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

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

(Marilyn Bergman, Alan Bergman, Johnny Mandel)

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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.