Monday 19 February 2018

Music therapy in 2068

So, after the BAMT 2018 conference, which was full of positivity and new ideas, with a great spirit of openness, there’s lots of different possible blog posts that could be written. But I have to go with one idea that’s inescapably in the foreground for me. During the ‘Question Time Debate’ Gary Ansdell made a couple of provocative comments. There’s a danger of me misquoting, for which I apologise in advance. (Hopefully the recordings will be available to check in on later.) First he said something about the alignment of music therapy with a psychotherapeutic model being an ‘old chestnut’, which is now well and truly ‘roasted’, and that music therapy has restricted itself as a profession by identifying with this model. Then, in the round of closing statements, he said that we should do away with ‘music therapy’ within the next 50 years, by which time enough musicians will have been trained appropriately to replace the role, because ‘there will never be enough music therapists’.

There’s something about the provocative statement that stays with you. It’s a real talent, to come out with those soundbites that annoy people just enough that they can’t quite let go of them, but not so much that they can simply dismiss them. If he’d said ‘5 years’, for example, that would have been easier to let go of.

This is part of the (very much partially roasted) ongoing discussion which some people, for some reason, wish would go away. A few thoughts have been occurring to me. First of all, on the idea that there might be something restrictive about the psychotherapeutic model; I wonder what psychotherapists would have to say about this. Do psychoanalytic, person-centred, transpersonal, Gestalt, integrative, existential, systemic or cognitive analytic (etc. etc.) psychotherapists find their models restrictive? Music therapists have drawn on ideas from all of these perspectives and many more. I also struggle, in certain senses, to see any fundamental difference between music therapy and psychotherapy, especially if we take both as rather broad terms. This may be a bias connected to the type of work I do, which is often with children and young people in a time-boundaried, confidential, attachment-based context, where the therapeutic relationship is central to the work. But actually I’m not so sure about this: I think psychotherapy, if it is ‘treatment by psychological rather than medical means’ (OED), covers a broad spectrum.

My own experience of (psychoanalytic) psychotherapy, as a client, is that it provided containment for feelings, emotions, wellings-up, that were difficult to manage in day-to-day life. The importance of having a space to take aspects of self that it can be difficult to fully contend with is not easy to assess, but it’s not to be underestimated. And I wouldn’t describe my own personal struggles as anything out of the ordinary. The verbal, cognitive aspects of this were important, but they were only a part of the whole experience, in which the presence of a supportive ‘other’ was really the key factor. (I almost wrote ‘non-judgemental’, but it’s not as simple as that in a transference relationship.) I would suggest that the overlap between what was going on in my own psychotherapy and what generally goes on in music therapy was substantial. You don’t even have to factor in the verbal aspects of music therapy for this to be the case. The supportive other, listening, reflecting back, partially understanding, and trying to understand more, over time – these, in my experience as a client were/are/will be the important therapeutic factors.

This is such a significant experience, so fundamental in the way it operates, that a word like ‘restrictive’ feels baffling. I can imagine an answer, along the lines of, ‘it depends on the client group, aims of therapy, setting, social context’, and so on, but you can say the same thing about psychotherapy, with its array of models which adapt to different individual and group settings. Of course, you could also argue from the other side, that verbal psychotherapy restricts itself by not having music as a medium of expression, although it can use attunement, inflection, silence, body language, facial expression, all the various modes of communication of which we’re often not fully aware.

This is too complex a topic to contend with fully in a blog post, and I hope to hear Gary say more on it, perhaps to correct my own (at best) partial understanding of what he meant. Maybe I'm repeating old arguments, but if I worried too much about that, this blog wouldn't exist in the first place...

I do welcome these kinds of statements, because without them we’d just be agreeing with each other. The other statement, about there only being 50 years left for music therapy, I can only respond to with a hunch, which is that, to me, it feels like we’re just getting started.

15 comments:

  1. I think myself that Gary's idea of psychotherapy being a tool and not 'the' model, as he discussed, is sort of OK. However, I prefer the more integrated thinking provided by Ken Bruscia in his 2011 AMTA speech where he suggests music therapists need to avoid'one way thinking' in order to best serve their client's needs. The podcast is well worth a listen if you haven't heard it. His arguments, including those from an ethical perspective, are very compelling I'd say: http://amtapro.musictherapy.org/?p=797

    In the light of the broad perspective which Bruscia provides, I think Gary's 'roasted old chestnut' remarks aren't very helpful for the profession in the UK. Indeed, they make it seem that he has a tendency for one way thinking himself in spite of his acknowledgement of psychotherapy as a tool?

    Personally, I think that the application of psychotherapy to music therapy has hardly begun and there is plenty more to explore and work out.

    Martin Lawes

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    1. Thanks Martin I'll give that a listen. And interesting insights as ever. I absolutely agree that we need to remain flexible in our thinking. I'm unclear on what's meant by 'psychotherapy' when it's presented as a single entity, as if a psychotherapeutic framing of MT is hemming it into some fixed set of criteria. It's like describing the 'concept of combining ingredients' as a 'tool' in cooking, it could be argued.

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    2. That's interesting, Luke - your thoughts about psychotherapy being presented as a single entity involving hemming into some fixed set of criteria.

      I had a few more thoughts. One relates to Gary’s idea, as I remember it, that psychotherapy is ‘essential but not sufficient’ - I think those were his words. I would strongly agree with that in any case, and it aligns well with Bruscia’s ideas about integral rather than ‘one way’ thinking. Gary also described his frustration about the psychotherapy model in terms of its being the ‘over roasted chestnut’. I don’t fully understand what he meant by this. Perhaps that it remains too much ‘the’ core model in the UK as far as he is concerned?

      On thing I can’t help wondering about are the ongoing repercussions of the debate in the BJMT which began in 1999: https://openmusiclibrary.org/article/4984/. This was where the music-centred practice of Gary and Colin Lee was severely criticised from a psychodynamic perspective by Elaine Streeter in relation to safety, efficacy, boundaries and lack of psychological thinking. Whilst Streeter made some important points, her approach to analysing the work of those who clearly worked in a different way was, in my view, an example of ‘one way’ thinking and not very helpful in that respect. This was indeed effectively pointed out in the responses made to her in the following journal edition, including by Gary.

      Then in 2002, Gary wrote his ‘winds of change’ article in Voices: https://voices.no/index.php/voices/article/view/83/65. This was interesting in the way he wrote about the ‘consensus model’ of 'improvisational music psychotherapy' as he described it. His view was that UK MT had gradually drawn towards a consensus in both forms of practice and in the underlying theoretical model which legitimates such practice. He analysed the core features of this ‘consensus model’ in relation to identity, role, aims and working practices and underlying attitudes, and contrasted practice in community MT. He wrote: “I suggest a 'paradigm shift' may be currently underway in the discipline, with the over-arching model which leads, supports and validates practice turning to one best characterised as Community Music Therapy. This is a context-based and music-centred model that highlights the social and cultural factors influencing Music Therapy practice, theory and research…. Can a Community Music Therapy model help bring about a more fruitful match between what musicians are best equipped to give, and what society in the coming generation will need from them?”.

      In a much more recent article, Simon Procter adopts a perspective that has affinities with Gary’s (http://musicandartsinaction.net/index.php/maia/article/view/improvmusictherapy/105). In discussing improvisation as a core practice in music therapy, Procter writes:
      “I now examine a story that the profession itself often tells about improvisation. It is a story rooted in a system of values that sees classical Freudian psychoanalysis as the ultimate form of therapy: other therapies therefore claim authenticity by asserting their bloodline to Freud”. He goes on to discuss “the claim made by many music therapists that ‘clinical improvisation’ is a musical analogy of free association”. Simon questions this and offers an alternative account of the value of improvisation which he proposes avoids “trapping music therapy in an ultimately leaky attempt to justify comparisons with non-musical work such as psychoanalysis.”

      Continued in a further reply

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    3. Continued from previous reply...

      Reflections

      In his Voices article, Gary proposes CoMT to involve a continuum of practice ranging from the individual to the communal which in principal makes sense to me. The issue for me is that he proposes that this should replace the psychotherapy model and seems unable to conceive how psychotherapeutic thinking and practice could continue to have a role to play – and I would suggest a vital one. Interestingly NR therapists such Jackie Robarts, Sandra Brown and Helen Patey have been able to integrate psychotherapeutic thinking very effectively in their work.

      I wonder whether the problem is the story that Gary and Simon tell themselves about UK MT where a rather sealed up, limited and limiting interpretation (misunderstanding) of the psychotherapy model is used for the convenience of their own arguments, misrepresenting the true picture. I think that many of us are able to be very flexible in our thinking and approach whilst using or drawing on the psychotherapy model. This enables us to meet client need as we couldn’t otherwise and in my view there will be an ongoing need for specialists who are trained to work psychotherapeutically ‘in’ music – i.e. music therapists. This is likely to include in 50 years’ time.

      On the other hand, part of the problem may be on the psychotherapy side of things. I agree with Simon, for instance, that the association of improvisation with free association is not an especially helpful one. This is where, in my view, in the application of psychotherapeutic thinking (psychoanalytic and other) to our understanding of the musical processes themselves, there is much room for development that could only enhance practice. Of especial importance I believe is our continuing to develop ways to understand, appreciate and work with the creative unconscious which I suspect many of us in fact do, but which is not so well supported theoretically. In other words, it’s about trusting the music and the creative process at a level that never becomes conscious. Much of what goes on in the music cannot be fully understood let alone interpreted and does not need to be. Working psychotherapeutically in the music, I would suggest, is not principally about making the unconscious conscious or making some kind of interpretation though this may feature.

      As we move into the dawning ‘health braining’ age of UK MT as I call it, with practices like Neurologic MT and CoMT established, for many, even perhaps a majority of us, the psychotherapy model remains as important as ever. We don’t need a paradigm shift where one model replaces another as the dominant (only) model but, as Bruscia helpfully suggests, a culture of integral thinking and practice. This is where we can use and potentially integrate different practices so as to meet different kinds of need.

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    4. Hi again Martin. Just one more thing (as Columbo says): I find Brusica's way of looking at this VERY helpful, but here's a thought (which will be another blog post): when I trained I needed to learn the psychotherapeutic stuff. I'd already done loads of workshops, teaching, performing, out-in-the-world stuff, but psychotherapy was new. I needed two years to begin to get to grips with it. Just a thought - will say more when I get there...

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    5. That sounds like the issue Bruscia mentions at the end of his talk about how to train people to be integral practitioners? This is when it may only be realistic to focus on one model during training. I note that he said he didn't have an answer after 40 years of training people!

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  2. This comment about not having music therapists in 50 years has danced around my head too since Gary said it. Initially I thought if he was simply saying something to liven the debate that, overall, felt that everyone was being very agreeable and it all felt very ‘nice’ and therefore not much ‘debate’ was happening (it will be interesting to hear it back, I agree).

    On reflection, it has made me think that maybe some music therapists can be too precious of our work and job title. They’re (we’re/I’m???) reluctant to think that certain aspects of our work could be done as well by others. Is it possible that, instead of thinking in 50 years there won’t be any music therapists, but that community musicians will be more therapeutic. In essence, will the difference between music therapists and community musicians be considerably smaller?

    Reading this back I still don’t know if I agree with myself but isn’t this what great debate is about sometimes, not even knowing what is your definite belief? Great blog Luke

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  3. Thanks Neil for reading the blog and thanks for your comment.

    But do we need to tidy psychotherapy away into a box because it's 'restrictive'? What's restrictive about it?

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    1. As I work in a different environment each day, with a vastly diverse range of clients and their needs, I can’t afford to be restrictive in my thinking. I like/need to work in an adaptable framework. So, whilst the basis of my training was psychodynamic, I’ve found myself over the past 17 years adding and altering my approach to become the type of therapist I am. I feel that the journey of a therapist should be to continue to explore and push our intellectual boundaries, and that to stay within one area is self-restrictive.

      It could be argued that my approach is “jack of all trades, master of none” but are we not aiming for client-led therapy? To say that each branch of psychotherapy needs to stay in its own box and that some are “well-roasted” is indeed restrictive and possibly not a true reflection on how the profession is at the moment. l, like Martin, see music therapists on a journey of massive discovery. Otherwise, what is the point of having a weekend of skill-sharing, reflection and networking if we are to put certain approaches to therapy to the sword and say that they are no longer relevant?

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    2. I knew there was something I'd heard before about therapy and being restrictive... It may not be fully relevant but I like the freedom it encourages us to have ... “It is very important to be aware that you may never be satisfied with your analytic career if you feel that you are restricted to what is narrowly called a ‘scientific’ approach. You will have to be able to have a chance of feeling that the interpretation you give is a beautiful one, or that you get a beautiful response from the patient. This aesthetic element of beauty makes a very difficult situation tolerable.” Bion,
      (from A Seminar held in Paris)

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    3. Thanks for all these reflections Neil, and what a lovely Bion quote. Honesty shines out of everything he ever said.

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    1. Hi, It was wonderful (as a New Zealander with UK roots) to be able to attend this conference, mingle with old friends and other people, and be exposed to such a range of ideas and practices. I enjoyed your voice and questions at the conference Luke. This particular phrase is one of several ear worms that's stayed with me too. Gary's statement seems to ignore the reality of the proliferation of practices - and the concepts of context and client choice. I agree about the value of psychotherapy - whether through talking, music or other arts therapy approaches. I have lived experiences that have best been addressed through individual therapy, and being only offered a group would (at least) not have helped. And I was also perturbed by Sarah Hoskyns stating in the same evening that psychodynamic music therapy is "not really possible" in NZ - it is less common and there is a strong CoMT discourse at present, but it is certainly there. As editor of the NZJMT I think my task now is to shoulder tap people so that published work represents the full range of practice!

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  5. Hi Alison. That's really interesting to hear and thanks so much for your comment. You mention groups, and of course we've also taken so much from Bion, Foulkes, Yalom etc. about approaches to group work too. Is CoMT really not in any way 'psychotherapeutic'? It may be that the language used avoids psychotherapy jargon, but many of the processes will be the same I'd have thought. All the best for your continuing work and do keep in touch!

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  6. Hi, Yes groups can of course be psychotherapeutic. What I didn't express very clearly is that at particular times it would have been less than constructive to be denied individual therapy and offered only a community music / MT group. Will ponder this some more on my return from wintry England to somewhere a little warmer!

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