Abstract
With a refreshing and long-needed focus on assistants and collaborators within music therapy, the 18 different authors of this book describe a range of different client groups, therapeutic approaches, theoretical considerations and research studies. Gro Trondalen opens the book by highlighting the importance of trust in musical relationships and the meaning of shared experiences. The three editors, John Strange, Helen Odell-Miller and Eleanor Richards, create the setting with an insightful and encouraging introduction to the book arguing for more awareness and focus on collaborators within music therapy of many different kinds. Every person in therapy (client) is part of a context and has a family. Many clients have assistants with them in the therapy sessions and many therapists collaborate in one way or another in relation to these facts. However, very few publications centre on the topic and the field of music therapy could use a better map of the territory. The editors highlight the difference between assistants and collaborators without favouring any of them but instead acknowledging both as they have different benefits and challenges. Details in each chapter portray the diversity of the book and let the reader know how each of the editors has their own experience on the topic. The purpose is not to provide a handbook of how in general to collaborate but to let each author tell their unique story and let the following 16 chapters help and inspire clinicians and trainees in their practice. The various clinical settings cover a wide range including family members, learning support assistants (LSAs), caregivers and medical staff and many chapters contain illustrative case examples.
In chapter 1, John Strange tells the story of how he, for many years, worked with LSAs in music therapy with clients with multiple learning disorders in school settings. He refers to these clients as students and I shall too, regarding his work. Strange calls the approach Triadic Support of Interaction by Improvisation (TSII). As part of his research, he asked the LSAs to watch video recordings of themselves, the music therapist and the student improvising together in music therapy. Interestingly enough, the LSAs observed highly relevant mental and emotional processes within both themselves and the students. Strange has a refreshing self-critical perspective and is respectful towards both LSAs and the students allowing a high level of ethical thinking to flavour the chapter.
Chapter 2 zooms in on the personal journey of Hannah Munro and her motivation for interviewing five music therapists on their experience of collaborating with staff in music therapy sessions. Her study showed how positive experiences are often related to group work and that successful collaboration requires awareness of roles and ongoing communication. There are many benefits and some challenges, and Munro points to the need of more guidelines on how to facilitate effective teamwork and how to ensure benefits for the client, the staff and the music therapist.
In chapter 3, Catherine Warner describes the challenges of music therapy trainees working with teaching assistants through narratives from three qualified music therapists as they look back on their former experiences. As head of a training programme, I notice how Warner displays a high level of research ethics as she considers how her other responsibilities might influence a focus on trainees and vice versa. Based on the three illustrative narratives, it becomes more evident how risks are present when assistants participate in sessions. However, assistants can also contribute immensely and the supervisor has a responsibility to help the trainee be aware of multicultural issues and encourage trainees to be tolerant and respectful towards assistants and other potential collaborators.
As family therapy is quite familiar to me, chapter 4, in my perspective, points to a very important aspect of collaboration. Pornpan Kaenampornpan walks us through her doctoral study on involvement of family members in music therapy with children with autism spectrum disorder (ASD). Her study included eight children with ASD and a close family member participating in 24 sessions two times a week. Based on her qualitative descriptions and analyses, she highlights the large influence family members can have on the effectiveness of children’s learning as they know the children best and can help the music therapist understand the child better. There are often challenges at first, but then with increased interaction, communication and understanding the needs of the child emerge in the phases of developing relationships with family members. Kaenampornpan also discusses contraindications of when not to involve family members and adds important aspects to conscious collaboration within music therapy.
The role of assistants within adult mental health and dementia is the focus in chapter 5 as Helen Odell-Miller guides us through her impressive wide-ranging clinical experience of collaboration and work with assistants. Her focus is on how working with assistants can ensure or strengthen the link to everyday life outside of music therapy groups. She compares this to the complexity of a family therapy approach and gently takes the reader through relevant historical insights, research and literature and her own rich clinical experience and research. Demonstrating a complex understanding of non-music therapy assistant practice, Odell-Miller, like several other authors, advocates for a high level of awareness of roles, including unconscious and conscious processes, within music therapy training. To me, role awareness is essential in ensuring successful collaboration and I felt myself resonating quite a lot with Odell-Miller’s descriptions.
In chapter 6, Ruth Melhuish presents a qualitative study on relationships between care staff and nursing home residents in both music therapy and dance movement therapy. In the study, 30 residents and 7 music therapists participated in weekly open group (8–12 people) sessions for 6 weeks and agreed to be interviewed afterwards. The focus of the study was how and why music therapy and dance movement therapy might be an effective way of supporting staff development. Melhuish explains how the semi-structured interviews highlighted three themes including discovering skills and feelings of the residents, learning from the therapist and changing care practice, and connection between staff and residents. The chapter is quite engaging and I acquired an inspirational sense of the personal journey of the author.
Results from another doctoral study is presented by Ming Hung Hsu in chapter 7 and here the focus is on how individual music therapy can support caregivers of care home residents in managing neuropsychiatric symptoms of dementia. Within interviews the caregivers noted how participating in individual music therapy could enhance their skills and knowledge and give them an extraordinary role in enriching the everyday lives of residents. The caregiver could help transfer the value and benefits of music therapy into everyday life. Again to my delight, the author puts emphasis on awareness of the role of the music therapist and the caregiver and offers insight into the characteristics and experience of caregivers joining individual music therapy including insight into Methodist Care Homes and their specific context.
Chapter 8 contains a breath-taking and emotional case study of close bonds being developed between carers and a group of three isolated and profoundly learning disabled aged around 20 years of age. For more than 3 years, Anthi Agrotou followed the group and here she describes the approach where each client had an allocated carer. Agrotou offers thoughts on clinical methods and techniques on how to facilitate attachment and empowering carers to be sensitive towards their assigned group-member. The focus is psychodynamic with explicit links to Melanie Klein’s theories on developmental positions and Agrotou understands the carers as auxiliary music therapists. When reading this chapter, I got a sense that theoretical perspective and clinical approach are tightly woven together, which gave me a fulfilling and comprehensive understanding even though I might disagree with certain points.
In chapter 9, Tessa Watson takes us through a well-established approach where music therapy is used as a sensory interaction group for people with profound and multiple learning disabilities and their carers. The clinical approach aims to facilitate an environment where healthy relationships can grow by reframing how staff facilitate healthy relating and developing their own working practice. Watson guides the reader through a session with activities while constantly referring to relevant theories such as containment and attachment and explaining the overall approach. Of special interest to me in this approach is the opportunity for the caregivers to process their emotional experiences and monitor potential unconscious and damaging projections together in a group with the music therapist keeping all aspects of the therapy transparent and with potential learning possibilities.
Jörg Fachner sets out to understand the characteristics of the role and actions of the co-therapist in Nordoff Robbins music therapy (NRMT) in a qualitative study in chapter 10. Fachner explains the co-creativity between the musician and the therapist ‘on the floor’ with the child in NRMT and how the therapists ideally should dynamically shift between leading and assisting roles. However, when examining the interviews of six NRMT music therapists, it becomes evident that the special collaboration can sometimes be a challenge in clinical practice. The study points to a gap in our literature on the collaborative work in NRMT, and Fachner, through the study, offers more insight into being more aware of the role of the co-therapist, the relational quality of the therapy, co-therapist as music therapist and co-therapist as non-musician or non-music therapists. Fachner ends his chapter with a clear statement: ‘It is the art of co-therapy to intervene and withdraw consciously’.
In chapter 11, music and attuned movement therapy (MAMT) is described by John Strange, Mary-Clare Fearn and Rebecca O’Connor with micro-level detailed case material zooming in on the role of the movement facilitator. The approach aims to meet the clinical needs of profoundly disabled children through a cross-modal interplay of sound and movement with the child, the music therapist and the movement facilitator (other staff or family member) as active participants. One of the specific aims in this close collaboration is to aid arousal regulation and develop breathing patterns and intentions to move. The authors provide a clear theoretical framework for the approach and explain how the role of the facilitator is to support the movement of the child with sound, music and/or touch, to foster awareness in the child. After the illustrative case descriptions and reflections, the authors also describe how MAMT can be, and is, applied within rehabilitation.
Chapter 12 is shorter than most of the other chapters as it looks back in time and describes how Tony Wigram in the 1970s worked together with physiotherapist Lyn Weekes in the treatment of children and adults with severe physical disabilities. John Strange joins Weekes to author this chapter, and it is quite a delight to read how professional collaboration was well established early on in the music therapy profession. The chapter clearly describes the role of each professional and additional helpers as well as the clear value and potential of the hybrid intervention and special partnership between Wigram and Weekes.
John Strange is also the author of chapter 13 and here the focus is the music therapist’s perception of how improvised music can support the student–assistant interaction. There is a strong connection to chapter 1 and LSAs’ interaction with students with multiple learning disorders. However, this chapter explores their music and therapeutic intention and effect (TSII). Strange points out how we need to be able to explain how music works in music therapy and that exploring the improvisations of assistants and students might aid such a task. He sets out to provide a response analysis method of the complex triadic process using theories from Bruscia, Ruud, Stern and Bowlby. In his research study, music therapists rated videos of LSA and student improvisations and considered the behaviour of both participants, the representations (inner working models) of students and LSAs, and the connecting, reinforcing or challenging effects in the music. The description of the panel discussion between the music therapists, involved in this research, on their perspective and understanding of each improvisation was quite interesting to me and Strange provides relevant reflections on the benefits and challenges of applying the complex analysis method both in research and clinical settings.
In chapter 14, Sarah Hadley explores the roles of transient (music therapists) and constant practitioners (staff, teachers, family members) and offers a challenging and to me highly relevant perspective where the music therapist may not be the most important ingredient in music therapy treatment. The title ‘Who knows me best?’ refers to the need to include and collaborate with constant practitioners in order to understand the client better before, during and after music therapy sessions and more importantly to ensure transfer to everyday life. Her work with children in orphanages in Romania displays a high level of clinical experience and theoretical foundation, and the basis for developing her interactive music making (IMM) training. Hadley provides the reader with diverse examples with children with ASD and Down syndrome. In the last part of the chapter, Hadley describes how she works with the students on the IMM programme, thus offering a counterweight to former chapters of the book which call for more training in collaboration for music therapists.
Motoko Hayata and John Strange describe benefits and challenges of including ‘mainstream child helpers’ (MCH) in inclusion groups with primary pupils with and without profound learning disabilities in chapter 15. The chapter includes two case examples that illustrate how the MCHs can function as creative and playful role models for the special needs education children (SEN) and how MCHs can increase their acceptance, awareness and helpfulness towards SEN children. The case examples also highlight how MCHs have individual needs for attention, complex music and high levels of independence/freedom that might be contraindicative for working with SEN children. Hayata and Strange advocate that awareness of these benefits and challenges is necessary when working in inclusion groups within educational and other relevant settings.
In chapter 16, Tone Leinebø and Trygve Aasgaard describe how they have worked collaboratively in paediatric hospital departments for many years. First, the authors provide understanding of the clinical needs of children in hospitals, including larger contextual issues such as the children’s everyday life and the atmosphere on wards. The environmental approach of moving wards with the children consists of working closely with staff and family members. The authors offer illustrative case vignettes to highlight different activities and their therapeutic value such as reducing anxiety, increasing coping mechanisms and empowerment. Also in this chapter, emphasis is given to the awareness of different relevant and appropriate roles of the music therapist. I rather enjoyed the concluding section where the authors state how striving for acknowledgement and professional pride can stand in the way of ensuring quality and providing the best possible support to children and their families. Music therapists often have to take on different roles and they need to be conscious about communicating their roles and the tasks in collaborative settings.
Building from another illustrative case example Eleanor Richards highlights the importance of being aware of relationships and attachment patterns in alliances created in music therapy. In chapter 17, she asks the question ‘Someone else in the room. Welcome or unwelcome?’ and draws in a psychodynamic understanding of an inner working model, of transference and countertransference. Richards, being co-editor of the book, looks across all the chapters and identifies attachment themes when working with collaborators of many sorts. Insightfully, she advocates how aspects of attachment can lead to positive change and development but also how it can also be a threat to the therapeutic process if not considered consciously and comprehensively.
In the final chapter, the authors reflect on the whole book and offer to lead the reader and the field forward in regard to training, service development and research when valuing human resources in collaborative work. The question clearly is not whether assistants and collaborators should be included in music therapy but that we need to raise awareness about the relevance and ensure that this is done appropriately, ethically and effectively for all participators involved. Equipping both assistants and music therapists for their roles and approaches is crucial, as well as advocating for joint efforts to implement collaborative approaches using research strategies and methods.
As the head of the Music Therapy Programme at Aalborg University in Denmark and as a family-centred music therapist, I strongly agree with the need for more awareness about the benefits of collaborative work within and outside our field, more collaborative training during and after education, and more implementation of collaborative work in clinical practice. I therefore warmly welcome the focus and content of the book that helps sharpen a map and draws new landlines of the benefits of collaboration including useful guidelines on navigation and how to sail there.