Journicle Review: Alternate Tunings


There are many reasons music therapy can be a preferred method of treatment for for anyone seeking therapeutic services. One of the biggest reasons, particularly for children and adults with developmental disabilities, is because of the ability of a music therapist (MT) to create an environment of success for a patient who is still working to achieve his/her goals. The opportunity to actively engage in music making and to create a pleasing product that a patient can own as theirs is an incredibly important aspect to their overall quality of life. One instrument MTs use most often is a guitar. It’s easily portable, patients who lack fine motor skills can still assist with gross motor strumming, you can improve fine motor skills by working on chord structures, and it encourages language when singing along. Guitars are also incredibly versatile. While they are typically tuned to EADGBE (standard tuning), there are many more ways to tune to allow for higher success. One artist in this article is cited with using more than 50 different tunings. Additionally, the Professional Competencies document given by the American Music Therapy Association, and the Scope of Practice document issued by the Certification Board for Music Therapists have foundational competencies in guitar theory, being able to tune to and use standard and other tuning; perform basic repertoire; and expanding musical skills. It is also included that you must use culturally based methods to determine client preference and their response to different styles.

In the journal article written by Dr. Christine Leist, she lists what she has found to be the nine most frequently used by musicians and their ease of use for MTs. The nine resulting tunings, with the exception of standard tuning, are as follows: Dropped D ( DADGBE), Double Dropped D (DADGBD), D Modal or Dsus4 (DADGAD), Open D (DADF#AD), Open G (DGDGBD), Open E (EBEG#BE), Open E Minor (EBEGBE), Open A (EAEAC#E), and Open A Minor (EAEACE). Dr. Leist also includes practical tips on how to most effectively tune your guitar while causing the least stress to your guitar's strings and neck.

Dropped D is the most commonly used alternate tuning form for musicians because of the ability to play power chords. Power chords involve barring, or holding down three strings with one finger, to create a chord using only chord members 1 and 5. It makes neither a major or minor chord, but is commonly used in rock music. I find that this tuning works well for patients with strong fine motor skills as you can play an entire song by moving one finger to different frets in the same position. Double dropped D is fairly similar to the former as its only difference is to also lower string 1 and power chords are still easily played. D Modal is commonly used in folk music with roots in Scottish, Irish, and North African music. Two commonly used chord figures are ‘D’ and ‘G’ major. Since both forms are common in standard tuning, it makes translating into D Modal much easier for clients who first learned standard tuning. Open D originated in Europe in the late 1700s and has been adapted by blues musicians for a slidable 12-bar blues chord form. Open G has origins in Spanish music as well as Hawaiian. It is also the standard tuning for a Banjo. Open E  and E Minor have a high risk of string  breakage and have no noted origin. However, you can easily adapt E Minor to E by raising the third of the chord. Open A and A minor have the same qualities.

When considering the needs of the clients and adapting instruments appropriately (Scope of Practice and Professional Competencies), it is important  that MTs consider the versatility of a guitar. Dr. Leist includes suggestions on how to implement different tunings into group settings by tuning multiple guitars to various tunings to allow for ensemble play where pts can hold and strum a guitar in sequence to create a song. She suggests adding Orff instruments to accompany. She also suggests for individual clients who want to play independently.

In specific one-on-one settings, I think open tunings are key for clients who lack attention and fine motor skill to learn different chord configurations and how to apply enough pressure to sound. Other alternate tunings provide simplified chord structures that allow for higher success than standard tuning. The difficulty would be the time in session it would take to tune, even when assuming your client is willing to let you tune their guitar differently. Unless you play your entire session using alternate tunings, or have another guitar readily available in standard (which is usually impractical), you need to make implementation creative and engaging for the client. Whether that is involving them in the tuning process with visual tuners, making a song they can sing to help you tune, or pre-tuning and inciting excitement with verbal cues, client involvement is key to making any new skill successful. MTs have some of the best tools for creating high achievement rates and self confidence growth. It is important for us to know and use all of our tools to their full potential to provide our clients with the most opportunities for their independent accomplishments and quality of life.


Leist, C. P. (2015). A Guide to Selected Alternate Guitar Tunings for Music Therapists. Music Therapy Perspectives, 33(1), 71-75.


Hannah Rhinehart, LPMT, MT-BC

The George Center, 12060 Etris Road, Roswell, GA, 30075