serotonin 2A stimulation, the hierarchical communication within and between brain networks is re-organised as such that it creates a temporal window of opportunity for enhanced implicit learning.

This formulation incorporates knowledge of psychedelics’ effects on brain dynamics (e.g. reconfiguration of functional connectivity, etc), and on the neuro-transmitter receptor level (e.g. serotonin 2A stimulation, BDNF release, etc). Simultaneously, the biological explanation would be insufficient in itself, if we omit the present understanding of long-term behavior changes facilitated by mechanisms of experience-dependent learning (implicit learning).

Likewise, in the context of discussing the therapeutic roles of music, a framework that includes the rich dimensions of subjectivity that music per definition brings, is essential.

Therefore I refer to this approach as inherently experiential.

When we wish to formulate an approach that is both heuristic and integrative, a common ground for understanding the various and distinct subjective effects of music on the direct experience of the listener is paramount.

I will freely reference different disciplines, yet what all have in common are frames of meaning-making around the effects of the music on the experience of the listener. These effects I will refer to as “the distinct therapeutic functions” of music.

Finally, I refer to this approach not only as “experiential” in reference to its therapeutic mechanisms, but also because I came to believe that the skill for working with music therapeutically can only effectively be acquired by therapists in an experience-based learning approach.

A therapeutic practice with music cannot be confined to introducing these ideas conceptually in writing alone such as here.

I therefore offer direct and diverse experiences alongside the theory and concepts presented.

In addition, I highly encourage practitioners to immerse themselves in an ongoing practice of music listening that continues beyond this article series.

A Person-Centred Approach

As I have often highlighted elsewhere, one of the challenges of working therapeutically with music is how deeply personal music is. And this depth of meaning and personal significance, takes on new levels of complexity in psychedelic therapy.

I formulated the need to recognise this as the need for a person-centred approach. An approach that aims to approximate the musical language of the listener, and aims to tailor music to the personal, immediate, and dynamic needs of the given moment.

In short, a person-centred approach to music selects music based on who the person is and what is experienced.

The term “person-centred” is of course borrowed from Carl Rogers, who introduced a client-centred or person-centred approach in talk therapy.

Although it’s hard these days to find therapies that consider themselves not client-centred, it can be easily misunderstood in the context of psychedelic therapy, and I will in the course of this series highlight how this applies specifically to therapeutic work with music.

Finally, when using the term “person-centred” I by no means intend to imply this has only relevance for 1:1 work. In fact, the person-centred nature of this approach has equal relevance for group-work, although the practical application may simply be somewhat different.

This reading continues in a separate and subsequent part to this article series