Journicle Review: The Iso-principle


One of my most engrained memories from my music therapy coursework is my professor, Dr. Kennedy, impressing upon us the importance of the iso principle. “This will be on your board certification test. Make sure you know it.” While I have yet to take the test, I found that this principle has become somewhat of a foundation that I base most of my sessions on. In 1948, Dr. Altshuler developed the concept of the iso principle in the psychiatric setting for mood disorders. He had a fairly lengthy assessment he conducted to determine a clients present mood, and using classical music, he would systematically incorporate supportive music that validated a patient through their unpleasant mood and gradually moved the music through a series of emotions to a more positive or stable mood. The ultimate premise was to implement the iso principle and facilitate mood change in a way that was not intrusive to the patient and validated their own feelings. While Dr. Altshuler’s initial findings were successful, the researchers in this article say that current descriptions and clinical illustrations regarding its use are scarce. They say it is a gap in the literature that that makes it unclear as to how the iso principle is currently being utilized in music therapy.

This case study focuses on Mary, a patient who suffers from a co-morbid diagnosis of Eating Disorder Not Otherwise Specified, Major Depressive Disorder, and Generalized Anxiety Disorder. Mary is a part of an intensive outpatient program for compulsive overeating with which she has a team of therapists who support her treatment. On her team is a psychotherapist, psychiatrist, a dietitian, and meal support. Mary and her psychotherapist discovered her need to access her feelings that were underlying her eating disorder and was referred to a music therapist.

Mary’s music therapist (MT) along with a music therapy intern (MTI) began to work with her to access her emotions and explore and walk through her feelings rather than talk around and intellectualize them. Mary began music therapy treatment with Bonny Method of Guided Imagery and Music.  Because of a difficult medication change, Mary’s team decided she needed a method that would help her manage her mood during this strenuous transition time. Since her insurance only allowed an hour of music therapy a week, Mary temporarily stopped guided imagery and focused on creating a therapeutic playlist. The MT introduced the concept of the iso principle and how it could help to manage her mood. Mary’s depression caused social anxiety which resulted in her shying away from friends and family during particularly difficult periods. Her alienation made only increased the feeling that she was alone. In creating her playlist, she became tearful stating that she was surprised someone would go through that much trouble for her. The concept introduced a sense of being cared and nurtured Mary had not experienced before.

The playlist was created over a series of weeks from Mary’s preferred music. She brought in 19 CDs and ranked each with the MTI on a 5 point scale for music, message, and overall. They would also comment descriptors for every song. When she and the MTI completed the rankings, the MTI and MT put together a 12 song playlist that began with songs that validated Mary’s feelings of depression and ended in a positive and hopeful message Mary and her therapists indicated desiring. The MT and MTI used a 10 point Likert-type scale (1=hopeful, 10=depressed). Prior to the first listening, Mary said she felt an 8 and afterwards a 5. She asked for multiple copies as she listened to the CD in many places and noticed a gradual and generalized shift in her mood. She stated that the playlist gave her hope and helped her to engage in social events and not to avoid others. Four weeks following the medication change, Mary said the playlist empowered her and helped her to have control over her mood management. Her use of the playlist allowed her to better engage in treatment and work toward recovery.

The iso principle was successful for Mary to take an active role in her recovery, to be creative, have easy at home implementation, and have non-pharmacological management plan. While research like Mary’s focuses on the iso principles affect on mood management, I feel as though it can be applied more generally to music therapy as a whole. Validating patient’s experiences in regard to mood, feelings, view of self, etc. is extremely important for everyone who walks through the door. The iso principle reminds me of an old friend who said “I love you so much, I’ll take you just the way you are. But I love you too much to leave you that way.” Being an aspiring music therapist, I’m often asked, so what is music therapy? Well, it’s taking every client just the way they are, and caring too much to leave them in the same place. Using music, of course.
Heiderscheit, A. & Madson, A. (2015). Use of the Iso Principle as a Central Method in Mood Management: A Psychotherapy Clinical Case Study. Music Therapy Perspectives, 33(1), 45-52.

Photo Courtesy of: