Abstract
All music therapists need to earn a living. But we can feel uncomfortable about how we discuss this with our clients or those who fund services on their behalf. People hold very disparate views that we are nervous to air, when it comes to considering our own needs alongside those of our clients. I have noticed that whenever issues around funding and remuneration are raised in conferences, there is an edginess and uncertainty to the debate. Is money, perhaps, the ultimate taboo?
Daniel Thomas, Director of the Arts Therapies Service ‘Chroma’, and Vicky Abad, founder and director of Boppin’ Babies Ltd, are two music therapists whose determination to tackle this taboo in recent years now unites them with their publication, ‘The Economics of Therapy. Caring for Clients, Colleagues, Commissioners and Cash-Flow in the Creative Arts Therapies’. Their starting point? ‘Without economics we can’t have therapy; without funding we can offer nothing’.
This book, however, is absolutely not just about money. Although Abad and Thomas carefully focus their lens on commercial enterprises and how the creative arts therapies can thrive within them, they have an additional aim for this publication: Not only ‘… to challenge therapists to think about funding and money in a more empowered way’ but ‘… to empower therapists to recognise the skills they already possess and use these to build their business practice’. (p. 21).
The book opens with an esoteric introduction from Brynjulf Stige who asserts the economics of therapy cannot be separated from ethics of practice. Anyone who finds Stige’s style difficult to penetrate should persevere. His assertion is certainly proven throughout the book and subsequent chapters are all accessible and very much rooted in practical experience. The book is divided into three sections: Section 1 considers what funding looks like in the current times and what commissioners want; Section 2 explores how we meet the needs of our funders, how we determine our value and the value of our services and the ethics and skills required to navigate this effectively; Section 3 turns to a number of different authors to present their experience through business and service case studies. Many of the chapters conclude with practical activities for the reader, who is encouraged to ‘Go and do it!’
Within the 11 chapters, the authors address a number of important questions, which perhaps lie at the heart of why remuneration and funding sometimes feels so difficult to discuss. These questions include the following:
How can we justify earning a living from people who are unwell and need our help?
How can we responsibly advertise and market our services?
How can we maintain integrity of time-limited treatment plans when our source of revenue ceases when treatment stops? (p. 34)
Some chapter authors raise questions requiring ethical consideration, and others make practical suggestions as to how we might address them. Early in the book I felt more questions were raised than were answered, but I would encourage the reader to read on to the middle chapters which bring some sensible and interesting ethical thinking. Perhaps, there are times when this book has a tendency to over-simplify the subjects it addresses. For example, a link is made between our financial health and the health and well-being of our clients, without any pause to reflect on the way the relationship between these factors might be different in the short and long term (p. 19). Long term, I absolutely agree: If a therapist sets a rate which is too low for them to be able to continue to offer sessions, an individual’s therapy might have to stop and they lose access to something potentially beneficial. Short term? I believe there are situations where clients might benefit from targeted input for a short period of time. Whether or not the therapist could afford to offer more sessions over a longer time period might not be relevant. At times, such over-simplification was challenging. Abad and Thomas certainly really made me think through my views relating to business, money and ethics in different ways, even if I didn’t ultimately fully embrace their every argument.
For example, the authors’ view of charities felt somewhat dismissive. As a director of a music therapy charity, I am, of course, bound to be particularly sensitive to this! However, given that the authors chose to write about charities I feel I do need to highlight that I don’t wholly agree with several of the statements, or I would certainly argue the subjects are more complex than suggested. Ultimately, I felt the authors believed that charity undermined economic health, while business builds it. It is a shame that the book turns its back on charities in this way because the skills the authors encourage readers to develop to build their business practice are as relevant in the third sector as in the for-profit world. The authors write persuasively about the existing abilities therapists could usefully apply to a business context, which could be equally valuable in a charity context, for example, Abad and Thomas’ excellent mnemonic concept of RAILE (Resilience, Attunement, Improvisation, Listening and Empathy).
The book is not afraid to challenge the reader or for there to be differing views between the writers. For example, while Abad and Thomas identify our developed ‘empathy’ as a transferable skill which could be helpful in a business context, Geretsegger, Fitzthum and Stegemann consider it a potential barrier (Chapter 4, pp. 68–90). If we engage too empathetically with our clients and commissioners, perhaps this makes it more difficult to negotiate fees? Is it possible that this is one of the core challenges to us as therapists when we try to think about our value? Perhaps, this contributes to our wariness of those who do succeed in financial negotiations or service development: Do we assume they are less empathetic and mistrust their integrity? For me, personally, the reflections of this chapter’s authors on value – including the relationship between state regulation and perceived value, the relationship between training costs and quality of graduates and the development of music therapy as an academic discipline – fully achieved their stated wish to inspire therapists ‘… to reflect on their own stance towards the value of music therapy (and other arts therapies)’ (p. 84). I enjoyed their assessment of the value of music therapy from three perspectives: from a societal perspective, from the music therapist’s personal perspective and from the perspective of cost-benefit. There is real scope to build on this solid and sensible starting point to consider the relevance of clinical outcomes or impact to perceived value.
Traditionally, our clients and their families are at the absolute heart of writing and reflecting, whether described within case studies or integral to our research studies. This book was notable for its absence of clinical context. Perhaps, this was intentional, in order to keep the book’s focus on the business aspects of our practice. However, the omission of clinical material left some authors’ theories feeling subjective at times. Hearing directly from clients or commissioners would really strengthen the claim that some of the country-specific or context-specific business ideas are transferable to other places.
The second half of the book embraces the nuts and bolts of business practice within the creative arts therapies. In Chapter 6, Petra Kern shares generously from the syllabus of the undergraduate Music Therapy programme at the University of Louisville. She includes a wealth of detail and recommended reading which might inspire our own training courses and CPD providers to create their own training resources. It is a very different approach to developing business skills than is put forward elsewhere in the book, perhaps reflecting both the undergraduate level and length of music therapy training in the United States and the growing trend in music therapists in the United States owning their own music therapy businesses. The American context continues into Chapter 7, where Rebecca Zarate identifies aspects of practice she feels need very different consideration in the United States than elsewhere.
The book concludes with a range of case studies looking at how music therapists have created businesses of different shapes and sizes from New Zealand, Australia, United Kingdom and Hong Kong. I thoroughly enjoyed Abad and Thomas’ extremely personal chapters which captured the very real stages, challenges and processes they have been through in establishing the businesses they steer to this day. Elaine Matthews Venter brings reflections from early in her entrepreneurship, taking the reader step by step through the process she followed when setting up private practice.
The book includes different country contexts, promises relevance to wider arts therapies practice and its content ranges vastly in terms of the level at which it is pitched – from Stige’s erudite introduction to Venter’s step-by-step guide to ‘creative journaling’ and the practical minutiae of setting up on your own. This means it has something for everyone. At a time when established mechanisms for commissioning and provision are under significant pressure, this book gives a lot to think about and will help to develop Music Therapists’ thinking about the economics of therapy.