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Dirk Cushenberry always felt his future was in music.

Cheryl Farris-Manning was torn between music and an interest in medicine.

Both choose a career in music therapy because it allows them to help people and maintain their musical pursuits.

Dirk Cushenberry works with profoundly mentally handicapped adults at the Richmond State School near Houston, Texas. The school has a handbell choir, a signing choir and a traditional choir.

"The choir sang at someone's wedding," says Cushenberry proudly. "That's the idea of it -- to have them as active as possible."

Cheryl Farris-Manning works part time as a music therapy consultant. "I have two private clients. I go see them in their home or day program," she explains. "It's very interesting. It's a great kind of career to have if you want to set your own goals and own timetable. Because you can design your practice the way you want."

Farris-Manning knew she wanted to take music therapy as soon as she read a brochure about the program. Until that moment, she couldn't decide between music and medicine.

"Music was very much the center of my life all through growing up, but I was also very interested in going into medicine. I wasn't thrilled with going to school 10 years for med school, and I wasn't thrilled about the idea of performing as a professional musician and the lifestyle that goes with that either," she remembers.

"So for me, it was a way for me to blend those interests."

Cushenberry remembers his first music therapy session. He and his brother went to the care home where his great grandmother lived. The residents were all wheeled into the main hall to listen to the boys play.

They were a hit. "One, it was being a kid," he says, "but it was also the music."

Cushenberry says he knew he wanted a career in music, but he talked himself out of it at least twice. "But the sense of calling stayed with me, " he admits. Layoffs at his company gave Cushenberry the push and opportunity he needed. "I went back to school and followed my dreams."

It was the right decision. Cushenberry says he's already been able to help people in ways he never could have imagined. During his internship, he worked in a psychiatric hospital.

"I was working with adolescents with rotten backgrounds," he explains. "I was helping them with their feelings. Some were good musicians. They were pretty sharp."

His group performed the song Hand in My Pocket by Alanis Morissette. "It was just orchestrating and adaptive work," Cushenberry says. But the kids loved it -- it gave them a sense of accomplishment some had never experienced before.

Another memorable experience happened during one of Cushenberry's practicum assignments at the University of Kansas. He was working with a doctoral student who liked to sing but couldn't play the piano because she had muscular dystrophy.

Cushenberry borrowed a musical instrument digital interface (MIDI), which links a synthesizer with a computer. Soon the woman was able to accompany herself musically.

"We performed for a couple classes -- I think about three," remembers Cushenberry. "She was excited!" When his practicum ended, the student decided to buy her own MIDI so she could continue composing.

Farris-Manning was very moved by an experience during a session with a patient with Alzheimer's. The woman was confused and couldn't speak. But when Farris-Manning played the hymn Abide With Me, the woman became coherent and even sang. "I felt it was a very poignant moment of connecting," Farris-Manning says.

Music therapy's effects aren't always so dramatic. Most patients express their pleasure in smaller gestures. "The little smiles and the peaceful breathing they get before a session," Farris-Manning explains.

But sometimes there's nothing -- perhaps for weeks on end -- and the hardest part of the job is trying to reach someone who isn't visibly responding at all. She says that can happen in long-term care homes where clients are bedridden and unresponsive.

"Music therapy can come to them, but it's very hard for the music therapist to know what's working, because there are few visible rewards and change is so slow," she explains.

Cushenberry is learning to appreciate small gains. The mentally challenged residents of his new school respond very differently to therapy than the teenagers in the psychiatric ward. "They have their successes too, though," he says hurriedly. "It's just an adjustment."