HONG KONG BAPTIST UNIVERSITY DEPARTMENT OF MUSIC A DESCRIPTIVE STUDY OF THE PRACTICE OF MUSIC THERAPY IN HONG KONG By LAM HOI YAN April, 2007 04002865 ABSTRACT The purpose of the study was to examine the development of music therapy in Hong Kong. Specifically, a number of related issues were studied including definition of music therapy, the origin of music therapy, the recent developments in music therapy in China, establishment of a music therapy session, and the setting of therapeutic goals and the use of techniques in the professional practices of music therapy. Data were obtained by interviewing local music therapists, focusing on the urrent professional status and practice of music therapy in Hong Kong. Finally, this paper evaluated the challenges of developing music therapy in Hong Kong in the contexts of Hong Kong’s culture and society. ACKNOWLEDGEMENTS I am deeply appreciative of Prof. Manny Brand for his guidance and assistance in producing this thesis. He has inspired me and made me aware of the possible I am ways to get the work done when I was quite confused at the initial stage. grateful to him for his useful advices and encouragement. I am indebted to the following music therapists for their participation in nterviews, support and suggestions on this project: Raymond Ng, Ivory Chan, Andrea Chan, Joanna Chan and Yasmin Li. It is my great pleasure to know all of them. Last, but by no means least, I wish to thank my dear parents for the love and support they have given to me so freely throughout my life, for the musical opportunities that they made available to me as a child, and for teaching me to do my very best in everything I undertake. TABLE OF CONTENT CHAPTER I Definition of Music Therapy Historical Use of Healing in Music Recent Development of Music Therapy in China 1 3 5 12 CHAPTER II
Music Therapy as a Professional Career Music Therapists working in Hong Kong Organizations Providing Music Therapy Service Main Population of Clients and Locations of Service Delivery Literature on Music Therapy Requirements of being a Music Therapist Certification/ Licensing 16 16 18 21 23 25 27 29 CHAPTER III Establishing a Music Therapy Practice Goals of Music Therapy Selected Music Therapy Techniques Use of Music in a Music Therapy Session 30 30 32 35 38 CHAPTER IV Traditional Chinese Beliefs and Attitudes toward Disabilities Professional Status Local Health Care System 41 41 44 47 CHAPTER V Summary Conclusion Recommendations 53 53 55 56
APPENDIX A APPENDIX B BIBLIOGRAPHY 58 60 77 1 CHAPTER I INTRODUCTION: ORGIN OF MUSIC THERAPY Music is an art deeply rooted in human nature. From the ancient to the present, music seems to be the essential part of human beings and musical activities are indispensably to human’s life. It is no doubt to say that music has traditionally been regarded as an enjoyable, pleasurable, and aesthetic experience, furthermore, it is seen inherently throughout the history that music as a therapeutic tool. For example, singing, chanting, dancing and drumming in spiritual and ritual ceremonies were common and usual in almost every tribal societies.
These activities served as a connection to higher spiritual forces and music is thought as a therapy on an unconscious level in such phenomenon. Turning music therapy into a profession has resulted from contribution of pioneers in the United States since 1960s. The profession of music therapy had been growing fast and blossomed in most European countries in the subsequent few decades. As music therapy leaders traveled around the world and promoted music therapy, it later came to Asian countries like Japan and Taiwan. In the past decade, many Asian music therapists who were trained abroad returned to their homeland and practiced music therapy.
Music therapy first came to my attention as I saw a television program about 2 music therapy in Hong Kong broadcasted in 1998. The way music helped children with autism, Down syndrome and physical disabilities amazed me a lot and inspired me to want to become a music therapist. therapists in Hong Kong. At that time, there were only three music There are twelve registered music therapists practicing locally at the moment, serving a more diversified population of clients including people with autism, developmental retardation, emotion problem, cancer, as well as psychiatric patients and geriatrics.
The increasing number of specialists in the field and the popularity of music therapy over the ten years have shown that interest in and demand of the subject among the general public and the professionals had grown a lot. This paper is going to describe and analyze the practice of music therapy and evaluate this profession as a possible career in Hong Kong. It will investigate the function of music therapy, look into the common therapeutic techniques used in music therapy practice and study the limitations of and prospects for music therapy in Hong Kong.
By interviewing with current music therapists, evaluation of the status and function of music therapy in Hong Kong will be shown in. In the last section, discussion on the challenges of developing music therapy and suggestions on further developing music therapy in Hong Kong will be drawn in the following context. 3 Very little research has been done on music therapy locally. There was one thesis titled The Use of Music Therapy In The Treatment Of Autistic Children With Special Reference To Hong Kong written by Jennifer Poh Tse-tse in 1997.
This original research provided an historical, descriptive and bibliographical study of music therapy in Hong Kong, including 5 case studies of music therapy as a treatment for autistic children (Poh, 1997). With reference to Poh’s thesis, this paper will assess the growth and application of music therapy over the past 10 years in Hong Kong. Definition of Music Therapy Defining music therapy is very difficult as music therapy only has a few decades of history. In fact, it is still developing into a discipline and a profession.
Although there are many definitions published by music therapy associations and individual therapists in different areas, none of them is thought as a universal definition. According to Brusica (1998), music therapy has different meanings to different people. The term “music” is difficult to define by philosophers, The interdisciplinary psychologists and musicologists due to cultural differences. nature of music therapy blurs the boundaries of music therapy. As an art, a science, and an interpersonal process, music therapy can be both objective and subjective, individual and universal, creatively unique and replicable, intrapersonal and interpersonal, collective and transpersonal. Due to the challenges in defining music therapy, Brusica proposed a working definition which implies that the process of defining is undergone. This working definition is a theoretical one for professionals and students to examine conceptual issues involved in defining music therapy: Music therapy is a systematic process of intervention wherein the therapist helps the client to promote health, using music experiences and the relationships that develop through them as dynamic forces of changes. Brusica, 1998) Another definition is constructed by the American Music Therapy Association (AMTA) which is the largest and leading professional association in the world. Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. (American Music Therapy Association definition, 2005) Both definitions project a professional identity and specify the body of knowledge, skills and abilities required in the field.
Brusica’s one informs the audience of the goal of music therapy that promotes health while the term “individualized goals” from AMTA’s definition is too general as an accomplishment of the therapeutic aim. A further definition published by the Association of Professional Music Therapists (the United Kingdom) explains how music therapists achieve the therapeutic goal by: 5 …As a general rule both client and therapist take an active part in the sessions by playing, singing and listening. The therapists do not teach the client to sing or play an instrument.
Rather, clients are encouraged to use accessible percussion and other instruments and their own voices to explore the world of sound and to create a musical language of their own. By responding musically, the therapist is able to support and encourage this process. The music played covers a wide range of styles in order to complement the individual needs of each client. Much of the music is improvised, thus enhancing the individual nature of each relationship. Through whatever form the therapy takes, the therapist aims to facilitate positive changes in behaviour and emotional well-being.
He or she also aims to help the client to develop an increased sense of self-awareness, and thereby to enhance his or her quality of life. The process may take place in individual or group music therapy sessions. (APMT, 2006) To summarize, the objective of music therapy is to help clients maintain physical and mental health through a series of treatments by a professional music therapist. The above three definitions, which are often cited by music therapists and scholars, not only explain what music therapy is, but also establish a new perspective or approach to conceive of.
Given all of the challenges inherent in defining music therapy, any upcoming new definitions would be an opportunity to broaden and deepen the understanding of music therapy. Historical Use of Healing in Music Using music as a healing tool is not an innovative idea to fight against disease and promote health, despite it is still a comparatively young profession. Since ancient times, music has become an essential element in human life. Ancient 6 people used music and dance as a universal language to express themselves and interact with each other.
In both western and eastern cultures, people made music in connection with spirit to expel disease. Now, discussion of the relationship of music and healing during the primitive and ancient cultures, the Greek and Roman cultures, the Middle Ages and Renaissance, the Baroque Period, the mid 18th century through 19th century and the 20th century period will be made in the following context. Primitive and Ancient Cultures Primitive people believed that the universe was controlled by magical forces or spirits. At that time, people suffered illness was regarded as a victim under a spell f an enemy, or viewed as a sinner who was punished by gods due to his unfaithfulness (Davis, 1992). As a result, the shaman, or a witch doctor, played an important role in earliest tribes of primitive African and American Indian. The “medicine man” was indeed the tribe’s chief musician, doctor and priest (Peters, 1987). Peters mentioned that the musician or the healer would determine the cause of the disease and apply the appropriate therapy to drive the spirit or devil from the patient’s body. During the ritual ceremony, drum rhythms, bells and chants were used in communicating with the invisible world (Hamel, 1979).
Another magical use of music was illustrated in the life of Hebrews. The 7 ancient Hebrews realized that music could have calming effects on people. According to I Samuel 16:14-23 from the Bible, an evil spirit troubled King Saul and his servant sent a man, David, who was a professional harp player, to kick the devil out from Saul. The harp music that David played calmed Saul and made him feel better. (Peters, 1987) Ancient Greek and Roman During the time of the ancient Greek and Roman, people had fundamental ideas on the knowledge of mathematics, philosophy, medicine and music.
The Greeks attributed illness to disharmony in a person’s being, rather than disturbance of the supernatural powers. Music, with its ethical and moral power, could be used to bring a person’s being back into a state of harmony and order and thus promote health (Peters, 1987). The Greek philosophers Plato and Aristotle, were regarded as the pioneers of music therapy. Both of them suggested that there was a profound effect on the health of the whole person with a carefully-controlled use of music (Alvin, 1975; Peters, 1987).
Likewise, the Romans also believed the healing power of music. Music could help curing snakebites and insomnia, and resisting plagues. Celsus, who was a prominent Roman artist in medicine, suggested that mental illness such as melancholy thoughts should be alleviated by using music, cymbals and sounds 8 (Peters, 1987). Roman times. The therapeutic use of music that the Greeks applied continued in During the fall of the Roman Empire, their scientific thinking sank into the Dark Ages with merely a rational conception of music therapy (Alvin, 1975).
Nevertheless, music still played an important role in religious rituals and magic healing. The Middle Ages (1100-1500 A. D. ) Similar to the Greeks, Boethius was an another influential authority on music in the early Middle Ages who had written a book titled De institutione musica (The Fundamentals of Music). He regarded that music exemplified the principle of Boethius strongly stated that music order in the universe (Grout, 1996, P. 29). affected human character and morals, given that music could have either favorable or unfavorable effects on the health and harmony of body and soul (Peters, 1987).
No matter why music became so important in education, holding a place in the four highest subjects in the medieval educational system (Grout, 1996). The Renaissance (1450–1600A. D) Both medical and musical achievement hit a big milestone during the Renaissance. The Renaissance people inspired by the preceding Greeks, regarding . health as a state of harmony and disease as a state of disharmony (Peters, 1987). 9 The new discovery of anatomy gave a huge room for investigation on human body. This advance had a significant impact on all remedial means, including the use of music in medicine.
Hence doctors could apply certain kind of music properly to The effect of music restore balance and health in body and spirit of their patients. on their patients and on its application in medical treatment were documented well as there were quite a lot of doctors, who were interested in music, writing essays on this. Music became a way of self-expression and a communication tool between As a result, music opened a gateway for composers, performers and audience. social gathering in the village and at Court (Alvin, 1975). The Baroque Period (1600 – 1750A. D. )
During the Baroque Period, people believed that music affected their emotion. It was illustrated in the writing of a famous English poet, William Shakespeare, so that the power of music to affect human beings was deeply penetrated in his words. “The man that hath no music in himself, Nor is not moved by concord of sweet sounds, Is fit for treasons, stratagems and spoils…” – SHAKESPEARE Furthermore, a German scholar Kircher (1602-1680) deduced a theory of temperaments and affections, advocating the use of music as a therapy. He believed that various styles of music served as distinguished functions for treatment.
Therefore, choosing a correct style of music was a key of success in treating illness (Davis, 1992). 10 The Mid 18th Century through 19th Century Due to the rising medical knowledge in physiology and neurology, claims on the power of music were examined rationally starting from the late 18th century. A lot of research was done on the purely physiological effect of music, stating a relation between bodily and musical rhythm, pulse and musical beat. The writers found that music affected human’s breathing, blood pressure or digestion.
One writer, Richard Browne, believed that singing affected the motion of the heart, the circulation of the blood, the digestion, the lungs and breathing (Alvin, 1975). Esquirol, a renowned psychiatrist, wrote a book titled Insanity in Mental Maladies in 1748. 1987). He regarded music as “a valuable remedial agent” (Alvin, 1975; Peters: In 1846, Dr Hector Chomet wrote a treatise on “The Influence of Music on Health and Life”, which was later presented to the Paris Academy of Sciences, stating the use of music as a help in the prevention and treatment of illness (Alvin, 1975).
During the 19th century, special education teachers began to use music as a therapeutic activity in class for visually handicapped and hearing impaired students in the United States (Darrow & Heller, 1985). The 20th Century The technological explosion in 20th century encouraged the scientific study of 11 the therapeutic effects of music. People started to conduct experiments with both human and animals to see the changes in behaviors according to various types of music. An experiment of playing 30-minute piano music to 1,400 psychotic The aim was to patients was carried out in the New York City asylum in 1878. erify if music could be acted as a tranquilizer. Although no concrete conclusion was drawn afterwards, the experiment led to a more open attitude towards music therapy. (Peters, 1987; Graham, 1974) Due to the arrival of the phonograph around the turn of the century, playing recorded music in hospitals became popular and convenient as a therapeutic tool for inducing sleep, calming fears from medication operations (Taylor, 1981). During World War I, music was used to help military patients in doing rehabilitation exercises for joints and muscles (Tyson, 1981).
Understanding the demand of using music in hospitals increased during World War I, Isa Maud Islen, a Norwegian immigrant with an extensive background as a nurse, hospital administrator and music director, founded the National Association for Music in Hospitals in 1926 (Graham, 1974). Afterwards there was an increasing use of music in hospitals for huge numbers of soldiers wounded in World War II. It was found that not only did music boost the morale among patients, but also facilitated the recovery process (Tyson, 1981). 12
The high demand of hospital musicians with basic clinical techniques led to the development of college-degree programs in music therapy (Peters, 1987). Therefore, the first curriculum was established in 1944 at Michigan State University to train music therapists (Schneider, Unkefer, & Gaston, 1968) and the National Association for Music Therapy (NAMT) was formed in 1950 to provide standards and regulations for music therapists in the United States (Lathom, 1980). The American Association for Music Therapy (AAMT) was founded separately in 1971 due to philosophical differences.
In January of 1998 the unification of the two associations came into reality and the American Music Therapy Association (AMTA) was born (Forinash, 2001). Recent Development of Music Therapy in China Before looking into details on the music therapy in Hong Kong, this paper is going to examine music therapy from a national perspective. The following Table 1. 1 summarizes the major events of music therapy development over the past decade in China. 13 Table 1. 1 Major events of music therapy development in China Year 1994 1997 Sequence of Events The China Conservatory of Music started the Master Degree of Music Therapy. Gao, Tian (?? ), the first music therapist who received music therapy training and registered in the United States, returned to his home country and practiced his profession. Gao, Tian established the Institute of Music Therapy in the Central Conservatory of Music in Beijing. 1998 The Central Conservatory of Music launched the first Master Degree of Music Therapy. Professor Tian Gao has been the department head of Music Therapy since then. The Central Conservatory of Music started the Bachelor Degree of Music Therapy. The Sichuan Conservatory of Music started the Bachelor Degree of Music Therapy.
The website of the Chinese Music Therapy Association (CMTA) was available online, providing a channel to access articles and news about music therapy and presenting a standard of music therapist as a professional. 2003 2004 2006 Apart from the three conservatories of music, music therapy divisions have been set up separately in Shanxi Medical College, Jiangxi College of Traditional Chinese Medicine and Fujian College of Traditional Chinese Medicine, providing music therapy training for medical students. Besides, some music therapists, including Yi-bing Qiul (??? ) and Qing-qing Dao (??? , who received music therapy training in Japan had come back to China to promote music therapy in the 1 According to Gao, Tian, each year only one candidate is enrolled in the Master Degree of Music Therapy provided by the China Conservatory of Music. The course has been terminated due to nil application. After some time, the course has been re-opened and is currently taught by Cheng, Hong Yi who is not a music therapist. 14 past few years. (CMTA, 2006) Currently there are two main groups of music therapists with different viewpoints on and practices of music therapy (Chen, 2004).
One group is formed by therapists graduated overseas, advocating western strategies in applying music therapy. Another group is mainly from Chinese medical professionals, with a traditional Chinese philosophy focusing on the concepts of Yin-Yang (two opposing forces in nature, the former feminine and negative and the latter masculine and positive) as well as the five elements (air, wood, water, fire and earth). As Chen stated, the discrepancy between the two groups is similar to the difference between Western and Chinese medical practice. The best solution is to overcome one’s eaknesses by acquiring others’ strong points. No matter which methodology is applied, music therapists have to consider the characteristics of Chinese people and adopt suitable therapeutic tools in clinical practice. Other than working practically in clinics, the Chinese music therapists also committed on research side. listed below for reference. Some recent publications on music therapy have been 15 Table 1. 2 Recent publications on music therapy Title A Basis of Music Therapy ????????? Author Zhang, Hongyi (??? ) Year of Publication 2000
Research Survey of Music Therapy in Recent 20 Lu, Yin-lan & Years, Shanghai journal of tradition Chinese Lai, Wen (?????? ) medicine ?????? ?? 20 ???????????? Music Therapy ?????? An Introduction to Music Therapy ????????? Fan, Xinsheng (??? ) Gao, Tian (?? ) 2002, Volume 2 2002 2006 As the popularity of music therapy has risen in China, the increasing number of music therapists graduated will certainly grow in the future. Yet, to serve the 1,300,000,000 population in mainland, there is still a long way to go for a profession of music therapy in both theoretical and practical aspects. 6 CHAPTER II MUSIC THERAPY IN HONG KONG Music Therapy as a Professional Career Compared to the history of music therapy in the United States, music therapy in Hong Kong has a very short life span. The first private local music therapy centre was established in 1990 by Hong Kong music therapist Mr Paul Pang, Kawa who graduated from the Florida State University in 1983. Perhaps the seven-year gap that Mr Pang did not really start his music therapy service implied that Hong Kong was not ready to initiate this industry at that time. According to the recent figure in 006, there are twelve music therapists working in Hong Kong currently (see Table 2. 1). Most of the music therapists studied and acquired their professional in the United States, as indicated by their title MT-BC (Board Certificate Music Therapist) while the others registered as music therapists in the United Kingdom and Australia respectively. males. Table 2. 1 Music Therapists in Hong Kong Name Alice Kong Andrea Chan, Wing Shan Gloria Tsang Gloria Wong Ivory Chan, Yuen Man Title RMT since 1994 RMT since 1999 MT-BC since 2006 MT-BC since 2005 MT-BC since 2005 Among the twelve music therapists, ten are females and two are 7 Joanna Chan, Mei-yuk Panda Ngai, Fung Yee Paul Pang, Kawa Piera Lee Raymond Ng, Wai Man Yasmin, Li Yau Wang RMT since 1997 MT-BC since 1999 MT-BC since 1998 RMT since 1984 MT-BC since 1993 RMT since 2004 MT-BC since 2001 RMT since 2002 The Hong Kong Music Therapy Association (HKMTA) was founded in 1995 by Mr Pang, together with two other Hong Kong music therapists Ms Piera Lee and Ms Alice Kong. 2 Mr Pang, being both a founder and the first president of the HKMTA as at July of 2002, has been taking a leadership role in developing music therapy in Hong Kong. Andrea Chan, one of the past presidents of the Association, tated that its objective is: “To promote, improve and advance the use of music therapy as a unique and effective treatment modality in clinical, educational and rehabilitation settings for the betterment of the public health and health and welfare in Hong Kong. The HKMTA is the primary organization structure for the self-governance of the members in order to uphold the best professional service for the public. ” (Chan, 2005) The HKMTA holds regular meetings for Hong Kong music therapists for the purpose of sharing work experience and future planning in advocating music therapy in Hong Kong.
Raymond Ng, who is the current president of the HKMTA, suggested that more communication among therapists would be encouraging and constructive. He finds advice from colleagues invaluable when they had similar 2 Quoted from Mr Pang’s sharing, http://www. musictherapy. com. hk/Home/Monthly%20sharing. htm 18 cases, and that, stimulating new ideas to cope with different clients in providing therapeutic services. Internal support groups will be set up, not only for experience sharing and case referrals, but also to initiate collaboration among the therapists.
According to Mr. Ng, there will be upcoming events such as public seminars to promote music therapy. Music therapy is not a recognized profession within the Hong Kong Special Administrative Region, the social service or the educational system, and has not been granted an official approval (Ng, Raymond, 20 October, 2006). There is no designated music therapy position within the social infrastructure. Music therapists, instead, have been hired as contractors and have had considerable freedom to hape their music therapy practice in schools and day care centres, or working in their own private music therapy agencies. Even though music therapy has been introduced as a treatment modality, it has been met with respect and interest. Music therapy practice has also been appreciated and regarded as a viable form of therapy by parents, caretakers and health care professionals. Music Therapists working in Hong Kong To have a closer look at music therapy in Hong Kong, a semi-structured interviewing is used in this research. The interview consists of a 19 uestion-and-answer based session and a short questionnaire. A set of open-ended questions were carefully structured, to allow the researcher to obtain the relevant information about the background of the respondents and their practice of music therapy. While the short questionnaire contained scale items, illustrating the most population of their clients and the most popular location of music therapy service delivery. Out of the twelve local music therapists, five of them, Andrea Chan, Ivory Chan, Joanna Chan, Raymond Ng and Yasmin Li were invited for formal interviews.
They had been selected as respondents because they were easily accessed and willing to share their job experiences. The profiles of each informant are listed accordingly as below. Andrea Chan Wing Shan Andrea Chan is a Registered Music Therapist graduated from Australia, Sydney in 1999. Since then she works in Hong Kong as a Music Therapist specializing in early training program with children from 0-6 years old. The youngest child she has worked with was 15 months. Andrea has held different introductory music therapy workshops and talks with various organizations.
She has been interviewed by RTHK, Cable News, Creation TV, Ming Pao, South China Morning Post and has written health column in Health Plus Magazine. In January 2005, Andrea joined a Christian Medical team to Medan and Aceh, Indonesia after the tsunami. They have set up a clinic at the local refugee camp, visited the local Chinese church, school and hospital. Andrea took her music and brought joy to many children and adults while they were in their most difficult time. 20 Ivory Chan Chan graduated from the Chinese University of Hong Kong, majoring in music and minoring in psychology.
With her outstanding academic and performance achievements, she was awarded the Hong Kong Jockey Club Music and Dance Fund in 2003. She received her master degree in Music Therapy at Florida State University and registered as a Board Certificated Music Therapist in 2005. She has been practicing music therapy in various organizations, including early intervention program, special schools, psychiatric hospitals, and elderly centres. Joanna Chan Mei Yuk Miss Joanna Chan gained her Music Therapy degree in 1997 from Michigan State University, USA, where the first music therapy program was found in the world.
She was also as Registered Music Therapist in the same year. Joanna took the certification examination in 1999 and became a Board Certified Music Therapist (MT-BC). In the year of 2000, she earned her Master degree in Counseling from University of South Australia. Since she returned from the States in 1997, Joanna has been a very active Music Therapist in Hong Kong who does not only provide quality professional service for people in needed but also advocate for the professional use of music therapy.
Joanna started up her music therapy clinic, Music Therapy Developmental Centre, in 1998 and has offered lectures and seminars in such institutes as Hong Kong University SPACE, University of Chinese, and Macau Polytechnic. Joanna has conducted and released the first music therapy in Hong Kong in 2000. In the same year, her first music therapy case study book in local content was published. At present, Joanna is a doctorate student in education studying at University of Durham, UK. Raymond Ng Wai Man Raymond Ng graduated from the Hong Kong Academy for Performing Arts, majoring in Chinese Music.
He joined the Hong Kong Chinese Orchestra and Kaohsiung City Chinese Orchestra as a professional musician. He then started his career in music education, teaching Chinese instruments and counseling in schools, acquiring a rich teaching experience across a wide range, from early childhood to adulthood. Raymond showed his enthusiasm in learning by receiving his Bachelor Degree in Music with the First Class Honours, Bachelor Degree in Psychology, Master Degree in Psychology of Music and Postgraduate Diploma 21 in Music Therapy. He was also awarded as one of the Outstanding Life-long Learners in 1999.
Recently he has been practicing music therapy services and offering trainings to related employees in hospitals and rehabilitation centres, including Hong Chi Association, The Hong Kong Society for the Blind, Hong Kong Family Welfare Society, Heep Hong Society, YWCA, Po Leung Kuk, Castle Peak Hospital, and Civil Service Bureau. He has also given lectures and seminars about music therapy in the Hong Kong Academy for Performing Arts, Hong Kong University SPACE and Chinese University (Department of Music). In 2005, he was invited as a speaker of music therapy seminar at Beijing’s Central Conservatory of Music.
In the upcoming years, apart from his regular therapeutic services, he is preparing a series of practical training in music therapy, in order to assist people in-need, parents, teachers, social workers and other professionals to reduce stress, improve self-understanding and life quality, clear goals of life and achieve communication skills with children and students. Yasmin Li Received her Bachelor Degree in Piano Performance in California State University, Long Beach, Yasmin was given two scholarships, during her college years.
When she came back to Hong Kong, for more than three years, she worked as a program officer in the Arts with the Disabled Association Hong Kong, initiated and organized arts program for people with or without disabilities to participate. In 2001, graduated from the Master Degree program in Music Therapy of New York University, and passed the board examination of the certification of music therapist in the United States. Currently, Yasmin is a private practice music therapist doing a member of outreaching programs to ifferent organizations for various populations, including people with mental challenges, depression, stress, emotional disturbances, cancer, Alzheimer’s disease, as well as for those who are simply interested in music therapy. Organizations Providing Music Therapy Service In order to provide music therapy in Hong Kong, there are private music therapy agencies established by local music therapists, special schools and health care organizations funded by either the Government or charitable organizations. 22
Currently there are four private music therapy centres set up by the local music therapists. Among them, Pang’s Music Therapy Centre boasts the longest history in the professional. Table 2. 2 List of private music therapy agencies in Hong Kong Private Music Therapy Agency Do Re Mi Music Therapy Centre Korner Stone Developmental Centre Panda Music Zone Pang’s Music Therapy Centre Director Ms Yau Wang Ms Joanna Chan, Mei Yuk Ms Panda Ngai, Fung Yee Mr Paul Pang, Kawa Year Since 2002 Since 2006 Since 2005 Since 1990
Apart from the private music therapy agencies, most music therapists work as freelancers in different kinds of organizations to carry out their music therapy practice. Table 2. 3 shows the local organization providing music therapy currently. Table 2. 3 List of organizations providing music therapy in Hong Kong 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Caritas Hong Kong Haven of Hope Sunnyside School Ebenezer School & Home for the Visually Impaired Heep Hong Society Hong Kong Vocational Centre Po Leung Kuk Elderly Service Siu Lam Psychiatric Centre St.
James’ Settlement The Evangelical Lutheran Church of Hong Kong The Hong Kong Society for the Blind The Spastic Association of Hong Kong Watchdog Early Learning and Development Center Wellness Service Centre YWCA Elderly Service Department Cheng Pon Hing Hostel for the Elderly 23 Main Population of Clients and Locations of Service Delivery In this research, the local music therapists were interviewed with a questionnaire which aimed at collecting information about the main population of their clients and the locations of service delivery. The respondents were asked to ank the most frequent types of disabilities that their clients possessed among the choices given in the questionnaire. The question contained six items including Learning Disabilities, Elderly & Alzheimer’s, Developmental Delay, Physical Disabilities, Substance Abuse Problem and others. Two respondents suggested that most children with autism might be either developmental delayed or learning disabilities. However, some children might be autistic only. Besides, two therapists stated that they conducted therapy with people having psychiatric problem.
Figure 2. 1 summarizes the most frequent types of disabilities that their clients possess. Figure 2. 1 The most frequent types of disabilities that clients possess The Most Frequent Types of Disabilities 3% 1% 6% 8% Developmental Delay, 30% 30% Learning Disabilities, 14% Elderly & Alzheimer’s, 13% Physical Disabilities, 13% 13% Autism, 13% Psychiatric Problem, 8% Cancer, 6% Emotional Problem, 3% 13% 14% Substance Abuse Problem, 1% 13% 24 The most frequent types of disabilities are developmental delay and learning disabilities.
People with developmental delay or disabilities are usually mental retarded; the severity might vary according to individual. For example, a developmentally delayed child is one who is behind schedule in attaining developmental milestones. However, a developmentally delayed child usually Conversely, a person with a reaches the developmental milestones eventually. learning disability has difficulty in collecting, organizing, or acting on verbal and nonverbal information. Most commonly, the person has trouble understanding or using written or spoken language.
The difficulty is due to a neurological difference in brain structure or functioning. (Tina de Benedictis, 2005) Another question in the questionnaire identified the common locations of service delivery by the music therapists in Hong Kong. Seven items including educational facility, geriatric facility, client’s home, medical facility, psychiatric facility, private music therapy agency and others were given. Since music therapists might work at different places in a day, they could select only one place or rank the locations of service delivery accordingly. care centre under the item of others.
Two therapists proposed day As shown in Figure 2. 2, most music therapists work in educational facility, geriatric facility and day care centre while they seldom work in psychiatric facility and medical facility in Hong Kong. 25 Figure 2. 2 The most common locations of service delivery Locations of Service Delivery Medical facility Psychiatric facility Home Studio Private MT agency Educational facility Educational facility Geriatric facility Day Care Centre Client’s home Private MT agency Client’s home Home Studio Psychiatric facility Medical facility Day Care Centre Geriatric facility
Educational facility Geriatric facility Day Care Centre Client’s home Private MT agency Home Studio Psychiatric facility Medical facility 32. 3% 16. 1% 16. 1% 12. 9% 12. 9% 6. 5% 1. 6% 1. 6% Literature on Music Therapy No professional music therapy journals are published in Hong Kong; however there is some music therapy research undertaken locally. It was found that most music therapists focused mainly on their clinical work and educational work, two music therapists, Joanna Chan and Ivory Chan participated in music therapy research a few years ago.
Yasmin Li mentioned that she was planning on starting a research project on either geriatrics or cancer patients soon in 2007. 26 The Effects of Singing on PMR (Profound Mentally Retarded) Students’ Classroom Participation in Hong Kong was the first music therapy research done by Joanna Chan in 2002. The project, supported by the Quality Education Fund, was implemented at Haven of Hope Sunnyside School which provides holistic education and training to severely mental handicapped children. To examine the ffectiveness of singing in classroom, sixty-five participants were asked to perform eight tasks, including greeting, shaking hands, vocalizing, clapping hands, stomping feet, passing ball, playing on drum and waving bye-bye. Results of the study indicated that singing could be an effective means for profound mentally retarded students in promoting their classroom participation (Joanna Chan, 2002). To create a relax environment during the study, the school installed music bells to replace the traditional bells to show class time and played soft music through the central broadcasting system.
Not only did this research inspire most special school teachers, but also start up a trend of playing soft background music during recess time in most normal schools. Another music therapy study Modifying Behaviors of Children with Autism: The Use of Musically Adapted Social Stories in Home-based Environments was carried out locally in 2005 by Ivory Chan. An individualized social story was created and music was composed accordingly for each participant that addressed a 27 behavioral problem. Results revealed that both spoken and sung forms of the ocial story were successful in significantly modifying problematic behaviors in two of the four autistic children, and the sung stories enhanced memorization of the social stories (Ivory Chan, 2005). Despite the fact that only half of the participants showed a positive change behaviorally, this research did open up the key of therapeutic treatments to autistic children within the Chinese culture. There were two publications on music therapy in Hong Kong written by an experienced local music therapist Joanna Chan. Chan published her first book in 2002 to share case studies of music therapy.
And, her second book, which describes a lot of music activities suggested in practicing music therapy, has just been released in 2007. Requirements of being a Music Therapist As music therapy has grown in popularity, it becomes evident that formal training is necessary for music therapists to be most effective. A music therapist should be a degree holder of music therapy and deeply interested and skillful in music. One should become as proficient as possible with music, musical When therapists work with clients, they must nstruments and music theory. concentrate on clients’ need rather than on learning how to use tools or play musical instruments. A good start for an aspiring music therapist is to study piano or guitar 28 because both instruments can play melody and harmony with wide range of variation in music. To become a music therapist, one must earn at least a bachelor degree in music therapy. However, there are no university music therapy degree programs The Hong Kong University SPACE and the Chinese vailable in Hong Kong. University of Hong Kong School of Continuing and Professional Studies currently offer introductory courses on music therapy taught by local music therapists. Therefore, going aboard for postsecondary training on music therapy is a requirement for being a music therapist. Like all of the local music therapists, one should have further studies on music therapy in the United States, United Kingdom or Australia. Typical courses in a bachelor’s degree program in music therapy nclude professional music therapy, music therapy theory, assessment, evaluation, populations served, ethics, and research and clinical interventions. Besides, one should consider taking supporting courses in music, psychology, counseling and human physiology. In addition to classroom study, students will complete an internship to acquire clinical practice serving individuals with special needs in the community as a graduation requirement. 29 Certification/ Licensing Practicing music therapists are not licensed in the Region. Hong Kong music herapists, instead, had already obtained music therapy certificates in the country that they graduated from. For example, in the United States, a music therapy graduate should only declare him/ her as a Board Certified Music Therapist by holding the MT-BC credential awarded by the Certification Board for Music Therapists (CBMT). To be a qualified music therapist in the States, one should successfully complete an academic and clinical training program approved by the American Music Therapy Association (AMTA), and, a written objective examination showing current competency in the profession of music therapy.
Recertification is required for every five years through re-examination or upon the successful completion and documentation of a hundred Continuing Music Therapy Education (CMTE) units, and through the completion of the CBMT Application for Recertification. 30 CHAPTER III APPLICATION OF MUSIC THERAPY IN HONG KONG Establishing a Music Therapy Practice To work out an effective music therapy program, music therapists should carefully plan music therapy intervention strategies. According to the five music therapists interviewed, the planning process generally should involve three general steps. . Initial assessment and treatment planning Before planning appropriate music therapy intervention strategies, a music therapist must know about the area(s) that a client needs help. First of all, the therapist must obtain any objective and subjective information regarding the client in order to determine client’s history and status, strengths and experiences. Second, the therapist must observe and interact with a client through music activities that give some indication on the client’s level of developmental, social, motor, auditory and communication skills.
Next, after conducting the initial assessment, the therapist must be able to interpret and synthesize the information obtained, defining the client’s problem(s) and area(s) of need. As Joanna Chan (2006) said, the initial assessment always gives background information of the client that is useful to plan the music therapy intervention according to the client’s needs. 31 2. Structure treatment Based on the information acquired, the music therapist should establish appropriate and realistic therapeutic goals for the client. focus to music therapy treatment procedures.
Goals give direction and Raymond Ng (2006) stated that while he was implementing the music therapy program in achieving long-term and short-term goals particularly, he would monitor the degree to which the client was benefitting from the treatment program. The therapist should decide what types of music activities that can be used to address client’s strengths and needs, and, arrange the music therapy environment to facilitate the client’s involvement. Also, music therapy sessions should be planned with appropriate duration and frequency. 3. Treatment implementation and termination
Once the intervention strategies have been derived, they should be implemented to help the client progress towards the established therapeutic goal(s). During treatment implementation, the therapist should apply or integrate music therapy approaches to achieve therapeutic goals. Music is used to communicate between the client and the therapist, encouraging a therapeutic relationship that requires trust and rapport. Moreover, the therapist should respond appropriately to client The therapist should behaviors and provide constructive feedback in return. 32 ecognize and manage aspects of client’s own feelings and behaviors that affect the therapeutic process and be able to mediate problems among clients. Throughout the treatment program, continuous observation and evaluation of the client’s responses help the music therapist determine if procedures are effective or if adjustments are need to be made (Raymond Ng, 2006; Joanna Chan, 2006). However, there may be special cases in which the client will not benefit from further intervention. In such cases, the therapist should define exit criteria from music therapy and assess potential benefits and detriments of termination from therapy.
The therapist should communicate with client’s family and professionals from other disciplines to determine need for continuation, revision or termination of services. (CBMT, 2005) Lastly, no matter how effective the music therapy treatment program, if no ongoing written documentation is provided, it is difficult for continuous evaluation of the therapy and further case referrals. The documentation should accurately It can facilitate the follow-up describe a client’s responses and progress. procedures when treatment termination is planned (Ivory Chan, 2006). Goals of Music Therapy
Music Therapy is the prescribed use of music to achieve a non-musical goal. 33 It helps to develop skills that will help an individual to develop and grow personally. Music therapists use music and music activities to help clients reach their therapeutic goals. As Joanna Chan said, improving the quality of life would become an ultimate goal for mankind in this century, and, her job is helping people achieve a better quality of life. of music therapy are: Chan (2007) suggested that the most common goals 1. Enhancing communication skills Both verbal and non-verbal communication skills can be developed through music activities.
Listening to music expands clients’ vocabulary base and singing Both instrumental playing and song-writing requires practice of their voices. facilitate self-expression. 2. Increasing cognitive functioning Music therapists use music to present and rehearse academic concepts and processes to achieve cognitive goals, which comprise of improved learning abilities such as memory, impulse control, recognition, learning, perception, attention, alertness, environmental awareness, and integration experiences. 3. Strengthening motor skills Music, as a multi-sensory stimulation, encourages creative movement to 34 romote body awareness and balance. Either free movement or dancing in rhythm provides motivation for physical activity. Through moving with music, clients learn spatial concepts and acquire fine and gross motor skills. 4. Improving psychological health Music taps into memories and emotions. Music listening, imagery and lyric analysis can help reducing anxious behaviors and symptoms of depression and lessening the tolerance of pain and stress. Music therapy helps clients restore self-image, develop appropriate emotional expression and deepen their awareness of self-control. 5. Establishing social skills
Most music activities used in a therapy session involve co-operation and active participation from clients. Improvisation between music therapist and clients can help reducing social withdrawal or isolation, and in turn, improve one’s self-esteem. A music therapy group provides an active environment for clients to make friends. Through the process of making group music, clients start to relate each other and acquire social skills. According to the local music therapists, the goals of music therapy are dependent upon the purpose of music therapy for each individual case. Goals, 35 ndicating expected outcomes in the targeted area, are clarified, based on the reason for referral and the information collected from the initial assessment. Goals may As be long-term or short-term, offering a purpose for therapy and a direction. Andrea Chan (2006) mentioned, a music therapy session might cover two or three goals through various music activities. Undoubtedly, flexibility to change the goals and plans is necessary through on-going review on the clients. Selected Music Therapy Techniques As the profession of music therapy has developed, certain specialized schools of treatment techniques have evolved.
Some of these are based on particular music approaches, while others are centered on educational models and theories. This section will only cover those schools of music therapy techniques that are commonly used by music therapists in Hong Kong. 1. Behavior Modification Principles According to Raymond Ng (2006), most music therapists having graduated from the universities in the United States adopt the behavior modification techniques which make use of operant conditioning principles. These techniques are used to reduce maladaptive behaviors and establish adaptive behaviors through selective reinforcement of a client’s responses.
Music activities can act as reinforcement while time-out from music can decrease inappropriate behavior. As indicated by 36 the local therapists, the behavior modification techniques have gained a prominent place in education and training programs for the mentally retarded clients. 2. Psychodynamically Oriented Music Therapy According to psychodynamic theory, one’s behavior results from the interaction of various components of the personality, including motivations, past and present events, and segments of the personality (Peters, 1987).
The psychodynamic theory focuses on bringing unconscious material into consciousness. Music therapists use various types of music activities, including improvisation, music listening and individual music lessons, to elicit and work through unconscious materials. Two respondents, Raymond Ng and Yasmin Li, apply this approach in their therapeutic services. 3. Guided Imagery and Music (GIM) The technique of GIM grew out of the search for mind-expanding techniques that could produce altered states of consciousness (Peters, 1987).
In GIM sessions, clients listen to tapes of specially selected music in a deeply relaxing state. The therapist then helps guide and shape the direction of the clients’ imageries by using verbal instructions or iconic stimulation. The local music therapist, Raymond Ng, trained in GIM techniques, stated that he rarely utilized this technique for children since he found children losing attention easily when giving instructions of imagery. 37 Each therapy program is designed according to the individual client’s needs and the therapist’s approach.
Sometimes, therapists have to integrate music therapy approaches to help assure that all efforts are complementary. While specific approaches have distinct advantages in certain settings or with certain types of clients, music therapists are cautioned against adopting one approach to the exclusion of all others. No one method can possibly have all the answers for each situation. Setting of a Music Therapy Room For music therapy to be most effective, certain conditions of a music therapy room must be fulfilled. According to the five respondents, some considerations are in the following: 1.
A music therapy room should be private, where there is little chance of being overheard or disturbed. In other words, the room should be conveniently isolated from external sound (Rolando O. , 1981) 2. A music therapy room should be simple and clear. Decoration is kept to minimum for not drawing too much attention to clients (Ng, 2006; Li, 2006). The room should provide a non-threatening and fun environment in which to learn about, explore and express emotions. 38 3. A music therapy room should be neither too big nor too small.
Ivory Chan (2006) said that a large room would cause great dispersion and the consequent loss of the notion of space due to its having points of reference that make contact with the music therapist difficult. Rolando (1981) recommended a room of 5 by 5 meters at best. 4. Musical instruments that are varied in timbre and of good quality are necessary for the communication between therapists and clients. These should preferably include a good piano and some simple percussion instruments. One of the local music therapists, Raymond Ng (2006), recommended some interesting percussion instruments such as octachime, talking drum, kazoo and autoharp. . Non-musical instruments such as chairs, hula hoops, balls and color maps are useful to facilitate the musical activities, as Andrea Chan (2006) suggested. 6. Sometimes, therapists like Raymond Ng (2006) use recorded music to inspire imagination of clients. Audio equipment such as a CD player is required. Use of Music in a Music Therapy Session Music has been proved to be an effective tool in therapeutic services as it breaks down walls of resistance and makes the reluctant clients willing to share and to express their identity and feeling.
Once the clients find complementary to their 39 taste, the therapists successfully set up conditions that increase communication and understanding. Music therapists must carefully choose the music used in therapy, depending upon the needs of the client. client must be considered. As Yasmin Li (2006) said, the individual tastes of the In some cases the music will need to be familiar, but on the other hand, as in mediation, classical music that the client cannot “sing along” with may be better.
For instance, destructive outcomes might result from rock and Instead, quiet, calm music can be used rolls music to people experiencing trauma. to soothe their pain. A good piece of music used in therapy rests on the basic components of music: melody, rhythm and lyrics. Melody, added to rhythm, varies with tension created and resolved, giving clients a sense of relief. Lyrics create a story, inspiring clients an idea of love, happiness or sorrow. Each of these components conveys a message or feeling, contributing reinforcement, motivation, auditory cues, and setting the occasion.
To meet the needs of individual clients, music therapists must acquire a wide range of music selection. Repertoires varied from classical to new age music, and from nursery songs to traditional Chinese folk songs are useful in their therapeutic 40 services. As Yasmin Li (2006) mentioned, the Chinese opera and the 1960-70 pop songs were very useful to stimulate conversation among the elderly or adults because of past associations with familiar melodies. Apart from the existing songs, music therapists should be able to compose new music to satisfy the musical aste of certain clients. 41 CHAPTER IV CHALLENGES OF DEVELOPING MUSIC THERAPY IN HONG KONG The growth of interest in music therapy in Hong Kong has occurred over a relatively short time, probably over the last ten years. This interest has developed as a result of the successes achieved by local music therapists working in health care, rehabilitation and special education setting. Some people regard that using music as a therapeutic tool is an innovative idea and see music therapy as a specialized professional that will soon gain more professional recognition from the public.
However, other people believe that there is still a long way to go further in such an obscure professional in a Chinese society. This chapter will look into the limitations of developing music therapy in Hong Kong in terms of cultural and social contexts. Traditional Chinese Beliefs and Attitudes toward Disabilities Throughout history people with disabilities have been labeled as misfortunate or victim. Cheung (1986) ascribed the roots of shame and guilt orientation to It can be explained by the concepts of Karma Buddhism in Chinese culture. cause-and-consequences) regarding the sickness as the consequence of a negative action from the past. The Buddhists believed that besides the physical cause of 42 disease, illness could be the effect of ad kamma in past lives (Ratanakul, 1999). If there is one family member who suffers from mental illness, the family usually keeps the patient at a low profile, treating the sufferer as if a shame on the family. Moreover, feng-shui which means geomancy is very common supernatural belief and practice among Chinese people. Lee (1985) considered that it is ythical idea for explaining and manipulating the environment, providing that feng-shui is no less popular than the worship of ancestors and deities in Hong Kong. For example, in order to manipulate feng-shui to change one’s life, people often invite geomancers to advise on the seating, orientation, and arrangement of furniture, and opening dates of domestic and business buildings. In most Chinese communities, the Chinese family dominates in coping and help-seeking when a family member becomes ill. According to a research in
Vancouver, it was found that the Chinese family has a specific coping pattern in dealing with serious psychiatric illness in the family (T. Lin and M. C. Lin, 1978, 1981). The Chinese pattern is characterized by five distinctive phrases, in Phase 1 starts with exclusively intra-family coping. The family sequential order. attempts to influence the sick member with every possible remedial means and resource to their limit of tolerance. It is followed by Phase 2 in which the family seeks assistance from trusted outsiders, such as friends and elders of the community. 3 The next step, Phase 3, is inviting outside helping agencies, such as herbalists, physicians, or religious healers. Phase 4 starts when the sick member is diagnosed The special’s help is sought first on an When the as mentally-ill by a trusted outside agency. outpatient basis and then through admission to a medical institution. hope for the recovery of the sick individual fades and the psychological and financial burden of caring for a mentally ill family member becomes unbearable, the final Phase 5 of rejection and scapegoating sets in. The family members are econciled to their “fate” of having a mental patient within the family, placing the sick member in a distant mental hospital. Probably bad feng-shui is blamed for the family’s fate in being burdened with an unfortunate, ill-starred, mentally ill member. (Tsung-yi Lin, 1985) As a result, the typical pattern of coping with severe mental illness observed in Chinese society reflects the key role of the family in handling mentally ill individuals at home and in help-seeking. This pattern is influenced by traditional As L. P. W. Chiu (1987) concepts of insanity and the pervasive social stigma. uggested that poor compliance with medication among Chinese psychiatric patients may be due to their inclination to explain the illness on the basis of superstitious or traditional beliefs, and hence their reliance on Chinese herbal medicine and other traditional methods such as feng-shui to manage the problem. All of these 44 concerns about disabilities well explain the resistance of seeking proper treatment and rehabilitation services including music therapy in Hong Kong. Professional Status Is music therapy a profession in Hong Kong? The question has been debated or over ten years since the first music therapist practiced his professional in Hong Kong. O’Morrow and Gerald S. (1989) asserted that there were no absolute, Nevertheless, inclusive, and exclusive criteria to specifically define a profession. professional status is regarded as a dynamic social status concept comparative to ever-changing social values, expectations and ideals of service. Millerson (1964) surveying the work of twenty-one authors on the definition of professions, extracted a total of twenty-three elements used by them to define a profession.
Some key characteristics are frequently cited, as follows. Skill based on theoretical knowledge The provision of training and occupation Tests of the competence of members Organization Adherence to a professional code of conduct Altruistic service Certainly the profession of music therapy asks for a graduate entry specialized in music therapy. However, no professional training of music therapists is available in Hong Kong. One should go overseas to pursue a professional qualification of music therapy. Popular places such as the United States, the United Kingdom, 5 Australia and Canada are good choices as music therapy has gained full status and recognition as professionals locally. The body of knowledge and art in music therapy is therefore acquired in any recognized universities providing music therapy course outside Hong Kong. With no doubt that any certified music therapists must go through various kinds of assessments while being trained and fulfill the requirements established by the local music therapy association to ensure the competencies of the therapists.
As studying abroad is not always an option, there is a need for opening comprehensive and professional courses to train music therapists in Hong Kong. Although there is one music therapy organization called Hong Kong Music Therapy Association (HKMTA) formed in 1995, it has not yet functioning to its full extent in developing music therapy as a profession in Hong Kong. Membership in HKMTA should be a degree holder of music therapy and registered in any authorized music therapy organizations around the world.
Yet, the HKMTA does not contribute to the advancement of education, training, professional standards, credentials, and research in support of the music therapy profession. No music therapist is included in the rehabilitation services in Hong Kong. According to the Hong Kong Rehabilitation Programme Plan published by Rehabilitation Division, Health and Welfare Bureau in 1999, there are 19 46 rehabilitation personnel introduced, such as clinical psychologist and speech therapist (see Table 4. 1). It describes the development and problems of the key rofessions or specialists and their job-related training. Besides, it proposed the estimated number of additional posts of rehabilitation personnel to meet the rapid expansion of welfare services and the rising expectation and demand of the community for better quality services. Nonetheless, no designated music therapy position is within the social infrastructure, including the medical, education, as well as the welfare sectors. Table 4. 1 Manpower of Rehabilitation Services in Hong Kong 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 8. 19. Audiologist Clinical Psychologist Doctor Educational Psychologist Nurse Occupational Therapist Orientation and Mobility Instructor Orthoptist Physiotherapist Placement Officer Podiatrist Prosthetist and Orthotist Sign Language Interpreter Social Worker Special Child Care Worker Special Education Teacher Speech Therapist Welfare Worker and Personal Care Worker Workshop Instructor 47 Unavailable training of music therapists in Hong Kong may be taken into consideration at planning the re