Today we have the pleasure of interviewing Stéphanie Lefebvre, a music therapist.

What is music therapy? What is its history and what are its applications and implications today?

Music therapy is a care practice that uses sound, music and vocal mediation for therapeutic purposes: development, communication, cognitive and sensory stimulation, etc. Based on scientific research, it is a complementary, non-medicinal intervention which, by mobilising people’s resources, contributes to their well-being and health.

It has a long history. In the founding texts of the monotheistic religions, there are accounts of instruments being used for healing purposes. We also know of cathartic rituals based on dance and music, such as the Tarantella in Italy. And then there’s the African myth that the sanza, also known as the thumb piano or kalimba, was created to restore lost harmony.

But let’s return to our century. Music therapists work in all sectors of care, in health and social care, in prisons and in private practice. Her theoretical and disciplinary field extends from psychoanalysis to neuroscience, via artistic practice and musicology. She works with an equally broad spectrum of people, from premature babies to the very elderly or people at the end of their lives. Patients may also meet a music therapist at any point in their treatment.

Thanks to the development of cerebral imaging, which began in the 1980s, the cognitive sciences of music have given music therapy a particular boost by providing tangible proof of its intuitions, particularly concerning the functioning of the “musician’s brain”. As a result, new fields of application have emerged, such as neuro-music therapy (NMT).

Music therapy is practised throughout the world. Its level of training comes under the heading of healthcare engineering. Unfortunately, most of the time it is not recognised by institutional health systems, as is the case in France, and it remains difficult to practise this profession without having to deal with a form of insecurity, on an indefinite basis, due to a lack of budgets on the one hand, and of a legal framework on the other. Let’s hope that things will continue to get organised in the years to come, thanks in particular to the work of professional associations such as the Fédération Française des Musicothérapeutes (FFM) and the European Music Therapy Confederation (EMTC).

More concretely, what does your day-to-day work as a music therapist involve?

On a day-to-day basis, I work with a wide variety of people. Three days a week, I have the pleasure of working in neonatal intensive care with premature babies at Amiens University Hospital, as part of an INSERM research project. On the other two days of the week, I meet children in DITEP with ADHD disorders, adults with severe disabilities following strokes, degenerative diseases or head trauma, in the Maison d’Accueil Spécialisé (MAS), elderly people with moderate to severe memory problems (Alzheimer’s or related disorders) in EHPAD (old people’s homes) and, finally, adults in Espace Ressource Cancer (ERC) and in onco-haematology departments, in town and in hospital, in remission or undergoing treatment, as part of support care policies.

It’s not always easy to move from one context to another, but the several-hour slots offered in each establishment make it necessary. It’s also an enriching experience. Like any music therapist, I have my ‘toolkit’ full of methods, playlists and instruments that can be adapted to different situations. I believe that what unites us is the human being in all its dimensions, at the heart of my commitment, in its link with music. In this respect, the work I have developed specifically around the sensory development of foetal life and premature babies is very valuable to me.

you are no stranger to the 5 senses for kids Foundation, as you work with Dr Sahar Moghimi, who was awarded the 2nd prize in the 2023 scientific research awards from the 5 senses for kids Foundation. Her project is entitled ” Neural coding of auditory rhythm during the third trimester of gestation “.

Can you tell us a little about your role in this project?

Initially, my role was to design and produce the musical stimuli played to the premature babies included in this protocol, at the Amiens University Hospital, in order to assess changes in their perception of rhythm from the time they were born in the third trimester of gestation until they were discharged from hospital and returned home. These babies are then followed up until the age of two to assess the extent to which exposure to this music supports their psychomotor, cognitive and social development.

I drew on my seventeen years’ experience of music therapy with babies born prematurely to create this music in such a way as to give the baby and its parents a soothing, reassuring and comforting experience, while meeting the specifications of a well-defined scientific study protocol. To achieve this, I called on the services of musicians: harpist, guitarist, double bassist, violinist, cellist and flutist. I produced the vocal parts myself, as well as the keyboard, ukulele and idiophone instruments (sanza, steel tongue drum). I also conducted the recording sessions so that the artistic and musical expression of each instrumentalist was adapted to the fragility of these babies, who are still immature on the cerebral and auditory levels but already have the capacity and need to feel that they are communicating and relating to those around them. In neonatal intensive care or neonatology units, babies are exposed to sounds that are often too high-pitched or too intense, such as machine alarms. I felt it was important to offer sounds produced by a human acoustic game imbued with positive intentionality, sensitivity, emotion and generosity, as a gift to these children whose lives have been tested from the very beginning.

Secondly, my role is to ensure that the baby is comfortable while these stimuli are being played throughout his or her stay in neonatology, and to provide ‘live’ music therapy sessions with the singing and instruments provided on a contingent and individual basis. I’m also in charge of organising follow-up tests in collaboration with the research team and the parents. I’m really pleased about this, because until now I haven’t had the opportunity to see the children again after they’ve been discharged from hospital. It’s very moving.

Studies on the medium-term effects of music on premature babies are difficult to carry out. I hope that in the next few months or years we’ll get some convincing results, which will help us to recommend music therapy more widely in neonatal units.

Independently of this project, how would you explain the role and impact of music therapy for toddlers?

Numerous studies have shown that music therapy with babies born prematurely not only helps to soothe them physiologically, but also stimulates their behavioural development, reduces parental anxiety and contributes to the process of attachment and the parent/child bond. It also helps babies to eat independently and gain weight. Before 34 weeks, babies are not mature enough to breathe, suck and swallow, and are fed via a nasogastric tube. I have often observed that with music and singing, which stimulates mouth movements and, more metaphorically, the “taste of life”, the baby, as if carried away by the rhythm and melody, can make progress in learning to feed from the breast or bottle. This generally delights parents, for whom the weight gain that accompanies the return home can be a source of anxiety.

All these positive effects of music therapy with the very young can be seen, in particular, in the fact that a baby’s language is musical. Already in utero, the foetus perceives its mother’s heartbeat, the rhythm of her footsteps and the sound of her respiratory and venous flow. It perceives the sound of its own voice and that of its father or siblings. Even long before his auditory sense develops, he ‘hears’ his mother through touch, his first sense to develop, i.e. through the sensation of the vibration of the amniotic fluid created by the sound. Scientists, biologists, gynaecologists and ultrasound scanners have taught us from their observations of foetal life that the cells of the embryo move rhythmically and isochronously, while an embryo less than two months old is cradled by its mother’s iliac artery. We also know that the foetus discriminates between elements of language even if, of course, it does not yet perceive the meaning, and above all, it retains the prosody, i.e. the melodic envelope. This is why lullabies are so appealing to babies, because their musical forms and criteria capture the atmosphere of the prenatal auditorium in which they were immersed, albeit in a way shortened by prematurity.

Between the baby, its parents and the music therapist – who have also been babies themselves – a relationship is created, over the course of the sessions, that touches the heart and the emotional being of each person. Music and the voice carry within them this relational potential at the origin of these psychic movements. Sometimes it encourages parents, sometimes staggered by the ordeal of premature birth, to express themselves, while at other times it allows them to enjoy a new-found intimacy with themselves and their baby in a highly medicalised context.

I firmly believe that the aesthetic dimension of the music chosen and adapted to each situation, as well as the experience of emotional tuning and melodic and rhythmic synchronisation, are essential in this context of music therapy.

Based on your experience as a music therapist, what recommendations would you give first and foremost to parents, but also to early childhood professionals?

Very humbly, I would recommend that parents should not hesitate to spend time talking and/or singing to their child, right from pregnancy and the very first moments after birth. They can choose music of their choice and play it at different times of the day. Small instruments such as sanzas or steel tongue drums are also quite accessible and enjoyable to play, even without being a musician.

As for early childhood professionals, I invite them to invest in their innate talents, because we are all endowed with “intuitive parenting” skills, a universal quality, whether or not we are parents ourselves, and which includes the ability to sing or speak naturally to the little one in a musical way. For those who feel less at ease, I invite them to take training, or even better, to call on the services of professional music therapists or musicians. Because music is much more than a leisure activity or a cultural or intellectual pursuit, it is a key factor in our development and accompanies us throughout our lives. In times of sorrow as in times of joy, it can be and remain a wonderful comfort blanket!

Thank you, Stéphanie Lefebvre!