Where do you start? (or 'The P word')

Where do you start?
How do you separate the present from the past?
How do you deal with all the things you thought would last
That didn't last?
With bits of memories scattered here and there
I look around and don't know where to start

(Marilyn Bergman, Alan Bergman, Johnny Mandel)

‘Music psychotherapy’ is a mildly contentious term in the UK. While art psychotherapist and art therapist are both legally recognised titles, the same isn’t true for music. Nevertheless, many music therapists refer to themselves as music psychotherapists. This can feel (to me) like a political act, an attempt to emphasise that they are psychological professionals, doing similar work to psychotherapists. There can be an implication linked to this that the work is psychodynamic in orientation. 

Gary Ansdell’s article ‘Community music and the winds of change’ from 2002, was arguably a watershed moment. This was the first time he identified (or perhaps constructed) a ‘consensus model’ of music therapy, which he described quite specifically as ‘improvisational music psychotherapy’.

I think Gary probably did the profession a service. His intention was to free music therapy practice from a restrictive model, where psychotherapeutic models of practice, including certain boundaries, were holding back music therapists from practising more freely, pointing towards the ‘community music therapy movement’. In her podcast interview 15 years later, Mercedes Pavlicevic was still talking about the potential for music therapists to explore ‘forbidden fruit’, implying that many of us still felt restricted in our practice, perhaps a little hemmed in by a psychotherapeutic identity, and cut off from other approaches. 

There are many music therapists who do other work, informed by their music therapy training, but which they wouldn’t identify as ‘music therapy’. There are also music therapists who incorporate broader practice into their music therapy roles. This was happening before Gary wrote his 2002 article and continued to happen afterwards. It seems likely that the CoMT movement gave this adjacent sort of practice a strong boost, which can only be a good thing. This may be one reason for using the term ‘music therapist’ instead of ‘music psychotherapist’, so that we can retain our flexibility as practitioners. Sometimes we can do weekly, psychodynamically informed individual work (which Ansdell, and others in the CoMT movement have never tried to suppress), but we can also run open groups, choirs, parent child singing groups, and so on. 

Meanwhile, music psychotherapy continues. Alanne (2023) has identified a broad range of practice, but his book is specifically about ‘psychodynamic music psychotherapy’. The term 'psychotherapy’ is broader, and does not necessarily imply a psychodynamic stance, as in, for example, ‘person-centred’, ‘humanistic’, Gestalt, and even cognitive behavioural psychotherapies (although CBT typically ditches the ‘psycho-prefix). While the term ‘psychodynamic’ can be applied to both theory and practice, with psychodynamic theory understood as a large body of work, we don't generally refer to ‘psychotherapeutic theory’, so much as to psychotherapeutic approaches, stances, treatments, and models of practice. With regard to individual work, I would suggest that the term ‘music psychotherapy’ could usefully be employed to refer to a model of music therapy which tends to draw on psychotherapeutic practice, including certain boundaries and key understandings about how the work might be practised. This might, for example, include boundaries of time and space, confidentiality as a principle, and an understanding that the relationship between the therapist and client is at the core of practice. 

Thus, ‘music psychotherapy’ might include Ansdell’s consensus model of ‘improvisational music psychotherapy’, along with GIM, vocal psychotherapy and also, actually, music-centred music therapy. It might not include CoMT, NMT and community music/arts in health, since these often involve different stances towards practice where the relationship between therapist and client facilitates the work rather than being central to it, along with different boundaries and rules around confidentiality, time and space. Open groups, class groups, community choirs, and the many other ways in which music can be used in community and institutional contexts, can be more inclusive, and perhaps less focused on difficulty, or pathology. 

This is not to say that one model is universally preferable to another. They all respond to different needs, in different contexts. Music therapists are needed in many settings, and have helpful, sometimes crucial, contributions to make. This raises a question about training. If music therapists are needed in community contexts, should we abandon psychotherapeutic models in favour of CoMT? Might we even consider Ansdell’s suggestion (at the BAMT conference in 2018) that music therapy might not need to exist at some future point in time, when the social and relational affordances of shared music making are widely available to all, and are understood and appreciated by society in general?

I remember a musician friend talking about their training on a jazz degree. They said that one of the most difficult things to master is to improvise over chord changes, in the bebop tradition. If you can get the chops to navigate the demands of bebop, this might equip you fairly well for a lot of other musical contexts. The particular combination of spontaneity, groove, harmonic and melodic sophistication, and instrumental/vocal technique needed in this important genre stands you in good stead for other genres and musical challenges. That’s not to say that bebop is the ‘best music’, or even the most complex, just that it’s a good musical grounding that can produce versatile musicians. 

Of course, you can argue about that if you like. Maybe you think bebop is too narrow, old hat, or unnecessarily complex. There might be a number of objections to this perspective. What I like about it is that it acknowledges that it can be helpful to nail your colours to one mast or another in the first instance, to have a clear starting point from which to develop in new directions. For example, one approach to music therapy training might be to decide that ‘psychodynamic music psychotherapy’ is a good grounding from which to develop further. If you can meet the demands of being in a room with another person, with musical resources available, a clear understanding of psychotherapeutic boundaries, some awareness of the perils of projection, the transference relationship, intersubjectivity, communicative musicality, along with cultural awareness and reflexivity, the knowledge that you yourself come from somewhere and bring your own ‘stuff’, be it musical or personal, then you might be off to a good start. This might enable you to develop in a variety of other directions in the future. You might abandon some ideas, take on new approaches, look back on your training with healthy scepticism, discover new paths in music therapy. 

Nordoff and Robbins did something like this when they set up their training in the 1970s. I’ve listened to recordings of Paul Nordoff’s lectures on musical techniques in music therapy. They are somewhat dogmatic, very culturally specific, and extremely clear and useful. To say, after hearing these, ‘this is proper music therapy and that’s it’ would be far too restrictive, and I’m sure this wasn’t the intention. No doubt, there were musical and cultural blind spots in this early version of music therapy training. However, it did produce a lot of highly skilled, focused practitioners, who have subsequently contributed a huge amount to the development of the profession, taking theory and practice in new directions. They were given, it seems, some clear indications of where to start from. 

This seems a helpful principle. Trainees might need a clear sense of core practice, a sense of what it might be to be a music therapist, of what the title implies. One important theory we refer to a lot in is Ainsworth’s concept of the ‘secure base’. This is a good metaphor for training. Start here, and on you go. And the ‘on you go’ starts right away, because trainees are questioning concepts from the beginning. ‘Music therapist’ isn’t just an umbrella term, it also attempts to define areas and make distinctions. A music therapist and a community musician can overlap, but the terms don’t mean the same thing. If I want to suggest, for example, that a music therapist has ‘something to bring’ to a community music setting, then I need to be clear what that something is. One thing it might be is a solid grounding in the micro-details of a developing musical relationship in a psychotherapeutic context. These experiences as a music psychotherapist can inform our practice in a wide range of settings. Psychodynamic theory, for example, can be applied to institutions and societies, as well as to therapeutic dyads. Part of it, perhaps the most important part, is in learning to be with another person in very difficult times, to navigate the challenges of relationship together, including the dark and difficult stuff, to allow this into the room, in its many guises (including musical ones) and figure it out from there. If you happen to make it through training without such experiences, then professional practice, in some contexts, may come as a shock. 

Identifying ‘psychodynamic music psychotherapy’ as fundamental to practice is an available choice. It’s still, often, somewhat taken as read. In Nigel Hartley’s polemical piece ‘Is music therapy fit for practice?’ (2008), he takes aim at the profession, suggesting that its narrowness puts it at risk. It’s a tour de force of an article in some ways. He doesn’t hold back from characterising a tendency towards rigidity in the profession as a whole, and his frustration is palpable. That said, it’s also contentious. The claim that many arts therapists are “confined to practising within a specific type of therapeutic framework” is supported by just one single example of a student who “refused to engage in one of the hospice’s school projects”. 

Despite the overall tone of exasperation with a profession that was supposedly painting itself into a psychotherapeutic corner, Hartley’s conclusion includes the following: “It is of course essential that arts therapists are given a solid grounding within the professional discipline that they will practise.” His overall argument can actually be summarised like this: keep training arts therapists in a core model, but also teach them to be flexible beyond this, so that they can adapt and respond in different contexts. I agree. Music therapists need to be creative and flexible wherever they find themselves. But they need to do this from a position of awareness of who and what they are, where they understand what it means to have a music therapy training, which has identified principles. What those principles are is open to discussion, always. But they need to exist (and btw HCPC SoPs are standards, not principles). Pluralism, but not whatever-ism. One starting point, ironically enough, is Ansdell’s consensus model, which has turned out to be surprisingly robust, and might point to a meaningful distinction between a broad-church music psychotherapy (including psychodynamic music psychotherapy) and the many other models of music therapy which include community and functional approaches, all of which have something to offer. Where you start is open to debate. But start somewhere.

References

Alanne, S., 2023 The Theory and Practice of Psychodynamic Music Psychotherapy. Barcelona Publishers.

Ansdell, G., 2002. Community music therapy & the winds of change. In Voices: A world forum for music therapy (Vol. 2, No. 2).

Hartley, N., 2008. The arts in health and social care—Is music therapy fit for purpose? British Journal of Music Therapy, 22(2), pp.88-96.