the results of using music therapy in the treatment have consistently shown to be positive. cultural aspects through the ages music has been an integral component of rituals, ceremonies, healing practices, and spiritual and cultural traditions. further, michael bakan, author of world music: traditions and transformations, states that "music is a mode of cultural production and can reveal much about how the culture works," something ethnomusicologists study. cultural considerations in music therapy services, education, and research the 21st century is a culturally pluralistic world. in some countries, such as the united states, an individual may have multiple cultural identities that are quite different from the music therapist's. these include race; ethnicity, culture, and/or heritage; religion; sex; ability/disability; education; or socioeconomic status. music therapists strive to achieve multicultural competence through a lifelong journey of formal and informal education and self-reflection. multicultural therapy "uses modalities and defines goals consistent with the life experiences and cultural values of clients": 6 rather than basing therapy on the therapist's worldview or the dominant culture's norms. empathy in general is an important aspect of any mental health practitioner and the same is true for music therapists, as is multicultural awareness. it is the added complexity to cultural empathy that comes from adding music that provides both the greater risk and potential to provide exceptional culturally sensitive therapy (valentino, 2006). an extensive knowledge of a culture is really needed to provide this effective treatment as providing culturally sensitive music therapy goes beyond knowing the language of speech, the country, or even some background about the culture. simply choosing music that is from the same country of origin or that has the same spoken language is not effective for providing music therapy as music genres vary as do the messages each piece of music sends. also, different cultures view and use music in various ways and may not always be the same as how the therapist views and uses music. melody schwantes and her colleagues wrote an article that describes the effective use of the mexican "corrido" in a bereavement group of mexican migrant farm workers (schwantes, wigram, lipscomb & richards, 2011). this support group was dealing with the loss of two of their coworkers after an accident they were in and so the corrido, a song form traditionally used for telling stories of the deceased. an important element that was also mentioned was that songwriting has shown to be a large cultural artifact in many cultures, and that there are many subtle messages and thoughts provided in songs that would otherwise be hard to identify. lastly, the authors of this study stated that "given the position and importance of songs in all cultures, the example in this therapeutic process demonstrates the powerful nature of lyrics and music to contain and express difficult and often unspoken feelings" (schwantes et al., 2011). usage by region african continent in 1999, the first program for music therapy in africa opened in pretoria, south africa. research has shown that in tanzania patients can receive palliative care for life-threatening illnesses directly after the diagnosis of these illnesses. this is different from many western countries, because they reserve palliative care for patients who have an incurable illness. music is also viewed differently between africa and western countries. in western countries and a majority of other countries throughout the world, music is traditionally seen as entertainment whereas in many african cultures, music is used in recounting stories, celebrating life events, or sending messages. music for healing in ancient times one of the first groups known to heal with sound were the aboriginal people of australia. the modern name of their healing tool is the didgeridoo, but it was originally called the yidaki. the yidaki produced sounds that are similar to the sound healing techniques used in modern day. the sound of the didgeridoo produces a low, bass frequency. for at least 40,000 years, the healing tool was believed to assist in healing "broken bones, muscle tears and illnesses of every kind". however, here are no reliable sources stating the didgeridoo's exact age. archaeological studies of rock art in northern australia suggest that the people of the kakadu region of the northern territory have been using the didgeridoo for less than 1,000 years, based on the dating of paintings on cave walls and shelters from this period. a clear rock painting in ginga wardelirrhmeng, on the northern edge of the arnhem land plateau, from the freshwater period (that had begun 1500 years ago) shows a didgeridoo player and two songmen participating in an ubarr ceremony. music therapy in modern times – an allied health profession 1949 in australia, music therapy (not clinical music therapy as understood today) was started through concerts organized by the australian red cross along with a red cross music therapy committee. the key australian body, the australian music therapy association (amta), was founded in 1975. history: ca1940 – present for earlier history related to western traditions, see § western cultures sub-section. in 1956, fran herman, one of canada's music therapy pioneers, began a 'remedial music' program at the home for incurable children, now known as the holland bloorview kids rehabilitation hospital, in toronto. her group 'the wheelchair players' continued until 1964, and is considered to be the first music therapy group project in canada. its production "the emperor's nightingale" was the subject of a documentary film. composer/pianist alfred rosé, a professor at the university of western ontario, also pioneered the use of music therapy in london, ontario at westminster hospital in 1952 and at the london psychiatric hospital in 1956. two other music therapy programs were initiated during the 1950s; one by norma sharpe at st. thomas psychiatric hospital in st. thomas, ontario, and the other by thérèse pageau at the hôpital st-jean-de-dieu (now hôpital louis-hippolyte lafontaine) in montreal. a conference in august 1974, organized by norma sharpe and six other music therapists, led to the founding of the canadian music therapy association, which was later renamed the canadian association for music therapy (camt). as of 2009, the organization had over 500 members. canada's first music therapy training program was founded in 1976, at capilano college (now capilano university) in north vancouver, by nancy mcmaster and carolyn kenny. china the relationship between music therapy and health has long been documented in ancient china. it is said that in ancient times, really good traditional chinese medicine did not use acupuncture or traditional chinese medicine, but music: at the end of a song, people were safe when they were discharged. as early as before the spring and autumn period and the warring states period, the yellow emperor's canon of internal medicine believed that the five tones (palace, shang, horn, emblem and feather) belonged to the five elements (gold, wood, water, fire and earth), and were associated with five basic emotions (joy, anger, worry, thought and fear), that is, the five chronicles. different music such as palace, shang, horn, micro and feather were used to target different diseases. more than 2000 years ago, the book yue ji also talked about the important role of music in regulating life harmony and improving health; "zuo zhuan" recorded the famous doctors of the state of qin and the discussion that music can prevent and treat diseases: "there are six or seven days, the hair is colorless, the emblem is five colors, and sex produces six diseases." it is emphasized that silence should be controlled and appropriate in order to have a beneficial regulating effect on the human body; the book "the soul and the body flow, the spirit also flows"; zhang jingyue and xu lingtai, famous medical experts in the ming and qing dynasties, also specially discussed phonology and medicine in the "classics with wings" and "yuefu chuansheng". for example, liu xueyu, one of the emperors of the tang dynasty, cured some stubborn diseases through the records of music in the tang dynasty. chinese contemporary music therapy began in the 1980s. in 1984, professor zhang boyuan of the department of psychology of peking university published the experimental report on the research of physical and mental defense of music, which was the first published scientific research article on music therapy in china; in 1986, professor gao tian of beijing conservatory of music published his paper "research on the relieving effect of music on pain"; in 1989, the chinese society of therapeutics was officially established; in 1994, pukaiyuan published his monograph music therapy; in 1995, he huajun and lu tingzhu published a monograph music therapy; in 2000, zhang hongyi edited and published fundamentals of music therapy; in 2002, fan xinsheng edited and published music therapy; in 2007, gao tian edited and published the basic theory of music therapy. in short, chinese music therapy has made rapid progress in theoretical research, literature review and clinical research. in addition, the music therapy methods under the guidance of ancient chinese music therapy theory and traditional chinese medicine theory with a long history have attracted worldwide attention. the prospect of chinese music therapy is broad. germany the germany music therapy society defines music therapy as the "targeted use of music as part of a therapeutic relationship to restore, maintain and promote mental, physical and cognitive health ." india the roots of musical therapy in india can be traced back to ancient hindu mythology, vedic texts, and local folk traditions. it is very possible that music therapy has been used for hundreds of years in indian culture. in the 1990s, another dimension to this, known as musopathy, was postulated by indian musician chitravina ravikiran based on fundamental criteria derived from acoustic physics. the indian association of music therapy was established in 2010 by dr. dinesh c. sharma with a motto "to use pleasant sounds in a specific manner like drug in due course of time as green medicine". he also published the international journal of music therapy (issn 2249-8664) to popularize and promote music therapy research on an international platform. suvarna nalapat has studied music therapy in the indian context. her books nadalayasindhu-ragachikitsamrutam (2008), music therapy in management education and administration (2008) and ragachikitsa (2008) are accepted textbooks on music therapy and indian arts. the music therapy trust of india is another venture in the country. it was started by margaret lobo. she is the founder and director of the otakar kraus music trust and her work began in 2004. lebanon in 2006, hamda farhat introduced music therapy to lebanon, developing and inventing therapeutic methods such as the triple method to treat hyperactivity, depression, anxiety, addiction, and post traumatic stress disorder. she has met with great success in working with many international organizations, and in the training of therapists, educators, and doctors. norway norway is recognized as an important country for music therapy research. its two major research centers are the center for music and health with the norwegian academy of music in oslo, and the grieg academy centre for music therapy (gamut), at university of bergen. the former was mostly developed by professor even ruud, while professor brynjulf stige is largely responsible for cultivating the latter. the center in bergen has 18 staff, including 2 professors and 4 associate professors, as well as lecturers and phd students. two of the field's major international research journals are based in bergen: nordic journal for music therapy and voices: a world forum for music therapy. norway's main contribution to the field is mostly in the area of "community music therapy", which tends to be as much oriented toward social work as individual psychotherapy, and music therapy research from this country uses a wide variety of methods to examine diverse methods across an array of social contexts, including community centers, medical clinics, retirement homes, and prisons. nigeria the origins of musical therapy practices in nigeria is unknown, however the country is identified to have a lengthy lineage and history of musical therapy being utilized throughout the culture. the most common people associated with music therapy are herbalists, witch doctors, and faith healers according to professor charles o. aluede of ambrose alli university (ekpoma, edo state, nigeria). applying music and thematic sounds to the healing process is believed to help the patient overcome true sickness in his/her mind which then will seemingly cure the disease. another practice involving music is called "igbeuku", a religious practice performed by