For 7 years now, music therapy has been part of the Center for Public Support “St. Sofia” of For Our Children Foundation. Every Friday on the first floor of our Early Childhood Development Complex in Sofia is noisy in the best way – one can hear the sound of musical instruments, singing and often the genuine laugh of a child.

This is happening thanks to Rositsa Nikolova, our music therapist. We talked with her about the essence of music therapy, how her professional experience lead her to this and how music therapy is developing in Bulgaria. Read the interview to learn more about this highly effective method of supportive therapy.

What is music therapy and where is it used?

Music therapy is a relatively young discipline worldwide, but it already finds a place in treatment and prevention in more than 40 countries worldwide. Since the 1950s, it has been developed as an evidence-based scientific discipline established in the health community. It is a supportive therapy method and is used in somatic medicine and psychotherapy. In clinical work we use the so-called “clinical music therapy” that accompanies primary rehabilitation or primary treatment. In psychotherapy, it is widely used in cases of psychological and emotional suffering and difficulties.

Music acts as an intermediary between the client and the therapist, opening a space in which their communication takes place. The interaction can unfold in different ways: through playing instruments, using voice, dancing, moving, composing, using speech, writing songs, etc. The aim is for the client to be accepted, supported and encouraged to express oneself, interact and communicate, as well as to meet their needs (physical, mental, emotional and social), with the aim of improving their quality of life by restoring functions, reducing deficits and developing potentials.

The benefits of music therapy have been proven in numerous studies conducted on clients of different ages and with different deficits. It is beneficial at any stage of a person’s life – from birth to late age. It is effective for people who have suffered a stroke, heart attack, patients in a coma, dementia, Alzheimer’s disease and other neurological diseases; in people with autism spectrum disorders, genetic diseases and children with special educational needs. Also in states of anxiety, crises, with clients wishing to resolve an urgent life problem or to release traumatic memories and deal with negative feelings and emotions.

How did you personally turn to music therapy as a method?

Music has been present in my life since I was a child – in my school years as a member of the Children’s Radio Choir of the Bulgarian National Radio, and during my student years at the “Pancho Vladigerov” National Academy of Music, where I graduated with a master’s degree in classical singing.

After years of touring the world, I came to a point where I needed a change and a new direction. It was at this time that I heard about the existence of music therapy and became intrigued. In 2012, I was accepted into the training program of the Music Therapy Institute – Sofia, where I went through several years of training, including theoretical and practical modules, as well as mandatory individual and group supervision, in accordance with the European standards and requirements. That’s how I got certified as a music psychotherapist.

For which children is music therapy suitable?

Children respond to music from an early age. Whether they have special needs or bot, music reaches their emotional world in a natural and gentle way. The most effective way to work with children is through play.

Music games are a source of joy. Through them, skills and habits can be built, imagination, musical memory, rhythm can be developed, independence and creativity can be provoked. A number of studies prove the influence of music on brain functions. Music interventions affect behavior, emotions and movements, social and communication skills.

Music therapy is suitable both for children in norm and for those with autism, Rett syndrome, Asperger syndrome, Down syndrome, cerebral palsy, fragile X syndrome, in children with attention deficit, oncological problems, mental retardation, behavioral and emotional difficulties, learning difficulties, etc.

Music therapy cannot cure, but it can alleviate the condition, support self-expression, improve communication and social skills, develop concentration, gross and fine motor skills, coordination of movements, speech and language.

By expressing their emotions, children can feel supported, respected and cared for, develop the ability to share as well as listen and switch from one activity to another. In working with the voice, they can also develop their skills of using it.

How does one music therapy session go?

Music therapy can be applied individually or in groups. The session can be held both in private practice and in hospitals, social homes, hospices, mental health centers, schools, kindergartens, etc. The music therapist can also visit the client’s home if he is unable to leave it.

In sessions with children, there is an initial interview with the parent/s, during which I get to know the current symptoms and the stated reason for seeking music therapy; with the family environment, habits, characteristics and activities of the child. What matters is the parent’s request and expectations and how realistic they are. A child doesn’t need to have musical skills to participate in a music therapy session.

The session usually takes place once a week in the same secure space. The duration for younger children is 30 minutes. It is important that the session has a structure and framework. There is a song for “Hello” and one for “Goodbye”.

Depending on the intended goals, I use different interventions. Clinical improvisation is appropriate for non-verbal children. It is a way for the child to express itself, to connect with others. Through various musical games we improve the ability to interact and wait their turn to perform.

During a session, I use my voice a lot – it is the most impactful tool for children, through which many of the therapeutic intentions and goals are carried out. Even non-verbal children are provoked and use different sounds to communicate and express their current emotional state. This is the beginning of vocalization, of channeling these sounds into syllables.

In my practice, I have seen how, provoked by musical activities, non-verbal children utter their first words or, in other cases, children with movement difficulties learn and master new ones. Children with eye contact deficits hold their gaze on the therapist during the session. There are many examples of the beneficial impact that music therapy has on child development. There are children on the autism spectrum who respond by covering their ears to certain frequencies or melodies, but there is always a way for the music therapist to reach the little client.

After the session is over, I usually give feedback to the parent on how it went, and I can also give directions for work at home. Writing reports and team discussions with the therapists working with the child is also of great importance.

How did you cross paths with For Our Children Foundation?

My first meeting with For Our Children Foundation took place in 2016, when Senior Early Childhood Intervention Expert Raya Tsvetanova contacted the Music Therapy Institute – Sofia with a request for a music therapist to work with children who are clients of the foundation. After an interview, I was approved and took on the challenge of working with children with special needs.

For seven years now I have been part of the wonderful team of For Our Children Foundation, where I hold sessions once a week with children aged 2-6 years.

I thank the foundation for the trust, the wonderful base and specialists with whom we work as a team in each case. The work is sometimes quite challenging, but it gives me inspiration and meaning, especially after seeing positive change and development.

How is music therapy developing in Bulgaria?

The Bulgarian Association for Music Therapy was founded in the spring of 1995 in Sofia. The first specialists were trained between 1999-2004 in correspondence with the approach Music and Imagery and Music-Guided Imagination at the Art Therapy Institute in San Francisco.

BAM is a group member of the Bulgarian Psychotherapy Association, and in 2003 it was accepted into the European Confederation of Music Therapy. From the same year, music therapy trainings at BAM began, and in 2009 the training program was approved and accepted by BAP.

Today, the training program is carried out at the Music Therapy Institute – Sofia, led by Lilia Ahtarova and Prof. Nadezhda Vitanova. Two specialties can be acquired at MIT-C: “Clinical Music Therapist” and “Music Psychotherapist”.

I am currently a qualified member of BAM and a member of the Board of the Bulgarian Association for Music Therapy. I work individually and in groups with children and adults with temporary and permanent disabilities, with children with autism, genetic and motor needs, I make art sessions for children with a psychological and social focus. I also work with adults with Alzheimer’s and dementia and other age-related changes. I have an individual practice with clients using psychological and art therapy approaches, self-discovery and support groups.

At the moment, I am also studying in a master’s program at the Neofit Rilski University of Blagoevgrad, majoring in Clinical Psychology.