Marcia J. Lajoie, MM, MT-BC is a music therapist and music educator at Massachusetts Hospital School serving children age 7-22 with multiple disabilities. Beyond holding traditional music therapy groups and individual sessions, she has formed a relationship with the Hospital School’s Pain Management Team to offer alternative strategies for patients. This AMTA.Pro Symposium begins with an informal conversation with Pain Management Team members talking about the evolution of the group. The symposium continues with an excerpt from an actual session illustrating the collaboration between professionals with guided meditation storytelling accompanied by improvised music. Following the brief session excerpt, music therapist Marcia Lajoie shares some observations from that session and about the therapeutic collaboration.


A Therapeutic Collaboration

Using Music, Movement, and Storytelling

Marcia Lajoie, MM, MT-BC

AMTA.Pro Symposium

August, 2010

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I. Flute introduction from guided meditation session

II. Informal conversation between Marcia Lajoie and Isabel Balmesada introducing AMTA members to the Massachusetts Hospital School and to the nature collaborative work in the Pain Management Program at the hospital school

Overview of Music Therapy at Massachusetts Hospital School

Massachusetts Hospital School, located in Canton, Massachusetts, is a Department of Public Health Facility serving children and young adults 7 to 22 years of age with multiple disabilities. Patients are admitted based on medical need and care. The majority of patients are residential during the week. Educational Services are provided to all patients through the Department of Elementary and Secondary Education.

The Music Therapy Program at Massachusetts Hospital School, created in 1999, works collaboratively with classroom teachers and other therapists to address and reinforce IEP goals. The Music Therapy program also provides opportunities for patients to participate in performing groups such as band, chorus, rock ensemble, switch ensemble, and drama.

Collaboration with Pain Management Clinic

The Pain Management Clinic at Massachusetts Hospital School was created in 1996. Music Therapy and Pain Management have been working collaboratively since 2004. Initially, two peer groups were formed with up to 4 patients in each group to assist patients with managing physical and emotional pain and with finding creative ways for self-expression. Patients are now referred by the medical team for 1:1 or group music therapy and pain management services.

Strategies utilized in Music Therapy and Meditation Peer Groups

Documentating therapy. Upon entry to the music therapy room, pre and post evaluation scales (rated 0 to 10) are used to objectively measure any change in four areas: Physical pain/tightness/discomfort, emotions, energy, and/or stress.

Getting Comfortable. Every effort is made to facilitate comfortable positioning for each individual prior to the guided meditation session.  This includes things such as tilting the wheelchair, taking off shoes and leg braces, or other comfort-inducing steps. Therapists also make certain the room environment, lighting, and temperature are conducive to relaxation.

Journey In and Noticing. At the beginning of the guided meditation, the patients in the peer group are encouraged to focus inward on their breath, their physical sensations, or their emotions They are then guided into a story that will help them visualize and explore internal sensations and the need to move any blockages or areas of tension. This allows the patient to acclimate to their surroundings and to focus on their individual physical or emotional needs.

Meditation/Storytelling. This process of weaving a story is improvisational and without a recipe. Story themes may include the season of the year, nature, animals, places, and contrasting emotions such as fear/anxiety and calm/peaceful.  The improvised music follows the story and provides a richer, deeper, and more supportive framework for individuals to create their own story within the story.

Improvised music

The music during sessions is improvised. The responsibility of the music therapist is to notice, listen to, and be aware of the patient’s posture, breathing, muscle tone, facial expression, and eye contact. The first note or phrase needs to connect to the patient. Based on observation, the music therapist  determines the intervals, key, tempo, volume, and rhythmic pattern. A melodic theme emerges as the therapist observes the patient and supports their movement. The movement and music together create a story.

Improvised music and movement during and after guided meditation

Solos. After the group meditation, there is often a short debriefing of the experience.  Any individual who wants a solo is given a chance to create a movement piece with musical accompaniment, a musical piece with an instrument, a poem, a story, or any combination of these. They may also chose to have the music therapist accompany them on the piano, flute, drum, or guitar. The rest of the group witnesses and supports the individual in the solo. A discussion of the experience is vital in anchoring the transformation that often occurs for the individual and the peer group members.

Creative and Expressive Movement. Expressive movement is also encouraged in the guided meditation or in a solo piece.  It is a way to communicate without words and to release tension and blockages.  The music therapist must be a keen observer,  following, supporting and helping expand this form of creative communication with the body, mind and spirit.

III. Excerpt from a Music Therapy and Pain Management session

Pre-treatment Pain Scale. The patient reports sadness at #8, with 10 being the most sad.

Meditation story. The storyteller focuses on sections of the body and releasing tension. She has been creating a visualization of taking tension and “letting it flow downward” and releasing it to the earth. The music therapist is following the story with her flute helping to enhance visualization. The script below is an excerpt from the improvised narrative.

STORYTELLER:  “…..It (earth) mixes it and stirs it and it creates something new that can grow.”

FLUTE enters

STORYTELLER:  “I am noticing something, my sadness, my tiredness.”

“My sadness would flow down like tears if I would let it”

FLUTE enters

STORYTELLER: “The tears would run down my cheeks, my chin, my chest, like rain off the leaves on the trees.”

FLUTE enters

The meditation story continues focusing on the individual who has expressed sadness and the “need to cry.”

Closing the guided meditation. Flute plays at the close of a guided meditation focusing on an individual’s need/request to express sadness. The patient is making subtle movements with fingers and hands.  His breathing is deep.

Discussion. Questions after the story segment allow individual to explore issues. How did that feel? Did the music take you somewhere? In response to the cue to describe what is going on inside, the individual said his “heart was tight.”

Post treatment. The individual indicated a sadness level #1 on the Pain scale, with 10 being the most sad. The session ends with the patient creating a movement story using piano to accompany and support his movements.

IV. Informal reflections from music therapist about the collaborative pain management session.

AMTA.Pro Symposium Speakers

Marcia Lajoie, MM, MT-BC received her Bachelor of Music Degree from the University of Massachusetts/Amherst in 1986 and completed her Master of Music in Music Therapy from the University of Miami in 1991. Marcia holds a Massachusetts teacher’s license and has taught classroom music and instrumental/band in the public schools in Florida and in Massachusetts.  She worked as a music therapist at the W.E. Fernald Developmental Center in Waltham, MA, and has worked as a music therapist since 1999 at the Massachusetts Hospital School in Canton, MA.

Isabel (Peggy) Balmaseda, M. Ed., A.B.T., Lic. Ac received both her undergraduate and graduate degrees in Physical Education and Movement Education, and graduated from the New England School of Acupuncture in 1996.Isabel has been the head of the Pain Management Clinic at Massachusetts Hospital School (MHS) since 1996. She is bridging her many years of experience as a movement educator with Asian Medicine and the expressive arts. Her approach to healing incorporates the use of storytelling, guided meditation, expressive movement, and live improvisational music by a music therapist as the major tools for self-expression and self-discovery.  Isabel highly values her collaboration with two music therapists, both at MHS and Perkins School for the Blind.

Carolanne Oller, B.A., A.B.T. began her studies of Chinese Medicine in Taiwan in 1992 and has been practicing Asian Bodywork, Tai chi, Chi Gong, and Meditation since that time. For the past 6 years she has been studying Meditation and Vibrational Medicine with Native American teachers. She co-developed the MHS integrative Pain Management clinic, and maintains a private practice, teaching in Brookline, MA.


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Acupuncture School- New England School of Acupuncture, 150 California Street, Newton, MA. 02458. Phone: 617-558-1788. Web:

Acupressure School – Acupressure Therapy Institute, 1 Billings Road, Quincy, MA. 02171. Phone: 617-697-1477. Web: