I attended an event recently for the Institute of Integrated Care, a collaboration between the Trust I work for and Greenwich University. The intention is to encourage new ways of thinking about how to deliver healthcare, with an emphasis on greater communication and collaboration between agencies that might not normally work together. It seems to be a positive step. One of the speakers talked about the importance of ‘disruption’. I like this word. It normally has negative connotations. Working with ’EBD’ children it’s a word one hears a lot, in the context of ‘disruptive behaviour’. In this context it was used with a positive connotation, the idea being that in order to change, we need to disrupt the old systems, the old ways of thinking. There is also a quality of randomness implied by the word, a suggestion that while we might not know what the consequences of our actions will be in any kind of detail, nevertheless it’s worth pressing ahead and shaking things up, because unless we have the courage to make a leap into the unknown, then we might stagnate. Change might never happen.
Think of the connections between professionals which can so often seem difficult, the crossed wires that can occur, the difficulties with ‘information sharing’. And when you work on the margins, as we often do, it’s easy to be forgotten by the mainstream. It’s still the case that sometimes I might hear about a CP conference for a child, or an annual review, after the event. If only we could establish stronger links, so that we feel we are working with other professionals to support an individual or a family, and so that music therapy can find a focus within a wider context, for each client. I know this would be good, because, sometimes it is possible. I have worked in collaboration with family therapists, working with the child while the systemic thinking is held by another professional. This is broadly beneficial, both for me and by extension for the client. It enables me to clarify the role of music therapy for this person in my mind. After all, music therapy isn’t a panacea. If things are going wrong elsewhere, if a family is in chaos, a child is suffering neglect or high stress at home then, frankly, there’s little I can do to help in a half hour weekly session. We need to know that there is some stability, otherwise we’re facing a Sisyphean task. We might be giving a child a brief positive experience which only serves to emphasise the deficits elsewhere, or the child might just be unable to access their creativity because other concerns are more immediate – Maslow’s triangle comes to mind. So we can’t work in isolation when dealing with complex situations, which we often are. And if we are working in isolation to some extent, then the system needs to be disrupted somehow.
And is therapy itself a disruptive process? We might think that therapy is about building up, or repairing. Are we trying, in the musical therapeutic relationship, to repair a broken attachment? We might be, but unless the client has other positive attachment relationships in their life, music therapy alone won’t be enough. More often it feels to me that I’m working with clients who have become entrenched in their coping mechanisms or defences. They express this musically, and I challenge it. I’ll search for ways of testing the client’s tolerance of newness. This might be quite a gentle process, such as when I make a suggestion about something else we might do, after allowing the client a long period of leading the session. But it might be more robust. One client who is adept at avoiding musical connections needed to be challenged more strongly. I tried setting a new pulse. He ignored it and ploughed on with his own music. I persisted for several minutes. Very slowly, he began to spend a few moments here in there inside the pulse I had set. After this, over time, I looked for opportunities to find pulse connections, and they became more frequent. He seemed to be developing trust, and expressing this through his musical responses. I couldn’t have predicted this, I could only give it a try, and see what happened.
One of the important characteristics of disruption, as I said, is that it is imprecise and unpredictable. But the imprecision of music therapy bothers me sometimes. I wonder whether it signifies a lack of effectiveness. If I can’t say what I’m trying to achieve with much precision then how can I claim to be ‘helping’ anyone. One answer is that where change is needed, disruption must happen first. The trick is how to respond to what happens next. When you try something, and the client reacts in a way you didn’t predict, you need to be ready, to be able to improvise. The pool will continue to stagnate, but disturb the surface of the water and you create movement, new clarity. The client repeating the same rhythm, always singing the same song, sitting in the same place, in the same mood, needs a new direction, but they don’t know how to find it themselves. Neither do we, but we know how to disrupt, and then how to improvise. There’s a whole row of doors to try: time to open one at random and see what’s on the other side.
Friday 27 November 2015
Monday 5 October 2015
In the zone
There is a place you can get to in music where you feel connected to what you are creating, where you feel one with it. This is not really a big mystery. It's actually quite easy to get to, but we put obstacles in the way. You're NOT there when you're trying to figure out dots on a page, or grappling with technique, but these things might (or might not) help you to get there. A child can sometimes get there straight away in a music therapy session, because knowledge of what they 'should' be doing is not getting in the way. A great composer, conducting their own symphony, has arrived there, but it took them a long time. Nevertheless this was a worthwhile struggle, because it expands the possibilities. Music connects us to something very important, more than early attachment. It points forward. It finds meaning. And I'm wasting my time trying to describe it in words, because, for one, I can't, and secondly, you don't need me to.
Monday 14 September 2015
“So what’s music therapy then?”
“The people who know nothing about music are the ones always talking about it”
- Nat King Cole
“So what is music therapy? What do you do?” Questions at social gatherings which by all accounts strike terror into the heart of every music therapist. How can we possibly explain the subtleties of our work? They probably imagine that we’re music teachers, or perhaps that we play relaxing music to people to make them ‘feel better’. Perhaps they think that music therapy is like medicine, that it cures certain mental or psychological conditions. Sometimes these conversations can lead to damning put-downs of psychotherapy in general, along the lines of “A friend of mine had therapy once, but it didn’t help them at all. In fact I think it made them worse”. At which point one’s impulse might be to distance ‘music therapy’ from ‘psychotherapy’ and say that what we do is ‘different’ and that ‘everyone understands music and how beneficial it can be’. But the truth is, we’re caught between two stools. Are we on the one hand a sort of music facilitator, directing our clients through various ‘musical activities’ which might turn out to be ‘fun’, or, on the other, beard-stroking psychotherapists with a few instruments to hand should they be required at some point for the client to express something ‘unconscious’ using the ‘medium of music’ (apologies to beard-less therapists). How do we characterise ourselves?
One problem is that the various attempts to define music therapy in one simple, catchy sentence or two have not proved very satisfying. There’s quite a concise one on the ‘Music Therapy Charity’ website:
"Music Therapy uses sound and music as a therapeutic medium to bring about change."
Less concise is the APMT’s definition of the time quoted in Bunt’s An Art Beyond Words
"Music therapy provides a framework in which a mutual relationship is set up between client and therapist. The growing relationship enables changes to occur, both in the conditions of the client and in the form that the therapy takes…By using music creatively in a clinical setting, the therapist seeks to establish an interaction, a shared musical experience leading to the pursuit of therapeutic goals"
which more or less says the same thing, but without the relationship stuff, which it could be argued is accounted for in the first one by the use of ‘therapeutic’. Also one might point out that these definitions describe what it ideally does, not what it is. And if “change” doesn’t occur, what then? Still music therapy? Bunt himself is more concise.
"Music therapy is the use of organised sounds and music within an evolving relationship between client and therapist to support and encourage physical, mental, social and emotional well-being."
But again this suggests that therapy is “the use of…”, which I don’t think it is. The things that we “use” in therapy are not the therapy itself, but the tools or resources that we employ in order to “do” therapy, whatever “therapy” is.
The new BAMT website makes no attempt at the pithy one sentence definition, instead giving us a couple of paragraphs outlining the benefits of music and a proviso that “the therapist’s approach is informed by different theoretical frameworks, depending on their training and the health needs which are to be met”. This seems a pragmatic approach, but we may have lost our grip on the conversation by then in that imaginary social situation.
Perhaps the only quick definition would have to be vague, something like “Music therapy is therapy which uses music somehow or other”. That still doesn’t work, because other therapists, such as play therapists or integrative arts therapists, will happily incorporate music without describing themselves as ‘music therapists’. Also, it makes no attempt to define the therapy part, which is actually the tricky bit. A really honest one might be: “Music therapy is therapy performed by someone who has a qualification in music therapy”, but that gets us back where we started. How about this: “Music therapy is a process in which one person, called a therapist, provides another person, called a client or patient, with musical resources such as instruments, sees what happens, then responds in ways which feel appropriate, whether musically or otherwise, with the client’s, or patient’s, best interests at heart”. That’s more or less it isn’t it?
I fear there are many who would raise objections to this. “Music therapy is not purely responsive. It can also be directive, depending on the needs of the client”. “What about aims and objectives? This definition is too vague”.
Perhaps Wittgenstein has the answer. My layman’s understanding is that Wittgenstein developed an approach to the philosophy of language which provides an alternative to the concept of definitions. For example, when we use the word table, we are not referring to an idealised prototype, but rather to an object which fits easily into a large group of ‘table-ish’ objects. So a table with only 3 legs is ok, or one with a hole in the middle, but one on a 45 degree slant might not qualify. Is 30 degrees ok? It would still be impractical for eating your dinner off, but would it be a 'table'? If I see a client and we sing songs together, is that music therapy? If we listen to ‘relaxing CDs’? If the client asks how to play a certain tune on the piano and I show them? What about if the client asks me to prepare them for their grade 4 saxophone exam and accompany them? Music therapy is a broad category, with some activities being more music therapy-ish than others, with no single prototype, but with a general shared understanding amongst music therapists of the sort of things it might be.
So that dreadful question “what do you do in music therapy?” is difficult because we don’t have one simple answer. Perhaps being a fireman is easier. “What do you do?” “We put out fires and rescue people”. Or being a postman. “I put cards through people’s doors telling them that they were out”. A teacher? Not so straightforward perhaps, for although “teaching people about stuff” certainly comes into it, there is also a fuzzier pastoral side to the job, as well as the crowd control aspects with those classes that present ‘behavioural issues’.
A particular problem is the word “therapy”. “Music” most people get, it’s where the therapy part comes in that confuses people and leads to various preconceptions. Perhaps the dictionary can help:
Therapy: the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process
Or ‘psychotherapy’: the treatment of psychological disorders or maladjustments by a professional technique
Is this what we do? Do we ‘treat’ ‘disease or disorders’ using music? One of the things that we make clear on our referral form at my place of work is that we are not working with diagnosis, but with emotional needs; a ‘need’ is not the same thing as a ‘disorder’. I think that if someone who was perfectly ‘well’ wanted to have music therapy as an enriching experience, then they could have it. It could still be called ‘music therapy’.
The problem seems to be that every time we try to pin it down, it slips away from us. Are we still actually in the process of working out what music therapy is? Maybe the best answer is “I’ll get back to you on that one in 50 years time”. Or perhaps music therapy is not an activity, or a thing-in-itself, but rather a striving towards an intention. Perhaps figuring out what music therapy is, is what music therapy is. Try saying that next time you’re in that awkward conversation.
(Leading Note 2012)
- Nat King Cole
“So what is music therapy? What do you do?” Questions at social gatherings which by all accounts strike terror into the heart of every music therapist. How can we possibly explain the subtleties of our work? They probably imagine that we’re music teachers, or perhaps that we play relaxing music to people to make them ‘feel better’. Perhaps they think that music therapy is like medicine, that it cures certain mental or psychological conditions. Sometimes these conversations can lead to damning put-downs of psychotherapy in general, along the lines of “A friend of mine had therapy once, but it didn’t help them at all. In fact I think it made them worse”. At which point one’s impulse might be to distance ‘music therapy’ from ‘psychotherapy’ and say that what we do is ‘different’ and that ‘everyone understands music and how beneficial it can be’. But the truth is, we’re caught between two stools. Are we on the one hand a sort of music facilitator, directing our clients through various ‘musical activities’ which might turn out to be ‘fun’, or, on the other, beard-stroking psychotherapists with a few instruments to hand should they be required at some point for the client to express something ‘unconscious’ using the ‘medium of music’ (apologies to beard-less therapists). How do we characterise ourselves?
One problem is that the various attempts to define music therapy in one simple, catchy sentence or two have not proved very satisfying. There’s quite a concise one on the ‘Music Therapy Charity’ website:
"Music Therapy uses sound and music as a therapeutic medium to bring about change."
Less concise is the APMT’s definition of the time quoted in Bunt’s An Art Beyond Words
"Music therapy provides a framework in which a mutual relationship is set up between client and therapist. The growing relationship enables changes to occur, both in the conditions of the client and in the form that the therapy takes…By using music creatively in a clinical setting, the therapist seeks to establish an interaction, a shared musical experience leading to the pursuit of therapeutic goals"
which more or less says the same thing, but without the relationship stuff, which it could be argued is accounted for in the first one by the use of ‘therapeutic’. Also one might point out that these definitions describe what it ideally does, not what it is. And if “change” doesn’t occur, what then? Still music therapy? Bunt himself is more concise.
"Music therapy is the use of organised sounds and music within an evolving relationship between client and therapist to support and encourage physical, mental, social and emotional well-being."
But again this suggests that therapy is “the use of…”, which I don’t think it is. The things that we “use” in therapy are not the therapy itself, but the tools or resources that we employ in order to “do” therapy, whatever “therapy” is.
The new BAMT website makes no attempt at the pithy one sentence definition, instead giving us a couple of paragraphs outlining the benefits of music and a proviso that “the therapist’s approach is informed by different theoretical frameworks, depending on their training and the health needs which are to be met”. This seems a pragmatic approach, but we may have lost our grip on the conversation by then in that imaginary social situation.
Perhaps the only quick definition would have to be vague, something like “Music therapy is therapy which uses music somehow or other”. That still doesn’t work, because other therapists, such as play therapists or integrative arts therapists, will happily incorporate music without describing themselves as ‘music therapists’. Also, it makes no attempt to define the therapy part, which is actually the tricky bit. A really honest one might be: “Music therapy is therapy performed by someone who has a qualification in music therapy”, but that gets us back where we started. How about this: “Music therapy is a process in which one person, called a therapist, provides another person, called a client or patient, with musical resources such as instruments, sees what happens, then responds in ways which feel appropriate, whether musically or otherwise, with the client’s, or patient’s, best interests at heart”. That’s more or less it isn’t it?
I fear there are many who would raise objections to this. “Music therapy is not purely responsive. It can also be directive, depending on the needs of the client”. “What about aims and objectives? This definition is too vague”.
Perhaps Wittgenstein has the answer. My layman’s understanding is that Wittgenstein developed an approach to the philosophy of language which provides an alternative to the concept of definitions. For example, when we use the word table, we are not referring to an idealised prototype, but rather to an object which fits easily into a large group of ‘table-ish’ objects. So a table with only 3 legs is ok, or one with a hole in the middle, but one on a 45 degree slant might not qualify. Is 30 degrees ok? It would still be impractical for eating your dinner off, but would it be a 'table'? If I see a client and we sing songs together, is that music therapy? If we listen to ‘relaxing CDs’? If the client asks how to play a certain tune on the piano and I show them? What about if the client asks me to prepare them for their grade 4 saxophone exam and accompany them? Music therapy is a broad category, with some activities being more music therapy-ish than others, with no single prototype, but with a general shared understanding amongst music therapists of the sort of things it might be.
So that dreadful question “what do you do in music therapy?” is difficult because we don’t have one simple answer. Perhaps being a fireman is easier. “What do you do?” “We put out fires and rescue people”. Or being a postman. “I put cards through people’s doors telling them that they were out”. A teacher? Not so straightforward perhaps, for although “teaching people about stuff” certainly comes into it, there is also a fuzzier pastoral side to the job, as well as the crowd control aspects with those classes that present ‘behavioural issues’.
A particular problem is the word “therapy”. “Music” most people get, it’s where the therapy part comes in that confuses people and leads to various preconceptions. Perhaps the dictionary can help:
Therapy: the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process
Or ‘psychotherapy’: the treatment of psychological disorders or maladjustments by a professional technique
Is this what we do? Do we ‘treat’ ‘disease or disorders’ using music? One of the things that we make clear on our referral form at my place of work is that we are not working with diagnosis, but with emotional needs; a ‘need’ is not the same thing as a ‘disorder’. I think that if someone who was perfectly ‘well’ wanted to have music therapy as an enriching experience, then they could have it. It could still be called ‘music therapy’.
The problem seems to be that every time we try to pin it down, it slips away from us. Are we still actually in the process of working out what music therapy is? Maybe the best answer is “I’ll get back to you on that one in 50 years time”. Or perhaps music therapy is not an activity, or a thing-in-itself, but rather a striving towards an intention. Perhaps figuring out what music therapy is, is what music therapy is. Try saying that next time you’re in that awkward conversation.
(Leading Note 2012)
Tuesday 1 September 2015
Music therapy - who needs it?
I was struggling with a group. The problem was that there were only 3 clients in it. If one person didn’t show up, we had a pair. If two didn’t, then it was an individual session, with (in this case) two therapists. This could either feel a bit too intense for the client, or they might enjoy the undivided attention. Either way, it was difficult to maintain the feeling that what we had here was really a ‘group’. So the group needed more members. But did these new members need the group? I let other professionals know that there were spaces available – I could take 3 more people with ease. I had one new referral which I was following up. The group had been running (slow open) for nearly 7 years, with changing personnel, and we’d been here before. However this was the longest period (all of that academic year) during which there had been only 3 regular members, excluding the therapists. If one person left for good then we’d officially be down to a pair and this would begin to feel tenuous.
So who was ‘helping’ whom? If a new person joined the group I’d be grateful to them for helping keep the group, as an entity, alive. This subverts something about the therapeutic purpose of the group, which is that people were in it because they needed something. This symbiotic relationship shows how groups differ from individual therapy. The group needed its members, and the members (presumably) needed the group. Then the school cancelled the contract very abruptly, but that’s another story.
Individual therapy is different. The client has been referred because of specific needs, and the therapist is hoping to meet them. There is a ‘working alliance’, but the relationship is asymmetrical. However, I’m reminded of a time when I was training, back in 2007, and on a placement in adult mental health. The client was getting curious about me. He asked “Why are you here and not making money playing music? Are you on community service or something, like George Michael?” I mentioned this in supervision, expecting it to elicit a chuckle. Community service – how hilarious! My supervisor looked back at me stony-faced. “That’s a very perceptive question. What is your drugs bust?” My narrative of naïve client and knowing, professional therapist had been subverted. The client had noticed something, which was that I had a reason to be there just as much as he did. An important difference was that he had some idea why he was there, but I was less sure.
Now I’m an experienced professional it’s quite different of course. Through personal psychotherapy I have come to understand my unconscious motives for being a therapist and I can devote myself, unhindered by my own desires or needs, to the needs of the client. Yeah right… During the summer holidays the sessions become less frequent; people go away, the school clinics are not happening. It’s a nice change of pace but it can be a bit dull at times. I like the excitement and drama of sessions; it’s one of the reasons I’m doing this job. I like that, being a therapist, you get to relate to another person in a completely different way. There is the possibility of revelation, of new knowledge, of emotional connection. It’s a privilege, and it’s also, in some respects, a need. As music therapists we have access to fundamental human experiences and to the expression of profundities about the individual every day. It’s a responsibility of course, and it can feel overwhelming. The dangers of secondary trauma shouldn’t be underestimated, and some clients are very difficult to work with. As with being a parent there are lots of sensible reasons not to do it. For us, though, for the moment at least, the benefits must outweigh the drawbacks. I never forget that the client comes first, but I also have to be honest with myself; I’ve chosen to be here too.
So who was ‘helping’ whom? If a new person joined the group I’d be grateful to them for helping keep the group, as an entity, alive. This subverts something about the therapeutic purpose of the group, which is that people were in it because they needed something. This symbiotic relationship shows how groups differ from individual therapy. The group needed its members, and the members (presumably) needed the group. Then the school cancelled the contract very abruptly, but that’s another story.
Individual therapy is different. The client has been referred because of specific needs, and the therapist is hoping to meet them. There is a ‘working alliance’, but the relationship is asymmetrical. However, I’m reminded of a time when I was training, back in 2007, and on a placement in adult mental health. The client was getting curious about me. He asked “Why are you here and not making money playing music? Are you on community service or something, like George Michael?” I mentioned this in supervision, expecting it to elicit a chuckle. Community service – how hilarious! My supervisor looked back at me stony-faced. “That’s a very perceptive question. What is your drugs bust?” My narrative of naïve client and knowing, professional therapist had been subverted. The client had noticed something, which was that I had a reason to be there just as much as he did. An important difference was that he had some idea why he was there, but I was less sure.
Now I’m an experienced professional it’s quite different of course. Through personal psychotherapy I have come to understand my unconscious motives for being a therapist and I can devote myself, unhindered by my own desires or needs, to the needs of the client. Yeah right… During the summer holidays the sessions become less frequent; people go away, the school clinics are not happening. It’s a nice change of pace but it can be a bit dull at times. I like the excitement and drama of sessions; it’s one of the reasons I’m doing this job. I like that, being a therapist, you get to relate to another person in a completely different way. There is the possibility of revelation, of new knowledge, of emotional connection. It’s a privilege, and it’s also, in some respects, a need. As music therapists we have access to fundamental human experiences and to the expression of profundities about the individual every day. It’s a responsibility of course, and it can feel overwhelming. The dangers of secondary trauma shouldn’t be underestimated, and some clients are very difficult to work with. As with being a parent there are lots of sensible reasons not to do it. For us, though, for the moment at least, the benefits must outweigh the drawbacks. I never forget that the client comes first, but I also have to be honest with myself; I’ve chosen to be here too.
Friday 14 August 2015
The MT USP
I’ve had supervision at times from non-music therapists, recently, for example, from an art therapist who is a psychoanalyst in training. A few years ago I had supervision from a dramatherapist who was also a cognitive-analytic psychotherapist. Both were very good at reflecting on musical processes during sessions. I remember playing an audio excerpt from a session to the dramatherapist, who listened very carefully and then observed “It’s like a dance”. She immediately understood the attunement process and was able to give me a new perspective on it. In a recent supervision my art therapist supervisor was able to reflect on a moment when a client was instructing me what to play. She pointed out that he felt a need for us to do exactly the same thing at the same time, that this was part of a merging process and connected to his difficulty trusting the ‘other’. This was useful, and directly linked to the music. I’ve also taken part in group supervisions led by psychotherapists and family therapists. They too were able to understand the significance of music and its role within the therapeutic relationship. Daniel Stern, who we have taken so much from as music therapists, used music-like terminology to describe the interactions between mother and infant despite not being a music therapist himself.
If I were asked to say what music therapists do that is unique, I might be inclined so say that we are able to reflect on musical relationship. I might say that we use instruments to develop a relationship with a client, and that music therapy is about encouraging the client to develop their sense of self, their ability to communicate, their confidence, through their use of music. I might point out that we think about attunement and use the template of the mother-infant relationship to think about musical relationship and about attachment. However, all of this would be missing one big important fact, which is that I am, myself, a musician. If I forget this, or I subjugate my ability to play to just one of a set of skills I might use in therapy, then I am underselling the significance of this. While I would place myself firmly in the psychodynamic camp as a music therapist, I would suggest that one of the pitfalls of the psychodynamic approach, and in particular the emphasis during training, is that musical skills can become side-lined. It’s fairly common for music therapists to find that they are not playing much during their sessions. For some this might lead to further training in counselling or psychotherapy. It’s also possible to rationalise this by saying that this is ‘still music therapy’, because we are thinking about the work from a music therapy perspective. Often this is entirely valid, but could it sometimes be because we have allowed ourselves to lose our connection to our own musicianship?
I’ve also noticed that there can be a tendency to play down the musical aspects of the work. Sometimes we might be concerned that other people will find it hard to understand musical terminology, but my experience is the opposite, that people generally do understand musical descriptions and they appreciate the opportunity to gain insight into the musical therapeutic process. We’ve recently, as a service, had to think about the process of making our clinical notes available to other professionals, and we had a very useful CPD session with an art therapist who talked about the importance of describing what we do in sessions, rather than only describing the client’s actions. I’ve starting writing things like “I accompanied X’s drumming on the piano, supporting his pulse and responding to his dynamic level”. This feels like a positive step.
This tendency to minimise our playing abilities may be linked to an important process during training, which is to do with empathy for the client. MTs in training need to gain awareness of the potential destructive power of their musical skills. Some clients can be easily overwhelmed by the therapist’s music and may find the experience belittling. It may play into their already fragile self-esteem and hamper their own ability to play, and it’s really important for the training therapist to be able to reflect on this. However this aspect of training can become an unhelpful superego voice later on. As a practising therapist I have found it necessary to relearn, perhaps to rediscover, my musical personality within a therapeutic context. Sometimes it’s very useful indeed for the client to feel that the therapist has musical skill. Sometimes the omnipotent client needs to be challenged through the music, and we need the resources, both psychological, musical and instrumental, to be able to do this.
During some group work with a very experienced colleague with 3-4 year old children with social communication difficulties we were observed by a senior member of the (NHS) trust. She spoke to us afterwards and was obviously impressed with the session. However she said a couple of things which gave us pause for thought: one was that the skills we were using were transferrable to the SLTs who were running the summer school to which we were contributing; the other was that parents often do ‘this sort of thing’ naturally with their children at home. Both statements were correct in a way, and we didn’t disagree. Perhaps we should have however. My colleague had been leading the session from the piano, using a number of NR play songs as well as some of her own musical structures. She’s a very experienced pianist who trained at music college for 4 years before training as a music therapist, not an easily ‘transferrable skill’ at all! Perhaps this was self-evident, and didn’t need to be said, but I wish I had said it. It might have drawn attention to something that’s easily forgotten, that most music therapists can play the shit out of their instruments and that this is a crucial part of the work. It’s at the top of the list of requirements when we apply for a training course, so let’s not allow it to slip down the list as we develop our professional careers, either through compliance with a restrictive superego or with a desire to ‘speak the same language’ as other professionals. If they can’t play an instrument that’s their loss. We don’t need to make it ours too.
Coming back to my musically perceptive supervisors, perhaps there are two ways of reflecting on this. The first thing that strikes me is that the ability to reflect on musical processes is not something unique to music therapists. Indeed psychoanalytic theorists such as Rose and Meltzer have drawn attention to musical processes within psychoanalysis. We need to make all that musical experience we had pre-training count, otherwise we could just become bad psychoanalysts (or, I suppose, good psychoanalysts, but this is another career path at any rate). Another more positive way of looking at this is that musical reflection is more easily shared than we might sometimes imagine. We can learn about music from non-musicians, and we can talk about music to other professionals. The really important thing that separates us from them is that we can do the music. This is not only about our pre-training experience, but also about our music therapy practice. We know through experience how to use music in a therapeutic context. This is a big skill, and not one to play down. You can transfer it all right, but it takes a few years and a lot of practice time.
If I were asked to say what music therapists do that is unique, I might be inclined so say that we are able to reflect on musical relationship. I might say that we use instruments to develop a relationship with a client, and that music therapy is about encouraging the client to develop their sense of self, their ability to communicate, their confidence, through their use of music. I might point out that we think about attunement and use the template of the mother-infant relationship to think about musical relationship and about attachment. However, all of this would be missing one big important fact, which is that I am, myself, a musician. If I forget this, or I subjugate my ability to play to just one of a set of skills I might use in therapy, then I am underselling the significance of this. While I would place myself firmly in the psychodynamic camp as a music therapist, I would suggest that one of the pitfalls of the psychodynamic approach, and in particular the emphasis during training, is that musical skills can become side-lined. It’s fairly common for music therapists to find that they are not playing much during their sessions. For some this might lead to further training in counselling or psychotherapy. It’s also possible to rationalise this by saying that this is ‘still music therapy’, because we are thinking about the work from a music therapy perspective. Often this is entirely valid, but could it sometimes be because we have allowed ourselves to lose our connection to our own musicianship?
I’ve also noticed that there can be a tendency to play down the musical aspects of the work. Sometimes we might be concerned that other people will find it hard to understand musical terminology, but my experience is the opposite, that people generally do understand musical descriptions and they appreciate the opportunity to gain insight into the musical therapeutic process. We’ve recently, as a service, had to think about the process of making our clinical notes available to other professionals, and we had a very useful CPD session with an art therapist who talked about the importance of describing what we do in sessions, rather than only describing the client’s actions. I’ve starting writing things like “I accompanied X’s drumming on the piano, supporting his pulse and responding to his dynamic level”. This feels like a positive step.
This tendency to minimise our playing abilities may be linked to an important process during training, which is to do with empathy for the client. MTs in training need to gain awareness of the potential destructive power of their musical skills. Some clients can be easily overwhelmed by the therapist’s music and may find the experience belittling. It may play into their already fragile self-esteem and hamper their own ability to play, and it’s really important for the training therapist to be able to reflect on this. However this aspect of training can become an unhelpful superego voice later on. As a practising therapist I have found it necessary to relearn, perhaps to rediscover, my musical personality within a therapeutic context. Sometimes it’s very useful indeed for the client to feel that the therapist has musical skill. Sometimes the omnipotent client needs to be challenged through the music, and we need the resources, both psychological, musical and instrumental, to be able to do this.
During some group work with a very experienced colleague with 3-4 year old children with social communication difficulties we were observed by a senior member of the (NHS) trust. She spoke to us afterwards and was obviously impressed with the session. However she said a couple of things which gave us pause for thought: one was that the skills we were using were transferrable to the SLTs who were running the summer school to which we were contributing; the other was that parents often do ‘this sort of thing’ naturally with their children at home. Both statements were correct in a way, and we didn’t disagree. Perhaps we should have however. My colleague had been leading the session from the piano, using a number of NR play songs as well as some of her own musical structures. She’s a very experienced pianist who trained at music college for 4 years before training as a music therapist, not an easily ‘transferrable skill’ at all! Perhaps this was self-evident, and didn’t need to be said, but I wish I had said it. It might have drawn attention to something that’s easily forgotten, that most music therapists can play the shit out of their instruments and that this is a crucial part of the work. It’s at the top of the list of requirements when we apply for a training course, so let’s not allow it to slip down the list as we develop our professional careers, either through compliance with a restrictive superego or with a desire to ‘speak the same language’ as other professionals. If they can’t play an instrument that’s their loss. We don’t need to make it ours too.
Coming back to my musically perceptive supervisors, perhaps there are two ways of reflecting on this. The first thing that strikes me is that the ability to reflect on musical processes is not something unique to music therapists. Indeed psychoanalytic theorists such as Rose and Meltzer have drawn attention to musical processes within psychoanalysis. We need to make all that musical experience we had pre-training count, otherwise we could just become bad psychoanalysts (or, I suppose, good psychoanalysts, but this is another career path at any rate). Another more positive way of looking at this is that musical reflection is more easily shared than we might sometimes imagine. We can learn about music from non-musicians, and we can talk about music to other professionals. The really important thing that separates us from them is that we can do the music. This is not only about our pre-training experience, but also about our music therapy practice. We know through experience how to use music in a therapeutic context. This is a big skill, and not one to play down. You can transfer it all right, but it takes a few years and a lot of practice time.
Monday 23 March 2015
You can lead a horse to water...
Multi-disciplinary working, or, putting it more bluntly, talking to other people in the line of work, has all sorts of positive connotations. We want to know, for example, what else is going on in a client’s life, so that we can make sense of the 30-50 minutes a week that they spend with us. Also, we hope that we can reciprocate. How a client is in music therapy might provide new and surprising information for those people who know them only outside the therapy room. All of us want to make sure that we are helping as best we can, which is quite right. This is not without difficult implications for the clinical work. How does the client feel about the fact that we talk about them with other people? This might happen in front of them, such as at a CPA, or an annual review meeting in school, or it might happen without them there, maybe without them being aware that it is going to happen. There’s plenty of scope for paranoid fantasies about the therapist’s betrayal of their confidence. However, on balance it’s usually a good thing. Therapy shouldn’t take place in a bubble, removed from all contact with the outside world, and we shouldn’t pretend to our clients that it does, because that would be dishonest.
Sometimes teamwork seems to have another function. I am working with a child whose family have a lot of social care involvement, along with a number of other agencies. The social worker is getting exasperated by the lack of progress of the parents. He’s doing his best, but “you can lead a horse to water…” At one core group meeting you could sense the frustration of these various professionals as it became evident that certain messages were not getting across. How can we make things better for these ‘children in need’, without the co-operation and understanding of their mother and father? There’s a sense that the parents are looking around for people to take their place, even be a parent to them. This isn’t stated overtly of course, because it’s probably unconscious, but it’s a strong dynamic. The professionals are left feeling that what they do can never be enough, that there is a bottomless abyss of need. A least, though, we have each other. Yalom describes a ‘welcome to the human race’ feeling that can happen in group psychotherapy (what he calls ‘universality’ in his therapeutic factors), but this goes for multi-disciplinary work too. If none of us can, with our combined skills and experience, fully give these people what they need, then at least we all know we tried our best. We can’t fix everything.
A recent occurrence in this same case illustrates something else that’s helpful about working with other professionals. I had a phone conversation with the social worker where he told me that the client had told dad that “music therapy isn’t working”. This was in the context that pressure was being put on him to “talk about his issues” in therapy. The parental hope was that music therapy would make him better behaved, easier, that it would take the strain off at home. In his next session, I tried to bracket this. I didn’t want to make the session all about what he’d said to someone else, quoted out of context. But I was more alert to possibilities in this area. He began to talk about a friend of his who should be having music therapy. I suspected that he was really talking about himself and the conversation developed in new directions. We were able to think about why he is here, what music therapy might be for. “How might music therapy help your friend?” opened us up to interesting speculation. Maybe we would have got there anyway, but my awareness of recent events outside the session was a useful influence. Perhaps it’s about striking the right balance between the inside and the outside. The outside shouldn’t encroach, dictate the session before it’s begun, but it also shouldn’t be ignored.
Sometimes teamwork seems to have another function. I am working with a child whose family have a lot of social care involvement, along with a number of other agencies. The social worker is getting exasperated by the lack of progress of the parents. He’s doing his best, but “you can lead a horse to water…” At one core group meeting you could sense the frustration of these various professionals as it became evident that certain messages were not getting across. How can we make things better for these ‘children in need’, without the co-operation and understanding of their mother and father? There’s a sense that the parents are looking around for people to take their place, even be a parent to them. This isn’t stated overtly of course, because it’s probably unconscious, but it’s a strong dynamic. The professionals are left feeling that what they do can never be enough, that there is a bottomless abyss of need. A least, though, we have each other. Yalom describes a ‘welcome to the human race’ feeling that can happen in group psychotherapy (what he calls ‘universality’ in his therapeutic factors), but this goes for multi-disciplinary work too. If none of us can, with our combined skills and experience, fully give these people what they need, then at least we all know we tried our best. We can’t fix everything.
A recent occurrence in this same case illustrates something else that’s helpful about working with other professionals. I had a phone conversation with the social worker where he told me that the client had told dad that “music therapy isn’t working”. This was in the context that pressure was being put on him to “talk about his issues” in therapy. The parental hope was that music therapy would make him better behaved, easier, that it would take the strain off at home. In his next session, I tried to bracket this. I didn’t want to make the session all about what he’d said to someone else, quoted out of context. But I was more alert to possibilities in this area. He began to talk about a friend of his who should be having music therapy. I suspected that he was really talking about himself and the conversation developed in new directions. We were able to think about why he is here, what music therapy might be for. “How might music therapy help your friend?” opened us up to interesting speculation. Maybe we would have got there anyway, but my awareness of recent events outside the session was a useful influence. Perhaps it’s about striking the right balance between the inside and the outside. The outside shouldn’t encroach, dictate the session before it’s begun, but it also shouldn’t be ignored.
Wednesday 7 January 2015
Science fiction, free will and music therapy
Two, or rather three, science fiction novels have provided me with some food for thought about the therapeutic process. One is Timequake, by Kurt Vonnegut, the other two are the second and third parts of the Foundation trilogy, by Isaac Asimov. In Timequake, Vonnegut introduces the titular concept, a scenario in which the whole world jumps back in time by 10 years and everyone is forced to relive the previous 10 years exactly as they did the first time around. When they arrive back where they started, the challenge is to make the adaptation back to having free will again. Cars crash because the drivers can’t remember how to control them. Kilgore Trout runs through the streets shouting “Free will! Free will!” Vonnegut draws a parallel with “real life timequakes” in the form of theatrical performances, where actors are compelled to respond to each other in the same way and make the same decisions every night. Another comparison might be with the experience of watching a film or TV programme which you have seen before. The important thing is the contrast between the moment just before the timequake ends and free will begins again. Although there is nothing obvious here to the outside observer, the difference between these two states is enormous. It’s the difference between knowing exactly what is about to happen next, from moment to moment, and being unable to change it, and then suddenly having no knowledge. It’s going from singular possibility to infinite possibility in a single moment.
In music therapy, when sessions begin to feel like timequakes, we know something is wrong. Predictability indicates stagnation. This can happen in small ways, such as when a client always plays the same tune in the same way. It can be in a broader sense, such as that feeling of repeating the same session from week to week – while the details might change, the fundamental feeling and status quo remains fixed. We need to find a way out of the timequake, to help the client, and ourselves, to rediscover free will.
In Foundation, Asimov introduces a truly terrifying villain called the ‘Mule’. The Mule looks like an ordinary human being, but he has the ability to manipulate others’ emotional state at will. This enables him (spoiler alert - almost) to take control of the entire galaxy. Characters come under his power in full awareness of what is happening to them, but they are unable to resist because, once under his control, they don’t want to. Rather than manipulating their will, a common device in other science fiction, or in fairy tales, he instantaneously manipulates their motivation. This is an interesting variation on the brainwashing idea, as usually those under the control of a dictator or a wicked witch are portrayed as robot-like, with their emotions suppressed. The minions of the Wicked Witch of the West instantly become benign and enlivened once Dorothy throws the bucket of water on her. In Asimov’s story, the Mule’s followers are happy to follow him, because they love him. They know why this is, because the Mule has no reason to conceal anything. Asimov has possibly created one of the most formidable and chilling villains in all of fiction, because in doing so he questions the nature of free will. The Mule’s followers feel themselves to be free, even though they know they are not, a fascinating paradox.
In music therapy, a pervasive fantasy is that we are going to make our clients feel better through our interventions. We know that change has to come from them, but we also want them to change. Perhaps we would like to think that music has the power to achieve this. The danger is that as long as we want a client to change, the dark magic of the ‘Mule’ might seem like a very useful power to have. What if, by merely wishing it, we could change a client’s emotional state? What a force for good this could be. A child in an anxious traumatised state could be immediately transformed into a calm and happy person. Job done. So, would we want the Mule’s powers if they were offered to us? Of course not. Because central to our concept of humanity is this elusive concept of free will. Some neurologists will tell you that free will is actually an illusion produced by certain aspects of brain function, but that it is an important illusion. Maybe so. But as therapists we are fully paid up followers of the free-will-believers-club. We subscribe to the illusion, if it is an illusion, because fundamentally we believe in our clients’ humanity, in their individuality. Feeling better would not be a fair exchange for this.
In music therapy, when sessions begin to feel like timequakes, we know something is wrong. Predictability indicates stagnation. This can happen in small ways, such as when a client always plays the same tune in the same way. It can be in a broader sense, such as that feeling of repeating the same session from week to week – while the details might change, the fundamental feeling and status quo remains fixed. We need to find a way out of the timequake, to help the client, and ourselves, to rediscover free will.
In Foundation, Asimov introduces a truly terrifying villain called the ‘Mule’. The Mule looks like an ordinary human being, but he has the ability to manipulate others’ emotional state at will. This enables him (spoiler alert - almost) to take control of the entire galaxy. Characters come under his power in full awareness of what is happening to them, but they are unable to resist because, once under his control, they don’t want to. Rather than manipulating their will, a common device in other science fiction, or in fairy tales, he instantaneously manipulates their motivation. This is an interesting variation on the brainwashing idea, as usually those under the control of a dictator or a wicked witch are portrayed as robot-like, with their emotions suppressed. The minions of the Wicked Witch of the West instantly become benign and enlivened once Dorothy throws the bucket of water on her. In Asimov’s story, the Mule’s followers are happy to follow him, because they love him. They know why this is, because the Mule has no reason to conceal anything. Asimov has possibly created one of the most formidable and chilling villains in all of fiction, because in doing so he questions the nature of free will. The Mule’s followers feel themselves to be free, even though they know they are not, a fascinating paradox.
In music therapy, a pervasive fantasy is that we are going to make our clients feel better through our interventions. We know that change has to come from them, but we also want them to change. Perhaps we would like to think that music has the power to achieve this. The danger is that as long as we want a client to change, the dark magic of the ‘Mule’ might seem like a very useful power to have. What if, by merely wishing it, we could change a client’s emotional state? What a force for good this could be. A child in an anxious traumatised state could be immediately transformed into a calm and happy person. Job done. So, would we want the Mule’s powers if they were offered to us? Of course not. Because central to our concept of humanity is this elusive concept of free will. Some neurologists will tell you that free will is actually an illusion produced by certain aspects of brain function, but that it is an important illusion. Maybe so. But as therapists we are fully paid up followers of the free-will-believers-club. We subscribe to the illusion, if it is an illusion, because fundamentally we believe in our clients’ humanity, in their individuality. Feeling better would not be a fair exchange for this.
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