Abstract
Introduction
This edition of the BJMT features three articles on music therapy work which are all innovative and different. Initially experimental, they are also inherently therapeutic, music-focused and client-led. Each describes work with groups of people, drawn together through one initial common circumstance who discover music and collective music making. They demonstrate the extra-musical experiences of being part of a musical collaboration and the benefits and experiences beyond initial expectations. In this editorial, I will consider the three papers and reflect on my own experiences of working within communities of adults living with mental health difficulties at SMART in Chelsea and the Band for Life project in the East End of London.
Overview and reflection
I graduated from Nordoff Robbins and have subsequently worked predominantly in adult mental health settings, both National Health Service (NHS) and community, for over 15 years. I have been involved with several projects which are identified as Community Music Therapy (Ansdell and DeNora with Wilson, 2016; Stige et al., 2010). Community Music Therapy makes sense to me because I am able to journey with people musically, as much and as far as possible, using music to support them in a way that is relevant and evolves with them in their wellbeing and musical journeys. It also aligns with the recovery model, widely used in mental health care. Consequently, choirs develop, performances are generated, a band forms which inevitably leads to gigs. Requests are made for tuition and further learning, and while all of those things might be available elsewhere, they do not or cannot always happen without the support of the music therapist who is sharing the journey.
This then leads to a change in the situations in which therapist and client meet, challenging us to segue from one circumstance to another with flexibility while remaining consistent within the boundaries of our role.
Challenges and limitations
As music therapists, we reflect on challenges, and developing flexible and appropriate solutions is what we do. While running open drop in sessions, I am always aware that anything can happen. More often than not, something very special occurs; someone sings for the first time, some new music is introduced or an improvisation takes on a different, exciting, unique quality. Very occasionally someone comes into the session who might be disruptive or destructive which requires staff to step up and deal with things in a way in which we prefer not to – exerting authority and making quick decisions.
Many of us are required to take on the role of keyworker which can be a very different way of working to that which we learned on our music therapy training courses. It often means being part of multi-disciplinary conversations where, as the keyworker, there is a responsibility to deal with issues raised. It can involve in helping to sort out housing, benefits, disputes, medication and so on. While I am limited in knowledge of some of the areas and have to source other professionals’ help, I have found getting to know someone more through this individual work can be helpful in terms of the music we do together.
Reading the articles in this edition, I was struck by the experimentation and element of taking a chance that featured in all of them, and it paid off. The outcomes were positive and empowering, highlighting common themes of collaboration, community, learning and communication.
Shared themes
Three themes that emerge from all the articles relate to the quality of the music produced, the collaboration and longevity of the projects. The projects aimed at achieving an outcome but clearly participants also gained much from the process of working towards that aim. An unexpected outcome and pleasure was the quality of the music produced, which in itself has enormous therapeutic value, reminding individuals of innate skills maybe lost in the trauma of their life experiences and enhancing and enlivening their self-perceptions. Felicity Baker’s study, a pilot of a songwriting intervention designed to support family caregivers of people living with dementia, aimed at exploring their identity and helping them to express the effects of their experiences with others in the same role. The results were positive and self-affirming experiences which clearly were unexpected to many of the participants. They learned new skills through songwriting and they felt they were ‘having a voice and being heard’ (Baker, 2018: 00). This example shows how music therapists can facilitate the production of music that has a recognisable and acceptable quality which increases the potency of the therapeutic intervention.
The Treehouse Choir (Gosine/Travasso) is a choir aimed at families coping with bereavement and traumatic grief journeys. This article highlights how the process of meeting was so important, and care was taken by the therapists to enable the sessions to meet the immediate needs of those carers and families – finding suitable times, considering how technology could help when circumstances meant someone was not able to be physically present and respecting the families’ need to bond over their shared experiences, without the therapist. It is important to acknowledge that we as therapists cannot always fully empathise. I am very aware that sometimes my role is to witness the depth and breadth of someone’s story, they are not asking me to fix it, but to hear and acknowledge it and to allow them ownership of that set of experiences. The individual is the expert on their own story.
During the past couple of years at SMART and Band for Life, we have done some work focusing on supporting clients to think about what they can do for others while they can learn and heal themselves. Our performances are the culmination of therapeutic processes, but they become something for their audience too. At Christmas, SMART musicians went carol singing in the Atrium at Chelsea and Westminster Hospital. We saw lots of very ill people, some stopped and listened, joined in, requested a favourite carol and together we shared a moment of collective music making with what felt like an implicit mutual understanding about difficult situations. The singers afterwards talked of the various individuals they had been aware of; people on the escalator singing with us, some children dancing to the music and they were so pleased that people responded to them, and their musical offering. At Band for Life, we run a workshop at a local project for older people, and members help to run the session. They know what they get from music and want others to experience it. I have been reflecting with members on the concept of ‘giving back’ and what it means for those who are in situations where their own needs are great.
I first started working with Nadia, 1 an experienced professional musician, shortly after a suicide attempt. At the point of the first anniversary, she came to a small closed singing session, just three of us, and brought up the fact she had been a year in recovery. I said that I had remembered, and was not sure how she would be feeling. She said it was relief – relief that she was still here, and, crucially, that she no longer felt like she wanted to sabotage her life, something she had felt almost constantly for many years. She attributed this to being part of the music project – for the opportunity to sing again, ‘properly’ as she says, rather than being crippled with internal demons about her ability as a result of past experiences in the industry, but also to be able to give something back in terms of singing for others. Performing for other members and for events that promote the organisation is a way of her being able to demonstrate gratitude, and reaffirms the path of recovery she is on, for herself and to help others in similar circumstances. In some situations, it can be helpful to encourage those for whom services are provided to think about how they might reciprocate or ‘pay forward’ the benefits they receive.
In this edition, Lars Tuastad writes about a rock band of ex-inmates from a crime rehabilitation programme and he notes that the participants benefitted from the structure of having a regular time for the band to practise which created an ‘orderly existence’, and consequently a sense of responsibility developed for each towards their role in the sessions and the band as a whole.
Participants commented that previously they might have disappeared if it felt difficult, but the shared responsibility to the band as a collaborative process changed their response from automatic and habitual to one of thought for others and reflection on their individual role and responsibility towards a commitment they had made.
Service users’ expectations can be facilitated by the music therapist, who can help the group manage the consequences too, but in order to produce an outcome, there needs to be collaboration to decide what will be expected from everyone, and how that might be achieved, which is the skilful process described in all these articles.
Defining
So how do we all manage these varying roles, conversations and musical interactions, and still define them as music therapy?
I have found it increasingly necessary to have frank, honest and open conversations with people in, around and outside the music. In my early years of working, I was very focused on being music-centred and this would have given me palpitations – talking! Outside the session! What do I say? Even more scary–what will other music therapists say? The consequences both professionally and personally were very anxiety-making as I tried to establish my own methods of practice.
In reality, our music therapy trainings do not, or cannot, give us the vocabulary for every circumstance ‘What is it I do when, and why, to remain professional, boundaried but flexible, appropriate but questioning, friendly but not friends’. It particularly started to be pertinent when I had to deliver news to the community at SMART, a core group of around 20–25 members, of the death of a member who was best friends with others in that community, and with whom I had worked for a long time and had, along with other staff, my own emotional responses to the loss. Finding a way to deliver shocking news while recognising and allowing my own grief and being open and supportive to the grief of others was hard, but grieving together and helping organise the funeral and a memorial service with his friends were special shared experiences which I value and learned from greatly.
Catherine Carr’s review of practice in the United Kingdom found despite UK trainings having a shared focus on improvisational music therapy, the training programmes vary in their theories and approaches. ‘This plurality, which is equally reflected in practitioners’ diverse identities and ways of practicing, is further enhanced by other emerging trainings’ (Carr et al., 2017: 69).
I wonder how many of us are working strictly within the theoretical framework in which we trained or are finding ourselves working in a way which is increasingly changing, client-driven and organisationally driven and is some way from the training methods from which we originated. I think I have moved in a variety of directions, always keeping the music-centred focus of the Nordoff Robbins approach as the core, but much influence has come not just from clients but from colleagues, arts therapists as well as other disciplines and professionals. In addition, of course, we learn from our experiences which influence and direct our future work.
In trying to decide how I might describe how I work, if Community Music Therapy does not feel quite the best fit it used to (many music therapists are broadening their remit and doing diverse work) I am increasingly drawn towards being of the moment and the situation, rather than trying to choose a position on the music therapy theoretical fence to perch upon. A ‘situationally determined approach’, Ken Aigen (2005) suggests, is one in which we could ‘choose to inhabit a music-centred stance when it was clinically warranted and a psychodynamic stance when it was clinically warranted’ (p. xx). I find the Mentalisation-Based Therapy (MBT) approach (Bateman and Fonagy, 2010) and Mindfulness (Mental Health Foundation Website, n.d.) useful for informing the thinking ‘in the moment’ and responding helpfully in order to co-produce solutions or ways forward. But I sum it up for myself as thinking of it as a ‘matter of fact music therapy’ approach and in talking to colleagues it seems to help describe and direct how I work in certain situations.
‘Matter of fact music therapy’ means thinking about what works best for the client(s) I am working with, depending on the context in which we are making music and the conversations we are having. It is heavily influenced by my music-centred training and subsequently moulded by my experiences.
Our work settings have a huge influence on what we might have to do, regardless sometimes of what we might want to do. There are a wealth of arts organisations around who are funded to offer workshops, concerts and events, often cheaper if not free, than employing a music therapist. The challenge is to continue to make sure we as a profession have a unique selling point which makes us different and complementary to other arts interventions, and also as individual practitioners to develop our own unique selling point – doing the type of work that plays to our strengths and preferences. We see in these articles there is much scope to use the basis of music therapy discipline to develop projects and practices for the good of those who need us (The All Party Parliamentary Group on Arts, Health and Wellbeing, 2017).
In the last edition of the journal, Alison Barrington (2017) writes in the editorial about the encouraging variety of papers that are being submitted. She comments, ‘The different approaches to music therapy that occur around the world means that the content of the papers is intriguing, challenging and exciting’, and that there is a ‘breadth of vision that is becoming so vital of the music therapy profession’.
Conclusion
As the articles in this edition demonstrate music therapists often need to be able to accommodate both the needs of the client and the institution in which we are working, and we know that what works for one client or organisation will not work for others.
Adopting a ‘matter of fact music therapy’ approach helps me define and describe the way I work. It is about starting with a stance that is welcoming and open to any possibility, but also consistent with a boundaried approach that is flexible but has a clear parameter of limitations. Music is the focus in its varied forms that people can come in and out of, move on from or return to, do more or less with, and relationships and rapport develop through shared experiences of music making and conversations that arise from the music making. It is also about planning, and frank discussion about what is possible and what is not.
We should continue to dialogue about the ways in which we are working, what we are choosing to do or what is being required from us in order to support the organisations and our employers. It is important to consider what role we might be able to play, plus what is right for us – where we feel most competent and skilled and how we can complement the work that is going on around us while holding on to our uniqueness as profession.