Conversational talks with a music therapist: Sally Ann Nichols

Sally Ann Nichols, MM, MT-BC, is a certified music therapist who currently works at a treatment center for active-duty military service members with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Jena Dunham sat down with her to talk about Sally Ann’s practice — and gather a few ideas for how we can all soothe our souls with some smooth tunes. 

Jena: Was music therapy something you always wanted to do? 

Sally Ann: I realized early that my purpose on Earth is to serve others, but I also know one of my primary talents is an understanding and love of music. I went to music school in Nashville as a voice major thinking I wanted to work in the music business. During my freshman year, I started volunteering with a choir for individuals with special needs.

Jena: Did you have a moment where you knew this what you were meant to do?

Sally Ann:  I saw the difference music made physically, emotionally, and socially among the choir members and learned about music therapy from the director of the choir. That was my eureka moment. I immediately searched out schools with strong music therapy programs, but soon and quite conveniently after this, my university announced it was starting a music therapy program. I think I changed my major the day of the announcement.

Jena: What’s the goal of music therapy?

Sally Ann: Music therapy uses music to accomplish non-musical goals. Interventions and goals change depending on who we’re working with, and we can target physical, mental, social, and spiritual needs. Though our scope of what we can treat is wide, we always base interventions in music, whether that’s listening, actively playing, or moving to music. 

Jena: Are there certain people — ages or demographics — that respond better to music therapy? 

Sally Ann: Music therapists work with literally all ages and all diagnoses. 

Jena: Does the approach shift with different people? 

Sally Ann: Music therapists function like any other therapist would — we assess, set goals, provide evidence-based treatments, and discharge when goals are met. In my career so far, I’ve worked across the spectrum — from using music to promote development in NICU babies all the way to using familiar music to enhance the comfort of patients in hospice care. 

My patients frequently have cognitive complaints like memory or attention difficulty. I may use guitar play to target these goals since playing an instrument requires working memory, linguistic skills, auditory comprehension, integration of tactile, auditory, and visual sensory information, processing speed, and bilateral motor coordination. 

Also, playing an instrument requires strong focus and self-regulation, which supports mindfulness practices for those who have difficulty “turning off” their brain from PTSD. I’m not a music educator, so my goal is never to have someone master a song or instrument. My goal is a result from music experience. 

Jena: What has surprised you about being a music therapist? 

Sally Ann: Seeing the power of music in action is a beautiful thing. 

In my career, I’ve watched a recent car wreck victim take her first steps post-injury to the song “Walking on Sunshine” because the music helped structure and pace her gait. I’ve experienced green berets breaking down for the first time in years because a song evoked an emotion they needed to feel. 

I’ve seen people take their final breaths before leaving this world while their favorite song is coming from my guitar. Music is powerful, and although I’m not necessarily surprised by this, it’s still incredible to me every time I see it. 

Jena: What’s the toughest part of your job? 

Sally Ann: People think being a music therapist is always sunshine and rainbows, and sometimes it certainly is. I often hear “you have the best job because you get to play music all day!” While it’s true that I have the best job, people sometimes forget that music is highly emotional. It does evoke those feelings of joy, but it also evokes painful memories and feelings that may have been stuck in the limbic system for a while waiting to be expressed. 

I hear a lot of tough things working with the military since music can bring up both positive and traumatic deployment events. Either way, it’s powerful because in TBI/PTSD care, music often is a way to express emotion that has been difficult to verbalize in traditional treatments. I’ve certainly struggled with carrying this weight into my personal life, because research shows that those unclear boundaries can lead to burnout. I deeply care for my patients and their wellbeing, but at the end of the day, I have to take off my therapist “hat” and focus on my own wellbeing. 

Jena: Why would someone turn to a therapist — music or otherwise?

Sally Ann: A therapist’s job is to help people sort through emotions and have empathy for those who we are helping. We help you carry your burdens for a little while so you can have some space to think and feel. 

Jena: Is there a genre of music you find to be most effective/therapeutic? 

Sally Ann: This is actually a misconception about music therapy! Research shows that utilizing patient preferred music is most effective. A song that seems “happy” to one person may mean something completely different to another person — it’s all based on your perspective. So if Kendrick Lamar is comforting and relaxing to you, then it is! 

“There’s no genre of music that’s most effective because we’re all different, and music preference is key. ”

There’s no genre of music that’s most effective because we’re all different, and music preference is key. This leads me to another common misconception — classical music isn’t always best for studying because it can be distracting. There can be big shifts in tempo, loudness, or instrumental changes that can actually draw you away from what you are trying to focus on. Steady, simple music that your brainstem will eventually filter out is best. 

In the same light, listening to Mozart doesn’t exactly make your kid smarter. Though it is true that age-appropriate music promotes child development, Mozart could actually be overstimulating for some children.

Jena: Are there any other common misconceptions about music therapy that you’d like to debunk? 

Sally Ann: You bet! A lot of people think that music can’t cause harm. Yes, music is physically non-invasive. I don’t have to poke you with needles to do my job. However, music structurally changes your brain. Also, music can be mentally or emotionally invasive, and this is something I assess when I first meet a new patient in my clinic. 

For example, one time a service member shared that he hated a particular song. This person had served in a military honor guard providing funeral honors for fallen comrades. Upon listening, the intro of this song had bagpipes. Guess what is frequently present at military funerals? Yep, bagpipes. Music caused this patient emotional distress and he never knew why. Because of this, music should be carefully considered before being utilized in treatment, which leads me to my next myth… 

Jena: Can anyone call themselves a music therapist? 

Sally Ann: To become a music therapist, you must complete a degree program, 1200 hours of clinical work, and sit for a board certification exam. We are specifically trained in music (obviously), but also in psychology, anatomy and physiology, counseling, music therapy practice, and the list goes on. 

Let me be clear — volunteer musicians playing in an open space in a medical facility is a beautiful thing and should keep going, but that by no means is clinical music therapy. It would be like calling a trainer at Planet Fitness a physical therapist. Both are important, but not one in the same. 

Because music can cause harm, it’s essential that the closer someone comes to one-on-one patient contact, the more important it is that that person is a board-certified music therapist. Check out www.cbmt.org for more information on music therapy training and certification. 

Jena: Do you have to be musical to benefit from music therapy?

Sally Ann: Whether you’re a musician or not, there’s a lot of evidence that everyone is innately musical. You have a heartbeat that’s constantly keeping blood pumped through your body. That’s rhythm, which is the backbone of music! How’d you remember your ABC’s as a kid? Through a melody. So even though you may say you don’t have a lick of musical talent, it’s innately inside us, which means we all can benefit. 

Jena: Do you have effective techniques that our readers could practice independently? 

Sally Ann: Even though clinical music therapy goals vary on patient needs, there are several music strategies I can recommend that could benefit anyone’s personal wellbeing. 

Here are a couple you could try today.

Active music listening

When’s the last time you’ve actually done nothing but sit still and listen to a song? Music can be a very effective way to clear our minds and to manage stress. change that, try active music listening. Pick a song you enjoy, and pay attention to one musical element at a time like tempo, melody, harmony, sound of the instruments, and loudness. Identify which instruments are being used, then pay attention to the rhythm of each instrument. What does each sound like, and how do they play off of each other or play in unison? Listen for the lyrics, and decide if the lyrics match the overall “mood” of the song. When practicing active music listening, you may find yourself completely immersed in the music and not everything else pinging in your brain.

Create a life soundtrack 

To practice music intentionality, you could create a life soundtrack. Identify songs that represent certain life events — positive or negative ones — or certain people. Look for songs that represent your past, your present, and how you see your future. They can be songs that have a deep meaning for you, describe something about you, or tell a story that resembles a situation you’ve experienced. Who knows, making a life soundtrack might help you develop some insights about your past or present that you never realized. It has for me. 

Click to find more information about music therapy or to find a local music therapist or click for more information about music therapy research.