Failures of imagination

It’s been some time since I wrote an entry for this blog. This is partly because I’ve been acclimatising to a new challenge: training in clinical research on the NIHR MRes scheme at City, University of London. I’ve been trying to get to grips with concepts such as systematic review, research ethics, statistical models, implementation of findings… I could go on. It’s a fascinating journey and I’m the only music therapist on the course, my fellow students coming from health professions such as physiotherapy, speech and language therapy, nursing, midwifery and OT, amongst others, none from a psychotherapeutic background. The course is strongly focused on evidence-based medicine, and, for a music therapist, this could be a welcome thing. We need more evidence for music therapy, both for efficacy and for process. We need to know whether it ‘works’, and, where it does, how it works. Of course, a lot of work has been done on this already, but it’s all relative. We’re a small profession and clinical trials of music therapy are still comparatively thin on the ground. Even the recent Cochrane review into music therapy for depression, with positive findings and statistical significance in the meta-analysis (I know what those words mean now!), is drawing on total numbers, for all the studies combined, of below 500. It’s a fine achievement, but that reality suggests we still have plenty of work to do.

But there’s also the valid question of whether clinical trials are the right way to go about researching efficacy in music therapy. I became involved in a discussion on twitter recently where some music therapists were talking about the need for ‘standardised measures’ and the importance of analysing ‘multi-site data’ in order to make our case to commissioners and funders, to show that what we are doing is ‘effective’. This could be a good thing, but it made me nervous. I remember Mercedes Pavlicevic, in her interview for Music Therapy Conversations, referring to her PhD research and saying that ‘I knew it worked, but I wanted to know how it worked’. I’ve heard this a lot, that we ‘know it works’. I’ve said it myself. In fact, her PhD goes some way towards answering both of these questions, in a particular context.

But, more generally, do we ‘know it works’?

I’ve encountered a lot of discussion on social media about religion. I need to get better at staying out of it! There’s a clip of Stephen Fry being very critical of the Christian concept of God, which has been very popular amongst people who want to critique religious authoritarianism. It’s an effective smackdown of the ‘all-knowing, all-seeing, yet empathic’ idea of God which he takes as inherently contradictory. By way of contrast, I heard the TV producer and presenter John Lloyd, in a TED talk, talking entertainingly about ‘Ignosticism’. The way he puts it (at 4:24) is that ‘I refuse to be drawn on the question of whether God exists until somebody properly defines the terms’. This is a quick way of extinguishing a lot of the confrontational ‘theological debate’ that you might find on social media, or in the pub, or wherever, if only people paid attention (which they usually don’t). It’s a useful concept, and if we narrow the focus down from ‘God’, to ‘music therapy’ (why not?), it highlights the core of the problem. Since we haven’t decided what music therapy is, saying that ‘it works’, can only ever be referring to one particular example of music therapy, or, at best, one approach (if we can define what we mean by ‘approach’). Tia De Nora (2006) has already identified this dilemma.

One step at a time, I suppose. One interesting question I’m not sure has been fully answered yet is, ‘What makes a good music therapist?’ Another question, ‘What is musical relationship?’, has been explored somewhat, but is such a huge topic that it has plenty more to offer. Measuring stuff can be useful, but we need to make absolutely sure it’s the right stuff. Empiricism could be what sets music therapists free, or what constricts us if we measure the wrong things. If we can figure out what can’t be measured, this might lead us back to where we started, with a big mysterious question mark about what it all means, and this might be a good thing. The calls for ‘standardised measures’ might betray an anxiety and perhaps a failure of imagination, because this mystery at the heart of existence, and at the heart of music, might be vital to the practice and understanding of music therapy. Perhaps, whether we’re talking about ‘God’ or ‘music therapy’, defining our terms might be one of those journeys where it’s better to travel than to arrive. Either that, or we need to remain ‘Ignostic’ about music therapy, and decide, very clearly and precisely, what it is, before we make any attempts to test whether ‘it works’. How ‘clearly and precisely’? Very. And if De Nora’s right, this might mean that each therapist/participant combination requires its own unique definition. Hmm, let’s hope not…