Receptive Music Therapy: Healing Through Listening

Overview

Receptive music therapy constitutes the second major approach of clinical music therapy. Unlike the active approach where the patient produces music, here the patient listens to musical works carefully selected by the therapist. But this listening is far from passive: it is a complete therapeutic act that mobilizes attention, free associations, mental imagery, bodily resonances, and deep emotional processes.

The receptive music therapist is an expert in musical programming, familiar with a vast repertoire — classical, world music, jazz, contemporary, electroacoustic — and knows which musical parameters (tempo, mode, timbre, dynamics, density) produce which psycho-physiological effects. They compose listening sequences called "musical montages" whose emotional architecture is designed according to the therapeutic objective.

Directed Listening and U-Shaped Musical Montage

The U-shaped musical montage is the foundational technique of receptive music therapy. It is a sequence of 3 to 5 musical excerpts (total duration: 15-25 minutes) arranged along a precise emotional curve:

1. Descending phase (relaxation): calm pieces, slow tempo (60-70 BPM), major or modal mode, soft timbres (strings, flute, harp). Objective: lowering vigilance, muscular relaxation, slowing heart and respiratory rates
2. Low point (emotional activation): the central excerpt is the most emotionally engaging. It may be deep, profound, destabilizing — this is when defenses are lowest and deep emotions can emerge
3. Ascending phase (recovery-relaxation): gradual return to serenity. Brighter pieces, slightly faster tempo, harmonic resolution. The patient gently returns from their inner exploration

The choice of excerpts is personalized through a psychomusical assessment conducted at the beginning of treatment, exploring the patient's sound identity: musical preferences, associated memories, particular sensitivities.

GIM Method (Guided Imagery and Music)

GIM (Guided Imagery and Music), developed in the 1970s by Helen Bonny, American psychologist and musician, is the most in-depth form of receptive music therapy. It is a full psychotherapeutic method using classical music as a catalyst for an expanded state of consciousness in which the patient explores their inner world through mental imagery.

The classical GIM protocol includes: a prelude (focused interview), induction (deep guided relaxation), music listening (30-45 minutes of classical music during which the patient describes emerging images in real time), return to waking state, and postlude (integration through drawing, writing, or dialogue). GIM requires specialized training of at least 3 years and is indicated for anxiety disorders, grief, complex trauma, psychosomatic disorders, and deep personal development.

Clinical Applications

Chronic and Acute Pain

Receptive music therapy is one of the best-documented approaches in pain management. Mechanisms include attentional distraction, endorphin release, endogenous opioid system activation, and anxiety reduction. Cochrane meta-analyses show significant reductions in pain intensity and analgesic consumption in patients listening to music perioperatively.

Pre-operative Anxiety

Musical listening in the 30 minutes preceding surgery significantly reduces anxiety (STAI scale), heart rate, and systolic blood pressure. Several operating theaters now integrate receptive music therapy into their patient preparation protocols.

Palliative Care

At end of life, receptive music therapy offers a space of comfort, dignity, and emotional connection. Listening to personally meaningful music facilitates reminiscence, verbalization of emotions related to death and the meaning of life, and quality of relationships with loved ones.

Neonatology

Receptive music therapy in neonatal intensive care units is a rapidly developing field. Listening to lullabies sung by the mother, gentle music at low volume, or recorded maternal heartbeats stabilizes the premature infant's vital parameters, improves feeding, and promotes weight gain. The maternal voice is the most effective stimulus.

Contraindications

• Hyperacusis and acute tinnitus: adapt volume (very low), frequencies (avoid piercing highs), and listening duration
• Acute psychosis: the altered state of consciousness induced by certain techniques (GIM) may be destabilizing. Prefer short, structured listening sessions without deep relaxation induction
• Severe dissociative disorder: GIM is formally contraindicated as the altered consciousness state may trigger dissociative episodes
• Traumatic music triggers: certain music may reactivate traumatic memories. Musical history assessment is essential to identify these risks
• Severe depression with suicidal ideation: melancholic music may worsen depressive rumination. Repertoire choice must be particularly careful