Culturally Adapted Music Therapy for Preterm Infants

A well-trained and experienced music therapist (HF) formulated individualized, culturally adapted treatment plans based on an initial child–parent assessment, which included assessment of parental needs, musical heritage, culture, context, and parental integration in the therapeutic process. The therapist individually adapted the aims over the course of hospitalization in accordance with the principles of neonatal music therapy and family-integrating care approaches (Haslbeck, 2014 ; Haslbeck and Hugoson, 2017 ; O'Brien K et al., 2018 ). Therapy sessions started immediately following parental consent, two to three times per week in the morning after feeding time. Each CMT intervention lasted approximately 20 min and was directed to the infant at the bedside alone or with the parents in skin-to-skin contact. Each infant received a minimum of eight sessions of CMT, since this is the recommended number of sessions suggested to measure a therapeutic effect (Hanson-Abromeit et al., 2008 ). During the CMT session, the infant was lying in the incubator or in warmers. Mostly, when the infants tolerated touch, the session started with an initial touch, for instance of the head and feet, which was transformed into therapeutic touch to offer contact and to feel and stimulate the breathing rhythm of the infant (Haslbeck, 2014 ; Hanley, 2008 ). After an initial period of observation, the humming was faded in smoothly, starting with some long, calm notes developing over time into a smooth melody in lullaby style. The humming and singing were individually tailored to the breathing rhythm, facial expression, and gesture of the infant. The families’ musical heritage and culture were addressed by integrating musical preferences into the improvisation, for example by incorporating the parents’ favorite song (e.g., folk song of their culture, pop song) in lullaby style (Loewy et al., 2013 ). At the end of the session, the music faded out smoothly, and the therapist cautiously removed her hands.
During therapy with the parents, the humming and singing was provided in the same manner, but the infant was placed on the parent's chest in skin-to-skin contact or, when the infants were older, on the parent's lap. Additionally, a vibro-acoustic monochord2 was used to accompany the singing and to fade the music in and out. This was placed at the elbow of the parents to allow its vibrations to transmit relaxation, particularly to parents still in a post-traumatic state. The parents were invited to relax, to observe their infant, or to sing along with the music therapist and were empowered to hum to their infant in general. If appropriate, the music therapist shared her perceptions of the infant's behavioral state and reactions (e.g., smiling, finger movements, if these occurred) to encourage positive and sensitive parent–infant interactions to empower the parents and parent–infant attachment. Before hospital discharge, the music therapist provided a final consultation and debriefing discussion with the parents, including therapeutic recommendations and offering music consultation for the first year of life (Fig. 1) (Haslbeck et al., 2017 (link)).Fig. 1

Creative Music Therapy with preterm infants and their parents. Responsiveness, communicative musicality, and empowerment via infant-directed humming/ singing and relaxing monochord sounds.

Fig. 1