Where do you start?

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.

Creative exorcism

I had an interesting conversation with the great drummer Matt Brown recently. I made the rather glib remark about music that ‘there’s nothing new under the sun’, or words to that effect, and he responded that he has to believe that originality is possible, that we can create new things in music. This got me thinking a lot over the next few days, because of course he’s right and I’m wrong, and I knew it as soon as he said it, but I wasn’t quite sure why.

I’m reminded of a time years ago at the 606 club where I was listening to a trumpet-led band which had Liam Noble on piano. It was in a sort of Miles 60s quintet vein (but with no saxophone), and in the break the bass player was chatting to us and he joked that the band sound was like ‘Miles, Ron, Tony (referring to Miles Davis, Ron Carter and Tony Williams) and Liam’. The joke being that because Liam has such a fresh and original voice on the piano that he couldn’t be compared to another pianist (which would have been, in this context, Herbie Hancock). Probably, with transcription and study one can find particular things that Liam does which are ‘new’, but maybe that's not the point. Even if there are no notes or rhythms that he plays that haven’t been played before by someone, he has a quality of individuality. He’s sometimes compared to Monk and Ellington, but he doesn’t really sound like either of them as much as he sounds like Liam. Kenny Werner calls this ‘the Monk effect’ - the capacity to make music that is assertively individual, where the musician determines the right notes rather than searches for them.

 In psychotherapy there’s Yalom’s concept of the here-and-now, which might be a useful referent. There can sometimes be a criticism of psychoanalysis that it dwells on the past, and the therapy should be about the present. Yalom recommends overtly bringing the present into the therapy space, ‘checking in’ with what’s happening right now in the room. But let’s also remember that when the past comes into therapy, it’s still happening in the present. The recalling is occurring in the room, and this is because it has relevance and agency in determining present feelings and maybe actions. This might imply that even when we are trying to recreate music from the past, we are still doing something new, by default. But on the other hand, intention might be important. Maybe, whether Matt is making new sounds or not, it makes a difference that he has the intention to be original, as in Miles' well-used quote, 'don't play what's there, play what's not there'.

In music therapy, the music, the improvisation, happens now. Even when recordings are being used, the improvised listening is happening now. When it comes down to it, there is only now. That’s it. There is also this thing called spontaneity, where we are able to be in the now, to intend to do something new, rather than to recreate something old. Much of psychotherapy is about exorcising demons from the past, as many people have pointed out. When we play, and also when we play (in Winnicott's sense), we need to be in the now, and being musically in the now also means exorcising the demons of the past, whether they are good demons, like Miles, Ron and Tony, or not-so-good. Everything’s new under the sun.

Bad jazz and good music

A friend of mine was talking about doing function gigs, playing in a multi-purpose band doing anything from pop covers to jazz standards. They said that they prefer doing pop with this band because “bad jazz just breaks your heart”. This isn’t someone I think of as terribly precious about music either. They’re a superb musician, but also a very practical person, adaptable and aware of the demands of the business, with the dry sense of humour that’s essential for survival. The comment was a moment of candour, a reveal of how important music is to them.

And I don’t think they were saying that playing pop music is easier, or that the music is less important. This wasn’t musical snobbery. I think this was about their experiences of particular musicians making a better job of pop covers, and being less at home playing jazz, and that this feels bad if you’re a jazz musician. Why might this be? For my friend I think that playing a well known cover in a function band might be a clear task. It’s about matching the original, doing a good pastiche, so that the punters at the wedding (or whatever) recognise it and respond. It’s like telling a joke. If it lands it lands. You need to be a skilled musician to make it work, but the task is clear. I heard a fantastic covers band at a wedding just a few weeks ago, who were able to do all of the above and then take it to another level, brilliant musicians bringing the songs to life. I loved it. I think it would have mostly sounded the same on the next gig. Improvisation is part of the issue. And playing jazz for a function gig involves improvising in a style and is not usually rehearsed in advance. It’s a sort of pastiche, but you might not be thinking of one particular source performance when you're playing, say, ‘Night and Day’. It can be done really well, if you put the right band together, but if you’re playing with people who aren’t playing the music with love, it can be a turgid affair, with people ploughing through a tune they don’t really know well enough, eyes glued to the chord chart, not much groove happening, no one listening. Jazz depends on musical connection and subtle communication between the players. Even if you’re playing very ‘inside’, say emulating a mainstream 50s sound, Getz or early Coltrane, all of the players are improvising all of the time, keeping the groove, making the phrasing, balancing the dynamics. There’s a lot to take care of. With the right players, I love doing a jazz function gig, but with the wrong ones it can ‘break your heart’.

There is plenty of scope for playing jazz badly, but for it still to sound sort of like jazz, perhaps to the punter who isn’t all that well versed. The drums go ting-ta-ting, the bass plays four crotchets in a bar, the piano comps a bit randomly and the horn player widdles around over the top. “I like some jazz, but I don’t like the widdling”, another friend once said to me, right before my gig. “It sounds like ‘widdling’ because you’re not listening properly”, I could have objected. But sometimes it IS widdling, by which I guess they meant aimless playing with no clear shape to the phrasing or melodic direction. There’s good music and bad music, as Duke said, and that includes jazz. In fact, maybe there’s more bad jazz, partly because playing it well is difficult, but also because playing it badly is easy. I tried not to ‘widdle’.

In music therapy improvisation (MTI) it would be unusual to play bad jazz. My experience of MTI is that the music is usually much more interesting than this. There’s no formula. As a therapist you wait to hear what comes out and then respond to it. There’s no requirement for a client in a session to be musically proficient. But as it happens, the music is often very engaging. Here’s a theory: it’s always engaging, as long as the intention is playful. A client can have zero experience playing instruments, but if they’re in a creative mood, and the therapist is hooked into this, it will sound good. Freedom is infectious. I would MUCH rather listen to the music in a music therapy session than to, say, jazz played formulaically, where playfulness is absent.

Priestley talked about the phenomenon of ‘anti-music’. Perhaps we need to think about this more than we do in music therapy. Musicians can inspire one another, but they can also break hearts, sap the life out of it. When someone is in their own world, imagining the music but not hearing it in the room, not paying attention to the other sounds around them, this can be a depressing, energy sapping experience. Bad music is a thing. As music therapists we can accept painful and challenging sounds into the room, but bad music is something else . It breaks your heart. Bad jazz has some special shortcuts to this, which might be about overcomplicating, not listening properly, having no love of the important details of a style, but really it all comes down to intention. Are the musicians caring about each other? This can be done with no technique at all. One person bashes a cluster of notes on a piano. There’s a pause. The next person hits a drum, matching the intensity and intention of the first - hey presto, good music!

Just in time

Now you're here and now I know just where I'm going

No more doubt or fear, I found my way

(Styne/Comden/Green)

In her Netflix special Joke Show, the comedian Michelle Wolf describes a blog as ‘a conversation no one wanted to have with you’. This sounds about right. So, liberated by this awareness, I’m pressing on, along with all the other bloggers…

A nagging question for me, in the field of music therapy, is one of musicianship. Actually it’s not only in music therapy, it’s music making more generally (btw I’m not a fan of the word ‘musicking’ despite attempts to get used to it - I prefer music as a mysterious noun). When making music with another person, and especially since becoming a music therapist, I am so often struck by how much the experience affects how I feel about them. If the music clicks, I usually click with the person too. Why is this? Perhaps what I need is to feel reciprocal listening, to feel that what I’m doing is being heard and responded to, and that my responses to them are important to them and have meaning for them.

But I’m more picky than that as well. I did a duo gig once with someone who (my experience) didn’t have a good time feel. Every time we began a tune at a medium or fastish tempo, I could feel it beginning to slow down to their comfort zone. I tried pushing, but this had limited effect. I felt frustrated, blocked, even offended. It was our first meeting, and so our first time playing together, so was I being impatient, not allowing the relationship to emerge? Maybe, but I had another experience recently with a new musician to me, where everything instantly clicked. We also got on. Generally I feel I’ve been lucky, experiencing the latter more frequently, and often surprised by musical frustrations when they come up.

A very experienced jazz musician once said to me that playing with good time is about memory. If you can remember the tempo then there’s no need to slow down. Losing time is about losing memory, or perhaps not bothering to remember, or not listening and paying attention properly. One of the benefits of being a music therapist might be that when this happens in a session, with a client, it could be understood as communication. As the therapist, I might notice the time dragging (assuming we’re playing in a recognisable pulse in the first place) and I could reflect on it. What does it tell me about the client? Are they dragging because they are feeling slow, depressed, heavy? Is there a physiological reason - slow processing time, motor difficulties, some other physical impairment or illness? Is there an unconscious meaning behind the slowness - are they holding me back so that I can feel what it’s like to be held back, for example?

All of this assumes that my time is ‘right’ and theirs is ‘wrong’, that I’m ‘in time’ and they’re falling behind, perhaps. This might be rather subjective, but it might also be empirically correct - one of us might be a better metronome (which one?). This would suggest that having good time awareness is a very important prerequisite for becoming a music therapist. It might even be extended to the idea that having a good ‘feel’ is important too, since feeling a groove and playing in time are so closely related. Is this the case? If so, what else might be important? Intonation? Sound quality? Control of dynamics? My intuitive response would be, yes, all of those. In other words, to be a good music therapist, you need to be a good musician. What a surprise! You get all the big insights here - stick with me.

There’s another nagging problem, voice in my head, whatever. How do I know the difference? How do I avoid projecting my own musical inadequacies onto another musician, who might be a music therapy client? The subtleties of groove, for example, can be experienced as ambiguous - who is dragging and who is rushing? Herbie Hancock’s Chameleon, from the classic Headhunters album, speeds up substantially throughout the track. It’s not about playing with strictly metronomic time, because we know who does this best of all, and it’s definitely not humans. Groove is mutually felt, negotiated, settled into. Sound quality is subjective. Musical personality is a matter of taste. Musicality is culturally determined as well, so a musical difference might be a cultural difference, rather than a difference in competence or sensitivity.

Where does this leave me? With a feeling that I have to trust my own musical judgement, while understanding that it’s fallible. But also with an awareness that musical differences can be felt as personal differences, that how someone is with me as a musician can have a profound effect on how I feel about them as a person. I also notice that the musicians with whom I have developed the best musical relationships are those with whom I feel a shared understanding and have developed trust. I feel intuitively that a person can tell me a lot about themselves through their music, which can include whether they trust me, and whether they want me to trust them. Another friendship with a musician comes to mind, one in which trust has eroded a little over the years, and where this loss is also (by me at least) felt musically whenever we find ourselves playing together. Interestingly, although this isn’t ideal, it is survivable, and maybe even transformable, who knows…

So musicians are people, and people are musicians. I think this idea is a big part of what brought me to music therapy in the first place, and what keeps me fascinated with this peculiar discipline. Why does this musician make me feel good, while this other one can make me feel bad? And why is music such an effective medium for transmitting these feelings? I will continue to try to understand this, which must include a developing awareness of whatever my part is in the shared process, just like, you know, in life.

It's not about me

When I interviewed Gary Ansdell we talked about the question of psychodynamic and music-centred approaches to music therapy, and the problematisation of this within the UK profession. I’ve written about my perspectives on this elsewhere, and maybe there’s no need to keep going on about it. Gary himself said that this had been framed as a binary, and that ‘binaries are boring’. The idea being that if we stopped talking about it for a while, maybe we could just get on with the job of ‘doing music therapy’, rather than solipsistically examining our theoretical stances as if the answers to how to do the actual work with actual people in real life lay somewhere buried in the ‘theory’, whatever that might be.  

‘Binaries are boring’. My response was scepticism. Maybe binaries are also interesting. Maybe there’s something about the framing of this problem that gets to the heart of what it means to be a music therapist, as opposed to a musician. David John spoke intriguingly about the need for music therapists to develop their therapist identity, because when they come on the training they often already have a well-developed musician-identity, which they put to good use in their therapeutic practice. On the other hand, I’ve noticed that trainees often have anxiety about their musical capabilities. They’ll say, ‘I don’t know what to play’, or ‘I don’t know how to improvise’, sometimes. Training can involve trainees confronting their own musicianship and subjecting it to challenging questions. What can they do already? But also, what do they need to be able to do in therapy which they can’t yet do? This is a different experience for each individual.

Another idea which Katrina McFerran put forward is that, ‘if the music is working, then the therapy is working’. I like the simplicity of this, and it has a ring of truth. The difficulty for me is that it’s easily refuted with the response, ‘except when it’s not’. Because I’ve definitely had experiences in music therapy where the interactions were lively and expressive and communicative, and all that we might hope to expect when the music in a session is ‘going well’, and the nub of the problem, the ‘reason for referral’, was not being addressed - yet. I’ve also worked with people where the music never got going, but where the assertion of this by the client was crucial to the progress of some important work. I think Katrina was right, for most of the time, but it's a rule of thumb which doesn’t always apply (in my experience).

So far this has all been old ground. Gary, if he’s reading this, will have skipped through these paragraphs, I suspect. (Hi Gary, if you’re reading this!) Onto my next point - binaries may be boring, but paradoxes are interesting. There is a paradox at the heart of music therapy, which is that music(ing) is both a way of making connection and a way of avoiding it. And it’s possible to do both at the same time. People are multi-faceted (stop the press), and so it’s possible for the music to be working, and relationships to be formed, while important stuff is being avoided. A therapeutic relationship isn’t one thing. Anyone who has done work with groups in which conflict gets played out knows this. We can have intentions as therapists which are not realised, but it’s in the failure to realise them that the development takes place. For example, I have found that my intention to facilitate musical cohesiveness through improvised interaction comes crashing to a halt, leading to important conversations about what went wrong.

Here’s another paradox: it’s possible to feel bad while doing good work, and vice versa. The Nordoff and Robbins (2007) concept of the ‘music child’ suggests a simple idea, that underneath all the difficulty and pain and suffering is a musical being that can transcend all that and connect with another on a deep level, which feels meaningful and, perhaps, ‘whole’. This is an alluring idea, because it feels true, and is often borne out by experience. It’s also (arguably) ableist. It potentially denies the disability or illness in search of the ‘true’ person ‘underneath’. A romantic idea about music therapy is that transcendent experiences can emerge, that client/participant and therapist can find themselves together ‘in flow’ and that they can come to life in the music. But this would be an unhelpful ‘aim’ in therapy, because it would mean that the client who is stuck or in pain, or monotonous in their expression is ‘wrong’, and that it is our job to change them into, or 'uncover', someone else, rather than to be with them where they are. 

Whenever we are presented with ‘wonderful’ musical interactions in therapy, or ‘amazing’ songs composed by a client, we can of course celebrate these, but we can also remember that it’s not these moments that encapsulate what therapy is about. The therapy was happening all the way along, and we’re seeing an edited highlight, a punter-friendly moment suitable for public consumption (assuming permissions are in place etc. etc.). We could also ask, what happened next? When the music stopped, where did this leave the client and therapist? Did the therapist feel good? The client? If we are looking for a pivotal moment, was it in the music, or was it in the inflection of the client’s voice when they said something after the music stopped?

Another paradox - it’s when you stop wanting to help that you start helping. So much of our egos can get tangled up in fantasies about that ‘therapist identity’ that David John was talking about. If we want to ‘be a good therapist’ or to ‘achieve therapeutic aims’, we are less likely to do so, because our desires get in the way. Achievements become all about us, not about the people we are working with. If we want the music to sound good, then it might, but for the wrong reasons. If we want the client to respond, then they might, but they might be responding because we want them to, which would only be useful if we then figured out how to set them free. We would have to untangle this web of therapist and client need and just be together wherever we found ourselves. (It might have been more efficient to do this a bit earlier, before we started searching for the ‘music child’, or reaching for a peak experience.) So the final paradox is that music is play, but that music and music therapy are also work*. When I feel stuck or depressed or trapped in the session, I may be doing my job. When I feel elated or free or expressive, I may be running away from it. How do I tell the difference? Stop trying and start noticing. And realise that it's not about me.

*This might also boil down to 'play is work'.

(All references to interviews are from Music Therapy Conversations)

Nordoff, P., Robbins, C., & Marcus, D. (2007). Creative music therapy: A guide to fostering clinical musicianship. Barcelona Pub.

Therapy as music

There is a dichotomy sometimes presented about stances towards music therapy. I have seen it in various guises. I came across it recently in an excellent article I was looking at from 2010 by Wheeler and Baker, a qualitative study exploring the ‘worldviews’ of music therapists, and the influence of personal and wider culture on practice. But I’ve also encountered it on Twitter, since everything is on Twitter, so why not this… On Twitter it was proposed as a question: ‘Are you a therapist doing music, or a musician doing therapy?’ (or the caveat - ‘It depends’). This, I think, connects with Bruscia’s distinction between ‘music as therapy’ and ‘music in therapy’, which appears in Improvisational Models and in Defining Music Therapy. It seems a useful distinction to make. I couldn't resist the bait, and responded with “It's a false dichotomy and in practice it's both, or something more complex - a music therapist 'doing music therapy'.” I probably felt quite pleased with myself at the time. 

It stays with me, this question, rather like the ‘music-centred vs. psychodynamic’ polarisation, I find it strangely alluring. And looking back at that Twitter exchange, I’m unsatisfied with the question, but equally unsatisfied with my ‘smart’ answer. It sort of sounded good to me, but it doesn’t really help, because really I’m copping out, not explaining what I mean by ‘a music therapist’. Can it be both? Is it useful to decide? 

For me it actually makes more sense to decide that it’s neither, on reflection. Because the problem is in the separation of these two ideas. This is what leads to music therapists worrying about talking in therapy, or imaginative play, because ‘we’re not trained for it’. We don’t know what to say, because nobody’s told us. This suggests that we do know what to play, whereas the state of not knowing is actually the key to an improvisational stance. I always come back to improvisation. Deciding whether we are ‘musicians doing therapy’ or ‘therapists using music’ implies a predetermined position, whereas I would never go into a session with an idea that I’m doing one of these two things. 

Another thing, which might be important, or might be a by-the-way. The Twitter question sidesteps this, but Bruscia’s constructions present something interesting. If we might have to choose between ‘music as therapy’, or ‘music in therapy’, could it also be meaningful the other way around? What about ‘therapy as music’ or ‘therapy in music’. I find both of these concepts appealing, and a little mysterious. Now we have four ideas, instead of two. 

We might look at this simply and consider that ‘therapy as music’ is what some psychoanalysts might do, who think about verbal exchanges from a musical perspective. That in itself could be worthwhile. Conversely, ‘therapy in music’ might be an aspect of ‘music as therapy’, the musical details which act as the mechanism for change. However, both structures seem capable of conveying more. They seem to suggest that therapy can be revealed by and contained by music, that a musical process and a therapeutic process might be part of the same experience, that there needn’t be a distinction between the two. Talking, movement, breathing, phrase, rhythm, touch, facial expression, and the intricate harmonic, melodic and rhythmic structures to which we sometimes attach the label ‘music’ might all be part of the same fundamental process, where people meet each other in moment-to-moment expression and interaction. 

This also gets us away from that other misleading idea, that there might be something inherently 'therapeutic' about music, and points towards something else, that there might be something musical about therapy, especially (but not exclusively) music therapy.

The need to be heard

Some of the most ‘therapeutic’ musical interactions I’ve witnessed during lockdown are between musicians themselves online. For example, I joined a Facebook group called ‘Tune of the week’ (TOTW). This is about (jazz) musicians showing their working to other musicians. It’s about preserving people’s musical identity at a time when it is facing the challenge of invisibility. Musicians need to be heard, and valued. People need to be heard. There has been a parallel tendency for music therapists to demonstrate their value at this time, to show that music therapy still has something to offer. This is perhaps similarly about preserving identity, but in this case the identity is that of the expert, the person who ‘knows how to use music therapeutically’. I’ve been part of this, interviewing two music therapists from Chiltern Music Therapy who gave expert advice on online interactions. There are also, for example, GIM resources for people with COVID-19, singalong packs produced by Nordoff Robbins music therapists, and online services for health professionals provided by NLMT. Chiltern runs an online group for parents and children. In my face to face work, back in the old world, I felt my work was closer to the ‘Tune of the week’ interactions than to these MT online resources. It was about relationship, and the way music can provide a bridge between people. My therapeutic expertise is partly about being a person with another person, through music (alongside the talking that’s necessary to facilitate it, and the thinking that supports both).

I might be in danger now of being unfair to music therapists promoting the profession, and trying to provide something helpful in a time of crisis. I might be creating a straw man based on an assumption that framing music therapy as a profession of experts who are ‘best placed to use music’ might be about identity but not about relationship, when it can be both. The interventions listed above are all valuable. As music therapists, we should be helping, and reminding people that musical connection is more important now than ever. So this isn’t an attempt to put those things down, more a note-to-self about how music works on a personal level, a reminder not to forget that my therapist-self relies on my musician-self. Inspired by TOTW, I’ve started up a Facebook group for music therapists called ‘Music Therapists’ Music’, for music therapists to share their own music with the group. Let’s see how that goes. I sense some shyness, which is fair enough. Music might be about showing off sometimes. It certainly can be in jazz. But only sometimes. In TOTW musicians are encouraging one another. It includes input from really expert players like Gareth Lockrane, but it’s inclusive. Anyone can put up a video, and talk about their musical challenges. It’s being done in a collegiate spirit. So perhaps one question I have is, as music therapists, can we look after one other? Can we share our musical identities, as a way of shoring up our therapeutic identities? ‘But aren’t they the same thing?’ Perhaps no more than my 'talking identity' would be the same as my therapeutic identity if I were a talking therapist. But, of course, it’s complicated...

As music therapists, we make use of, adapt, and edit our musical identity for each client or group. We use those bits of our musical identity that are useful at the time. But TOTW is a reminder to me of my own need to be heard, which is part of the reason I’m a musician, and so underlies my reasons for being a music therapist. Being a music therapist (in my experience) involves a tension between musician and therapist, but a useful tension, where my awareness of my own musical needs helps me understand what’s happening for the client. If I adopt a stance of ‘expert music therapist’, I might be giving up one kind of performance for another. The interactions on TOTW show musicians exposing their working, their musical struggles, and they show musicians being supportive, encouraging one another, reassuring each other that they are being listened to, and heard. Of course, there's also some showing off, but that's part of the process.

And another thing: RIP the great Lee Konitz, for whom improvising was a way of life, and who was always uncompromising in preserving what he felt was most important about music.

Playing and Reality

Something has been stopping me from adding to this blog recently. I think I was getting in the habit of trying to say something ‘important’ every time. Meanwhile, I add ideas to an online notebook. There are pages and pages of them, or there would be if it was printed out on A4. So instead, I’m going to put down some thoughts, and see where they lead. Lately, I have been thinking a lot about music and culture. Actually I’m not sure what this means, but I did find that talking to Natasha Thomas on Music Therapy Conversations set me thinking about a lot of stuff. Here’s one question that came to my mind: could a Gnawa musician be a music therapist?

If you aren’t aware of Gnawa music already, maybe you’ve now googled it and found some YouTube clips. There are plenty. I did an ethnomusicology Master’s project on Gnawa music back in the early 90s. I looked at the role of the m’allem in the tradition. In a Lila, which is a night-long ceremony in which ancestral spirits called mluk are evoked and sung to/about, along with dance, the m’allem leads the musicians from the ginbri, a three-stringed bass instrument. He (usually he) also leads call-and-response singing, with the rest of the group singing the responses. It’s a complex and rich tradition which mixes Islam with West African influences.
The ginbri, to my ears, seems to have six notes encompassing one octave. Usually D-E-G-A-C-D. There is some flexibility around the C, I think, which can be more like a B sometimes. The vocal melodies also seem to stay within these pentatonic parameters, for the most part. There are two fundamental rhythms, one using a two-against-three pattern and the other like a lilting 12/8, which can’t be accurately notated because the ‘quavers’ aren’t straight, and seem to flatten out at faster tempos, rather as swing feel in jazz tends to. There’s my etic perception of the music.

In music therapy training in the UK, we tend to encourage musical flexibility, the ability to adapt to different styles, according to the needs of each individual client. What would we do if an experienced Gnawa m’allem enrolled on a training course? Talk about ‘coals to Newcastle’! Gnawa music is a healing tradition. Musicians are tasked with evoking ancestral spirits so that the dancers can reconnect, address problems of health and well-being with the mluk. If a m’allem enrolled on a training, surely they would be doing the tuition?

Or we would be comparing notes, so to speak? In fact, perhaps ironically in the context of this line of thinking, Gnawa musicians are very flexible, open to fusing their music with jazz and other traditions. More prosaically what I wonder about is: can six notes be enough? Clearly they can. Maybe, to make music work with only six notes is the sign of mastery. The fact that I feel like I need all that harmonic colour, the complexities of the well-tempered chromatic system of twelve notes equally spaced in an octave and the capacity to modulate, to play ‘atonally’, to create consonance or dissonance, that’s my stuff. You don’t really need it, not if you’re a true m’allem, which translates roughly as ‘master musician’. Six notes, or five, if you don’t count the octave, with flexibility of intonation, but no modulation. The same as the blues, and no doubt related in its origins.

I imagine a positivist perspective on Gnawa music would posit that the mluk are not ‘real’ and that any healing resulting from a Lila would be a sort of ‘placebo’. But if we adopt a culturally open and curious stance, reality shifts. We might realise that it’s not about that, that we’re looking at it the wrong way to understand it meaningfully. Have a listen to the Paul Nordoff lectures if you can get hold of them. This is a master preaching to his disciples. It’s every bit as culturally specific as the Gnawa tradition. Notes and rhythms are presented as pure communication, capable of reaching all human beings if the timing is right, but it’s all firmly within the classical tradition of major and minor scales, equal temperament, etc. etc. Are we more like the Gnawa, developing our own rituals and beliefs in musical relationship as a route to healing (for example) attachment difficulties, than we are like ‘clinicians’, using music to achieve therapeutic goals in a health context? And if we are, is this a ‘good’ or a ‘bad’ thing?

What I am

Me and my guitar. always in the same mood.
I am mostly flesh and bones and he is mostly wood.
Never does grow impatient for the changes I don't know, no.
If he can't go to heaven, maybe, I don't want to go, Lord.

James Taylor - Me and My Guitar

I remember an inspirational music teacher saying to the youth orchestra that "You always need to remember 'I am a viola player' all the time, even when you aren't playing. When you're on the tube, or hanging out with our friends, or at school, you should still think to yourself, 'I'm a violinist' or 'I'm a trombonist', or 'I'm a saxophone player'. Your instrument is part of who you are". It's certainly true for me even now, many years later. And it's strongly instrument-specific as well. I play the piano, but I would never say 'I am a piano player'. Why not? Because I am a saxophone player. It's become part of me. I even play other instruments professionally as a doubler, but I'm no longer a 'clarinettist' (I used to be, years ago).

What does 'I am a saxophone player' mean? It means, for me, that without this knowledge, I would lose some essential part of myself. I need it to maintain some aspect of my identity. I'm also a 'music therapist', but this doesn't have the same resonance. I work as a music therapist, but I'm not 'a music therapist' in the way that I'm 'a saxophone player'. Maybe some people feel like this about their job, but I'm not sure. I think it might be something about the physical object itself.

Could this be related to transitional phenomena? Is my instrument a kind of transitional object? Does it keep me in touch with some essential internalisation which I need to maintain my sense of self over time, to keep my sense of continuity as a person? This seems plausible. Think about having to give up your instrument. There are people for whom this happens, through circumstances beyond their control. We might acknowledge this as a deep tragedy in many such circumstances, perhaps beyond the misfortune of, say, losing a job, or breaking a leg, and more akin to losing a person, an important attachment figure. I once had to stop playing for a few weeks when I injured a finger, which was a sobering experience. Reconnecting with my instrument after this was a big relief. I'd lost someone I loved and now they were back.

Maybe this connection is something to hold onto as a music therapist. Maybe it's important that the work doesn't take this away. Winnicott talks about decathexis in relation to transitional phenomena, about how they are 'spread out' over 'the whole cultural field' (1971 Playing and Reality page something-or-other). But when you are connected to an instrument perhaps you are able to re-focus, to concentrate your creativity once more, in a similar (but different) way you did with your teddy bear when you were three years old. Keep on cathecting, as the song might go (if you can find a rhyme)...

It's not about you

How many singers are really worth listening to? I haven't watched talent shows much in recent years, but to me they're of a piece, whether it's Britain's Got Talent or The Young Musician of the Year, they're all barking up the wrong tree. Artistic expression shouldnt be about competition. The problem is not that the X factor and other talent shows are promoting distorted values. Of course they are. The problem is that they are partly right. I dont want to listen to most people sing, given a choice between that and, say, watching Fargo. This isn't to disparage or discourage, its just my own selfish perspective. Engaging random strangers with your music, building a following, developing as a public artist, these are hard things to do, and most people can't do it. There are a limited number of people who I'll go out of my way to listen to.

The X factor is right. There are only a few singers I really want to listen to. This is ok. They're promoting the concept of 'stardom', which is elitist by definition. An irony of the show is that they're not actually trying to find singers with the 'X factor', which to me, might be those people with marked individuality (Bob Dylan, Billy Holiday, Nick Drake, Stevie Wonder, Bowie), people who don't sound like anyone else, who are idiosyncratic. Maybe a show which really looked for this quality would be more interesting, but this would have to ignore the real aim, which is to make a fast buck out of the winner while their notoriety lasts. Really interesting singers need time to develop their voice and persona.

Where does this leave me as a music therapist? Do I sit there feeling angry with clients because they aren't geniuses? Of course not. The transaction is hopefully more honest. A performer is selling you something, an idea that they might be special, that of all the people in this big room full of people, they might be the one most worth listening to. The exasperation comes from the wrongness of this presumption. A music therapy session begins from a different place. I'm making a commitment to be interested in the client's music, no matter what it might be. Often, it comes from the client's place of self deprecation or doubt. I'm trying to encourage them to explore what they might be able to express if they give it a try, with no expectation. Maybe they will find themselves worth listening to. Maybe I can show them that I find them worth listening to.

Some of my favourite performers are able to retain this feeling of vulnerability even in front of an audience, as if they are playing or singing to themselves, not assuming their own greatness, but finding the greatness in the music itself - Miles, Bill Evans, Coltrane, Andras Schiff, Abbey Lincoln, Martha Arberich, Laura Veirs. 'It's not about you' might be something they understood on a deeper level some time ago.

The honesty of the musical transactions that can happen in music therapy can result in more satisfying musical experiences than in many performer/audience relationships. In music therapy, it is 'about you', the client, and it's about you and me. As Andy Lale said in his 'Music Therapy Conversations' interview, the fantasies of stardom might be a good starting point, but only as a stepping stone towards something more real and honest. Neither of us is 'gonna be a star', but who cares? We might get to be something more interesting: a person.

Curiouser and curiouser

"she was so much surprised, that for the moment she quite forgot how to speak good English" (Lewis Carroll, Alice's Adventures in Wonderland)

In one of Gareth Malone’s programmes where he encourages people to sing who normally wouldn’t, there was a bit where he criticised someone for singing in an American accent. He was working with a talented young man in a school, who he was preparing for a ‘big solo’ in the choir. Gareth was being nice about it, but he took the mickey out of him a bit, impersonating him. Then he showed him how to sing properly, with a ‘normal’ voice, using his own accent. A similar thing happened to my daughter, who is a singer songwriter and was writing songs and singing jazz standards when she was at school. The head of music used to similarly berate her for singing American. I was never quite clear why, but it seemed to be an accepted narrative that this was just not the way to do things properly. It was also clear that the students he most admired were the ones taking classical singing lessons and singing with a ‘trained’ voice. Perhaps it was just musical snobbery, but it wasn’t presented as such. Neither Gareth Malone nor the school teacher had any problem with popular or jazz styles per se, they just seemed to have a problem with the accent.

First of all, I would argue the case for singing songs with an American accent on purely stylistic grounds. If you’re singing songs from the Great American Songbook, or songs in a soul style, if you’ve been listening to a lot of Billy Holiday or Stevie Wonder, then it would be natural to sing in an accent appropriate to the style. I presume neither Gareth Malone nor the music teacher would have had any problem, for example, with singing Puccini in an Italian accent. This also plays, perhaps, into my own chip on the shoulder about being a jazz musician and experiencing snobbery towards this during my own musical education, particularly when studying music at university. I’ll bracket that however, because, well, who cares…

Maybe the problem is with singing in a bad American accent, so that it sounds inauthentic, and that singing with one’s natural accent would be preferable to this. I feel this when I hear Robbie Williams, for example (but I might be alone in this), or even Elton John. I don’t feel it when I hear Laura Marling, who is definitely English, definitely sings with an American accent, and has been embraced as a performer in the US. She even talks with an American accent in at least one song, which is sort of comic, but also makes sense. An English voice would just sound wrong, so it probably felt like the only option. So perhaps if you get the accent right, Gareth would be happy. I don’t think so, but I’d be really interested to know how singing teachers perceive this. I should have asked Joanna Eden.

Doesn’t matter, because none of this is the important bit. Now we come to music therapy. The difference between a music therapist and Gareth Malone, or my daughter’s music teacher, is that a music therapist would first of all accept the song as it came out. They wouldn’t try to correct the accent. Perhaps even more importantly, they would also be curious about it. Why sing the song in this way? What has the client/participant/singer been listening to? What is their musical and personal history? Does the song have a personal significance for them? If they have written the song, what, or who was their inspiration? When they sing in a certain accent, are they thinking of a particular person, a particular recording, do they have a musical hero? Is there someone they want to be like, and does singing make them feel a bit more like this person? When you think about it like this, from, if you like, a ‘clinical’ perspective, then criticising someone’s choice of accent could feel damaging, belittling. It could feel like you’re not really paying attention, but instead seeking your own musical agenda, to get things ‘right’, the way you, and the ‘musical establishment’, want things to be.

In other words, not exploring where the music comes from, what it’s expressing about the person, could be a failure of curiosity. I like the word ‘curious’. It leaves things open. If we were to stop being curious about the client in therapy, we’d have lost our way. This is why the music in music therapy might not always sound how you want it to sound, because the therapist isn’t making any corrections. Instead, they are discovering where the client, and the music, leads us next. This is likely to be somewhere interesting, as long as no-one is adjusting their vowels.

Vitamin C

I’ve written before about whether ‘music makes you feel better’. There might, in particular, be something therapeutic about shared music. This might happen in lots of different contexts: community settings, acute wards, closed groups, individual therapy, and so on. While music therapists might argue about how to frame the work, about whether it’s the music itself, or the relationship with the therapist, or unconscious processes being expressed through music, there seems to be some general agreement that music is an important part of the therapeutic process in music therapy, whatever it might be.

I went to a good gig last night. I try to do this as often as possible, but it never feels often enough. Anyway, I really enjoyed it, hearing Simon Purcell with the great alto player Mike Williams at Oliver’s in Greenwich. I’m missing music at the moment, not getting enough time to practice and not doing that many gigs, absorbed in my current research studies, which I’m enjoying in a different way. Research is creative, but in a more cerebral way than making music. One of the questions arising out of the research is about the perceived effects of music therapy sessions. What do parents observe about their children’s response to music therapy? I hope to tell you more about this soon! One idea that has come up in discussions I’ve had with parents in other contexts, which won't be news to music therapists, is that children are often calmer, less anxious, after their music therapy session. This can last a while, sometimes as long as a day or two. This chimes with my own experience of music. I feel better after playing, or after hearing a live performance. This usually lasts for a little while, but never more than a day or two. The experience fades. If I haven’t been to any live music for a while, I begin to lose interest in listening to recorded music, as if the real experience has to be recent enough to bolster the simulation.

So perhaps music is like vitamin C. We need it, but we need it regularly. Our bodies, or our psyches, don’t absorb and retain it, but it’s essential for our well-being that it’s passing through us. This raises some big questions about music therapy, particularly if we are looking for ‘effects’. If the effects of music itself don’t last, but need to be maintained, then what should music therapy look like? Is it more like asthma medication than antibiotics? Is music an essential balm for the chronic aspects of the human condition? If so, we could never expect music therapy to have good results at, say, six-month follow-up, because it would always have worn off by then. It might instead be about clients learning to use music for themselves, to understand their own relationship to music, so that they can return to it and use it in beneficial ways.

There might be another possibility, that it’s not about the music itself, but about music as a facilitator of relationship. Music simulates pre-verbal communication and thus allows human beings to connect with one another at a deeper level than language. This might help to repair attachments, perhaps. The problem with this is that there are lots of ways to form attachments. Music might assist attachment, but it’s definitely not essential to it. And in any case, as Claire Flower pointed out in her podcast interview, what can we achieve in half an hour a week? Children form positive attachments with other people whom they spend a lot of regular time with, over a long time span; parents, siblings, teachers, teaching assistants, friends, maybe therapists (if they see them for long enough). We might have a real dilemma here. Is it about the music? Is it about relationships? Is it about the interaction between the two? Do we have to choose one of these? You might think I’m being too reductive. Perhaps it’s all just ‘a lot more complicated than that’, or it’s about being holistic, rather than fragmenting these aspects of life into different categories. People, music, relationships; these aren’t things that can be separated out and examined independently. Ok. So why is it called ‘music therapy’ then?

Thinking about thinking

The great drummer Jon Hiseman has just died. This post isn’t a tribute to him, but I was very sorry to hear of his passing. (Here’s an example of his playing, which is brilliant.) I did meet him once, doing a recording for someone in his studio. I forget the details around this as it was a long time ago, maybe early nineties. What really stayed with me is something that he said during a conversation in the studio. He remarked that the best music is played by people who are thinking about something else entirely, or words to that effect. What I believe he meant was that, when you are doing a gig, if you are having to think about the music in order to get it right, then there might be mistakes, or a feeling of uptightness about it perhaps. It’s when you know the music so well that you can play it while thinking about doing the laundry, or taking the car in for a service, or doing your accounts, that the music really sounds good, really flows. It was a remark that has stayed with me ever since. I actually think about it a lot. I think it disturbed me at the time as it seemed to imply some kind of disconnection, maybe something inauthentic about the performance. I feel differently about it now.

Seeing the news was a moment of synchronicity for me, because I’d just been thinking about this idea in relation to some clinical work. I found myself, in a session, thinking about something else, unrelated to the client or the music. This can feel transgressive. We’re supposed to be paying attention to the client, and to the music, to the ‘shared-musical space’, perhaps. I even wrote about Jon Hiseman in my process notes. Later, after writing this, I saw the news of his death.

This isn’t a post about synchronicity however, although you can have that one too if you like it. What it really got me thinking about was what I think about when I’m playing. I’ve have so many discussions with other musicians and music therapists about this. Some people have said that, when improvising, thought gets in the way. You need to be ‘in the zone’, where you’re not tripping yourself up with concerns about what ‘should’ be happening, where you can be ‘in flow’. The music flows along, and we stay with it, riding it like a wave, trusting the process. As soon as we think, ‘is this right?’ or ‘is this good?’ or ‘what shall we do next?’, we are getting in our own way. Mercédès Pavlicevic talked about the problem of thought in clinical improvisation in her podcast interview, expressing a similar idea. She said it might go something like, ‘Why am I in F sharp?’, and then the moment’s lost. She’ll be missed too, very much.

There may be a difference, of course, between the role of thinking in improvised or in tightly rehearsed music. Jon Hiseman may have been talking about the phenomenon of playing music that’s been well played-in, perhaps where a band is really gelling, some way into a tour. I’ve certainly experienced this. It doesn’t necessarily feel good to the performer. It can feel routine. But for the audience it might be a thrilling experience hearing a band playing really tightly together, giving the impression of total unity, where the individual musicians are just firing neurons within a complex whole that’s not perceived by any one of them as an entity, but by the listeners. You can listen to a recording of a gig you were on and feel like it was someone else playing, because the experience is so different to being part of the process of producing the sound.

While going through the motions might produce a tight performance, could the same be said for improvisation? Well, yes, I think it could. Kenny Werner talks a lot about this a lot in Effortless Mastery. When you let go and just let yourself play without trying to critique or edit, that’s when the best stuff happens. Thought gets in the way. Maybe there are differences between these two phenomena, maybe they are the same, maybe there are overlaps, but it doesn’t matter, because that’s not what concerned me when thinking about what happened in the session.

The question that came to my mind when thinking about my moment of drifting off, of thinking about something else, was, if I’m not thinking about the music, then what am I thinking about? I’m usually thinking about something. I’m not a yogi. This might be worth exploring. It may be that I need to work on my capacity to be in the here-and-now. Perhaps all music therapists should practise meditation in order to work on this, to enter a more thoughtless, mindful state. Probably not a bad idea. I don’t think it’s the answer though. I think the process of thinking, getting in the way of the music, being with the client some of the time, attuning, failing to attune, drifting off, playing good music or bad music, I think it’s all the process. The idea that we are attentive to the client, and that we are sharing in the musical process together, connecting in the music, is nonsense, or, at least, it’s not realistic. We are in some kind of music-making process with the client, and the two of us are failing to connect with each other in one way or another. We might be trying to connect, but we’re never going to make it, because our experiences will always be different. Even when the music comes together, it’s coming together in at least two different ways (I’m not going to even try to talk about group work). But this, I hope, is ok. I hope it is, because I’m never going to pay total attention to the client, not for a whole session. I’ll keep trying, but occasionally I’m going to drift off. I wish I hadn’t mentioned ‘doing your accounts’. What was I saying?

Music therapy in 2068

So, after the BAMT 2018 conference, which was full of positivity and new ideas, with a great spirit of openness, there’s lots of different possible blog posts that could be written. But I have to go with one idea that’s inescapably in the foreground for me. During the ‘Question Time Debate’ Gary Ansdell made a couple of provocative comments. There’s a danger of me misquoting, for which I apologise in advance. (Hopefully the recordings will be available to check in on later.) First he said something about the alignment of music therapy with a psychotherapeutic model being an ‘old chestnut’, which is now well and truly ‘roasted’, and that music therapy has restricted itself as a profession by identifying with this model. Then, in the round of closing statements, he said that we should do away with ‘music therapy’ within the next 50 years, by which time enough musicians will have been trained appropriately to replace the role, because ‘there will never be enough music therapists’.

There’s something about the provocative statement that stays with you. It’s a real talent, to come out with those soundbites that annoy people just enough that they can’t quite let go of them, but not so much that they can simply dismiss them. If he’d said ‘5 years’, for example, that would have been easier to let go of.

This is part of the (very much partially roasted) ongoing discussion which some people, for some reason, wish would go away. A few thoughts have been occurring to me. First of all, on the idea that there might be something restrictive about the psychotherapeutic model; I wonder what psychotherapists would have to say about this. Do psychoanalytic, person-centred, transpersonal, Gestalt, integrative, existential, systemic or cognitive analytic (etc. etc.) psychotherapists find their models restrictive? Music therapists have drawn on ideas from all of these perspectives and many more. I also struggle, in certain senses, to see any fundamental difference between music therapy and psychotherapy, especially if we take both as rather broad terms. This may be a bias connected to the type of work I do, which is often with children and young people in a time-boundaried, confidential, attachment-based context, where the therapeutic relationship is central to the work. But actually I’m not so sure about this: I think psychotherapy, if it is ‘treatment by psychological rather than medical means’ (OED), covers a broad spectrum.

My own experience of (psychoanalytic) psychotherapy, as a client, is that it provided containment for feelings, emotions, wellings-up, that were difficult to manage in day-to-day life. The importance of having a space to take aspects of self that it can be difficult to fully contend with is not easy to assess, but it’s not to be underestimated. And I wouldn’t describe my own personal struggles as anything out of the ordinary. The verbal, cognitive aspects of this were important, but they were only a part of the whole experience, in which the presence of a supportive ‘other’ was really the key factor. (I almost wrote ‘non-judgemental’, but it’s not as simple as that in a transference relationship.) I would suggest that the overlap between what was going on in my own psychotherapy and what generally goes on in music therapy was substantial. You don’t even have to factor in the verbal aspects of music therapy for this to be the case. The supportive other, listening, reflecting back, partially understanding, and trying to understand more, over time – these, in my experience as a client were/are/will be the important therapeutic factors.

This is such a significant experience, so fundamental in the way it operates, that a word like ‘restrictive’ feels baffling. I can imagine an answer, along the lines of, ‘it depends on the client group, aims of therapy, setting, social context’, and so on, but you can say the same thing about psychotherapy, with its array of models which adapt to different individual and group settings. Of course, you could also argue from the other side, that verbal psychotherapy restricts itself by not having music as a medium of expression, although it can use attunement, inflection, silence, body language, facial expression, all the various modes of communication of which we’re often not fully aware.

This is too complex a topic to contend with fully in a blog post, and I hope to hear Gary say more on it, perhaps to correct my own (at best) partial understanding of what he meant. Maybe I'm repeating old arguments, but if I worried too much about that, this blog wouldn't exist in the first place...

I do welcome these kinds of statements, because without them we’d just be agreeing with each other. The other statement, about there only being 50 years left for music therapy, I can only respond to with a hunch, which is that, to me, it feels like we’re just getting started.

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…

Having fun?

I heard a story about a conductor of a well-known orchestra who used some rehearsal time to play some pieces ‘for fun’, much to the irritation of the musicians. All professional musicians, above all, want to get to the end of the rehearsal as soon as possible, and the idea of playing something ‘for fun’ is anathema. Perhaps I’m generalising too much, but, if I am, not that much. Rehearsing is work, and work is nice when it stops. That’s not to say that rehearsing is never fun, but if you start to call it that, it annoys people. The ‘fun’, if it’s there, should be a side effect, not the rationale for the rehearsal. Sometimes jazz musicians get told how much ‘fun’ it must be to play jazz, by people that don’t. Maybe there is some envy of the perceived spontaneity of jazz, as well as the feeling of joy that the music sometimes conveys. There’s a quote attributed to Johnny Griffin – ‘Jazz is music made by and for people who have chosen to feel good in spite of conditions’. But you could apply this to a lot of music, since the initial impetus for getting involved in music in the first place is to feel good in some way, whether it’s through self-validation, connection to others, enjoyment of the music itself, or perhaps a feeling of being uplifted or enlightened.

I remember an interesting comment my father, a big jazz aficionado and a talented musician himself, made about Bud Powell, that he wasn’t surprised that the ‘psychological minefield of bebop’ might be linked to mental health problems. Bud Powell, dogged by mental health problems and alcoholism throughout his career, was a musical pioneer of great artistic integrity. The link between great art and mental health problems is well documented, and my father’s comment further implied that there may be something perilous in the content of the style, perhaps something psychologically dangerous about musical innovation, especially where what is being expressed feels darker and more difficult than what went before, as was the case with bebop.

Also, ‘feeling good’ and ‘having fun’ might not be the same things. But even if they are, music doesn’t always lead to one or other. Music can explore difficulty and express ugliness, pain, frustration, things which don’t necessarily make for an evening out. Of course, these difficult emotional worlds might be part of a larger narrative, one that is ultimately meaningful and transformative. Dissonance might be experienced in the moment as unsettling, but then in context as creating tension which leads to resolution. Music has to have a dark side, even when it is ultimately expressing something positive or joyful.

As a music therapist, I’m often told “That must be so rewarding”, by people who aren’t music therapists. Sometimes, as I collect a child for their session, a teacher, or parent, says to the child, “Have fun”. Music has this association with enjoyment, entertainment, diversion, that talking doesn’t. Nobody would say to someone going into their psychotherapy session, “Have fun!” If they did, it would immediately be recognised as deadpan humour. The capacity of music to express the difficult, the painful, is forgotten about in these moments. Bud Powell, perhaps, was one of those gifted human beings who could transform his personal pain into a kind of beauty, without taking away the underlying truth in what he played, or perhaps he was using music to ‘feel good, in spite of conditions’, but either way, he was bringing joy to others. The client in music therapy doesn’t have this responsibility.

The therapist, of course, has another kind of responsibility, which is to accept the client’s music (or lack of music), beautiful and rewarding or not. Then also to respond, to meet what the client brings, which can include the absence of music, the avoidance of music, the creation of music which is aggressive, confrontational, disruptive, destructive, nullifying, or, of course, expressive, emotive, poignant, communicative or even, indeed, beautiful. But whatever it is, it’s there. It’s the challenge the music therapist has to meet. Occasionally, this might be fun, and we can welcome this, but don’t expect it. The dark side of the music in music therapy doesn’t always resolve, or find a meaningful context. Sometimes it can express things you wouldn’t choose to hear, if you were using the music for entertainment, and it can be left hanging, or unclear, or it can feel empty. So it could be argued that music therapy has discovered, or revealed, a particular use for music, as the effective conduit for a darkness which can’t be expressed in any other medium. Have fun, kids…

Right here, right now

In a recent session I had one of those moments of doubt. The thought came to my mind that music therapy just doesn’t work. A child I am working with because of some particular difficulties was able to talk about them a bit, and was able to make music, to respond and interact, to be expressive. But I didn’t feel there was any link between the two. I felt that the supposed thread running from reasons for referral through the music therapy intervention itself, to some kind of positive outcome, was nothing more than a fiction, possibly even a con. The idea grew in my mind: music therapy is an activity, a way of people spending time with each other possibly, maybe an enjoyable experience, but the proposition that it has the potential to effect change, particularly change of any specificity, seemed ludicrous. How on earth could this child, by spending time with me hitting a few percussion instruments and then maybe singing a goodbye song, reach any kind of resolution of their broader difficulties? It was bordering on dishonest to claim anything of the sort.

Then I dropped it and got back in the room. I let go of the idea of fixing the problem and returned to the present moment. From then on the session changed dynamic. Things started to happen, including symbolic things, like the child talking about the way they would like things to be, the things that they miss in the session, which they wish were in the room. They became more expressive and imaginative.

Quelle surprise! But it’s easy to forget this tendency, and it’s tempting to assume that big sweeping thoughts are about big sweeping things, rather than really about what’s happening right now. Perhaps this is a good example of counter-transference, or projective identification. Perhaps I took on something from this child unconsciously and it was abstracted and expressed in my own psyche as a negative, particular thought. It would be possible to view this as a dangerous moment, where the potential to rubbish music therapy presents itself, a moment of final disillusionment with the process, and even with the profession. More useful, however, is the idea that moments like this are vital to the process of therapy, that we have to allow the client to take us to this empty place before we are able to press the reset button and experience the present moment anew. Bion was right about memory and desire, but knowing this doesn’t stop them creeping into the session, especially when we have care plans and evaluation forms and ‘aims of therapy’ rattling round our heads. In the room you have to forget that stuff, just as Mo Farah has to forget about winning while he’s actually running.

And what’s the point of music anyway? As soon as you have to ask that question you know you’re off track. I was at a concert of Bach last week. I knew it was good, but I couldn’t get into it. For a moment I thought ’What’s the point of Bach?’ But then, what’s the point of there being a point, and does there need to be a point, and why all this worrying about the point? Is this a superego thing? Is there a voice inside there somewhere asking about aims and purposes and outcomes all the time, which gets louder or quieter, depending on the level of meaning of whatever is happening right now? Maybe there is this for the client, too. Maybe the better it’s going for both of us, the less we are likely to be asking ourselves stupid questions, or making big empty internal pronouncements. But I don’t think there’s any escape from this. It’s part of the role, and the job, to keep questioning. Just so long as the questions can make way for the real work when the time is right, ‘the time’ being right now.

To Boldly Go

First, a joke:

Q Why is there no jazz in Star Trek?

A Because it’s set in the future

Thanks to my friend Matt Regan for reminding me of that one the other day. You have to be a jazz musician to tell it, otherwise it’s just mean.

If you’ve read this blog before and are inclined to feel there are too many references to science fiction, then best to skip this post. I’m a big science fiction fan. At its best, it’s full of beautiful metaphors, which it uses to amplify the themes and dilemmas of real life. I also like watching spaceships fire lasers at each other, and cool monsters, so it can connect me to my 8-year-old self too. Some people were critical of the new Star Trek reboot, because it contains a bit too much crash-bang and not enough consideration of the socio-political or philosophical issues which you find in the TV series. I liked it. I particularly like the symbolism at the beginning of the first one, where Captain Kirk’s father has to sacrifice himself by crashing a starship directly into a sun, in order to save the lives of everyone else on board, including his wife, who is in labour, giving birth to the future Captain Kirk. The silliness of a lot of sci-fi in TV and film is usually a long way from the masterpieces of Philip K Dick or Kurt Vonnegut, but it can often be saved by the use of powerful symbols which drive the narrative. So, here we have the young Captain Kirk, trying to atone for his failure to live up to the myth of his absent heroic father.

Then, in Dr Who, we have the archetype of the wise old man in the form of the Doctor. Even when he manifests as a younger man, as has been a recent tendency, we are frequently reminded that he’s over 900 years old. Kids hide behind the sofa during the scary bits, but they keep watching. The Doctor is almost as scary as the monsters at times, but we know that he will always ultimately prevail, and that he’s on our side. I’ve continued watching Dr Who recently, even as the storylines have buckled beneath their own grandiosity and hyper-complexity. Some episodes have been ludicrous, but every now and then you get a gem of a science fiction idea. The episode, ‘Blink’, where the marooned Doctor communicates with people 20 years in the future through a videotape, and the weeping angels are first introduced, is a great science fiction short story. The recent episodes in which a huge spacecraft is trapped on the event horizon of a black hole, so that time passes much faster at one end of the ship than another, cleverly uses Einstein’s theory of relativity in a playful and inventive way.

Then, after a disappointing Wimbledon men’s final the other day, we Dr Who fans were introduced to the new forthcoming female manifestation of the Doctor. It was an image of a male archetype transformed into a woman. Whatever the socio-cultural context, and bracketing the fact that this is essentially a fairly silly children’s TV programme, this is a powerful idea. For me, someone who has watched Dr Who since the 1970s, it was full of resonance. The father figure reveals the feminine, the anima perhaps. Male and female roles, sexuality, identity, are fluid things. They can change. So, on one level, the Doctor can be a woman, and little girls can have someone new to identify with, on another level, the Doctor always had the potential to be a woman.

As a therapist this fluidity is important. The transference relationship in therapy is gender-fluid. Sometimes my role embodies paternal function, sometimes there are maternal aspects to it, or even sibling aspects. Sometimes I have to be serious and focused, at other times I have to engage in imaginative creative play with a 5-year-old, pretend to be the ‘evil baddie’, the ‘rescuer’, or the ‘rescued’. ‘Male’ and ‘female’ can blur within these imaginary roles. Before I was a music therapist I was (and still am) a freelance musician in the jazz and commercial world, as well as a teacher. I went from a corner of the music scene which was largely male-dominated (increasingly less so now) to the music therapy scene, which is the opposite. This required some flexibility of identity and thinking. As a male music therapist I’m taking on a role that is sometimes stereotyped as female, similarly to a male nurse, perhaps. This is a positive challenge. It involves letting certain ideas go, but not throwing out the baby with the bathwater. ‘Paternal’ and ‘maternal’ roles, whatever they might be, and whether taken on by men or women, are both important, and therapists have to be able to encompass both at different times.

I’m sticking with science fiction as a genre with plenty to offer in the way of symbolism and philosophical thought experiments. And it’s good to see that the ‘wise old man’, or the ‘young hero’, can be female, and that the ‘damsel in distress’, or the ‘glamorous assistant’, can be male, or that they can all be both or neither, depending on the context and on perception.

And, by the way, the irony of the joke is that while there might not be any jazz in Star Trek, Star Trek is pretty popular amongst jazz musicians. Check out the Phil Woods version of the theme from the original series – swingin’!

Musical expression and 'The Glass Bead Game'

When I was training, back in 2006, I remember having a conversation with another musician on the way to a gig. He asked me what happens in music therapy and I explained that it’s partly about the client having an opportunity to express themselves musically. He replied that he wasn’t sure about this, because in his experience it took him years of practice before he was able to express himself in music. It’s tempting to shrug this off as a misunderstanding. Either I failed to explain music therapy clearly enough, or he failed to grasp it, or both. The problem is that he’s also right. Expression in music requires some degree of instrumental or vocal control, and we can often feel as performers that we’ve failed to quite communicate exactly what it was we were trying to put across. To some degree this is always the case, especially in improvisation. There are always missed opportunities, fluffed notes, moments where the groove doesn’t quite sit, and even if there aren’t, to what extent are we expressing ourselves in the music we make?

Kenny Werner (in Effortless Mastery and in his masterclasses) talks about the ‘freedom from having to sound good’, and Nachmanovitch (in Improvisation in Art and Life) about the ‘judging spectre’. Both espouse ideas about improvisation which are about freeing oneself from judgement. This concept presents an alternative to my diligent colleague, striving for years towards the ideal of self-expression. In music therapy a phrase I’ve often heard is ‘innate musicality’, suggesting that we can connect with the musician in every human being if they are open to this. Nordoff and Robbins famously described the ‘music child’, that entity which can transcend other impediments and express something underlying and positive in any human being, no matter what obstacles might exist to other forms of connection. There is also a link to be made between preverbal parent-infant interaction and clinical improvisation. Music is within us from birth and predates language in our development, so in music therapy we are able to connect with something very early in human development, which has therapeutic advantages, enabling us to go where the talking therapist perhaps may not.

There is an aspect to music, however, which can sometimes be downplayed in the rationale for music therapy, that is, its sophistication and refinement. This is exemplified by Herman Hesse in The Glass Bead Game, where music is a core aspect of the training of students in the elite school where most of the novel is set. The Music Master is a guru-like figure and students of the Game are required to become adept in counterpoint to a high level, along with mathematics, as they strive towards perfection. Another more left-field novel, which explores music’s otherness is Thomas M. Disch’s On Wings of Song. Disch’s book, referencing the poem by Heine, describes a future dystopia where singing is discouraged, but where people prepared to risk it are able to use song as a means for achieving literal (and illegal) out-of-body experiences. Not everyone is able to do this, and the protagonist is a figure who struggles with his inability to harness this potential. Disch, a novelist of boundless pessimism, is using music as a metaphor for something else, a means of escape from an awful reality. But it’s an interesting metaphor, because it fits with a perception of music in our society, that it’s often something elitist, reserved only for the talented, those who are ‘musical’, whatever that might mean.

The requirements for admission onto music therapy training courses include, in part, a high level of musicianship. Why? In music therapy, who is doing the ‘expressing’? If the client can express themselves through music, why do they need a therapist to be proficient to degree level in musical performance on an instrument? This requirement implies that we may be doing some of the musical expressing on behalf of the client. But as music therapists we are also, often, trying to democratise music making, to encourage clients to believe in their own ability to be expressive, regardless of musical skill and experience. We are attempting to prise music out of the hands of the musical elite and make the experience of music making available to all. This is a tricky balancing act, because we can’t deny the role that musical elitism plays in our preparation for this role. We have to acknowledge that we are giving a hand up to our clients when they have less musical skill than we do, that we are doing something for them, as well as with them. (A case in point: Wigram in his book on improvisation techniques describes reflecting, the musical expression of the client’s overall presentation and affect, rather than a direct matching of their music. This is sometimes loosely referred to by music therapists as ‘playing the counter-transference’.) What we are doing and what level of expertise we draw on depends on the client and the context, of course, but our own musical history is always present. There are two sides to the coin: on the one side the potential envy of the client, on the other, the importance of our capacity to contain, reflect, draw out. Our musical skill, our musicality, is an important factor in therapy, and while it might contribute to the client’s ambivalence, we couldn’t do our job without it. The client can’t have it both ways, and neither can we.