“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)

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.