“I think it’s just heart-opening, is really what it is,” said music therapist Jay Brown, seen here with client Bobby Joe Keever. Photo credit: Taylor Sisk
“I think it’s just heart-opening, is really what it is,” said music therapist Jay Brown, seen here with client Bobby Joe Keever. Photo credit: Taylor Sisk

By Taylor Sisk

“I never sang when I was drunk,” says Richard Miller. “I was too busy getting into trouble.”

“She’s got me singing,” he then adds, nodding toward Cindy Morris.

Morris is a music therapist who specializes in working with individuals with previous or current substance-addiction issues. Here at Hospitality House of Boone – which offers both immediate shelter and long-term housing – she’s known as the Music Lesson Lady.

According to the American Music Therapy Association, the first references to music therapy surface in the late 1700s, including an article in Columbian Magazine in 1789 titled “Music Physically Considered.”

Music therapy was practiced in Veterans Administration hospitals after World Wars I and II to treat soldiers suffering from shell shock, a condition that now falls within the definition of post-traumatic stress disorder. Music seemed to speak to many of these soldiers who otherwise were unreachable.

Richard Miller, a resident of Hospitality House of Boone, composes songs with Cindy Morris. Photo credit: Taylor Sisk
Richard Miller, a resident of Hospitality House of Boone, composes songs with Cindy Morris. Photo credit: Taylor Sisk

The three primary populations treated with music therapy today are people living with mental health issues, those with intellectual disabilities and older adults. It’s also now being practiced increasingly in hospice care for all ages, pediatric oncology and neonatal intensive care.

Though legislation to establish regulations for those who practice music therapy has stalled in the North Carolina General Assembly, the evidence-based practice is nationally certified under the American Music Therapy Association and is regularly incorporated into, for example, mental health and autism treatment programs.

Music therapy, said Cathy McKinney, founding director of Appalachian State University’s music therapy program (one of three universities in the state, along with East Carolina and Queens, with undergraduate and master’s programs), the practice involves both goals and objectives specific to the client and the “research base for why you make a choice about what kind of music therapy you’re going to use.”

“It’s amazing the bridge that music can gap,” said Sarah Renshaw, a graduate of ASU’s master’s program. “It’s powerful.”

Those in the profession will often tell you that to gain a true measure of that power, you must witness music therapy in action.

“When you see it happening,” Renshaw said, “it clicks.”

‘It don’t matter’

Miller, 58, was born and raised in West Jefferson, a half hour up Hwy. 221. He’s been living at Hospitality House for two years. He has crystal blue eyes that settle right into yours then shift to the middle distance without a flicker. It’s the gaze of a man who’s done time: 15 years for a crime committed under the influence of alcohol.

Prison sobered him up, and he’s stayed that way.

Morris visits Miller once a week, and they pass an hour singing, writing and listening to music. Morris believes the sessions offer Miller “a place for him to feel safe exploring emotions that he’d held in for a while.”

Writing songs, or just relating emotions expressed in songs to his own life, has helped open him up. Miller, Morris said, seems proud of the songs he’s produced. “Man,” he’ll say, “that’s me singing.”

They’re now working on a CD of seven or eight songs for which Miller provides the bulk of the lyrics and Morris arranges.

“You want to listen first?” Morris asks, settling in with her guitar. “Or do you want to sing?”

“It don’t matter, girl,” Miller replies.


Being an effective music therapist, McKinney said, requires knowing a fair amount about a lot of things.

You need to have music-performance and -perception skills and knowledge of, among other things, anatomy, psychology and group dynamics.

Music therapy works in different ways for different populations. With kids, for example, Renshaw said, it might first be the path that leads them into the room.

“If they hear they’re going to therapy, they’re not about it,” she said. “But if they walk in and there’s someone sitting there with a guitar, immediately there’s a rapport, which is so crucial to the process.”

Music is also an effective learning device for kids. We all remember the “Alphabet Song,” right?

Appalachian State University music department faculty, from left, Christine Pollard Leist, Sarah Renshaw, Cathy McKinney and Melody Schwantes. Photo credit: Taylor Sisk
Appalachian State University music department faculty, from left, Christine Pollard Leist, Sarah Renshaw, Cathy McKinney and Melody Schwantes. Photo credit: Taylor Sisk

Christine Pollard Leist, another ASU music therapy faculty member, explained that while it’s not possible for those who’ve experienced a stroke or traumatic head injury to regenerate neurons, they can make new connections, and music can facilitate that.

Research on people who’ve suffered brain injuries has shown “improvement in executive function and overall emotional adjustment, and lessening of depression, sensation seeking, and anxiety.”

Another study found that 13 sessions of music therapy with people with schizophrenia improved cognitive function and social competence, with the participants showing “joyful emotions” throughout the sessions.

Then for older adults, there’s that intertwining of music and memory.

Jay Brown works for CarePartners Health Services in Asheville. His clients are hospice patients. Brown spent 15 years working as a gigging musician – playing in clubs, pubs and restaurants – before returning to school to study music therapy.

Brown arrives on a recent Wednesday afternoon for his twice-monthly visit to the home of Bobby Joe and Joyce Keever, in Candler, just west of Asheville. Bobby Joe, 81, has chronic heart disease and is receiving home hospice care.

Brown starts out on banjo, Keever on xylophone, for a traditional mountain tune. Brown then goes solo on another old-time tune.

“Sounds like that silly song Daddy made up, remember?” Joyce asks. Bobby Joe smiles in acknowledgement.

The Keevers were high school sweethearts. Between songs, the reminiscing comes easy: Selma Burgess, the girl who nearly kept them apart; chipped ham sandwiches at Babe Maloy’s Drive-In; everyone’s car radio tuned to the same radio station, all night long. Bobby Joe trusted Joyce with his car when he went off to the service in Myrtle Beach, and she tore up his transmission.

A few hymns follow, including “His Eye Is on the Sparrow”: I sing because I’m happy/I sing because I’m free/His eye is on the sparrow/And I know He watches me.

Goals met

McKinney said that even with an increased focus on integrative care in the medical profession in general, educating other health care providers on the role music therapy can play in a treatment plan is a “slow process.”

“It’s educating one person at a time,” she said.

But the profession is rapidly growing. Applicants to ASU’s program, McKinney said, have almost doubled in the past five years.

It’s enriching work, Jay Brown said, for all involved.

“All these barriers that we tend to have when we meet people – it takes a long time to get through them,” he said. Music cuts right to it.

Of his hospice work, Brown said, “It’s a time when people are looking forward and backward at the same time. Here they are just immersed in all these memories, and they’re also thinking, ‘Where am I going next? What’s going to happen to me?’”

The goals he’s helped set for Bobby Joe Keever involve social interaction, reminiscing, encouraging emotional expression. And since Keever can no longer attend church, the hymns offer spiritual support.

Initially, Brown and Keever talked about anxiety, which Keever was experiencing as the nature of his condition sunk in. Brown says he hasn’t seen much of that since.

They now do another duet, this one organ/xylophone: “Shall We Gather at the River,” Keever’s favorite hymn.

Next is “Just a Closer Walk with Jesus,” which was played at Joyce’s mother’s funeral.

“Amazing Grace,” follows. “There’s not one to beat that one,” Joyce says.

As the session draws to a close, Joyce notes that Bobby Joe hadn’t said hardly three words to her all morning, but that the music has clearly lifted him. Bobby Joe acknowledges he feels a lot better, and that he generally does after Brown’s visits.

“Sometimes, he’ll say, ‘I just don’t believe I feel like it today,’” Joyce says. “And I’ll tell Jay to come on anyway. And he’s glad he came. Perks him up.”

“The wonderful thing about music,” said ASU’s Cindy Tate, “is that it can bypass areas that are damaged.” She’s referring here to those who’ve suffered a stroke or traumatic brain injury, but evidence suggest it’s equally true of the heart.

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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Taylor Sisk is a writer, editor, researcher, producer and documentary filmmaker who served as the rural health reporter from 2015 into 2016. He has served as a managing and contributing editor of The Carrboro...