the act of making music, whereas receptive music therapy guides patients or clients in listening or responding to live or recorded music. either or both can lead to verbal discussions, depending on client needs and the therapist's orientation. receptive receptive music therapy involves listening to recorded or live genres of music such as classical, rock, jazz, and/or country music. in receptive music therapy, patients are the recipient of the music experience, meaning that they are actively listening and responding to the music rather than creating it. during music sessions, patients participate in song discussion, music relaxation, and are given the ability to listen to their preferred music genre. it can improve mood, decrease stress, decrease pain, enhance relaxation, and decrease anxiety; this can help with coping skills. there is also evidence chemistry in one's body may change, e.g. lowered cortisol levels. active in active music therapy, patients engage in some form of music-making, e.g. vocalizing, rapping, chanting, singing, playing instruments, improvising, song writing, composing, or conducting. researchers at baylor, scott, and white universities are studying the effect of harmonica playing on patients with copd to determine if it helps improve lung function. another example of active music therapy takes place in a nursing home in japan: therapists teach the elderly how to play easy-to-use instruments so they can overcome physical difficulties. models and approaches music therapist kenneth bruscia stated "a model is a comprehensive approach to assessment, treatment, and evaluation that includes theoretical principles, clinical indications and contraindications, goals, methodological guidelines and specifications, and the characteristic use of certain procedural sequences and techniques.": 129 in the literature, the terms model, orientation, or approach might be encountered and may have slightly different meanings. regardless, music therapists use both psychology models and models specific to music therapy. the theories these models are based on include beliefs about human needs, causes of distress, and how humans grow or heal. models developed specifically for music therapy include analytical music therapy,: 230 benenzon,: 143–144 the bonny method of guided imagery and music (gim),: 230 community music therapy, nordoff-robbins music therapy (creative music therapy),: 230 neurologic music therapy, and vocal psychotherapy. psychological orientations used in music therapy include psychodynamic, cognitive behavioral, humanistic, existential,: 230 and the biomedical model. the bonny method of guided imagery and music further information: guided imagery to be trained in this method, students are required to be healthcare professionals. some courses are only open to music therapists and mental health professionals. music educator and therapist helen lindquist bonny (1921–2010) developed an approach influenced by humanistic and transpersonal psychological views, known as the bonny method of guided imagery in music (bgim or gim). guided imagery refers to a technique used in natural and alternative medicine that involves using mental imagery to help with the physiological and psychological ailments of patients. the practitioner often suggests a relaxing and focusing image, and through the use of imagination and discussion, they aim to find constructive solutions to manage their problems. bonny applied this psychotherapeutic method to the field of music therapy by using music as the means of guiding the patient to a higher state of consciousness where healing and constructive self-awareness can take place. music is considered a "co-therapist" because of its importance. gim with children can be used in one-on-one or group settings, and involves relaxation techniques, identification and sharing of personal feeling states, and improvisation to discover the self, and foster growth. the choice of music is carefully selected for the client based on their musical preferences and the goals of the session. the piece is usually classical, and it must reflect the age and attention abilities of the child in length and genre. a full explanation of the exercises must be offered at their level of understanding. the use of guided imagery with autistic children has been found to decrease stereotypical behaviors and hyperactivity, increase attention and the ability to follow instructions, and increase self-initiated communication, both verbal and non-verbal. nordoff-robbins paul nordoff, a juilliard school graduate and professor of music, was a pianist and composer who, upon seeing disabled children respond so positively to music, gave up his academic career to further investigate the possibility of music as a means for therapy. clive robbins, a special educator, partnered with nordoff for over 17 years in the exploration and research of music's effects on disabled children—first in the uk, and then in the united states in the 1950s and 60s. their pilot projects included placements at care units for autistic children and child psychiatry departments, where they put programs in place for children with mental disorders, emotional disturbances, developmental delays, and other handicaps. their success at establishing a means of communication and relationship with children with cognitive impairments at the university of pennsylvania gave rise to the national institutes of health's first grant given of this nature, and the 5-year study "music therapy project for psychotic children under seven at the day care unit" involved research, publication, training and treatment. several publications, including therapy in music for handicapped children, creative music therapy, music therapy in special education, as well as instrumental and song books for children, were released during this time. nordoff and robbins's success became known globally in the mental health community, and they were invited to share their findings and offer training on an international tour that lasted several years. funds were granted to support the founding of the nordoff robbins music therapy centre in great britain in 1974, where a one-year graduate program for students was implemented. in the early eighties, a center was opened in australia, and various programs and institutes for music therapy were founded in germany and other countries. in the united states, the nordoff-robbins center for music therapy was established at new york university in 1989 today, nordoff-robbins is a music therapy theoretical model / approach. the nordoff-robbins approach, based on the belief that everyone is capable of finding meaning in and benefiting from musical experience, is now practiced by hundreds of therapists internationally. this approach focuses on treatment through the creation of music by both therapist and client together. the therapist uses various techniques so that even the most low functioning individuals can actively participate. orff gertrude orff developed orff music therapy at the kinderzentrum münchen. both the clinical setting of social pediatrics and the orff schulwerk (schoolwork) approach in music education (developed by german composer carl orff) influence this method, which is used with children with developmental problems, delays, and disabilities. theodor hellbrügge developed the area of social pediatrics after the second world war in germany. he understood that medicine alone could not meet the complex needs of developmentally disabled children. hellbrügge consulted psychologists, occupational therapists and other mental healthcare professionals whose knowledge and skills could aid in the diagnostics and treatment of children. gertrude orff was asked to develop a form of therapy based on the orff schulwerk approach to support the emotional development of patients. elements found in both the music therapy and education approaches include the understanding of holistic music presentation as involving word, sound and movement, the use of both music and play improvisation as providing a creative stimulus for the child to investigate and explore, orff instrumentation, including keyboard instruments and percussion instruments as a means of participation and interaction in a therapeutic setting, and the multisensory aspects of music used by the therapist to meet the particular needs of the child, such as both feeling and hearing sound. corresponding with the attitudes of humanistic psychology, the developmental potential of the child, as in the acknowledgement of their strengths as well as their handicaps, and the importance of the therapist-child relationship, are central factors in orff music therapy. the strong emphasis on social integration and the involvement of parents in the therapeutic process found in social pediatrics also influence theoretical foundations. knowledge of developmental psychology puts into perspective how developmental disabilities influence the child, as do their social and familial environments. the basis for interaction in this method is known as responsive interaction, in which the therapist meets the child at their level and responds according to their initiatives, combining both humanistic and developmental psychology philosophies. involving the parents in this type of interaction by having them participate directly or observe the therapist's techniques equips the parents with ideas of how to interact appropriately with their child, thus fostering a positive parent-child relationship. use with children music therapy may be used with adolescent populations to treat disorders usually diagnosed in adolescence, such as mood/anxiety disorders and eating disorders, or inappropriate behaviors, including suicide attempts, withdrawal from family, social isolation from peers, aggression, running away, and substance abuse. goals in treating adolescents with music therapy, especially for those at high risk, often include increased recognition and awareness of emotions and moods, improved decision-making skills, opportunities for creative self expression, decreased anxiety, increased self-confidence, improved self-esteem, and better listening skills. music therapy has multiple benefits that contribute to the maintenance of health and the drive toward rehabilitation for children. advanced technology that can monitor cortical activity offers a look at how music engages and produces changes in the brain during the perception and production of musical stimuli. music therapy, when used with other rehabilitation methods, has increased the success rate of sensorimotor, cognitive, and communicative rehabilitation. methods among adolescents, group meetings and individual sessions are the main methods for music therapy. both methods may include listening to music, discussing concerning moods and emotions in or toward music, analyzing the meanings of specific songs, writing lyrics, composing or performing music, and musical improvisation. private individual sessions can provide personal attention and are most effective when using music preferred by the patient. using music that adolescents can relate to or connect with can help adolescent patients view the therapist as safe and trustworthy, and to engage in therapy with less resistance. music therapy conducted in groups allows adolescent individuals to feel a sense of belonging, express their opinions, learn how to socialize and verbalize appropriately with peers, improve compromising skills, and develop tolerance and empathy. group sessions that emphasize cooperation and cohesion can be effective in working with adolescents. music therapy intervention programs typically include about 18 sessions of treatment. the achievement of a physical rehabilitation goal relies on the child's existing motivation and feelings towards music and their commitment to engage in meaningful, rewarding efforts. regaining full functioning also confides in the prognosis of recovery, the condition of the client, and the environmental resources available. both techniques use systematic processes where the therapists assist the client by using musical experiences and connections that collaborate as a dynamic force of change toward rehabilitation. assessment assessment includes obtaining a full medical history, musical (ability to duplicate a melody or identify changes in rhythm, etc.) and non-musical functioning (social, physical/motor, emotional, etc.). premature infants premature infants are those born at 37 weeks after conception or earlier. they are subject to numerous health risks, such as abnormal breathing patterns, decreased body fat and muscle tissue, as well as feeding issues. the coordination for sucking and breathing is often not fully developed, making feeding a challenge. the improved developmental activity and behavioral status of premature infants when they are discharged from the nicu, is directly related to the stimulation programs and interventions they benefited from during hospitalization, such as music therapy. music is typically conducted by a music therapist in the neonatal intensive care unit (nicu), with five main techniques designed to benefit premature infants: live or recorded music: live or recorded music has been effective in promoting respiratory regularity and oxygen saturation levels, as well as decreasing signs of neonatal distress. since premature infants have sensitive and immature sensory modalities, music is often performed in a gentle and controlled environment, either in the form of audio recordings or live vocalization, although live singing has been proven to have a greater effect. live music also reduces the physiological responses in parents. studies have shown that by combining live music, such as harp music, with the kangaroo care, maternal anxiety is reduced. this allows for parents, especially mothers, to spend important time bonding with their premature infants. female singing voices are also more effective at soothing premature infants. despite being born premature, infants show a preference for the sound of a female singing voice, making