I attended an event recently for the Institute of Integrated Care, a collaboration between the Trust I work for and Greenwich University. The intention is to encourage new ways of thinking about how to deliver healthcare, with an emphasis on greater communication and collaboration between agencies that might not normally work together. It seems to be a positive step. One of the speakers talked about the importance of ‘disruption’. I like this word. It normally has negative connotations. Working with ’EBD’ children it’s a word one hears a lot, in the context of ‘disruptive behaviour’. In this context it was used with a positive connotation, the idea being that in order to change, we need to disrupt the old systems, the old ways of thinking. There is also a quality of randomness implied by the word, a suggestion that while we might not know what the consequences of our actions will be in any kind of detail, nevertheless it’s worth pressing ahead and shaking things up, because unless we have the courage to make a leap into the unknown, then we might stagnate. Change might never happen.
Think of the connections between professionals which can so often seem difficult, the crossed wires that can occur, the difficulties with ‘information sharing’. And when you work on the margins, as we often do, it’s easy to be forgotten by the mainstream. It’s still the case that sometimes I might hear about a CP conference for a child, or an annual review, after the event. If only we could establish stronger links, so that we feel we are working with other professionals to support an individual or a family, and so that music therapy can find a focus within a wider context, for each client. I know this would be good, because, sometimes it is possible. I have worked in collaboration with family therapists, working with the child while the systemic thinking is held by another professional. This is broadly beneficial, both for me and by extension for the client. It enables me to clarify the role of music therapy for this person in my mind. After all, music therapy isn’t a panacea. If things are going wrong elsewhere, if a family is in chaos, a child is suffering neglect or high stress at home then, frankly, there’s little I can do to help in a half hour weekly session. We need to know that there is some stability, otherwise we’re facing a Sisyphean task. We might be giving a child a brief positive experience which only serves to emphasise the deficits elsewhere, or the child might just be unable to access their creativity because other concerns are more immediate – Maslow’s triangle comes to mind. So we can’t work in isolation when dealing with complex situations, which we often are. And if we are working in isolation to some extent, then the system needs to be disrupted somehow.
And is therapy itself a disruptive process? We might think that therapy is about building up, or repairing. Are we trying, in the musical therapeutic relationship, to repair a broken attachment? We might be, but unless the client has other positive attachment relationships in their life, music therapy alone won’t be enough. More often it feels to me that I’m working with clients who have become entrenched in their coping mechanisms or defences. They express this musically, and I challenge it. I’ll search for ways of testing the client’s tolerance of newness. This might be quite a gentle process, such as when I make a suggestion about something else we might do, after allowing the client a long period of leading the session. But it might be more robust. One client who is adept at avoiding musical connections needed to be challenged more strongly. I tried setting a new pulse. He ignored it and ploughed on with his own music. I persisted for several minutes. Very slowly, he began to spend a few moments here in there inside the pulse I had set. After this, over time, I looked for opportunities to find pulse connections, and they became more frequent. He seemed to be developing trust, and expressing this through his musical responses. I couldn’t have predicted this, I could only give it a try, and see what happened.
One of the important characteristics of disruption, as I said, is that it is imprecise and unpredictable. But the imprecision of music therapy bothers me sometimes. I wonder whether it signifies a lack of effectiveness. If I can’t say what I’m trying to achieve with much precision then how can I claim to be ‘helping’ anyone. One answer is that where change is needed, disruption must happen first. The trick is how to respond to what happens next. When you try something, and the client reacts in a way you didn’t predict, you need to be ready, to be able to improvise. The pool will continue to stagnate, but disturb the surface of the water and you create movement, new clarity. The client repeating the same rhythm, always singing the same song, sitting in the same place, in the same mood, needs a new direction, but they don’t know how to find it themselves. Neither do we, but we know how to disrupt, and then how to improvise. There’s a whole row of doors to try: time to open one at random and see what’s on the other side.
