What are the types of music therapy? Read about active approaches using instruments and singing, receptive listening-based ones, the evidence and the limits.
When you start looking into music therapy for someone close to you, the first question that comes up is usually: "But they can't play an instrument." Then a second question follows: "Does just listening to music count as music therapy?" These two questions actually sum up the basic distinction between the types of music therapy: on one side, active approaches in which the person plays, sings or keeps a rhythm themselves; on the other, receptive approaches based on listening and on talking about the music heard. In this article we look, calmly and clearly, at these two main paths, how they are used in sessions, which groups they have been studied in, how strong the evidence is, and how listening to music at home differs from therapy.
What Are the Types of Music Therapy? The Basic Distinction
In its broadest definition, music therapy is an approach in which a trained practitioner engages in musical interaction with a person within a therapeutic framework. Cochrane reviews define music therapy in this way too, and emphasise that simply listening to recorded music does not fall within this definition. In other words, in music therapy the relationship built through music, and the fact that the process is aimed at a goal, matter as much as the music itself.
Within this framework, the types of music therapy are usually grouped under two main headings:
- Active approaches: Work in which the person produces the music themselves. Playing an instrument, singing, keeping a rhythm, improvising or writing song lyrics all belong to this group.
- Receptive approaches: Work in which the person listens to music and shares their experience of it with the practitioner. Here, music opens a door to talking about feelings, memories and images.
In practice, these two paths often intertwine. A session may begin with listening and turn into keeping a rhythm together; in another session, a person may first sing a song and then talk about what it reminds them of. Which path takes priority is decided according to the person's age, needs, physical condition and preferences. If you have not yet read about the general framework of music therapy, our article on music therapy could be a good place to start.
Active Music Therapy: Playing, Singing, Improvising
In active music therapy, the person is inside the music. You do not need musical training for this approach; the instruments used are often easy-to-play percussion such as drums, tambourines, maracas and xylophones. What matters is not technical achievement but the musical interaction itself.
Some of the activities often used in active approaches:
- Improvisation: The person and the practitioner make sound together without a pre-set piece. If the rhythm the person is playing is slow, the practitioner accompanies it; if it speeds up, so does the practitioner. This mutual attunement is thought of as a form of non-verbal communication.
- Singing: Singing familiar songs together involves using the breath and the voice, and the experience of doing something together.
- Rhythm work: Structured exercises such as keeping, changing and stopping a rhythm are associated with attention and turn-taking skills.
- Songwriting: The person turns their own feelings or story into the lyrics and melody of a song. This can be a powerful means of expression, especially for adolescents and adults.
One benefit of active approaches is that they open up space for expression where words fall short. For example, a child whose speech has not yet developed, or an adult who struggles to put feelings into words, can express anger, sadness or excitement by striking a drum.
Practices used in neurological rehabilitation, such as walking or speech work with rhythm, can also be seen as a sub-field of active approaches. This field is being studied in rehabilitation after stroke or with Parkinson's disease; you can find details in our article on neurologic music therapy.
Receptive Music Therapy: Listening and Talking About It
In receptive approaches, the person does not produce music; they listen. But this listening is different from leaving the radio on in the background at home. The music is chosen deliberately, the listening is directed towards a goal, and the experience is then talked about.
Some activities that may be used in receptive approaches:
- Guided listening: While listening to a particular piece, the person pays attention to sensations in their body or to images and feelings that come to mind. These are then shared with the practitioner.
- Talking about song lyrics: The lyrics of a song the person finds meaningful are read together. Questions such as "Why is this song important to you?" or "Which line touches you?" can open a door to the person's own story.
- Listening with relaxation: Calm music is used together with breathing or relaxation exercises.
- Songs of a life: Songs that have accompanied different periods of the person's life are brought together. This activity can be used especially with older people, to build connection through memories.
Receptive approaches may be more suitable when active physical participation is difficult, for example with patients confined to bed for long periods or during times of great fatigue. They can also offer a less challenging starting point for people who are shy about making music and say "my voice is terrible".
When distinguishing between the types of music therapy, you can look not only at the question "playing or listening?" but also at the format of the work. Some processes are carried out individually: the person and the practitioner work one to one, and the work is shaped entirely around the person's needs. Others are done in groups: singing together, building a shared rhythm or improvising in turn brings to the fore a sense of belonging and the experience of being in tune with others. Group work may be considered particularly for older people experiencing loneliness, residents of care homes or people going through a similar process. The effects of choir and group music work are also an area of research; however, since the sources this article draws on do not contain a settled review-level finding on this, it would not be right to say anything about the size of the effect.
Another distinction is the degree of structure. Some work is planned step by step: a particular rhythm exercise, a particular relaxation piece, a particular goal. Other work is freer, and the flow of the session changes according to the feeling the person brings that day. Both paths have their place; which one is chosen again depends on the person.
Types of Music Therapy: Who Have They Been Studied With, and for What?
The types of music therapy have been studied in many different groups. The picture emerging from Cochrane reviews can be summarised as follows:
- Depression: A review updated in 2017 examined 9 studies and 421 participants. When music therapy was added to usual care, a reduction in depressive symptoms was seen in the short term (up to three months); the evidence was rated as low to moderate certainty, and clinical guidelines do not yet recommend adding it routinely.
- Autism: A 2022 review reported a probable improvement in overall symptoms at the end of treatment (moderate certainty); its effect on social interaction and communication is unclear. It probably has no adverse effects, but its long-term effect is unknown.
- Dementia: The current review covers 30 studies and 1,720 people. It reports that music-based interventions probably reduce depressive symptoms and may improve overall behavioural problems, but that no marked effect should be expected on agitation, aggression or cognitive function.
- People with cancer: A 2011 review examined 30 studies and 1,891 patients and found a reduction in anxiety, along with possible positive effects on mood, pain and quality of life. It noted that the evidence for some outcomes was of low quality.
Most of these reviews look at active and receptive approaches together; there is not enough data to say with certainty which type is more helpful in which group. The shared limitations are familiar too: small samples, no possibility of blinding, self-reported measures and short follow-up periods.
The types of music therapy open different doors; but no door on its own takes the place of medication, psychotherapy or medical care.
The Difference Between Listening to Music and Music Therapy
Music is part of all our lives. A song heard through headphones while waiting for the school or work bus in the morning, a folk song (türkü) sung together around a holiday table, a fasıl (traditional Turkish classical music set) put on during a tired evening… These can affect our mood, calm us down or cheer us up. But they are not music therapy; they are valuable parts of everyday life and tools of self-care.
A few elements mark the difference:
- Framework: Music therapy has a particular goal, regular sessions and a process.
- Relationship: Music is used within an interaction with a trained practitioner.
- Assessment: The person's needs are assessed, the process is monitored and adjusted where necessary.
Some claims frequently found online also need to be treated with caution. Statements such as "music at this frequency gets rid of anxiety", "432 Hz brings healing" or "this makam (melodic mode) is good for that illness" have no scientific basis. Pairings of makams with illnesses are historical beliefs based on the Ottoman-era theory of temperament; they contradict each other from one source to another and have not been tested in today's sense. They are interesting as a cultural heritage, but they cannot be used as treatment advice.
The Legal and Training Framework for Music Therapy in Turkey
In Turkey, music therapy is one of the 15 methods defined in the Regulation on Traditional and Complementary Medicine Practices (Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği), published in the Official Gazette on 27 October 2014. Within this framework, the authority to practise lies mainly with certified physicians; according to statements by the Ministry of Health, in some methods such as music therapy, certified allied health personnel may also work under a physician's supervision. For details of the regulation, see our article on GETAT music therapy.
On the academic side, Anadolu University offers a non-thesis master's programme in music therapy. Because admission requirements and content may change over time, up-to-date information should be obtained from the institution's own announcements.
This information is meant to convey one message to the reader: music therapy is a supportive approach delivered by trained people, alongside psychotherapy and medical treatment where needed. Details about certificate and training programmes vary; it is important to follow current legislation.
When Should You Seek Professional Support? The Place of Music in Therapy
Music does many people good; but in some situations it is not enough on its own. If you notice the following signs in yourself or someone close to you, it may help to talk to a mental health professional:
- Low mood, hopelessness or an inability to enjoy anything, lasting more than two weeks
- Anxiety that markedly affects sleep, appetite, or work or school life
- Using music only to sink deeper into feelings that make you feel worse
- Thoughts of harming yourself or ending your life
If the last point applies, call 112 (emergency services) without delay or go to your nearest emergency department.
In psychotherapy, music may play a part as a supportive tool, depending on the client's wishes. The owner of this website is a clinical psychologist and does not offer services under the title of music therapy; however, a person's relationship with music can be discussed during therapy. For example, you might notice together which songs a person turns to in difficult moments, and whether those songs comfort them or pull them into a loop. Small steps such as putting together a playlist that does the person good, or accompanying relaxation exercises with calm music, can also be part of the process.
Let's say a retired teacher cannot bring herself to play the records she and her late husband used to listen to together. This avoidance is talked about in therapy; over time, when she feels ready, listening to a song and sharing what she feels becomes part of her grieving process. Here, music is not the therapy itself but part of the life that is talked about in therapy.
If you are finding it hard to cope with your feelings, through music or any other way, the routes that suit you can be explored together in individual therapy.
Frequently Asked Questions
Do you need to be able to play an instrument for active music therapy?
No. Active approaches usually use easy-to-play percussion instruments and the voice. The aim is not musical achievement but the interaction built through music; someone who has never played an instrument can take part.
Which type of music therapy is more effective?
There is not enough research to give a definite answer to this question. Most reviews examine active and receptive approaches together. Which path is suitable is decided according to the person's age, needs and preferences.
Does listening to music on my own at home count as music therapy?
No, but it can be a valuable self-care tool. Music therapy is a process carried out with a trained practitioner within a therapeutic framework; listening to music on your own does not fall within this definition.
Which music therapy approach is used with children?
With children, active approaches that blend with play are usually preferred: keeping a rhythm, singing, improvising with simple instruments. In some conditions such as autism, research shows a probable benefit for overall symptoms, but the limits of the evidence should be kept in mind.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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