BAMT Conference Roundtable Report - ‘So what is music therapy then?’ – Talking about music therapy with non-music therapists

I was delighted that Ann Sloboda, Alexia Quin, Sarah Hadley, Karen Sharp and Neta Spiro had agreed to be on the panel for this roundtable discussion. This was an interesting process, as when we met for our pre-conference discussion it became clear that we could talk on the subject for a lot longer than the allotted 90 minutes. I had invited each person because of their particular experiences of having to communicate about music therapy, so we would have perspectives from the course leader, the head of a charity, the NHS service manager, the trainee and the researcher. We decided that, instead of following the usual model of having a series of short presentations followed by a discussion, we would simply introduce ourselves and then launch straight into the latter part. I had certain ideas about what each of the panellists might bring to the table, based on their professional experience and positions. What I certainly didn’t know was how much the rest of the people in the room would bring to the discussion which, as it turned out, was a lot.

We considered whether we even need a definition for music therapy, whether this is a useful concept, or whether it is more helpful to describe what music therapy might achieve in a specific context. Part of this process was stimulated by some attempts at definition which Neta presented to the room. She had a number of these at the ready, but in the event we looked at only two, so lively was the ensuing discussion. These were the BAMT definition, which was relatively succinct, and the definition of the American Music Therapy Association, which was lengthy and seemed to be attempting to cover all bases, perhaps as a response to the legalities of the medical insurance system in the USA. Both definitions had parts which people found contentious, while both had useful content as well. Parts of the American definition were very clear and definite, which was good, but there was a danger of promising too much. Is it still ‘music therapy’ if ‘therapeutic aims’ are not wholly met?

The diversity of contexts in which music therapists find themselves, along with the variety of personal experiences which they bring to the work, both have an impact on the way the work is talked about. One person, who came from a business background before becoming a music therapist, compared our task to that of marketing a product. Do we describe a bottle of Domestos as ‘blue and made of plastic’, or do we say that it ‘kills 99% of known germs’. In other words, is it more useful to talk about what music therapy might achieve than trying to pin down what it ‘is’? Another person described their work in a Steiner school, where the process of music therapy might be described as ‘soul care’, acknowledging that such a formulation is very context-specific and would probably not be useful in a mainstream school or within a ‘medical-model’ culture.

There was some discussion about the importance of the way we talk about music therapy. Do we try to present ourselves as ‘knowledgeable experts’, using fancy language to demonstrate our level of training and experience, or should we always aim for clarity and simplicity? (I think it would be fair to say that the consensus was towards the latter.) Certain statements seemed to be at the core of what most people in the room thought about music therapy, such as the idea of ‘the power of music’ and the idea that ‘music is essential to every human being’. Had we had more time it would have been interesting to explore these assumptions a bit more. I asked, ‘Is music always powerful?’, which met with some acknowledgement of the validity of the question, but we didn’t explore this in depth.

A couple of things seemed clear. One was that music therapists, or at least the ones who came to this roundtable, are pretty good at talking about their work with non-music therapists, and they think carefully about the language they use to describe it, adopting a pragmatic approach which can adapt according to the situation. Another was that an important aspect of this is confidence. People were sometimes uncomfortable with being asked to give a definition, and I put the panel members on the spot a couple of times with his one. The aim of this discussion was never to arrive at an agreed definition, but rather to explore the challenges that the idea presents, and to share approaches. This felt like an appropriate thing to be doing as part of a conference which was exploring the developing identity of the profession. It has given all of us plenty of food for thought. No doubt the discussions will continue.

Your Supervisor is Always Wrong

Don’t get me wrong, supervision is very important. I’ve been supervising for a few years and always find it a privilege to be involved in the shared process of thinking about a client. In music therapy we have this unique ingredient of listening back to audio or watching video. It doesn’t happen often enough, usually for logistical reasons, but when it does it can throw new light on the work. We can also make suggestions about what to do musically, based on our musical impressions of the client. ‘You could try matching the pulse here’, ‘perhaps the client would respond to your voice’, ‘try playing a bit less; wait to hear what the client does with the silence’. There’s an imaginative process where the supervisor tries to get a sense of the client, probably picturing them a certain way, thinking about what it might be like to be with them. There might be some elements of role play in supervision. Sometimes I might imagine what I would say to a client, and say this, in the tone of voice I might use, so that the supervisee gets an idea of what I’m driving at, of the affect as well as the intention.

As a supervisee I usually feel these moments, when the supervisor imagines what they might do with this client, making suggestions or acting out a scenario, to be off the mark. I almost always think, to some extent, ‘No you haven’t quite got it’, or even ‘Seriously? That’ll never work’. This is such a consistent thing, with every supervisor, that it’s either about me (always possible – maybe I just hate getting advice) or about the process of supervision. Winnicott has this to say: “What matters to the patient is not the accuracy of the interpretation so much as the willingness of the analyst to help, the analyst’s capacity to identify with the patient”, and perhaps this applies to supervision as well, since we are mirroring something about the therapeutic process.

I’ve had these experiences in peer supervision too. One sticks in my mind, when I was describing a client who would go running out of the therapy room, and a colleague suggested singing about this, reflecting the client’s actions in the music. This seemed so far-fetched in relation to this young man that it was almost comical. I tried to imagine his reaction if I started singing ‘You’re running out of the room’ in a light baritone, perhaps with a Schubertian accompaniment – ludicrous! But perhaps there was something useful about the process. Imagining what my client might do with a certain response put me back in the room for a moment. The incongruity of the suggestion helped to highlight something, even if it was just that this client might not be someone who would respond to sung reflection. Generally, of course, it’s not such a far-out idea. With some clients, particularly younger children, singing about what they’re doing can make a useful connection. With this person the idea threw his personality into sharp relief. There was no way he would connect with this approach, but it was useful to think about why.

When the supervisor ‘gets it wrong’, this is really an important part of their job. Perhaps as a supervisor myself I’m looking for a get-out clause, but as a supervisee I can feel the helpfulness of this idea. As well as providing a sort of reverse image of the client (is this akin to Bion’s ‘intense beam of darkness’, helping to support our negative capability?) it also reminds me that the supervisor is with me now, but in the session I’m on my own with the client. I can get support, but the clinical work is still my responsibility. Furthermore it emphasises the time differential. In supervision you are either imagining yourself back into the past or projecting yourself into the future. What could I have done? What did this mean? How could I respond next time? Anything the supervisor says, to state the obvious, they are saying now, in supervision. If you try to freeze-frame and carry this forward into the next session it probably won’t work. Bion again – ‘without memory or desire’ – including the desire to implement suggestions from supervision. Listen to your supervisor, absorb their words, experience the containment, then forget about it all, clear your head, and do the next session.