Why I hate being a ‘therapist’

In my relationships with persons I have found that it does not help, in the long run, to act as though I were something that I am not. Carl Rogers

“It sounds like you’re angry. I wonder what you might be angry about.”

“There seem to be some really difficult feelings here around being able to play. Perhaps playing can feel awkward sometimes.”

“Mm, mm. It seems like you’ve identified something really important”.

“You REALLY don’t want me to play. You want to be IN CHARGE today!”.

“That felt like a sad piece. You’re feeling sad about something”.

“Perhaps the drum stick hitting the drum reminds you of accidentally witnessing, as a young child, your parents having sex?”

Ok, the last one’s a joke, but you get the idea. And here’s something I have heard music therapists say outside the session: “I was enjoying the music, but maybe that’s wrong”, and on other occasions, “My client wants to talk a lot, but I don’t feel qualified. I feel like they need a counsellor”. When I was training I once brought an excerpt from a session to supervision where the client was playing on the white notes of the piano. I harmonised in the lower register, interpreting the melody in A minor, then using the chord progression A7b9/C# to D- to give the melody harmonic impetus. The client said ‘Mm, you make it sound good’. My supervisor and I interpreted this as an indication of envy, that this was the client’s defence against feelings of inadequacy, and that I should bear this in mind, and try to meet the client at their level, without bringing my own needs, for colour, excitement, perhaps validation, to the music.

None of this is wrong, but there’s a flavour to all this stuff which smacks of trying very hard to be a THERAPIST, writ large. It’s easy to slip into something which feels like one of Eric Berne’s ‘games’. For example, there’s a game called ‘Greenhouse’, described as a tendency for recently qualified therapists “to have an exaggerated respect for what they call ‘Genuine Feelings.’ The expression of such a feeling may be preceded by an announcement that it is on its way. After the announcement, the feeling is described, or rather presented before the group, as though it were a rare flower which should be regarded with awe. The reactions of the other members are received very solemnly, and they take on the air of connoisseurs at a botanical garden. The problem seems to be, in the jargon of game analysis, whether this one is good enough to be exhibited in the National Feeling Show.” I turn once again for wisdom to my 15-year-old daughter, who would probably respond with ‘Oh my god, it’s just not that deep!’ when presented with such a thing. Like the kid noticing that the Emperor’s naked, she’d be closer to the truth than those ‘clever’ therapists.

I suppose what I’m trying to identify here is a tendency I’ve noticed in myself and others to want to be a ‘good therapist’. During training, all sorts of natural impulses, to reassure, to respond with emotion, to enjoy the music, to disclose personal experiences, are questioned. We are encouraged to re-examine what we do, to treat our own motives with skepticism. We are attempting a paradigm shift into a new way of being, called ‘being a therapist’. The intention is to open us up to the client, to avoid getting in our own way, so that we can at least entertain the possibility of being with another person without trying to make them into something we want them to be. But, as with any shift of perspective, new dangers can emerge. We can get stuck in a sort of therapist persona, which is just a version of what we imagined a therapist was supposed to be like, based on observed behaviours and a desire not to get it horribly wrong. An idea came into my mind after hearing bits of the Radio 4 series ‘In Therapy’, which is that the more I sound like Susie Orbach, the worse the therapy is going. No disrespect intended, because Susie Orbach is entitled to sound like herself, but I can’t do the strokey-beardy, noddy-heady therapist thing, because it’s just not me: it’s me pretending to be a therapist. This has nothing much to do with client groups or adapting to different personal needs, it doesn’t work in ANY situation.

There are musical manifestations of this tendency too. If you find yourself deliberately not feeling the groove, not allowing your body to respond to the music happening in the here-and-now, then you’re stuck in the ‘game of music therapy’. If you force yourself to sing ‘Johnny’s playing the drum’ because you saw someone do that on a video or at a conference, but you can feel it’s not right; if you sit there, paralysed, doing nothing, because you’re wary of angering the client with your music, or your ‘training superego’ is looming over you; above all, if you feel the complete absence of any sense of humour from your music; these are all signs that you’re stuck in ‘the game’. Relax, remember who you are, and re-orient yourself in the present moment. Perhaps the musical therapeutic process, from the perspective of the therapist, should be about becoming more yourself. In this sense, you are hopefully mirroring the client’s process. As soon as I feel I can make a joke with a client, or I find myself moving my body to the music as we play, or I’m able to express a feeling without laying a heavy significance on it, but just seeing it there and letting it drift past, these are signs that it’s going ok. The less you feel like a ‘therapist’, the better therapist you’re probably being.

Why music therapy is the best job in the world

The other day my wife and I got into a ‘heated debate’ with my father-in-law. On the surface, this was the old left vs. right, caring vs. capitalist, young (well - …ish) and idealist vs. older and more cynical dynamic, although I’m sure he’d want to frame this differently. There was something quite exhilarating about this, even if the location of the debate, the pub, meant that the robustness of the argument became more questionable as the evening wore on. It boiled down to this: his argument – people who have greater ‘scope and scale’ in their role at work, where, if they screw up, more money and jobs are at stake, should rightly be paid more; our argument – there is a danger that ‘paid more’ ends up equating to ‘deserves higher status and respect’, and by extension, leads to assumptions about other things, like ability and intelligence. I gave the entirely self-serving example that being an effective music therapist requires just as much skill and intelligence as being the CEO of a company, but that this doesn’t stop some CEOs, or other people high up the corporate ladder, adopting, shall we say, an air of authority that can extend beyond the workplace.

I was reminded of another family event, when our generation of my wife’s extended family used to gather for dinner at Christmas time. These events were a lot of fun, despite the black-tie formality. But I recall at least one occasion when it was announced that a (male) member of the family had been ‘made a partner’ in their bank, or some such, and we all applauded. I had my own reservations about this implied slight to all those other people in the room (mostly women) who were doing equally demanding jobs, but pulling in less cash, and presumably, deemed to be lower down on the ‘scope and scale’ chart, hence, no applause for them (or me…). Nothing against those prestigious ‘partners’ per se, you understand ;)

I used to work on a project with a domestic violence charity. When we started this in 2009 there was a woman who I’ll call Catherine, who was the main point of contact in the charity for the project. She had a job title of ‘Children’s Support Worker’. She’d developed relationships with families over a long period of time, which meant that she was trusted by people in times of the most extreme stress of their lives, when they feared for their own safety and that of their children. She knew them well and was able to provide me, and the other music therapist on the project, with all of the most crucial information about the child and family, as well as helping them through the process of the child’s referral to music therapy and providing all of the emotional and practical support which that entailed. I hope she was getting paid ok, but I’m willing to bet that whatever it was, it was nowhere near her real value, not only as a human being, but also as a skilled practitioner of her craft. Frontline work is the basis on which all other work happens. Without her, and others like her, we’d all be nowhere. Needless to say, I didn’t think of this example in the pub the other day.

I recently made an application for some biggish funding for a clinical project in which music therapy would have teamed up with other health teams, charity workers, and social care. It was a long shot, and we didn’t get it. We’re a tiny profession, and we’re on the front line, which isn’t the place big funding bids normally achieve success from. My rationale was a ‘bottom-up’ approach. Therapeutic work, involving as it does the connection between the internal worlds of the client and therapist, could be seen as the bedrock of the client’s psychological wellbeing, as far as health interventions go. It’s the psychological and emotional front line. And improvised music takes place on the interface between the affectual worlds of the people using it to communicate. Music, and other non-verbal communicative channels, are at the coalface of human connection. And human connection is everything. Without it, there’s no thought, there’s no language, there’s, in a sense, no world-out-there. So it all depends how you look at it. We’re either at the lower end of the health hierarchy, a small profession, looking up at those consultant paediatricians, psychiatrists, heads of services and so on, or we’re constantly involved in a collaborative process of recreating the universe. I prefer the second one – it’s got more ‘scope and scale’.

Good advice

“When I was young, people told me: you’ll see when you’re fifty. I’m fifty. I’ve seen nothing”
Eric Satie

There’s a meme that crops up on social media with some frequency where older people give advice about life. What’s really important, when it comes down to it? Here’s an example. It’s mostly good quality. You know, don’t focus too much on work. The simple things are the best things. The moments of connection with those you love are worth more than your professional successes. Floss. Stuff like that. Here’s one I’m not so sure about: “Don't marry someone just because you love them. Make sure your lifestyles, dreams and plans are compatible in addition to loving them. Those little quirks and character flaws you overlook for love can become huge problems later in a long-term relationship, especially if they conflict with what you planned or where you want to go with your life.” Not terrible advice, but I found myself reacting to it negatively. What about trusting your instincts, being spontaneous, taking a chance on an intuition? Life can’t always go to plan, but seize the moment, right? You might disagree, but I’m hoping that some of the people I love aren’t too bothered by my ‘little quirks and character flaws’, or I could be in trouble…

This kind of advice is famously lampooned by Shakespeare in Hamlet, through the character of Polonius. In his speech to Laertes he gives lots of good advice, but in that sanctimonious tone that could drive anyone to distraction. Polonius is an old bore, to put it bluntly. Of course it’s a good idea to “Take each man’s censure, but reserve thy judgment”, but don’t keep going on about it… There are at least two responses to ‘good advice’: 1 listen carefully, because you might learn something and 2 ‘Whatever Grandad’. The first is probably the more sensible, the second the more adolescent. Thing is, I like that second response. It appeals to the adolescent in me and it’s much more expressive. It’s an assertion of individuality, the wish to make up one’s own mind about things, to learn from experience, the hard way, which, when it comes down to it, is probably the only real way. As a parent of teenagers I’ve often found myself in the Polonius role, bored by the sound of my own advisory voice, imparting the best course of action to an eye-rolling 15-year-old (when they’re being polite).

Richard Frankel, in The Adolescent Psyche, talks about the transition in adolescence from prohibition to inhibition, in other words, the development of what you might loosely call a conscience. This transition is where the eye rolling comes in. Once you’ve started to figure certain things out for yourself it’s unbearably tedious to have them pedantically explained to you by an old bald bloke. My capacity to connect with that feeling is, I hope, the piece of floating driftwood that sometimes helps me not to sink, as I negotiate other people’s adolescence. I read ‘older people’s advice’, feel irritated, and can then empathise with the teenagers I know. And they’re not only understandable, they’re also often right. Older people are full of it, and younger people have often got to the solution first. This also helps when working therapeutically. The therapist might be in a position of power in the therapeutic dyad, but they’re not much use to the adolescent client unless they can empathise, unless they can understand how irritating they are, just sitting there. One client I was working with was appalled to discover that I was the same age as a certain pop icon they identified with, because of their adolescent stance. Maybe this was a moment of realisation for them – ‘I’m on my own, because even Eminem is old now’.

Advice to my younger self? I’m with Eric Satie: ‘Relax. When you’re older, you still won’t know anything’.

The Flip Side

It's pretty grim for anyone on the left right now, or indeed for anyone not on the extreme right. How could all this stuff be happening? There are lots of explanations of course. The big puzzle for me was that people could vote for Trump once he'd crossed that line. Once the recording came out I assumed it was all over. No matter someone's policies or other appeals (bit vague on those too myself to be honest) surely the blatant misogyny would be the end of it. But if you're looking for a saviour, then you can become complicit in the con. That infamous recording contained the clue as to why it wouldn't be Trump's undoing. The key is the ignored first part of the statement, so distracted were we by the description of sexual assault - "when you’re a star, they let you do it. You can do anything". 'They' being the women he was boasting of assaulting, but perhaps also, metaphorically, the voters. 'When you're a star...'. What clearer description of idealisation, of positive projection, could there be? Here's someone who understands how to abuse power. Once those projections have been elicited you're invulnerable. It's not that you can do no wrong, but whatever wrong you do will be forgiven, because now you're the man. You're a 'star'.

I have often worked with victims of domestic abuse in music therapy. Children with abusive fathers feel enormous ambivalence towards the perpetrator. Often, they want to believe the best about him (it's usually a 'him') despite evidence to the contrary. It's a terrible 'Catch 22' situation. The person they want to attach their hopes to is not someone who has their best interests at heart, but it's almost impossible to let go. This kind of therapy is slow work because just as it's difficult to disengage from unrealistic hope of the father, so it's also difficult to form new attachments based on a more integrated view of the other.

As music therapists, we have to be very mindful of the dangers of idealisation, as it can flip very quickly the other way. The client who loves you is a hair's breadth from disappointment, envy, hatred. If the music is exciting and fun it can easily become empty and repetitive, and if your music is admired it can equally be resented and suppressed by the client when they hit idealisation's brick wall. There's no future in idealisation, but in the meantime the idealiser is vulnerable to exploitation. It's only by repeatedly not choosing to exploit our position of power as therapists that we gradually build trust over time with the trauma victim. They know really that their illusions are fragile, so they try to maintain control. The play can be rigid, stultifying, accompanied by a feeling of stuckness. As a therapist you can start to lose your sense of identity. But this is better than being idealised. It's the beginning of the next step. The path to integration is tortuous and takes place incrementally, and disillusionment is an inevitable and healthy part of the process. Donald Trump would make a terrible therapist.

The “stuff of life”

"What we play is life, my whole life, my whole soul, my whole spirit is to blow that horn," Louis Armstrong

There’s an interesting interview with Simon Procter on the Live Music Now website, in which he discusses music therapy as a career choice. Simon, as most of you will be aware, is one of the Directors of Music Services at Nordoff Robbins. In the interview he expounds very eloquently about the kind of things music therapists do, how they might overlap with community musicians, what their special skills are, how they are trained, the kind of people they might work with. It’s very clear, concise and informative, helpful advice for someone who might have had experience of working for Live Music Now as a community musician or performer and is interested in how they might develop their career along a new path, perhaps inspired by their experiences. Not surprisingly he gives the NR training course a bit of a plug. There are other trainings available, but these are easy enough to find online for anyone interested, and he’s in the business of promoting his own course, which seems fair.

Then, in response to the question “How does the NR approach differ from other training courses?”, he says this:

The Nordoff Robbins approach is ‘music-centred’ rather than psychoanalytic or behavioural. We take musicians and teach them to work musically with people. We emphasise musical outcomes for clients: we see music and musical experience as the stuff of life, not just as symbolic of something else.

Here we have two false dichotomies: one is that music therapy must be either ‘music-centred’ or psychoanalytic/behavioural, the other that music is either ‘the stuff of life’ or ‘just symbolic of something else’. Perhaps these are both expressing the same idea in slightly different ways. Procter isn’t here advancing a theory or using the sort of language that is required for an academic article, so perhaps we shouldn’t be too picky. However, he is speaking to prospective music therapy trainees, so it’s important that the language is clear, and not misleading. Of course, ‘music-centred’ is a well-worn phrase in relation to NR, but this doesn’t mean it can’t be challenged (despite the scare quotes).

First, a declaration of personal interest: I went to Guildhall, where I also do some teaching now. Trainees there are also taught how to ‘work musically with people’. As for an ‘emphasis on musical outcomes’, I would say that these are seen as a means to an end, that being the well-being of the client. I strongly doubt that anyone would contest this at NR, at any stage in the history of the institution. Perhaps they might say that musical outcomes and general well-being go hand-in-hand, but surely not that a musical outcome supersedes the client’s well-being. I would also assert that this could happen, having worked in schools where the end product of the school concert does not always take into account the emotional processes of the students, who might very well be put under pressure or stress in order to achieve musical aims. I could also elucidate on the stresses and strains of the professional musician. Involvement with music doesn’t automatically link to wellness.

What does he mean by music being ‘the stuff of life’? Perhaps that music is an intrinsic part of life, a medium that expresses things about being alive, without any need for interpretation or translation into another medium. This seems a fair statement to make, but other things might also be ‘the stuff of life’: human relationships, for example. In which case, psychodynamic processes (leaving behavioural approaches to one side) would also be ‘the stuff of life’, concerned as they are with the development of the individual in relation to others. Being musical would not preclude a thing from being subject to psychodynamic interpretation or understanding. Putting it simply, music could be ‘the stuff of life’ and ‘symbolic of something else’ (as opposed to ‘just…’). Furthermore this focus on being ‘symbolic’ is leaving out quite a bit of psychoanalytic theory as it might apply to music. Attachment theory, Stern’s affect attunement and Winnicott’s theories about play and creativity are not only, or even mainly, about things being ‘symbolic’ of other things. They describe processes of development through relationships, and, as we know, relationships can be expressed musically (would any NR therapist refute that?). One could assert, indeed, that music is relationship, rather than being symbolic of it: the relationship between tones, between rhythms in time, and between the people taking part.

You don’t have to use psychodynamic methods of thinking and interpretation, but they don’t deflect you from a musical focus. There is nothing non-music-centred about psychodynamic thinking as applied to music therapy. Thus, it can be music-centred and psychodynamically informed. Throw out psychodynamic thinking (or behavioural approaches) if you like, but to present it as having a focus which is not music-centred could be misleading, particularly to potential trainees, who might not know much about different approaches, and may also be keen to hold onto their identity as musicians. These sorts of concerns might also be relevant when communicating with people about music therapy in other contexts, such as when discussing it with other professionals or service users. The rhetoric of a phrase like the ‘stuff of life’ attempts to romanticise an approach in a way which seems to be more about obscuration than elucidation. Of course music is the ‘stuff of life’, and so is everything else.

‘God Only Knows’

In my recent blog post I said that “the half-diminished chord in ‘God Only Knows’ is probably not the active ingredient in music therapy”. This got me thinking. Brian Wilson had a complex relationship with his father and, viewed in this light, the words of the song take on an interesting meaning. “God only knows what I’d be without you”. It sounds like a love song at first, but then when you listen to the words in detail it becomes apparent that they don’t quite fit this narrative. The ‘what’ in particular is a surprise. I’ve wondered about this, whether the song is really addressed to a lover, or a parent. Since the lyrics were written by Tony Asher, the idea that this is Brian Wilson addressing his father seems fanciful, but on the other hand, the idea that there could be a love song where there is ambiguity, not only about who is being addressed, but about the nature of the relationship, is an intriguing one. Taken as a work of art removed of context, ‘God Only Knows’ could fit this model. It may be that the ambiguities running through the lyrics, alongside the harmonic ambiguities underpinning it, are what make the song so moving.

The half-diminished chord comes with the line “I'll make you so sure about it". In fact the function of the chord isn’t the usual II-7b5 as it’s a chromatic transitional chord on the #4 of E major, which leads to an A major chord in the next bar. It’s a moment of intensified harmonic ambiguity within a harmonically ambiguous piece of music. If it’s not an example of the “active ingredient” in music therapy, it’s certainly an active ingredient in some sort of process. It has a harmonic and emotional function, albeit one which might be hard to pin down.

I also said in my recent post that “music therapy doesn’t operate within a performer to audience dynamic”. I was thinking of the analogy of therapist with performer and client with audience which often seems to be an assumption made about music therapy. There might be an idea that the therapist is doing something to the client using music. This is not normally what happens in music therapy, but to say that this is ‘incorrect’ would be to oversimplify. Since the therapeutic process is two-way, the therapist’s music does have certain effects on the client. If we flip the analogy around, however, it becomes even more interesting. What if the client is the performer and the therapist is the audience? This actually works quite well a lot of the time. The half diminished chord in ‘God Only Knows’ becomes the active ingredient in music therapy when it is played by the client. Since actually doing this requires a level of musical sophistication we don’t routinely encounter the analogy might seem a bit absurd. But if we extend the analogy to include any moment of musical intensity then it begins to make more sense. Furthermore, as musical performers we all understand this. Music can be therapeutic when you go to a gig or listen to a recording, but this NEVER approaches the intensity of a meaningful performance in which you are an active participant. Not all performances are as meaningful or rewarding as they could be, but those that are; it’s a reason to be alive, to be frank.

So, ‘music isn’t medicine’? It’s misleading to say that it is, but it might also be misleading to say that it isn’t. That newly qualified colleague I mentioned before who has ‘been doing music therapy for years’. Well, the next question might be – ‘who on?’ The peak experiences that we sometimes have during performances are hard to pin down, but certainly have some quality of sharedness about them, of connection to others. Unfortunately audiences, and fellow musicians, make unreliable therapists. Sometimes they’re right there for us, but sometimes they’re not. Maybe the music therapist is partly analogous to the reliably attentive audience, partly to the sensitive fellow performer. This is still a therapy about making links, and when the links aren’t there in any musical experience, we’re unlikely to shout out ‘music is therapy!’ Maybe all music is really about making links. God only knows… ;)

Music Isn’t Medicine

I saw on Twitter recently that someone in the USA had tweeted ‘music is therapy’. They were at a conference and expressing their enthusiasm about an experience they’d had there. I didn’t do anything socially unacceptable, like replying to the tweet with my pedantic objections. I just thought to myself ‘no it isn’t’. But then I thought – what’s the motivation for saying this?

Another thing that happened, related to this, again on social media: a friend and colleague recently qualified as a music therapist, with flying colours in fact. She put this up on Facebook. She’s a highly respected performer of many years’ standing, and another musician wrote ‘you’ve been doing music therapy for years’, which was obviously meant in a nice way. People who don’t know much about music therapy, when they hear the term, tend to think first of all about the potential therapeutic properties of music itself, which is quite natural. On the BAMT website there’s a good video by Kalani Das which explains why this is an error (www.bamt.org ). However, music therapists do sometimes perpetuate the idea that music is intrinsically therapeutic, and that this is part of what we have to offer. It’s a good selling point perhaps.

The problem is partly semantic. Things can be ‘therapeutic’ without being ‘therapy’, just as things can smell nice without being perfume. Furthermore, music isn’t necessarily therapeutic, any more than talking is. Shakespeare or Eastenders might be therapeutic, Newsnight might not be. With music, the effect depends on context, and on what the music is. Some music has an anti-therapeutic effect on me, there being certain musical sounds which can transform my mood markedly for the worse.

Of course, some music is therapeutic, and can make me feel a lot better than I did before listening to it. This might be where a misunderstanding arises, because most of us have had this experience. If we didn’t, we probably wouldn’t bother listening to music. When we listen to music that we like, we’ve usually chosen it. There might also be something in a piece of music that we feel connects to us on a personal level, making us feel that we have shared emotional experiences with the composer or performers. One interesting question might be, is this feeling of connection intrinsic to the music itself, or is it a side effect? Is the ‘good’ feeling something transferred to us from the performer or is it arising within us? In a music therapy context, it doesn’t really matter; because music therapy doesn’t operate within a performer to audience dynamic, and, in the immediate term, doesn’t necessarily make the client feel ‘better’.

Leaving aside the fact that the music in therapy usually involves active musical participation on both sides, in contrast to a performance, it’s not the aesthetic or emotional content of the music that has the primary therapeutic effect. It’s not about the universality of music so much as the specificity of the therapeutic context. That feeling that you get from the half-diminished chord in ‘God Only Knows’ is probably not the active ingredient in music therapy. Music is a means of connection (among others like talking, body language, turning up on time etc.) but it's not the music itself (and there is such a thing as 'music itself') which is the therapeutic agent. Music therapy is, to a great extent, about the purposeful use of music to make links. These links might be interpersonal, inter-psychic or intra-psychic. The links, whether between the therapist and the client, different group members, the client’s array of internal objects, or the client and their attachment figures, are the therapy. Here it is again: the links are the therapy. So, snappy tag-lines (and magic chords) aside, music isn’t medicine.